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189 Cards in this Set

  • Front
  • Back
Onset of Seizure, Migraine, Vascular lesion
RAPID, LOCALIZED
Onset of Transient Ischemic Attack
GRADUAL AND LESS LOCALIZED
Onset of Ischemia
STUTTERING ONSET
Onset of Toxic, Metabolic, Infectious, Inflammatory
GRADUAL OVER HOURS
Onset of Multiple Sclerosis
RELAPSING, DIFFERENT LEVELS
Onset of Neurodegenerative, Neoplasm, Chronic Inflammation
SLOW PROGRESSION
Site of Cranial nerve lesion; crossed weakness
BRAIN STEM
Site of “Long Tract” disorders of motor, sensory, visual, or cerebellar pathways
White matter - Cerebrum
Site of Cognitive impairment; movement disorder; seizure
Gray matter [neuronal]- Cerebrum
Site of Mixed upper and lower motor neuron changes; weakness sparing head
SPINAL CORD
Site of Metabolic; degenerative
PROGRESSIVE, SYMMETRIC, NOT CIRCUMSCRIBED
Tear of a superior cerebral vein as it enters the Saggital Sinus
Subdural Hematoma
Severe headache followed by drowsiness, confusion, contralateral weakness, positive Babinski reflex
Subdural Hematoma
Tear of Middle Meningeal Artery [usual]
Epidural Hemorrhage
Rapid onset; drowsiness, confusion; symptoms depend upon site of pressure
Epidural Hemorrhage
Bleeding is localized and spreads along ____ pathways
white matter
____ is a significant factor for large artery thrombotic stroke
Carotid stenosis
Small vessel disease refers specifically to ___
penetrating arteries
Small vessel disease can cause what type of infarcts?
small deep [lacunar] infarcts
Embolic fragments originate in the ____. Defects are of sudden onset, may resolve.
heart or aorta
Systemic hypoperfusion may lead to ___.
ischemia.
Those of sub-Saharan origin, Asians, and women have a lower incidence of occlusive disease of the___ and ___ than do men of European origin
extracranial carotid and vertebral arteries
____ hemorrhage is more common among those of sub-Saharan origin or Asian origin.
Hypertensive intracerebral
___ is typically a feature of hemorrhagic strokes
Headache
___ is common in patients with intracerebral hemorrhage, subarachnoid hemorrhage, and vertebrobasilar artery ischemia
Vomiting
Reduced alertness favors ___
hemorrhage
Accompanying neurologic signs favor ___ hemorrhage
intracerebral
Loss of consciousness, ___ artery ischemia.
vertebrobasilar
Multifocal headaches and headaches described as sharp and stabbing have a ___ cause
benign
____ headache is unilateral, pounding
Temporal arteritis
___ lesions present with occipito- nuchal headaches
Posterior fossa
___ lesions present with fronto- temporal headaches. Prostrating. Invariably unilateral.
Supratentorial
___ headache is of sudden onset [“thunderclap”].
Aneurysm
___ irritation presents with nuchal rigidity
Meningeal
___ may present with severe eye pain. The pupil may be dilated. The eye is red
Glaucoma
___ have slow buildup and last for hours. Can wake patient, visual disturbances, Light and sound intolerance. Nausea and vomiting, rapid pulse and sweating
Migraines
___ pain is most common pattern in migraine
Hemicranial
What the sensory system input from meningeal vessels can initiate migraines?
trigemino-vascular
A ___ headache has sudden onset, peaks in 3-5 minutes, and rapidly dissipates. Occur in cycles.
cluster
Episodic, daily headache for at least 3 weeks. May have several daily. Cycle terminates spontaneously. Cycle can recur years later.
CLUSTER HEADACHE
Unilateral periorbital pain with an ipsilateral red, watery eye. Nasal discharge and nasal congestion may be present. [Possibly ipsilateral Horner’s syndrome].
CLUSTER HEADACHE
Very brief, sharp, severe pains located in the scalp outside of the trigeminal distribution are named by their defining characteristic as "___."
ice pick pains
FEATURES OF DELERIUM: Infectious meningitis, anticholinergic intoxication, withdrawal from ethanol or sedative drugs, sepsis
Fever
FEATURES OF DELERIUM: Intoxication with ethanol or sedative drugs, hepatic encephalopathy, hypoglycemia, hypothyroidism, sepsis
Hypothermia
FEATURES OF DELERIUM: Anticholinergic intoxication, withdrawal from ethanol or sedative drugs, hypertensive encephalopathy, subarachnoid hemorrhage, sympathomimetic intoxication
Hypertension
FEATURES OF DELERIUM: Anticholinergic intoxication, withdrawal from ethanol or sedative drugs, thyrotoxicosis, sepsis
Tachycardia
FEATURES OF DELERIUM: Hypothyroidism
Bradycardia
FEATURES OF DELERIUM: Hepatic encephalopathy, hyperglycemia, sepsis
Hyperventilation
FEATURES OF DELERIUM: Meningitis, subarachnoid hemorrhage
Meningismus
FEATURES OF DELERIUM: Meningococcal meningitis
  Skin rash
FEATURES OF DELERIUM: Hypocalcemia
Tetany
FEATURES OF DELERIUM: Hypertensive encephalopathy, intracranial mass
Papilledema
FEATURES OF DELERIUM: Head trauma, anticholinergic intoxication, withdrawal from ethanol or sedative drugs, sympathomimetic intoxication
Dilated pupils
FEATURES OF DELERIUM: Opioid intoxication
Constricted pupils
FEATURES OF DELERIUM: Intoxication with ethanol, sedative drugs, or phencyclidine, vertebrobasilar ischemia, Wernicke encephalopathy
Nystagmus/ophthalmoplegia
FEATURES OF DELERIUM: Withdrawal from ethanol or sedative drugs, sympathomimetic intoxication, thyrotoxicosis
Tremor
FEATURES OF DELERIUM: Metabolic encephalopathy
Asterixis
FEATURES OF DELERIUM: Cerebral infarction, head trauma, hyperglycemia, hypoglycemia
Hemiparesis
FEATURES OF DELERIUM: Withdrawal from ethanol or sedative drugs, head trauma, hyperglycemia, hypoglycemia
Seizures
FEATURES OF DELERIUM: Intoxication with ethanol or sedative drugs, Wernicke encephalopathy
Ataxia
Which drug of abuse presents with pinpoint pupils and depressed reflexes?
Opiates
Drug of Abuse? Hypokinesia, Euphoria, somnolence
Opiates
Drug of Abuse? Tremor, Euphoria, hallucinations, panic
LSD
Which Dementia?  Unprotected sexual intercourse, intravenous drug abuse, hemophilia, or blood transfusions
HIV-associated dementia
FEATURES OF DEMENTIA: Hypothermia and Hypotension
Hypothyroidism
FEATURES OF DEMENTIA: Hypertension
Vascular dementia
FEATURES OF DEMENTIA: Chronic meningitis
Meningismus
FEATURES OF DEMENTIA: Acquired hepatocerebral degeneration
Jaundice, Asterixis
FEATURES OF DEMENTIA: Brain tumor, chronic subdural hematoma
Papilledema
FEATURES OF DEMENTIA: Neurosyphilis
Argyll Robertson pupils
FEATURES OF DEMENTIA: Progressive supranuclear palsy
Ophthalmoplegia
FEATURES OF DEMENTIA: Vascular dementia, progressive supranuclear palsy
Pseudobulbar palsy
FEATURES OF DEMENTIA: Dementia with Lewy bodies, corticobasal ganglionic degeneration, acquired hepatocerebral degeneration, Wilson disease, HIV-associated dementia
Tremor
FEATURES OF DEMENTIA: Creutzfeldt-Jakob disease, HIV-associated dementia
Myoclonus
FEATURES OF DEMENTIA: Dementia with Lewy bodies, corticobasal ganglionic degeneration, acquired hepatocerebral degeneration, Creutzfeldt-Jakob disease, progressive supranuclear palsy, Wilson disease
Rigidity
FEATURES OF DEMENTIA: Huntington disease, Wilson disease
Chorea
FEATURES OF DEMENTIA: Normal pressure hydrocephalus
Gait apraxia
FEATURES OF DEMENTIA: Neurosyphilis, vitamin B12 deficiency, HIV-associated dementia
Polyneuropathy with hyporeflexia
DEMENTIA OR DEPRESSION? Indifferent to memory impairment. Semantic paraphasia.
DEMENTIA
DEMENTIA OR DEPRESSION? Cognitive deficit
DEMENTIA
DEMENTIA OR DEPRESSION? Signs of depression secondary
DEMENTIA
DEMENTIA OR DEPRESSION? Rarely past history of depression
DEMENTIA
DEMENTIA OR DEPRESSION? Can describe memory impairment precisely and in detail
DEPRESSION
DEMENTIA OR DEPRESSION? No or minimal cognitive deficit
DEPRESSION
DEMENTIA OR DEPRESSION? Brooding, anxiety, sleep disturbance, loss of appetite, self doubt at presentation
DEPRESSION
DEMENTIA OR DEPRESSION? Usually past history of depression
DEPRESSION
SYNCOPE OR SEIZURE? Incontinence or even some automatisms (lip smacking)
DO NOT distinguish syncope from seizure.
SYNCOPE OR SEIZURE? aura associated with its onset. Sweating, nausea, pallor are not described. Following the seizure the patient may have myalgias. Mental confusion may persist for minutes.
SEIZURE
SYNCOPE OR SEIZURE? no aura. Sweating, nausea, pallor are generally described. Following the episode, mental confusion may last for seconds. Myalgias are uncommon
Syncope
SYNCOPE OR SEIZURE? occurs generally in the daytime. It does not awaken from sleep
Syncope
SYNCOPE OR SEIZURE? may occur at any time and may awaken from sleep
Seizures
SYNCOPE OR SEIZURE? episodes are brief [seconds]
Syncopal
SYNCOPE OR SEIZURE? last minutes
seizures
Usual causes of syncope are ___
neurocardiogenic [20%]
two concurrent events of Seizures
High frequency bursts of action potentials, followed by a hyperpolarizing after-potential mediated by GABA receptors or Potassium ion channels depending upon cell type
Repetitive discharges lead to an increase in extracellular Potassium ion , which blunts hyper-polarization and depolarizes neighboring neurons.
Hypersynchronization
Site of Seizure: Abrupt onset. May occur several times daily. Adversive head movements or complex movements. Mood change. Autonomic dysfunction. Speech arrest. Limited post-ictal confusion.
Frontal lobe
Site of Seizure: Nausea, heat sensation. Visual or auditory hallucinations. Compulsive thoughts; déjà vu; automatisms. Dyspnea, palpitations, urinary urgency. Post-ictal confusion.
Temporal lobe
Site of Seizure: Sensory and major motor [Jacksonian] seizures. Post-ictal confusion.
Parietal lobe
Site of Seizure: Unformed visual hallucinations.
Occipital lobe
Which PARTIAL SEIZURES? No loss of consciousness; seizures involve only sensory or motor systems
Simple
Which PARTIAL SEIZURES? Impaired consciousness; onset localized, but spreads; involves limbic system; usually involves temporal lobe; may involve automatisms
Complex
Which GENERALIZED SEIZURES? Loss of consciousness; associated with generalized tonic muscle contractions [flexion: arms; extension: legs] followed by rhythmic contractions of limbs. Post-ictal phase can involve altered consciousness. 10-12Hz spikes on EEG .
Tonic-clonic [Grand mal]
Which GENERALIZED SEIZURES? Loss of consciousness; rigid, violent muscle contractions; limbs fixed in abnormal positions
Tonic
Which GENERALIZED SEIZURES? Loss of consciousness; rhythmic muscle jerks; involves all parts of the body
Clonic
Which GENERALIZED SEIZURES? Brief loss of consciousness; may be frequent . 3Hz bilateral discharges on EEG.
Absence [Petit mal]
Which GENERALIZED SEIZURES? Sudden loss of muscle tone [fall]
Atonic
Age group of seizure? ischemia, hypoxia, trauma, metabolic [glucose, Calcium, Magnesium, pyridoxine],developmental, genetic
Neonates
Age group of Seizure? infection, trauma, genetic
Infants [1 month – 12 years of age]
Age group of seizure? trauma, infection, genetic, tumor, drugs
Adolescents [12-18 years of age]
Age group of seizure? trauma, alcohol or drugs, tumor
Young Adults [18 – 35 years of age]
Age group of seizure? CVA, tumor, alcohol or drugs, metabolic, degenerative
Adults [over 35 years of age]
A first seizure in someone older than 40 should raise the possibility of ___
bacterial endocarditis
Loss of muscle tone triggered by emotional stimuli. May occur with narcolepsy.
Catalepsy
Disequilibrium suggests a ____
central process
Vertigo as a ___ is associated with short course, precipitating factor, autonomic symptoms. Facial sensory changes and tinnitus may be described. Nystagmus is always present; unidirectional, never vertical
peripheral process
Vertigo as a ___ process may have no obvious precipitating factor. Autonomic symptoms are not prominent. Ataxia, sensory and motor symptoms. Nystagmus may be absent; if present, is uni- or bidirectional or may be may be vertical
central
In ATAXIA, Cerebellar lesions are ___
ipsilateral
Unable to stand with feet together. Lurch. May see to and fro movement of trunk. “Drunken” gait. This is a lesion of the___
anterior lobe of Cerebellum
Lesions of the vermis involve ___
gait disturbance alone
___ lesions are associated with limb ataxia and nystagmus. The shoulder is lower on the affected side. The patient falls to the side of the lesion
Cerebellar hemispheric
Lesions of the ___ are associated with truncal ataxia. There is no motor incoordination but the inability to stand upright without support
4th Ventricle
Upper motor neuron disease. Spastic: affected arm flexed and affected leg extended; difficulty in flexing hip and knee as well as dorsiflexing ankle; paretic leg swings out.
Hemiparetic
Thoracic level lesion. Spastic: slow, stiff movements; hips adducted, legs extended. May cross one leg over the other when walking [“scissor” gait].
Paraperetic
Substantia nigra lesion. Difficulty initiating movement. General flexion of body. Rigid, with tremor. Short intitiating steps [“shuffle”] with rapid movement at end of sequence [“fenestration”]. May see retropulsive steps if mild force exerted on patient
Parkinsonian
Sway with eyes closed. Wide based stance. Slap ground with feet [“tabetic”gait].
Proprioceptive difficulty
Incoordination of voluntary movements is associated with lesions of the ___ of the cerebellum
dentate nucleus
___ tremor is discrete, asymptomatic. May occur when holding heavy object [isometric]. May be exaggerated with stress
Physiologic
___ tremor is familial. 60% autosomal dominant. Involves hands, head, voice, trunk [in decreasing frequency]. May be postural. Improved by alcohol
Essential
__ tremor reflects cerebellar dysfunction. Postural tremor and head/neck tremor may be seen when patient standing.
Intention
___ tremor seen in nigrostriatal or cerebello-spinothalamic tract lesions [e.g., Parkinson’s]. Usually proximal
Resting
___ tremor may be proximal or distal.
Neuropathic
Loss of tonic vestibular discharge on side leads to___.
imbalance [nystagmus and vertigo]
Peripheral lesions [nerve or receptor destruction] result in ___. Fast component beats away from diseased ear.
no brainstem input
Central lesions produce ___ nystagmus.
vertical
which CENTRAL LESIONS? Tendency to fall to ipsilateral side. Diminished caloric sensation on inpsilateral side. Nystagmus to ipsilateral side
Horizontal plane
which CENTRAL LESIONS? Tendency to fall forward/ backward. Elevator sensation. Nystagmus is vertical
Saggital plane
which CENTRAL LESIONS? Tendency to fall sideways [latero-pulsion]. Nystagmus is vertical and to side of lesion.
Frontal plane
___ is associated with bilateral dorsal midbrain lesion. Vertical up and downbeat nystgmaus is present in brain stem lesion.
Retraction nystagmus
__ aphasia: “Uh..well..umm..like”
Global
___ aphasia: “1..2..days..bed”
Expressive
___ aphasia [phonemic paraphrasia]: “When whence beside bespoke”
Receptive
___ aphasia: “Started..well..started”
Conductive
___ lesions associated with slurred speech, dyspnea, hoarseness, or whispering. May “speak through nose”.
Peripheral
___ lesions associated with clipped, scanning speech.
Cerebellar
___lesions associated with monotonous, soft, slurred speech. May see explosive, loud, uncoordinated, clipped speech, however
Basal ganglia
Slurred, effortful, slow speech is seen with ___ disturbances
metabolic
Monotonous, slow, hoarse, pressured speech is seen with ___ lesions. Deep, variable pitch.
white matter
In the brain stem, ___ signs are contralateral to the lesion. ___ signs are ipsilateral to the lesion.
long tract, Cranial nerve
At spinal cord level, loss of pain and temperature is on side ___ of lesion. Long tract signs are not all on one side
opposite
Central monoparesis is distinguished from a peripheral paresis in that contraction of___ muscles is not impaired. For example, the hand may drop but grasp is unimpaired in a central lesion.
antagonist
In posture, Lesion of the ___ leads to contra-lateral hemiparesis.
internal capsule
In posture, Lesion of the ___ leads to ipsilateral cranial nerve injury and contra-lateral hemiparesis.
brainstem
___ occurs at the level of decussation in the pyramids. For example, paresis in the right arm with paresis in the left leg.
Crossed paresis
In posture, ___ paraparesis occurs because of a lesion in the central spinal cord
Spastic
___ posture is characterized by limb extension.
Decerebrate
___ posture is characterized by flexion of the upper limbs with extension of the lower limbs
Decorticate
An expanding supratentorial mass lesion may cause brain tissue to be displaced into an adjacent intracranial compartment, resulting in 1-4
[1] cingulate herniation under the falx, [2] downward transtentorial [central] herniation, [3] uncal herniation over the edge of the tentorium, or [4] cerebellar tonsillar herniation into the foramen magnum.
___ sign: ectopic impulse generation with cervical flexion [demyelination of cervical cord]
L’Hermitte
Symptoms worsen with heat or exercise ___
[conduction block in demyelinated nerve]
Recurrent dysphagia or dysarthria with exercise or fatigue ___
[Myasthenia Gravis]
Slowly advancing visual defects with luminous edges ___
[Migraine]
Constant pain in the ear without evidence of middle ear disease suggests ___.
cancer of the pharynx
Age of DEVELOPMENTAL MILESTONES? Rooting reflex, Orients to voice
0-3 months
Age of DEVELOPMENTAL MILESTONES? Moro reflex lost; holds head up, Social smile
3 months
Age of DEVELOPMENTAL MILESTONES? Rolls front to back; sits propped up, Recognizes people
4-5 months
Age of DEVELOPMENTAL MILESTONES? Sits alone; crawls, Anxious with strangers
7-9 months
Age of DEVELOPMENTAL MILESTONES? Upgoing Babinski disappears
12-14 months
Age of DEVELOPMENTAL MILESTONES? Walks; speaks few words, Separation anxiety
15 months
Age of DEVELOPMENTAL MILESTONES? Climbs stairs; stacks 3 blocks
12-24 months
Age of DEVELOPMENTAL MILESTONES? Rapprochment; parallel play; gender identity
24-48 months
Age of DEVELOPMENTAL MILESTONES? Stacks 9 blocks, Toilet training
30-36 months
Age of DEVELOPMENTAL MILESTONES? Rides tricycle; copies line and circle, Rides tricycle; copies line and circle
3 years
Age of DEVELOPMENTAL MILESTONES? Draw stick figure; copy a cross; hop on one foot, Cooperative play; grooms self
4 years
Age of DEVELOPMENTAL MILESTONES? Copy triangle, Reads; understands concept of death;
6 years
Age of DEVELOPMENTAL MILESTONES? Rides bicycle, Same sex identification; conscience develops
6-11 years
Age of DEVELOPMENTAL MILESTONES? Abstract reasoning; forms personality
11 years [girls]; 13 years [boys]
Facial asymmetry [show teeth or smile]
Arm drift [patient closes eyes and extends both arms straight out for 10 seconds with the palms up; one arm drifts down]
Weak grip [unilateral] or alteration in speech
diagnostic of an acute stroke for >45y/o healthy
Drug of Abuse?
Chorea, tremor, dystonia, myoclonus
Anxiety, agitation, hypervigliance.
Cocaine
Drug of Abuse?
Chorea, tremor, muscle spasms
Euphoria or dysphoria, hyperactivity, hypervigilance, hallucinations
Amphetamines
Drug of Abuse?
Tremor, rigidity
Anxiety, hyperactivity, psychosis
MDMA
Drug of Abuse?
Ataxia, tremor, increased muscle tone
Euphoria or dysphoria, psychosis, aggression
PCP
TIA [basilar artery] With dizziness, diplopia, ataxia, or paresthesia
TIA [anterior cerebral artery]
Posterior fossa tumor. Follows flexion of neck.
Colloid cyst of 3rd ventricle. Position dependent headache
Drop attack
site of DYSEQUILIBRIUM? Nystagmus, head and trunk titubation, gait ataxia
Tumor, multiple sclerosis
Midline
Site of DYSEQUILIBRIUM?
Gait ataxia
Wernicke encephalopathy, alcoholic cerebellar degeneration, tumor, multiple sclerosis
Superior vermis
Site of DYSEQUILIBRIUM?
Nystagmus, ipsilateral gaze paresis, dysarthria [especially left hemisphere lesion], ipsilateral hypotonia, ipsilateral limb ataxia, gait ataxia, falling to side of lesion
Infarction, hemorrhage, tumor, multiple sclerosis
Cerebellar hemisphere
Site of DYSEQUILIBRIUM?
Nystagmus, bilateral gaze paresis, dysarthria, bilateral hypotonia, bilateral limb ataxia, gait ataxia
Drug intoxications, hypothyroidism, hereditary cerebellar degeneration, paraneoplastic cerebellar degeneration, Wilson disease, infectious and parainfectious encephalomyelitis, Creutzfeldt-Jakob disease, multiple sclerosis
Pancerebellar
Babinski positive
Spasticity
With time, hyperactive reflexes, leading to clonus
Absent cremaster, abdominal reflexes
UPPER MOTOR NEURONS problem
Flaccidity
Absent reflexes, muscle atrophy
Fasciculations and fibrillation
LOWER MOTOR NEURONS problem