Neuro Tricks

Front 1

Atypical Parkinsonism
The most important Clinical evidence?

Back 1

Poor Response to L Dopa

Hint 1

Absent Tremor only in 30%

Front 2

Anticoagulation in Pt with Stoke?
a Cryptogenic or Small Vessel

b -AF

c +Recurrence, MI, Vascular (+PAD)

d Vascular stent or Prev. MI

e +AF

Back 2

a Aspirin or Warfarin

b Aspirin 81mg
C Clopidorgrel or Aspirin+Dipyridamole
d Combination
e
warfarin

Front 3

Progressive Gait impairment (Lower Body Parkinsonism)+ Urinary incontinence :
NI??

Back 3

MRI Brain: Expanded Lat & 3rd Ventricle

Hint 3

Normal Pressure Hydrocephalus
+ Dec. Cognitive function → Dementia
Mx by serial LP

Front 4

Mirgraine Rx and Pregnancy ?

Back 4

Paracetol , Ondansteron & Placil are Safe

Hint 4

Triptans class C
Dont Use until all B used , Naproxen B but C in 3rd Trimester

Front 5

Post Concussion & Post Traumatic Stress disorders?
How to differntiate?

Back 5

PTSD : Anxiety disorder

Persistent memory about the event Cognitive, Emotional and memory defects + Headaches, Sleep distrub or which occur in Nightmaires, and Accident Remembering

Hint 5

PCS Symptom Resemble CFS:
Headache Dizziness Fatigue Irritability Sleep problems Concentrationproblems-Memoryproblems

stress/emotion/alcohol-,anxiety, or depression-

Changes in personality-

Apathy

Front 6

Stenting indication of ICA stenosis?

Back 6

Recurrent Symptoms

Evidence of Continuing Ischemia

Front 7

Post Stroke mx? whats most important?

Back 7

Early rehabilitation
+ Manage complications

Front 8

How to Differntiate btw Malignant Hypert & NMS ?
Remember the TRIAD

Back 8

NMS a/w ( Haloperidol) or any antipsychotic medication
+ TRIAD of
(Hyperthermia &Automomic Dysf.)+ (Extrapyramidal signs: Rigidity or Dystonia(Parkinsonsim+
Elevated Muscle enz.) and Delirium
MH: Inherited Anasthetics more+ Acute Kidney injury (RMLysis)

Hint 8

NMS:
Mx: Stop Medication + Supportive (Fluids) / Bromocriptine & Dantrolene play the Rule
DDX: Serotonin Syndrome
( Confusion, Myoclonus , Diaphoresis) triggered by Overdose due to SSRI or MAOI

Front 9

if pt indicated for rtPA be you search for?

Back 9

Contraindicatiions

Front 10

Natalizumab JC SE?

Back 10

Increased Risk of JC virus inf.:
PML

Hint 10

نتالي زبة تكول jc مو ماب

Front 11

Dopamin Agonist (Ropinirole) Side Effects ?

Back 11

Punding

Hint 11

Compulsive disorder , doing complex repetitive activities whitout Purposes , Rx by Dec. the dose. ( other behavioral : Internet use , Shopping , Gambling )

Front 12

Arnold Chiari malformation , which type of Nystagmus?

Back 12

Down beat nystagmus +- Syrinx

4 types

Headaches aggravated by Valsalva maneuvers, such as yawning, laughing, crying, coughing, sneezing or straining, bending over, or getting up suddenly[26]

Tinnitus (ringing in the ears)

Lhermitte's sign

Vertigo (dizziness)

Nausea

Nystagmus (irregular eye movements; typically, so-called "downbeat nystagmus")

Facial pain

Muscle weakness

Impaired gag reflex

Difficulty swallowing

Restless leg syndrome

Sleep apnea

Sleep disorders[27]

Dysphagia (difficulty swallowing)[28]

Impaired coordination

Severe cases may develop all the symptoms and signs of a bulbar palsy

Paralysis due to pressure at the cervico-medullary junction may progress in a so-called "clockwise" fashion, affecting the right arm, then the right leg, then the left leg, and finally the left arm; or the opposite way around.

Increased intracranial pressure

Pupillary dilation

Dysautonomia: tachycardia (rapid heart), syncope (fainting), polydipsia (extreme thirst), chronic fatigue [29]

The blockage of cerebrospinal fluid (CSF) flow may also cause a syrinx to form, eventually leading to syringomyelia. Central cord symptoms such as hand weakness, dissociated sensory loss, and, in severe cases, paralysis may occur.[30]

Hint 12

+- hydrocephalus can occur due to the narrowing at the foramen magnum

Front 13

A 72 year old man presents to A and E with a funny turn. he has a history of hypertension. On examination he is found to have grade 3/5 and reduced sensation in his right arm and leg. He is also found to have reduced sensation on the left side of his face and there is evidence of a Horners Syndrome. He is ataxic. Where is the lesion likely to be?

Back 13

Lateral Medullary Syndrome

Hint 13

Brain stem affected

Front 14

Give Example of MAOI?
and other or COMPT?

Back 14

Seligiline
Entecapone

Hint 14

Entecapone : Adjunct

Front 15

Tricks in Parkinson Mx?
A Main Drug
B Drug induced P
C Adjunct to Levo Dopa
D Elderly
E

Back 15

A Ropinirol
B Antimuscarnic: Procyclidine
C COMT I : Entecapone
D Levodopa
E

Hint 15

Levodopa SE:
dyskinesia(involuntary writhing movements), 'on-off' effect, dry mouth, anorexia,palpitations, postural hypotension,psychosis

Front 16

Medical Mx of Restless leg syndorme?

Back 16

Ropinirole

Hint 16

رجل مشدودة بحبل

Front 17

spontaneous, continuous lower limb movements that may beassociated with paraesthesia

or

uncontrollable urge to move legs

or Symptoms are worse at rest· paraesthesias e.g. 'crawling' or 'throbbing' sensations ?

Back 17

Restless leg syndrome

Hint 17

Rx with Ropinirole

Front 18

with Axillary and groin freckles
DX?

Back 18

NF1: Ch 17 ,1 in 4000 mild >>

which may be evident at birth and nearly always by the time the child is 10 years old, may include light brown spots on the skin ("cafe-au-lait" spots), two or more growths on the iris of the eye, a tumor on the optic nerve, a larger than normal head circumference, and abnormal development of the spine, a skull bone, or the tibia.

Hint 18

Lisch Nodule

Front 19

Ramsay Hunt Syndrome?

Back 19

Vesicular rash of the ear or mouth (as many as 80% of cases)

The rash might precede the onset of facial paresis/palsy (involvement of the seventh cranial nerve [CN VII])

Ipsilateral lower motor neuron facial paresis/palsy (CN VII)

Vertigo and ipsilateral hearing loss (CN VII)

Tinnitus

Otalgia

Headaches

Dysarthria

Gait ataxia

Fever

Cervical adenopathy

Hint 19

Facial weakness usually reaches maximum severity by 1 week after the onset of symptoms.

Front 20

Forgotten Feature in LEMS?

Back 20

Front 21

3 Forgotten causes of of Facial Pulsy?

Back 21

Front 22

How to dif bw Hunting and AD?

Back 22

Front 23

Css of Resless leg syndrome?

Back 23

Front 24

Tips of Fredritchs ataxia?

Back 24

Front 25

Myotonic Dystrophy Tips?

Back 25

Front 26

???

Back 26

Front 27

PML? CAUSE And Patho?

Back 27

Hint 27

Natalizumab play a cause to jc

Front 28

Shy Drager R5?

Back 28

Front 29

????

Back 29

Front 30

TRIAD of IIH?

Back 30

Hint 30

اتذكر ال ايييجة الي حاطة ايدهة علة راسهة

Front 31

Causes of Dactylitis?

Back 31

Front 32

Presentation of Acoustic Neuroma?

Back 32

Front 33

HSV Encephalitis? R5

Not Meningitis

Back 33

Front 34

Visual opacities? 6 types

Back 34

Front 35

Optic Defect localizing signs?

Back 35

Front 36

R5 MERRF?

Back 36

Front 37

Site of Huntington Defect?

Back 37

Front 38

Paraneoplastics Neuro Manifest?

Back 38

Front 39

Copper def 3 F and likely cause?

Back 39

Front 40

S2 splitting Conditions

Back 40

Hint 40

Where memory sight in Brain?

Front 41

Allodynia a/w?

Back 41

Front 42

Brands of Antidepressants?

Back 42

Front 43

Chondrocalcinosis X Ray ¿

Back 43

Hint 43

R5 of Tardive dyskinesia?

Front 44

5 As of Alzehiemer D?

Back 44

Front 45

>> of Dementias?

Back 45

Front 46

How to diff CDH?

Back 46

Hint 46

<> 4h

Front 47

Cogn. Imp Drugs?

Back 47

Front 48

BISAP?

Back 48

Be sure from net

Front 49

Css of Cerebral Hemorrhage?

Back 49

Front 50

Rule of Dexamerhazone in Meningitis?

Back 50

Just pneumococcal one

1 dose before ABs

And Continue *4 for 4 days

Front 51

Primipixole SE?

Back 51

→ Sudden Sleep, Hallucination

Front 52

When u say this Imfarct is lacunar?

Back 52

Small Vessel: < 0.5 mm are the lenticulostriates, the brainstem penetrating and the thalamogeniculate.

Front 53

Common Css, of ICH acc to Age?

Back 53

< 45 y: Drug Abuse ( Cocaine and amphetamin) and AV Malformation

>55 y HT and amyloid Angiopathy

Hint 53

Excessive Alcohol Also

Front 54

2 presentation of Berry Aneurysm?

Back 54

1 Sever Headache

2 CN 3 Pulsy with ipsilateral Pupillary dilatation and ?

Hint 54

Xanthocromia: conversion of Hemoglobin to Billirubin

Front 55

Notes on Drugs

Back 55

Drugs Cause Perph. Neurop: NM VIA TCA

Amiodarone→للدوة الوحيد الي يسوي → Demylination

Triptans→ لاتنطي حتة لو rf لل ischemia وينطه at onset of Headache مو Aura

Amytriptyline: امي تبتليني البولة محصورة مالتهة

Citalopram يطير الشهوة عليك بس ما يخصيك عكس ال opiates

بالبال بالخاطر ال buscopan كونترا انديكيتد بال MS؟؟؟

Front 56

4 components of Stroke?

Back 56

Aphasia (Language not muscle)

Weakness

Numbness

Ophthalmic

Front 57

You cant say Apraxia in?

You cant say snsory or cerebellar in?

Back 57

Motor abn

Unconsiousness (Motor may be preserved : respond to pain)

Front 58

>> pres in Conversion disorder?

Back 58

Blindness

Front 59

Old age + dysphagia 1st slowly to solids then rapid liquids

with Depression or Postural Inst?

Back 59

Parkinson

Front 60

Mycosis Fungoides?

Back 60

Hint 60

Albert Bazin $

Front 61

Contents of Language?

Back 61

Front 62

Forgotten C? Cluster of Horns

2 TT?

Back 62

Front 63

Pentad of Wernick's En. ? 2 of 4

Causes?

Back 63

Front 64

Neuro Paraneoplastic Abs?

Back 64

Front 65

3 Drugs © Parkinson?

Back 65

Front 66

EMG changes in MND?

يعني هي العضلة مابيهة شي بس صوجة هو ماعندة طاقة

Back 66

↓AP ↑Amplitude

Front 67

What diff Apoplexy from SAH?

3

Back 67

Hypotention

Hypothyroid

Extraocular Pulsy

Front 68

Myo Dystrophy Classification?

Cardiac involvement ?

Back 68

Front 69

Amaurosis Fugax? ©

Back 69

Front 70

NPH 2° to ?

Back 70

Head Injury

SAH

Meningitis

Hint 70

Reversible

Rx by Shunt

Front 71

Exam of Encephalopathy?

Back 71

Front 72

Neurological Complication inRenal disease?

Back 72

Front 73

Trouble With:Speech control—volume, pitch, articulationWriting and typingOver- or under- sensitivity to light, touch, space, taste, or smells

Back 73

Dyspraxia Seen in Stage 2 HE

Hint 73

Personal grooming and other self-help activitiesCooking or other household choresDrivingClumsiness

Front 74

>> inherited Neurological Disorder?

Back 74

CMT

the initial symptom is foot drop

the it may go to Hands, eye SC and others

Motor and Sensory (Pain Preserved) with Hammer Toe

No Available Rx

Hint 74

Front 75

Charcot Joint? or

Neuropathic Athropathy

Back 75

1. Complication of neuropathy and repeated joint trauma
2. Progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity
3. History / PE: Decreased pain, proprioception, and temperature perception
4. Treatment:
   Treat underlying disease
   Mechanical devices (eg. special shoes)
   Decrease further trauma
5. Associated With:
   
   Diabetes mellitus
   Perpheral nerve damage
   Syringomyelia
   Spinal cord injury
   Vitamin B12 deficiency
   Tabes dorsalis
   

Hint 75

Front 76

Tabes dorsalis?

Back 76

syphilitic myelopathy (Dorsal Colomn)

Front 77

Todd Paralysis

Back 77

Weakness in Upper limb contra lateral to the Side of Seizure

Front 78

>> cause of temporal lobe epilepsy?

Back 78

Mesial Temporal Seclerosis

(Hippocambus)

Front 79

Pelvic Thrusting >> seen in ?

Back 79

Frontal Lobe Epilepsy

also:

<30s

absent Post Ictal

Sexual Automatism

Eye Deviation CL to the Seizure site

Vocalization (very common)

Contiousness more Preserved

HemiClonic (CL Face arm and leg seizures)

Jacksonian F

Fencing Posture(Flexing the ipsi and relaxing the CL with DEviation of face and Eye to CL)

Front 80

Pain located on the front of the thigh and shin, further radiates towards the inner ankle, sometimes the medial toe

Back 80

L4 radiculopathy

Hint 80

Occasionally, failure of the quadriceps muscle and reflex weakness

Front 81

Sensory loss posterolateral aspect of leg and lateral aspect of foot Weakness in plantar flexion of foot Reduced ankle reflex -n-->"}

Back 81

L5 radiculopathy

Pain radiates to the side of the thigh and lower leg towards the back of the foot and toes 1-3

All reflexes are preserved

Front 82

S1 radiculopathy?

Back 82

Pain radiates to the posterior side of the thigh and lower leg to the ankle side, sometimes on up to the fourth toeGluteal muscles are weakenedDifficulty standing on toes

Front 83

Causes of 3rd CNP?

Back 83

Causes

• diabetes mellitus

• vasculitis e.g. temporal arteritis, SLE

• false localizing sign* due to uncal herniation through tentorium if raised ICP

• posterior communicating artery aneurysm (pupil dilated+Sever Headache)

• cavernous sinus thrombosis

• Weber's syndrome: ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes

• Berry Aneurysms

• other possible causes: amyloid, multiple sclerosis

Front 84

DDX of Peripheral or Ring Enhaced lesion?

MAGIC DR

Back 84

1. cerebral abscess
2. tuberculoma
3. neurocysticercosis
4. metastasis
5. glioblastoma multiforme
6. subacute infarct / haemorrhage / contusion
7. demyelination (incomplete ring)tumef
8. active demyelinating lesion (incomplete ring)
9. radiation
10. necrosis
11. postoperative change
12. lymphoma - in immunocompromised patient

Hint 84

MAGIC DR:

M: metastasis

A: abscess

G: glioblastoma multiforme

I: infarct (subacute phase)

C: contusion

D: demyelinating disease

R: radiation necrosis or resolving haematoma

Front 85

C5 radiculopathy?

Back 85

Pain is found along the lateral brachium of the affected side of the arm.

C5 innervated muscle weakness may be found i.e rhomboids, deltoid etc.

Front 86

C6 radiculopathy?

Back 86

Pain is found along the lateral antebrachium of the affected arm

C6 innervated muscles are weak i.e forearm pronator and supinators, wrist extensors etc.

Front 87

C7 radiculopathy?

Back 87

Pain is found along the middle finger of the affected armC7 innervated muscle weakness is found i.e wrist flexors, finger extensors etc.

Front 88

contralateralhemiparesis and sensory loss,

lower extremity > upper

· disconnection syndrome (Conducting Aphasia)

Back 88

Anterior cerebral artery ·

Front 89

· contralateral hemiparesis and sensory loss, upper extremity > lower

· contralateral hemianopia

· aphasia (Wernicke's)

· gaze abnormalities

Back 89

Middle cerebral artery

Front 90

· contralateral hemianopia with macular sparing

· disconnection syndrome

Back 90

Posterior cerebral artery

Front 91

· present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Back 91

Lacunar

Front 92

· ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy

· contralateral: limb sensory loss

Back 92

Lateral medulla (posterior inferior cerebellar artery)

Front 93

· VI nerve: horizontal gaze palsy

· VII nerve

· contralateral hemiparesis

Back 93

Pontine

Front 94

· sensory inattention

· apraxias

· astereognosis(tactile agnosia)

· inferior homonymous quadrantanopia

· alexia, acalculia, finger agnosia and right-left disorientation

Back 94

Parietal lobe lesions

Hint 94

Gerstmann's syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

Front 95

· homonymous hemianopia (with macula sparing)

· cortical blindness

· visual agnosia

Back 95

Occipital lobe lesions

Front 96

· Wernicke's aphasia

· superior homonymous quadrantanopia

· auditory agnosia

· prosop-agnosia (difficulty recognising faces)

Back 96

Temporal lobe lesion

Front 97

· expressive (Broca's) aphasia

· disinhibition (perceptual(hypersexuality, hyperphagia), Motor, and Cognitive) also in TBI

· perseveration ( Difficulty in Switching between ideas or Orders) most Commonly in TBI

· anosmia

· inability to generate a list

Back 97

Frontal lobes lesions

Hint 97

(Broca's) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus

Front 98

· midline lesions: gait and truncal ataxia

· hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus

Back 98

Cerebellum lesions

Front 99

· lefthomonymous hemianopia means?

Back 99

visual field defect to the left

Lesion of right optic tract

Front 100

· incongruous defects;

Back 100

= optic tract lesion

Front 101

congruous defects =

Back 101

optic radiation lesion or occipital cortex

Front 102

what means congrous and in congrous?

Back 102

A congruous defect simply means complete or symmetrical visual field loss and conversely an incongruous defect is incomplete or asymmetric.

Front 103

Homonymous hemianopia Presentations? 3

Back 103

· incongruous defects: lesion of optic tract

· congruous defects: lesion of optic radiation or occipital cortex

· macula sparing: lesion of occipital cortex

Front 104

macula sparing?

Back 104

: lesion of occipital cortex

Front 105

Bitemporal hemianopia

Back 105

· lesion of optic chiasm

· upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

· lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma