Misc Neuropsychiatry/Neuropsychology

Question 1

What commonly used neuropsychological test is used to objectify mental flexibility/perseveration?

Answer 1

Wisconsin Card Sorting Test

Question 2

What test can be used to elicit field dependence as well as defects in frontal lobe function?

Answer 2

Stroop Test

Question 3

What do dorsolateral prefrontal cortex lesions yield?

Answer 3

Pseudo-depression - flattened affect, unresponsiveness and defects in higher-order cortical function

Question 4

What do orbitofrontal prefrontal cortex lesions yield?

Answer 4

Pseudo-psychopathy; like a drunk teenager

Failure to modulate limbic structures leading to disinhibition and jollyness/anger bordering on mania

Question 5

What 3 structures are thought to comprise the pain matrix?

Answer 5

Thalamus
Insula
Anterior cingulate cortex

Question 6

What is thought to be the relationship between the prefrontal cortex, periaqueductal grey and pain matrix in perception of pain?

Answer 6

Increased prefrontal cortex activity -> increased opiate release from periaqueductal grey structures -> reduced activity and perception of pain in pain matrix

Question 7

Who described utilisation behaviour?

Answer 7

Lhermitte

Question 8

What is thought to be the malfunctioning region in utilisation behaviour?

Answer 8

Basal ganglia

Question 9

What are the 3 major dopaminergic pathways?

Answer 9

Mesolimbic
Mesocortical
Nigrostriatal

Question 10

Where does the mesolimbic tract project?

Answer 10

Nucleus accumbens

Question 11

What does the nucleus accumbens integrate? What loop is it probably a part of?

Answer 11

Dopaminergic function from mesolimbic tract
Prefrontal cortex fibres
Amygdala and hippocampus
Part of the cortico-basal-thalamic loop

Question 12

What is the sole source of histaminergic pathways in the brain? Where is it found?

Answer 12

Tuberomammilary nucleus

In the posterior hypothalamus

Question 13

What is the main role of the tuberomammilary nucleus and where is it found?

Answer 13

In the posterior hypothalamus - produces histaminergic pathways

Question 14

What affect do histaminergic pathways have on arousal and cortical activation?

Answer 14

They increase it directly via cortical projections and indirectly via acetylcholine release from forebrain/pons

Question 15

Where do the major dopaminergic pathways originate?

Answer 15

Ventral tegmental area

Question 16

What is Anton-Babinski syndrome?

Answer 16

Cortical blindness + visual anosognosia

Question 17

What are the 2 most common disease causing VGKC antibodies?

Answer 17

LGI1

Caspr2

Question 18

What is the third type of VGKC antibody not associated with tumours?

Answer 18

Anti-DDPX

Question 19

What CSF changes are seen in VGKC disease?

Answer 19

Often none

Question 20

What is the typical presentation of LGI-1 disease?

Answer 20

Cognitive impairment and seizures
Hyponatraemia
Sleep disorder
Movement disorder

Question 21

What phenomenon is the hallmark of VGKC disease?

Answer 21

Peripheral nerve hyperexcitability

Or central nerve hyperexcitability presenting with limbic encephalitis

Question 22

What VGKC antibody classically causes cognitive impairment and seizures?

Answer 22

LGI-1

Question 23

What is the classical presentation of CASPR-2 disease?

Answer 23

Morvan’s syndrome

Neuromyotonia

Question 24

What 3 conditions fall under the umbrella of peripheral nerve hyperexcitability?

Answer 24

Benign fasciculation syndrome
Mild cramp fasciculation syndrome
Neuromyotonia

Question 25

What is neuromyotonia?

Answer 25

Peripheral nerve hyperexcitability with muscle twitching, cramps, sweating, dysaesthesia, dystonia Often muscle hypertrophy and myokymia

Question 26

What is myokymia?

Answer 26

Involuntary spontaneous localised muscle twitching e.g. Lower eyelid spasm

Question 27

What is the name for the peripheral nerve hyperexcitability phenomenon of muscle twitching, cramps, sweating, dysaesthesia in association with muscle hypertrophy and myokymia?

Answer 27

Neuromyotonia

Question 28

What is suggestive of Neuromyotonia in terms of the presence of myokymia?

Answer 28

Present in unrelated muscle groups

Question 29

What is Morvan's syndrome/Morvan's Fibrillary Chorea?

Answer 29

Florid Neuromyotonia Cognitive impairment Sleep disorder Autonomic dysfunction - sweating, cardiac arrythmias

Question 30

What syndrome is suggested by neuromytonia, autonomic dysfunction, cognitive impairment and sleep disorder?

Answer 30

Morvan syndrome

Question 31

What is the pathology underlying Morvan syndrome? Specific Ab?

Answer 31

VGKC antibodies causing peripheral nerve hyperexcitability | Often CASPR-2

Question 32

What tumour is occasionally seen in VGKC disease?

Answer 32

Thymoma

Question 33

What virus can cause an indolent, slowly progressive limbic encephalitis?

Answer 33

HSV6

Question 34

What is the nature of a classical amyloidosis neuropathy?

Answer 34

Painful, with autonomic involvement

Question 35

What are the 3 classical features of POEMS?

Answer 35

Plasma cell proliferative disorder (myeloma) Polyneuropathy Multi organ damage

Question 36

What is interesting about the myeloma seen in POEMS?

Answer 36

Tends to be osteosclerotic rather than osteolytic, which is common in normal myeloma

Question 37

What does POEMS stand for?

Answer 37

``` P- Papilloedema, pulmonary disease and peripheral Polyneuropathy O- organomegaly (liver), oedema E- endocrinopathy (mostly sex hormones) M- monoclonal paraprotein (IgG, lambda) S- skin changes ```

Question 38

What is the paraprotein type in most paraproteinaemic Neuropathies? What about POEMS?

Answer 38

``` IgM Usually IgG (occasionally A) in POEMS ```

Question 39

3 abnormal blood results seen in POEMS?

Answer 39

Thrombocytosis Polycythaemia Increased blood VEGF

Question 40

What stain is best for observing amyloidosis on biopsy tissue?

Answer 40

Conga Red