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1
Q

Aphasia

A

language abnormality

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2
Q

Right hemiparesis
Frustrated
Inability to produce language

A

Brocha lesion

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3
Q

Lesion in Brocha’s aphasia

A

posterior inferior frontal gyrus in left

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4
Q

Inability to comprehend
Neologisms
Paraphasia
Contralateral homonymous superior quadrantnopia

A

Wernicke’s

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5
Q

Lesion in Wernike’s

A

posterior superior temporal gyrus

Inferior MCA

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6
Q

Conduction aphasia

A

inability to repeat what is said

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7
Q

Lesion in conduction aphasia

A

arcuate fasciculus

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8
Q

Global aphasia

A

Large lesion affecting brocha’s and Wernike’s

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9
Q

Occipital lesion with involvement of the splenium of the corpus callosum causes

A

Alexia without agraphia

contralateral homonymous hemianopia

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10
Q

Apraxia

A

inability to perform learned tasks

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11
Q

Agnosia

A

Inability to recognize objects

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12
Q

prosopagnosia

A

inability to recognize faces

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13
Q

lesion in angular gyrus

A

Gerstmann Syndrome

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14
Q

Symptoms of Gerstmann syndrome

A

agraphia
acalculia
R-L confusion
finger agnosia

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15
Q

Neglect

A

Lesion in the non-dominant side causes neglect of left side of world

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16
Q

dementia with visual hallucinations

A

Lewy Body dementia

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17
Q

Chromosomal abnomralities in Alzeheimers’s

A 
Chromosone 1 presenilin 2
Chromosome 12 alpha 2 macroglobin
Chromosome 14 Presenilin 1
Chromosome 19 ApoE4 
Chromosome 21 APP
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18
Q

Pseudodementia

A

dementia from depression

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19
Q

Rx of alzehemier’s

A

Donepezil
Rivastigmine
Memantine

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20
Q

Criteria for vascular dementia

A

Dementia + one of the following

1) abrupt onset (macrovascular) or step wise (microvascular)
2) focal neurologic sign
3) imaging showing multiple local infarcts or lacunes

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21
Q

Pathogenesis of Lewy Body dementia

A

alpha syneculin accumulation in the cortical neurons (in parkinson’s alpha syneculin is found in the substantia nigra)

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22
Q

Genetic Defect Huntington

A

Autosomal dominant CAG repeat on chromosomal 4

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23
Q

Presentation Triad in Huntington

A

Chorea
Behavioral changes
Dementia

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24
Q

Pathology of Huntington

A

atrophy of caudate

Loss of inhibitory neurons in basal ganglia

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25
Dementia failure of vertical gaze dysarthria, dysphagia Gait ataxia
Progressive Supranuclear palsy
26
Atrophy of dorsal midbrain, globus pallidus and subthalamic nuclei
Progressive supranuclear palsy
27
Behavioral changes followed by dementia
Frontotemporal dementia
28
Rapidly progressing dementia | myoclonus
Prion related
29
14-3-3 CSF positive
CJD
30
Nomral sleep stages ad EEG findings
``` Stage 1 theta Stage 2 sleep spindles + k complexes Stage 3 Delta Stage 4 50% increase in delta REM ```
31
What inhibits stage three sleep? | What inhibits REM sleep?
Stage III Benzos | REM Antidepressants + alcohol
32
Circadian rhythm us controlled by what area of the brain
suprachiasmatic nucleus
33
Common deficiency in restless leg syndrome and management
Anemia---assess ferritin level
34
Treatment of Restless leg syndrome
Dopaminergic agents Ropinirole Pramipexole levodopa
35
Criteria for Narcolepsy
Excessive daytime sleepiness Cataplexy Hypnogogic hallucinations Sleep paralysis
36
Pathophysiology of Narcolepsy
loss of hypocretin secreting neurons
37
Diagnosis of narcolepsy
Decreased hypocretin in CSF Multi-sleep Latency Test (PSG) (>2 episodes of REM upon falling asleep)
38
Treatment of narcolepsy
Modafinil Methylphenidate dextroamphetamine
39
Treatment of cataplexy
TCA: clomipramine | Sodium oxabute
40
Somnabulism
Interruption of sleep with motor behaviors such as walking, dressing driving
41
Sleep terrors
No memory Wake in terror with autonomic signs Do not occur In REM sleep
42
REM behavior disorder
punching, kicking, jumping yelling etc during sleep
43
People with REM have increased incidence of
Parkinsons, Lewy Body demetnia
44
Treatment of REM behavior disorder
Clonazapam
45
Treatment for nocturnal cramps
quinine
46
bitemporal hemianopia
compression of optic chiasm | 2' to aneurysm, pituitary tumor
47
Disease associated with Saccular aneurysms and common sites
ADPKD Ehlers-Danlos Bifurcation of the anterior cerebral and anterior communicating
48
Charcot-Bouchard microaneurysm
Small vessel aneurysms that result from chronic hypertensions. Most commonly affecting the lenticulostriate vessels of the basal ganglia and thalamus
49
Central Post stroke syndrome
in 10% of stroke patients, weeks to months after stroke simple stimuli will cause pain. Due to thalamic lesions
50
Treatment of vasospasm in subarachnoid hemorrhage
nimodipine
51
Types of herniation from intracereberal hemorrhage
Cingulate Downward transtentorial Uncal herniation Cerebellar tonislar
52
Signs of transtentorial herniation
altered mental status -occurs first bilateral small pupils reactive to light -disruption of 1st order sympathetics Cheyne-Stokes breathing flexor/extensor posturing
53
Signs of uncal herniation
ipsilateral blown pupil, nonreactive Down and out gaze False localization (ipsilesional hemparesis) *Commonly from epidural hematoma
54
Signs of Cerebellar herniation
respiratory arrest secondary to medullary compression. Rapidly fatal.
55
Epidural hematoma
Lateral skull fracture leading to a bleed in the middle meningeal artery, lens shaped on exam
56
History and Physical of Epidural hematoma
LOC followed by a lucid interval | Uncal herniation
57
Subdural hematoma
rupture of bridging veins after trauma causing accumulation of blood between the arachnoid and the dura causing a CRESCENT shaped mass
58
History and Physical with Subdural hematoma
headache altered mental status contralateral hemiparesis
59
Area most vulnerable to hypoxia
Hippocampus
60
type of necrosis in the brain
Liquefactive
61
MCA stroke
Motor upper limb and face-contralateral paralysis Sensory upper limb and face-contralateral Aphasia or heminegelct
62
Anterior Cerebral Artery Stroke
Contralateral Motor paresis to the leg | Contralateral Loss of sensation to the limb
63
Lenticulostriate artery stroke
Contralateral hemiparesis/hemplegia
64
Medial Medullary Syndrome
ASA occlusion Contralateral hemiparesis-lateral corticospinal decrease contralteral proprioception Ipsilateral hypoglossal dysfunction
65
Lateral Medullary Syndrome
PICA stroke DYSPHAGIA/HOARSNESS- Vomiting, vertigo, nystagmus ipsilateral decrease in face pain and temp contralateral decrease in body pain and temp ipsilateral horners Ataxia/dysmetria
66
Lateral Pontine Syndrome
``` AICA Stroke Paralysis of face Vomiting, vertigo, nystagmus Ipsilateral pain and temp loss on face Contralateral pain and temp loss body Ataxia Dysmetria ```
67
PCA stroke
Contralateral hemianopia with macular sparing
68
Basilar Artery stroke
"Locked in" Syndrome
69
Anterior Communicating artery Stroke (or aneurysm)
Visual fields deficits
70
Posterior Communicating artery stroke
CNIII palsy Down and out with ptosis and mydriasis
71
Pathway of CSF
Monroe Sylvius Luschka/Magendie/Luschka
72
Idiopathic intracranial hypertension
pseudotumor cerebri | Increased ICP with no cause on imaging
73
History and physical of pseudo tumor cerebri
Hx: HA, diplopia (CNVI palsy), no metnal status change PE: Papilledema
74
RF for pseudotumor cerebri
Childbearing age Vitamin A excess Danazol
75
Treatment of pseudo tumor cerebri
Weight loss Acetazolamide Topiramate Invasive procedures in refractory
76
Pathophysiology of NPH
expansion of the ventricles OUT OF PROPORTION with the sulci causes expansion of the corona radiata
77
Clinical Findings in Normal pressure hydrocephalus
Urinary incontinence Dementia Magenetic Ataxia CT/MRI with enlarged ventricles out of proportion with sulci
78
Treatment of NPH
cerebral fluid shunting
79
Pathophysiology of Communicating hydrocephalus with symptoms
Decreased CSF reabsorption Increased ICP papillidema herniation
80
Pathophysiology of Noncommunicating hydrocephalus
Outflow obstruction
81
Appearance of hydrocephalus from cortical atrophy causing appearance of increased ventricle size
Ex vacuo ventriculomegaly
82
Characteristics of simple partial seizure
No alteration in consciousness Motor features such as progressive jerking Sensory, autonomic and psychic features localized to half body
83
Characteristics of Complex partial
Alteration of consciousness Auditory/visual hallucinations automatisms-lip smacking Temporal love 70-80%
84
Management of Partial seizures
EEG for localization and R/O pseudo Blood work for secondary causes MRI or CT with contrast
85
Treatment of recurrent partial seizures (5)
``` Phenytoin oxcarbazepine carbamazepine phenobarbital valproic acid ```
86
First line anticonvulsant in children
Phenobarbital
87
Treatment for seizure lasting longer than ____ minutes
2 minutes IV benzodiazepines phenytoin-prophylaxis
88
Side effects of medications used to treat status
Benzos: repiratory depression, sedation, tolerance Phenytoin: megaloblastic anemia, teratogen (fetal hydatoin syndrome), SLE, Steven Johnson, P450 inducer (CI in porphyria)
89
Side Effects Carbamazepine (6)
``` Aplastic anemia Hepatotoxicity teratogen P450 inducer (CI in porphyria) SIADH Steven's Johnson Syndrome ```
90
Side effects of valproic acid
Hepatotoxic | Neural tube defects
91
Side effects of first line seizure therapy in children
``` Phenobarbital sedation tolerance P450 induction cardiorespiratory depression ```
92
Characteristics of tonic clonic seizure
Sudden onset LOC 1-2 minutes of repetitive, symmetric clonic movements Tongue biting and urinary incontinence are common
93
EEG for tonic clonic seizure
10 Hz activity during tonic phase | Slow waves during clonic phase
94
Management of Tonic clonic seziure
PROTECT the AIRWAY Treat underlying cause Medications
95
Treatment tonic clonic seizure
Phenytoin fosphenytoin valproic acid Lamotrigine and Topiramate are adjuvant therapy
96
SE of Lamotrigine and Topiramate
Lamotrigine Steven Johnson | Topiramate Sedation, kidney stones, weight loss
97
Characteristics absent seizures
child with 5-10 seconds impaired consciousness | Eye-fluttering and lip smacking
98
EEG of absent seizure
3 per second spike and wave discharges
99
Treatment of absent seziures
1st line Ethosuximide | 2nd line Valproic acid
100
SE of Ethosuxiide
``` Fatigue GI distress Headache Itching Steven Johnson ```
101
Definition Status epilepticus
Seizure lasting longer than 10 minutes or | Repetitive seizures where patient does not return to baseline consciousness
102
Management of Status Epilepticus
ABC! Administer thiamine, glucose and naloxone IV benzos and loading dos fosphenytoin If unrelenting intubate and load phenopbarb Stat CT head to look for hemorrhage EEG
103
West Syndrome
Infantile spasms generalized epilepsy beginning in first six months of life tonic bilateral symmetric jerk of head, trunks and extrems in clusters of 5-10 arrest psychomotor development
104
EEG findings in Infantile spasm
hypsarrythmia
105
Treatment of infantile spasm
ACTH prednisone clonazepam
106
Lennox Gestaut syndrome
Childhood usually 2-6yrs with multiple daily seizures (usually nocturnal) Usually resistant to treatment.
107
Causes of infantile spasm
PKU Tuberous sclerosis infections Hypoxic ischemic injury
108
BPPV
Bengin Paroxysmal Positional Vertigo | transient (
109
Diagnosis of BPPV
Dix-Hallpike maneuver While sitting turn head 45 degrees Go supine while quickly moving head to the side Positive for BPPV if nystagmus and vertigo produced
110
Treatment for BPPV
modified Epley procedure
111
Acute onset severe vertigo ataxia N/V nystagmus
Acute Peripheral Vestibulopathy Labyrinthitis-auditory changes Vestibuloitis- no auditory changes
112
Diagnosis Acute peripheral vestibulopathy
Diagnosis of exclusion-must rule out stroke AICA stroke resembles labyrinthitis PICA stroke resmebles vestibuloitis
113
Treatment of acute peripheral vestibulopathy
Corticosteroids
114
recurrent episodes of severe vertigo with auditory loss, N/V
Meniere Disease
115
Diagnostic criteria for Meniere
two episodes lasting >20 mins Hearing loss documented once on audiology tinnitus or oral fullness
116
recurrent mild-severe vertigo with headache and photophobia
Vestibular migrane
117
Concerning differential in vestibular migrane
TIA causing dizziness vertebral artery dissection with neck pain Meniere disease with auditory symptoms
118
Syncope more likely to be seizure if
>30 seconds bites tongue has post-ictal symptoms limb jerking
119
Management of syncope if clearly not vasovagal
Holter monitor ECG/cardiac enzymes EEG echocardiogram, tilt-table, neuroimaging
120
Possible causes of syncope
``` Cardiac arrythmias Cardiac outflow obstruction Basilar TIA vasovagal orthostatic hypotension ```
121
Pathophysiology of Migraines
changes in serotonin and vasculature causes irritation of trigeminal nucleus
122
Clinical presentation migraine
throbbing, unilateral headache >2 hours but
123
Abortive therapy for migraine
Triptans metoclopramide analgesic therapy
124
Migraine prophylaxis
anticonvulsants: gabapentin, topiramate TCAs: amitriptyline Beta blockers CCBs
125
Clinical presentation of cluster headache
excrutiating, unilateral, periorbital headache in males that affects same side at same time of day during same part year. Lacrimation
126
Acute therapy cluster headache
Oxygen dihydroergotamine octerotide sumatriptan
127
Prophylactic Therapy
Transitional: prednisone, ergotamine Maintenance: verapamil, methylsergide, Li, valproate, topiramate
128
Management of tension headache
Obtain ESR over concerns for Giant cell arteritis if patient >50
129
Tension headache
bandlike, tight pain without N/V phobias
130
Cavernous sinus thrombosis
Almost always a septic thrombosis from orbit, nasal sinus or central face
131
Causitive agents of cavernous sinus thrombosis
S aureus most common Aspergillus Mucor
132
Presentation of cavernous sinus thrombosis
Headache orbital pain, edema, diplopia Recent history of sinusitis or facial infection Fever
133
Diagnosis of Cavernous sinus thrombosis
Increase WBC Blood cultures CSF exam MRI with contrast and MR venography
134
Treatment of cavernous sinus thrombosis
``` nafcillin or oxacillin ceftriaxone or cefepime metronidazole for anerobes Vanc for MRSA Surgery if no response to antis in 24hrs ```
135
Pathogenesis of Parkinson's
Loss of dopaminergic neurons in the substantial nigra pars compacta
136
Symptoms of Parkinson's
Pill Rolling Tremor Cogwheel rigidity Shuffling Gait Bradykinesia
137
RX of Parkinsons
Levodopa Carbidopa Selegeline Amantadine
138
``` Rigidity Fever Elevated CK leucocytosis (And RX) ```
Neuroleptic malignant | RX with dantrolene and bromocriptine
139
Akathisia (and RX)
Feel the need to move | Rx with beta blockers and anticholinergics
140
bilateral postural tremor
Essential tremor | improves with alcohol
141
Treatment of essential tremor
Primidone Propranolol Topiramate gabapentin
142
Treatment of chorea
haloperidol
143
Hereditary Chorea
Huntington Wilson neuro-acanthocytosis
144
Rx of myoclonus
clonzaepam and valproate
145
Treatment of tics
Haloperidol or atypical neuroleptics Clonazepam Clonidine
146
Children and Concussion: Return to play
No LOC and symptoms lasting 15 mins - One week | LOC 1-2 weeks
147
Diffuse axonal injury
Associated with severe trauma | punctuate hemorrhage in the deep white matter
148
encephalopathy background slowing and triphasic waves Liver dysfunction
Hepatic encephalopathy
149
Facial neuropathy optic neuroptahy Pappiledema noncaseating granuloma
Neurosarcoid
150
Diagnosis of sarcoid
requires histology
151
elevated ACE | CSF with protein and pleocytosis
Sarcoid
152
Treatment sarcoid
Steroid
153
Complications of diabetes
Distal polyneuropathy-particularly pain and temp. Focal peripheral neuropathy radiculopathy chronic inflammatory demyelinating polyradiculopathy
154
meralgia paresthetica
compression of the lateral cutaneous nerve
155
Frontal-temporal dementia seizures pyramidal signs focal demylenation and necrosis of corpus callosum
Marchiafava-Bignami syndrome | from alcohol use
156
Isolated memory disturbance with confabulation
Korsakoff Syndrome
157
Confusion ataxia ophthalmoplegia
Werinick's
158
Symptoms in SLE
``` Hypercoaguable state-->stroke Chorea Transverse myelitis Headaches Seizures distal symmetric sensory polyneuropathy ```
159
Treatment of SLE
Corticosteroids and cyclophosphamide
160
recurrent thrombosis recurrent fetal loss thrombocytopenia
Antiphospholipid syndrome
161
Treatment of antiphospholipid syndrome
Long term warfarin therapy
162
Gliomas
``` Originate from glial cells, supportive non neuronal cells Astrocytoma Oligodendroglioma epydymoma Choroid plexus papilloma ```
163
High malignant primary brain tumors with anaplasia and high cellularity. Necrosis Neovascular proliferation
Glioblastoma Multiforme (Grade 4 astrocytoma)
164
Presentation of GBM
Headaches Seizures Focal Neurologic deficits Mental Status changes
165
butterfly pattern from invasion of corpus callosum
GBM
166
Stain with GFAP | pseudopalisading on histology
GBM
167
GFAP+ tumor more common in children
Pilocytic astrocytoma
168
Location of Pilocytic astrocytoma
Posterior fossa in children
169
Rosenthal fibers
Astrocytoma
170
Brain tumor Common in frontal lobes Very slow growth
Oligodendroglioma
171
Histology: fried egg cells | calcifications
Oligodendroglioma
172
Chemotherapy for oligodendroglioma
Procarbazine Lomustine Vincristine
173
Tumor most commonly found in the fourth ventricle
Ependymoma
174
perivascular pseudorosettes
Ependymoma
175
spindle cells in a whorled pattern
meningioma
176
psamomma bodies
meningioma
177
Highly malignant cerebellar tumor
Medulloblastoma
178
primitive neuroectodermal tumor commonly impairing the fourth ventricle
Medulloblastoma
179
Drop metastasis to spinal cord
Medulloblastoma
180
Most classically at the cerebellopontine angle
Schwannoma
181
S100 positive
Schwannoma
182
Localizes to CN8
Schwannoma
183
Brain tumor associated with Von Hipple Lindau
Hemangioblastoma
184
Brain tumor that can generate secondary polycythemia
Hemangioblastoma
185
Benign childhood tumor that can be confused with pituitary adenoma
Craniopharyngioma
186
Tumor from remnants of Rathke's pouch
Craniopharyngioma
187
Differential of ophthalmoplegia
``` Werinicke's Miller Fisher Multiple sclerosis Cerebellar stroke Posterior fossa mass ```
188
Ataxia arereflexia ophthalmoplegia
Miller Fisher | A decesending paralysis that is similar to Guianne Barre Syndrome
189
Akinetic gait
Parkinsons | Stooped posture with a narrow based gait, slow shuffling with small steps
190
Frontal/Magnetic gait
HYDROCEPHALUS tumor stroke neurodegenerative
191
Waddling Gait
Hip-Girdle weakness: Muscular dystrophy Spinal muscle atrophy acquired proximal myopathy
192
Slapping gait
B12 deficiency | Tabes dorsalis
193
Vermal vs Hemispehric ataxia
Vermal:truncal Hemispheric: ipsilateral ataxia.
194
abrupt vertigo, vomiting, ataxia
Cerebellar hemorrhage or ischemia
195
Progressive vermal ataxia over weeks to months
Alcoholic cerebellar ataxia is the most common cause of progressive ataxia
196
Age 2-7 Dysarthria Ataxia
Postinfectious cerebellitis
197
Truncal/gait ataxia Dysarthria ocular motility issues
Paraneoplastic cerebellar degeneration
198
``` loss reflexes ataxia severe dysarthria spasticity impaired vibration and position ```
Fredrich's Ataxia
199
Brief episodes of ataxia, vertigo, nausea, vomiting,
Inherited episodic ataxia | autosomal recessive
200
Mutations in Inherited episodic ataia
EA-1 mutation in voltage gated K channel | EA-2 mutation in Q/C calcium channel
201
Ataxia Dysarthria Strong family history
Autosomal dominant Spinocerebellar degenerations
202
Mutation in autosomal dominant spinnocerebellar degeneration
CAG repeat in the SCA6 gene which corresponds to the Q/C Ca channel that is in EA-2
203
Types of bladder incontinence
Urge Stress Overflow
204
Treatment of urge incontinence
Anticholinergics-tolterodine, oxybutynin, propantheline TCA-imipramine Desmopressin
205
Treatment of stress incontinence
Alpha adernergic agonist-phenylpropanolamine, pseudoephedrine Estrogen
206
Treatment of Atonic overflow incontinence
Crede's maneuver | self catheterization
207
Disease causing bladder instability
``` Multiple sclerosis Spinal cord injury Frontal/pontine strokes Parkinsons Peripheral nerve disease ```
208
Contraidications for triptans
Cornoary artery disease
209
unilateral headache autonomic features short duration, high frequency
Paroxysmal hemicrania
210
Headache worse when upright | bilateral headache
Low-pressure headache
211
Treatment of low pressure headache
Recumbencey Fluid replacement Caffeine Blood patch
212
Headache severe when recumbent worse in the morning pulsatile tinnitus
Idiopathic intracranial hypertension
213
Headache Jaw Claudition Fever, weight loss, fatigue
Temporal Arteritis
214
electric painful sensation in the face triggered by tactile stimulation
Trigeminal neuralgia
215
Treatment of trigeminal neuralgia
carbamazepine
216
burning, itching and hypersensitivity to touch along the face
postherpetic neuralgia
217
Treatment of postherpeti neuralgia
TCA | gabapentin
218
Interferon therapy requires monitoring of?
CBC | Liver fucntion
219
Side effects of mitoxantron
cardiotoxicity
220
multiple, patchy, bilateral confluent lesions effecting the posterior cerebral hemisphere
Acute disseminated encephalomyelitis
221
dementia focal cortical dysfunction cerebellar anamolies
Progressive Monofocal leukoencephalopathy | Pateints with AIDS, leukemia and lymphoma
222
Pathophysiology of PML
JC virus infects and demyelinates oligodendrocytes
223
Seeding of bacterial meningitis
hematagenous spread from lungs direct from procedures From sinuses or mastoiditis
224
MAnagement of presentation of bacterial meningitis
LP must be performed CT scan and LP if pappiledema If delay in LP then given empiric antibiotic therapy
225
Abcess formation
From sinuses Open trauma Neuro procedures
226
Multiple abcess formation
hematagenous from endocraditis | immunocompromised
227
HSV encephalitis pathophysiology
invasion of the brain paranchyma specifically the medial temporal lobe
228
Symptoms of HSV encephalitis
Memory impairment seizures olfactory hallucinations
229
india ink
Cryptococcus
230
multiple intracranial lesions
Toxoplasma | Lymphoma
231
seizure HA increased ICP multiple cystic lesions
Neurocysticercosis | From pork taenia solium
232
Treatment of neurocysticercosis
albendazole | steroids
233
complications of HIV
``` dementia myelopathy txxoplasma cryptococcus PML ```

Neurology (3 decks)

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