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117 Cards in this Set

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Which muscle groups are more often involved in polymyositis?
PROXIMAL muscles

NOTE: does NOT cause facial/ocular muscle weakness
What is the most usual demographic for polymyositis pts.?
50s-60s

Women twice as likely as men
What is the most common treatment for polymyositis?
Corticosteroids
What do oculocephalic reflexes test?
Integrity of the brainstem

If intact, when head moved laterally, eyes should move in OPP direction

NOTE: aka known as Doll's eye phenomenon
What do DTRs of 2/4 mean?
NORMAL
Equal & reactive pupils in comatose pts. point towards what type of coma?
Metabolic/medical coma
Subdural is what type of bleed?
(arterial vs. venous)
Venous

Do NOT require much trauma to begin
Present slowly
Common in elderly
Epidural is what type of bleed?
(arterial vs. venous)
Arterial

Usually assoc. w/ a significant trauma
Have a fairly acute onset

NOTE: may have a biphasic pattern
(pt wakes up, goes out again, etc.)
In uncal herniation, what side is the dilated pupil on?
(relative to the herniation)
SAME side

NOTE: weakness may be found on the contralateral side
What two significant diseases have been assoc. w/ BILATERAL Bell's palsy?
HIV
Lyme disease
What nerve supplies taste to the anterior 2/3 of the tongue?

The posterior 1/3?
CN VII (anterior)

CN V (posterior)
How are the arms oriented in deCORTICATE posture?

Where is the lesion?
Flexed

SUPERIOR to the red nucleus

NOTE: the rubrospinal tract is spared
(SO, overrides influence from postural pathways)
How are the arms oriented in deCEREBRATE posture?

Where is the lesion?
Extended
(pathways that mediate flexor activity are interrupted)

INFERIOR to the red nucleus
BUT, superior to the pontine reticular formation

NOTE: the pontine retic. formation and lat. vest. nucleus have powerful extensor effects
What is gold standard treatment for Guillan-Barre?
Plasmapharesis
What do you think first w/ LP essentially nl, except for elevated PROTEIN?
Diabetes
What type of neuron injury are fasciculations assoc. w/?
(upper vs. lower)
LOWER
What part of the brain should you think of when you see CROSSED symptoms?
BRAINSTEM
What condition are fasciculations of the tongue a prominent sign of?
ALS
The vermis of the cerebellum is more assoc. w/ what?

Midline structures or extremities
Midline structures
What is most common sign of cerebellar disease?

How do you test for it?
Incoordination

Test by finger-to-nose, heel-to-shin, etc.

NOTE: not always limited to distal extremities
Do cerebellar lesions produce ipsilateral or contralateral signs?
IPSIlateral

This is due to the double crossing of cerebellar outputs
What is titubation?

What is it a sign of?
Tremor of the head and trunk when erect

Sign of dysequilibrium.
In the cerebellum, could be an injury to the vermis
Is the Romberg sign helpful in cerebellar ataxia?
NO

Cerebellar ataxia results in the pt. not being able to stand w/ feet together
(REGARDLESS of whether or not eyes are open)
Ataxia and nystagmus are caused by disease of what part of the cerebellum?
Posterior, inferior vermis

NOTE: derived from same area as labyrinths
What type of tremor is manifested by cerebellar disease?
Intention tremor
What are the 3 cardinal signs of cerebellar disease?
Dyssynergia
Dysequilibrium
Altered tone
What is dysdiadokinesia?
Incoordination of the extremities due to cerebellar disease

Inability to do things like finger-to-nose & heel-to-shin
Where does alcoholic degeneration affect the cerebellum?
ANTERIOR cerebellum
Combination of what two types of signs result from infarct of the PICA?
CO-existence of unilateral cerebellar signs and lateral medullary signs
What lesion is most often associated w/ neglect?
Right parietal lesion

Neglect is usually left-sided, due to a RIGHT-sided lesion
What is a scotoma
A defect WITHIN the field of vision

A blind spot, or area of diminished visual acuity

NOTE: what is important, is that field of vision is NOT limited
Deficiency is WITHIN field
Where are our optic discs located relative to our fovea?
Medially

NOTE: because of flipping, blind spot "appears" laterally
Junctional scotoma

Where does the responsible lesion occur?
At the junction of the optic nerve and chiasm

NOTE: due to inferior nasal retinal fibers looping up into contralateral optic nerve
What is an altitudinal hemianopia?

What usually causes it?
Loss of vision in an entire upper of lower half of one or both fields

Ischemia in upper/lower half of optic nerve
What condition is commonly assoc. w/ central scotomas?

What disease is this condition frequently a manifestation of?
Optic neuritis

MS
What is a centrocecal scotoma?
Scotoma that includes BOTH central vision and the physiological blind spot
What neuro disease are axillary freckling and cafe au lait spots assoc. w/?
Neurofibromatosis
What is strabismus?
Misalignment of the eyes
What type of brain lesions are early morning headaches assoc. w/?
MASS lesions
Lesions that cause increased intracranial pressure
Which cranial nerve is quickest to get damaged in increased intracranial P?
CN VI

Has the longest path in thr brain
Unfortunately, lesion in this is least helpful in localization
What reflex is assoc. w/ L5?
Trick ?

There is NO reflex assoc. w/ L5
Which reflex is associated w/ S1?
Achilles reflex
Which reflex is assoc. w/ L4?
Patellar reflex
Where does the spinal cord end?
(In terms of vertebral level)
Between L1 and L2
Classes of drugs used for migraine prophylaxis (5)
Beta-blockers (propranolol)
TCAs (amitryptiline)
Calcium channel blockers (verapamil)
Anti-convulsants (valproate)

Methysergide
Major type of drug used in abortive therapy of migraines
Triptans (Sumatriptan)
Types of drugs used in prophylaxis of tension headaches (2)
SSRIs
TCAs
Drugs used in abortive treatment of tension headaches (2)
NSAIDs
Acetaminophen

NOTE: occasionally, narcotics are used
What is the DOC for complex partial seizures?
Carbamazepine
What is the DOC for absence seizures?
Ethosuxamide
What is a Jacksonian March?
Spread of a seizure to adjacent body parts
Complex partial seizures have a predilection for which lobe?
Temporal lobe
Autonomic features are usually seen in seizures originating where?
Temporal lobe
What behavior is indicative of a complex partial seizure?
Arrest of behavior, followed by automatisms
(ie lip smacking, chewing movements)
Secondarily generalized seizures usually present w/ what type of features?
(w/ regards to sensory, tonic, motor, etc.)
Tonic-clonic seizure features
(convulsive)
What features distinguishes complex partial from absence seizures?
---Complex partial---
Post-ictal state
Focal
Last longer

---Absence---
NO post-ictal state
Generalized
Shorter

NOTE: absence also have a diagnostic 3Hz pattern on EEG
What other name are absence seizures known by?
Petit mal
How does the clonic phases of GTC seizures evolve?
Starts off low amplitude, high frequency
Becomes high amplitude, low frequency
What is the imaging study of choice in further investigating epilepsy?
MRI
What is the DOC for juvenile myoclonic epilepsy?
Valproic acid
What type of seizures should Tiagabine NOT be used for?
Primary generalized seizures
How soon after a spinal cord injury must corticosteroids be given?
Within 8 hours
What is autotopagnosia?

Where is the corresponding lesion?
Distorted perception of body organization and of environment

Parietal lobe
What is anosognoia?

Where is the corresponding lesion?
Ignorance of one's own disease, specifically of paralysis

Parietal lobe
Limb apraxia typically corresponds to lesions where?
Left frotnoparietal area or corpus callosum
Which hemisphere is typically dominant for constructional and affective speech?
RIGHT hemisphere
What is graphestesia?
Ability to recognize letters, etc. written on skin
What is the dominant hemisphere for language in 95% or people?
LEFT hemisphere
Where is Broca's area?
Inferior portion of the third frontal lobe
Where is Wernicke's area?
Posterior, superior temporal lobe
What cerebral artery supplies the areas involved in speech?
Middle cerebral artery
What connects Wernicke's area and Broca's area?

Lesions here cause what type of aphasia?
Arcuate fasciculus

Conduction aphasia
What are the types of aphasias in which repetition is good?
Transcortical aphasias
What words are used to characterized Wernicke's aphasia (3)
Fluent -- can talk fluidly, BUT words don't make sense

Receptive -- can't understand commands

Sensory
What words are used to describe Broca's aphasia (3)?
NON-fluent -- speech is very labored and telegraphic

Expressive -- CAN understand commands, just can't express response vocally

Motor
A fluent aphasia w/ good comprehension is what type?
Conduction aphasia
What are the characteristics of a global aphasia (3)?
Non-fluent
Poor repetition
Poor comprehension
What two movements are good tests for L5 nerve function?
Dorsiflexion
Eversion
What two movements are good tests for S1 nerve function?
Walking on tip-toes
Inversion
The back of the calf and the lateral foot correspond to dermatome of which nerve?
S1
MS is a disease of what specifically?
(what structure in CNS)
CENTRAL white matter
What two findings in CSF are indicative of MS?
Elevate spinal fluid IgG
Monoclonal bands
What is the preferred type of neuroimaging for confirmation of MS?
MRI

Should be able to see plaques in the white matter
How are corticosteroids used to treat MS?

What are their limitations?
Help shorten flares

Do NOTHING to modify ultimate course of disease
What two therapies in notes for MS actually improve outcome?
Beta-interferon
Glatiramer
What condition is assoc. w/ dementia + myoclonus?
Creutzfeldt-Jakob disease
Embolic strokes often seed in which cerebral artery?
Right Middle Cerebral artery
What virus is by far the most common cause of aseptic/viral meningitis?

What seasonality does it show?
Enterovirus

More prevalent in the summer time
4 characteristics of dementia
Memory impairment
Deficits of higher cortical functions
NORMAL alertness
Interferes with normal functioning
2 most common meningitis causing bacterial pathogens in adults
Strep pneumoniae
Neisseria meningitides
DOC for herpes encephalitis
Acyclovir
Image test recommended in workup for herpes encephalitis
T2-weighted MRI (focus on temporal lobes)
How does CSF differ between bacterial meningitis and HSV encephalitis?
HSV encephalitis typically has a NORMAL glucose
HSV encephalitis often has RBCs present in CSF
2 most common pathogens associated w/ brain abscesses
Strep
Staph
What is the most frequent cause of peripheral neuropathy?
Diabetes
What chromosome is the mutation in Huntington's disease on?
Chromosome 4

Causes an expansion of CAG repeats
What is the pathological hallmark of Huntington's as seen on MRI?
Marked caudate atrophy
What is usually the first detectable clinical sign of Huntington's?
Slowed eye movements
How long after onset do Huntington's pts. usually die?
Only 12 - 15 years

There are currently no drugs available for treating progression of HD
Internuclear opthalmoplegia represents a lesion where?

What is the only disease that can elicit SOLELY this defect?
Medial longitudinal fasciculus

MS
(any other condition that impacts the MLF extends beyond it, causing other symptoms)
What does the medial longitudinal fasciculus connect?
A PPRF w/ its contralateral oculomotor nucleus
How do the eyes deviate w/ regards to an IRRITATIVE pre-frontal lesion?
AWAY from it
How do the eyes deviate w/ regards to a DESTRUCTIVE pre-frontal lesion?
TOWARDS it
What lobe of brain do saccades originate in?
Frontal lobes
What lobe of brain do pursuit movements originate in?
Occipitoparietal lobe
What do pursuit movements do?
Track an already fixed, moving object
Increased input from a labyrinth causes eyes to deviate in what direction?
(relative to the labyrinth)
AWAY from the labyrinth
Decreased input from a labyrinth causes eyes to deviate in what direction?
(relative to the labyrinth)
TOWARDS the labyrinth
What part of the brain are vertical gaze and convergence mediated by?
Upper brainstem tectum and pretectum
Including superior colliculi
What component is nystagmus named for?
The FAST (corrective) component
A lesion of the sympathetic innervation of the eye causes what condition?
Horner's Syndrome
How does sympathetic innervation get to the eye?
Hypothalamus --> SC (synapse in Superior Cervical ganglion)
P-synaptic fibers ascend carotid artery back into cranium
What are the characteristics of the Argyll Robertson pupil?

What condition is it associated w/?
Miotic
Irregular in contour
UNresponsive to light

Neurosyphilis
Sympathetic innervation does what to the pupil?
DILATES it
What are the characteristics of the Adie pupil?
Dilated
UNresponsive to light
Assoc. w/ HYPOactive DTRs

SO, dilation represents lack of PS innervation
Path of pupillary light reflex
Retina --> chiasm --> tract --> pretectal brainstem

Pretectal brainstem --> EW nucleus (bilateral)

Each EW nucleus --> IPSIlateral ciliary ganglion --> IPSIlateral eye
What fingers does the median nerve innervate?

The ulnar nerve?
1, 2, 3, 1/2 of 4

1/2 of 4, 5