neuro 18

Question 1

cardinal feature of toxic-metabolic encephalopathy

Answer 1

waxing and waning level of arousal; asterixis is a frequent finding

Question 2

most common presentation of neurosarcoidosis

Answer 2

cranial neuropathy due to chronic basal meningitis, with facial and optic nerves most freq affected

Question 3

pathology for neurosarcoidosis

Answer 3

noncaseating granuloma

Question 4

treatment for neurosarcoidosis

Answer 4

steroids

Question 5

neuropathy in DM

Answer 5

distal symmetric sensory polynuropathy; predilection for involvement of small myelinated and unmyelinated fibers; loss of temp and pinprick sensation

Question 6

autonomic neuropathy in DM

Answer 6

gustatory sweating, orthostatic hypotension, diarrhea, and impotence

Question 7

Whipple disease

Answer 7

dementia, seizures, myoclonus, ataxia, supranuc ophthalmoplegia, oculomasticatory myorhthmia

Question 8

Wernicke’s encephalopathy triad

Answer 8

opthalmoplegia, truncal ataxia, and confusion; developing over a period of days to weeks

Question 9

opthalmoplegia

Answer 9

weakness or paralysis of extraocular muscles

Question 10

other manifestations of Wernicke’s encephalopathy

Answer 10

impaired pupillary light response; hypothermia; postural hypotension; and other evidence of nutritional def

Question 11

what causes wernicke’s enceph

Answer 11

deficiency in thiamine

Question 12

treatment for wernicke enceph

Answer 12

IV thiamine; ocular signs can resolve within hours and the confusion over days to weeks; the gait ataxia may persist

Question 13

Korsakoff’s syndrome

Answer 13

isolated memory deficits that persist after Wernicke’s enceph; patients have confabulation

Question 14

what causes subacute combined degernation of the spinal cord?

Answer 14

vit B12 def; degeneration of posterior (dorsal columns) and lateral white matter tracts of the SC

Question 15

presentation of vit B12 def

Answer 15

insidious onset of paresthesias in the hands and feet; with time, weakness and spasticity develop in the legs;

Question 16

what is elevated when B12 is deficient?

Answer 16

homocysteine and methylmalonic acid, the precursors of B12

Question 17

folate def

Answer 17

may cause the same def as in B12 but typically you see the heme def without the neuro

Question 18

characteristics of antiphospholipid syndrome

Answer 18

venous or arterial thrombosis; recurrent fetal loss; and thrombocytopena; this disease is assoc with elevated titers of antibodies directed against phosppholipids

Question 19

anti-phospholipid antibodies

Answer 19

in vitro prolongation of the PTT (lupus anticoagulant); can occur in isolation or in assoc with underlying immune disorder

Question 20

when to do a work up for anti-phospholipid antibody

Answer 20

young patients with stoke or in those with otherwise unexplained stroke; dx requires demonstration of high titer IgG antiphospholipid antibodies on two occasions

Question 21

treatment of anti-phospholipid antibody syndrome

Answer 21

warfarin to achieve INR between 3 and 4

Question 22

antiphospholipid antibody refers to what

Answer 22

it’s a general term that encompasses the lupus anti-coagulant, anticardiolipin antibodies, and antibodies against a mixture of various phospholipids

Question 23

nervous system is more commonly affected by hypo or hyperthyroidism

Answer 23

hypothyroidism

Question 24

central pontine myelinosis

Answer 24

rare demyelinating disorder that occurs most often in alcholics and may be precipitated b too-rapid correction of hyponatremia

Question 25

clinical presentation of central pontine myelinosis

Answer 25

affects the pons and the basal gang, thalamus, and subcortical white matter; acute confusion, spastic quadriparesis, locked-in syndrome, dysarthria, and dysphagia

Question 26

lumbosacral radiculoplexus neuropathy

Answer 26

asymm pain followed by weakness and atrophy in one leg

Question 27

most common cause of lumbosacrak raduculoplexus neuropathy

Answer 27

type 2 DM, also occurs in type 1

Question 28

hypothyroidism

Answer 28

assoc with entrapment neuropaties (carpal tunnel) or an axonal polyneuropathy

Question 29

sarcoidosis

Answer 29

assoc with cranial neuropathies, a meningoencephalities, or hypothal dysfunction

Question 30

weakness involving both the upper and lower face

Answer 30

dysfunction of the LMN

Question 31

weakness that spares the forehead

Answer 31

dysfunction of UMN

Question 32

causes of facial neuropathy

Answer 32

Lyme and sarcoidosis