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322 Cards in this Set
- Front
- Back
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Dx
Visual hallucinations, cognitive decline, fluctuations of alertness, extrapyramidal symptoms, extraordinary sensitivity to neuroleptics |
Dementia with Lewy Bodies
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Dx
Dementia with visual hallucinations and extra-sensitivity to antipsychotics |
Dementia with Lewy Bodies
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Ddx between
Dementia with Lewy Bodies Parkinson's Alzheimer's |
Parkinson's - Motor deficit begins at least 1 year before cognitive dementia.
Alzheimer's Dementia with Lewy Bodies - overlaps with both Alzheimer's and Parkinson's. Cognitive decline happens concurrent with motor deficit. DwLBs is caused by a loss of ACh producing neurons (causing cognitive dementia) and loss of dopaminergic neurons (causing parkinson's syndrome) |
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What is a central scotoma?
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An area of deficit in the visual field which has normal visual field around it (as in macular degeneration)
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Dx
Inability to adduct 1 eye, and nystagmus in the other eye when abducting |
Internuclear Ophthalmoplegia (INO) in the eye that can't adduct (nl eye will have nystagmus)
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Dx
Optic neuritis, year later - right INO |
MS
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CSF abnormalities in
Subarachnoid Hemorrhage (2) |
1) Xanthochromia - from old blood
2) Lymphocytic high WBCs |
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Dx
Obtundant with blown R pupil |
Increased ICP cuasing herniation that compressed CN III.
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Localize the lesion
Symmetrical muscle weakness of proximal muscles and neck flexors and extensors |
Muscle problem
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Dx
3 kHz spike with staring spells |
Absence seizure
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Tx for
Absence seizures |
1) Ethosuximide
2) Valproic Acid |
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Tx for
Prevention of migraines |
1) TCAs (Amytriptyline and Nortriptyline)
2) Propanolol 3) Verapamil |
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Huntington's localizes to which chromosome
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Ch 4
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Dx
Ataxia, dysarthria, nystagmus |
Cerebellar degeneration (usually paraneoplastic). Alcohol affects vermis so usually is only ataxic gait in symptomology.
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Dx
Increased frequency and urination |
Spastic bladder
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Oxybutynin
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Anti cholinergic for spastic incontinence
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Tolteradine
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Anti cholinergic for spastic incontinence
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Imipramine
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Anti cholinergic for spastic incontinence
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Neurologic complications of diabetes
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Peripheral neuropathy
Autonomic neuropathy Cranial neuropathy Radiculopathy (but not myopathy) |
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Dx
Multiple non-contiguous peripheral nerves involved |
Mononeuropathy multiplex
(underlying rheum e.g. vasculitis probable cause) |
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Dx
Effortful, nonfluent speech, inability to repeat, preserved comprehension |
Broca's aphasia
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Dx
Neck stiffness, HA, lymphotic pleiocytosis, elevated protein, nl glucose |
Aseptic (viral) meningitis
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Dx
Meningitis that is aseptic with temporal lobe involvement/necrosis |
HSV-1
Give acycolvir immediately |
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Localize the lesion
Neglect of right arm |
Left parietal lobe lesion
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Tx for
Status epilepticus |
1) Benzos 1st line
2) Phenytoin and Phenobarbital used after benzos 3) Propofol if refractory |
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Tx for
MS 1) Reduce relapses 2) Refractory cases 3) Acute relapses |
1) Reduce relapses - Interferon beta-1 or Glatiramer acetate
2) Refractory cases - Azathioprine 3) Acute relapses - Methylprednisone |
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Dx
Meningoencephalitis, seizures, myelopathy, peripheral neuropathy |
Neurosarcoid
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Localize the lesion
Complete half body sensory loss |
Contralateral thalamus
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Dx
Middle meningeal artery bleed |
Epidural hematoma
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Localize the lesion
Proprioception loss, weakness. Pain and temperature spared. |
Dorsal columns and Corticospinal tracts (Tabes Dorsalis)
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Localize the lesion
Ipsilateral weakness, ipsilateral proprioception loss, contralateral loss of pain and temperature |
Brown-Sequard hemi spine lesion
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Localize the lesion
Weakness and loss of pain and temperature bilaterally |
Anterior spinal cord (ventral horns and spinothalamic tract involved)
(anterior spinal artery infarction) |
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Dx study for
Hypomelanotic lesions, seizures |
Head CT or MRI for cortical tubers,subependymal astrocytomas in Tuberous Sclerosis Complex
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Dx
Hypomelanotic lesions, seizures |
Tuberous Sclerosis Complex
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Genetics of TSC (Tuberous Sclerosis Complex)
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TSC I - Ch9 Hamartin
TSC II - Ch16 Tuberin both tumor supressor genes |
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GBS CSF findings
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High protein
Low WBCs |
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Pathophysiology of
GBS |
Demyelination of multiple nerve roots
hence AIDP (Acute Inflammatory Demyelinating Polyradiculoneuropathy) |
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Tx for
GBS |
IVIG or Plasmapharesis
(steroids not proven to work) |
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Dx
Seconds to minutes of vertigo, n/v |
Benign Positional Paroxysmal Vertigo
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Difference in pathophys between
Myasthenia Gravis and Lambert Eaton |
MG - Antibodies to post synaptic ACh receptor
LE - Antibodies to pre synaptic voltage gated Ca channel |
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Dx
Jaw pain, high ESR |
Temporal arteritis
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Tx for
Temporal Arteritis |
Prednisone for months
(to prevent ophthalmic artery involvement leading to blindness) |
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Use of Pemoline or Pimozide
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Stimulants (noamphetamines) for narcolepsy
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Areas susceptible to intracerebral hemorrhage
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Basal ganglia
Thalamus Pons Cerebellum |
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Dx study for
Hemorrhage into posterior fossa |
Still non-contrast head CT
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Dx
Gait: Stooped posture, slow, shuffling, small steps, reduced arm swing |
Parkinson's disease
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Dx
Gait: Impaired gait initiation, difficulty lifting feet off ground, small and shuffling steps |
Frontal gait
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Dx
Gait: Stiff leg with increased adductor tone and circumduction of the hip |
Hemiplegic gait
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Dx
Gait: Slow, cautious, wide-based gait |
Ataxic gait
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Dx
Proximal muscle weakness, markedly elevated CK |
Duchenne's muscular dystrophy
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Localize the lesion
Right face weakness and left body weakness |
Pons
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S/e of
Carbamazepine |
Hyponatremia
Agranulocytosis Steven Johnson's |
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Dx
Tearing or bridging veins |
Subdural hematoma
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Most common cause of subarachnoid hemorrhage
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Trauma
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Dx
Diffuse, homogenous enhancement (i.e. not ring enhancing) on gad contrast MRI |
Primary CNS Lymphoma
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Dx
Loss of touch discrimination, vibration, and proprioception |
Tabes Dorsalis
(dorsal column gracilis and cuneatus) |
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Dx
Ipsi - loss of touch, vibration, proprioception, spastic weakness, singular flaccid weakness Contra - loss of pain and temperature 1 segment below |
Cord Hemisection
Brown-Sequard |
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Dx
Bilateral - spastic weakness, loss of pain and temperature, local flaccid paralysis, loss of voluntary bladder and bowel control Horner's if above T2 |
Ventral artery occlusion
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Localize the lesion
Bilateral arm leg dystaxia |
Spinocerebellar tract
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Dx
Bilateral loss of touch, vibration, proprioception, bilateral spastic weakness, bilateral arm and leg dystaxia |
Subacute combined degeneration (Vitamin B12 neuropathy)
also could be Friedriech's ataxia |
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Dx
Bilateral loss of pain and temperature, bilateral flaccid paralysis of hands |
Syringomyelia
(central cervical cord lesion) |
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Dx
Paresthesias, pain, sensory loss, hyporeflexia, and muscle weakness |
Disc herniation
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Dx
Gradual unilateral hearing loss |
Acoustic schwannoma
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Dx
Tachy, diaphoresis, SOB, light headedness, tingling in hands and feet |
Hyperventilation
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What is the nystagmus in BPPV?
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Unidirectional
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Dx
Dizziness, dysarthria, ataxia, bilateral dysmetria of upper and lower extremities over a 10 day period |
Paraneoplastic syndrome (anti-yo)
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Dx
Severe headache, dizziness, falling to 1 side, vomiting. bilateral horizontal nystagmus |
Cerebellar hemorrhage
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Dx
Momentary vertigo, diplopia, numbness around mouth. Symptoms quickly resolve. |
Vertebrobasilar TIA
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Dx
Parkinsonism, ataxia, autonomic dysfunction, |
Multiple system atrophy
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Dx
Post meningeal shuffling gait, urinary incontinence, ataxia |
Communicating hydrocephalus (non-obstructive that is)
Caused by scarred arachnoid granulations (which should absorb CSF). He has Normal Pressure Hydrocephalus. |
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Tx for
Normal pressure hydrocephalus |
Shunt
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Dx
Brain atrophy with dilated ventricles (2) |
Alzheimer's with Hydrocephalys ex vacuo
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Dx
Frontal HA, tripping over feet, spastisicity in legs with hyperreflexia. Sensory exam is normal. |
Parasagittal meningioma
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Dx
Ventricles 1-3 large, but 4 is normal size |
Aqueductal stenosis
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Dx
HA and unsteadiness which worsen when the pt leans forward |
Obstructive hydrocephalus
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Most childhood tumors are subtentorial, while most adult tumors are supratentorial
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Dx
17 yo with HA, n, facial weakness, limb dysmetria |
Medulloblastoma
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Dx
Mild cognitive deficits after a surgery |
Hypoxic-Ischemic encephalopathy due to microemboli during surgery
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Dx
Sleep disturbances, mood change, poor concentration and memory, lightheadednes, nausea, trauma |
Concussion
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Dx
14-3-3 protein in CSF |
Creutzfeld Jakob
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Dx
Paranoia, hoarding, visuospatial defects |
Early Alzheimer's
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Glasgow coma scale for brain death
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3
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Dx
Cognitive impairment involving more than memory which interferes with occupational or social functioning |
Dementia (general)
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Dx
Cognitive impairment which affects more than memory but does not affect occupational or social functioning |
Mild Cognitive Impairment
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Disease modifying meds for alzheimer's (3)
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Galantine
Donepezil Rivastgmine |
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Decreases effectiveness of OCPs
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Phenytoin
(also oxcarbazepine) |
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Drugs that cause cerebellar ataxia
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Cytosine arabinoside
5-fluorouracil |
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Drugs that cause peripheral neuropathy
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Chemotherapies (docetaxel, paclitaxel, platinum)
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Tx for
Antipsychotic induced dystonia |
Diphenhdramine
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Drug induced psychosis
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Steroids
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Most common cause of neural tube defects (medication)
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Valproic Acid
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S/e
Weight gain, hair loss |
VPA
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Drug that causes increased levels of AEDs
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Erythromycin
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AED most likely to cause Hyponatremia
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Oxcarbazepine
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Antidepressant that decreases seizure threshold
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Bupropion
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Drug that causes
Loss of autoregulation, hypertension, vasospasm, seizures, confusion (2) |
Tacrolimus or Cyclosporine
(Posterior reversible encephalopathy syndrome) |
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Dx
HA, confusion, seizures, and visual loss after new drug initiation |
Posterior reversible encephalopathy syndrome
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Dx
Diplopia worse with far vision, mild eye pain, inability to abduct eye |
CN VI palsy, usually due to infarct
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Dx
Bitemporal anopsia with agalactorrhea after pregnancy |
Sheehan's syndrome (pituitary apoplexy), i.e. death to pituitary gland due to hypovolemic shock after childbirth
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Complication of Sheehan's syndrome
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Adrenal insufficiency due to low ACTH production
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Common iatrogenic cause of cataracts
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Steroids
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Dx
HA with horner's |
Cluster HA
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Most common cause of INO
old - young - |
old - Paramedian pontine perforating stroke
young - demyelinating disease |
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Dx
Pain with eye movement and central scotoma |
Optic neuritis
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Dx
Shoulder, neck and hip pain with HA and blurry vision |
Temporal arteritis in someone with polymyaglia rheumatica (commonly run together)
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Dx
Dizziness, slurred speech, diplopia, severe HA, vomitting, short lived |
Basilar migraine
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Dx
Collapses, vomiting, rigid neck, one eye is dilated, ptotic, and abducted |
CN III palsy due to Posterior communicating artery eneurysm
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Dx
Consistent 6 month headache with homonymous superior quadrant anopia |
Meyer's loop defect due to brain tumor
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Dx
Visual field loss that doesn't decrease with increasing distance |
Tunnel vision (conversion or malingering)
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Tx for
Tic Douloureux or Trigeminal neuralgia |
Carbamazepine
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Dx
Jaw pain and anemia |
Temporal arteritis
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Dx
Hyderdense lesion that ehances uniformly with contrast with HA |
Meningioma
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Dx
Daily HAs that worsen over the course of the day, worse with stress or loud noises |
Tension type headache
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Who should not get triptans for their migraines?
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Pts with HTN or CAD
(triptans cause vasoconstriction) |
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Dx
Diffuse hyperreflexia, current illness, hypodense areas of temporal lobes |
HSV encephalitis
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CSF of HSV
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WBCs in the 100s, RBCs even with champagne tap
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Dx
Elevated ICP in immunocompromised |
Cryptococcus
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Tx for
Cryptococcus |
Amphotericin B and Flucytosine
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Dx
Profound hearing loss from CNS infection |
H Flu encephalitis
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Dx
Mutliple cranial neuropathies, raised ICP, hydrocephalus, low CSF glucose |
TB meningitis
(usually in S. America) |
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Dx
Tingling in distal limbs, weakness, absent deep tendon reflexes after vaccination |
GBS
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Dx
Multiple mass lesions in HIV pt |
Toxoplasmosis
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CNS lymphoma is associated with what in HIV pts
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Ebstein Barr Virus
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Dx
Bilateral facial weakness |
Lyme disease
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Dx
Back point tenderness, with bilateral hyperreflexia |
Abscess in spine
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Tx for
Neurocysticercosis |
Albendazole
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Most common cause of acquired epilepsy in 3rd world
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Neurocysticercosis
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Prophylatic tx for Nisseria meningitis
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Rifampin
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Dx
Meningitis with purple rash on abdomen |
Nisseria Meningitis
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Tx for
Bell's palsy |
Prednisone and acycolvir
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Dx
Walks on toes, generalized hyperreflexia, bilateral babinski, writhing movements of upper limbs |
Cerebral palsy
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Dx
Clumsy walking, high arched foot, lack of sensation in feet to touch and proprioception |
Charcot-Marie-Tooth disease
(demyelinating disease of peripheral nervous system) |
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Dx
Teenager with weakness, high CK, atrophy of shoulder and pelvis |
Becker's muscular dystrophy
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Dx
Bilateral acoustic neurmoas, what does he have also? |
Neurofibromatosis 2
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Dx
Dumbbell shaped lesion in spinal cord, skin lesions, pain and absent reflexes |
Neurofibromatosis 1
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Dx
Subependymal nodules clustering around foramen of monro, intellectually retarded |
Tuberous Sclerosis
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Dx
Torticollis, facial tics |
Tourette's
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Dx
Exercise induced muscle weakness and dark urine, second wind phenomenon |
McArdle's disease (glycogen storage disease), can't breakdown glycogen into glucose, gylcolysis intact
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Dx
Infant with seizures, decreased brain size, increased muscle tone, clonus at ankles, hyperdensities along margins of lateral ventricles |
Congenital Cytomegalovirus
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Dx
Ataxia with walking, areflexic, high foot arch |
Freidriech's ataxia
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Dx
Ptosis, type 2 diabetes, hypothyroid, frontal balding, inability to relax muscles after contraction |
Myotonic dystrophy
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Associated with Isoniazid
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B6 Pyridoxine
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Tx for
Organophosphate poisoning |
Atropine for muscarinic effects and Pralidoxime for the nicotinic effects
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Dx
Increased ICP (Pseudotumor cerebri) due to intoxication |
Vitamin A excess
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Dx
Confusion, ataxia, nystagmus in all gazes bilaterally, abducens weakness |
Thiamine deficiency
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Dx
Colectomy, ataxic gait, positive romberg, absent reflexes, diminished proprioception |
Vitamin E deficiency
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Dx
Abdominal pain, constipation, weakness of extensor muscles, sensation intact |
Lead poisoning
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Dx
TPN intoxication |
Manganese intoxication
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Dx
Paresthesias in hands and feet, bilateral babinskis, hyporeflexia in upper and lower limbs, atrophic gastritis |
B12 deficiency
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Electrolyte abnormality that causes seizures
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Hyponatremia
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Dx
Pigmentation over axillae, tinnitus, vomiting, nausea, grayish lines on nails |
Arsenic poisoning
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Dx
Microcytic anemia with extensor muscle weakness |
Lead poisoning
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Dx
4th and 5th fringer pain, interosseous weakness |
Ulnar neuropathy
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Dx
Positive leg raise test, alleviated by leaning forward |
Spinal stenosis
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Dx
Inability to stand on toes |
S1 radiculopathy
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Dx
Inability to dorsiflex |
L15 radiculopathy
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Dx
LMN problems at arms, UMN problems at legs |
Syringomyelia
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Dx
Muscles weakness worsening with exertion vs Improving with exertion |
Worsening - MG
Improving - LE |
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Dx
Post surgical weakness of ankle dorsiflexion, eversion, and great toe extension in one leg |
Peroneal nerve compression around head of fibula
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Tx for
Trigeminal neuralgia |
Carbazepine (Na blocking agent)
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Localization
Down Syndrome causes what |
Early dementia
Nucleus Basalis of Meynert |
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Localization
CO poisoning |
Globus pallidus
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Area involved in Huntington's disease
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Caudate nucleus
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Area involved in hemiballismus
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Subthalamic nucleus
(lacunar strokes) |
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Confusion, lethargy, memory problems in weight loss.
Dx? Localization? |
Thiamine deficiency
Mammilary bodies |
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Dx
HA, dilated pupils that are non reactive, retractory nystagmus to upward gaze |
Dorsal midbrain syndrome
(pineal gland tumor) |
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Area involved in volountary action, good for deep brain stimulation
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Subthalamic nucleus
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Localize:
Uncontrollable eating |
Hypothalamus (supraoptic nucleus)
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Dx
CA, weakness that improves with exertion |
Lambert Eaton
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Localize
Becomes suddenly comatose |
Brainstem (most likely pontine hemorrhage or basilar occlusion), pinpoint pupils, quadriparesis, impaired eye movements
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Localize
Pure motor loss of face arm and leg unilaterally |
Internal capsule stroke
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Localize
Endocarditis with sudden loss of unilateral leg strength |
ACA bacterial emboli
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Localize
Extensor muscles of arms weak, no sensory loss |
Radial nerve palsy
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Localize
Vertigo, dysphagia, facial numbmness, opposite arm and leg numbness, horner's, nystagmus |
Wallenburg syndrome
(vertebral artery occlusion or PICA occlusion to medulla) |
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Dx
Pregnant woman develops HA, lethargy, and generalized seizure |
Venous sinus thrombosis
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Tx for
Venous sinus thrombosis |
Warfarin
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Tx for
Neuroleptic malignant syndrome |
Dantrolene
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Dx
Absence seizures as a child, stiffness in legs, urinary incontinence, decreased vibration and proprioception, post void residual |
Progressive supranuclear palsy
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Dx criteria for
Dementia with Lewy Bodies |
1) Fluctuating cognition with pronounced variations in attention and alertness
2) Recurrent visual hallucinations that are typically well-formed and detailed 3) Spontaneous motor features of Parkinsonism |
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Dx
Neuroleptic malignancy |
Dementia with Lewy Bodies
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Dx
Decreased concentration, memory loss, dysarthria, tremors, irritability, mild HAs, personality change to slovenly, irresponsible and confused |
Neurosyphilis
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Dx
Personality change (euphoria, disinhibition, apathy), compulsive behaviors (hyperorality), impaired memory, visual spatial function intact |
Pick's Disease aka Fronto-temporal Dementia
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Dx
Tremor absent at rest but pronounced with goal directed behavior |
Essential Tremor
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Dx
Resting tremor which improves with intention |
Parkinsonian Tremor
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Huntington's chorea movements are exacerbated by what?
|
Fine motor movements
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Dx
Tremor localizing to spine with ataxia |
Spinocerebellar ataxia
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Tx for
Essential tremor |
1) Propanolol
alt. Primodone or Topiramate 2) second line = Deep brain stimulation or surgery |
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Tx for
Subdural hematoma |
Surgical evacuation
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Cause of subdural hematomas
|
Trauma that tears bridging veins
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Dx
Sudden onset vertigo, vomiting, occipital HA, HTN, possible coma or 6th nerve palsy |
Cerebellar hemorrhage
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Dx
Dehydration, confusion, coma, dry flushed skin |
Heat stroke
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Dx
Acute onset vertigo and nystagmus without any other neurological deficits |
Vestibular neuronitis
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Dx
Recurrent vertigo with tinnitus and hearing problems, no HA or vomiting |
Meniere's disease
(increased pressure in endolymph hence feeling of fullness) |
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Localize the lesion
Contralateral motor and sensory deficits more pronounced (but non existent) in the lower limb vs the upper limb |
ACA stroke
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Localize the lesion and Dx
Pure motor hemiparesis unilateral motor deficit (face, arm, leg to a less extent); mild dysarthria, NO sensory, visual or higher cortical dysfunction |
Lacunar infarct in posterior limb of internal capsule
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Localize the lesion and Dx
Pure Sensory stroke Unilateral numness, paresthesias and hemisensory deficit involving face, arm, trunk, and leg |
Stroke in the Ventroposterolateral nucleus of the Thalamus
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Localize the lesion and Dx
Ataxic hemiparesis Weakness that is more prominent in the lower extremity along with ipsilateral arm and leg coordination |
Lacunar infarct of posterior capsule (sic)
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Localize the lesion
Dysarthria, clumsy hand syndrome Hand weakness, mild motor aphasia, NO Sensory loss |
Lacunar stroke at the basis pontis
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How does arterial dissection present?
|
Full blown stroke syndrome
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How does berry aneursym present?
|
Oculomotor deficits before rupture and
Subarachnoid hemorrhage after rupture |
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Dx
Painless proximal weakness |
Steroid induce myopathy
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Tx for
Acute agitation in elderly and demented patients |
Haloperidol
I.e. not benzos |
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Dx
Anesthesia of lumbar dermotomes, bowel and bladder incontinence, low back pain |
Cuada Equina syndrome
(causes: lumbar disk disease, malignancy, absecess) |
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Tx for
Myasthenia Gravis |
Pyrodostigmine
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Dx study for
Myasthenia gravis |
Edrophonium (short acting anti-cholinesterase)
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Tx for
Muscarinic side effects of anti-cholinergics |
Atropine
|
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Second line tx for
Myasthenia gravis |
Prednisone, azathioprine, cyclosporine
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Third line tx for
Myasthenia gravis |
IVIG and
Plasmapharesis |
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Dx
Ipsilateral ataxia, nystagmus, intention tremors, loss of coordination, HA |
Cerebellar tumor
(patient falls to side of lesion) |
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Dx
Inability to conjugate gaze with lateral gaze but can conjugate gaze with accomodation |
INO due to MLF lesion
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Dx
HA, arhtralgias, myalgias |
Lyme disease
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Dx
Weakness, hyperreflexia, extensor plantar response bilaterally |
Cord compression
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Dx study for
Weakness, hyperreflexia, extensor plantar response bilaterally |
MRI for cord compression
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Dx
Progressive dementia, myoclonus, sharp triphasic synchronous discharges on EEG |
Creutzfeld Jakob
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Pathophys of
Malignant hyperthermia |
Ca efflux from sarcoplasmic reticulum
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Dx
Memory loss, apraxia, langue difficulties, personality changes, impaired judgment |
Alzheimer's
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Dx
Focal neurological signs of acute onset that worsen over the day |
Intracranial bleed
(in the basal ganglia, thalamus, pons, and cerbellum most common places) |
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S/e of
Carbidopa levodopa |
Hallucinations, dizziness, HA., agitation
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Dx
Rapid onset of severe pain, vision loss, halos, red eye, dilated pupil poorly responsive to light, lacrimation |
Acute angle closure glaucoma
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Tx for
Cauda equina |
Emergency surgery
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Dx
Wide shuffling gait, dementia, urinary incontinence, enlarged ventricles |
Normal pressure hydrocephalus
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Alzheimer's patients generally don't have problems with urinary incontinence or gait
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hmmm
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Dx study in
Myasthenia gravis for treatment considerations |
Chest CT for thymoma
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Dx
Tinnitus, hearing loss, cafe au lait spots |
Neurofibromatosus II
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Dx study for
Tinnitus, hearing loss, cafe au lait spots |
MRI with gad for neurofibromatosis II
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Dx
Suspected small stroke with motor disturbance but no stroke seen on non contrast head CT. Htn, DM |
Lacunar stroke (usually of posterior internal capsule)
Sometimes not big enough to show up on head CT |
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Dx
Carotid artery thrombosis or stenosis |
Embolic stroke
(Not a cause of lacunar strokes) |
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Dx
Persistent HA, vision changes, nausea, vomiting, pailledema |
Brain tumor
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Dx
Transient paralysis after a seizure |
Toddy's palsy
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Electrolyte imbalance following subarachnoid hemorrhage
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Hyponatremia
(The brain secretes ADH retaining water, and Brain naturitic peptide that causes salt loss) |
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Electrolyte imbalance in intracranial hemorrhage
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Hyponatremia
(Caused by SIADH) |
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Dx
Thenar emminence atrophy |
Carpal tunnel (median nerve)
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Dx
Areflexic weakness in upper extremities and loss of pain/temp but preservation of position and vibration in a cape distribution |
Syringomyelia - a cord cavity
(destruction of grey and white matter tracts next to central canal) |
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Dx
Cafe au lait spots, macrocephaly, feeding problems, short stature, LD. Freckles on armpit and groin. |
Neurofibromatosis 1
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Which cranial nerve innervates the cornea
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V Trigeminal
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What does CN VII control?
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Facial muscles
Taste in anterior 2/3 of tongue Lacrimation Salivation Eye lid closing (minor) |
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What does CN X control?
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Swallowing
Palate elevation Talking Abdominal viscera |
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Dx
Muscle weakness, with skin rash, ill defined mass in lungs |
Dermatomyositis from lung cancer
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Dx
EBV DNA in an immunocompromised person with solitary weakly ring enhancing mass in brain that is periventricular |
Primary CNS lymphoma
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Dx
Personality changes, compulsive behaviors, and impaired memory |
Fronto-temporal dementia
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Dx
Fluctuating cognitive impairment, parkinsonism but poor response to dopaminergic therapy |
Dementia with Lewy Bodies
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What does atropine do?
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Blocks musacrinic activity
(anti cholinergic) |
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Dx
Papilledema, HA, vomiting, nausea, obese female, normal imaging. |
Pseudotumor cerebri (benign intracranial hypertension)
Impaired absorption of CSF |
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Tx for
Pseudotumor cerebri |
Weight loss, stop OCPs,
Acetazolamide |
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Complication of pseudotumor cerebri
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Blindness (optic nerve sheath needs sheath fenestration)
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Dx
Tx for essential tremor that causes abdominal pain, hallucinations, confusion, HA |
Primidone
(causes porphyria) |
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MMSE consistent with dementia
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Less than 24/30
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What areas are affected by Alzheimer's?
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Diffuse cortical and subcortical atrophy in the temporal and parietal lobes more than others
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Dx
CT/MRI brian lesion of butterfly appearance with central necrosis and serpiginous contrast enhancement |
Glioblastoma Multiforme
(a type of high grade astrocytoma) |
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Dx study for
1st episode of unprovoked seizure |
Contrast head CT
(to rule out intracranial hemorrhage) |
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Pathophys of
Normal pressure hydrocephalus |
Decreased CSF absorption
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Dx
Dementia, muscle twitching, and periodic sharp waves on EEG |
Creutzfeld Jakob
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How does glatimer acetate work?
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Inhibits T cell mediated autoimmunity to myelin basic protein
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Dx
Parkinsonism, orthostatic hypotension, impotence, incontinence, or other autonomic symptoms |
Multiple system atrophy
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Tx for
Multiple system atrophy |
Restrictive clothing, volume expansion, salt supplementation
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Dx
CSF: lymphocytic pleocytosis, increased reds, elevated protein. HA, seizure, fever. |
HSV-1 encephalitis
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Mgmt
Acute delirium or acute ataxia in malnourished patient |
Thiamine supplementation
(i.e. rule out reversible causes of confusion) |
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Fatal complication of
Subarachnoid hemorrhage and tx |
Vasospam
tx is Nimodipine (CCB) |
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Dx
Contralateral loss of pain/temp, ipsi loss of vibration and proprioception |
Brown sequard
Lesion is 1-2 segments up |
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GBS is preceded by what?
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Usually campylobacter
but also URIs! |
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CSF in GBS
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High protein, normal whites, reds, and glucose
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CSF Findings in MS
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1) nl pressure,
2) nl protein 3) nl cell counts (whites under 30) 4) Oligoclonal bands! |
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Dx
Large bright spot on head CT |
Hemorrhagic stroke
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Dx
Memory changes, weight gain, fatigue, constipation, hoarseness. |
Hypothryoid
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What is special about forehead?
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Bilaterally innervated, while rest of face is unilaterally innervated.
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Dx
HIV pt with focal neurological signs and multiple non-enhancing lesions with no mass effect |
Multifocal leukoencephalopathy
(PML caused by JC virus) |
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Dx
Ring enhancing lesion in HIV patient |
Toxoplasmosis
(positive serology is not indicative really) |
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Tx for
Seizure 1st and 2nd line |
1st - Benzos
2nd - Phenytoin |
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Complication of NF-1
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CNS tumors
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Tx for
Heat stroke over 105 |
Evaporative cooling of patient
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Localize
Neglect |
Contralateal parietal lobe
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Difference between hemorrhage and infarct on head CT
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Hemorrhage is hyperdense
Infarct is hypodense |
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Tx for
Absence seizure |
Ethosuximide
possibly Valproic Acid |
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Tx for
Primary generalized tonic clonic seizures |
Carbamazepine
or Phenytoin 2nd line is Lamotrigine |
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Tx for
Mixed seizures |
Lamotrigine
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When is phenobarbital used in seizure
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As adjunctive
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Localize the lesion
Severe dysthesia with hemi-sensory loss |
Thalamus
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Most common cause of subarachnoid hemorrhage in non-trauma case
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Saccular aneurysm rupture
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Mgmt
Hemorrhagic stroke in pt with INR of 4.0 |
Fresh Frozen Plasma
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Dx
Focal neurologic deficit with gradual worsening over minutes to hours (i.e. not abrupt), hemiparesis, eventual HA, vomiting, altered MS |
Putamen hemorrhage
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Dx
Foot drop |
L5 radiculopathy most common
then Peroneal nerve if congenital Charcot marie tooth |
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Differentiate alzheimer's and pseudodementia
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Alzheimer's will also have in addition to memory loss and gait problems, aparaxia, agnosia, executive function problems.
Also, people with alzheimer's usually don't complain about or notice their memory problems, whereas those with pseudodementia do rue their cognitive loss. |
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Dx
Pulsatile tinnitus, abducens nerve palsy, nausea, vomiting. |
Psuedotumor cerebri
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Mgmt for
Suspected pseudotumor cerebri |
MRI for space occupying lesion
then LP with opening pressure |
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Dx
Empty sella, slit like ventricles |
Pseudotumor cerebri
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Things to check before starting a triptan (3)
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1. Pregnancy
2. Uncontrolled HTN 3. CAD |
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Dx
Rapidly ascending paralysis, absence of fever, absence of sensory abnormalities, and normal CSF |
Tick borne paralysis
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Indications for
Carotid endarterectomy |
Asymptomatic patients with a stenosis of 60 to 99%
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Which meds cause ototoxicity
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Aminogylcosides like gentamicin
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Tx for
Aborting a cluster headache |
100% Oxygen
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Tx for
Cluster headache prophylaxis |
Verapamil, prednisone, ergotamine, or lithium
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Tx for
Migraine or cluster headache abortion |
Sumatriptans
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Tx for
Migraine prophylaxis |
Amytriptyline, vpa, or beta blockers
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Tx for
Migraine abortion |
NSAIDs, Triptans, Ergots, or dexamethasone
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Dx
Seleginine and tricylcic antidepressants |
Serotonin syndrome
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Dx
Dry skin, mouth, constipation, vision changes, and confusion in parkinson's patient |
Trihexyphenidyl toxicity
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Which drug can cause pseudotumor cerebri?
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Vitamin A and Isotretinoin (acne med)
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Tx for
Suspected TIA |
Aspirin,
if not tolerated then Dipyridamole |
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Acute Mgmt of
Suspected stroke (2) |
1) Non-contrast Head CT
2) If infarction --> Carotid doppler and TEE to find possible embolic site |
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Dx
sudden Ataxia, vomiting, occipital headache, gaze palsy, facial weakness |
Cerebellar hemorrhage
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Dx
Sudden Deep coma, paraplegia, pinpoint pupils that respond to light, no horizontal eye movements |
Pontine hemorrhage
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How does subarachnoid hemorrhage present? (2)
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1) Sudden onset WHOL
2) NO focal neurological signs |
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Tx for
Psuedotumor cerebri |
Acetazolamide
(choroid carbonic anhydrase inhibitor) |
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Dx
Neck pain or contraction due to medication for nausea |
Metoclopramide
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Dx
Sudden eye pain, photophobia, mid-dilated pupil, and red eye |
Acute ange closure glaucoma
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Tx for
Trigeminal neuralgia |
Carbamazepine
if refractory, surgery to relieve nerve |
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Dx
Oculomotor dysfunction, gait ataxia, and encephalopathy |
Wernicke's encephalopathy (thiamine deficiency)
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Dx
Gait instability, difficulty with rapid alternating movements, and intention tremor |
Cerebellar dysfunction from drinking
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Localize lesion
Expressive aphasia |
Dominant frontal lobe
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Dx
Retroribital eye pain/headache, red eye, horner's. |
Cluster headache
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Dx
Confusion, high temp, tachy, coagulopathic bleeding |
Heat stroke
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Localize lesion
Subdural hematoma Epidural hematoma |
Sub - Bridging veins
Epi - Middle meningeal artery |
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Only Tx for
ALS |
Riluzole
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Dx
Loss of consciousness seizure with tongue biting, started with aura |
Partial complex that become generalized
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Dx
Immunocompetent, single lesion in brain with known sinus involvement |
Anaerobic bacterial abscess
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Tx for
Tremor in Parkinsons |
Trihexyphenidyl
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Dx
Hypopituitarism with bitemporal vision loss |
Craniopharyngioma
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Tx for
Acute migraine with nausea |
Prochlorperazine
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Best thing to monitor for lung function in GBS
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Vital capacity
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Tx for
GBS |
IVIG
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Dx
Ipsilateral ataxia, nystagmus, intention tremor |
Cerebellar tumor
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Associated with small cell carcinoma of the lung
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Lambert Eaton syndrom
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