Neurology 1 Flashcards
-Brain Lesions-CVA
Visual problem in pituitary tumor compressing optic chiasm (10x)
bitemporal hemianopsia
Unsteady gait, appendicular ataxia in LE only, normal eye movement. Walks with lurching broad-based gait. Dx? (8x)
Cerebellar degeneration (alcoholic)
66y c/o frequent falls, several month h/o of anxiety, unwillingness to leave home. Exam: mild impairment of vertical gaze on smooth pursuit/saccades, mild axial rigiditiy & minimal rigidity of UE, mild slowness of finger tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Pt slow in rising from chair. Most likely dx (8x)
Progressive supranuclear palsy
Severe occipital h/a, BL papilledema and no other abnl. Chronic acne treated wtih isotretinoin. LP elevated opening pressure with no cells, 62mg/dL glucose, 22mg/rL protein. Normal CT. Dx? (7x)
pseudotumor cerebri
79y deteriorating mental state over 3-wk period has an exaggerated startle repsonse with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Myoclonic jerks also seen. Dx: (5x)
Spongiform encephalopathy
Slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or h/a reported. Likely dx? (4x)
Normal pressure hydrocephalus
65y fell several times past 6mo. MSE nl. Smooth pursuit, saccadic movements impaired. Worse w/ vertical gaze. Full ROM w/ doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)
Progressive Supranuclear Palsy
Acute onset of pain, decr vision in R eye. Colors look faded when viewed through the R eye. On Exam, R afferent pupillary defect and swollen R optic disc. Pt spontaneously recovers over the next 6 wks. Likely to develop later. (4x)
Multiple sclerosis
28y + emotional lability & impulsivity. LFTs elevated. Close relative had similar sx and died at 30y from hepatic failure. Which blood level would dx? (3x)
Ceruloplasmin
Several days of fever + severe h/a presenting to ED b/o generalized seizure. Pt confused and somnolent. Also reported to have been irritable, c/o foul smells. T2 MRI displayed (hyperintensity of L temporal) Dx? (3x)
Herpes encephalitis
9y F has 3m h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6m ago, Tanner stage 4. Dx? (2x)
Hypothalamic hamartoma
5y with 4m h/o morning h/a, vomiting, recent problems with gait, falls, diploplia (2x)
Medulloblastoma
70y + flaccid paralysis following severe water intoxication. Develops dysphagia adn dysarthria without other cranial never involvement. Sensory exam limited but grossly normal, DTRs are symmetric, cognition intact. Likely Dx (2x)
Central pontine myelinolysis
Young adult gained 70lb in last year c/o daily severe h/a sometimes associated with graying of vision. Papilledema present. CT and MRI brain shows smaller ventricles than normal. Goal of rx (2x)
Prevent blindness
Superior homonymous quandrantic defects in the visual fields result from lesions to which of the following structures? (2x)
Temporal optic radiations
Tremor with freq of ~3Hz, irregular amplitude, most evident towards the end of reaching movements. Dx? (2x)
cerebellar tumor
acute onset of fever, sore throat, diplopia & dysarthria. Exam reveals inflamed throat, L adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, & mild R hemiparesis. CT uninformative. Spinal fluid has protein 24, 10 mononuclear cells, glucose 70. Dx? (2x)
multiple sclerosis
Which is most reliable CSF finding for pt with multiple sclerosis in chronic phase of dz? (2x)
presence of monoclonal bands
Benign intracranial HTN etiology (2x)
hypervitaminosis A
Gait abnl, slow mvmt, asymmetric UE rigidity. Difficulty in voluntary vertical upward/downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems with horizontal & vertical gaze. Oculocephalic reflexes nl. Involuntary saccades. Dx? (2x)
Progressive supranuclear palsy
Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. The most likely medical cause of this presentation is (2x)
Herpes simplex virus (HSV) infection
What condition is a forerunniner of Multiple sclerosis? (2x)
transverse myelitis
Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning associated comas (2x)
Globus pallidus
43yo newly w/ AIDS. Pt has inc social withdrawal and irritability over several weeks. Can’t remember phone number, unable to do chores, appears distracted. Mild R hemiparesis, L limb ataxia, bilateral visual field defects. LP normal. T2 scan shown. What is dx? (2x)
Progressive multifocal leukoencephalitis
57y new onset speech difficulty cannot name objects and sometimes cannot say “yes or no” and cannot “if ands or buts” but can follow verbal and written commands. No problems with chewing/swallowing. What is the condition? (2x)
Broca’s Aphasia
h/o dementia & myoclonus shows what pathologic changes with crystal violet changes?
cytosolic vacuolation of neuroglia with prion inclusions
What is the expected presentation with Wernicke’s encephalopathy?
Amnesia, confabulation, lack of insight
80y F lives in nursing home, believes she lives in hospital dorm and is working with maintenance staff. No distress, alert, oriented, calm, organized speech, behavior otherwise normal. Example of what memory disturbance?
Confabulation
AIDS pt with new onset h/a & cognitive decline, MRI shows multiple ring-enhancing lesions, cause?
Toxoplasmosis gondii
Neuropsychological test that examines both visual/spatial & executive functions
Clock drawing
Image of a clock, with all the numbers drawn only on the R hand side
Parietal lobe
Head injury with personality changes, impulsivity, euphoria. Site of injury?
Orbitofrontal cortex
What is the transmissible element that causes progressive decline and myoclonic jerks? Brain bx shows spongiform changes
Prion
Kluver-Bucy syndrome can be induced in animals with bilateral resection of which structures?
Temporal lobes –> plasticity, hyperorality, hypersexuality, hyperphagia
MC psych complication from TBI
Depression
Executive dysfxn comes from damage to
Fronto-subcortical
36y pt w/ double vision, vertigo, vomiting, paresis of medial rectus on lateral gaze w/ coarse nystagmus in abducting eye w/ lateral eye mvmt. Dx?
Multiple sclerosis
35y pt w/ new onset h/a, what suggests mass lesion w/ raised ICP?
Papilledema on eye exam
Aphasia 2/2 lesion in posterior third of L superior temporal gyrus. Dx?
Wernicke
5y presents w/ sudden onset slurred speech & gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria, extensor plantar responses. Recent h/o measles. MRI, UA, blood work unremarkable. Dx?
Acute cerebellitis
Neuro exam 59y testing slap palm of hand on knee alternating with dorsum hand rapidly. Difficulty w maneuver, clumsy, irregular. Which describes this abnl?
Dysdiadochokinesia
Abulia refers to impairment in ability to
Spontaneously move and speak (inability to act decisively, absence of willpower)
Prosopagnosia
Inability to recognize faces
56y M, normal brain scan, no prior psych hx is impulsive and disinhibited with personality changes. What would PET scan show?
Bilateral temporal lobes w reduced perfusion
Inability to recognize objects by touch
Astereognosis
Which cancer has the highest likelihood of going to the brain?
Lung
Etiology of meningitis assoc w fever, H/A, CSF pleocytosis with lymphocyte predominance, slightly elevated CSF protein, and normal CSF glucose. Dx?
Coxsackie Virus
MC solid tumor of CNS in kids
Neuroblastoma
75y pt eval for progressive gait, urine incontinence, cognitive decline. After CSF removal, improved gait & balance. CT shows?
Enlargement of frontal horns
41y chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort maintenance, irritability (MRI: hyperintensity in frontal lobe and what looks like a finger protrusion) Dx?
Multiple sclerosis
25y w severe H/A, vomiting. Pain is dull & mostly in occipital region. Exam: b/l papilledema, otherwise WNL. LP: opening pressure 200mm H2O, no cells, 62 mg/dl glucose, 31 mg/dl protein. CT: normal. Dx?
Pseudotumor cerebri
Histology consistent with Jakob-Cretzfeldt dz
Cytosolic vacuolation of neurons and glia with prion inclusions
Dx for 68y c/o falls. PE shows upright rigid posture, stiff gait, extended knees, pivoting while turning
Progressive supranuclear palsy
Dx for 32y F w/ vertigo and Internuclear ophthalmoplegia
Multiple sclerosis
66y w frequent falls. On exam: difficulty with upward gaze & severe axial rigidity, which is less apparent in upper and lower extremities. Mild slowness of movement on finger tapping, hand opening, wrist opposition. Pt’s fingers acquire cramped pastures with effort of these tasks. The pt’s neck is extended. Gait is somewhat slow, with short steps, and the pt is slow when arising from a chair. Dx?
Progressive supranuclear palsy
70y pt develops confusion, lethargy, generalized tonic-clonic seizure. Lab reveals serum Na of 95mEq/L. This is most likely a complication of excessively rapid correction of which metabolic problem?
Central pontine myelinolysis
Hippocampal atrophy has been identified in all of the following disorders
MDD, Alzheimer’s Dz, PTSD (not dissociative amnesia)
Severe occipital H/A, b/l papilledema, vomiting. Just started birth control. LP shows elevated opening pressure no cells, 62mg/dl glucose, 31mg/dl protein, RBC 400. CT is normal. Dx?
Sagittal sinus thrombosis