MKSAP Neuro III Flashcards
(22 cards)
Idiopathic brachial plexopathy (also known as neuralgic amyotrophy and Parsonage-Turner syndrome) is characterized by:
Subacute severe pain followed by resolution of pain and progressive weakness and atrophy involving the shoulder girdle and upper extremity muscles. Can also have mixed presentation with motor, sensory an pain symptoms. This syndrome often is triggered by a preceding event, such an infection or surgery.
First-line agents used to treat Tourette syndrome when the associated tics interfere with education, daily function, or work are …. (there are 4)
clonidine, guanfacine, topiramate, and tetrabenazine (NOT just CBT)
First line agents for relapsing-remitting MS (there are two)
- Interferon beta
2. Glatiramer acetate (better in patients with liver disease)
Subacute ataxia, areflexia, and ophthalmoplegia, with or without diffuse weakness. Antibodies to GQ1b (a ganglioside component of nerve) are present.
Miller Fisher varian of GBS
Numbness, distal extremity weakness, unsteady gait, areflexia, high arches, hammer toes, and atrophy of distal extremity muscles and foreleg muscles (“stork leg” deformity).
Charcot-Marie-Tooth (CMT) disease (inherited neuropathy)
Painful ophthalmoplegia affecting multiple nerves involved with extraocular movement indicates a pathologic process in the _____ or ____.
superior orbital fissure or cavernous sinus
Thrombosis of the cavernous sinus most commonly arises from _____.
Contiguous spread of infection, most likely from nasal, sinus, and dental sites. Staphylococcus aureus is the most common organism and is found in 70% of affected patients.
Occipital and neck pain and posterior fossa symptoms, such as dysarthria, dysphagia, ataxia, and hemifield visual loss.
Vertebral artery dissection
Orbital pain, partial Horner syndrome (ptosis and miosis only), and ipsilateral signs of cerebral or retinal ischemia
Dissection of the carotid artery
What is autoimmune limbic encephalitis
new-onset status epilepticus and progressive confusion in a previously healthy patient. Antibodies (LGI1) directed against the voltage-gated potassium channel receptor complex. This condition is marked by the presence of hyponatremia, myoclonus, and limbic encephalitis (amnesia, temporal lobe seizures, and confusion).
New-onset status epilepticus in a previously healthy person suggests the presence of a ____.
Neurologic autoimmune disorder. Often paraneoplastic.
In a patient with treatment-refractory depression who also has cognitive and functional decline, ____ can be useful in identifying a pattern or degree of cognitive impairment that is not typical of depression-related cognitive impairment.
Neuropsychological testing
What is the next step in medically intractable epilepsy?
Video EEG to see if pt is candidate for surgery
High-risk features of intracranial aneurysm
- size equal to or greater than 7 millimeters
- rapid growth
- cranial nerve deficit,
What is pimavanserin?
Nondopaminergic atypical antipsychotic agent and only FDA-approved medication for Parkinson psychosis
1st step in treated Parkinson disease psychosis?
Discontinue dopaminergic agonists (like pramipexole)
What do you test in patients with biopsy-inaccessible lesions who have suspected primary central nervous system lymphoma?
Slit lamp exam and vitreous fluid collection with cytology
What is McArdle disease
metabolic myopathy associated with exercise intolerance, cramping, myalgia, mild weakness, “second-wind” phenomenon, and myoglobinuria.
What is myotonia?
Delayed muscle relaxation
Classic feature of polymyositis
Symmetric painless proximal weakness of the arms and legs
___________ commonly occurs in dementia with Lewy bodies (DLB) and can help distinguish DLB from Alzheimer disease and other cognitive disorders.
Rapid eye movement sleep behavior disorder
Note that all synucleinopathies (Parkinson’s, etc) have this issue.
Patients who have intracerebral hemorrhage without elevated intracranial pressure whose systolic blood pressure is greater than 180 mm Hg should be treated with an intravenous antihypertensive agent, such as nicardipine, to a target blood pressure of _____.
140 mm Hg (systolic)
