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119 Cards in this Set
- Front
- Back
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crossed findings
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brainstem pathology
or Brown Seqard in cord |
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sensory and motor loss, think______
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brain or peripheral.
if some spared, think spinal cord |
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Wallenberg syndrome
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pain/temp loss ipsi face, contra arm/leg
no motor weakness PICA or vert occlusion / dissection (trauma) |
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loss of sensation in legs, buttocks, leg weakness
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cauda equina or conus is prominent bowel/bladder/sexual dysfcn
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UMN signs?
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hyperreflexia
spasticity UE extensors, LE flexors weak upgoing toes |
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aphasia is __ sided MCA stroke
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left
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neglect is ___ sided MCA stroke
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right
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homonymous hemianopia in what kind of stroke?
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MCA
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medial medullary syndrome
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ipsi tongue deviation
contra vib/prop medullary lesions spare the face |
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lesions of ____ spare the face
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medulla
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if you see facial involvement of stroke, think ____ or above
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pons
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subcortical means ___
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deep white matter or post. limb of the internal capsule
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b/l CST dysfcn in ____
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cord compression
cord transection anterior spinal a. syndrome |
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both upper and lower motor neuron signs?
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ALS
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anterior horn cell diseases
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ALS
spinal muscular atrophy polio |
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causes of radiculopathy?
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compressive disk
tumors diabetes CMV |
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causes of plexopathy
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Lyme
diabetes cancer |
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GBS is areflexia and _____ muscle weakness
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proximal
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axonal neuropathies present with
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distal loss of reflexes
caused by toxic, metabolic process |
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presynatpic NMJ?
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botulism
Lambert Eaton |
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causes of toxic myopathy?
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alcohol
statins |
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hypothyroidism causes
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myopathy.
high CK |
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inflammatory myopathies?
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polymyositis
dermatomyositis inclusion body myositis |
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if proximal muscle weakness, think
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NMJ or myopathy
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small pupil?
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Horner's
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large pupil?
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CN III palsy (maybe from aneurysm)
Adie's tonic pupil |
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CNIII palsy?
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first dilation. then opthalmoplegia and ptosis
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Adie's tonic pupil?
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lesion of (parasymp from) ciliary ganglion.
big pupil, blurred vision (no accomodation), photophobia |
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what constrict's Adie's pupil?
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0.1% pilocarpine
(muscarinic agonist) |
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if one eye is larger, think
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aneurysm
or Adie's. try pilocarpine |
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if one eye is smaller, think
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Horner's.
won't dilate to 10% cocaine. amphetamine will dilate a pre-ganglionic lesion |
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eyes deviate ___ in a stroke
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towards
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R PPRF lets ___ eye look ___
controls ___ VI nucleus |
right eye look right
ipsi VI |
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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) |
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R MLF lets you look ___
L MLF lets you look ___ |
R lets you look R
L lets you look L |
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MLF connects ipsi ____ and contra ___
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ipsi III
contra VI |
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lesion in one and a half syndrome?
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unilateral PPRF and MLF lesion
ipsi eye can't move contra has abducting nystagmus |
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vertical eye movement d/o?
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Perinaud's syndrome
PSP oculogyric crisis |
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rigidity is a feature of ____ dz
spasticity is a feature of ___ dz |
basal ganglia
UMN |
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output of basal ganglia?
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GPi and SNr
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in Parkinson's loss of dopaminergic neurons in
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SNc
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features of Parkinson's
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rigidity
bradykinesia tremor postural instability |
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dopamine agonists?
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bromocriptine
ropinirole pramipexole |
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anticholinergics?
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benadryl
cogentin trihexyphenadyl |
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3 types of tremor?
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resting
postural intention |
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what kind of tremor is essential tremor?
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postural
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rx for essential tremor?
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primidone
propanolol |
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causes of intention tremor?
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cerebellar
brainstem Wilson's dz alcohol, anti-convulsants |
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features of essential tremor?
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autosomal dominant
bilateral improves with alcohol. |
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rx for dystonia?
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baclofen
benzos botox |
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causes of dystonia?
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cerebral palsy
anti-psychotics Wilson's dz intracranial dz |
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what's autosomal dominant with incomplete penetrance?
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Tourette's syndrome
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causes of myoclonus?
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anoxic brain injury
encephalitis toxic metabolic encephalopathy epileptic d/o paraneoplastic d/o neurodegenerative d/o |
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rx for myoclonus?
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valproic acid
clonazepam livitiracetam (Keppra) |
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stupor
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can be temporarily aroused
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vegetative state
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appear awake, lack of cognitive function
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Cheynes-Stokes breathing
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periodic breathing due to b/l hemisopheric disturbance.
cycles of apnea followed by cres-decres breathing |
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central hyperventilation occurs with lesions in
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midbrain to upper pons
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apneustic breathing is ___
lesion in _____ |
deep, regular breathing with inspiratory and expiratory pauses
mid to lower PONS |
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ataxic breathing
lesion in ____ |
irregular breathing
medulla |
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pinpoint pupils characterize
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pontine lesions
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argyl-robertson pupil can be lesion in ____
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midbrain
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upgaze palsy is lesion in ___
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midbrain
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skew deviation is lesion in ____
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pons or medulla
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triple flexion is a ____ response, indicating lesion in ____
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motor response
spine |
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paratonia is ___
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motor response found in coma
rigidity incr as force is applied |
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decerebrate posturing indicates lesion
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below red nucleus and ponto-med jcn
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roving eye movements indicate
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unconscious state
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Drugs for status epilepticus?
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Ativan 0.1mg/kg
Valium 0.25mg/kg Phenytoin 20mg/kg tra 50mg/min Phenobarbital 20mg/kg tra 100mg/min |
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back pain, +/- fever, leg weakness or numbness
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cord compression
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___ % of population have epileptic seizure
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10
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___% population have epilepsy
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1
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what causes seizures in the elderly?
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cerebrovascular dz
neoplastic dz |
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what's an epileptic seizure?
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discrete paroxysmal event
synchronized electrical activity in the brain w/w/o change in responsiveness |
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rigidity is a feature of ____ dz
spasticity is a feature of ___ dz |
basal ganglia
upper motor neuron |
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SNr is for ____
SNc is for ____ |
output of BG
Parkinson's dz |
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in PD, what neurotransmitter is depleted?
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DA
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features of PD
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rigidity
bradykinesia resting tremor postural instability |
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parkinson's tremor has how many herz?
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3-5
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PD tremor _____ with distraction
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increases
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Types of tremor?
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resting
postural kinetic (intention) |
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what does alcohol improve?
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essential tremor
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causes of kinetic tremor?
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cerebellar
brainstem Wilson's drug toxicity |
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causes of dystonia?
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cerebral palsy
Wilson's anti-psychotics focal intracranial dz |
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tx for dystonia
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baclofen
benzos botulinum toxin |
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huntington's triad?
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chorea
cognitive decline family hx |
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tx for myoclonus?
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valproic acid
clonazepam keppra |
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most common cause of SAH is
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trauma
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tx for temporal arteritis
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prednisone
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complex regional pain syndrome
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hx of trauma
pain, erythema, swelling nerve block, clonidine patch |
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Tolosa-Hunt syndrome
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idiopathic granulomatous inflammation of canvernous sinus
painful opthalmoplegia |
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pseudotumor cerebri
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overweight woman
blurred vision, diplopia VI palsies normal CT/MR, elevated OP repeated LPs, acetazolamide, topamax |
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structural causes of HA?
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neoplasm
hydrocephalus pseudotumor cerebri |
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cluster HA
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lacrimation, rhinorrhea
steady boring pain behind eye prednisone, lidocaine CCB, Lithium |
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HA responsive to NSAIDs
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tension
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migraine prophy?
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propanolol
verapamil valproate topiramate |
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sx of peripheral vertigo?
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ear pain
tinnitus unilateral hearing loss |
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sx of central vertigo
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dysarthria
dysphagia diplopia syncope |
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Dix-Hallpike looks for
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downbeating and torsional nystagmus
offending ear is the one that's down during the test |
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provocative tests for nystagmus
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hyperventilation
head shaking Dix-Hallpike |
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causes of lightheadedness?
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ANEMIA
volume depletion |
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Meniere's dz
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episodic vertigo
progressive tinnitus, hearing loss caused by increase in endolymph |
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acute tx for vertigo?
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meclizine
(anti-cholinergic for vertigo/motion sickness) |
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central causes of vertigo?
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stroke
demyelinating dz |
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peripheral causes of vertigo?
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labyrinthitis
meds alcohol intoxication BPPV, Meniere's dz acoustic neuroma, cerebellopontine angle tumor |
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diagnostic tests for vertigo?
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tox screen
FTA electronystagography MRI/MRA |
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coordination exam for vertigo?
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past-pointing
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what kind of stroke presents with confusion?
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R parietal
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signs of cortical dementia?
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aphasia
apraxia alexia AMNESIA |
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subcortical dementia
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HIV
Huntington's Parkinson's slowness of thought |
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Binswanger's?
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demyleniation from chronic HTN
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Pick's disease?
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similar to Alzheimer's, except frontotemporal tau inclusions
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Lewy bodies are characteristic of
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parkinson's dz
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diffuse lewy body dz
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like PD + visual hallucinations
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Tx for Alzheimer's?
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AchE inhibitors like donepezil (Aricept)
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findings in Alzheimer's?
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neurofibrillary tangles
senile plaques |
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weakness: if the face is involved, think
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pons or above
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lyme dz causes...
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peripheral neuropathy
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hypothyroidism can caues ___ CKs
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high
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