high yield final review Flashcards by Kelly MacWhorter

MCA stroke

Contralateral sensory loss
Contralateral weakness
Gaze deviates toward the side of infarction
Contralateral homonymous hemianopia without macular sparing
Aphasia if in dominant hemisphere - Broca, Wernicke, Conduction
Hemineglect if in nondominant hemisphere

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ACA stroke

Contralateral weakness lower limbs > upper limbs
Contralateral sensory loss lower limbs > upper limbs
Abulia
Urinary incontinence
Dysarthria
Transcortical motor aphasia
Limb apraxia

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Symptoms of Thalamic Stroke, PCA

Decreased arousal
Variable sensory loss
Aphasia
Visual field losses
Apathy, agitation, personality changes

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Sudden HA, focal deficits meningeal irritation (neck pain, photophobia)

subarachnoid hemorrhage secondary to berry aneursym

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PICA stroke, ie Lateral Medullary Syndrome

Can also be seen with vertebral artery infarction
Dysphagia, hoarseness, hiccups, decreased gag reflex: specific to posterior inferior cerebellar artery lesions (vs. vertebral artery)
Nystagmus, vertigo
Body: contralateral decrease in pain and temperature sensations
Face: ipsilateral decrease in pain and temperature sensations
Ipsilateral limb ataxia and dysmetria
Autonomic dysfunction: ipsilateral Horner syndrome

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Horner Syndrome

decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face

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Infarction of the posterior limb of the internal capsule is the most common type of_____ stroke and may manifest clinically with pure motor stroke, pure sensory stroke (rare), sensorimotor stroke, dysarthria-clumsy hand syndrome, and/or ataxic hemiparesis.

lacunar, it lenticulostriate

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Menierre Disease

impaired resorption of endolymphatic fluid caussing backup in inner with, w/ sx of vertigo, hearing loss, and tinnitus + usually N/V and nystagmus

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What is Weber and Rinne of Menierre’s Disease?

Weber test: lateralization to the healthy ear (sensorineural hearing loss in affected ear)
Rinne test: bilaterally positive

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Vestibular Neuritis

following viral infections of the upper airways, acute-onset vertigo, nausea, vomiting, and gait instability in otherwise healthy patients; tx w/ steroids to preserve hearing

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Does vestibular neuritis have cochlear sx?

NO! No hearing loss, No tinnitus

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Typical temporal lobe epilepsy presentation

Aura + complex partial seizure
Motor symptoms: typically oral alimentary automatisms like lip-smacking; fidgeting, stretching, walking in place
Autonomic symptoms: tachycardia, urge to void the bladder, mydriasis, sweating, salivating
Altered mental status: appear absent minded but no LOC

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Typical frontal lobe epilepsy presentation

simple partial seizures featuring various motor symptoms (muscle tension, vocalization, gaze deviation, or head directed towards the unaffected side )

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Infantile spasms/ west syndrome 2/2 tuberous sclerosis, perinatal infxn, HIE

Sudden symmetric, synchronous spasms, usually in clusters of 5–10
Jerking flexion (jackknife movement) or extension of the neck, torso, and extremities
Followed by a tonic phase

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Infantile spasm EEG

high-voltage delta waves with irregular multifocal spikes and slow waves

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most common primary tumor of childhood

pilocytic astrocytoma

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most common malignant brain tumor of childhood

medulloblastoma

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malignant tumor in kids, blocks CSF flow, anaplastic small round blue cells that surround a central neuropil (Homer-Wright rosettes)

medulloblatoma

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This childhood tumor can appear like medulloblastoma but actually lives in the 4th ventircle not the cerebellum

ependymoma

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suprasellar, rathke pouch, bitemporal hemianopsia, can affect pituitary hormones through compression

craniopharyngioma

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Hearing test of bilateral scwhannoma

Audiometry - Hearing loss with greater deficit for higher frequencies
Weber test: lateralization to the normal ear; no lateralization if NO problem or if BOTH w/ symmetrical schwannoma
Rinne test: air conduction > bone conduction in both ears

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how to treat prolactin secreting pituitary adenoma?

bromocriptine, cabergoline

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A life-threatening complication of bacterial meningitis (especially meningococcal meningitis) is

Waterhouse-Friderichsen syndrome, which is characterized by disseminated intravascular coagulation and acute adrenal gland insufficienc

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meningitis gram + rods

listeria

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meningitis gram + diplococci

pneumococci

meningitis gram - diplococci

meningitidis

meningitis gram - coccobacilli

haem influ

CSF cloudy w/ pleocytosis of leukocytes, low glucose, high protein

suggestive of bacterial; viral would be near normal

empiric meningitis tx 1-50 y/o

vanc + ceph (cefotaxime or ceftriaxone)

empiric mengitis tx > 50

vanc + amp + ceph

ring enhancing lesions

``` Brain metastases Tuberculomas Neurocysticercosis Subacute hemorrhage and/or infarction Toxoplasmosis Primary CNS lymphoma ```

Neurocysticercosis

A tapeworm infection that affects the brain, muscle, and other tissues. Cysticercosis is spread by contact with tapeworm-infected human feces. Contaminated food, water, and dirty hands are all sources. Cysticercosis may cause lumps under the skin. When it spreads to the brain or spinal cord, headaches and seizures may occur.

Tx of HIV pt with cerebral toxo (ring-enhancing lesion)

Pyrimethamine, sulfadiazine, and leucovorin

Demyelinating disease of the CNS caused by reactivation of the JC virus

PML

encephalopathic sx associated with HSV encephalitis

Focal neurological deficits (primarily affects the medial temporal lobe) [5] Altered sense of smell and loss of vision Aphasia Memory loss Hemiparesis Ataxia Hyperreflexia Seizures (focal or generalized) Altered mental status (e.g., confusion, disorientation, lowered level of consciousness) Behavioral changes (e.g., hypersexuality, hypomania, agitation) Meningeal signs (e.g., nuchal rigidity, photophobia) may occur. Coma

How to differentiate HSV encephalitis from meningitis?

combination of altered mental status, seizures, and focal neurological deficits is more common for HSE!

HSE imaging findings

Hyperintense temporal lobe lesions and signal abnormalities (usually in the hippocampus)

rapidly progressive dementia and myoclonus, neuron‑specific enolase, S100 protein, tau protein, 14-3-3 protein, EEG with triphasic periodic sharp wave complexes with a frequency of 1–2 Hz, definitive diagnosis with biopsy, die within 12 mo

CJD

How does clostridium tetanus lead to sustained muscle contractions?

Tetanospasmin reaches the CNS through retrograde axonal transport. Toxin binds to receptors of peripheral nerves and is then transported to interneurons (Renshaw cells) in the CNS via vesicles. Acts as protease that cleaves synaptobrevin, a SNARE protein → prevents the release of inhibitory neurotransmitters (i.e., GABA and glycine) from Renshaw cells → uninhibited activation of alpha motor neurons → muscle spasms, rigidity, and autonomic instability

Tetanus in a neonate

unsterilized cutting of umbilical cord; Difficulty opening the mouth and feeding due to trismus and risus sardonicus, Muscle stiffness and opisthotonus, Clenched hands

are but lethal late complication of measles

subacute sclerosing panencephalitis (SSPE) - A lethal, generalized, demyelinating inflammation of the brain caused by persistent measles virus infection. SSPE is characterized by dementia, myoclonus, and epilepsy, leading to coma and death. It is a very rare complication that develops several years after initial infection with measles.

tertiary syphillis affects on CNS

pupillary defect + dementia + tabes dorsalis (Tabes dorsalis - demyelination of the dorsal columns and the dorsal root ganglia; Broad-based ataxia + pains and loss of sensation)

tabes dorsalis and SCD due to vitamin B12 deficiency are similar in that they BOTH lead to degeneration of the ___

dorsal columns! can be seen as hyperintensity on imaging

this virus replicates in the gastrointestinal tract following oral ingestion → enters the bloodstream → potential invasion of the grey matter of the spinal cord (particularly the anterior horn cells) → myelitis w/ sx weakness, decreased muscle tone, and hyporeflexia

polio

how to differentiate coma vs brain death

coma (no sleep-wake cycles) and brain death (no sleep-wake cycles or brainstem function)

Examples of dyssomnias (trouble falling asleep or staying asleep)

``` Insomnia disorder Hypersomnolence disorder Obstructive sleep apnea Central sleep apnea Narcolepsy Circadian rhythm sleep wake disorder ```

Examples of parasomnias: abnormal behaviors or experiences that occur while falling asleep, during sleep, or while waking up

Non-REM sleep arousal disorder (Sleepwalking, Sleep terrors) REM sleep arousal disorder (REM sleep behavior disorder, Nightmare disorder) Restless legs syndrome

A non-REM sleep arousal disorder characterized by episodes of apparent nightmares, during which patients will show signs of stress (including tachycardia or diaphoresis), are difficult to rouse, and do not recall what they dreamed after awakening.

sleep terror disorder

A parasomnia characterized by dream enactment (e.g., purposeful movements, such as reaching for objects) due to loss of REM sleep atonia. Associated with Parkinson disease, multiple system atrophy, and dementia with Lewy bodies.

REM sleep behavior disorder

REM sleep EEG

Beta Waves

Non-REM sleep EEG

Theta and Delta

When do Beta Waves (> 13 hz) occur?

Awake and when in REM sleep

sleepwalking, night terror disorder, bedwetting occur during this part of sleep

deep N3 Non-Rem sleep

imaging findings with alzheimers disease

Diffuse cortical atrophy | Hippocampal atrophy

dementia + hallucinations + act out dreams + parkinsonism

lewy body dementia

alcoholic + Confusion Ataxia Ophthalmoplegia + chronic will see atrophy of mamillary bodies

Wernicke encephalopathy

drugs used in dementia treatment

cholinesterase inhibitors (donepezil, rivastigmine, galantamine) + NMDA antagonism (memantine)

looks like PD (slow, rigid, tremor) but also has autonomic sx (ED, bladder control, bp and hr issues) +/- cerebellar issues (balance, eye, speech)

multiple systems atrophy

postural instability (easy falls) + frontal lobe abnormalities (apathy, disinhibition, impaired reasoning + gaze palsy + dementia and PD-like symptoms

progressive supranuclear palsy

MRI finding consistent with PSP

atrophy of midbrain structures with a relatively intact pons region

PD+ w/ Lewy bodies and Autonomic dysfunction with urogenital problems

MSA

PD+ w/ Vertical gaze palsy and Frontal lobe disturbances

PSP

PD+ w/ Asymmetric motor symptoms and Alien limb phenomenon

Corticobasilar Degeneration

PD+ w/ Lewy bodies and Visual hallucinations

LBD

trauma, middle meningeal artery, initially lucid then onset sx 2/2 + of ICP, biconvex hyperintensity

EPI dural hematoma (think above is TOUGH and needs artery to MAKE SPACE)

crescent shaped, bridging vein, Increasing headache over days or weeks Changes in mental status

subdural hematoma

ipsilateral Horner syndrome, palate weakness, hemiataxia, and contralateral sensory disturbances

PICA or vertebral artery, lateral medulla

bilateral damage to the ventral pons characterized by quadriplegia and bulbar palsy

locked in syndrome

woman of child-bearing age on OCP w/ HA, worsened to seizures and focal neuro sx, papilledema, N/V + tx w/ heparin

venous thrombosis

pathogenesis of venous thrombosis

Thrombogenesis occurs in the cerebral venous system, including the dural sinuses → ↓ cerebral drainage → ↑ intracranial pressure → clinical features

high yield final review Flashcards

(70 cards)