Blueprints Flashcards
(33 cards)
Xanthochromia
Typical in SAH, hemorrhagic encephalitis
Positive EBV PCR in CSF
Suggestive of CNS Lymphoma
Peripheral nystagmus
Peripheral nystagmus is often unidirectional, with
the fast phase away from the lesion; it combines
horizontal and torsional movements and is inhibited
by fixation.
Central nystagmus
Central nystagmus is normally bidirectional; often
purely horizontal, vertical, or torsional; and not inhibited
by fixation.
Vertical Saccades
Vertical saccades originate from bilateral frontal
eye fields or the superior colliculus.
Ménière disease
Ménière disease is characterized by episodic
vertigo with nausea and vomiting; fluctuating, but
progressive hearing loss; tinnitus; and a sensation of
fullness or pressure in the ear. It is caused by an
intermittent increase in endolymphatic volume.
benign positional paroxysmal vertigo
BPPV
BPPV results from freely moving crystals of calcium
carbonate within one of the semicircular canals.
When the head is stationary, these crystals settle in
the most dependent part of the canal (usually posterior).
With head movements, the crystals move more
slowly than the endolymph within which they lie;
once the head comes to rest, their inertia causes
ongoing stimulation of the hair cells, resulting in the
illusion of movement (vertigo). Diagnosis is established
by demonstrating the characteristic downbeating
and torsional nystagmus with the Dix-Hallpike
test
perilymph fistula
A perilymph fistula results from disruption of the
lining of the endolymphatic system. Typically, the
patient reports hearing a “pop” at the time of a sudden
increase in middle ear pressure, with sneezing,
nose-blowing, coughing, or straining. This is followed
by the abrupt onset of vertigo.
Vestibular neuronitis
Vestibular neuronitis presents as an acute unilateral
(complete or incomplete) peripheral vestibulopathy.
The designation neuronitis is inaccurate
because there is no evidence of inflammation, but
the term is retained here because of its common
usage. Patients develop a sudden and spontaneous
onset of vertigo, nausea, and vomiting. The onset is
usually over minutes to hours; symptoms peak
within 24 hours and then improve gradually over
several days or weeks. Complete recovery may not
occur for months. Nystagmus is strictly unilateral
and may be suppressed by visual fixation. Recovery
represents central compensation for the loss of peripheral
vestibular function
episodic ataxia
The episodic ataxia (EA) syndromes are characterized
by brief episodes of ataxia, vertigo, nausea, and vomiting caused by mutations
in calcium and potassium channel genes.
spinocerebellar ataxias (SCAs).
The typical presentation is the
insidious onset of progressive impairment of gait and
dysarthria in early adult life.The autosomal dominant SCAs are a group of
degenerative disorders caused by trinucleotide
expansions. CAG
Miller Fischer syndrome
The Miller Fisher syndrome (MFS) is a disorder
characterized by the triad of ataxia, areflexia, opthalmoplegia. The ataxia is due to proprioceptive
loss rather than to cerebellar dysfunction.
Lennox-Gastaut
Tonic, atonic, myoclonic, generalized tonic clonic, absence. mental retardation. slow (1-2 Hz) spike and wave
valproic acid and lamotrigine treatment
Benign rolandic epilepsy
Simple partial involving mouth and face, generalized toni-clonic
Nocturnal preponderance of seizures
Centrotemporal spikes
Carbamazepine treatment
Absence
Hyperventilation as trigger
3-hz spike and wave
Ethosuximide, valproic acid
Juvenile myoclonic epilepsy
Myoclonic absence, generlaized tonic-clonic
Early morning preponderance of seizures
4 to 6 polyspike-and-wave
Valproic acid, lamotrigine
Parkinson
mutations: alpha synuclein, parkin, DJ-1, PINK1, UCH-L1, LRRK2
The tremor is slow (3-5 Hz) and most prominent when the limb is at rest
Stiff-person syndrome
Characterized by chronic axial muscle rigidity and stiffness with superimposed painful muscle spasms. Stiff-person syndrome may be associated with anti-GAD antibodies. Benzodiazepines and baclofen are the most useful antispasticity agents
Sarcoidosis
Cranial neuropathy
due to chronic basal meningitis is the most
common presentation of neurosarcoidosis, with the
facial and optic nerves most frequently affected.
steroids. Visual changes are common and may
be due to direct involvement of the optic nerve or its
meningeal covering or to uveitis. Raised intracranial
pressure with papilledema may result from a spaceoccupying
lesion, diffuse meningeal involvement, or
hydrocephalus.
Glioblastoma
multiforme (grade IV
astrocytoma)
Common, highly malignant 1° brain tumor with ~ 1-year median survival. Found in cerebral
hemispheres A . Can cross corpus callosum (“butterfly glioma”). Stain astrocytes for GFAP.
Histology: “pseudopalisading” B pleomorphic tumor cells—border central areas of necrosis and
hemorrhage.
Meningioma
Common, typically benign 1° brain tumor. Most often occurs in convexities of hemispheres (near
surfaces of brain) and parasagittal region. Arises from arachnoid cells, is extra-axial (external
to brain parenchyma), and may have a dural attachment (“tail” C ). Often asymptomatic; may
present with seizures or focal neurologic signs. Resection and/or radiosurgery.
Histology: spindle cells concentrically arranged in a whorled pattern; psammoma bodies (laminated
calcifications D).
Hemangioblastoma
Most often cerebellar E . Associated with von Hippel-Lindau syndrome when found with retinal
angiomas. Can produce erythropoietin 2° polycythemia.
Histology: closely arranged, thin-walled capillaries with minimal intervening parenchyma F .
Schwannoma
Classically at the cerebellopontine angle, but can be along any peripheral nerve G. Schwann cell
origin H, S-100 ⊕; often localized to CN VIII vestibular schwannoma. Resectable or treated
with stereotactic radiosurgery.
Bilateral vestibular schwannomas found in NF-2.
Oligodendroglioma
Relatively rare, slow growing. Most often in frontal lobes I . “Chicken-wire” capillary pattern.
Histology: oligodendrocytes = “fried egg” cells—round nuclei with clear cytoplasm J . Often
calcified in oligodendroglioma.
