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119 Cards in this Set

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crossed findings
brainstem pathology
or
Brown Seqard in cord
sensory and motor loss, think______
brain or peripheral.

if some spared, think spinal cord
Wallenberg syndrome
pain/temp loss ipsi face, contra arm/leg
no motor weakness
PICA or vert occlusion / dissection (trauma)
loss of sensation in legs, buttocks, leg weakness
cauda equina or conus is prominent bowel/bladder/sexual dysfcn
UMN signs?
hyperreflexia
spasticity
UE extensors, LE flexors weak
upgoing toes
aphasia is __ sided MCA stroke
left
neglect is ___ sided MCA stroke
right
homonymous hemianopia in what kind of stroke?
MCA
medial medullary syndrome
ipsi tongue deviation
contra vib/prop

medullary lesions spare the face
lesions of ____ spare the face
medulla
if you see facial involvement of stroke, think ____ or above
pons
subcortical means ___
deep white matter or post. limb of the internal capsule
b/l CST dysfcn in ____
cord compression
cord transection
anterior spinal a. syndrome
both upper and lower motor neuron signs?
ALS
anterior horn cell diseases
ALS
spinal muscular atrophy
polio
causes of radiculopathy?
compressive disk
tumors
diabetes
CMV
causes of plexopathy
Lyme
diabetes
cancer
GBS is areflexia and _____ muscle weakness
proximal
axonal neuropathies present with
distal loss of reflexes
caused by toxic, metabolic process
presynatpic NMJ?
botulism
Lambert Eaton
causes of toxic myopathy?
alcohol
statins
hypothyroidism causes
myopathy.
high CK
inflammatory myopathies?
polymyositis
dermatomyositis
inclusion body myositis
if proximal muscle weakness, think
NMJ or myopathy
small pupil?
Horner's
large pupil?
CN III palsy (maybe from aneurysm)
Adie's tonic pupil
CNIII palsy?
first dilation. then opthalmoplegia and ptosis
Adie's tonic pupil?
lesion of (parasymp from) ciliary ganglion.
big pupil, blurred vision (no accomodation), photophobia
what constrict's Adie's pupil?
0.1% pilocarpine
(muscarinic agonist)
if one eye is larger, think
aneurysm
or
Adie's. try pilocarpine
if one eye is smaller, think
Horner's.
won't dilate to 10% cocaine.
amphetamine will dilate a pre-ganglionic lesion
eyes deviate ___ in a stroke
towards
R PPRF lets ___ eye look ___

controls ___ VI nucleus
right eye look right

ipsi VI
R MLF lets ___ adduct and ___ eye do lateral gaze

connects ___ CNIII and ____ CNVI
R eye adduct, L eye does lateral gaze

ipsi CNIII (adduction) and contra CNVI (lateral)
R MLF lets you look ___
L MLF lets you look ___
R lets you look R
L lets you look L
MLF connects ipsi ____ and contra ___
ipsi III
contra VI
lesion in one and a half syndrome?
unilateral PPRF and MLF lesion

ipsi eye can't move
contra has abducting nystagmus
vertical eye movement d/o?
Perinaud's syndrome
PSP
oculogyric crisis
rigidity is a feature of ____ dz

spasticity is a feature of ___ dz
basal ganglia

UMN
output of basal ganglia?
GPi and SNr
in Parkinson's loss of dopaminergic neurons in
SNc
features of Parkinson's
rigidity
bradykinesia
tremor
postural instability
dopamine agonists?
bromocriptine
ropinirole
pramipexole
anticholinergics?
benadryl
cogentin
trihexyphenadyl
3 types of tremor?
resting
postural
intention
what kind of tremor is essential tremor?
postural
rx for essential tremor?
primidone
propanolol
causes of intention tremor?
cerebellar
brainstem
Wilson's dz
alcohol, anti-convulsants
features of essential tremor?
autosomal dominant
bilateral
improves with alcohol.
rx for dystonia?
baclofen
benzos
botox
causes of dystonia?
cerebral palsy
anti-psychotics
Wilson's dz
intracranial dz
what's autosomal dominant with incomplete penetrance?
Tourette's syndrome
causes of myoclonus?
anoxic brain injury
encephalitis
toxic metabolic encephalopathy
epileptic d/o
paraneoplastic d/o
neurodegenerative d/o
rx for myoclonus?
valproic acid
clonazepam
livitiracetam (Keppra)
stupor
can be temporarily aroused
vegetative state
appear awake, lack of cognitive function
Cheynes-Stokes breathing
periodic breathing due to b/l hemisopheric disturbance.

cycles of apnea followed by cres-decres breathing
central hyperventilation occurs with lesions in
midbrain to upper pons
apneustic breathing is ___
lesion in _____
deep, regular breathing with inspiratory and expiratory pauses

mid to lower PONS
ataxic breathing

lesion in ____
irregular breathing

medulla
pinpoint pupils characterize
pontine lesions
argyl-robertson pupil can be lesion in ____
midbrain
upgaze palsy is lesion in ___
midbrain
skew deviation is lesion in ____
pons or medulla
triple flexion is a ____ response, indicating lesion in ____
motor response
spine
paratonia is ___
motor response found in coma

rigidity incr as force is applied
decerebrate posturing indicates lesion
below red nucleus and ponto-med jcn
roving eye movements indicate
unconscious state
Drugs for status epilepticus?
Ativan 0.1mg/kg
Valium 0.25mg/kg

Phenytoin 20mg/kg tra 50mg/min
Phenobarbital 20mg/kg tra 100mg/min
back pain, +/- fever, leg weakness or numbness
cord compression
___ % of population have epileptic seizure
10
___% population have epilepsy
1
what causes seizures in the elderly?
cerebrovascular dz
neoplastic dz
what's an epileptic seizure?
discrete paroxysmal event
synchronized electrical activity in the brain
w/w/o change in responsiveness
rigidity is a feature of ____ dz

spasticity is a feature of ___ dz
basal ganglia

upper motor neuron
SNr is for ____

SNc is for ____
output of BG

Parkinson's dz
in PD, what neurotransmitter is depleted?
DA
features of PD
rigidity
bradykinesia
resting tremor
postural instability
parkinson's tremor has how many herz?
3-5
PD tremor _____ with distraction
increases
Types of tremor?
resting
postural
kinetic (intention)
what does alcohol improve?
essential tremor
causes of kinetic tremor?
cerebellar
brainstem
Wilson's
drug toxicity
causes of dystonia?
cerebral palsy
Wilson's
anti-psychotics
focal intracranial dz
tx for dystonia
baclofen
benzos
botulinum toxin
huntington's triad?
chorea
cognitive decline
family hx
tx for myoclonus?
valproic acid
clonazepam
keppra
most common cause of SAH is
trauma
tx for temporal arteritis
prednisone
complex regional pain syndrome
hx of trauma
pain, erythema, swelling
nerve block, clonidine patch
Tolosa-Hunt syndrome
idiopathic granulomatous inflammation of canvernous sinus
painful opthalmoplegia
pseudotumor cerebri
overweight woman
blurred vision, diplopia
VI palsies
normal CT/MR, elevated OP
repeated LPs, acetazolamide, topamax
structural causes of HA?
neoplasm
hydrocephalus
pseudotumor cerebri
cluster HA
lacrimation, rhinorrhea
steady boring pain behind eye

prednisone, lidocaine
CCB, Lithium
HA responsive to NSAIDs
tension
migraine prophy?
propanolol
verapamil
valproate
topiramate
sx of peripheral vertigo?
ear pain
tinnitus
unilateral hearing loss
sx of central vertigo
dysarthria
dysphagia
diplopia
syncope
Dix-Hallpike looks for
downbeating and torsional nystagmus
offending ear is the one that's down during the test
provocative tests for nystagmus
hyperventilation
head shaking
Dix-Hallpike
causes of lightheadedness?
ANEMIA
volume depletion
Meniere's dz
episodic vertigo
progressive tinnitus, hearing loss
caused by increase in endolymph
acute tx for vertigo?
meclizine
(anti-cholinergic for vertigo/motion sickness)
central causes of vertigo?
stroke
demyelinating dz
peripheral causes of vertigo?
labyrinthitis
meds
alcohol intoxication
BPPV, Meniere's dz
acoustic neuroma, cerebellopontine angle tumor
diagnostic tests for vertigo?
tox screen
FTA
electronystagography
MRI/MRA
coordination exam for vertigo?
past-pointing
what kind of stroke presents with confusion?
R parietal
signs of cortical dementia?
aphasia
apraxia
alexia
AMNESIA
subcortical dementia
HIV
Huntington's
Parkinson's

slowness of thought
Binswanger's?
demyleniation from chronic HTN
Pick's disease?
similar to Alzheimer's, except frontotemporal tau inclusions
Lewy bodies are characteristic of
parkinson's dz
diffuse lewy body dz
like PD + visual hallucinations
Tx for Alzheimer's?
AchE inhibitors like donepezil (Aricept)
findings in Alzheimer's?
neurofibrillary tangles
senile plaques
weakness: if the face is involved, think
pons or above
lyme dz causes...
peripheral neuropathy
hypothyroidism can caues ___ CKs
high