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177 Cards in this Set
- Front
- Back
Increased T1 signal in wall of left carotid artery caused by? |
carotid dissection - also causes sx of horner's syndrome |
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def of T1 vs T2 weighted images? |
see: http://www.mribhatia.com/basicmritf1/index.html |
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MS-like presentation in 5-8 y/o who then recovers after 6 mo and may/may not ever have another episode, while may have residiual sx. MRI shows subcortical or white-gray jxn hyperdensities like in MS, as well as periventricular hyperdensities? |
ADEM |
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Is T2 specific for demyelination? |
NO, |
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triad of parkinsons? |
cogwheel rigidity, |
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types of tremors and causes? |
1 'resting tremor' = lost when distracted = due to substantia negra lesion ie parkinsons |
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ohter causes of choreiform movements besides huntington's? |
HUNTINGTON'S |
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s/e's of phenytoin? normal levels of phyntoin? |
HI GLAND: |
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impaired convergence caused by? |
normally w/ age |
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weakness developing in proximal muscles causing difficulty getting up off toilet, seats, etc? |
primary muscle disease ie |
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tuning fork on forehead =? on ear? |
WEber test |
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origin of purely vertical nystagmus? |
usually CENTRAL |
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causes of nystagmus? |
idiopathic |
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m/c lumbo/sacral nerve compressions? sx/signs? |
S1 (slipped disc =L5-S1) |
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compression radiculopathy affects nereve at which levels for cervical vs. l/s radiculopathy? |
BOTH = compression of nerve # that corresponds to Vert body BELOW the nerve's exit ie if b/w L4-L5, = L5 compression, and if C1-C2 = C2 compression. this is b/c in cervical spine, most slipped discs are lateral herniations and they impinge on the cervical nerves that exit laterally at level of vb below them (C2 exits b/w C1 and C2) However, in the L/S region, nerves actually exit at level below their vbodies ie L5
actually exits BELOW L5 vb and b/wL5 and S1. HOWEVER, in the l/s region, compression usually occurs due to POSTERIORLATERAL herniation, causing impingement of the nerve still descending but entering lateral region of canal...thus, an L4-L5 slipped disc will herniate posteriolaterally and impinge on the nerve descending, this nerve exits b/e L5 and S1 and is thus L5...so L4-L5 slipped disc ALSO causes compression of nerve corresponding to lower vb = L5 (even though this nerve doesnt leave SC until it reaches L5-S1. Confusing? |
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bilat decreased abduction of eyes ...imediately think? |
increased ICP!! -> causes stretching of both CN VI's (although can also cause unilateral) |
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what's a hollenhorst plaque? |
atheroembolic lesions of chol/calcified deposits seen in retinal arterioles due to ath disease, seen along w/vision loss |
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absent of retinal venous pulsations? |
15% normal |
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Vertigo Workup: |
1) r/o dizziness by hx |
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causes of peripheral vertigo? |
1) BPPV: intense, occurs w/changes of position, usually abates if pt stays still |
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causes of cnetral vertigo? |
vbasilar isch or infarct affecting vestib nucleus |
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common severe cause of horner's? |
carotid dissection!! |
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horner's syndrome vs. CNIII lesion/palsy? |
H: mIosis, ptosis (less prominent than cn III lesion), and anhydrosis (NOT seen if INTERNAL carotid dissection) |
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describe blood findings on CT? |
blood is more dense than CSF, even more dense than gray or white matter! thus, a blood clot caused by subdural hematoma will show as a hyperdense crescent shaped mass on CT. |
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subarachnoid hemm suspected...workup? |
brain CT...if normal still do LP for xanthacromia or elevated csf rbc's or incr opening pressure |
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infectious cause of RBC's in CSF? |
herpes encephalitis |
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tx for subarachnoid hemorrhage? |
Do cerebral angiogram and get neurosurg consult |
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meningioma tx? |
surg resection... |
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type II nfibrmoatosis? type I |
Cafe aulait spots |
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causes of dysdiadokinesis? |
think children: cerebellar tumors |
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lying w/eyes closed in dark room = what type of brain waves? |
alpha waves = 8-13Hz |
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L occip lobe and splenium of corpus callosum lesion causes what sx? |
Alexia (can't read) w/o agraphia (cant write) |
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workup of suspected CVA? tx? |
do Brain CT!!! if find lesion and do not find hemorrhage, and IF w/in 3 hrs of sx, give thrombolytic therapy (tPA) |
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incr blood CPK + ESR levels + proximal muscle weakness + EMG abnormalities indicating primary muscle disease? |
think dermatomyositis or polymyositis: |
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dermatomyositis vs polymyositis? |
d: + violet colored skin rash on extensors ie knuckles and jts, |
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after what time does the CT for SAH decrease in sensitivity? |
up to 12 hrs detects 98% but then sensitivity decreases...so need to do LP also and look for xanthochromia = yellow pigment due to b/d of rbc's and release of bilirubin =yellow/green pigment |
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increased ICPin obese woman that's pregnant or w/ hypervitaminosis? |
pseudotumor cerebri |
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is there a risk to doing LP if suspect pseudotumor cerebri? |
no..LP does not cause herniation |
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sx of pseudotumor cerebri? |
incr ICP in overweight woman, w/ hich CSF opening pressure but no other LP findings |
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paradoxical pain in areas of recent sensory loss due to stroke? |
think thalamic stroke = thalamic pain syndrome...onset of px in areas of recent sensory loss |
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nucleus ambiguous contains motor nuclei of what cn's? where is it located? |
9, 10... |
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multiple hemorrhages seen on MRI via increasd hemosiderin (incr due to rbc b/d by macrophages) deposits in multiple places in brain, in elderly >70 adult? |
amyloid angiopathy = b amyloid (same as in alzheimers) causes weakening ov vessel walls...hemorrhage, etc. |
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sah seen in iv drug user? |
suspect mycotic aneurysm rupture- do LP!! |
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cortical lesion that does NOT change with enhanced vs unenhanced CT? |
blood hematoma... |
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adr of lamotrigine if given to fast? |
severe rash!! |
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what antiepileptic drug should you give to post cva pt who has seizures? |
give phenytoin b/c is fast acting |
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diff b/w diffusion weighted imaging and CT? |
ct may not detect ischemic changes occuring for even up to 4-6 hours after event, while dwMRI is sensitive after even 5-10 mins |
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m/c site for hematoma formation after hemorrhage from lenticulostriate vessel? |
putamen |
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charcot-bouchard aneurysm? |
occurs in l/s vessels affecting: cnucleus, thalamus, pons, cerbellum, putamen, etc. |
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m/c cause of SAH/brain hemorrhage under 40? 40-60? |
bleed from av malformation , m=w |
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size required for CT to pick up aneurysm? |
>5mm |
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what does mycotic aneurysm mean? |
any bacterial/infectious agent causing decr vessel wall strength and causing aneurysm |
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CN III deficit + headache: think what area of lesion? |
think brainstem: wehre III exits = just above pons, where pcomm (m/c) as well as post cerebral art or sup cerebelar art are...so aneurysm in any of these would produce cn III sx. |
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tx for SAH? |
nimodipine = decreases chance of stroke |
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% of carotid stenosis pts w/ TIA's, txed by medication, that will still go on to have stroke? |
26%! |
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LEFT VS RIGHT mlf syndrome vs bilat MLF? |
left mlf = mlf which innervates left MR is deficient therefore can't look RIGHT with your left eye. |
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26% w/carotid stenosis >70% on meds still have stroke...what % if do carotid endarterectomy? |
after surgery = 9% will still have stroke!! |
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aphasia cuased by parietal lobe hemorrhage, and causing difficulty repeating sentences but not difficulty understanding them? |
conduction aphasia |
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most common remaining sx of broca's aphasia |
problem w/ syntax = constructing full sentences ...pt can use simple words but not full sentences |
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language deficit often seen in severe hotn ie after MI? |
causes watershed infarct of MCA and PCA = diffuse neuronal death b/w frontal and temporal lobes = MIXED TRANSCORTICAL APHASIA=pt only repeats what is said to him, but no comprehension or spontaneous speech |
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first language deficit often seen in dementia? |
anomia = difficulty naming things, while everything else w/ langauge is intact (repetition, comprehension, fluency |
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broca's aphasia- like but with preserved repetition? |
transcortical motor aphasia ie due to small frontal embolic stroke |
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wernicke's aphasia-like with preserved repetition? |
transcortical sensory aphasia ie due to lesion underelying cortex of wernicke's area, in white matter |
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reason why IV lorazepam is better than IV diazepam for status epilepticus? |
b/c although both have rapid onset, IV L is long acting so doesn't need to be supplemented w/ phenytoin for prevention of seizures hours later |
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antiepileptic that may cause arrhythmias if given in fast infusion? |
phenytoin |
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simple partial seizure workup? |
MUST rule out focal brain lesion! do brain CT/ MRI! IF negative, then do EEG/holter to dx simple partial seizure if possible. |
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diff b/w onset of delirium tremens and alcohol w/drawl seizures? |
dt = 2-4 days after w/drawal |
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infantile spasms plus parosxymal flexions of body and profoundly disorganized EEG ("Hypsarrhythmia") |
West syndrome |
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pt w/ hx of west syndrome (infantile spasms) who begnis to have mental decline w/ seizures of 1-2Hz generalized spike-wave discharges? |
Lennox-Gastaut syndrome |
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m/c cause of myoclonic seizures? |
BJME benign juvenile myoclonicepilepsy = sx of involuntary jerkign when waking up in kids...also may be triggered by light flashes or loud sounds (think cats) |
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persistent FOCAL motor sei\ure ie hand keeps twitching for hours ie after surgical procedure |
epilepsia partialis continua |
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longterm tx for complex partial seizures in young women? |
carbamazepine or pheynytoin but cuases hirsutism, gingival hyperplasia, IGLAND, etc. |
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infantile spasms + retardation + hypsarrhythmia (abnormal, variable eeg changes) |
West syndrome -a generalized seizure disorder |
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Tx for West Syndrome? |
ACTH... and vigabatrin |
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Tx for absense seizures? |
ethosuximide, if cannot use, give vproic acid |
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Tx for preeclampsia (seizure prevention)? tx for abating an eclamptic seizure in pregger |
both= mgso4 |
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hemicranial throbbing, aura, nausea, vomiting, photophobia, phonophobia = what type of migraine? |
classic |
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headache very severe w/ blindness or vis changes and or irritbility to frank psychosis, and even transient quadriplegia? |
basilar migraine!! |
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lancinating jaw pains, often triggered by cold drinks/icecream, etc? tx? |
trigeminal neuralgia |
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what other nerol disease is trigem neuralgia often cuased by? |
MS!!!, also acoustic schwannomas, basilar aneurysms, posterior meningiomas, etc = "symptomatic trigeminal neuralgia" |
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LOS (loss of sens) over forehead along with ophthalmoplegia + intense sharp pain in and about the eye? |
Tolosa Hunt syndrome = inflamm dise of sup orb fissrure or cav sinus. spares pupillary fxn |
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constant, deep pain of face, not stabbing/lancinating? |
atypical face pain |
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tx to abort vs longterm prophylaxis of migraine? |
abortive: triptans, ergotamine |
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when to give longterm prophyl for migraines? |
if more than 2 /month |
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tx for fever, wt loss, incr esr, thickened temp artery? |
=temp arteritis |
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csf finding in pseudotumor cerebri? |
NORMAL EXCEPT elevated opening pressure |
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sx of, tx for pseudotumor cerebri? |
sx: hache, progressive vision loss, tinnitis, diplopia, shoulder and arm pain. |
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median nerve hand distribution sensory? |
the M plus thumb= 2nd, 3rd, 4th (1/2) digits + thumb |
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median innervated muscles of hand|? Ulnar? |
all hand muscles = ulnar except lateral 2lumbricals and 3 thenar muscles- fpb, oppp, abdpb (addpb=ulnar) |
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wrist drop...what nerve? |
compression of radial nerve (extensors) = "saturday night palsy" seen in alcoholics laying for long pds and compressing nerve |
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if suspected subdural hematoma NON acute, what imaging and why? |
do MRI b/c CT scan may miss blood b/c by 3-5 days it has degraded into less dense fluid and may look just like brain tissue |
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common neurolog problem seen in ppl on renal dialysis? |
chronic subdural hematoma!! |
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coup injuries of brain? |
inferior frontal lobes and ant temporal lobe contusions |
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tx for spinal cord injury? |
high dose iv methylprednisolone |
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when must methylprednisolone be given after sc injury to have effect? |
w/in 8 hrs |
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von Economo's encephalitis (e lethargica) has what inital effects? later? |
initial =disturbed eye movements...m/c sequela = severe, unremitting parkinsonism |
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sarcoidosis has what neurolog effect? |
facial paresis! due to cn VII involvement w/o sensory loss |
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poliomyelitis vs GB? |
pm = purely motor loss due to ant horn cell destruction by virus. |
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The lack of muscle, a high arch, and hammer toes are signs of the genetic disease. |
Charco-Marie-Tooth disease = demyelinating periph nerve disease affecting motor and sensory of feet |
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m/c fungal meningitis in AIDS pt or i/c pt? Abscess in same? |
think cryptococcus neoformans |
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puerto rican comes in w/ parapearesis? |
S. mansoni |
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csf exam in CJakob disease? |
normal, mildly elevated protein |
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recurrent meningitis m/c due to? |
csf leak ie through cribiform- hx of rhinorrhea or ears - otorrhea |
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best CT to look for abscess or tumor? |
contrast ct |
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m/c cause of ring enhancing lesions of brain in aids pt? |
toxo |
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if need to do CSF check , but afraid of mass effect due to icp? |
may do ventricular CSF aspiration! |
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tx for AIDS toxo inf of brain |
sulfadiazine and pyrimethamine |
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PML is caused by? in aids pt, tx? |
JC virus! tx = HAART but prognosis is poor |
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tx for hsv encephalitis? |
IV acyclovir |
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csf findings in HSV encephalitis? |
incr protein |
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ameobic meningoencephalitis is caused by? |
acanthamoeba, hartmanella.. |
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undercooked pork ingestion or fecal contamination - causing cysts in brain? what organism? |
cysticercosis = Taenia Solium |
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what diseases of brain have microglial nodules? |
CMV encephalitis - subependymal and subpial nodules |
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m/c means of spread of infection to brain causing abscess? |
blood, from lungs, heart, sinuses, ears |
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tx of CMV retinitis? |
gancyclovir |
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tx of rabies? |
supportive; immunization against rabies immediatley |
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anti parkinsons drugs? |
amantadine, |
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how does neurosyphilis mimic brain tumor? |
gumma in brain looks like a tumor (is actually very rare) |
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rabies tx? |
patients receive one dose of human rabies immunoglobulin (HRIG) and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of the immunoglobulin is injected in the region of the bite, if possible, with the remainder injected intramuscularly away from the bite. |
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also is the m/c cause of osteomyelitis and otitis externa in aids pt? m/c brain abscess in aids pt? |
aspergillus (also causes abscess i brain along w/ cryptococcus, candida, mucor,)...but m/c cause of abscess in brain in aids pt is TOXO |
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m/c sx of brain abscess? |
headache!! |
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most common pathogen of brain abscesses? |
strept..aer and anaer...but in aids pt = toxo |
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an inherited disease that causes progressive damage to the nervous system resulting in symptoms ranging from gait disturbance (progressive staggerign and falling, onset before age 25) and speech problems to heart disease (afib, tc, hocomp) |
friedrich's ataxia |
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6 mo onset of dementia, tremor, ataxia, and myoclonus in pt w/ basal ganglia increased T2 signals bilaterally, |
spongiform encephelopathy =CJacob's disease! |
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tx for listeria monocytogenes meningitis |
amp and gent |
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meningitis often seen in pts w/renal failure/ renal tplant, and i/c pts? |
list monocytogenes |
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person receives growth hormone supplement..what brain disease may pt get? |
prions!! |
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cause of pml |
jc virus |
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m/c cause of position sense loss |
dm neuropathy |
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progressive loss of cognitive fx intelligence, and umn signs in child who had measles in past, with oligoclonal bands and increased igG fraction in csf? |
Subacute sclerosing panencephalitis...worsk like MS but demyelniation destruction is due to measles virus. |
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what is bacillary angiomatosis? tx? |
neurovascular proliferative skin lesion seen in hiv pts with b henslea (cats) or b qintana (lice) encephalitis...affects pulvinar of posterior thalamus! |
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v-H-L disease? |
tumors in multiple orgnas: brain, sc, retina - hemangioblastomas |
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m/c source of mets to brain? |
lung |
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what ends up lodging in the gray-white jxn? |
bact from brian abscesses |
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precocious puberty + paroxysms of laughter (gelastic seizures) in kid? |
hypothalamus hamartoma |
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hypopituitarism and visual field changes in kids? |
craniopharyngiomas - arise in the 3rd vent and sellar turcica |
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cause of death in pts with posterior fossa tumors? |
transtentorial herniation or transforaminal herniation |
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clear, yellow-brown,[3] oval to round, dome-shaped papules that project from the surface of the iris. These nodules typically do not affect vision, but are very useful in diagnosis.[1] They are detected by slit lamp examination. |
lisch nodules of NF type I |
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NF I vs II? |
NF I is classic disease: |
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4 signs of parinaud's syndrome? |
vertigal gaze impairment, |
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parinauds syndrome seen in what 2 conditions? |
pineal region tumors, |
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hydrocephalus may cause what in nkids? |
bilat setting sun sign - eyes deviated inward due to cn 6 palsies and downward b/c parinaud's syndrome |
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woman w/ cancer develops progressive gait disturbances, dysmetria of limbs, wide based gait, and hypermetric saccades? |
paraneoplastic cerebellar degeneration - due usually to small cell lung cxr - |
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what antibodies are seen in br cxr /gyn subtype of paraneoplstic cerebellar degen (PCD) |
anti Yo = anti purkinje cell ab's |
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sx of hypercalcemia? |
DECREASED muscle activity, decr reflexes, proximal weakness, and nausea, vomiting, lethargy...(ALL these are same for lambert-eaton syndrome) |
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lambert eaton vs myasthenia gravis? |
LE is worse in morning, better in evening vs MG is opposite |
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underlying mech of Lambert Eaton? |
loss of fxn of voltage gated Ca channels at nmj due to autoantiboides IgG |
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brain cells lost in hepatic failure? |
due to toxic metabolites, ASTROCYTES are lost |
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ANY rapid increase in bp causing >210/112 mmHg? |
HYPERTENSIVE ENCEPHALOPATHY: |
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m/c neurological finding in Chronic renal failure? |
peripheral neuropathy |
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tx for restless leg syndrome? |
clonazepam |
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most reliable tx for peripheral neuropathy of chronic renal disease? |
renal transplant! |
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acroparasthesia, sensory ataxia memory loss, and impotence, UMN signs in all extremities, sensorimotor neuropathy, anemia, and sore tongue, gastritis? |
b12 deficiency!!! chronic atrophic gastritis may be initial cause! look for anemia (pernicious) |
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what lab tests must be done for any dementia? |
TSH for hypothyroidism |
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B12 cofactor involved in what conversions? |
methylmalonyl CoA -> succinyl CoA |
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what look for in urine for B12 def? in blood? |
methylmalonyl CoA!! and |
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what tracts are affected in B12 def? |
lateral corticospinal= all extremity UMN signs: spasticity, rigidity, incr reflexes, incr primitive reflexes |
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loss of central vision (centrocecal scotoma) due to? |
optic neuritis of MS OR vit B12 deficiency OR |
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periph neuropathy in pt tx'd for cough, pneumonia, hemoptysis, wt loss? |
TB tx INH causes decr B6.. |
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diarrhea, dermatitis (hyperpig in sun affected regions ) and dementia in person who is veg and eats lots of corn? what def? |
pellagra!!!!! = Low B3=niacin =nicotinic acid b/c B3 levels are low in corn. |
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hypersomnia + recnet onset obesity, also seen w/ OSA? |
OHS: obesity hypoventilation syndrome= Pickwickian syndrome = pulm htn caused by hypoxia from shallow breathing due to obesity -> plum htn also causes cor pulmonale, chf, etc in this! |
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herpes encephalitis in non-i/c pt USUALLY presents first with? |
psychiatric changes! then -->complex partial seizure w/ olf aura, -> gen seizures, etc. |
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what is marcus gunn pupil? |
= afferent pupillary defect (problem in optic nerve II sensing light, or retina sensing light, etc. ->positive swinging flashlight test =when given light, affected eye DILATES from being constricted before (as does unaffected/unilluminated) and both stay normally dilated...then when light swings to unaffected eye, both constrict normally : seen in MS |
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classic example of light-near dissoc? |
argyll robertson pupil; |
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fetid odor and unconsciousness? |
= sign of metabolic disturbance: |
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normal adult EEG has background of? alzheimers? CJ disease? |
Alpha activity at 8-12 hz |
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28% of pt w/hydroceph who undergoes VP shunt may have what complic |
subdural hematoma!! b/c decr pressure allows brain to pull away from cranium and allows tearing of bridging vns |
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drugs for alzh? |
achei's |
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type of aphasia seen in alzh dementia? |
transcortical sensory aphasia = diff understanding complex linguistic phrases; no problem repeating phrases |
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cj disease sx? |
initial blurry vsion, diplopia, other vision changes |
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neurosyphilis CSF changes? |
lymphocytes predominate |
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pendular convergence movements ofthe eyes in association with contractions of masticatory muscles ? dx? |
oculomasticatory myorhythmia due to Whipple's disease (T. whippelii) |
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alien hand syndrome...dx? |
think PML in aids pt b/c affects subcortical regions of parietal/occipital lobes = visual illusions /phenomena. |
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pt gets flu,then gets disturbed eye movements, then chorea, then parkinson type sx? |
post-flu parkinsonism = NOT reversible!! rare, seen in vonEconomico's encephalitis during Flu epideic of 1918-26 |
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huntington's anticipation effect occurs if gene passed down by mother or father? why? |
father - b/c sperm have incr chance of mutagenesis |
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huntington's chorea may be unmasked by giving what? |
l-dopa |
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progressive damage to substantia negra caused by what substance? = what disease? what distinguishing feature? |
use of high potency opiate MPTP |