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152 Cards in this Set

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  • Back
What are the three signs of an UMN lesion?
hyper reflexia
weakness
What are the signs of a LMN lesion?
fasciculations
atrophy
weakness
What is clonus?
maintained reflex
What would a lesion of the arcuate fasciculus cause?
normal language, but cannot repeat
Where is a lesion if language is involved?
cortex
what part of the brain involves cranial nerves 9 and 10?
medulla
what is wallenbergs?
alternation pain and temp
What artery might have an infart if wallenberg is the result? And what would be the cause?
PICA
thrombus
What is brown-sequard?
hemi-sected spinal cord
Go bottom up in localization
muscle
neuromuscular junction
LMN
UMN
Cortex
What should you test on the general examination?
Pulse, bruit, heart rhythm and blood pressure in case of stroke
orthostatic blood pressure measurements with syncope
temporal artery palpataion
palpation of muscles to look for tenderness in myopathy
Breakdown the mini mental state test of higher intellectual function
Attention
Orientation
Memory
Calculation
Abstract thought
Spatial orientation
Vision
Language
What is asomatognsia
inability to recognize body parts
what is anasognosnia
unaware of weakness or defecit
what is the word for inability to feel an object being drawn?
agraphestheisa
what is prospognosia?
inability to recognize faces
what is asteriognosis
inability to recognize objects placed in the hand
What do you test for in language?
comprehension
fluency
naming
repetition
reading
writing
when can you see multiple cranial nerves deficites?
basilar meningitis- TB, fungal, carcinomatous
What divides LMN VII vs. UMN VII?
UMN VII- motor cortex to mid-pons
LMN VII- lower pons prior to decussation
Where in the brainstem does the facial nerve originate?
mid-pons
where in the brainstem does the hypoglossal originate
medulla
What are the two possible sites of lesion if both pain and strength are impaired?
periphery or cortex
What is the site of a lesion that has one side w/ pain temp loss and the opposite side w/ vibration/position sensation loss?
spinal cord on the side of the vibration/sensation loss.
if there is pain/temp loss on one side of the face and the other side of the body, where is the lesion?
between the pons and C2
ipsilateral facial numbness
What is the difference in ptosis presentation for third nerve palsy and Horner's?
both cause ptosis and pupillary asymmetry
third nerve-> ptosis on the large pupil side
horner's on the small pupil side.
Where is the lesion when Diplopia is present?
brainstem or periphery, no tthe cortex
where is the lesion in a gaze palsy?
cortex or brainstem, not the periphery
Where is a lesion that causes dysarthria?
subcortical, brainstem, or cerebellar lesion.
What three signs in headache necessitate an MRI?
papilledema
focal neurologic defecit
recent onset

or positional headaches
what medications treat partial seizures?
carbamazepine
phenytoin
oxcarbazepine
valproic acid
phenobarbital
what medications treat absence seizures?
ethosuximide
valproic acid
what is the risk of using valproic acid and lamotrigine?
lamotrigine must be started at a very low dose. it can lead to a severe skin reaction.
abulia
loss of initiative, willpower or drive
acalculia
inability to calculate
agnosia
inablitity to recognize one or meor classes of environmental stimuli, even though the necessary intellectual and
Gerstmann's
Right-Left confusion
agraphia
acalculia
finger agnosia

angular gyrus in dominant hemisphere
what are the centers of alertness?
both cerebral hemishperes
thalamus
reticular activating system.
Where is the lesion in someone who demonstrates impersistance, perseveration
bilateral prefrontal cortex
What is the first branch of the ICA?
ophthalmic artery.
athetosis
slow, sinuous writing of the distal parts of limbs
ballism
violent, large-amplitude, involuntary flinging movementes of the proximal parts of limbs
festination
involuntary tendency for steps to accelerate and decrease in amplitude
what part of the brain is most involved in tremor?
basal ganglia
(striatum, globus pallidus, substantia nigra, subthalamic nucleus
Hyperkinetic movement disorders
involuntary movements
- chorea
- athetosis
- ballism
what are the hallmark signs of parkinsonism?
bradykinesia
rigidity
resting tremor
postural instability
How is dystonia classified?
focal- specific localized muscle groups
segmental- two or more contiguous areas of the body
multifocal- two or more not contiguous areas of the body
hemidystonia- one side of the body
generalized- entire body
dystonia
involuntary , sustained muscle contractions with preferred direction
abnl posture.
what causes postural and kinetic tremors?
abnl cerebellar outflow to the thalamus
what is alpha-synuclein
principal component of LB
maintains the integrity of neurotransmitter vesicles.
mutation of this gene-> parkinsons.
Progressive supranuclear palsy
parkinsons tremor
downgaze palsy
then an upgaze palsy
then difficulty with voluntary horizontal gaze.
oculocephalic reflexes are intact
neck dystonia and rigidity occur.
What is the treatment for progressive supranuclear palsy?
tricyclics
dopamine agonists
antidepressants
methysergide
Corticobasal degeneration
after 50
presents with clumsiness, stiffness, or jerking of one arm
spreads to involve the ipsilateral limb
dystonic posturing, apraxia
can cause alien limb
rigidity and bradykinesia
Multiple System Atrophy
combo parkinsons, cerebellar dysfunction, autnomic impairment
spasticity, CN abnlties, ant horn cell dysfunction. Peripheral polyneuropathy in any combination. 2/3rds have REM sleep behavior disorder.
what is the difference between MSA-C and MSA-P?
C- cerebellar predominant
P- Parkinsons predomninant
What is shy-drager syndrome?
parkinsons and autonomic symps in MSA-P
What are teh pathologic changes in MSA?
neuronal loss in striatum, brainstem, cerebellum, and spinal cord nuclei w/ selective nitration of alpha-synuclein in glial cytoplasmic inclusions.
Friedreichs ataxia
AR ataxia
early in adolescence with progressive gait difficulty

loss of position and vibration sense in the lower extremities
no tendon reflexes in the lower extremities.
ataxic gait, speech.
what is the underlying genetic cause of friedrichs?
unstable expansion of GAA
frataxin protein
Ataxia telangiectasia
first decade of life.
develops an ataxic gait, followed by upper extremity ataxia and ataxic speech.
difficulty initiating gaze
what is the mutation in ataxia telangiectasias?
poinositol 3 kinase
spinocerebellar ataxia
dominant inheritance
differentiation requires genetic testing.
slow progression.

mutation is an expanded CAG sequence
torticollis
patients head turned to one side, flexed, extended, tilted, or any combo
blepharospasm
blilateral eye closure- exacerbated by bright light
writer's cramp
hand assumes an infoluntary twisted posture when writing.
generalized dystonia
seen in kids, DYT1 gene is AD w/ low penetrance.
what is the treatment for focal dystonia?
botulinum toxin
What are the neurologic symps of Wilson's disease?
copper toxicity- tremor, dystonia, dysarthria, dysphagia, congitive detriorationa nd psychiatric symps.
What will a slit-lamp show in Wilson's disease?
Keyser-Fleishcer rings in most of those with neuro symps.
What are some instances to use CT over MRI?
skull fracture
intracranial bleeds- acute bleeds are white on CT w/in 20 min.
Trauma- CT is faster and safer.
Hydrocephalus- ventricles are easily seen, faster and cheaper
What is white in T2 MRIs?
edema and water accumulation.
(and CSF, but the other stuff is pathologic)
DWI- Ischemia appears white.
What are the CSF results in Bacterial meningitis?
Increased PMNs
decreased gcose
Increased proteins
increased opening pressure
cloudy
CSF in viral meningitis
Increased monos
noraml gcose
maybee increased protein and opening pressure
clear
CSF in SAH
increased blood, RBCs and WBCs, increased protein
yellow/red
GBS CSF
increased protein
MS CSF
increased gammaglobulin
CSF pseudotumor
increased opening pressure
Cheyne-Stokes respirations
crescendo-decrescendo from bilateral hemisphere dysfunction
Central neurognic hyperventilation
rapid deep breathing due to midbrain damage
Apneustic breating
prolonged inspirations with apnea from pontine dysfunction
Ataxic breating
irregular breating from medullary dysfunction.
What are the causes of delirium?
MOVE STUPID
Metabolic
Oxygen
Vascular
Endocrine/Electrolytes
Seizures
Trauma/Tumor/Temp
Uremia
Psychogenic
Infection/Intox
Drugs/Degeneration
What are the differences between delirium and dementia?
Delirium- Fluctuating orientation, stupor or agitated, rapid onset, reversible

Dementia- memory loss, normal arousal, slow development, irreversible.
what are the five As of Dementia?
Amnesia
Aphasia
Apraxia
Agnosia
Abstract thought
What are the causes of dementia other than alzheimers?
DEMENTIA
Degenerative disease- Park, Pick, Hunting, LBD
Endocrine- Thyroid, Parathyroid, pit-adrenal axis
Metabolic- alcohol, fluid e-lytes, b12, gcose, hepatic/renal
Exogenous- heavy metals, CO, drugs
Neoplasm
Trauma- subdeural hematoma
Infection- Meningitis, encephalitis, abscess, endocarditis, HIV, syphilis, prions, Lyme disease
Affective disorders- Pseudodemitia 2ry to depression
Stroke/Structure- Multi-infarct, ischemia, vasculitis, normal pressure hydrocephalus
what are some drugs used in alzheimers?
Anticholinesterase inhibitors
Rivastigmine
galantamine
donepezil

Anti-oxidants- Vit E- Alpha tocopherol selegiline
rivastigmine
AChE inhibitor
- alzheimers
galantamine
AChE inhibitor
- alzheimers
donepezil
AChE inhibitor
- alzheimers
alpha-tocopherol
vit E
antioxidant
for alzheimers
selegiline
anti-oxidant
for alzheimers
Meniere's disease
intermittent vertigo from dilation and periodic rupture of the endolymphatic compartment of the inner ear.
What is the DDx for peripheral vestibular disorders?
BPPV
Meniere's disease
peripheral vestibulopathy
otosclerosis
cerebellopontine-angle tumor
vestibulopathy/acoustic neuropathy
What is the DDx for acute central ataxias?
Drugs
Wernicke's
Vertebrobasilar ischemia
Bertebrobasilar infarction
Inflammatory disorders
Cerebellar hemorrhage
What is the DDX for chronic central ataxias?
MS
Cerebellar degen
hypothyroidsim
Wilson's
CJD
Posterior fossa mass
Ataxia-telangiectasia
what agents can be used prophylactically in migraine?
B-blockers- propranolol
Ca-channel blockers- verapamil
TCA- amitriptyline
Valproic acid
What is abortive therapy for cluster headaches?
100% O2, sumatriptan, erogts, intranasal lidocaine, corticosteroids
What is the prophylactic treatment for migraines?
Ca-channel blockers
ergots
valproic acid
prednisone
topiramate
methysergide
Astrocytoma
Headache and increased ICP
Unilateral paralysis in CN V-VII and X
Slow, protracted course
Good prognosis
Resection or rads
GBM- Grade IV astrocytoma
most common 1ry brain tumor
presents w/ headache and ICP
rapid progression
Rx- Surgery, Rads
Meningioma
Originates from the dura mater or arachnoid
good prognosis
increased incidence w/ age
Surgical resection; radiation for unresectable tumors
Acoustic neuroma
Ipsilateral hearing loss, tinnitus, vertigo, and cerebellar dysfunction
Schwann cells
Surgery
Medulloblastoma
Kids
4th ventricle-> increased ICP
Malignant, may spread to subarachnoid space
Surgery, rads, chemo
Ependymoma
Common in kids
arise from ependyma of a ventricle or spinal cord
bromocriptine
increases dopa tone
good for parkinsons
Pramipexole
increases dopa tone
good for parkinsons
What is the Rx for huntingtons?
Reserpine- decreases unwanted movements
Haloperidol- for the psychosis
Antidepressants
Benzos- for anxiety
Genetic counseling for offspring
Lhermitte's sign
electrical sensation running down the spine and into the lower extremities w/ neck flexion
Uthoff's phenomenon
exacerbation of weakness w/ heat.
What is the Rx for MS?
ABC
Avonex- IFN B 1a
Betaseron- IFN B 1b
Copaxone- copolymer 1

Steroids for acute exacerbations
- PT and symptomatic treatment.
Lennox-Gastaut
Juvenile epilepsy, 1.5-2 Hz, loss of body tone
west syndrome:
what is it, what is it's treatment?
infantile spasms
ACTH
What drug is used in complex partial seizures
Carbamezapine, phenytoin
Absence seizures
ethosuximide
divalproex sodium
what is the Rx for seizure in preeclampsia
MgSO4
what is the treatment for trigeminal neuralgia?
carbamazepine
phenytoin
gabapentin

Not Effective: indomethacin, valproic acid
What neurologic disease is associated with trigeminal neuralgia?
MS
what is similar between facial pain and trigeminal neuralgia?
unilateral

facial pain is constant, trigeminal is paroxysmal
what are some prophylactic medications for migraine
verapamil
amitriptyline
valproate
propranolol
what are abortive againts
Ergots
triptans
metoclopramide
what is the manifestation of encephalitis lethargica?
movement disorders
parkinsons
What nerve is damaged in sarcoid?
VII
How do you treat Toxo?
Sulfadiazine and Pyrimethamine
what is the Rx for JC on top of HIV?
HAART
What CN does Lyme disease affect?
III
what eeg is seen with HSV?
bilateral epileptiform discharges
how do you treat lyme disease?
ceftriaxone
what is the Rx for Rabies
Supportive therapy
What is the Rx for CMV?
gancyclovir
what is a gumma?
largely avascular granuloma
seen in syphylis
what causess osteomyelitis in HIV?
Aspergillus
what is the most common cause of brain abcess in HIV?
normal people?
toxo
strep
What virus causes SSPE?
measles
What is the hallmark of bartonella encephalitis?
seizure
what cells change in chronic liver failure?
astrocytes
what cells change in chronic liver failure?
astrocytes
in what dementia is myclonus common?
CJD
what is the triad of normal-pressure hydrocephalus?
gait disturbance, dementia, and incontinence.
What is the treatment for alzheimers?
Donepezil
what aphasia is common in alzheimers?
Transcortical sensory aphasia
what is the drug used when a long-term neuroleptic causes parkinsonism?
Trihexyphenidyl
what is the drug of choice for turet's
haloperidol
what is Meigs' syndrome?
forceful blinking and grimacing movements, tongue protrusion
locked-in syndrome
paralysis with perserved conciousness.
infarction of the pons.
what is the role of baclofen in MS?
anti-spasmodic
Neuromyelitis optica
bilateral optic neuritis with transverse myelitis.
Adrenoleukodystrophy
adrenal dysfunction with progressive degnerative disease.
x-linked.
brain damage, atp binding transporter.
Pelizaeus-Merzbacher disease
demylenation- sudanophilic leukodystrophies.
most are male.
early onset
rapid hyponatremia correction in alcoholic casues what?
central pontine myelinolysis.
what part of the CNS does alcohol effect?
superior vermis
TOCP causes what?
severe motor polyneuropathy
how does lead kill kids?
edema