46,49,59,61

Question 1

essential tremor affects which body parts

Answer 1

both hands and forearms and less commonly the head and voice

begins in one upper extremity and soon compromises the other.

Question 2

age of onset in essential tremor

Answer 2

bimodal- 20s or 60s
unimodal- 50s

tremor frequency decreases with age

Question 3

which drugs can exacerbate essential tremor

Answer 3

valproic acid

lithium

Question 4

differential for essential tremor

Answer 4

Parkinson’s disease and dystonic tremor.

Question 5

first line medical management for essential tremors depending on age

Answer 5

young- propranolol

old- primidone

Question 6

surgical management for essential tremors

Answer 6

stereotactic thalamotomy and thalamic stimulation

target: ventralis intermedius nucleus of the thalamus.

Question 7

posture. Involuntary sustained twisting is referred to as

Answer 7

dystonia

Question 8

drugs that can cause dystonia

Answer 8

dopamine blocking drugs (neuroleptic/antipsychotics)

antiemetics (prochlorperazine or metoclopramide)

Question 9

Focal dystonia commonly affects which muscles?

Answer 9

cervical muscles –> twisting of head to side (torticollis)

Question 10

other types of focal dystonia

Answer 10

blepharospasm (an involuntary closure of the eyelids),

dystonic writer’s cramp,

spasmodic dysphonia,

oromandibular dystonia.

Question 11

Young patients with focal dystonia should be

screened for

Answer 11

Wilson’s disease.

Question 12

diagnosing focal dystonia

Answer 12

clinical

Question 13

treatment for mild dystonia

Answer 13

nothing

Question 14

treatment for severe dystonia

Answer 14

*botox- lasts up to 3-6 mo

anitcholinergics, benzos

Question 15

type of gait in cerebellar dysfunction

Answer 15

wide based gait

Question 16

cardinal features of cerebellar dysfunction

Answer 16

disturbances in motor control,
muscle tone regulation,
coordination of skilled movements.

Question 17

can speech be affected in cerebellar dysfunction?

Answer 17

yes- speech slurred- cerebellar dysarthria

Question 18

arterial supply of cerebellum and which main arteries they come from

Answer 18

PICA- vertebral artery

AICA- basilar

SCA- basilar

Question 19

The distal portions of PICA bifurcate into a medial trunk that supplies the _____ and a lateral trunk that supplies the ______

Answer 19

medial: vermis and the adjacent cerebellar hemisphere
lateral: cortical surface of the tonsil and cerebellar hemisphere.

Question 20

AICA supplies the

Answer 20

lateral tegmentum of the lower two-thirds of the pons

ventrolateral cerebellum.

Question 21

The _____ arises from AICA to supply the facial and auditory nerves.

Answer 21

internal auditory artery

Question 22

SCA supplies the .

Answer 22

superolateral cerebellar hemispheres,

superior cerebellar peduncle,

the dentate nucleus,

part of middle cerebellar peduncle

Question 23

cerebellar infarction (caused by thrombosis or embolus) presents with what?

Answer 23

severe vertigo, nausea, vomiting, and ataxia.

Loss of balance and difficulty maintaining posture, standing, and walking

Question 24

what can happen with bilateral or large cerebellar infarcts?

Answer 24

edematous cerebellum may compress the aqueduct of Sylvius or the fourth ventricle
–> obstructive hydrocephalus,

or may compress the brainstem–> decreased alertness.

Question 25

With a cerebellar pressure cone, there is downward displacement of the cerebellar tonsils through the foramen magnum, resulting in

Answer 25

neck stiffness, cardiac and respiratory rhythm disturbances, apnea, and death.

Question 26

With upward transtentorial herniation, there is upward displacement of the superior aspect of the cerebellar hemisphere through the edge of the _____ resulting in ____

Answer 26

tentorial incisura midbrain compression

Question 27

Clinical manifestations of upward cerebellar herniation include

Answer 27

lethargy, coma, paralysis of upward gaze, midposition and unreactive pupils, and abnormal extensor posturing.

Question 28

management of cerebellar infarcts

Answer 28

ICU, stroke unit ``` Emergency surgery (e.g., ventriculostomy or posterior fossa decompression or both) ```

Question 29

most common dominantly inherited ataxia | in the world is ____

Answer 29

SCA 3 (Machado-Joseph disease)

Question 30

SCA stands for

Answer 30

spinocerebellar ataxia

Question 31

SCA 3 clinical features

Answer 31

progressive ataxia along with abnormalities of eye movements, speech, and swallowing. Onset-30s or 40s supranuclear ophthalmoparesis. Facial myokymia (resembling fasciculations)

Question 32

SCA-1 presentation

Answer 32

begins with gait ataxia, and over time patients develop severe dysarthria and dysphagia. Ophthalmoparesis, spasticity, and choreoathetosis

Question 33

most patients with SCA 1 become wheelchair bound within ___ years

Answer 33

15

Question 34

SCA 6 presentation

Answer 34

milder, slow course mild sensory loss

Question 35

SCA 7 is associated with

Answer 35

retinal degeneration.

Question 36

SCA 10 is common in what population and has what manifestation

Answer 36

Mexican families seizures

Question 37

SCA 12 is associated with

Answer 37

prominent early tremor of the arms and head

Question 38

SCA 17 presentation (onset, features)

Answer 38

midlife cognitive decline and basal ganglia signs