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263 Cards in this Set
- Front
- Back
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What are the causes of unilateral anosmia
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Trauma
Tumor |
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What are the causes of bilateral anosmia
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Virus
Allergy Smoking Trauma |
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You see Argyll Robertson pupil in which disease
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Tabes Dorsalis - NEUROSYPHILLIS
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Lesion causing Argyll Robertson pupil involves _
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Descending pupilloconstrictor fibers
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Argyll Robertson pupils present as _
How do pupils react to light? |
Small irregular pupils
Pupils constrict to accomodation but DO NOT react to light |
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Adie pupil is caused by a lesion in _
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Ciliary ganglion
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How does Adie pupil presents
How do pupils react to light |
Unilateral or bilateral dilated pupils
Constricts poorly to light but better to accomodation, pupil redilates slowly, light-near dissociation |
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Afferent pupillary defect is also called _
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Marcus Gunn Pupil
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In Marcus Gunn pupil there is lesion in _
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Optic pathway anterior to optic chiasm
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Which disease would you see Marcus Gunn pupil with
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Optic neuritis
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Perception of relative dimming of the light stimulus compared to "good" eye resulting in bilateral enlargement of pupils - this is called _
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Marcus Gunn pupil
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Unequal pupils is called _
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ANISOCORIA
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Facial nerve supplies _
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Muscles of facial expression
Taste to anterior 2/3 of the tongue Stapedius muscle |
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If patient has weakness or paralysis of 1/2 of the face and you know facial nerve is involved - is it lower motor neuron or upper motor neuron damage? - what is the location of injury?
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Lower motor neuron - peripheral nerve or brainstem (pons)
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Patient has weakness of the lower quarter of the face, you know facial nerve is involved - what is the location of injury and is it upper or lower motor neuron damage
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Upper motor neuron- lesion is above the pons - innervation of upper face is bihemispheric
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When you inject cold water in patients ear, eyes deviate _ and nystagmus is _
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Eyes deviate toward the injection and nystagmus is to OPPOSITE SIDE (COWS)
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When you inject warm water in patients ear, eyes deviate _ and nystagmus is _
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Eyes deviate away from the injection and nystagmus is to SAME SIDE (COWS)
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If patient presents with hoarseness, swallowing dysfunction and deviation of uvula -which CN's involved?
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IX and X
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Which way is uvula deviated when there is damage to CN IX and X
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Uvula deviates AWAY from side of weakness
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In damage to CN XII where does tongue point
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Tongue points to SIDE OF WEAKNESS
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If there is symmetric change to reflexes - what are the possible diagnoses
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Polyradiculopathy
Peripheral neuropathy Myelopathy |
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If there is asymmetric change to reflexes what are the possible diagnoses
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Radiculopathy
CNS pathology |
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What is the level of reflex for biceps and brachioradialis
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C6
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What is the level of reflex of triceps reflex
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C7
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What is the level of reflex of patellar reflex
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L4
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What is the level of the reflex of Achilles reflex
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S1
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Signs of cerebellar damage
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Ataxia
Dysdiadochinesia Nystagmus |
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Patient cannot heel walk - which muscle is weak? which nerve?
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Anterior tibialis
L5 |
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Patient cannot toe walk - which muscle is weak ? which nerve?
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Gastrocnemius/Soleus
S1 |
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Patient cannot tandem walk - which condition does he have?
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Ataxia - could be damage to cerebrum, brainstem, cerebellum or spinal cord
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RHOMBERG TEST - this test relies on 3 major systems interacting together. You need 2 of them to maintain your balance - name 3 systems
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Vision
Posterior columns/position sense Vestibular |
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If patient has positive RHOMBERG TEST - which diseases are possible
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Peripheral neuropathy
Spinal cord disease Vestibular dysfunction |
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Are paresthesias normal in elderly
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NO
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What type of hypotension occurs in elderly
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Orthostatic hypotension
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In hyperthermia there is _ peripheral vasodilation
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INCREASED
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Which stages of sleep are reduced in elderly
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Stage IV and REM sleep
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Which medications can increase risk of falls
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Benzodiazepines
Other sedatives and antidepressants |
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Those fibers are poorly myelinated,primarily sensory and autonomic, symptoms of damage include burning, tingling, numbness and pain
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Small fibers
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Fibers are heavily myelinated, primarily motor and sensory, symptoms include weakness, vibratory and position sense loss, numbness and areflexia
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Large fibers
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Types of peripheral neuropathies
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Peripheral symmetric polyneuropathy
Mononeuropathy Mononeuropathy multiplex Plexopathy Radiculopathy |
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Symptoms and signs of peripheral neuropathy
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Weakness
Areflexia Cramps Ataxias Deformities Numbness Pain Spasms Trophic changes Autonomic dysfunction |
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Decreased sensation is called _
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Hypesthesia
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Increased sensation is called _
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Hypersthesia
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Unpleasant, abnormal sensation produced by normal stimulus is called _
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Dysesthesia
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Perverted abnormal sensation like burning,prickling, formication (crawling)
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Paresthesia
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Name autonomic neuropathies
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Diabetes Mellitus
Amyloid Guillain Barre syndrome Porphyria Thallium poisoning |
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Which diseases cause mononeuropathy multiplex
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Diabetes mellitus
Vasculitis - RA, polyarteritis nodosa Trauma Plasma cell dyscrasia Leprosy Sarcoidosis |
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Which diseases would give you palpably enlarged nerves
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Inherited - Charcot Marie Tooth disease, neurofibromatosis
Leprosy Amyloid Acromegaly Chronic inflammatory demyelinating polyneuropathy |
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Name acute idiopathic inflammatory polyneuropathy
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Guillain Barre syndrome
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Guilliam Barre syndrome causes _ paralysis
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Ascending
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What is pathology in GB syndrome
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Axonal degeneration
Segmental demyelination Lymphocytic infiltration |
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Patient presents with paresthesias, weakness, areflexia, facial diplegia, autonomic instability - diagnosis?
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GB syndrome
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Patient presents with weakness - what is your differential diagnosis
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Poliomyelitis
Myelitis Diphtheria Tick paralysis Heavy metal poisoning Botulism Toxin Porphyria HIV |
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Patient presents with GB syndrome - which workup do you do
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H&P
LP EMG Serology Toxicology |
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Treatment for GB syndrome
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Supportive care
Plasmapheresis IV IgG DO NOT give steroids |
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Poor outcome predictors in patients with GB
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Older age
Rapid onset Ventilator Severely reduced distal cMAP on EMG |
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Most common complication of chronic renal failure - presents as painless progressive symmetric sensorimotor peripheral polyneuropathy - patient will complain of burning, cramping, crawling, itching, creeping which is worse at night - RESTLESS LEGS
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UREMIC POLYNEUROPATHY
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Treatment for uremic polyneuropathy
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Renal transplant
Symptomatic |
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Second most common cause of neuropathy
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Alcoholism
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Pathology of alcoholic polyneuropathy
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Direct toxic effect
Nutritional defficiencies - B1, B3, B6, B12, folic acid, Zn |
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Alcoholic polyneuropathy is symmetric _ polyneuropathy
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Sensorimotor
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This disease is know to cause mononeuropathy, mononeuropathy multiplex, symmetric sensorimotor polyneuropathy, autonomic neuropathy, thoracoabdominal radiculopathy and amyotrophy
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DIABETES
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Mononeuropathy and mononeuropathy multiplex in diabetics are caused by _
Which CN's are affected What other nerves are affeted? |
Compression
Infarct - occlusion of vasa nervosum CN's - III, VI, VII Peripheral - femoral,sciatic, peroneal, radial, ulnar, median |
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Which type of neuropathy starts as "glove-stocking" neuropathy
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Diabetic symmetric sensorimotor polyneuropathy
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Diabetic pseudotabes causes loss of _
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position sense
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In diabetic polyneuropathy which fibers are affected first
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SMALL
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Treatment for dysesthetic peripheral polyneuropathy
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Desipramine
Amitryptiline Phenytoin Carbamazepine Lidocaine Baclofen Mexiletene Capsaicin Gabapentin |
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Which type of neuropathy presents with GI and GU symptoms, impotence, impaired sweating and vascular function
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Autonomic neuropathy
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In radiculopathy which nerve roots are most frequently affected
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THORACIC
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Radiculopathy in diabetics is associated with _
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Poor diabetic control and weight loss
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Diabetics get this - its painful and can resemble herpes zoster ?
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Radiculopathy
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Painful gradually progressive proximal leg weakness in diabetics with no sensory loss is called _
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AMYOTROPHY
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Which toxin causes sensorimotor peripheral polyneuropathy, Mees lines and GI symptoms
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ARSENIC
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Which toxin causes wrist drop
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LEAD
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Which toxin causes blindness and peripheral neuropathy
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MERCURY
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Which toxin causes sensory and autonomic findings and alopecia
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THALLIUM
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Which drug can cause neuropathy and B6 defficiency
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Isoniazid - TB drug
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Patient presents with vesicular eruption, pain, dysesthesias and numbness - diagnosis?
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HERPES ZOSTER - shingles
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Herpes Zoster reactivation - SHINGLES - usually affects _
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Immunocompromised and elderly
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Eruption in the external auditory meatus causing facial paralysis is called _
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RAMSAY HUNT SYNDROME
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Dysesthetic pain following herpes zoster infection is called _
Treatment |
Postherpetic neuralgia
Treatment - difficult - amitryptiline, carbamazepine, capsaicin, gabapentin |
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Name infectious causes of neuropathies
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Herpes zoster
Lyme disease HIV Diphtheria Leprosy |
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Which autoimmune disease causes cranial mononeuropathies and peripheral polyneuropathies
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SARCOIDOSIS
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Which disease causes light chain and transthyretin accumulation, small fiber neuropathy and carpal tunnel syndrome
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AMYLOIDOSIS
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Another name for Charcot Marie Tooth disease
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Peroneal muscular atrophy
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Type I Charcot Marie Tooth disease is _ type
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DEMYELINATING
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Type II Charcot Marie Tooth disease is _ type
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AXONAL
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Stork leg deformity, foot drop, steppage gait, palpably enlarged nerves and peripheral polyneuropathy indicated _ disease
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Charcot Marie Tooth disease type I
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Which type of Charcot Marie Tooth disease is less severe presents with atrophy and peripheral polyneuropathy
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Type II - AXONAL
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This disease is caused by abnormal heme metabolism, presents as acute motor neuropathy with autonomic findings, can be precipitated by barbiturates or other drug and is associated with recurrent episodes of seizures, abdominal pain and psychiatric disorders
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PORPHYRIA
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This disease presents as acute onset facial paralysis, hyperacusis and impaired taste, preceded by pain behind ear - diagnosis?
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BELLS PALSY
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Unilateral Bells palsy - differential?
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DM
Trauma Tumor Stroke GB syndrome Lyme disease Ramsay Hunt syndrome |
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Bilateral Bells palsy - differential
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GB syndrome
MG Basal meningitis Sarcoidosis Lyme disease |
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Recurrent Bells palsy - differential
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MS
Lyme disease Sarcoidosis |
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Patient presents with Bells palsy - workup?
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H&P
CBC, UA, fasting glucose, sed rate Chest X ray, LP, MRI EMG with NCS |
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Patient presents with Bells palsy - how do you treat
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PROTECT EYE (eyes doesnt close, need to lubricate or patch), PT, surgery, steroids
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Possible complications of Bells palsy
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Aberrant regeneration
Hemifacial spasm |
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This disease occurs in middle age and later life, presents with paroxysms of intense, stabbing, shooting pain in V2/V3 distribution, pain is recurrent and last for several weeks at time, can be triggered by shaving, brushing teeth, mouth movements or cold stimulus, could be mistaken for sinus disease or tooth abscess
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TRIGEMINAL NEURALGIA
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Possible causes of trigeminal neuralgia
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Tumor
Vascular MS Idiopathic |
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How would you diagnose trigeminal neuralgia
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H&P
MRI |
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How do you treat trigeminal neuralgia
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Meds - phenytoin, carbamazepine, clonazepam, baclofen, lamotrigine
Surgery - Jannetta procedure, Gasserian ganglion block |
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Horners syndrome is caused by _
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Interruption of sympathetic innervation
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Causes of Horners syndrome
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Stroke
Cervical spinal disease T1 radiculopathy - Pancoasts tumor Neck pathology - thyroiditis Carotid artery dissection Cavernous sinus pathology - aneurysm Orbital pathology |
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How do you diagnose Horners syndrome
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H&P
Cocaine Hydroxyamphetamine |
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Name two major brachial plexopathies
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Klumpke palsy
Erbs palsy |
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This condition causes severe pain followed by weakness - commonly involves axillary, long thoracic, suprascapular nerves - UPPER TRUNK OF BRACHIAL PLEXUS, sensory symptoms involve axillary distribution - treatment - PT+ meds, prognosis - 89% improve in 3 years, 5% recur - NAME CONDITION
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Idiopathic brachial plexitis - PARSONAGE-TURNER SYNDROME
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Shoulder dislocation would result in damage to which nerves
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AXILLARY AND MUSCULOCUTANEOUS
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This condition causes paresthesias and dysesthesias in the hands particularly first three digits, pain is worse at night and patients shakes their hands to take pain away, there is atrophy of thenar eminence - DIAGNOSIS
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CARPAL TUNNEL SYNDROME
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Possible causes of carpal tunnel
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Trauma
Amyloid Acromegaly Hypothyroidism Pregnancy Structural changes RA DM |
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How do you diagnose carpal tunnel syndrome
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H&P
EMG with NCS |
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This condition causes numbness of medial fourth and entire fifth digits, atrophy of the hand (EXCEPT thenar eminence), entrapment sites are elbow and wrist, Tinel sign is positive, there is loss of dexterity and clawhand deformity - NAME CONDITION
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ULNAR MONONEUROPATHY
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Causes of ulnar mononeuropathy
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TRAUMA
BONY ABNORMALITIES DIABETES MELLITUS |
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Diagnosis of ulnar mononeuropathy
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H&P
EMG with NCS |
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Patient presents with wrist drop, finger drop and numbness of posterior lateral hand - DIAGNOSIS
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Radial mononeuropathy
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Causes of radial mononeuropathy
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Trauma
Injection Fracture Lead Diabetes mellitus Handcuff neuropathy |
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Foot drop occurs due to weakness of which muscle
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TIBIALIS ANTERIOR
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This condition causes foot drop, numbness between 1st and 2nd toes and anterolateral leg, tibialis posterior is UNAFFECTED - can be caused by DM, trauma, compression or vasculitis - DIAGNOSIS
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FIBULAR MONONEUROPATHY (PERONEAL MONONEUROPATHY)
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This condition presents with weakness of all muscles below knee, weak hamstrings, numbness below knee (EXCEPT saphenous nerve) and foot drop - can be caused by trauma, surgery, injection, external compression and masses - NAME CONDITION
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SCIATIC MONONEUROPATHY
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This condition presents with weakness of quadriceps muscles resulting in difficulty EXTENDING THE KNEE, numbness of medial leg - can be caused by DM, catheterization or hematoma - treat underlying cause, leg brace or PT - NAME CONDITION
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FEMORAL MONONEUROPATHY
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This condition is due to compression of LATERAL FEMORAL CUTANEOUS NERVE, presents with paresthesias or dysthesias of LATERAL THIGH - caused by obesity, weight loss, tight clothes or tight belts - provide symptomatic treatment, injections or transection of the nerve - NAME CONDITION
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MERALGIA PARESTHETICA
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In this condition symptoms extend beyond a single nerve or root, muscles affected are iliopsoas, adductors, quadriceps + gluteal, hamstrings and leg muscles - can be caused by tumor, abscess, trauma, obstetric, hematoma, radiation, DM or idiopathic. You can diagnose it by H&P, EMG with NCS or imaging, treat - underlying cause, AFO, rehab - NAME CONDITION
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LUMBOSACRAL PLEXOPATHY
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The area of skin supplied with afferent nerve fibers by single posterior spinal root
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DERMATOME
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A group of muscles innervated from single spinal segment
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MYOTOME
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Area of bone innervated by single spinal segment
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SCLEROTOME
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In disc herniation _ penetrates _
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Nucleus pulposus penetrates annulus fibrosus
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Disk herniation usually occurs in what direction
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DORSOLATERAL (can be lateral or central)
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Large disk herniations will involve multiple nerve roots resulting in _
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Cauda equina syndrome or spinal stenosis
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In this condition pain is aggravated by Valsalva maneuver, patient has radiating pain and paresthesias, POSITIVE STRAIGHT LEG RAISING TEST, patient is bent forward and lumbar curve is flattened, paraspinal muscle spasms occur - DIAGNOSIS - it most commonly involves which nerve roots
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DISC HERNIATION
L5/S1 |
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This condition can be acquired or hereditary and is caused by degenerative arthritis involving facet joints, leads to hypertrophy and osteophyte formation, involved discs become flattened and narrowed, subluxation of facet joints occurs - NAME CONDITION
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SPONDYLOLYSIS
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Slippage of one vertebra over another is called _
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SPONDYLOLISTHESIS
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Multiple root involvement, widespread arthritic changes and long standing low back pain indicate _
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BONY CHANGES
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Patient presents with paresthesia of medial leg and weakness of quadriceps, physical exam confirms quadriceps weakness and depressed knee jerk - DISC LEVEL + ROOT
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DISC LEVEL - L 3-4
ROOT L4 |
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Patient presents with paresthesias of anterolateral leg and dorsum of foot. Physical exam reveals weak tibialis anterior, tibialis posterior, hams, toe extensors and gluteal muscles - DISC LEVEL+ ROOT
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DISC LEVEL - L4-5
ROOT L5 |
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Patient presents with paresthesia over sole and lateral foot and weak plantar flexors. Physical exam reveals weak gastrocnemius, gluteal muscles, toe flexors and depressed ankle jerk - DISC LEVEL + ROOT
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DISC LEVEL - L5-S1
ROOT S1 |
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This condition results from central disc herniation usually involving L4-L5 level, involves multiple roots L5-S3 -causes INTERMITTENT NEUROGENIC CLAUDICATION
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CAUDA EQUINA SYNDROME
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This condition results from thick scarred arachnoid adhering to pia and dura, caused most commonly by contrast dye and surgery, can be caused by intrathecal agents (dye, anesthetic drugs, steroids, amphotericin B, methotrexate), infections (TB, cryptococcus, syphillis, viral), trauma (spinal surgery, vertebral injuries, disc herniations) and spinal subarachnoid hemorrhage, you diagnose it by H&P, EMG with NCS and imaging, and treat with conservative treatment (manipulation, PT, bed rest, meds - prednisone, NSAIDS, analgesics), chemonucleolysis or surgery - NAME CONDITION
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ARACHNOIDITIS
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In _ radiculopathy level of hernitation in SAME as root
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CERVICAL
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Patient presents with shoulder pain and numbness of shoulder- LEVEL
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C5
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Patient presents with pain and numb thumb and index finger - LEVEL
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C6
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Patient presents with pain and numb middle finger, pectoral and upper back pain - LEVEL
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C7
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Patient presents with pain and numb 4th and 5th digits and medial forearm - LEVEL
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C8
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Patient presents with weak biceps and brachioradialis reflexes - DISC LEVEL + ROOT
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C4-C5
C5 OR C5-C6 C6 |
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Patient presents with weak triceps reflex- DISC LEVEL + ROOT
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C6-C7
C7 |
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Patient presents with weak triceps and finger reflexes - DISC LEVEL + ROOT
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C7-C8
C8 |
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Patient presents with weak finger reflex and Horners syndrome - DISC LEVEL + ROOT
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T1-T2
T1 |
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Patient has C5 or C6 root compression - DIFFERENTIAL DIAGNOSIS
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CARPAL TUNNEL
BRACHIAL PLEXOPATHY MONONEUROPATHY (RADIAL, MUSCULOCUTANEOUS, SUPRASCAPULAR) |
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Patient has C7 root compression - DIFFERENTIAL DIAGNOSIS
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CARPAL TUNNEL
RADIAL MONONEUROPATHY BRACHIAL PLEXOPATHY |
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Patient has C8 root compression - DIFFERENTIAL DIAGNOSIS
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BRACHIAL PLEXOPATHY
ULNAR MONONEUROPATHY |
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This condition presents with episodic blanching (red, white and blue) of fingers precipitated by cold or emotion, idiopathic etiology, symptomatic of disease or medication, it is caused by INCREASED arterial constriction or decrease in intraluminal distending pressure, causes - arterial obstruction, CTD, trauma or medication - TREAT underlying cause, eliminate precipitating factors, sympathectomy usually ineffective - NAME CONDITION
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RAYNAUDS PHENOMENON
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This condition was first described by Weir Mitchell during civil war, its caused by trauma to nerve resulting in injury to SYMPATHETIC FIBERS - patient presents with persistent, SEVERE, burning dysesthetic pain associated with sudomotor, vasomotor and atrophic changes - TREAT - responds to procaine injections and regional sympathectomy - NAME CONDITION
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CAUSALGIA
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This condition is caused by blunt trauma to soft tissue and bone, other causes - stroke, MI, angina and DJD, believed to be secondary to autonomic dysfunction. In ACUTE STAGE I - increased temp, increased hair and nail growth, increased blood flow, rubor,edema, decreased range of motion, may last up to 3 months. In STAGE II - DYSTROPHIC - hyperesthesia, cold intolerance, decreased temp, decreased hair growth, brittle nails, pale limbs, cyanotic demineralized bone, STAGE III - ATROPHIC - decreased pain, hyperesthesia, smooth and glossy skin, muscle wasting and contractures - NAME CONDITION - how do you diagnose and treat it
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REFLEX SYMPATHETIC DYSTROPHY
DX - H&P, bone scan, thermography, X rays TREATMENT - sympathetic block (surgical or chemical), regional IV meds, psychological care, PT, TENS unit, manipulation MEDS - NSAIDS, propranolol, nifedipine, reserpine, guanethidine, prednisone, antidepressants, antiarrythmics, anticonvulsants, phenothiazines and gabapentin |
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Both MS and GB are demyelinating diseases - how do you differentiate
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MS - CENTRAL
GB - PERIPHERAL |
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This condition is cased by degeneration of ANTERIOR HORN CELLS as result of deletion of hene on chromosome 5q which is responsible for encoding protein called " survival motor neuron" - NO UMN SIGNS - NAME CONDITION - how do you diagnose and treat it
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SPINAL MUSCULAR ATROPHY
DIAGNOSIS - H&P, EMG, muscle biopsy SYMPTOMATIC TREATMENT |
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This type of muscular spinal atrophy becomes evident in first few weeks of life, common cause for FLOPPY BABY SYNDROME, baby shows decreased intrauterine movement, progressive symmetric weakness, weak cry, swallowing difficulty and respiratory failure - death within few years - NAME CONDITION
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WERDNIG HOFFMAN DISEASE
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This type of spinal muscular atrophy becomes evident in childhood and presents with generalized weakness, oropharyngeal muscles spared and longer life span
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KUGELBERG- WELANDER DISEASE
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This disease is caused by degeneration of CST and anterior horn cells, most commonly sporadic but 10% are familial (chromosome 20, AD), some are due to mutation is SOD 1 or alterations of VEGF - NAME DISEASE
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AMYOTROPHIC LATERAL SCLEROSIS
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Risk factors for ALS
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Male and age
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Which muscles are spared in ALS
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Extraocular and urinary sphincter
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How would ALS present
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LMN and UMN signs, bulbar palsy
LMN signs - muscle atrophy, weakness, dysphagia, weight loss, cramps and fasciculations UMN signs - hyperreflexia, spasticity, weakness, gait difficulty, Babinski sign Bulbar palsy - dysphagia, aspiration, hoarseness |
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Differential diagnosis of ALS
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Cervical spondylosis
Syringomyelia Anti- GM1 autoantibody Myelopathies |
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How do you diagnose and treat ALS, prognosis?
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DIAGNOSIS - H&P, EMG, MRI of spine or brain
TREATMENT - suppoortive (vaccinations, nutrition), symptomatic (spasticity meds - diazepam, baclofen, dantrolene), RILUZOLE - new med can extend life by 10% PROGNOSIS - die from respiratory failure or UTI within 5 years |
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This condition is caused by chronic progressive TUBULAR CAVITATION of spinal cord, develops after trauma, hematomyelia, cystic degeneration of glioma or ischemia, patient presents with DISSOCIATED sensory loss, shawl like pain and temp loss, atrophy and weakness of hands, paraparesis, fasciculations, hyperreflexia, Babinski sign, bowel and bladder impairment, pain in neck and shoulders, scoliosis and Charcot joints - NAME CONDITION - differential diagnosis, diagnosis and treatment
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SYRINGOMYELIA
Diff diagnosis - ALS, MS, spinal cord tumor, cervical spondylosis Diagnosis - MRI + myelogram Treatment - surgical, radiation |
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Dilation of central canal is called _
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Hydromyelia
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Syringomyelia is associated with _ malformation
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Arnold Chiari malformation
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This condition is result of B12 defficiency (pernicious anemia), has CNS and PNS features and myelin loss in posterior columns - presents with sensory ataxia, paresthesias in feet, impaired vibration and position sense, UMN signs - spasticity, hyperreflexia and Babinski - NAME CONDITION - how would you diagnose and treat
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SUBACUTE COMBINED DEGENERATION
DIAGNOSIS - H&P, B12 level - homocysteine and METHYLMALONIC ACID LEVELS, CBC - megaloblastic, hyperchromatic and macrocytic changes TREATMENT - B12 shots - will arrest process but not totally reverse |
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This condition is a congenital anomaly - downward elongation of hindbrain into cervical column - caused by cord fixation, developmental arrest or overgrowth of neural tube - associated with spina bifida, hydrocephalus and syringomyelia - in first few years presents as hydrocephalus, in adult onset presents as ataxia, weakness, nystagmus and myelopathic features (Babinski, hyperreflexia) - NAME CONDITION, diagnosis and treatment
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ARNOLD CHIARI MALFORMATION
DIAGNOSIS - H&P, MRI TREATMENT - Surgery |
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This condition results from failure of closure of the bony spine, most common at lumbosacral level but can occur anywhere along spine or cranium, caused by lack of folic acid or folic acid antagonists (trimethoprim, phenytoin, carbamazepine, phenobarbital, triametrene, primidone). It can range from asymptomatic to dermatological features (overgrowth of hair, sinus, nevus flammeus, pit or lipoma) and neurological features (weakness, atrophy, gait disturbance, urinary and bowel symptoms, sensory loss and areflexia) - NAME CONDITION + DX + TREATMETN
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SPINA BIFIDA
Dx - H&P, MRI, CT, Plain X rays Treatment - prevention (vit A, folic acid), surgical |
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This is familial and hereditary disease which is localized to chromosome 9&11, caused by defficiency of functional frataxin, onset occurs in 1st or 2nd decade - degeneration of posterior funiculi, lateral CST's, spinocerebellar tracts, dorsal roots and CLARKES COLUMN, presents with areflexia, ataxia, loss of position sense, nystagmus, scoliosis, pes cavus and cardiomyopathy, + BABINSKI - NAME CONDITION + TREATMENT
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FRIEDREICHS ATAXIA
Symptomatic treatment |
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This condition results from progressive degenerative disc changes with bony changes causing pressure on cord resulting in ischemia to cord, patient presents with myelopathic findings - DIAGNOSE by H&P and MRI, treat - surgery or conservative - NAME CONDITION
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CERVICAL SPONDYLOLYSIS WITH MYELOPATHY
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This condition presents with urinary (and/or fecal) incontinence, failure of erection and ejaculation, paralysis of pelvic floor, sensory loss, reflexes spared - NAME CONDITION AND WHAT OTHER DISEASE DOES IT USUALLY OCCUR WITH
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CONUS MEDULLARIS SYNDROME
USUALLY OCCURS WITH CAUDA EQUINA SYNDROME |
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This condition is caused by HEMISECTION OF SPINAL CORD, presents as IPSILATERAL WEAKNESS AND VIBRATION/POSITION SENSE LOSS + CONTRALATERAL PAIN AND TEMPERATURE LOSS - can be caused by trauma, radiation or tumor - NAME CONDITION
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BROWN SEQUARD SYNDROME
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This condition is caused by atherosclerosis or dissecting aneurysm resulting in occlusion of artery of Adamkiewicz, there is infarct to anterior 2/3 of spinal cord - patient presents with PARALYSIS + DISSOCIATIVE CHANGES - NAME CONDITION
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ANTERIOR SPINAL ARTERY SYNDROME
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Occlusion of this artery results in LOSS OF VIBRATION AND POSITION SENSE
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POSTERIOR SPINAL ARTERY (both occluded at same time)
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This condition is abrupt, occurs after complete or incomplete spinal cord injury, presents with complete paralysis, anesthesia, areflexia and hypotonia - after 3-4 weeks UMN signs may appear - NAME CONDITION
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SPINAL SHOCK
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This condition results after spinal shock and presents as PERMANENT MOTOR, SENSORY AND AUTONOMIC LOSS- NAME CONDITION
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CHRONIC CORD TRANSECTION
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This phenomenon lasts typically 15-30 minutes, occurs before, during or after head pain begins - can be visual (scintillating scotoma), paresthesias, weakness, aphasia, vertigo, its a migraine equivalent - NAME PHENOMENON
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AURA
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Aura phase of migraine is associated with _
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REDUCTION IN CEREBRAL BLOOD FLOW
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Pain in migraine is generated by _
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Sterile neurogenic inflammation
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Migraine is neurovascular disorder involving activation of _ - which can result in pain that is referred unilaterally or bilaterally anywhere along trigeminocervical network, can result in pain that is refered to posterior head and neck, can cause reflex activation of cranial parasympathetic nerves leading to sinus like symptoms
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Trigeminal nucleus caudalis
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Most frequently reported trigger of migraine
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STRESS
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This type of headache is severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes - can be accompanied on the same side by conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating,miosis, ptosis or eyelid edema - patient is usually young male, pain occurs at night or often same time each day, patient paces or pounds fist or head with attack, may commit suicide -
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CLUSTER HEADACHE
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In order to be diagnoses with SINUS HEADACHE patient MUST have _
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PURULENT NASAL DISCHARGE
PATHOLOGIC SINUS FINDINGS IN TESTS INCLUDING X RAYS, CT OR MRI |
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Which aspects of history should you elicit when patient presents with headache
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QUALITY OF PAIN -aching, pressure, squeezung, throbbing/pounding, sharp/dull
DURATION - over or less than 4 hours LOCATION FREQUENCY - twice weekly or less, daily or every other day INTENSITY - is it getting progressively worse WARNING - is there aura or prodrome SLEEP PATTERN PSYCHOSOCIAL STRESSORS N/V MOTION SICKNESS MEDICAL HISTORY (DM, HTN, stroke, seizure, asthma, heart disease) AGE OF ONSET FAMILY HISTORY (motion sickness, headaches) SMOKING/ALCOHOL/DRUGS TRIGGERS - sensory stimuli, menses, exercise, valsalva maneuver, chewing ASSOCIATED SIGNS - CN palsies, Horners, tearing/lacrimation/red eye, diarrhea MEDS - OTC, caffeine, narcotics, migraine medications DIETARY FACTORS- fasting, food triggers (caffeine, aspartame, chocolates, MSG) SINUS DISEASE |
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Which aspects of physical exam should you elicit when patient presents with headache
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VITALS
EYE EXAM - pupils, fundoscopic exam MUSCULOSKELETAL EXAM - jaw, cervical spine (nuchal rigidity, ROM) NASAL EXAM NECK EXAM NEUROLOGICAL EXAM |
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Patient presents with headache - WORKUP
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H&P
NEUROIMAGING - MRI, CT BLOOD WORK - sed rate, antibodies (ANA, APLA) LP BIOPSY ANGIOGRAM |
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Name some serious etiologies of headache
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BRAIN TUMOR - primary or metastatic
HEMORRHAGE/INFARCTS INFECTIONS VASCULITIS IDIOPATHIC TRANSCRANIAL HTN ACUTE HYDROCEPHALUS GLAUCOMA |
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Name drugs used for SYMPTOMATIC treatment of migraines
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OTC ANALGESICS
COMBINATION MEDS NSAIDS TRIPTANS ERGOTS MIDRIN OPIOIDS NEUROLEPTICS |
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Name drugs used for PREVENTITIVE treatment of migraines
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BETA BLOCKERS
CA CHANNEL BLOCKERS ANTIDEPRESSANTS ANTICONVULSANTS METHYSERGIDE NSAIDS CYPROHEPTADINE |
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Name drugs used for symptomatic treatment of CLUSTER HEADACHES
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OXYGEN
DIHYDROERGOTAMINE SUMATRIPTAN SPHENOPALATINE BLOCK INTRANASAL LIDOCAINE INTRANASAL CAPSAICIN INDOMETHACIN OPIOIDS |
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Treatment for TENSION HEADACHE
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PSYCHOLOGICAL COUNSELING
MIDRIN FIORICET, PHRENILIN ANTIDEPRESSANTS PT MANIPULATION |
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This headache occurs daily or near daily, its refractory, occurs in primary headache sufferer, only relief for headache is irresistible and predictable use of relief medications, those are usually early morning headaches, patient experiences withdrawal symptoms when medications are withdrawn, can also have improvement of headache when medications are withdrawn, prophylactic medications are ineffective, patient can exhibit signs of med abuse - NAME TYPE OF HEADACHE, NAME TREATMENT AND PROPHYLACTC MEDS
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REBOUND HEADACHE - eliminate triggers, consider drug rehab, proper diet (avoid fasting and modify diet), encourage proper sleep and use prophylactic meds
PROPHYLACTIC MEDS- beta blockers, antidepressants, NSAIDS, antiserotonin drugs, Ca channel blockers, MOA inhibitors, anticonvulsants |
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This type of headache presents as sustained, severe migraine which is not terminated effectively by outpatient medications, requires acute therapeutic treatments over day or longer - NAME CONDITION AND TREATMENT
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INTRACTABLE MIGRAINE - STATUS MIGRAINOSUS
TREATMENT - should match intensity and severity of headache - parenteral pain therapy, rehydration, control nausea and vomitting, remove provoking factors, support services (psycohological), monitoring |
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This condition is potentially serious drug related complication - symptoms may vary from mild to cardiac arrest and coma, many cases go undetected, high risk groups - OCD, bipolar, eating disorders and Parkinsons, it is idiosyncratic - not predictable based on dose or duration of therapy, patient can present with neuromuscular, autonomic or neuropsychiatric symptoms - NAME CONDITION
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SEROTONIN SYNDROME
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Chills, fever, headache, nausea and vomitting, nuchal rigidity, Kernig and Brudzinski signs, Cushings reflex, change in consciousness, coma and increased ICP are all signs of _
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MENINGITIS
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Bulging fontanelle, irritability, poor feeding, vomitting, drowsiness and fever are signs and symptoms of _ in infants
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MENINGITIS
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Possible complications of meningitis
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Seizures
Deafness Hydrocephalus Blindness Syndrome of INAPPROPRIATE ANTIDIURETIC HORMONE Mental defficiency |
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This condition can be sporadic or epidemic, key signs and symptoms - PETECHIAL OR HEMORRHAGIC SKIN RASH, complications include DIC, adrenal hemorrhage or circulatory collapse - NAME CONDITION
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MENINGOCOCCAL MENINGITIS
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This type of meningitis usually occurs in children under 5, secondary to SINUSITIS, OTITIS MEDIA, SKULL FRACTURE. In adults associated with DM, alcoholism or immune defficiency - NAME CONDITION
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H. INFLUENZAE MENINGITIS
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This type of meningitis usually occurs in elderly, secondary to infections of lung,ear, sinus or skull. Associated with alcoholism, asplenia or sickle cell disease - now is the most common cause of meningitis - more common in adults than children
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PNEUMOCOCCAL MENINGITIS
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Prognosis for meningitis
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50-100% die without antibiotics
10-30% die with treatment |
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Treatment for meningitis
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ANTIBIOTICS
SUPPORTIVE CARE DEXAMETHASONE IN CHILDREN PROPHYLAXIA |
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This type of meningitis can occur from skin spread, surgery or endocarditis - may result in abscess or thrombosis of venous sinuses
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STAPHYLOCOCCAL MENINGITIS
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Most common cause of meningitis in newborns
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E. coli and group B strep
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This infection is now infrequent may affect spinal cord, cortex or brainstem - symptoms include meningeal signs, fever, headache, paralysis (acute asymmetric flaccid), may involve respiratory, limb or bulbar muscles - death rate is 10% due to respiratory failure
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POLIOMYELITIS
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This disease is caused by a virus - presents with drowsiness, coma, seizure, headache, vomitting, fever. LABS show elevated WBC count, CSF exam shows increased pressure, increased lymphocytes, increased protein but normal glucose - PROGNOSIS, TREATMENT?
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ENCEPHALITIS
PROGNOSIS -mental defficiency, seizure, focal deficits TREATMENT- supportive |
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This disease enters brain via TRIGEMINAL GANGLION or olfactory bulbs and resides in temporal and frontal lobes - presents with fever, headache, focal seizures, focal signs - aphasia, personality changes, agitation, hallucinations or meningeal signs - WHAT WILL CSF SHOW, PROGNOSIS AND TREATMENT
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HERPES ENCEPHALITIS
DIAGNOSIS - CSF - increased WBC, RBC, protein, decreased OR normal glucose, EEG, IMAGING, BRAIN BIOPSY PROGNOSIS - 70% fatal TREATMENT - ACYCLOVIR |
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This infectious disease shows typical meningeal symptoms, CSF shows high lymphocyte count and protein, normal glucose (EXCEPT mumps, herpes, lymphocytic choriomeningitis, others), bacterial cultures are negative , patients usually recover without sequelae - supportive treatment
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VIRAL (ASEPTIC) MENINGITIS
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This infectious disease presents with hydrophobia, Negri bodies symptoms begin up to a year after inoculation, get pain and numbness at the site of inoculation, fever, apathy, lethargy, seizure, excitability, spasmodic contractions of pharynx/larynx, fatal in 2-10 days after symptoms begin - prevention through vaccination
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RABIES
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This infectious disease occurs by direct extension, metastasis or trauma. Causes - Staph, Strep, anaerobes or in immunocompromised - Toxoplasma, fungal, TB. Patient presents with headache, fever, chills, nausea, vomitting, seizures and focal findings. CSF studies are nonspecific, MRI is diagnostic. Treatment with antibiotics or surgery
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BRAIN ABSCESS
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This infectious disease presents with skin depigmentation and anesthesia, mononeuropathies including ulnar, greater auricular, tibial, peroneal, CN 's V and VII - you diagnose it by H&P and treat with dapsone, rifampin and clofamazine
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LEPROSY
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Patient presents with pain, fever, neck stiffness, headache and radicular pain and myelopathy. Thoracic region is involved the most. Labs show increased sed rate, increased WBC, CSF shows aseptic meningitis picture, MRI and myelogram were ordered - results pending. Differential diagnosis include GB, transverse myelitis, GB and meningitis
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EPIDURAL ABSCESS
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This infection is associated with chronic disease - renal failure, DM, transplant and alcoholism
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LISTERIA MONOCYTOGENES
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What are the causes of bacterial meningitis
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Partially treated bacterial meningitis
Trauma CSF leaks Mollaret meningitis Sarcoidosis Behcet syndrome Tumor Fungal |
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This infection causes basilar meningitis with subacute symptoms of headache, anorexia, 2 weeks to 3 months duration, moderate temperature of 100-102 F, seizure, cranial nerve findings. CSF shows very high protein, increased lymphocytes and decreased glucose
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TB meningitis
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This infectious disease has unknown cause and initiates generalized granulomatous process, it can affect meninges, cranial or peripheral nerves and muscles. Patient exhibits signs of basilar meningitis. Labs show INCREASED ANGIOTENSIN CONVERTING ENZYME and INCREASED SERUM CALCIUM. Analysis of CSF shows INCREASED PROTEIN, DECREASED GLUCOSE, 10-200 cells mostly lymphocytes, cultures are negative - DIAGNOSIS + TREATMENT
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NEUROSARCOIDOSIS
TREATMENT- STEROIDS |
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This infectious disease is common in Latin America, Mexico, SW USA. Patient exhibits focal symptoms and hydrocephalus. H&P, imaging and biopsy are used to diagnose. DIAGNOSIS + TREATMENT + ORGANISM CAUSING IT
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TAENIA SOLIUM (PORK TAPEWORM)
CYSTICERCOSIS TREATMENT - ANTIBIOTICS, STEROIDS |
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Patient presents with mononucleosis like symptoms, MRI shows multiple masses and patient exhibits focal findings. History is positive for AIDS. WHICH TESTS TO ORDER + DIAGNOSIS + TREATMENT
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ORDER SEROLOGY
TOXOPLASMOSIS TREATMENT - ANTIBIOTICS |
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This infectious disease is rare, familial in 10-15%, transmissible. Patient presents with rapid dementia, extrapyramidal and pyramidal signs and STIMULUS SENSITIVE MYOCLONUS. EEG shows PERIODIC SHARP WAVES, CT scan shows atrophy. WHAT TEST SHOULD BE ORDERED, PROGNOSIS, DIAGNOSIS
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CREUTZFELD JAKOB DISEASE
DEATH WITHIN 1-2 YEARS ORDER BIOPSY |
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This infectious disease is associated with chronic illness and decreased immunity, diabetes mellitus, renal failure, sarcoid, leukemia, lymphoa, lupus and AIDS. Patient presents with subacute symptoms of headache, mental changes and focal findings. DIAGNOSIS + WHAT DIAGNOSTIC PROCEDURE CONFIRMS IT + PROGNOSIS + TREATMENT
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CRYPTOCOCCOSIS
DIAGNOSIS BY SPINAL TAP - INDIA INK STAIN, CRYPTOCOCCAL ANTIGEN, INCREASED PROTEIN, DECREASED GLUCOSE, 10-500 LYMPHOCYTES AND FUNGAL CULTURES PROGNOSIS - FATAL IF NOT TREATED TREATMENT - ANTIFUNGALS |
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Patient presents with stiffness, restlessness, irritability, opisthotonis, risus sardonicus and seizure. He also has lockjaw
DIAGNOSIS + PROGNOSIS + TREATMENT |
TETANUS
50% MORTALITY TREATMENT- ANTISERUM, PENICILLIN, SUPPORTIVE, IMMUNIZATION |
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What is normal CSF pressure
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50-200 mm H2O
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What is normal CSF cell count
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0-5 lymphocytes
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What is normal glucose in CSF
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1/2 to 2/3 of serum glucose
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What is normal protein in CSF
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15-45 mg/dl
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Analysis of CSF shows normal glucose, increased lymphocytes, increased protein, negative bacterial cultures and negative Gram stain DIAGNOSIS
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ASEPTIC MENINGITIS
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Analysis of CSF shows decreased glucose, increased PMN's, increased protein, positive cultures and positive stains - DIAGNOSIS
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BACTERIAL AND FUNGAL MENINGITIS
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Analysis of CSF shows decreased glucose, increased white cells, increased protein, negative cultures, negative stains and positive cytology DIAGNOSIS
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TUMOR MENINGITIS
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What are the indications for spinal tap
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Fever with or without meningeal signs
Unexplained delirium or dementia Unexplained headache Diagnostic purposes - subarachnoid hemorrhage, MS, GB, metastatic cancer |
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What are the contraindications for spinal tap
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Coagulopathy - low platelets, anticoagulation
Focal skin infection Increased ICP with mass lesion Papilledema itself IS NOT a contraindication |
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Complications of spinal tap
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Headache
Infections Bleeding Diplopia (CN VI) Pain |
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How do you distinguish traumatic tap from subarachnoid hemorrhage
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SUBARACHNOID HEMORRHAGE - CSF IS YELLOWISH/REDDISH WHEN SPUN DOWN
TRAUMATIC TAP - CSF CLEARS WHEN SPUN DOWN |
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Patient presents with morning headaches - DIFFERENTIAL DIAGNOSIS
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HTN
SINUS REBOUND TUMOR |
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Cognitive changes, headache, seizure, vomitting, focal motor and sensory deficits and papilledema should lead you to suspect _
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TUMOR
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Patient presents with neurological symptoms and you suspect brain tumor - WHAT WORKUP DO YOU DO
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H&P
MRI WITH GADOLINIUM EVOKED POTENTIALS BIOPSY SPINAL TAP BLOOD STUDIES |
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4 types of gliomas
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ASTROCYTOMA
OLIGODENDROGLIOMA MEDULLOBLASTOMA EPENDYMOMA |
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60% of all primary intracranial tumors
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ASTROCYTOMA
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Prognosis of astrocytoma is best predicted by _
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Necrosis and rate of growth
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This tumor is mostly seen in children and young adults. Patient presents with CN findings, long tract signs and increased intracranial pressure. Survival is 5-47 months
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BRAINSTEM GLIOMA
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This neoplasm has 25% incidence in patients with neurofibromatosis, presents with visual and endocrine changes and hydrocephalus
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OPTIC NERVE GLIOMA
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Which glioma has the worst prognosis
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GLIOBLASTOMA MULTIFORME
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This tumor constitutes 5% of gliomas, usually affects young adults, located in frontal lobe, 50% of patient would show calcifications on MRI - its a well circumscribed firm tumor
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OLIGODENDROGLIOMA
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This tumor makes up 5-10% of gliomas and 20-40% of all posterior fossa tumors, 75% occur under age of 16. Its a primitive tumor that arises from FETAL EXTERNAL GRANULAR LAYER, arises from posterior vermis and involves 4th ventricle, it also sheds cells can get TUMOR MENINGITIS WITH THIS. Patient would present with increased intracranial pressure, ataxia, headache, focal findings and altered consciousness
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MEDULLOBLASTOMA
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This tumor makes up 3% of all gliomas and 10% of all intracranial neoplasms in children. Location is in 4th ventricle, spinal cord or cerebellopontine angle. Patient presents with hydrocephalus + focal findings, 5 year survival 30-40%
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EPENDYMOMA
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This tumor makes up 0.5% of intracranial tumors, most common in lateral ventricle, takes form of GIANT CHOROID PLEXUS, 50% of symptoms in 1st year, 75% in first decade. Treatment - resection + shunt
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CHOROID PLEXUS PAPILLOMA
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This tumor makes up 80-90% of cerebellopontine angle tumors and 5-10% of all intracranial tumors, associated with neurofibromatosis - SLOW GROWING TUMOR. Patient presents with hearing loss, tinnitus, unsteady gait and CN V and VII findings
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ACOUSTIC NEUROMA
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Patient has a tumor at cerebellopontine angle - DIFFERENTIAL DIAGNOSIS
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MENINGIOMA
PAPILLOMA EPENDYMOMA CHOLESTEATOMA NEUROMA |
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This is a round, nodular, vascular, well circumscribed tumor, causes hyperostosis of overlying skull, presents with CEREBRAL EDEMA, constitutes 15% of all intracranial tumors, seen more common in women, clinical features depend on location
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MENINGIOMA
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This tumor is located in the white matter near the ventricle - can involve frontal lobe, cerebellar vermis, corpus callosum and basal ganglia, spinal seeding is sometimes sees, once rare but the incidence has increased with AIDS, risk for opportunistic infections, survival only slightly better than glioblastoma multiforme
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PRIMARY CNS LYMPHOMA
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These tumors presents with hydrocephalus, lethargy, vomitting, papilledema and gait disturbance
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PINEAL REGION TUMORS
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Paralysis of upgaze, convergence/retraction nystagmus and light-near dissociation are all indicative of _
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PARINAUD SYNDROME
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This tumor often secretes PROLACTIN (or other hormones), symptoms are due to endocrine or mass effect, patient presents with headache, visual changes, CN III, IV or VI problems and endocrine problems
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PITUITARY TUMOR
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Differential diagnosis for pituitary tumor
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CRANIOPHARYNGIOMA
MENINGIOMA ANEURYSM |
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First line treatment for prolactinoma
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BROMOCRIPTINE
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This tumor arises from Rathkes pouch, 6-10% of all childhood tumors. Patient presents with visual disturbance, endocrinopathy, headaches, ICP and papilledema and CN palsies. Diagnose by H&P, MRI/CT and biopsy
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CRANIOPHARYNGIOMA
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This tumor is derived from PARAPHYSIS, anterior superior location in 3d ventricle - oval or round gelatinous green tumor
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COLLOID CYST
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This disease is due to HEMANGIOBLASTOMA OF CEREBELLUM - associated with multiple angiomas of the retina, liver and pancreatic cysts, associated with POLYCYTHEMIA
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VON HIPPEL LINDAU DISEASE
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Which primary cancers most often cause brain metastasis - median survival less than 9 months
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LUNG
BREAST MELANOMA RENAL GI |
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This disease condition can occur both with primary and secondary cancers - multiple levels of CNS involvement, roots, CN's, compression, headache and papilledema - diagnose with H&P, CSF examination and MRI with gadolinium, treat with radiation and intrathecal chemo
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LEPTOMENINGEAL CARCINOMATOSIS
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This disease presents with fluctuating weakness, ptosis and diplopia, can affect facial and pharyngeal muscles
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MYASTHENIA GRAVIS
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Differential diagnosis of MG
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ALS
MUSCULAR DYSTROPHY LAMBERT EATON SYNDROME BOTULISM ORGANOPHOSPHATE POISONING |
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Treatment of MG
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MEDS - PYRIDOSTIGMINE, NEOSTIGMINE
IV IGG PLASMAPHERESIS IMMUNOSUPPRESSIVE DRUGS - STEROIDS, AZATHIOPRINE, CYCLOPHOSPHAMIDE, CYCLOSPORIN SURGERY - THYMECTOMY |
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When baby doesnt have myasthenia but has symptoms due to maternal antibodies (weak cry, suck, respiratory insufficiency) its called
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NEONATAL MYASTHENIA
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Mechanism of action of botulinum toxin
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Presynaptic inhibition of Ach release
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