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771 Cards in this Set
- Front
- Back
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Tests fxn of which brain STRUCTURE:
List words beginning wiht letter |
Frontal lobe
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Where exit skull:
II |
Optic canal
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Which CN:
AFFERENT limb of pupillary light reflex |
II
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Where exit skull:
III |
SOF
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Where exit skull:
IV |
SOF
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Where exit skull:
VI |
SOF
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Where exit skull:
V1 |
SOF
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Which nerves exit SOF? (4)
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III
IV V1 VI |
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Which CN:
Tensor tympani |
V
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Which CN:
Tensor veli palitini |
V
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Where exit skull:
V2 |
Foramen rotundum
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Where exit skull:
V3 |
Foramen ovale
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Which CN exits through:
-foramen ovale -foramen rotundum |
Ovale = V3
Rotundum = V2 |
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CN V: innervates which 2 muscles?
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Tensor tympani
Tensor veli palitini |
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Which CN:
Afferent limb of corneal reflex |
V
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Which CN:
-ant 2/3 tast -post 1/3 taste |
Ant 2/3 = VII
Post 1/3 = IX |
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CN VII: what portion of taste?
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ANTERIOR 2/3
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Which CN:
Efferent limb of corneal reflex |
VII
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Where exit skull:
VII |
IAM
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Where is injury?
Unable to elevate RIGHT palate |
R glossopharyneal
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If injure R CN XII --> which direction does tongue deviate?
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Deviates to RIGHT
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If injure L CN XI --> unable to turn head which direction?
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RIGHT
*opposite |
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Where is injury:
Unable to turn head to L |
R CN XI
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Where is injury?:
Tongue deviate to right |
RIGHT CN XII
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Where exit skull:
IX-XI |
Jugular foramen
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Where exit skull:
XII |
Hypoglossal foramen
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Which nerves exit skull through jugular foramen?
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IX-XI
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Which CN:
Levator palpebrae |
III
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Which CN:
Superior oblique |
IV (trochlear)
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Trochlear nerve innervates which EOM?
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SO
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Abducens nerve innervates which EOM?
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Lateral rectus
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Which CN:
Lateral rectus |
VI
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Which CN:
Afferent limb of gag Eff |
Aff: IX
Eff: X |
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Which CN:
Carries parasympathetic to viscera |
X
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Which CN:
Sensory to epiglottis |
X
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X: motor and/or sensory?
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BOTH
-Motor component of gag reflex -Sensory to epiglottis |
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Strength grading:
-cannot overcome gravity -overcomes gravity but no resistance |
2: no gravity
3: gravity but no resistance |
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Name for:
Flick distal 3rd finger --> flex thumb |
Hoffman's sign
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Name for:
UNable to perform rapid alternative movements |
Dysdiadochokinesis
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Dysdiadochokinesis: what is it?
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Unable to perform rapid alt movements
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Abducens nerve innervates which EOM?
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Lateral rectus
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Which CN:
Lateral rectus |
VI
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Which CN:
Afferent limb of gag Eff |
Aff: IX
Eff: X |
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Which CN:
Carries parasympathetic to viscera |
X
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Which CN:
Sensory to epiglottis |
X
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X: motor and/or sensory?
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BOTH
-Motor component of gag reflex -Sensory to epiglottis |
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Strength grading:
-cannot overcome gravity -overcomes gravity but no resistance |
2: no gravity
3: gravity but no resistance |
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Name for:
Flick distal 3rd finger --> flex thumb |
Hoffman's sign
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Name for:
UNable to perform rapid alternative movements |
Dysdiadochokinesis
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Dysdiadochokinesis: what is it?
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Unable to perform rapid alt movements
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Positive Romberg: what is underlying deficit?
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JOINT POSITION SENSE
(NOT cerebellar) |
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If decreased arm swing w/walk --> suspect what type of pathology?
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Extra-pyramidal
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Gait apraxia (stuck to floor): injury what brain lobe?
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Frontal!
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CSF: how many ml/min? total volume is how many mls? replace entire volume how frequently?
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0.5 ml/min
150 mls q5h |
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Perform LP at what level?
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L3-4
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CSF glucose normally what fraction of serum?
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2/3 BG
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CSF: normally how many lymphocytes? how many PMNs?
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<5 lymphos
no PMNs |
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CSF: normal opening pressure
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60-150
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CSF: see lymphocytes in demyelinating illness?
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YES
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SC ends at what level?
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L1-2
(LP at L3-4) |
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Guillan Barre: CSF protein? glucose?
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Elev protein
Normal glucose |
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ADEM: how affect CSF:
-protein -WBCs -Glucose |
Elev protein
ELEVATED WBCs (lymphos + PMNs) Normal glucose |
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Best imaging for:
Craniocervical junction |
MRI
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Which imaging:
Radiofreq pulses |
MRI
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Which imaging:
Measuers time to echo |
MRI
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T1 or T2 MRI:
Longer time to echo; longer time to repetition |
T2
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T1 or T2 MRI:
Water dark |
T1
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Which imaging:
T2 --> invert signal from CSF |
FLAIR
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T1 or T2 MRI:
Fat bright |
T1
(H2O dark) |
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Which imaging:
Best for EDEMA |
FLAIR
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FLAIR: good for seeing what?
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EDEMA
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Which imaging:
Best for ACUTE CVA |
DWI
(#1 for stroke!!!!) |
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If pt has allergy to CT contrast --> ok to use MRI gadolinum?
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Yes - no cross-reactivity
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Which imaging:
Best for local disruption of BBB |
HEAD CT!
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MRI: safe in preg?
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Yes
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Nephrotoxic?:
-CT contrast -gadolinum |
CT contrast yes, Gad no
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EEG: what waves:
Most prominent posterior head |
Alpha (8-14)
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EEG: what waves:
8-14 Hz |
Alpha
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EEG: what waves:
Awake w/eyes closed |
Alpha (8-14)
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EEG: what waves:
Most prominent frontal head |
Beta (14-30)
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EEG: what waves:
14-30 Hz |
Beta
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EEG: what waves:
4-7 Hz |
Theta
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EEG: what waves:
0.5 - 3.0 Hz |
Delta
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What frequency:
Alpha waves |
8-14
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What frequency:
Beta waves |
14-30
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What frequency:
Theta waves |
4-7
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What frequency:
Delta waves |
0.5 - 3.0
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EEG: detect disturbance of deep structures?
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No - surface only
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Known epilepsy: abn EEG in what %?
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30% only!
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How is compound muscle AP (CMAP) affected in:
-Demyelination neuropathy -Axonal neuropathy |
Demyelin: normal or mild decrease CMAP
Axonal: decrease |
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Nerve conduction study or EMG:
Insert needle |
EMG
NCS uses skin electrodes |
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Nerve conduction study or EMG:
Measures compound muscle APs (CMAP), conduction velocity, latency |
NCS
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Nerve conduction study or EMG:
Measures volitional motor unit potentials --> motor unit recruitment |
EMG
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EMG: how affect RECRUITMENT:
-neurogenic dz -myopathic dz |
Neurogenic: decreased recruitment
Myopathic: normal recruitment |
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NCS: able to disting demyelination vs. axonal pathology/
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Yes
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Oculocephalic reflex:
-Aff -Eff |
Aff: VIII
Eff: III, IV & VI |
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Coma: put ice in ear --> which way move eyes?
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Ice --> TOWARD
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Gag reflex:
-Aff -Efff |
Aff: IX
Eff: X |
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Which worse px:
decerebrate or decorticate |
Decorticate (flex arms)
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Coma pt with suspected brainstem lesion: order what imaging?
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CT (r/o acute bleed) even though MRI better at seeing stem
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Coma pts: when are steroids useful?
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Only if edema 2/2 tumor
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Name for:
No awareness or cognition; eyes open, normal sleep-wake cycle & resp |
Persistent vegetative state
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Locked-in: eye movement horiz or vert?
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VERTICAL
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Optic neurons pass through optic tract --> what structure?
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Optic tract --> LATERAL GENICULATE NUCLEUS (thalamus) --> occipital cortex
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Another name for:
striate cortex |
Visual cortex
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Parieal or Temporal Optic radiations:
Meyers Loop |
Temporal
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Where is lesion:
L homonymous hemianopsia |
R optic tract
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Where is lesion:
L inferior homo quadrantinopia |
R parietal radiations
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Where is lesion:
L superior homo quad |
R temporal rads (Meyers loop)
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Where is lesion:
L homo hemianopia w/macular sparing |
R occipital cortex
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Tests what ability:
Ishihara plates |
Color vision
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Red desaturation: suspect what dz?
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Early optic neuritis
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Horner: pupil constricted or dilated?
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Constricted (miosis)
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Retinal axon have bodies in what nucleus? lei
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IEdinger Westphal nuc
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Iris dilation: sympathetics in ISPI or CONTRAlat hypothal?
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IPSI
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Sympathetics to eye travel along which vessel?
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Internal carotid artery
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Internal carotid artery: carries symps or parasymps?
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Symps
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Normal anisocoria: does degree of aniso change with light?
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NO
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How determine if pt has pre-gang or post-gang Horner's?
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Hydroxyamphetamine drops
Pregang: pupil dilates Post: no dilate |
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CN III palsy: pupil dilated or constricted?
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Dilated
(lose parasymps in CN III) |
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CN III: parasymps innner or outer nerve?
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Outer
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DM: more common to see CN III palsy OR pupil dilated?
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Palsy (vasc inside nerve; parasymp outside nerve)
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Another name for:
Adie's pupil |
Tonic pupil
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Tonic pupil: etiology?
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Disrupt parasympathetics from ciliar gang
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1% pilocarpine: dilate or constrict pupil?
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Constrict
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Argyll Roberston pupil: dilated or constricted?
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Constricted; accomodate to convergence but no react to light
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Light-near dissociation:
-what is it? |
Problem w/light response --> pupil constricts more to a near-stimulus than light
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Optic disc swelling: #1 presenting sx
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dimming/blacking out vision x few seconds
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Anterior ischemic optic neuropathy: suspect if see what phys exam finding?
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Disc hemorrhages
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What dz:
Frontal lobe mass --> ipsi optic disc atrophy & contralat papilledema |
Foster-Kennedy Synd
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Foster-Kennedy Synd: what findings?
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Frontal lobe mass --> ipsi optic disc atrophy & contralat papilledema
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Pseudotumor cerebri: how tx?
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ACETAZOLAMIDE
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Drusen: suspect what inh pattern?
|
AD
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Name for:
Calcified, glistening hyaline bodies in eye |
Drusen (AD inh)
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Name for:
Exercise/hot bath --> worse MS |
Uhthoff's
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Anterior Ischemic Optic Neuropathy:
-painful? -uni/bilat disc edema? |
PAINLESS
UNI |
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Difference b/w non/comitant stabismus
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Comitant: misalign constant in all gaze directions; full ROM both eyes; usu OPHTH prob
Non: degree misalign changes with direction; usu NEURO prob |
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#1 etio CN III palsy
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VASC (HTN, DM)
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CN III dysfxn --> which direction does eye deviate?
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Down & out
(contrast CN IV: down & in) |
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CN IV dysfxn --> eye deviates what direction?
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Down & In
(contrast CN III: down & out) |
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Where is lesion:
Oblique diplopia; worse w/adduction & down vision |
CN IV (SO)
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Where is lesion:
Diplopia going down stairs & reading |
CN IV
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CN IV dysfxn: which way tilt head?
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Away from lesion
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Where is lesion:
Esotropia on ipsilateral gaze |
CN VI
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Park's 3 step test: detects what CN palsy?
|
IV
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Another name for:
Horizontal gaze center |
PPRF
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What structure:
Connect CN VI to CN III |
MLF
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MLF: connects what structures?
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IV & III --> conjugate horiz gaze
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MLF: horiz or vert gaze?
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Horiz
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INO: lesion of what structure?
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MLF
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Where is lesion:
No adduct R eye when look to L; L eye nystagmus |
R INO (MLF)
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INO: able to converge eyes?
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YES (MLF not inv in convergence)
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Name for:
Lesion of PPRF & ipsilat MLF |
One-and-a-half synd
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One-and-a-half synd: lesion what structures?
|
PPRF & ispi MLF
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What dz:
Ipsilat EOM palsy, contralat INO --> only able to move contralat eye in abduction |
One-and-a-half synd
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Vertical EOM: controlled by what nucleus?
|
Rostral interstitial nucleus of MLF (riMLF; located pretectal)
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Parinaud's synd:
-what is underlying lesion? -lose up or downgaze? |
Pineal tumor compresses midbrain
Lose upgaze |
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What dz:
no upgaze (nystagmus if try); light-near dissociation of pupils |
Parinaud's
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Saccades normally originate what structures?
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1. Frontal eye field
2. Superior colliculus |
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If unilat cerebral lesion --> damage IPSI or CONTRA saccades?
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Contra
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Where is lesion:
Unilat saccades |
Contralat cerebral
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Where is lesion:
no visually-guided saccades |
Bilat parieto-occip
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Where is lesion:
Impaired vertical saccades |
dienceph-mesenceph
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Pons lesion --> impaired ipsi or contralat horiz saccades?
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Ipsi
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Pursuit EOM: controlled by ipsi or contra visual cortex
|
IPSI!
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Vertical pursuit EOM: controlled by what structure?
|
Interstitial nucleus of Cajal
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Congenital nystagmus: present at birth? bad?
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Present at birth
Physio variant |
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Name for:
Nystagmus that changes horiz direction every 2-3mins |
Periodic Alternating
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Anticonvulsants --> S/E what TYPE of nystagmus?
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Periodic Alternating
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Chiari malformation --> what TYPE of nystagmus?
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Downbeat
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Spinocerebellar degen --> what TYPE of nystag?
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Downbeat
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Lesion of ant cerebellar vermis or lower stem --> what TYPE of nystag?
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Upbeat
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Wernicke --> what TYPE of nystag?
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Upbeat
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See-saw nystagmus: suspect what etio?
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3rd ventricle tumor
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3rd ventricle tumor: what TYPE of nystag?
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Seesaw
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Where is lesion:
Rebound nystagmus |
Post fossa or cerebellum
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Peripheral nystagmus: fast AWAY or TOWARDS lesion?
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Fast away
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Central or periph nystagmus:
Rare pure horizontal, often see rotatory component |
PERIPHERAL!!!
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Central or periph nystagmus:
Never vertical |
Periph
(do see a rotatory componentI{) |
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Central or periph nystagmus:
P/w severe vertigo |
Periph
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Central or periph nystagmus:
Improves w/fixation |
Periph
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NMJ disorders:
-weakness prox or distal? -weakness fluctuate? |
Prox
FLUCTUATES hr-to-hr |
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NMJ disorders: what sensory changes?
|
NONE
(may see ANS changes) |
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Are most muscles innerv by fibers from single or multiple nerve roots?
|
Mul
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Nerve root disease: see sensory changes? changes in reflexes?
|
Rarely sens changes
May see decreased DTRs |
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WHAT ROOT:
Biceps reflex |
C5
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WHAT ROOT:
Triceps reflex |
C7
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WHAT ROOT:
Brachioradialis reflex |
C6
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WHAT ROOT:
Patellar reflex |
L4
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WHAT ROOT:
Hip adductor reflex |
L3
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WHAT ROOT:
Ankle reflex |
S1
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What is next diagnostic test:
-single radiculopathy -Polyradiculopathy |
Single: MRI spine to r/o structural
Poly: LP to r/o infxn-inflamm |
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If suspect plexus disorder --> next test?
|
MRI plexus
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Plexopathy: common 2/2 to mets?
|
YES
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#1 etio lumbosacral plexopathy
|
Diabetic amyotrophy
|
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How disting ant horn cell injury vs. corticospinal tract injury (based on level of weakness)?
|
Ant horn: weak at level of inj
corticospinal: weak below level |
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Int capsule injury --> weakness in face, arms or legs?
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ALL
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Ipsi or contra weakness:
-hemi lesion -pons lesion |
Hemi: contra weak
Pons: IPSI FACE, contra arm & leg (crossed signs) |
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Where is lesion:
NEGLECT |
R hemi
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UMN: which is weaker:
muscles that shorten leg or lengthen leg |
Shorten leg
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UMN: weak lower and/or upper facE?
|
Weak LOWER only
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UMN; hypo or hyperreflex
|
Hyper
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LMN or UMN:
-wasting -fasciculations |
both LMN
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LMN or UMN:
Weak UPPER & LOWER face |
LMN
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Spinothalamic tract:
What 2 types of nerve fibers? |
A-delta
C THIN/UNMYELIN fibers |
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Spinothalamic tract: fast or slow conduction?
|
SLOW (since thin & unmyelin fibers)
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Spinothalamic tract: where is 1st synapse? 2nd?
|
Dorsal horn
VPL of thalamus |
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Spinothalamic tract: ascend SC in IPSI or CONTRA?
|
CONTRA
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Carried in which SC tract:
Light touch |
DC-ML
|
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Carried in which SC tract:
Vibration, proprio-R |
DC-ML
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DC-ML:
What 2 nerve types? |
A-Alpha
A-Beta (heavy myelinated) |
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STT or DC-ML:
heavy myelin |
DC-ML
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STT or DC-ML:
-A-alpha -A-beta -A-delta |
A-alpha & -beta: DC-ML
A-delta: STT |
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DC-ML:
- asc ipsi or contralat SC - where is 1st synapse? 2nd? |
IPSI
1st: nuclei gracilis/cuneatus 2nd: CONTRAlat thalamus |
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DC-ML:
-where do fibers cross? forms what structure? |
Cross in lower medulla --> forms medial lemniscus
|
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What SC tract:
synapse in nuclei cuneatus & gracilis |
DC-ML
|
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DC-ML: medial or lateral:
-Llegs -arms |
Legs = medial
Arms = lateral |
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Difference b/w dysthesia & allodynia
|
Dysthesia: non-painful stim --> unpleasant sensation
Allodynia: non-painful --> pain |
|
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Distribution of sensory loss (ipsi/contra face/body):
- brainstem lesion - thalamus |
Stem:
Face: ipsi body: contra thalamus: all contra |
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Common to see ISOLATED vertigo 2/2 brainstem ischemia?
|
NO - usu have other s/sx
|
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Periph or central vertigo: which more common?
|
Periph
|
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Vestibular neuritis: where is inflamm?
|
TRICK! none - misnomer
|
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What dz:
Acute unilat nystagmus, vertigo; nystagmus suppressed w/fixation; sxs peak 24h --> resolves days-wks |
Vestibular neuritis
|
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Vestibular neuritis: is pt able to suppress nystagmus?
|
Yes with fixation
|
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Vestibular neuritis: when do sxs peak?
|
24h
|
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What dz:
Episodic vertigo with n/v; progressive hearing loss, tinnitus, fullness |
Menieres
|
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|
Menieres:
mxn |
Increased endolymph
|
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What dz:
hear POP s/p sneeze --> abrupt vertigo |
Perilymph fistula
|
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What dz:
Turn head --> few seconds --> vertigo x sec-mins |
BPPV
|
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What dz:
Turn head --> few seconds --> vertigo x sec-mins |
BPPV
|
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BPPV: due what type of crystals?
|
Calcium carbonate
|
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BPPV: due what type of crystals?
|
Calcium carbonate
|
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What dz:
Dix-Hallpike, Eply |
BPPV
|
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What dz:
Dix-Hallpike, Eply |
BPPV
|
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BPPV:
-what is dx test? -tx epnonym? |
Dx: Dix Hallpike (downbeat)
Tx: Epley |
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BPPV:
-what is dx test? -tx epnonym? |
Dx: Dix Hallpike (downbeat)
Tx: Epley |
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#1 etio syncope
|
Decreased cardiac output
|
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#1 etio syncope
|
Decreased cardiac output
|
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Neurogenic syncope: mxn?
|
transient decrease ANS heart control, stim vagal n --> ACUTE hypotension
|
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Neurogenic syncope: mxn?
|
transient decrease ANS heart control, stim vagal n --> ACUTE hypotension
|
|
|
Neurogenic syncope: tx what 2 drugs?
|
Midodrine
Fludrocortisone |
|
|
Neurogenic syncope: tx what 2 drugs?
|
Midodrine
Fludrocortisone |
|
|
Head CT: bleed appears black or white?
|
White
|
|
|
Head CT: bleed appears black or white?
|
White
|
|
|
GCS: what is score of 2 on motor? 3 on motor?
|
2 = extension to pain
3 = flexion to pain (better) |
|
|
GCS: what is score of 2 on motor? 3 on motor?
|
2 = extension to pain
3 = flexion to pain (better) |
|
|
#1 ICH
|
Acute SDH
|
|
|
#1 ICH
|
Acute SDH
|
|
|
Acute SDH: low or high M&M?
|
High M&M
(contrast EDH: low M&M if drain) |
|
|
EDH: ipsi or contralat:
-pupil dilation -hemiparesis |
Ipsi pupil dilate
Contra hemiparesis |
|
|
What type of bleed:
Lenticular shape |
EDH
|
|
|
Brain contusion: most common what mxn? which lobes?
|
s/p DECEL
1. Inf frontal 2. Temporal |
|
|
SAH: #1 etio
|
Trauma
|
|
|
Which type of brain bleed assoc w/acute hydroceph?
|
SAH
|
|
|
DAI: GM or WM changes?
|
WM
|
|
|
#1 etio coma w/out mass lesion
|
DAI
|
|
|
What are:
Duret's hemmohrages |
Bleeds of corpus callosum & brainstem; see in DAI
|
|
|
Where is mass?:
-uncal/tentorial herniation -cingulate herniation -TRANStentorial herniation -tonsillar herniation |
Uncal: middle cranial fossa
Cingulate: frontal Transtent: supratent Tonsillar: Post fossa |
|
|
What TYPE of herniation?:
-Frontal mass -Supratentorial mass -Mid cranial fossa -Post cranial fossa |
Frontal: cingulate herniation (non-specific)
Supratent: transtent --> bilate small reactive pupils Mid cranial fossa: uncal/tentorial Post cranial fossa: tonsillar |
|
|
Another name for:
Tentorial herniation |
Uncal herniation
|
|
|
Another name for:
Uncal herniation |
Tentorial herniat
|
|
|
Uncal herniation: where does uncus herniate?
|
From temporal lobe --> post fossa (!rostal stem)
|
|
|
Which type of herniation:
Unilateral blown pupil |
Uncal/tentorial
|
|
|
Cingulate herniation: cingulate gyrus herniates across what structure?
|
Falx cerebri
|
|
|
What type of herniation: BILAT SMALL REACTIVE PUPILS
|
Transtentorial/central herniation
|
|
|
How appear pupils:
-uncal herniation -transtentorial herniation |
Uncal: unilat blow pupil
Transtent: bilat small REACTIVE |
|
|
Which type of herniation:
CHEYNE-STOKES |
Transtentorial
|
|
|
Name for breathing pattern:
Cresc --> decresc --> pause |
Cheyne-Stokes
|
|
|
Tonsillar herniation: where do tonsils herniate?
|
Through foramen magnum --> compress medulla --> resp arrest
|
|
|
Which type of herniation:
Compress medulla --> rapid resp arrest |
Tonsillar herniation (thru foramen magnum)
|
|
|
If suspect herniation --> hypervent to what goal CO2?
|
25-30
|
|
|
Causes of death (general): #1-3
|
1: HD
2: cancer 3: stroke |
|
|
Stroke: M or F?
|
M>F
|
|
|
STROKE: intra- or extra-cranial hemorrhage:
-Caucasian -Blacks -Asian |
Cauc: emboli (extracranial)
Black: Intracranial Asian: Intra |
|
|
CVA: what % ischemic? hemorrhagic?
|
80% isch, 20% hemorr
|
|
|
Name for: TIA-like episode resolving after 30m-24h?
|
Reversible Ischemic Neurologic deficit
(TIA <30m) |
|
|
#1 risk THROMBOTIC stroke
|
ATHEROSCLEROSIS
|
|
|
CVA: sickle cell dz increase risk of thrombotic or embolic stroke?
|
Thrombotic
|
|
|
Thrombotic or embolic stroke:
Sxs evolve mins-hrs |
Thrombotic
(embolic: max sxs at onset) |
|
|
Thrombotic or embolic stroke:
Max sxs at onset |
Embolic
|
|
|
#1 source embolic stroke
|
Heart (valves, tumors)
|
|
|
Embolic CVA: what 2 heart defects --> increase risk paroxysmal emboli?
|
1. PFO
2. ASD |
|
|
Hemorrhagic CVA: leads to SAH or ICH?:
-Aneurysm -AVM |
Aneurysm: SAH
AVM: EITHER |
|
|
SAH: see focal s/sx?
|
NO
lethargy, vomit, worse HA of life |
|
|
#1 etio:
-SAH -ICH |
TRAUMA
|
|
|
Hemorrhagic CVA: leads to SAH or ICH?:
HTN |
ICH (#2 etio)
|
|
|
Hemorrhagic CVA: leads to SAH or ICH?:
Cocaine |
ICH
|
|
|
Hemorrhagic CVA: leads to SAH or ICH?:
Amyloid angiopathy |
ICH
|
|
|
ICH 2/2 HTN: #1-4 sites
|
1. Bas gang
2. Thalamus 3. Pons 4. Cerebellum |
|
|
ICH: focal s/sx?
|
YES (contrast SAH)
|
|
|
Which intracranial bleed MOST likely to see sz (although still rare)?
|
ICH
|
|
|
Anterior circulation: supplied by which BVs?
|
CAROTIDS
|
|
|
Carotids: supply ant and/or post circ?
|
ANT ONLY
|
|
|
1st branch of internal carotid artery
|
Ophthalm art
|
|
|
Opthalm artery: branches from what vessel?
|
Internal carotid
|
|
|
PCA: branches from what vessel?
|
INTERNAL CAROTID
(Not basilar) |
|
|
Lenticulostriate art: branches from which BV?
|
MCA
|
|
|
2 vertebral arts unite at what brain structure?
|
Junction of medulla-pons
|
|
|
Vertebral arts: branch from what BVs?
|
Subclavians
|
|
|
What BVs:
Pass through transverse foramina |
Vertebrals
|
|
|
Vertebral arts: pass through which SC structures?
|
TRANSVERSE FORAMINA
|
|
|
What BV supplies:
-midbrain -thalamus |
PCA (both)
|
|
|
What BV supplies:
-occip lboe -inf temp lobe |
PCA (BOTH)
|
|
|
Where is CVA? (blood vessel)
R weakness & sensoryy loss; R visual field defect; APHASIA |
L ICA or MCA
|
|
|
Where is CVA (blood vessel)?
R leg weakness only |
L ACA
(if MCA: see more diffuse motor & sens loss, aphasia, R neglect) |
|
|
Where is CVA (blood vessel)?
R neglect |
L ICA or MCA
|
|
|
Lesion on R or L?:
APHASIA |
LEFT LESION
|
|
|
Lesion on R or L?:
Unable to read, write, calculate |
LEFT LESION
|
|
|
Lesion on R or L?:
Aprosody |
RIGHT lesion
|
|
|
Lesion on R or L?:
Difficulty drawing/copying |
RIGHT lesion
|
|
|
Where is CVA (blood vessel)?
R sensory loss only |
L PCA
(if only inv THALAMUS) |
|
|
Where is CVA (blood vessel)?
Unable to name colors |
LEFT PCA
|
|
|
Where is CVA (blood vessel)?
ALEXIA W/OUT AGRAPHIA |
LEFT PCA
(can write but unable to read) |
|
|
Where is CVA (blood vessel)?
Occipital HA; nystag |
Vertebrobasilar
|
|
|
What dz:
2/2 occlusion of vertebral/basilar arter --> infarct dorsal lat medulla |
Wallenberg's
|
|
|
What dz:
Ipsi atax, ipsi Horner's, ipsi face sens loss, contra loss pain/temp limbs |
Wallenbergs
|
|
|
Wallenberg's: ipsi or contra deficit?:
-atax -Horner's -facial sens loss -pain/temp loss in limbs |
Ipsi: atax, Horner's, face sens loss
Contra: pain-temp loss in limbs |
|
|
Where is CVA (blood vessel)?
Crossed sensory loss |
Vertebrobasilar
(WALLENBERGS) |
|
|
CVA in what structure:
-pure motor stroke -pure sens stroke |
Motor: post limb int capsule (less common pons)
Sens: thalamus |
|
|
CVA dx: may not see CT changes until how long?
|
12-24h
|
|
|
DWI MRI: how appear ischemia (dark/bright)? See brainstem, cerebellum?
|
BRIGHT
see stem & bellum |
|
|
Lacunar infarcts: #1 etio? what patho changes?
|
CHRONIC HTN
Lipohyalinosis, microatheroma |
|
|
Carotid endartectomy if what % stenosis?
|
>70% carotids
|
|
|
If CVA 2/2 cardiac emboli:
Initiate what drug? |
Hep --> Coumadin
|
|
|
Leads to what type of ataxia?:
Vermis lesion |
Truncal & gait
|
|
|
Cerebellar hemi lesion --> IPSI/CONTRA limb ataxia?
|
IPSI!!!!
|
|
|
What type of ataxia?:
Unable to sit unsupported |
Truncal atax
|
|
|
Sub/acute or progressive ataxia:
MS |
Sub/acute
|
|
|
Sub/acute or progressive ataxia:
Dom-inherited episodic ataxia |
Sub/acute
|
|
|
Sub/acute or progressive ataxia:
Paraneoplastic cerebellar degen |
sub/acute --> progressive
|
|
|
Sub/acute or progressive ataxia:
Auto Dom spinocerebellar degen |
Progressive/chronic
|
|
|
Sub/acute or progressive ataxia:
CJD |
Progress/chronic
|
|
|
Sub/acute or progressive ataxia:
Vitamin E def |
Progress/chronic
|
|
|
Sub/acute or progressive ataxia:
Hypothyroid |
Progressive
|
|
|
Cerebellar hemorrhage: how tx?
|
Med emerg --> surg decompress
|
|
|
#1 etio ACQUIRED cerebellar degen
|
EtOHic cerebellar degen
|
|
|
Suspect what etio:
progressive gait & truncal ataxia + polyneuropathy |
Alcoholic cerebellar degen
|
|
|
Alcoholic cerebellar degen: mainly affects HEMIS or VERMIS?
|
VERMIS --> truncal/gait atax
|
|
|
Post-infectious cerebellitis:
-What ages? -viral or bact? |
2-7yo
VIRAL (esp VZV) |
|
|
What dz:
5yo w/VZV --> acute ataxia with dysarthria |
Post-infectious cerebellitis
|
|
|
Post-infectious cerebellitis: how dx?
|
DX OF EXCLUSION
must r/o post fossa mass, drug intox |
|
|
Post-infectious cerebellitis: how long duration? full recovery?
|
weeks --> full recover
|
|
|
Paraneoplastic cerebellar degeneration (PCD): assoc w/what cancers?
|
GYN, SMALL CELL LUNG
|
|
|
Paraneoplastic cerebellar degeneration (PCD): truncal, gait or limb ataxia?
|
ALL
|
|
|
Paraneoplastic cerebellar degeneration (PCD): stabilizes? permanent disability?
|
Stabilizes after weeks --> perm disability
|
|
|
Paraneoplastic cerebellar degeneration (PCD): how appear MRI?
|
NORMAL
|
|
|
What dz:
Woman w/small cell lung cancer & ovarian cancer --> ataxic, dysarth, nystag |
Paraneoplastic cerebellar degeneration (PCD)
|
|
|
What dz:
Anti-Yo, Anti-Hu |
Paraneoplastic cerebellar degeneration (PCD)
|
|
|
Paraneoplastic cerebellar degeneration (PCD): what Abs?
|
Anti-Yo & -Hu
|
|
|
What dz:
Gyn & small cell cancers |
Paraneoplastic cerebellar degeneration (PCD)
|
|
|
Friedrich's ataxia: how inh?
|
AR
|
|
|
Friedrich's ataxia:
-which more pronounced: arms or legs? -onset in child or adol? -hypo or hyperreflex? |
Arms > legs
Child LOSE DTRs --> spastic, extensor |
|
|
What dz:
Child w/AR-inherited atax (decreased vibration & position), no DTRs, spastic, dysarth |
Friedrich's ataxia
|
|
|
Friedrich's and/or Inherited Episodic atax:
-progressive |
Freidrichs
(episodic is in fact episodic) |
|
|
Inherited Episodic Ataxia: 2/2 mutations in what proteins?
|
K+ & Ca2+ channels
|
|
|
Inherited Episodic Ataxia: type EA-1 or EA-2?:
mutate K+ channel |
EA-1
(EA-2 is Ca2+) |
|
|
Inherited Episodic Ataxia: type EA-1 or EA-2?:
mutate Ca2+ channel |
EA-2
(EA-1 is K+) |
|
|
Inherited Episodic Ataxia: type EA-1 or EA-2?:
shorter episodes |
EA-1
(K+ channel) |
|
|
Inherited Episodic Ataxia: type EA-1 or EA-2?:
Interictal nystagmus |
EA-2
(CA2+ channel) |
|
|
Inherited SpinoCerebellar Degen:
-how inh? what mutation? -present child, adol, young adult? |
AD; CAG expansions
Young adult |
|
|
What dz:
Young adult with insidious progressive gait atax, dysarth, mild cogn decline (late) |
Autosomal Dominant Spinocerebellar Degen
|
|
|
What dz:
Atax + areflex + opthalmoplegia |
TRIAD =
Miller-Fischer Syndrome |
|
|
Miller-Fischer syndrome: what triad?
|
1. Atax
2. Areflex 3. Ophthalmoplegia |
|
|
What dz:
IgG anti-GQ1B Abs (90% pts) |
Miller-Fischer Syndrome
|
|
|
Miller-Fischer Syndrome: px?
|
Self-limited --> good px
|
|
|
Suspect what underlying etio (general location):
-hemiplegic gait -paraplegic gait |
Hemi: hemi stroke
Para: SC dz |
|
|
Name for:
arm flexed & adduct (no swing); leg scrapes floor |
Hemiplegic gait
|
|
|
Name for:
Bilat hemiplegia --> cross legs when walk --> scissoring gait |
Spastic (paraparetic) gait
|
|
|
Hemiplegic gait: where is lesion?
|
brainstem or cerebellum
|
|
|
Akinetic-rigid gait: where is lesion?
|
Basal gang
|
|
|
Basal ganglia lesion --> what type of gait?
|
Akinetic/rigid
|
|
|
Brainstem/cerebellar lesion --> what type of gait?
|
Hemiplegic gait
|
|
|
What type of gait?:
Narrow; slow shuffle; little arm swing |
Akinetic/rigid (bas gang)
|
|
|
What type of gait?:
iFESTINATION |
Akinetic/rigid (basal gang)
|
|
|
What type of gait?:
Difficult initiation of gait |
Akinetic-rigid (basal gang)
|
|
|
What type of gait?:
Stooped; flexed shoulders, neck, trunk |
Akinetic/rigid (basal gang)
|
|
|
Progressive supranuclear palsy: presents with what type of gait?
|
Akinetic rigid
*EXTENDED POSTURE (contrast PD: flexed) |
|
|
What type of gait?:
Magnetic (small shuffle) |
FRONTAL GAIT
|
|
|
What type of gait?:
Abortive stepping --> unable to move forward |
Frontal gait (magnetic)
|
|
|
Contract hip abductor --> ispi or contralat leg rises?
|
CONTRA
|
|
|
Weak hip abductor --> pelvis tilts same or opp side?
|
Opposite
(since hip abd normally raises opp leg) |
|
|
What type of gait?:
Wide, slapping gait |
Sensory ataxia
|
|
|
B12 defic:
-large or small fiber? -what type of gait? |
Large
Sensory atax (wide, slapping) |
|
|
What type of gait:
Astasia-abasia |
Psychogenic
|
|
|
What brain structure:
Activates mictrution |
pons M region
|
|
|
Para/symp:
-store pee -release pee |
Store: symp
Pee: parasymp |
|
|
Pons M region: fxn?
|
Control mictrution
|
|
|
Parasymps in what level of SC control mictrution?
|
S2-S4
|
|
|
Mictrurition: WHICH NERVE
- parasymps --> decrease urethr sphincter tone -parasymps --> contract detruss |
Tone: Pudendal
Detruss: pelvic |
|
|
Lateral or medial pons:
Controls pee STORAGE |
Lateral pons (L region)
|
|
|
Which NERVE:
symps --> contract sphincters, relax bladder --> store pee |
Hypogastric n
|
|
|
Normal PVR (bladder vol)
|
<50 ml
|
|
|
Spastic bladder: increase or decrease:
-compliance -capacity |
Decrease both
(contrast atonic bladder: increase compliance & capacity) |
|
|
Spastic or atonic bladder:
UMN |
Spastic
|
|
|
Spastic or atonic bladder:
Sacral plexopathy |
ATONIC (LMN)
|
|
|
MS: what type of urine incontinence?
|
Urge
|
|
|
What TYPE of urine incont:
Detrussor hyperflexia |
Urge
|
|
|
What TYPE of urine incont:
Detrussor-sphincter dyssenergia --> renal damage |
Urge
|
|
|
Name for:
inapprop cxn ext sphinct AND bladder --> AUR, reflux --> renal damage |
Detrussor-sphincter dyssenergia
(see in urge incont) |
|
|
What TYPE of urine incont:
Urethral hypermobil |
Stress
|
|
|
What TYPE of urine incont:
2/2 myelomeningocele |
stress
(intrins sphincter deficiency) |
|
|
What TYPE of urine incont:
Dribblign |
Overflow
|
|
|
Incontinent s/p frontal or pons CVA: good or bad px?
|
Bad
|
|
|
PD: mxn of incontinence?
|
Hyperflex detrussor --> urge incont
PLUS sphincter bradykinesia |
|
|
Bladder dysfxn more common in small or large fiber neuropathies?
|
SMALL
|
|
|
What TYPE of urine incont:
Tx w/ Anticholinergics |
Urge
|
|
|
What TYPE of urine incont:
Tx w/oxybutynin |
Urge (anticholin)
|
|
|
What TYPE of urine incont:
Tx w/TOLTERODINE |
Urge (anticholin)
|
|
|
What TYPE of urine incont:
Tx with IMIPRAMINE |
Urge
|
|
|
What TYPE of urine incont:
Tx w/once daily DDAVP |
Urge
|
|
|
What TYPE of urine incont:
Tx w/intrabladder capsaicin (how long last?) |
Urge (lasts 6mos)
|
|
|
What TYPE of urine incont:
Tx w/alpha-adrenergics |
Stress
|
|
|
What TYPE of urine incont:
Tx with phenylpropanolamine, pseudoephedrine |
Stress
|
|
|
What TYPE of urine incont:
Tx with bethanecol |
Overflow (atonic)
|
|
|
Overflow incont: tx w/what SINGLE DRUG?
|
Bethanecol
|
|
|
What nerve:
Motor & sens to penis/clit |
Pudendal
|
|
|
Para/symp:
ERECTION |
Parasymps
|
|
|
Para/symps:
NO, cGMP --> erection |
Parasymps
|
|
|
Para/symps:
Ejaculation |
Symps
|
|
|
Erectile dysfxn: can be 2/2 what two drug classes?
|
1. AntiHTN
2. Anti-dep |
|
|
Txs what dz:
PAPAVERINE injection |
ED
|
|
|
Difference b/w:
Hypnagogig Hypnopompic |
Gogic: sleep onset
Pompic: awake |
|
|
Occurs during which sleep phase:
-nightmare -night terror |
Mare: REM
terror: Slow wave |
|
|
Due to blockage of what receptor?:
-Tardive dysk -Akath |
D2-R
(both) |
|
|
NMS: what marker increases?
|
CK
|
|
|
What dz:
Rigid + fever + labile ANS + change MS |
NMS
|
|
|
NMS:
-tx fever? -what drugs? (2) |
Yes - antipyretic
Dantrolene, bromocript |
|
|
Name for:
Unpleasant desire for constant move |
Akathisia
|
|
|
Akathisia: tx w/what drug classes?
|
Anticholin
B-b |
|
|
Name for:
Neuroleptics --> chewing, lip-smaking, may inv trunk/limbs |
Tardive dyskinesia
|
|
|
What dz:
Fluctuating, progressive rigidity with PAINFUL spasms (worse w/startle) |
Stiff Man Syndrome
|
|
|
Stiff Man Syndrome: classic feature?
|
Painful spasms worse w/sudden move, startle
|
|
|
Stiff Man Synd: initially where --> spreads where?
|
Initially AXIAL/TRUNK --> prox limbs
|
|
|
What dz:
lumbar hyperlordosis, TIN MAN |
Stiff Man syndrome
|
|
|
What dz:
EMG: continuous motor unit activity but NO SC DZ |
Stiff Man syndrome
|
|
|
What dz:
CSF: Abs against glutamic acid decarboxylase |
Stiff Man Syndrome
|
|
|
Stiff Man Syndrome: CSF findings?
|
Abs agaisnt glutamic acid decarboxylase
|
|
|
What TYPE OF TREMOR:
PD |
Resting
|
|
|
What TYPE OF TREMOR:
Essential tremor |
Postural
|
|
|
What TYPE OF TREMOR:
Theophylline, B-blockers |
Postural
|
|
|
What TYPE OF TREMOR:
EtOH |
Postural
|
|
|
What TYPE OF TREMOR:
MS |
Action
|
|
|
What TYPE OF TREMOR:
WILSONS |
ACtion
|
|
|
Essential tremor: always bilat?
|
Yes
|
|
|
Essential tremor: how tx?
|
1. Primidone
2. Propranolol |
|
|
Txs what dz:
Primidone + propranolol |
Essential tremor
|
|
|
Chorea: always aware?
|
NO
|
|
|
Chorea: how tx?
|
HALOPERIDOL
|
|
|
Sydenham's chorea: what etio?
|
STREP
|
|
|
Hemiballism: ipsi or contralat lesion?
|
Contralat caudate/putamen/STN
|
|
|
Hemiballism: #1 etio
|
CVA
|
|
|
Ballism: lesion what structures?
|
Putamen, caudate, STN
|
|
|
Name for:
Pt w/dystonia --> gently touching body part leads to decreased dystonia |
Geste antagoniste
|
|
|
Geste antagoniste: what dz?
|
Dystonia
Touch body part --> decreased dystonia |
|
|
Dystonia: worse with in/voluntary movement?
|
Vol
|
|
|
Idiopathic/Primary Torsion dystonia:
-how inh? -what protein dyssfxn? |
AD
ATP-binding protein A |
|
|
Myoclonus: how tx?
|
Clonazepam
|
|
|
Simple or complex tic: finger cracking
|
Complex
|
|
|
Tourettes: assoc w/learning disability? what other psych dx?
|
YES - LEARNING DISABL
Also OCD |
|
|
PANDAS: what etio?
|
Group A beta-hem strep
|
|
|
PANDAS: Abs against which structure?
|
Basal gang
|
|
|
PANDAS: how tx?
|
clonazepam, clonidine
|
|
|
Tics: how tx?
|
Haldol, atypicals
|
|
|
Wilson's dz: how inh?
|
AR
|
|
|
What dz: neuropsych & liver failure
|
Wilson's Dz
|
|
|
Wilson's dz:
Increased or decreased copper conjugating to ceruloplasmin? |
DECREASE
No conjugate --> CU enters biliary excret pathway |
|
|
Wilson's dz:
Hyper or hypokinetic? |
BOTH
|
|
|
Kayser-Fleischer:
-what dz? -0deposit what structure? |
Wilson's
Descemet's membrane |
|
|
Wilson's dz:
What lab changes? Most sensitive? |
Increase Cu
Decreased ceruloplasmin Most sens: 24h urine Cu |
|
|
Wilson's dz:
How tx? (2) |
Penicillinamine
Zinc |
|
|
Which episodes last longer:
Paroxysmal KINESOGENIC or DYSTONIC choreoathetosis |
DYSTONIC (mins-hr)
(Kineso: secs) |
|
|
Paroxysmal dyskinesias: how tx?
|
CARBAMAzEPINE
|
|
|
How present differently:
1. Encephalopathy of fulminant liver failure vs. 2. Portal-systemic encaphlo assoc w/cirrhosis |
Fulm liver fail: coma in DAYS
Portal-syst: WAX/WANE cerebral fxn |
|
|
Hepatic encephalo:
How many GRADES? |
0 (normal) - 4 (coma)
|
|
|
Hepatic encephalo:
Increased or decreased tone? Hypo/hyperreflex? |
INCREASED TONE
HYPERREFLEX |
|
|
Hepatic encephalo:
Increased NH4 --> how affect brain neurotransmission? |
INCREASE GLUTAMINE --> DECREASE GLUTAMATE transmission
Also increase periph-type benzo-Rs in brain |
|
|
Hepatic encephalo:
Leads to deposition of WHAT nutrient in WHAT structure? |
Manganese in basal gang
|
|
|
What dz: (besides manganese tox)
See manganese deposition in basal gang? |
Hepatic encephal
|
|
|
What dz: (not Alz)
See ALZ TYPE II ASTROCYTE |
Hepatic encephalo
|
|
|
Hepatic encephalo:
What histologic finding? |
Alz type III astrocyte
|
|
|
Hepatic encephalo:
T/F may be primary astrocytopathy |
T
|
|
|
What dz:
EEG: triphasic waves |
Hepatic encephlo
|
|
|
Polyarteritis nodosa: what neuro s/sx?
|
Mononeuritis monoplex
Szs CVA |
|
|
Which ARTERITIS:
May p/w basal meningitis |
Wegner's
|
|
|
Which ARTERITIS:
ASEPTIC MENINGOENCEPHALITIS |
Behcet's
|
|
|
Behcet's: what neuro s/sx?
|
ASEPTIC MENINGOENCEPHALITIS
|
|
|
What dz:
Non-caseating granulomas |
Neurosarcoidosis
|
|
|
#1 sx neurosarcoidosis
|
Chronic basal meningitis --> FACIAL & OPTIC neuropathies
|
|
|
Sarcoidosis: common to see CNS inv?
|
NO - only 5% pts
|
|
|
Sarcoidosis: how dx?
|
BX (however usu presumptive)
|
|
|
What dz:
Increase serum ANGIO-CONVERTING ENZYME (ACE) |
Sarcoidosis
|
|
|
Sarcoidosis: increase what enzyme?
|
ACE
|
|
|
Sarcoidosis: how tx?
|
STEROIDS
|
|
|
Hypo or hypergly:
Transient painful polyneuro; CHOREA |
HYPERgly
|
|
|
DM: lose temp sens?
|
YES - temp & pinprick (small & unmyelin)
|
|
|
Name for:
Compress lateral cutaneous n of thigh --> non-radicular pain, truncal sens loss & focal abductor weakness |
Meralgia Paresthetica
|
|
|
Meralgia Paresthetica: assoc what dz? what n?
|
DM
Lateral cutaneous n of thigh |
|
|
Meralgia Paresthetica: radicular distribution?
|
NO - follows lat cutaneous n of thigh
|
|
|
Diabetic amyotrophy:
Prox or distal polyneuro? |
PROXIMAL!!!!
|
|
|
Diabetic amyotrophy:
How tx? |
STEROIDS (may be immune-mediated!)
|
|
|
DM w/acute dysthesia-pain in feet: likely to resolve w/eugly?
|
YES
|
|
|
HONK or DKA:
Dystonia, chorea |
HONK (rare)
(DKA p/w cerebral edema) |
|
|
HONK or DKA:
Cerebral edema |
DKA
|
|
|
Repeated hypoglycemia --> inj what SC cells?
|
Ant horns --> ALS-like syndrome
|
|
|
DM: increase risk of stroke?
|
Yes - esp lacunar
|
|
|
EtOH cerebellar degen: see nystag?
|
NO
Affects vermis --> trunk/postural atax |
|
|
Tobacco-EtOH ambylopia:
-painful? -what type of vision loss? |
PAINLESS
Centrocecal scotoma |
|
|
What syndrome:
EtOH --> focal demyelin & necros corpus callosum --> frontal type dementia |
Marchiafava-Bignami syndrome
|
|
|
Marchiafava-Bignami syndrome: etio? pathophysio?
|
EtOH --> necrose corp callosum --> frontal type dementia
|
|
|
Wernicke Triad: develops over what amt time?
|
Days-wks
|
|
|
Wernicke --> give thiamine --> how long until improve:
-atax -confusion -ocular |
Ocular: hrs
Confusion: wks Ataxia: may persist |
|
|
Subacute combined degen of SC: etio?
|
B12 DEFICIENCY
|
|
|
What dz:
Insidious parasthesias in hands/feet --> weak spastic legs; LARGE fiber neuropathy; + macro anemia |
B12-def --> Subacute combined degen of SC
|
|
|
Leads to what dz:
EtOHic --> overrapid correct hypoNa |
Central pontine myelinolysis
|
|
|
Central pontine myelinolysis: etio?
|
Overrapid correct hypoNa
|
|
|
What dz:
EtOHic admitted to hospital --> acute confusion, spastic quadriparesis, LOCKED-in |
Central pontine myelinolysis
|
|
|
What underlying dz:
Early CVA (ven & art), fetal loss, thrombocytopenia |
Antiphospholipid syndrome
|
|
|
Antiphospholipid syndrome: ven or art thromboses?
|
BOTH
|
|
|
What dz:
Anticardiolipin Abs |
Antiphospholipid syndrome
|
|
|
Antiphospholipid syndrome: commonly assoc what dz?
|
SLE
|
|
|
What syndrome:
Antiphospholipid syndrome pt with cerebral ischemia & livedoreticularis |
Sneddon's syndrome
|
|
|
Antiphospholipid syndrome: what TYPE of Ig?
|
IgG
|
|
|
Antiphospholipid syndrome: how officially dx?
|
IgG APL Abs on 2+ occassion, 6 weeks apart
|
|
|
Antiphospholipid syndrome: how tx/
|
Coumadin w/INR 3-4
|
|
|
Neuro sxs more commoin hypo or hyper thyroid?
|
Hypo
|
|
|
Hypo or hyperthyroid:
PSYCHOSIS |
HYPO
|
|
|
Hypo or hyperthyroid:
Myasth Gravis |
HYPO
|
|
|
Hypo or hyperthyroid:
Entrapment neuros |
HYPO
|
|
|
#1 brain met (what % of total brain mets)?
|
Lung (50% all mets)
|
|
|
What primary cancer:
Leptomeningeal met |
ACUTE LEUKEMIA
|
|
|
Acute leukemia: mets to what part of brain?
|
Leptomeninges
|
|
|
Mets to MENINGES or DURA?:
Breast |
Dura
(same as prostate) |
|
|
1' brain cancer;
Only known risk |
Ionizing radiation (10-20yr latency)
|
|
|
Brain cancer:
What % have HA? |
70% total
(presenting feat in only 30%) |
|
|
Does a normal MRI r/o tumor?
|
Virtually yes
|
|
|
What TYPE of tumor:
Oligodendroglioma |
GLIAL TUMOR
(same as astrocytoma) |
|
|
What type of original cell:
Astrocytoma |
GLIAL CELL TUMOR
|
|
|
Peaks what age:
-low-grade astryocytoma -GBM |
Low-grade: 30-40yo
GBM: 60-70yo |
|
|
How tx:
-low-grade astrocytoma -GBM -Oligodendroglioma -Medulloblastoma -Meningioma -CNS lymphoma -Acoustic neuroma |
Low astro: surg OR xrt
GBM: surg + xrt Oligodendro: chemo Medullo: surg + xrt + chemo Mening: surg CNS lymph: xrt + chemo (no surg) Acoustic: surg + xrt |
|
|
Low-grade astrocytoma:
-how tx? -how long survive? |
resect OR xrt
5yrs |
|
|
What brain tumor:
Irreg, RING-LIKE enhancement |
GBM
|
|
|
GBM: how tx? survival?
|
surg + xrt (contrast low-grade: one or other)
1yr |
|
|
Oligodendroglioma: how tx? survival?
|
CHEMO ONLY
Survive 10 yrs (longer than low-grade astro) |
|
|
Which type of tumor:
CHEMO ONLY |
Oligodendroglioma
(CNS lymphoma may tx chemo +/- xrt) |
|
|
#1 pedi brain tumor
|
Medulloblastoma
|
|
|
Medulloblastoma: arises what part of cerebellum?
|
MIDLINE --> obstruct aqueduct --> truncal atax
|
|
|
What brain tumor:
Pedi w/no 4th ventricle seen on MRI |
Medulloblastoma --> blocks cerebral acq --> not see 4th vent
|
|
|
Medulloblastoma: common mets throughout CNS?
|
YES! Must image SC, radionuclide bone & BM asp
|
|
|
What brain tumor:
Also obtain SC image, bone marrow asp & radionuclide scan |
Medulloblatoma (commonly mets throughout CNS)
|
|
|
Medulloblastoma: what % kids survive past 10 yrs?
|
<50%
|
|
|
#1 BENIGN brain tumor
|
Meningioma
|
|
|
Meningioma:
-M or F? -<50 or >50? -what % supratent? |
F > M
>50yo 90% supratent |
|
|
What brain tumor:
DURAL TAIL |
Mening
|
|
|
Meningioma: how tx?
|
Surg only
|
|
|
Meningioma: can follow w/annual CT if what size?
|
<2cm
|
|
|
#1 type CNS lymphoma
|
DIFFUSE NON-HODG
|
|
|
1' CNS lymphoma: B or T cell?
|
B cell (98%)
|
|
|
1' CNS lymphoma:
Usu sub/cortical? |
Sub
|
|
|
1' CNS lymphoma:
How officialy dx? |
Stereotactic bx
|
|
|
1' CNS lymphoma:
Commonly mets to what structure? |
EYE (20%); also CSF
|
|
|
1' CNS lymphoma:
Resect? |
No -- MTX only (crosses BBB)
+/- XRT |
|
|
MTX: crosses BBB?
|
Yes
Use to tx 1' CNS lymphoma |
|
|
Acoustic neuroma: more common acoustic or vestib fibers?
|
VESTIB!! (misnomer)
|
|
|
Acoustic neuroma:
-benign or malig? -uni/bilat? |
Usu benign
Uni, except NF-2 |
|
|
What neurocut disroder:
Bilat acoustic neuroma |
NF-2
|
|
|
What type of tumor:
80% all cerebropontine angle tumors |
Acoustic neuroma
|
|
|
Acoustic neuroma:
how tx? |
Resect + XRT
|
|
|
#1 pituitary cancer
|
Adenoma
|
|
|
Acoustic neuroma: more common acoustic or vestib fibers?
|
VESTIB!! (misnomer)
|
|
|
Pit adenoma:
-#1 sx -hypo or hyper pit? |
HA
Hypo or Hyper |
|
|
Acoustic neuroma:
-benign or malig? -uni/bilat? |
Usu benign
Uni, except NF-2 |
|
|
Pit adenoma: how tx (what med) if PRL-secretign
|
DA agonist (bromo)
|
|
|
What neurocut disroder:
Bilat acoustic neuroma |
NF-2
|
|
|
MS: preserve axons?
|
YES
(just lose myelin) |
|
|
What type of tumor:
80% all cerebropontine angle tumors |
Acoustic neuroma
|
|
|
MS: szs early or late?
|
Late
|
|
|
Acoustic neuroma:
how tx? |
Resect + XRT
|
|
|
#1 pituitary cancer
|
Adenoma
|
|
|
Pit adenoma:
-#1 sx -hypo or hyper pit? |
HA
Hypo or Hyper |
|
|
Pit adenoma: how tx (what med) if PRL-secretign
|
DA agonist (bromo)
|
|
|
MS: preserve axons?
|
YES
(just lose myelin) |
|
|
MS: szs early or late?
|
Late
|
|
|
Acoustic neuroma: more common acoustic or vestib fibers?
|
VESTIB!! (misnomer)
|
|
|
Acoustic neuroma:
-benign or malig? -uni/bilat? |
Usu benign
Uni, except NF-2 |
|
|
What neurocut disroder:
Bilat acoustic neuroma |
NF-2
|
|
|
What type of tumor:
80% all cerebropontine angle tumors |
Acoustic neuroma
|
|
|
Acoustic neuroma:
how tx? |
Resect + XRT
|
|
|
#1 pituitary cancer
|
Adenoma
|
|
|
Pit adenoma:
-#1 sx -hypo or hyper pit? |
HA
Hypo or Hyper |
|
|
Pit adenoma: how tx (what med) if PRL-secretign
|
DA agonist (bromo)
|
|
|
MS: preserve axons?
|
YES
(just lose myelin) |
|
|
MS: szs early or late?
|
Late
|
|
|
MS: see papilledema?
|
YES! optic disc pallor/atrophy
|
|
|
What dz:
RED DESATURATION |
MS
|
|
|
What dz:
Relative Afferent Pupillary Defect |
RAPD
|
|
|
MS:
What SC disorder? |
Transverse myelitis
|
|
|
What dz:
MS pt w/bilat weakness & sens loss; increased DTRs |
Transverse myelitis
|
|
|
What dz;
MS pt with TINGLING/PAINFUL band around torso |
Transverse myelitis
|
|
|
INO: dysfxn what structure?
|
MLF
|
|
|
INO: is convergence intact?
|
Yes
|
|
|
MS: if relapse-remit --> episodes last how long?
|
Wks-mos
|
|
|
MS: what fraction pts have minimal disability? unemployed? wheelchair?
|
1/3 min
1/3 unemp 1/3 wheel |
|
|
Which has better px:
-young vs old onset -M vs. F -sens or motor sxs |
BETTER PX:
Young, Fem, Sens |
|
|
MS: appears hypo or hyperintense on T2?
|
Hyper
|
|
|
MS: see prolif of what cells on histo?
|
Glial cells
|
|
|
MS: tx po or IV steroids?
|
IV
|
|
|
MS: can steroids prevent onset of MS?
|
No - only delay
|
|
|
MS: S/E of B1aIFN
|
Flu-like, depression
|
|
|
ADEM: patches most common which brain regions?
|
Posterior hemis
|
|
|
ADEM vs. MS:
-EARLY behavioral/cogn chagnes |
ADEM
|
|
|
ADEM vs. MS:
CSF: higher WBC |
ADEM
|
|
|
ADEM: see oligoclonal bands in CSF?
|
No (contrast MS)
|
|
|
ADEM:
-how tx? -increased risk future event? |
Steroids
NO RELAPSE (monophasic) |
|
|
Bacterial mening:
What is opening pressure? CSF glucose what % BG? |
20-50
<40% |
|
|
Bacterial mening:
CSF gram stain + in what %? cx? |
stain: 70%
cx: 80% |
|
|
Bacterial mening:
#1 pathogen overall |
Strep pneumo
|
|
|
What abx: bacterial meningitis in:
-0-3mos --3mo -50yo ->50yyo |
0-3: amp & CTX
3mo - 50yo: vanco & CTX >50yo: amp & CTX |
|
|
Bacterial meningitis: adjunct steroids in ALL pts?
|
NO - children only
(decreases hearing loss & neuro sequelae) |
|
|
TB meningitis: see cranial nerve palses?
|
YES (esp if chronic meningitis)
|
|
|
TB meningitis: how long for CSF cx?
|
6wks
|
|
|
What dz:
MRI shows basilar meningeal inflamm; tuberculoma |
TB meningitis
|
|
|
Brain abscess: usu single or multi orgs?
|
MULTI
|
|
|
If multiple brain abscess --> suspect what underlying dz?
|
Endocard
|
|
|
Brain abscess:
see neck stiff? fever? |
NO!
|
|
|
Brain abscess:
Able to cx blood, CSF? |
Rarely grows pathogen
|
|
|
Brain abscess:
Able to perform LP |
NO!
|
|
|
Brain abscess:
How tx? |
Surg drain + abx (6w)
|
|
|
Syphilis: painless chancre how long after exposure? lasts how long?
|
3 weeks after exposure
lasts 2-8w |
|
|
2' or 3' neurosyph:
Meningitis |
2'
(see 2-12w s/p expos) |
|
|
2' or 3' neurosyph:
Cranial neuropathy |
2'
(2-12w s/p expos) |
|
|
2' or 3' neurosyph:
Decreased hearing |
2'
(2-12w s/p exposure) |
|
|
Neurosyph:
What % untx pts develop 3' neurosyph? |
30%
|
|
|
Tabes Dorsalis; painful?
|
YES - lightening pains + ataxia
|
|
|
Tabes Dorsalis: increase or decrease DTRs?
|
DECREASE
|
|
|
What dz:
Charcot joints (pain/temp loss --> trophic changes) |
Neurosyphilis w/Tabes Dorsales
|
|
|
Which has higher specificity?
FTA or VDRL |
FTA
(screen w/VDRL --> FTA to confirm) |
|
|
T/F negative FTA excludes syph
|
Yes
|
|
|
Lyme dz meningitis: lymphocytes or PMNs?
|
LYMPHOS
|
|
|
Lyme dz: how tx if CNS involvement (e.g. mening)?
|
IV ceftriaxone
|
|
|
Epidemic viral meningitis: what 2 classes of viruses?
|
Enteroviruses (Cox, Echo) & Arbo
|
|
|
Epidemic viral meningitis:
Which season? |
Summer
|
|
|
What dz:
Sharp waves in temp lobe |
HSV meningitis
|
|
|
HSV meningitis: what % die if no tx?
|
70%
|
|
|
How tx zoster of CORNEA?
|
PO!!! ACV
|
|
|
What virus: PML
|
JV virus
|
|
|
PML: see focal s/sx?
|
YES! Demyelinate subcortical WM
|
|
|
PMH (JC virus): CSF findigns? defin dx?
|
CSF: normal
Defin: brain bx |
|
|
PML (2/2 JC): how tx?
|
SUPPORTIVE --> die 1yr
|
|
|
#1 pathogen fungal meningitis
|
Cryptococcus neoformans
(coccidio #2) |
|
|
What fungal pathogen:
Soil & pigeon poo |
Cryptococc
|
|
|
Cryptococcal meningitis: how affect CSF glucose?
|
DECREASED
|
|
|
What fungal pathogen:
Inhale; Southwest US & Mex |
Coccidio
|
|
|
Cryptococcal meningitis:
--how dx -tx |
dx: India Ink CSF; LATEX ANTIGEN
Tx: ampho B & flucytosine |
|
|
Coccidio meningitis: how tx?
|
IV & intrathecal ampho B
(same as cryptococcal) |
|
|
Toxo: intra or extracellular?
|
INTRACELL
|
|
|
#1 intracranial mass in AIDS pt
|
Toxo
|
|
|
Toxo: 2 most common locations of masses
|
Basal gang
WM-GM jxn |
|
|
Toxo: does pt develop Abs?
|
Yes
|
|
|
Toxo: how tx?
|
Pyrimethamine + sulfadiazine + folinic acid x 6w --> lifelong mainten
|
|
|
#1 CNS parasite
|
Cysticercosis
|
|
|
Cysticercosis:
What pathogen? what food product? |
Taenia solium
Pork |
|
|
Cysticercosis:
how tx? |
Albendazole
AEDs Shunt (NO SURG RESECT) |
|
|
What SC level:
-begin filum terminale -end conus medullaris |
Filum: T12
Conus: L1 |
|
|
SC: # of arts & supply what fraction of SC:
-ant spinal art(s) -post |
1 ant --> 2/3 SC
2 post --> 1/3 SC |
|
|
Dorsal or Ventral:
Sensory cell bodies |
Dorsal
|
|
|
Intermediolateral column: contains what neurons?
|
Pre-gang symps
|
|
|
Corticospinal tract: where decussate?
|
Medulla
|
|
|
Corticospinal tract: lateral = leg or arm?
|
Leg
(*same as spinothalamic) |
|
|
What SC tract: proprioR, touch
|
DCML
|
|
|
Spinothalamic tract: where decuss?
|
ANT COMMISURE (in SC, a few levels higher)
|
|
|
Spinothalamic tract: is lateral = leg or arm?
|
Leg
(same as corticospinal) |
|
|
DCML: lateral = leg or arms?
|
ARMS !!!
(unique) |
|
|
Where is 1st synapse?:
-spinothalamic -dc-ml |
Spinothalamic: Dorsal horn --> decuss in ant commissure
DC-ML: 1st synapse not until MEDULLA |
|
|
Complete SC transection: preserve arm motor if lesion below what level?
|
T1
|
|
|
Cervical spondylosis: weakenss in UMN or LMN pattern?
|
UMN
|
|
|
What SC synd:
Unilate hemisect SC |
Brown-Sequard
|
|
|
What SC synd:
Ipsi weakness; ipsi joint, touch; CONTRA pain & temp |
Brown-Sequard
|
|
|
Brown-seq: ipsi or contra:
-weak -joint & touch loss -pain & temp loss |
Weak: ipsi (decuss at medulla)
Joint: ipsi (decuss at medulla) Pain & temp: CONTRA (decuss at ant comissure of SC) |
|
|
#1 etio Brown-Sequard
|
Trauma
(mets are #2) |
|
|
Central cord synd: most common in C, T or L spine?
|
C
|
|
|
What SC synd:
Capelike loss of pain & temp both arms |
Central cord syndrome
(interrupts ant commissure of SC) |
|
|
What SC synd:
Lose ant horns & STT --> paraplegia, no pain/temp; intact joint position & touch |
Ant Spinal Artery Syndrome
(ant 2/3 SC) |
|
|
Anterior Spinal Artery Syndrome: lose what modalities
|
Lose ant horns (motor) & STT (pain & temp)
|
|
|
What dz:
Inherited anterior horn degen --> infant w/spinal muscular atrophy |
Werdnig-Hoffman dz
|
|
|
Werdnig-Hoffman dz: what structures degenerate? how acq
|
INHERITED degen of ant horns
|
|
|
Polio: affects what structures?
|
Ant horns
|
|
|
Subacute combined degeneration: what etio?
|
B12 def
|
|
|
What vitamin deficiency:
Spastic, ataxic gait |
Vitamin B12 --> subacute combined degen
|
|
|
#1 inherited periph neuropathy
|
CMT
|
|
|
CMT: demyelinating OR axonal?
|
DEMYELINATING
EXCEPT CMT-2 (axonal motor neuropathy) |
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What % AIDs pts have distal sensory polyneuro?
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30%
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HIV: multiple mononeuropathies appear early or late?
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LATE
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HIV: how tx:
Acute Inflamm Deymelinating Polyneuro |
Responds to IVIg, plasmaph
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HIV: lumbrosacral polyradiculopathy common or rare? assoc w/what virus?
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Rare
CMV superinfection |
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What dz:
HIV pt with decreased perineal sensation |
Lumbosacral polyradiculopathy
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Leprosy: which more affected:
-Sens or motor? -2 most common nerves |
SENS
Ulnar & peroneal |
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Leprosy: periph nerves hypertrophy or atrophy? see myelin changes?
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Hypertroph
Myeline changes |
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What entrapment syndrome:
2/2 flexor tenosynovitis |
Median n
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What entrapment syndrome:
2/2 HYPOTHYROID |
Median n
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CTS: assoc w/hypo or hyperthyroid?
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HYPO
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What entrapment syndrome:
Assoc w/acromegaly |
CTS
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What entrapment syndrome:
Assoc w/SLE |
Median nerve CTS
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What entrapment syndrome:
ELBOW INJURY |
Ulnar
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What entrapment syndrome:
Meidal 4th & 5th fingers |
Ulnar
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What entrapment syndrome:
Difficulty spreading fingers |
Ulnar
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What nerves innervates medial 4th & 5th fingers?
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Ulnar
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What entrapment syndrome:
CLAW HAND |
Ulnar
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What entrapment syndrome:
Decreased DORSAL hand sens |
Radial
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What entrapment syndrome:
Weak triceps, brachiorad, supinator |
Radial
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What entrapment syndrome:
WRIST DROP |
Radial
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What entrapment syndrome:
Crutches in axilla |
Radial
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What entrapment syndrome:
Saturday Night Palsy (spiral groove) |
Radial
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Meralgia paresthetica: what motor sxs?
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NONE
ONly burning, sens loss |
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What entrapment syndrome:
Lithotomy position |
Femoral neuropathy
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What entrapment syndrome:
Weak leg when stand/walk |
Femoral
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What entrapment syndrome:
Decreased patellar reflexes |
Femoral
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Femoral neuropathy: affect adductors?
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NO
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What entrapment syndrome:
Foot drop |
Peroneal
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What entrapment syndrome:
B/W fibula neck & peroneus longus |
Peroneal
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What muscle: everts foot
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Peroneals
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ALS: what % is INHERITED?
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5% (AD)
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ALS: see remissions?
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no
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Riluzole: what dz?
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ALS (prolongs life 3mos, no change QOL)
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What induces exocytosis of ACh vesicles?
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Na+ AP --> activate P/Q Ca+ channels --> Ca influx
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Anticholinesterase: present in synapse and/or neuron endplate?
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Synapse only
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#1 NMJ dz
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MG
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MG: ocular inv? bulbar?
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BOTH
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MG: suspect what etio if:
-young person -old |
Young: thymic HYPERPLASIA
Old: thymoma |
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MG: worse AM or PM?
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PM (fatigable)
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MG: inv pupils?
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Never
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MG: how affect DTRS?
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NO AFFECT
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Edrophonium (Tensilon): admin what route?
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IV
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MG: what % pts have Abs? does absence of Abs ==> r/o dz?
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80%
absence does not r/o |
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MG: most sensitive dx test
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Single fiber EMG
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MG: tx what drug?
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Pyridostigmine
(ST relief w/IVIg, plasmaph, steroids) |
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Lambert-Eaton:
Abs against what protein? |
P/Q CA2+ channel
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Lambert-Eaton:
What type fo cancer? |
Small cell (=oat)
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Lambert-Eaton:
See ocular, bulbar inv? |
NO (contrast MG)
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Lambert-Eaton or MG: ANS sxs (dry eyes, ED)
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LE
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Lambert-Eaton:
Affects DTRs? |
DECREASED (contrsat MG: no affect DTRs)
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What dz:
MUSCLE FACILITATION (rapid brief exercise --> ST increase strength |
Lambert-Eaton
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What gene mutated:
-Duchenes -Beckers |
DYSTROPHIN (same)
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Duchene's or Beckers;
More severe |
DMD
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Duchene's or Beckers;
Death 20yo |
Duch
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Duchene's or Beckers;
Higher CK |
DMD
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Musc dystrophy: if stain bx for dystrophin protein --> see increase or decrease?
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DECREASED
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Limb Girdle Musclular Dystrophies:
-M or F -How inherit? |
M=F
AD or AR |
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Limb Girdle Musclular Dystrophies:
What protein mutated? |
Sarcoglycans
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What dzs:
Mutated sarcoglycans |
Limb Girdle Musclular Dystrophies
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Limb Girdle Musclular Dystrophies:
What marker is elevated? |
CK
(same as musc dystrophies) |
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Name for:
Focal facial dystonia (blinking, tongue thrusting) |
Meig's syndrome
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Meig's syndrome: what is it? how tx?
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Focal FACIAL dystonia (e.g. lipsmacking)
Tx: Botox |
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Name for:
Focal facial dystonia (blinking, tongue thrusting) |
Meig's syndrome
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Meig's syndrome: what is it? how tx?
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Focal FACIAL dystonia (e.g. lipsmacking)
Tx: Botox |
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What dz:
Caudate atrophy --> RHOMBOID lateral vents |
Huntington's
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MPTP: damages what structure?
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Caudate --> PD
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Lewy bodies: intra cyto or intranuclear?
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CYTO
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How tx (med):
PD 2/2 neuroleptics |
Trihexyphenidyl
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How tx: (med)
Tourettes |
Haldol
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MS: epidemio?
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1 in 1,000
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If give IV steroids --> give what ppx med?
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Ranitidine (prevent GI S/E)
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Canavan's dz:
-how inh? -regress at what age? |
AR
6mo --> rigid, szs, SPONGIFORM, MACROCEPH |
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Canavan's dz:
Macro or microceph? |
Macro
also see spongiform brain |
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What dz:
6mo regresses -> szs, rigid, macroceph, spongiform brain |
Canavan's dz
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What dz:
20yo M with progressive centroceccal scotoma |
Leber's Optic Atrophy
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Leber's Optic atrophy:
-how inh? |
Mitochonridal
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What dz:
Degenerating WM & low cortisol |
Adrenoleukodystrophy
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Adrenoleukodystrophy: survive how long?
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3yrs
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What dz:
Sudanophilic leukodystrophy --> 3mo male with optic atrophy, choreo, szs |
Pelizaeus-Merzbacher dz
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Spina bifida oculta: what meningeal defects? SC defects?
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None
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What dz:
Dimple & hair tuft at spine base |
Spina bifida oculta
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