Core Neurology: 10/14/2007

Front 1

where is lesion in crossed hemiparesis?

Back 1

(face on one side, body on other): between VII nuc in pons and pyramids of medulla

Front 2

tx of TIA

Back 2

antiplatelet agents (eg Aspirin, clopidogrel, ticlopidine, even with cardioembolic TIA), +/- anticoagulation (esp with cardioembolic TIA)

Front 3

when to do carotid endarterectomy in TIA?

Back 3

if anterior-circ TIA and 50+% stenosis on appropriate side; do angiography to define surgically accessible lesions; still need medical tx with ASA

Front 4

when to use other antiplatelet agents besides ASA in TIA?

Back 4

if TIA continues despite ASA (can also try increasing ASA dose or adding warfarin)

Front 5

contraindications for IV tPA

Back 5

pt on warfarin/heparin, PLT < 100k, seizures at onset, ICH/stroke/headtrauma past 3 mos, major surgery past 2 wks, GI/UTI bleed past 3 wks, SBP > 185

Front 6

when to anticoagulate in stroke?

Back 6

only if cardioembolic origin -- prevents new occurance, doesn’t change course of present infarct

Front 7

what are the sx of cerebellar hemorrhage?

Back 7

distinctive: headache, dizziness, vomiting, inability to stand/walk; coma within 24 hrs (not as early as pontine hemorrhage)

Front 8

tx of cerebellar hemorrhage

Back 8

surgical decompression

Front 9

BP goal in intracerebral hemorrhage

Back 9

DBP ~ 100 (slowly), often using nitropaste (can be titrated by wiping off…)

Front 10

most common location of traumatic intracerebral bleed

Back 10

frontal and temporal poles

Front 11

damage where produces intention/kinetic tremors?

Back 11

cerebellum

Front 12

what happens to resting tremor of parkinsons during sleep?

Back 12

ceases (like most tremors of BG / snigra)

Front 13

at what level is dilantin toxic? What are the sx?

Back 13

>20-30mg/dL -- gaze-evoked NYSTAGMUS, ataxia, dysarthria, impaired judgement, lethargy (like being drunk)

Front 14

at what level is dilantin therapeutic?

Back 14

10-20 mg/dL

Front 15

where does down-beating nystagmus localize to?

Back 15

cervicomedullary junction (eg meningioma at foramen magnum)

Front 16

only objective finding of S1 radiculopathy

Back 16

loss of ankle reflex

Front 17

bilateral weakness of eye abduction can often be what?

Back 17

false localizing sign; not just CN VI injury, might be from elevated ICP stretching fibers of CN VI (longest CN)

Front 18

comparison of ptosis in horner syndrome vs CN III palsy

Back 18

much more servere ptosis seen in CN III palsy

Front 19

main pathology in arnold-chiari malformation

Back 19

herniation of cerebellar tonsil through foramen magnum

Front 20

surgical resection vs chemo for meningiomas

Back 20

highly resectable, not very responsive to chemo

Front 21

what is dysdiadochokinesia?

Back 21

impairment of rapid alternating movements, suggesting cerebellar dysfunction

Front 22

causes of dysdiadochokinesia

Back 22

MS, movement disorders (parkinsonism, choreoathetosis)

Front 23

frequency of alpha and beta waves (EEG)

Back 23

ALPHA: 8-13hz; BETA: >14hz

Front 24

MCC glove-and-stocking sensory disturbance (3)

Back 24

metabolic/nutritional: 1) DM; 2) THIAMINE deficiency; 3) NEUROTOXIN damage (eg insecticides)

Front 25

CSF findings in idiopathic seizures

Back 25

none; CSF is normal

Front 26

CSF findings in guillain-barre (protein, cell count, color)

Back 26

albumino-cytologic dissociation (elevated protein, eg >1g, with normal cell count); also, often xanthochromic (yellow) due to high protein content

Front 27

symptoms of HSV type I encephalitis

Back 27

progressive behavioral disturbances, hallucinations, seizures, obtundation

Front 28

most common type of lacunar stroke and location of lesion

Back 28

pure motor -- posterior limb of IC

Front 29

what is thalamic pain syndrome?

Back 29

paradoxial pain associated with decreased pain sensitivity in recovery from pure sensory stroke (eg thalamic lacunar stroke)

Front 30

on which side is the ataxia and Horner in Wallenberg (lateral medullary) syndrome?

Back 30

both ipsilateral (unlike pain/temp loss, which is contralateral)

Front 31

which artery occluded in Wallenberg (lateral medullary) syndrome?

Back 31

vertebral (occasionally PICA)

Front 32

MCC lobar hemorrhage in elderly w/o HTN

Back 32

CAA (cerebral amyloid angiopathy)

Front 33

mycotic aneurysms a/w what cardiac pathology?

Back 33

subacute bacterial endocarditis (low virulence organisms -- highly virulent organisms --> meningitis, multifocal brain abscess with seeding of infected emboli to the brain)

Front 34

lamotrigine vs phenytoin for acute seizure

Back 34

phenytoin better acutely b/c lamotrigine needs to be slowly titrated over weeks b/c of risk of severe rash (stevens-johnson)

Front 35

what is Todd's paralysis? How long does it last?

Back 35

postictal paralysis/weakness (?neuronal exhaustion); lasts hours-days

Front 36

what is sturge weber syndrome?

Back 36

port-wine stains of face (esp V1 distribution), a/w glaucoma, seizures, mental retaration, and ipsilateral leptomeningeal angiomas

Front 37

age-dependent cause of SAH/ICH

Back 37

before age 40, AVM more likely than aneurysm

Front 38

what is nimodipine, and what is it used for?

Back 38

CCB; used to prevent vasospasm 2/2 SAH, which can cause stroke

Front 39

classic sx of extracranial ICA disease

Back 39

episodes of ipsilateral TMB, TIAs with motor weakness; high likelihood of stroke

Front 40

what tx to reduce risk of stroke in pt with symptomatic stenosis (>70%)?

Back 40

carotid endarterectomy

Front 41

diff bw broca's and transcortical motor aphasias

Back 41

repetition preserved in transcortical motor aphasia

Front 42

preferred benzo for status epilepticus, what are the benefits?

Back 42

lorazepam (Ativan) -- rapid onset, cleared more slowly from brain than diazepam (valium)

Front 43

what risk with rapid phenytoin infusion?

Back 43

cardiac arrhythmias / hypotension; ==> takes ~20 min to infuse, give lorazepam first.

Front 44

characteristics of Lennox-Gastaut syndrome

Back 44

mental dysfunction, multiple seizuers types, 1-2 Hz generalized spike-wave discharges on EEG

Front 45

where do you find seizures that have olfactory aura?

Back 45

mesial temporal lobe (specifically uncus or parahippocampal gyrus)

Front 46

role of antiepileptics after head trauma

Back 46

prophylactic antiepileptics INDICATED (esp phenytoin) to reduce incidence of early post-traumatic seizures

Front 47

most common consequence of temporal lobectomy

Back 47

contralateral superior quadrantanopsia; aphasia and homonyous hemianopsia less common

Front 48

main tx of refractory mesial temporal sclerosis

Back 48

temporal lobectomy

Front 49

when do seizures a/w benign juvenile myoclonic epilepsy (BJME) occur?

Back 49

when patient wakes up (unlike sleep myoclonus, which occur as pt is falling sleep)

Front 50

defn of status epilepticus

Back 50

seizure lasting continuously for >30min, or serioes of seizures over 30 min without patient regaining full consciousness in between

Front 51

what is epilepsia partialis continua?

Back 51

persistent focal motor seizure activity (essentially a focal motor status epilepticus), can last days-months, poor response to tx

Front 52

what type of seizures common with history of febrile seizures? What drug used to tx?

Back 52

complex partial seizures, often in the temporal lobe; tx = carbemazepine

Front 53

what is west syndrome?

Back 53

often known as infantile spasms; consists of TRIAD (need 2/3): 1) INFANTILE SPASMS; 2) interictal EEG pattern terms HYPSARRHYTHMIA (chatoc, high/extremely high-voltage polymorphic rhythms; 3) MENTAL RETARDATION

Front 54

common medical tx of West syndrome

Back 54

ACTH, conventional AEDs, but none very good;

Front 55

tx for generalized absence seizures

Back 55

ethosuccimide, unless GI s/e not tolerated or a/w generalized tonic-clonic seizures

Front 56

difference between classic and common migraine

Back 56

classic migraine preceeded by aura of neurologic dysfunction, most often visual

Front 57

classic vs basilar migraine

Back 57

basilar has much more severe neurologic deficits; can have visual deficits evolving to complete blindness, irritability --> frank psychosis, mild hemiparesis --> transient quadriplegia, stupor, syncope, and coma all possible

Front 58

whay systemic dz a/w trigeminal neuralgia?

Back 58

MS, basilar artery aneurysms, acoustic schwannomas, and posterior fossa meningiomas

Front 59

what is tolosa-hunt syndrome?

Back 59

painful (forehead ache) ophthalmoplegia caused by nonspecific inflammation of cavernous sinus or superior orbital fissure

Front 60

pain in trigeminal neuralgia vs atypical facial pain

Back 60

TRIGEMINAL NEURALGIA: paroxysmal, lancinating pains; ATYPICAL FACIAL PAIN: constant, deep pain

Front 61

rx to abort common migraine

Back 61

ergot alkaloids, sumatriptan, metoclopramide

Front 62

what drugs used for prophyalxis against migraines?

Back 62

amitryptiline, propanolol, verapamil, valproate

Front 63

neck findings in tension-type headaches

Back 63

neck muscle spasm --> reduced neck range of motion, paracervical tenderness

Front 64

what is a scotoma, and with what type of h/a is it associated?

Back 64

blind spot, often seen as part of the visual aura of a classic migraine

Front 65

early sx of MS

Back 65

enuresis, ataxia, dysarthria, blurry vision (from optic neuritis); can also get trigeminal neuralgia

Front 66

characteristic feature of cluster headaches

Back 66

"cluster" temporally, eg can be seasonal; classically, pain originates in eye and spreads over temporal area, often accompanied by extreme irritability and ipsilateral autonomic phenomena (tearing, congestion, pupillary constriction)

Front 67

weight loss seen with what h/a etiology?

Back 67

temporal arteritis (can also see fevers)

Front 68

tx for postherpetic neuralgia

Back 68

TCAs (eg imipramine) more effective than analgesiscs

Front 69

sx of pseudotumor cerebri

Back 69

headaches, transient visual obscurations, progressive visual loss, pulsatile tinnitus, diplopia, shoulder/arm pain

Front 70

what type of h/a precipitated by EtOH

Back 70

cluster