Neuro Boot Camp V7.0

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Standard Operating Procedures (SOP)

Gold Edition: Exhaustive Reference

1. Spinal Cord Syndromes & Tracts

Syndrome	Location	Affected Structures	Clinical Presentation
Brown-Séquard	Hemisection	Dorsal Cols, CST, Spinothalamic	Ipsi: Loss of Vib/Prop (at & below), UMN signs (below), LMN signs (at level). Contra: Loss of Pain/Temp (1-2 segments below).
Syringomyelia	Central Canal (C8-T1)	Ant. White Commissure	Bilateral "Cape-like" loss of Pain/Temp (Upper extremities). Fine touch preserved. Assoc w/ Chiari I.
Subacute Combined Degeneration	Dorsal Col + Lat CST	Myelin (B12 deficiency)	Ataxia, Paresthesia, UMN signs (Spasticity, +Babinski). Tip: B12 def also has megaloblastic anemia. Vit E def looks similar but no anemia.
Tabes Dorsalis	Dorsal Roots/Cols	Treponema pallidum (Syphilis)	Sensory Ataxia, +Romberg, Absent DTRs, "Lightning pains", Argyll Robertson pupils.
ALS	Ant Horn + Lat CST	Motor Neurons (UMN+LMN)	Combined UMN (hyperreflexia) + LMN (fasciculations/atrophy). NO sensory loss. Assoc w/ SOD1 mutation.
Ant. Spinal Artery (ASA)	Ant 2/3 Cord	CST, Spinothalamic, Ant Horn	Complete paralysis below lesion. Loss of pain/temp below. Sparing of Dorsal Columns (Vib/Prop).
Cauda Equina	Lumbar Roots	Nerve Roots (L2+)	Saddle anesthesia, Bowel/Bladder dysfunction, Absent anal wink. Surgical Emergency.

2. Brainstem Syndromes (Rule of 4s)

Rule of 4s:
• 4 structures in Midline (Start with M): Motor pathway, Medial Lemniscus, MLF, Motor nuclei (3, 4, 6, 12).
• 4 structures in Side (Lateral): Spinothalamic, Spinocerebellar, Sensory CN (5, 7, 8, 9, 10, 11), Sympathetic.

Syndrome	Vessel	Key Structures	Deficits
Medial Medullary	ASA	CST, Medial Lemniscus, CN XII	Contra hemiparesis, Contra prop/vib loss. Ipsi Tongue Deviation ("Lick your wounds").
Lat Medullary (Wallenberg)	PICA	Spinothalamic, Symp, Nucleus Ambiguus	Contra pain/temp (body). Ipsi pain/temp (face). Dysphagia, Hoarseness, ↓ Gag reflex. Horner syndrome. Vertigo.
Lat Pontine	AICA	Spinothalamic, Symp, CN VII, VIII	Contra pain/temp (body). Ipsi pain/temp (face). Facial Paralysis + Hearing Loss/Tinnitus. NO hoarseness.
Medial Pontine	Basilar	CST, CN VI	Contra hemiparesis. Ipsi CN VI palsy (Lat Rectus - cannot look out).
Locked-In	Basilar	Bilateral Ventral Pons	Quadriplegia. Horizontal gaze palsy. Vertical gaze/blinking spared.
Weber (Midbrain)	PCA	CST, CN III	Contra hemiparesis. Ipsi CN III palsy (Down & Out, Blown Pupil).

3. Cranial Nerves: The Complete List

CN	Name	Exit	Function/Deficit
I	Olfactory	Cribriform	Smell. Anosmia (Kallmann syndrome).
II	Optic	Optic Canal	Vision. Afferent of Pupillary Reflex.
III	Oculomotor	SOF	Most eye muscles, pupil constriction, lid elevation. Lesion: "Down & Out", Ptosis, Mydriasis.
IV	Trochlear	SOF	Sup. Oblique. Lesion: Eye drifts UP (Head tilt away from lesion).
V	Trigeminal	SOF/Rot/Ovale	Sensation (Face), Mastication. Lesion: Jaw deviates TOWARD side of lesion.
VI	Abducens	SOF	Lat. Rectus. Lesion: Eye turns IN.
VII	Facial	Int. Auditory	Face motor, Taste (ant 2/3), Tear/Saliva. Lesion: Bell's Palsy (whole half of face).
VIII	Vestibulocochlear	Int. Auditory	Hearing/Balance. Lesion: Vertigo, Deafness.
IX	Glossopharyngeal	Jugular	Taste (post 1/3), Swallowing, Carotid body. Lesion: Loss of Gag.
X	Vagus	Jugular	Viscera, Swallowing, Voice. Lesion: Uvula deviates AWAY from lesion.
XI	Accessory	Jugular	SCM/Trapezius. Lesion: Shoulder droop, cant turn head contra.
XII	Hypoglossal	Hypoglossal	Tongue motor. Lesion: Tongue deviates TOWARD lesion.

4. Thalamus, Hypothalamus & Basal Ganglia

Thalamic Nucleus	Input	Destination/Function
VPL	Spinothalamic/DCML	Somatosensory Cortex (Body sensation)
VPM	Trigeminal/Gustatory	Somatosensory Cortex (Face sensation/Taste)
LGN	CN II (Optic)	Calcarine Sulcus (Vision). "Lateral = Light"
MGN	Superior Olive	Temporal Lobe (Hearing). "Medial = Music"
VL	Basal Ganglia/Cerebellum	Motor Cortex (Movement planning)

Hypothalamus:
• Lateral: Hunger. (Inhibited by Leptin). Lesion = Anorexia ("Lateral injury makes you Lean").
• Ventromedial: Satiety. (Stimulated by Leptin). Lesion = Hyperphagia ("Ventromedial makes you Very Massive").
• Anterior: Cooling (Parasymp). Lesion = Hyperthermia ("A/C = Anterior Cooling").
• Posterior: Heating (Symp). Lesion = Poikilothermia ("Posterior = Poikilo").
• Suprachiasmatic: Circadian rhythm (Input from retina).
• Supraoptic/Paraventricular: ADH and Oxytocin production.

5. Visual Pathway & Defects

Location	Defect	Etiology
Optic Nerve	Monocular Blindness	MS (Optic Neuritis).
Optic Chiasm	Bitemporal Hemianopia	Pituitary Adenoma / Craniopharyngioma.
Optic Tract	Contra Homonymous Hemianopia	PCA stroke (rarely).
Meyer's Loop (Temporal)	Contra Upper Quadrantanopia ("Pie in Sky")	MCA stroke (Inferior division).
Dorsal Radiation (Parietal)	Contra Lower Quadrantanopia ("Pie in Floor")	MCA stroke (Superior division).
Occipital Cortex	Hemianopia with Macular Sparing	PCA stroke (Macula has MCA collateral).

6. Neurodegenerative & Dementia

Disease	Protein Pathology	Key Genes/Findings
Alzheimer	Intra: Tau (Tangles) Extra: Amyloid (Plaques)	APP (Chr 21), Presenilin 1 (Chr 14), ApoE4 (Late onset).
Parkinson	Alpha-Synuclein	Lewy Bodies. Depigmentation of Substantia Nigra. TRAP symptoms.
Lewy Body Dementia	Alpha-Synuclein	Dementia + Visual Hallucinations + Parkinsonism.
Frontotemporal (Pick)	Tau (Pick bodies) or TDP-43	Personality change, Aphasia. "Knife-edge" atrophy.
Huntington	CAG Repeat (Chr 4)	Caudate atrophy (Boxcar ventricles). Anticipation. Decreased GABA/ACh.
Creutzfeldt-Jakob	Prions (PrP-sc)	Spongiform cortex. Rapidly progressive. Startle myoclonus.

7. Brain Tumors (High Yield)

Tumor	Demographic	Histology/Features
Glioblastoma	Adults	"Butterfly" lesion. Pseudopalisading necrosis. GFAP+. Worst prognosis.
Meningioma	Adults	Parasagittal. Psammoma bodies (whorled). Spindle cells.
Schwannoma	Adults	Cerebellopontine angle (CN VIII). S-100+. Bilateral = NF2.
Oligodendroglioma	Adults	Frontal lobe calcification. "Fried Egg" cells. Chicken-wire capillaries.
Pilocytic Astrocytoma	Children	Cerebellum. Cystic + solid nodule. Rosenthal fibers (corkscrew). Benign.
Medulloblastoma	Children	Cerebellum (Vermis). Homer-Wright Rosettes. Malignant (Drop metastasis).
Ependymoma	Children	4th Ventricle. Perivascular rosettes. Hydrocephalus.

8. Pharmacology: Local Anesthetics

Class	Drugs	Metabolism
Esters	Procaine, Cocaine, Tetracaine	Plasma esterases (High allergy risk). 1 'i' in name.
Amides	Lidocaine, Mepivacaine, Bupivacaine	Liver. 2 'i's in name.
Blockade Order	Small Myelinated > Small Unmyelinated > Large Myelinated > Large Unmyelinated. Pain > Temp > Touch > Pressure.