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314 Cards in this Set
- Front
- Back
Nonspecific signs/symptoms of increased ICP |
Headaches (on awakening, dependent on head position, progressive) |
|
Diagnostic test for CNS neoplasm
|
MRI w/ and w/o gadolinium
Brain biopsy is only definitive way to dx |
|
Ways to control elevated ICP |
Steroids Hyperventilation
|
|
Differential dx of ring-enhancing brain lesion |
Mets
Brain abscess Toxoplasmosis
|
|
Brain tumor in severely immunocompromised patient? (e.g. transplant recipient, AIDS patient) |
Primary lymphoma! |
|
PATHOGNOMONIC for neurofibromatosis II |
BILATERAL schwannomas |
|
CSF reveals malignant cells, elevated protein and lymphocytes, decreased glucose |
Meningeal carcinomatosis (cancer metastasizes to meninges via blood) |
|
Hearing loss, tinnitis, loss of balance, nystagmus, motor/sensory deficits of face
imaging shows mass |
Schwannoma (cerebellopontine angle) |
|
ICP is determined by |
Volume of brain |
|
Secondary insults to brain s/p trauma
|
Hypotension |
|
Normal ICP
|
5-15 mm H2O
ICP>20 is worrisome |
|
Effects of increased ICP
|
increase in cerebral perfusion pressure ---> hypoperfusion --> loss of autoregulation --> cerebral vasodilation --> vasogenic edema --> increased ICP |
|
Bilateral fixed and dilated pupils suggest
|
Increased ICP
|
|
What is target MAP in the context of ICP |
MAP > 80 mmHg |
|
Sgns of basilar skull fracture
|
Raccoon eyes - periorbital ecchymoses |
|
Cushing triad |
hypertension bradycardia respiratory irregularity |
|
Risk factors for subdural hematoma
|
Brain atrophy (EtOH, elderly)
Pts undergoing anticoagulation |
|
Signs of subdural hematoma
|
Headache
Decreased level of consciousness (mass effect) Cortical dysfx |
|
Mechanism of myasthenia gravis
|
Autoantibodies against nicotinic acetylcholine receptors of NM junction -->
reduced postsynaptic response to acetylcholine |
|
Proximal, asymmetric mm weakness with preservation of sensation and reflexes, worse with exercise
|
Myasthenia gravis
|
|
Dx test for myasthenia gravis |
Acetylcholine receptor antibody test |
|
Myasthenia gravis associated with?
|
Thymoma
|
|
Tx for myasthenia gravis |
AChE inhibitors |
|
Myasthenic crisis
|
Diaphragm and intercostal fatigue
--> acute respiratory failure |
|
Lambert-Eaton is associated with? |
SMALL cell lung cancer |
|
Lambert Eaton mechanism |
Autoantibodies against presynaptic calcium channels |
|
Proximal muscle weakness, hyporeflexia, symptoms improved with repeated use |
Lambert Eaton syndrome...
"ya just gotta warm up for a bit" :-( |
|
Inheritance of Duchenne MD? |
X linked recessive |
|
Progressive, symmetric mm weakness starting in childhood with pelvic girdle affected |
Duchenne MD |
|
Signs/symptoms of Duchenne? |
Gower's manuever (hands to get up) |
|
Causes of syringomyelia |
Cranial base malformation (Arnold-Chiari) |
|
Bilateral loss of pain and temp sensation in caplike distribution |
Syringomyelia (collection of fluid in spinal cord --> central cavitation of cervical cord) |
|
Tx for syringomyelia
|
Syringosubarachnoid shunt (surgical)
|
|
Diagnosis of Duchenne's MD
|
Serum creatine phosphokinase
DNA testing |
|
Contralateral loss of pain and temperature |
Brown-Sequard (spinal cord hemisection)
|
|
Tracts affected in syringomyelia |
Lateral spinothalamic tracts
|
|
Tracts affected in Brown-Sequard |
Spinothalamic
Corticospinal Dorsal columns |
|
Lower extremity weakness or plegia |
Transverse myelitis (often after viral infection)
|
|
Causes of Horner's syndrome (ipsilateral ptosis, miosis, anhydrosis) |
Idiopathic (most common)
Pancoast tumor (superior sulcus) Internal carotid dissection Brainstem stroke Cervical spine injury |
|
Asymmetric muscle weakness, absent DTR, atrophic/flaccid muscles, normal sensation
|
Poliomyelitis
|
|
Aphasia is more common when which hemisphere is involved?
|
Left
|
|
Visual spatial deficits are more common when what hemisphere is involved?
|
Right
|
|
Crossed hemiplegia (ipsilateral face and contralateral body) can be localized where?
|
Brainstem (corticospinal tract, dorsal columns, spinothalamic tract cross but CN do not)
|
|
Spinal cord injury - how to localize?
|
Level of lesion corresponds to sensory level (pinprick felt above level but not below) |
|
Localize this lesion: |
Roots (radiculopathy) or |
|
Menier disease |
Vertigo
Tinnitus Hearing loss |
|
Differences between central and peripheral vertigo: |
Central: gradual onset, mild intensity, associated neurologic findings, mild nystagmus (multidirectional and vertical)
Peripheral: Sudden onset, severe intensity, rapidly refractory, unilateral vertical nystagmus |
|
Tilt-table testing used for
|
Dx neurocardiogenic syncope (if episodes are recurrent, unexplained, no structural heart disease)
|
|
Causes of epilepsy |
4 M's: |
|
Features of simple partial seizures
|
Consciousness intact
May involve transient unilateral clonic-tonic movements |
|
Features of complex partial seizures
|
Consciousness impaired
Postictal confusion Automatisms Olfactory/gustatory hallucinations |
|
Impaired consciousness, no loss of postural tone or continence, no postictal confusion |
Absence seizures
|
|
Labs to order in unfamiliar seizing pt |
Serum glu, Ca, sodium, BUN
|
|
Drugs of choice for generalized tonic-clonic and partial seizures |
Phenytoin, carbamazepine
Phenobarbital, valproate, primidone |
|
Drugs of choice for petit mal (absence) seizures |
Ethosuximide
Valproate |
|
ALS affects what areas? |
UMN/LMN: |
|
Progressive muscle weakness first noted in legs/arms, no associated pain, muscle atrophy |
ALS
|
|
Normal and unaffected even in late stages of ALS |
Bowel/bladder control |
|
Seen on EMG in myopathy |
No electrical activity at rest, but amplitude DECREASES with muscle conraction |
|
EMG findings for MS, GBS |
Decreased nerve conduction velocity |
|
Riluzole MOA? |
Glutamate-blocking agent used to delay death in ALS (3-5 mo) |
|
Receptive aphasia (fluent)
|
Wernicke |
|
Broca aphasia |
Expressive aphasia (nonfluent)
|
|
Where is lesion? |
Posterior to central sulcus (W's) |
|
Where is lesion?
Aphasia + nonfluent speech |
Anterior to central sulcus (B's) |
|
Brief, frequent attacks of severe lancinating facial pain
No motor or sensory paralysis |
THIS IS TRIGEMINAL NEURALGIA |
|
Drug of choice for trigeminal neuralgia |
Carbamazepine |
|
Localize lesion: |
Corticobulbar (unilateral) |
|
Localize lesion:
emotional lability
bilateral facial weakness and a brisk jaw jerk. |
Pseudobulbar palsy (bilateral corticobulbar tracts) |
|
Localize lesion: |
Cortical/subcortical |
|
Difference in presentation, LMN vs. myopathy
|
LMN = distal weakness |
|
Symmetric weakness of pelvic or shoulder girdle muscles
|
Myopathy
|
|
weakness of the lower two-thirds of the face with preservation of the upper third suggests? |
UMN lesion |
|
failure of vertical gaze |
Progressive supranuclear palsy |
|
In PSP what lobe abnls predominate |
Frontal lobe
|
|
Pathology of PSP |
Atrophy of dorsal midbrain, GP, STN
|
|
Argyrophilic round intraneuronal inclusions |
Pick bodies (frontotemporal dementia)
|
|
Rapidly progressive dementia with pyramidal signs, myoclonus, cerebellar or extrapyramidal signs |
CJD |
|
Presence of protein 14-3-3 in CSF |
CJD
|
|
HIV associated dementia shows what on MRI
|
Cortical, subcortical atrophy |
|
Neuropathy (paresthesias, sensory ataxia, visual loss, orthostatic hypotension), memory loss |
Dementia due to Vit B12 deficiency |
|
Red desaturation can be seen early in what problems? |
Early optic nerve problems
(e.g. optic neuritis/Devic dx) |
|
Pupillary constrictor (miosis) is innervated by? |
PARA-sympathetic nerve fibers |
|
Pupillary dilator (mydriasis) is innervated by? |
Cervical sYmpathetic system |
|
Sympathetic system pathway
|
First order: Ipsilateral posterolateral hypothalamus to intermediolateral cell columns (C8-T1) |
|
First sign of CN III compression = Dilated pupil |
|
|
Ilsilateral optic disc atrophy due to compression by space-occupying lesion in frontal lobe and papilledema in contralateral optic disc due to increased ICP
|
Foster-Kennedy syndrome |
|
Painful visual loss, worse w. exercise/hot baths Retro-orbital pain
Loss of color discrimination Central scotoma |
Optic neuritis (IV methyprednisolone) |
|
Asymptomatic; enlarged blind spot with initially normal visual acuity
glistening hyaline bodies in fundi |
Drusen or pseudopapilledema |
|
Morning headache, ataxia, transient visual obscuration, central acuity spared, no color loss, enlarged blind spot, bilateral disc hyperemia |
Increased intracranial pressure |
|
Sudden painless visual loss in pt >50 yo, associated with HTN, DM |
Ischemia |
|
Destruction of abducens nucleus in brainstem
|
Complete ipsilateral conjugate gaze palsy (connection to contralateral third nerve through MLF) |
|
Voluntary saccades arise from?
|
Frontal eye field and superior colliculus contralateral to direction of gaze |
|
Child between 2-7 yo following viral infection presents with acute onset limb, gait ataxia, dysarthria |
Postinfectious cerebellitis |
|
Acute/subacute onset of truncal, gait, limb ataxia Dysarthria
Ocular dysmetria or nystagmus (no opthalmoplegia) |
Paraneoplastic cerebellar degeneration
(GYN or SMALL cell lung cancer --> MRI is often nl, assoc. with autoantibodies) |
|
Progressive ataxia in childhood with loss of reflexes
Spasticity and extensor plantar responses
Impaired vibration and position sense |
Friedrich's ataxia (AR) |
|
Brief episodes of ataxia, vertigo, nausea, vomiting caused by mutations of? |
Inherited episodic ataxia (EA-1): voltage gated K channel |
|
Insidious onset of progressive gait impairment, dysarthria in early adult life with mild-mod cognitive decline later on |
Spinocerebellar ataxias (CAG expansion) |
|
Triad of ATAXIA, AREFLEXIA, OPHTHALMOPLEGIA in postinfectious autoimmune process |
Miller Fisher syndrome --> ataxia due to proprioceptive loss
(not cerebellar dysfx, no nystagmus) |
|
Cerebellar vermal lesions assoc with? |
Truncal and gait ataxia |
|
Cerebellar hemispheric lesions assoc with? |
Ipsilateral limb ataxia |
|
Affected leg is stiff and does not flex at hip, knee, or ankle |
Hemiparetic gait
|
|
Spastic gait with increased adductor tone and legs tend to cross during walking
|
Scissoring gait (paraparetic/bilateral hemiparesis)
|
|
headache in a young obese woman, worse in AM, worse when recumbent, accompanied by pulsatile tinnitus and blurring precipitated by valsalva maneuver |
Idiopathic intracranial HTN |
|
Broca's aphasia: where is the lesion
|
Posterior part of inferior frontal gyrus in dominant (left) hemisphere |
|
Broca's aphasia - deficits?
|
Impaired fluency
Impaired repetition Normal comprehension |
|
Huntington disease triad
|
Chorea behavioral change/personality disorder dementia |
|
Diagnosis of Huntington |
Family h/x CAUDATE ATROPHY |
|
Pathology in Huntington's disease
|
Destruction of caudate and putamen (striatal and nigral GABAergic neurons) |
|
Personality change, speech disturbance, inattentiveness, extrapyramidal signs, progressive dementia |
Pick dementia |
|
Rapidly progressive dementia with pyramidal signs, myoclonus, cerebellar or extrapyramidal signs, periodic sharp waves in EEG |
CJD
|
|
CSF findings on CJD
|
Normal but presence of 14-3-3- protein (sensitive and specific) |
|
Progressive dementia with neuropathy (paresthesias, sensory ataxia, visual loss, orthostatic hypotension), memory loss, anemia, sore tongue
|
Vit B12 deficiency
|
|
50% theta slow wave activity
|
Stage 1 sleep
|
|
Sleep spindles and K complexes
|
Stage 2 sleep
|
|
20-50% delta wave activity
|
Stage 3 sleep
|
|
>50% delta activity
|
Stage 4 (slow wave sleep)
|
|
A typical night of sleep
|
4-6 cycles, lasting 90 min each (stage 1 absent after first sleep cycle)
|
|
REM sleep with age
|
Decreases from 20-25% per night to 15-20% per night |
|
REM sleep over course of night
|
REM accounts for greater proportion of sleep as night progresses
|
|
Drug that suppress stages 3 and 4 of sleep
|
Benzos
|
|
Drug that suppress REM sleep
|
Antidepressants and alcohol
|
|
Restless leg syndrome tx
|
Dopaminergic agents e.g. ropinirole, pramipexole |
|
What can happen to restless leg syndrome symptoms with dopaminergic tx? |
Augmentation: symptoms occur earlier in the day |
|
Narcolepsy components:
|
Excessive daytime sleepiness with narcolepsy, cataplexy, sleep paralysis, hypnagogic hallucinations |
|
Pathophysiology of narcolepsy/cataplexy
|
Loss of hypocretin secreting neurons in hypothalamus |
|
Dx of narcolepsy
|
CSF with hypocretin <110 |
|
Cataplexy tx with?
|
TCAs clomipramine |
|
Foster Kennedy Syndrome |
Ipsilateral anosmia
Ipsilateral optic atrophy Contralateral papilledema |
|
Tx for chorea
|
Neuroleptics
e.g. haloperidol (anti-dopaminergic) |
|
Childhood onset of Parkinsonism with bradykinesia and rigidity, dystonia, myoclonus, seizures |
Westphal variant of Huntington diease |
|
Dystonia |
Sustained muscle contractions |
|
Etiology for dystonia
|
Abnl low basal ganglia output structures |
|
Cardinal features of Parkinson disease |
Tremor at rest |
|
Sensory involvement in Parkinson disease
|
Loss of sense of smell |
|
Early onset dementia |
Dementia with Lewy bodies |
|
Supranuclear downgaze palsy and square wave jerks, upright posture, frequent falls |
Progressive supranuclear palsy
|
|
Levodopa is broken down peripherally by?
|
Gut: aromatic amino acid decarboxylase (carbidopa inhibits) |
|
Dopaminergic agent requiring conversion
|
Levodopa |
|
Symptomatic tx in Parkinson's
|
Selegiline, rasagiline (MAO-B inhibitors)
Anticholinergics (trihexyphenidyl, diphenhydramine) Amantadine (NMDA receptor antagonist) |
|
Reduces cardinal features of parkinson's + drug-induced dyskinesias
|
Amantadine
|
|
Agents causing drug-induced Parkinsonism
|
Antipsychotics, antiemetics e.g. metoclopramide, prochlorperazine |
|
Arching spasms of back, neck, stereotypical repetitive movements of tongue, jaw
|
Tardive dyskinesia
|
|
Risk factors for tardive dyskinesia
|
Advanced age
female gender Coexistent brain damage |
|
Tx for tardive dyskinesia
|
Increased doses of dopamine receptor blockers
Dopamine depletion (reserpine, tetrabenazine) |
|
Hemisection of spinal cord produces?
|
Ipsilateral hemiparesis |
|
Anterior cord syndrome
|
Bilateral spinothalamic tract (loss of pain and temp)
Bilateral weakness (corticospinal tract) Preservation of dorsal columns (fine touch, proprioception, vibration) |
|
Central cord syndrome
|
Bilateral loss of pain and temp sensation, weakness of upper extremities (motor fibers to legs are lateral and thus spared). |
|
Complete loss of motor and sensory function of upper and lower extremities + resp difficulty
Preserved reflexes mediated by CNs Loss of autonomic function |
High cervical spine cord injury
|
|
Air in acute EDH suggests?
|
Fracture of sinuses or mastoid air cells
|
|
Initial evaluation for suspected epidural hematoma
|
Noncontrast CT (homogenous density, high density, convex)
|
|
Characteristics of delirium
|
Cognitive impairment |
|
When is a head CT indicated for concussion?
|
LOC!!!! |
|
Post-concussion syndrome
|
Irritability
Depression Insomnia Subjective intellectual dysfx Anxiety Fatigue |
|
Return to Play - Grade 2 concussion |
Removal from game -->return after 1 wk |
|
Return to play - Grade 3 concussion (+LOC)
|
ER evaluation --> 1 week if exam nl |
|
Atherosclerosis affects which brain vessels?
|
Carotid bifurcation
|
|
Lacunar strokes associated with?
|
(small vessels) |
|
Tx of ischemic stroke
|
tPA (within 3 hrs)
Antiplatelet drugs (aspirin, clopidogrel, dipyridamide) |
|
Complications of subarachnoid hemorrhage (delayed)
|
Vasospasm
Acute hydrocepalus |
|
Imaging type for detecting hyperacute ischemic injury caused by vasospasm |
Diffusion-weighted MRI |
|
Carotid dissection predisposing factors |
Fibromuscular dysplasia
Ehlers-Danlos |
|
Carotid dissection often assoc with?
|
Ipsilateral ptosis + miosis (Horner's)
Headache Recent head/neck injury |
|
Drugs for absence seizures
|
valproate
lamotrigine
ethosuximide |
|
Automatisms - e.g. bilateral cycling, swimming movements
+/- post-ictal period, appear to be awake but do not respond normally to environment |
Complex partial seizure |
|
Seizure with preservation of consciousness (focal), + aura
|
Simple partial seizure |
|
Momentary lapses in awareness without automatisms (can have blinking or lip smacking), no aura
|
Absence seizures
|
|
Aura involving abd sensation, fear, unreality, deja-vu |
Temporal lobe seizure
|
|
Aura involving electrical sensation, tingling, numbness |
Parietal lobe
|
|
Aura involving visual changes
|
Occipital lobe seizures
|
|
Acute LOC without nausea, sweating, abd discomfort, regained consciousness quickly without confusion
|
Cardiogenic syncope |
|
Causes of syncope
|
Cardiogenic |
|
Nonepileptic syncope w/u includes
|
EKG Holter monitor EEG Orthostatics |
|
Unilateral, periorbital/cheek pain |
Migraine |
|
Precipitous headache in temporal region, unilateral, pain + stiffness in neck, shoulders, back, pelvic girdle
|
Temporal arteritis (assoc with polymyalgia rheumatica)
|
|
Post-spinal headache characteristics
|
Better when lying down, can be assoc w/ n/v
|
|
Sudden pulsatile head pain involving entire head, before or after orgasm
|
Postcoital cephalgia
|
|
Headache in young obese woman with menstrual irregularities, + visual disturbances
|
Benign intracranial hypertension
|
|
Sudden orbital or eye pain + n/v beginning after use of anticholinergic meds
|
Acute glaucoma
|
|
Orbital or neck pain + Horner syndrome after trauma
|
Carotid dissection
|
|
Headache assoc with brain tumor
|
Typical tension or migraine headache occurring frequently, may wake pt from sleep
+ Focal abnls |
|
Sudden onset headache with n/v/ stiff neck, fast decompensation, "worst headache"
|
Subarachnoid
|
|
Abortive therapy for migraine
|
Triptans
Ergotamine Dihydroergotamine Midrin: Isometheptene mucate (vasoconstrictor), dichloralphenazone (muscle relaxant), acetaminophen |
|
Triptan mechanism
|
5HT-1D receptor agonists
|
|
Side effects of triptans
|
N/V
Numbness/tingling CI if h/o CAD or HTN |
|
Prophylactic tx for migraines
|
Anticonvulsants (topiramate)
Beta-blockers (propanolol) Calcium channel blockers (verapamil) Antidepressants |
|
Chronic daily headache characteristics
|
Headache >15 days/month, >4 hrs/day
H/x of episodic migraines |
|
Tx for chronic daily heacahe
|
Removal of acetaminophen or aspirin (analgesic rebound worsens headaches)
Tramadol, propoxyphene (analgesic) - bridging Anticonvulsants, antidepressants, beta blockers and calcium channel blockers Botulinum toxin |
|
Botox is useful for what types of chronic daily headache?
|
Trigger points of head pain
Cervical pain or spasm |
|
Posterior cortical dementia
|
Intellectual functioning lost --> behavior preserved
e.g. Alzheimer's (early involvement of recent memory, language dysfx, apraxia, agnosia) |
|
The only "lower neurological fx" to be impaired in early Alzheimer disease
|
Olfaction
|
|
Imaging in AD shows?
|
Cortical atrophy (parietal, temporal, hippocampal) |
|
Degeneration of cholinergic cells projecting from basal forebrain (nucleus basalis of Meynert) to cortex
Seen in? |
Alzheimer's
|
|
Insidious decline in cognitive function in pts with cerebrovascular disease (e.g. HTN) --> diffuse subcortical white matter changes on imaging
|
Binswanger disease (vs. STEPWISE decline in multi-infarct)
|
|
Medical causes of dementia
|
Wernicke encephalopathy (B1)
Vit B12 deficiency Hypothyroidism HIV Neurosyphilis Normal press hydrocephalus MS, Huntington, neoplastic |
|
Dementia
Executive dysfx Motor parkinsonism Fluctuating cognition Hallucinations Sensitivity to neuroleptics Sleep-related disorder |
Diffuse Lewy Body dementia
|
|
Paresthesias in hands and feet
Loss of vibratory sense + pathological lesions in dorsal columns and lateral corticospinal tracts |
Subacute combined degeneration (vit B12)
+ beefy tongue, premature whitening of hair, megaloblastic anemia |
|
Nerve conduction studies in Vit B12 deficiency
|
Demyelination and denervation
|
|
Acute, unilateral loss of visual acuity or visual field + ocular pain in a young adult
|
Optic neuritis
|
|
Optic neuritis is assoc with?
|
Multiple sclerosis
Sjogren Guillain Barre HIV infection |
|
Optic neuritis tx
|
IV corticosteroids (hasten recovery but have no effect on visual fx or recurrence)
|
|
Tx for optic neuritis dx in MS
|
Interferon beta 1a
|
|
Weakness + stiffness
Tingling/pins and needles, numbness, band around torso Limb tremor, ataxia, scanning speech (cerebellar) Optic neuritis and trigeminal neuralgia |
Multiple sclerosis
|
|
Charcot's triad
|
Intention tremor
Dysarthria Nystagmus |
|
Severe, lancinating maxillary or mandibular pain - brief
|
Trigeminal neuralgia (carbamazepine)
|
|
Bright lesions on T2-weighted imaging, in corpus callosum and periventricular regions + inferior to tentorium
|
MS
|
|
Imaging technique to detect MS
|
T2 weighted images
FLAIR (fluid attenuated inversion recovery) Decreased N-acetylaspartate measured by SPECT + CSF - IgG and oligoclonal bands |
|
Tx for MS
|
IV steroids (do not decrease future attacks)
Immunomodulation - Interferon b-1a - interferon b-1b - Glatiramer acetate (synthetic polypeptide of myelin basic protein) |
|
Tx for MS patient with secondary progressive or worsening relapsing-remitting disease
|
IV mitoxantrone (antineoplastic immunomodulatory agent)
|
|
Oligoclonal bands are found in?
|
SLE
Neurosarcoidosis SSPE Subarachnoid hemorrhage Syphilis CNS lymphoma |
|
Multiple neurologic symptoms 1-3 weeks post-infection or vaccination in young adult/children
|
Acute Disseminated Encephalomyelitis
|
|
Pathology of ADEM
|
Perivenular demyelination, relative sparing of axons
(peripheral subcortical cerebral white matter, thalami) |
|
Distinguish between MS and ADEM
|
Post-infection
Early-onset ataxia High lesion load on MRI Involvement of deep gray matter (thalami) Absence of oligoclonal bands |
|
Tx for ADEM
|
Corticosteroids can shorten duration of disease
|
|
Mechanism of botulinum toxin
|
Binds presynaptic cholinergic receptors on motor nerve terminals --> inhibit acetylcholine release --> disrupted neurotransmission between nerve and end plate on muscle
|
|
Cancers that metastasize to brain
|
Lung
Breast Kidney Skin Uterus |
|
Non-neoplastic malformations involving neurons and glia near hypothalamus, involving neuroendocrine fx (precocious puberty or acromegaly); pts may experience paroxysms of laughter
|
Hypothalamic hamartomas
(gelastic seizures = paroxysmal laughter) |
|
Pt with AIDS and tumor that can directly invade optic nerve
|
Primary lymphoma
|
|
Hepatic encephalopathy causes changes to what cells?
|
Increased astrocytes
|
|
HTN encephalopathy will show what CSF changes?
|
Mod increase in CSF protein (<100)
|
|
Neuro consequence of chronic renal failure
|
Peripheral neuropathy - symmetric, distal, mixed sensorimotor due to axonal degeneration
Improved with dialysis |
|
Tx for restless leg syndrome
|
Gabapentin |
|
Type of visual field cut seen in vit B12 deficiency
|
Centrocecal scotoma
|
|
Cancers that metastasize to brain
|
Lung
Breast Kidney Skin Uterus |
|
Non-neoplastic malformations involving neurons and glia near hypothalamus, involving neuroendocrine fx (precocious puberty or acromegaly); pts may experience paroxysms of laughter
|
Hypothalamic hamartomas
(gelastic seizures = paroxysmal laughter) |
|
Pt with AIDS and tumor that can directly invade optic nerve
|
Primary lymphoma
|
|
Hepatic encephalopathy causes changes to what cells?
|
Increased astrocytes
|
|
HTN encephalopathy will show what CSF changes?
|
Mod increase in CSF protein (<100)
|
|
Neuro consequence of chronic renal failure
|
Peripheral neuropathy - symmetric, distal, mixed sensorimotor due to axonal degeneration
Improved with dialysis |
|
Tx for restless leg syndrome
|
Gabapentin
Clonazepam L-dopa Dopamine agonists Opiates |
|
Type of visual field cut seen in vit B12 deficiency
|
Centrocecal scotoma
|
|
Anemia, dermatitis, memory deficits in diet limited to corn
|
Pellagra
(nicotinic acid or tryptophan) |
|
spinocerebellar degeneration, polyneuropathy, pigmentary retinopathy - deficiency in?
|
Vit E (early childhood)
|
|
obesity + hypersomnia + sleep apnea
|
Pickwickian syndrome (hypoxemia, pulm HTN)
|
|
EEG findings with hepatic encephalopathy
|
Triphasic waves
|
|
Normal background posterior-dominant rhythm on EEG
|
alpha 8-12 Hz
|
|
Gait d/o in NPH looks like?
|
Apraxic gait (like Parkinson gait)
|
|
NPH on CT/MRI
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Enlarged temporal/frontal horns of lateral ventricles out of proportion to cortical atrophy; blunted frontal horns
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Language disturbance in Alzheimer's
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Decreased fluency
Dysnomia Transcortical sensory aphasia Repetition intact |
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Type of dementia in Huntington's
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Subcortical - impaired executive fx and concentration
no aphasia, apraxia, amnesia (classical cortical features) |
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Headache, dementia, psychosis, decreased consciousness, myopathic weakness, delay in relaxation phase of reflexes (hung up reflex), cerebellar ataxia
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Hypothyroidism
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Seizures, myoclonus, ataxia, supranuclear gaze disturbance, hypothalamic dysfx, dementia, pendular convergence movements of eyes w/ masticatory mm movement (oculomasticatory myorhythmia)
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Whipple disease (T. whippelii)
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Areas affected by progressive multifocal leukoencephalopathy (JC virus)
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Subcortical white matter - occipital, parietal --> visual complaints, alien hand syndrome |
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Which drugs enhance chorea in Huntington's disease?
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Dopaminergic (L-dopa, bromocriptine, lisuride)
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Trihexylphenidyl MOA
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decreases acetylcholine transmission --> can be used to counteract parkisonian side effects for neuroleptic drugs
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Blepharospasm, forceful jaw opening, lip retraction, neck contractions, tongue thrusting, idiopathic in 6th decade
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Meige syndrome |
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Tx for tremor that comes on with action, involves arms/head, diminished with EtOH
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Beta-blockers
Primidone (anticonvulsant) |
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Side effect of metoclopramide hydrochloride (Reglan)
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parkisonism, tardive dyskinesia
|
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Lhermitte sign
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Electrical sensation radiating down spine when neck is passively flexed (spinal cord disease, MS)
|
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Tx to reduce freq of MS flares
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Interferon beta-IB
Glatiramer (immunomodulator) Glucocorticoids to tx acute flare |
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Developmental regression at 6 month, extensor posturing + rigidity, myoclonic seizures (defect in NAA metabolism --> elevated levels in brain), brain has spongiform appearance
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Canavan disease
|
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Symptomatic tx for MS
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Baclofen (antispasmodic)
Tizanidine (a2-agonist, muscle relaxant) Benzodiazepine |
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Bilateral optic neuritis + transverse myelitis (paraparesis, bladder/bowel dysfx, sensory deficit)
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Neuromyelitis optica (more likely to develop relapsing-remitting MS)
|
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Male children in first few months of life, + nystagmus, limb tremors, optic atrophy, chorea, seizures, gait ataxia
Demyelination with sudanophilic staining |
Sudanophilic leukodystrophy (Pelizaeus-Merzbacher disease) |
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Intracranial calcifications that follow gyral pattern of cerebral crotex --> railroad tracks on XR
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Sturge-Weber
|
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Lateral ventricles with typical batwing conformation
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Agenesis of corpus callosum
|
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Children with scaly erythematous rash on face, episodic ataxia
Hartnup disease - deficiency in? |
tryptophan (precursor for nicotinamide) and other neutral amnio acids |
|
Polycystic liver disease
Polycystic kidney disease Retinal angiomas (telangiectasia) Cerebellar tumors Hemangiomas, adenomas, hemangioblastomas |
von Hippel-Lindau
|
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Erythrocytosis with cerebellar signs
Microscopic hematuria Hepatosplenomegaly |
Von Hippel Lindau
|
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Acanthocytes
Posterior column and spinocerebellar degeneration Retinitis pigmentosa |
Abetalipoproteinemia
|
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Associated with Arnold-Chiari type 2 (downward displacement of cerebellar tonsils into foramen magnum)
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Spina bifida
|
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Retinal problem assoc with tuberous sclerosis
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Retinal phakoma (gliomatous tumors)
CNS calcifications, ash-leaf spots, renal tumors, cardiac rhabdomyomas, seizure disorders |
|
enlargement of the fourth ventricle; a partial or complete absence of the cerebellar vermis, the posterior midline area of cerebellar cortex responsible for coordination of the axial musculature; and cyst formation near the internal base of the skull.
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Dandy-Walker malformation
|
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Effect of EtOH on developing brain
|
impaired neuronal migration --> MR, learning disabilities, hyperactivity, microcephaly
|
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proximal muscle weakness in cancer patient
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Dermatomyositis (paraneoplastic) - but not assoc with CNS tumors
|
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man with problem relaxing grip, hypersomnolence, premature baldness, testicular atrophy, cataracts
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Myotonic dystrophy
|
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EMG pattern for myotonic dystrophy
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"Dive bomber pattern" |
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Signs of poor prognosis in ALS
|
Facial fasciculations
Diaphragmatic weakness |
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Most common site of CNS atrophy associated with chronic alcoholism
|
Superior vermis
|
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organophosphate toxicity
|
Severe motor polyneuropathy (UMN and LMN)
anticholinesterase activity = headache, vomiting, abd cramps, sweating, wheezing |
|
Toxic lead exposure
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Brain edema --> herniation |
|
Pyridostigmine, physostigmine, edrophonium are?
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Anticholinesterase
|
|
Atropine is a?
|
Anticholinergic
|
|
Toxicity:
Personality change, tremor, ataxia in a paper/pulp/electrochemical plant |
Mercury
Damage to cerebellum, calcarine cortex of occipital lobe (visual field constriction) |
|
Toxicity: wrist and finger drops and mild sensory abnormalities in distribution of radial nerves
|
Lead toxicity
+ abd pian, constipation, anemia, basophilic stippling, lead lines along gingival margin |
|
Toxicity: Mucosal irritation, hemolysis, tonic-clonic seizures, polyneuropathy, psych changes
|
Arsenic
|
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Toxicity: peripheral neuropathy, degeneration of posterior columns/dorsal roots assoc with rye ingestion
|
Ergot
|
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Toxicity: Parkinsonism
|
MPTP |
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Toxicity: Confusion, headache, coma/posturing/seizures --> delayed neurologic deterioration with parkinsonian features 1-3 weeks after initial event
|
CO |
|
Contralateral hemiparesis, retardation, seizures, glaucoma, intracranial calcifications assoc with leptomeningeal angiomatosis
|
Sturge-Weber (port wine stain)
|
|
Effects of HTN on retina
|
Segmental narrowing of arterioles |
|
Retinal microaneurysms are associated with?
|
DM |
|
Osteomyelitis of the petrous pyramid leading to abducens and trigeminal nerve injury
|
Gradenigo syndrome (facial pain and diplopia)
|
|
Trauma to the face is most likely to injure which mm of the eye?
|
Superior oblique (CN 4) --> impaired intorsion of eye --> slight head tilt
|
|
Eye nerve most likely affected by varicella zoster
|
CN 4 |
|
MLF syndrome
|
weak adduction of affected eye
abduction nystagmus of contralateral eye |
|
Jerky downward motion of both eyes with slow return
|
Ocular bobbing - pontine damage |
|
Transient loss of vision caused by disease of arteries - which artery?
|
Internal carotid (emboli)
|
|
Absence of thiamine in EtOHic leads to?
|
Periaqueductal and mamillary body lesions --> autonomic failure |
|
Decremental response of muscles to repetitive stimulation of nerve at low frequency
Incremental response to repetitive stimulation at high frequency |
Botulism
|
|
Bugs most responsible for meningitis in 6 mo old
|
H. flu |
|
Signs of cauda equina compression
|
Loss of bowel and bladder control
Paraparesis/paraplegia |
|
Deteriorating consciousness, autonomic disturbances (hypotension, hypothermia), ocular motor problems, gait difficulty in an alcoholic
|
Wernicke encephalopathy --> hemorrhagic necrosis
|
|
Acute severe fever, tachypnea, tachycardia, rigidity --> diffuse segmental muscle necrosis
|
Malignant hyperthermia
|
|
Fourth nerve palsy (superior rectus)
|
Difficulty looking down and medially (can't go down stairs)
|
|
Evidence of basilar skull fracture
|
Periorbital ecchymosis (raccoon eyes) |
|
Person with head trauma has multiple punctate hemorrhage on MRI - reason?
|
Diffuse axonal injury - swelling in white matter, corpus callosum, upper brainstem. |
|
Tx for trigeminal neuralgia
|
Carbamazepine
Phenytoin Baclofen |
|
Tx for incontinence in MS
|
Imipramine
Oxybutynin (anticholinergic) |
|
Tx for spasticity
|
Baclofen
Tizanidine |
|
Tx for status epilepticus
|
Lorazepam/Diazepam IV |
|
Tx of glioblastoma multiforme
|
Complete gross resection + radiation therapy |
|
Factors w. WORSE prognosis in MS ?? ??? |
2+ attacks per yr
Motor or cerebellar component
Older age onset (40+ yr old)
Residual motor or cerebellar fx 6 mo. s/p attack
Moderate disability within 5 yrs |
|
GOOD prognostic indicators?? |
Initial presentation w/optic neuritis
Pure sensory sxs during attacks |
|
transient monocular blindness |
ICA/opthalamic a. stroke
(amaurosis fugax) |
|
Hemiplegia (Leg >arm) Confusion Abulia Incontinence +Babinski |
ACA stroke
(abulia = "loss of volition") |
|
Aphasia
Homonymous hemianopia (w.macular sparing)
Thalamic Pain Syndrome (w. contralateral hemisensory dysfx) |
PCA stroke |
|
Dysarthria
Diploplia
Ipsilateral Horner syn
ipsilateral facial + contralateral limb numbness |
Wallenberg Syndrome!
Vertebral artery (sometimes PICA) |
|
Pinpoint pupils
Quadraplegia+sensory loss ("long tract signs")
CN abnormalities
Cerebellar dysfx |
Basilar stroke |
|
Diploplia
Nystagmus
Vertigo +/- N/V
Ipsilateral limb ataxia |
Cerebellar stroke |
|
Pure hemiplegia
Pure hemianesthesia
Ataxic hemiparesis
Dysarthria + Clumsy Hand
|
Lacunar stroke |
|
Aphasia if dominant Apraxia/neglect if non-dominant
Hemianesthesia Hemiplegia (Arm or Face >>> leg) Homonymous hemianopia |
MCA |
|
Stroke in MCA branch on dominant side (either inf or sup. branch) causing what? |
Superior = expressive
Inferior = receptive |
|
Presentation of
Pyridoxine toxicity (vB6 tox from TB tx) |
Sensory Neuropathy areflexia |