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97 Cards in this Set
- Front
- Back
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How does Vertebral artery dissection typically present?
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- neck or head pain
Horner's syndrome (ptosis & miosis) - dysarthria - dysphagia - decreased pain and temperature sensation, - dysmetria - ataxia - vertigo. |
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What is the difference between simple and complex seizures?
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with simple, consciousness is not impaired
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How does juvenile myoclonic epilepsy manifest?
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myoclonic jerks followed by a generalized tonic–clonic seizure
(it is idiopathic and remission is rare) |
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What is Guillain–Barré syndrome?
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mmune-mediated demyelinating polyneuropathy characterized by proximal and distal weakness, distal sensory loss, autonomic symptoms, cranial nerve involvement, and respiratory failure in 25% of patients
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How is Guillan-Barre syndrome treated?
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Plasma exchange or IVIG
- avoid plasma exhange in patients with labile BP - Avoid IVIG in pts with renal insufficiency, CHF or IgA deficiency |
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How should small, asymptomatic meningiomas be managed?
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monitor eith neuroimaging every 4 months x 1 yr, then yearly x 5 yrs
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How are larger, symptomatic meningiomas treated?
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surgically
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How can small (< 3 cm), symptomatic meningiomas be treated?
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sterotactic radiation
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What findings suggest frontotemporal dementia?
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- Personality change
- lost initiative, - slowing of thought (score < 12 on verbal fluency test) - relative preservation of recent memory, |
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How is frontotemporal dementia diagnosed?
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MRI shows atrophy of the anterior frontal and temporal lobes
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What do you typically see on MRI in patients with multiple sclerosis?
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ausative white-matter lesion in the midbrain, as well as multiple hyperintense lesions adjacent to the lateral ventricle
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In MS, what does treatment with interferon-beta do?
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decreases the incidence of additional attacks in patients with monosymptomatic demyelination (including optic neuritis and myelopathy)
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What are first line agents for treating essential tremor (postural and action tremor)?
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Propranolol and primidone
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How long to cluster headaches usually last?
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less than 180 minutes
(patients usually like to be mobile because rest worsens pain) |
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What is the initial treatment for transverse myelitis?
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high-dose intravenous corticosteroids
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What is an autosomal dominant disorder that usually presents with clumsiness or difficulty running in the first decade of life?
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hereditary sensorimotor neuropathy (Charcot–Marie–Tooth disease),
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What are the classic clinical features of a hereditary sensorimotor neuropathy (Charcot–Marie–Tooth disease)?
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- distal muscle atrophy, weakness
- sensory loss associated with pes cavus deformities (high arches) and hammertoes |
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What is the median survival of Grade 4 astrocytoma (glioblastoma multiforme)?
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9-12 months
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What are the most important determinants of survival in glioma?
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cell type (astrocytomas worse than oligodendroglial tumors) and grade (higher the grade, the worse the prognosis)
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How is Alzheimer's disease characterized?
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primary dementia with prominent amnesia
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How is dementia with Lewy bodies characterized?
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- fluctuating cognition,
- parkinsonism - and/or visual hallucinations |
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Patients with relapsing multiple sclerosis should be considered for which therapies?
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immunomodulatory therapy with either a form of interferon-beta or glatiramer acetate
(decrease frequency of relapse and rate of accumultion of new lesions on MRI) |
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What is standard treatment for a significant acute exacerbation of multiple sclerosis?
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High-dose intravenous methylprednisolone (typically 1000 mg daily for 3 to 5 days)
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What can be used to treat cervical dystonia?
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Botulinum toxin injections
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What is Lhermitte's sign?
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“electric shock”–like sensation down the neck, back, or extremities occurring with neck flexion
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What is Lhermitte's sign an important clue for?
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cervical spinal cord disorder
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What does cervical spondylosis refer to?
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chronic degenerative and hypertrophic changes of the vertebrae, ligaments, and disks that can narrow the spinal canal.
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Which antiepileptics can interfere with warfarin and lower its levels?
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phenytoin and carbamazepine
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How does peripheral nervous system vasculitis usually present?
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asymmetric weakness and sensory loss in specific nerve distributions
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What are the three specific criteria for dementia with Lewy bodies?
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- fluctuating encephalopathy -
- parkinsonism - visual hallucinations |
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What type of deficiency do patients with demetia with Lewy bodies have? How do you treat them?
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- central cholinergic deficiency, so
- treat with centrally acting anticholinesterase agents (onepezil, galantamine, or rivastigmine) |
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What are different causes of Chorea?
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- hereditary and degenerative disease (Huntington's or Wilson's disease) or
- secondary to drugs (neuroleptic agents, levodopa, dopamine agonists, anticholinergic agents) - metabolic disorders (hypothyroid) - infections - immune-mediated diseases, (SLE with antiphospholipid antibodies) - vascular lesions |
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What is paroxysmal hemicrania?
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unilateral headache of seconds to minutes in duration that despite its brevity can be disabling
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What neurologic symptoms can Vitamin B12 deficiency cause?
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- paresthesias
- loss of vibration and position sense - sensory ataxia - weakness - upper motor neuron signs (symptoms of spinal cord dysfunction with prominent posterior column dysfunction) |
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How does Cytomegalovirus polyradiculopathy in end-stage AIDS present?
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- symptoms of leg weakness
- "saddle" anesthesia - urinary retention |
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How should a young patient with totally resected low-grade glioma be managed?
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observation with serial neuroimaging with MRI at 3-4 month intervals for the first yr, then Q6 months in the 2nd yr and yearly after that
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What suggests a history of vascular dementia?
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- history of vascular risk factors
- abrupt onset with subsequent improvement - periventricular white matter ischemia on imaging, - focal neurologic findings. |
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What should be checked before starting therapy for restless leg syndrome?
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serum iron levels (iron is recommended if ferritin is less than 45-50 ng/ml)
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How is restless leg treated?
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dopamine agonist
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How is pseudotumor cerebri characterized?
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- papilledema
- postural change with headache - visual changes - recent report of rapid weight gain, - or introduction of oral contraceptives or tetracycline. |
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What neurologic changes are seen with anterior spinal artery infarction?
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weakness and pinprick loss of sensation with sparing of vibration and position sense.
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What will you see on LP with subarachnoid hemorrhage?
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xanthochromic staining of CSF ( can be detected up to 14 days after hemorrhage)
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What can cause focal neurologic symptoms 3 to 7 days after a subarachnoid hemorrhage?
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vasospasm with cerebral ischemia
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Which patients with epilepsy are likely to remain seizure free after withdrawal of medication?
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- no structural brain lesion
- no epileptiform or focal abnormalities on electroencephalogram, - a sustained seizure-free period - no abnormalities on neurologic examination |
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How long should patients with epilepsy stop driving after discontinuation of medication or after starting a taper?
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should stop driving for at least 3 months and preferably 6 months from the start of the taper.
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What should patients with with primary central nervous system lymphoma be evaluated for?
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vitreal or uveal involvement
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what is the primary therapy for central nervous system lymphoma?
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high-dose methotrexate
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What class of medication is donepezil?
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an acetylcholinesterase inhibitor
(may cause mild peripheral cholinergic side effects, including increased vagal tone, with bradycardia, and occasionally atrioventricular block) |
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Describe Primary progressive multiple sclerosis.
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an insidious spinal cord dysfunction or as ataxia, progressing without distinct acute exacerbations; it tends to have fewer cerebral lesions on MRI compared with other forms of multiple sclerosis
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How does metoclopramide cause parkinsonism?
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blocks dopamine receptors both in the periphery and inside the central nervous system, can induce parkinsonism.
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What is the most appropriate treatment for episodic cluster headache?
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prednisone
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What are the classic symptoms of cerebellar stroke?
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- vertigo
- headache - ataxia |
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Which patients are unlikely to ever become seizure free with drug therapy?
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Those who fail to respond to three trials of antiepileptic drugs
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How is Myasthenia gravis characterized?
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by fatigable weakness with a predilection for ocular, bulbar, proximal-extremity, neck, and respiratory muscles.
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How is Amyotrophic lateral sclerosis characterized?
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hyperreflexia and distal, asymmetric muscle weakness; ocular muscles not affected
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What can help differentiate myasthenia gravis from Guillain barre?
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- if fatiguable or intermittent, then more likely myasthenia gravis
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What suggests Creutzfeldt–Jakob disease?
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subacute progression of dementia with myoclonus and other motor signs and a normal brain MRI.
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What EEG findings suggest Creutzfeldt-Jakob disease?
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periodic sharp waves
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What medication has a modest benefit in slowing progression of secondary progressive or severe relapsing–remitting multiple sclerosis?
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Mitoxantrone (risk of cardiotoxicity)
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How is Normal pressure hydrocephalus characterized?
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- gait impairment
- cognitive decline - urinary incontinence |
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How is progressive supranuclear palsy characterized?
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parkinsonism with early gait and balance involvement, vertical gaze palsy, severe dysarthria, and dysphagia
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What medication can be used to decreae CSF production in patients with pseudotumor cerebri?
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acetozolamide
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What would classify as a persistent vegetative state?
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if present 3 months after nontraumatic brain injury and 12 months after traumatic brain injury
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What is the preferred initial therapy for a patient in status epilepticus?
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Lorazepam
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What medication can be used for status epilepticus in patients who fail to respond to lorazepam and phenytoin?
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Phenobarbital
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How is Myasthenia gravis crisis treated?
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plasmapheresis or intravenous immunoglobulin
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How is Myasthenia gravis crisis characterized?
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requiring nasogastric feeding and/or severe respiratory muscle weakness necessitating ventilation
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What is a treatment for amyotrophic lateral sclerosis?
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Riluzole
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How is Radiation-induced leukoencephalopathy characterized?
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- gait apraxia
- dementia - urinary incontinence (affects cortical white matter and occurs months to years after radiation) |
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What is the first-line pharmacologic agent for treatment of multiple sclerosis-related fatigue?
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Amantadine
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Why is Pemoline used less frequently for MS fatigue?
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hepatotoxicity
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What is a stimulant used extensively in narcolepsy?
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Modafinil (nonamphetamine stimulant)
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What is Shy-Drager syndrome (multuple system atrophy)?
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dysautonomia (orthostatic hypotension, neurogenic bladder, constipation, and impotence), gait-predominant parkinsonism, and corticospinal tract signs.
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What is the appropriate treatment for trigeminal neuralgia?
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carbamazepine
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What causes the locked-in state? What is seen clinically?
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- basilar artery occlusion
- quadriplegia, paralysis of horizontal eye movements and bulbar muscles, and can communicate only by moving their eyes vertically or blinking |
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In patients on combination therapy with aspirin and dipyridamole, what is a potential side effect?
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headache from vasodilatory effect of dipyridamole
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How is Amyotrophic lateral sclerosis characterized?
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- pathologic hyperreflexia, spasticity
- extensor plantar responses, along with atrophy - fasciculations - weakness. |
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What medications have modest efficacy on cognitive and global function in mild to moderate Alzheimer's disease?
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cholinesterase inhibitors (including galantamine, donepezil, and rivastigmine)
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What medication as been shown to be efficacious for relief of cognitive symptoms in moderate to severe, but not mild, Alzheimer's disease?
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memantine
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What is the first-line treatment for patients older than 70 years with new-onset Parkinson's disease?
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carbidopa-levodopa
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What can be used in younger patients with Parkinson's disease?
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Pramipexole (dopamine agonist)
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What is effective monotherapy for partial onset seizures?
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Oxcarbazepine
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For what disorder is ethosuximide used?
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partial seizures
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When should noninvasive positive-pressure ventilation be started in patients with amyotrophic lateral sclerosis?
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When forced vital capacity is <50% or when they have symptoms of nocturnal hypoventilation
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What can be measured if suspecting Paraneoplastic cerebellar degeneration?
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anti-Yo antibody in CSF (in patients with gynecologic tumors)
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Why is haloperidol contraindicated in Parkinson's disease?
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because it blocks D2 dopamine receptors and worsens parkinsonism
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Which neuroleptic agents can be used to treat hallucinations in patients with Parkinson's disease?
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quetiapine and clozapine
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What can infection and fever to do chronic neurologic deficit?
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Infection with fever can temporarily exacerbate a chronic neurologic defect in a patient with a previous stroke
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What disorder presents with distal weakness and muscle stiffness and is characterized by cataracts, frontal balding, temporal muscle atrophy, and cognitive dysfunction?
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myotonic dystrophy
(Cardiac disease resulting in arrhythmias and respiratory failure due to diaphragmatic weakness are common features of myotonic dystrophy) |
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How is myotonic dystrophy inherited?
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autosomal dominant
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What autosomal dominant disorder presents with distal muscle weakness, atrophy and sensory abnormalities?
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Charcot-Marie-Tooth disease
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How is Lambert-Eaton myasthenic syndrome characterized? How is it diagnosed?
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- symmetrical proximal muscle weakness and autonomic dysfunction
- motor nerve conduction studies with repetitive stimulation |
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How can acute dystonic reactions be treated?
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- benztropine 1-2 mg IV followed by a few days of oral diphenhydramine
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What is characterized by rapidly progressive decline in short-term memory and seizures?
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paraneoplastic limbic encephalitis
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What malignancy is associated with Paraneoplastic limbic encephalitis? What antibosy would be detected?
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- small cell lung cancer
- anti-Hu antibody |
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What is characterized by ventilator dependence, generalized or proximal flaccid paralysis, muscle atrophy, and high creatine kinase levels?
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critical illness myopathy
(generally patients treated with high-dose corticosteroids and neuromuscular blocking agents) |
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What is seen with needle electromyography in patients with polymyositis?
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diffuse fibrillations and myopathic motor unit potentials
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