Neuro Flashcards
(186 cards)
1
Q
Phenytoin Mechanism, Kinetics, AE/Toxicity
A
Mechanism: Na channel inactivation
Kinetics: zero order kinetics
Most common: gingival hyperplasia (gum hypertrophy)
During infusion: hypotension, febrile reaction, bradycardia, arrhythmia
Neurologic AE: ataxia, choreoathetoid movement, dysarthria, nystagmus, diplopia, peripheral neuropathy
Other: Purple glove syndrome, TEN, osteomalacia, hypothyroidism
Fosphenytoin has decreased AE, also an IM route
2
Q
MS Disease Modifying Therapy
A
Corticosteroids - tx acute attacks
Glatiramer - decreases flares
Interferon beta-1a - decreases relapses, lesions, and rate of disability
Interferon Beta-1B - decreases flares, lesions, rate of disabilty
3
Q
How common is MS?
A
1 in 1000 in the US
4
Q
Canavan disease
A
Spongiform demyelination, defect in aspartoacylase on Ch 17, AR
Macrocephaly
Developmental regression at 3-6 month, with sx including posturing, rigidity, myoclonus.
Lab: N-acetyl-L-aspartic acid in blood, urine, brain
5
Q
What drugs treat spasm symptoms in MS?
A
Baclofen
Tizanidine
Benzodiazepines
6
Q
Uhthoff phenomenon
A
Symptoms of MS increase in the heat (shower, summer)
7
Q
Marchiafava-Bignami disease
A
Demyelination of corpus callosum
Seen in chronic alcoholism
8
Q
ADEM
A
Demyelinating disease, rapid, often post-infectious, often fatal.
Damage to small blood vessels and perivascular tissues.
MRI/CT: rapidly evolving white matter damage
high ESR
CSF with high pressure, elevated protein/RBC/WBC, nl glucose
9
Q
Pelizaeus-Merzbacher disease
A
Sudanophilic leukodystrophy.
X-linked
Pendylar nyastagmus
tremor w/o seizure, optic atrophy, choreoathetotic limb movemets, seizures, gait ataxia
10
Q
Leber optic atrophy
A
Presents with centrocecal scotoma (enlargement of physiologic blind spot to impinge on central vision), painless, bilateral or sequential
Hereditary, due to mitochondrial DNA mutation, mainly in men
11
Q
Alexander disease
A
Leukodystrophy of glial fibrillary acidic protein
Ch 11 or 17, AR
Childhood onset of macrocephaly, seizures, spasticity, developmental delay
Abnormal protein deposits: Rosenthal fibers in astroglial cells
12
Q
Adrenoleukodystrophy
A
Progressive degenerative disease of white matter and cerebellum.
X-linked
Sx limb ataxia, nystagmus, mental retardation, adrenal dysfunction; may be neuropathy or myelopathy in adults
Lab: low serum cortisol
Defect in VLCFA oxication
13
Q
Vasogenic vs Cytotoxic Edema
A
Vasogenic: Leakage of fluid from capillaries, disruption of BBB, mainly affecting white matter. Seen with tumors, abscesses, maturing contusion/hemorrhage. MRI shows hyperintensity. Tx with steroids.
Cytotoxic: Extracellular water goes into cells and causes swelling. No change in capillary permeability or disruption of BBB. Mostly affects grey matter. Seen with cerebral ischemia. Diffusion weighted imaging shows decrease/restricted diffusion.
14
Q
Causes of brain hemorrhage
A
Most common: hypertension, trauma, iatrogenic (blood thinners)
Elderly: cerebral amyloid angiopathy
Children: vascular malformations
Other: aneurysm, vasculitis, tumor, infection, septic emboli
15
Q
Drug-induced optic neuritis
A
Ethambutol, in tx of tuberculosis
16
Q
Infectious causes of optic neuritis
A
Lyme, Syphilis, HIV, EBV, CMV, TB, toxoplasmosis, toxocariasis, Bartonella
17
Q
Typical optic neuritis
A
Young, white adult, unilateral sx.
Mild periocular pain worse on eye movement, moderate uniocular vision loss with spontaneous improvement, nl or swollen optic disk. May be worse with heat.
30-70% are first presentation of MS.
18
Q
Carbidopa/Levodopa
A
Given with
AE: Low blood pressure, worsen hallucinations,
19
Q
Entacopone
A
COMT Inhibitors
AE: diarrhea
20
Q
Rasagiline
A
MAO-B inhibitor
Neuroprotective (decrease progression of parkinson’s disease)
AE: well tolerated
21
Q
Dopamine agonists
A
Pramipexole (Mirapex)
Ropinerole (Requip)
AE: impulse control behaviors (e.g. gambling, spending, eating)
22
Q
Rytary
A
Extended release Carbidopa/Levodopa
23
Q
Migraine HA, sx and tx
A
Unilateral, throbbing/pulsating, 3-72 hours, with photophobia, phonophobia, nausea, exacerbated by movement.
Classic = with aura (preceding, during, or following HA); common = without aura
Abortive tx: sumatriptan (oral, subq, nasal, sublingual), ergots, caffine, metoclopramide, prochlorperazine, promethazine
Prophylactic tx: propranolol, amytriptyline, valproate, verapimil
24
Q
Cluster HA
A
Subset of TAC
Unilateral, trigeminal pain (usually V1), ipsilateral autonomic sx (lactimation, injection, edema, rhinorrhea, Horner’s).
Excrutiating pain, orbital/temporal. May occur over weeks-months with high frequency
Abortive tx: high flow O2, triptan
Steroids may shorten duration/reduce frequency
Avoid alcohol
Prophylaxis: verapimil, lithium
25
Trigeminal neuralgia
Neuropathic pain, severe, in V2 or V3. Short episodes of electrical-like sensation, may be triggered by tactile sensation. Pain is lancinating, paroxysmal (worse with cold), unilateral
Tx carbamazepine (1st line), phenytoin, gabapentin
Associated with MS
26
Basilar migraine
Women>men
Aura preceding headache. Aura may have visual changes, irritability, psychosis, stupor, syncope, coma. Aura lasts 20-30 min.
27
What is the physical exam finding of tension headache?
Reduced neck ROM and paracervical tenderness
28
Sumatriptan: mechanism, use, toxicity
5-HT 1b/1D agonist. Inhibits trigeminal nerve activation, induces vasoconstriction, prevents vasoactive peptide release
Tx acute migraine or cluster headaches (abortive)
Contraindicated in CAD or prinzmetal angina due to vasospasm
29
What medication do you use to treat VZV zoster?
Oral acyclovir.
IV acyclovir used in meningitis, but it has renal toxicity so must be given with saline and limited in CKD, diabetic nephropathy.
30
Schwannoma
Common in middle-aged women, around vestibular (VIII), involving trigeminal and facial nerves at cerebellopontine angle
Bilateral are associated with neurofibromatosis 2 (plus juvenile cataract, meningioma, and ependymoma)
Tx with stereotactic radiosurgery, esp if
31
Metabolic causes of seizure
```
Hypoglycemia
Nonketotic hyperglycemia - focal motor seizures
Hyponatremia
Hypernatremia
Hypocalcemia (most often in neonates)
Hypomagnesemia
Renal failure / uremia
Hyperthyroidism (exacerbate epilepsy)
Acute intermittent porphyria
Alcohol and benzodiazepine withdrawl
```
32
What are four neurologic manifestations of RA?
| Hint: two structural, one 2/2 drug, one associated dz
Atlantoaxial subluxation --> cervical myelopathy
Compression or entrapment neuropathy --> carpal tunnel
PML (increased risk in patients treated with rituximab.
Hyperviscosity (APS)
33
Blowout fracture: dx and complication
Trauma, limitation of upward gaze, Increased intraocular pressure
Complication: entrapment of inferior rectus muscle --> limitation of upward gaze
34
Cavernous sinus
What cranial nerves pass through the cavernous sinus?
CN III, IV, V1, V2 in the lateral wall
| VI runs through it, next to the internal carotid
35
Alcohol withdrawal
Seizure day 1
DT day 2-4 (confusion, arrhythmia, autonomic hyperactivity)
Treat with benzodiazepines
36
Carpal tunnel syndrome
Compression of median nerve
Sx: weakness of thenar muscles, esp Abductor Pollicis Brevis decreased sensation of 3.5 digits, Tinel's sign, Phalen's sign. Numbness may awaken patient from sleep.
Nerve conduction studies: impaired
Tx: nocturnal wrist splinting, surgical decompression, steroid injections, oral steroids
From C5-T1
37
Celecoxib
COX2 selective NSAID
used to tx osteoarthritis, RA, ankylosing spondylitis
38
glucosamine and chrondroitin
Supplements used to treat OA
39
Interferon beta-1a: side effects
AE: flu-like, anemia, depression, development of neutralizing antibodies
40
Interferon beta-1b: side effects
Flu-like sx, depression, development of neutralizing antibodies
41
Glatiramer acetate side effects
AE: injection rxn, injection-related chest pain, SOB
42
Natalizumab: mechanism, AE
Monoclonal antibody against alpha-4-integrins
Admin in monthly infusions
AE: PML, hepatotoxicity
Do not use in combination with other agents
43
Fingolimod: mechanism, AE
Mixed agonist/antagonist of sphingosine-1P1 receptor.
First oral MS medication.
AE: bradycardia, leukopenia
Monitor with ECG during first administration
44
Botulinum
Prevents release of stimulatory acetylcholine
Leads to flaccid paralysis
Descending paralysis, dilated pupils
45
Neuroleptic malignant syndrome
Muscle rigidity, fever, autonomic instability, delirium, elevated CK, elevated WBC
2/2 to sudden reduction in dopamine activity (blockade of dopamine receptors aka antipsychotics, withdrawal of dopaminergic agents)
Tx: dantrolene (inhibit Ca++ ions, tx rigidity), bromocriptine (dopamine agonist)
46
Serotonin syndrome
Elevated body temp, agitation, hyperreflexia, tremor/myoclonas, diarrhea, sweating, dilated pupils, seizures. May have high CK
2/2 use of SSRI, MAOI, TCA, meperidine, dextromorphan (cough syrup), trazadone, mitrazapine, tramadol,
Tx benzos, cyproheptadine (serotonin antagonist)
47
Craniopharyngioma
Suprasellar tumor, slow growing but invasive.
Calcifications on imaging
Associated with endocrine dysfunction (central DI, short stature)
48
What are some types of dopamine antagonists?
Atypical antipsyhotics (clozapine, olanzapine, quetiapine, risperidone)
Antiemetics (metoclopramide, droperidol)
TCAs (amoxapine, trimipramine, clomipramine)
All can cause drug-induced parkinsonism
49
What is citalopram?
SSRI
50
Narcolepsy
loss of orexin NT
associated with cataplexy (collapse with laughter or strong emotion)
tx with stimulants during day (e.g. modafinil, dextroamphetamine), benzos at night
51
What do you use to treat restless leg syndrome?
Pramipexole (dopamine agonist)
52
Lenox-Gastaut syndrome
Pediatric disorder by age 8 - mental dysfunction, multiple seizure types, 1-2 Hz generalized waves on EEG (slow spike and wave)
Associated with h/o infantile spasms (West syndrome)
53
Landau-Kleffner syndrome
Loss of language with abnormal EEG in sleep
54
What part of the brain do olfactory aura/hallucinations come from?
Mesial temporal lobe, or hippocampus/parahippocampus
55
What is West Syndrome, and what is the best treatment?
West syndrome: triad of infantile spasm, neurologic or psychomotor deterioration (loss of milestones), inter-ictal EEG pattern of hypsarrhythmia (chaotic, high amplitude with multifocal spike and slow wave discharge)
Sx stereotyped clusters and axial contractions, often when infant awakens, between 3 mo and 1 year
Tx ACTH
May be associated with tuberous sclerosis (with hypopigmented spots)
56
What is the best treatment for absence seizures?
Ethosuximide or valproate
57
What is the best tx for complex partial seizures? And what are common AE?
Leviteracetam
AE = neuropsychiatric symptoms including irritability, agitation, depression
58
Frontal lobe seizure
Dramatic, prominent motor manifestations, often nocturnal lasting 15-45 seconds.
May have loud vocalizations, Jacksonian march
59
Temporal lobe seizure
Aura (epigastric rising sensation, smell, sense of fear via amygdala), automatisms, dystonic posturing
post-ictal fatigue, confusion
ictal EEG shows discharge best developed in temporal lobe
60
Occipital lobe seizures
Sudden visional changes, visual halucinations
61
Mesial temporal lobe epilepsy
Loss of hippocampal neurons and gliosis in CA1
Partial seizures, with autonomic and psychic aura, localized repetitive clonic activity (epilepsia partialis continua)
Caused by stroke, tumor, rasmussen encephalitis (pediatrics)
62
Childhood absence epilepsy
Onset 4-8yo, 45% with family history
EEG 3Hz spike wave, elicited with hyperventilation
"staring spells"
Tx ethosuxamide, depakote, lamtrogine
Generally outgrow seizures
63
Juvenile Myoclonic epilepsy
Onset 13-18yo, clonic movements involving arms and shoulders symmetrically
Tx depakote, lamotrigine, topiramate
Generally no remission of seizures, need AED for life
64
Psychogenic seizure
Limb movement discordantly/alternating, speaking or maintained mentation with generalized body movements, hip thrusting
65
Benign Rolandic epilepsy of childhood
4-8yo, family history of febrile seizures or epilepsy
Unilateral paresthesias on face, unilateral clonic activity in face --> drooling, speech impairment, may secondarily generalize. Occur shortly after child falls asleep
66
Febrile seizures
3mo to 3 years
3% chance of developing epilepsy downstream
May have only mildly elevated temp at time of seizure
67
Which antiepileptics should probably not be used in pregnancy and why?
Phenytoin - fetal hydantoin syndrome (IUGR, dysmorphic facial features, hypoplastic nails and distal phalanges)
Valproate and carbamazepine - neural tube defects
68
What neuroanatomy may cause coma?
Reticular activating system (diffuse brainstem), bilateral thalami, bilateral cortex
69
Corneal reflex (afferent and efferent, anatomy)
AFFERENT: CN V
EFFERET: CN VII
Assesses pons
70
Gag reflex (afferent and efferent, anatomy)
Afferent: CN IX
Efferent: CN X
Assesses medulla
71
Persistent vegetative state
Regained elements of wakefulness, not awareness, >4 weeks
72
What drug is used to treat Lennox-Gaustat syndrome, and what is the potential adverse effect?
Felbamate
Aplastic anemia, liver failure
73
How do you manage acute back pain?
Maintain moderate activity, use NSAIDS or acetaminophen
Consider muscle relaxants, spinal manipulation, or brief course of opioids
Acute defined as 4-6 weeks
74
General paresis
Manifestation of neurosyphilis
Dementia, delusion, dysarthria, tremor, seizures, spasticity, Argyll Robertson pupils
Monocytic pleocytosis, +VDRL
75
Rett syndrome
X linked disorder
Young girls, rapid regression in 2nd year of life, with characteristic repetitive hand movements (wringing), hypotonia, gait abnormalities, seizures
76
Transcortical sensory aphasia
Reduction in ability to understand complex linguistic structures
Seen in alzheimers
77
Whipple's disease
GI complaints + seizures, myoclonus, ataxia, dementia
Pathognomonic: oculomasticatory myorhythmia (pendular convergence movements of eyes with contractions of masticatory muscles)
Biopsy of jejunum shows PAS positive cells
Tx antibiotics
78
Sensory deficit or pain in anterior thigh
Femoral nerve
Leg flexion at hip, leg extension at knee
Quadriceps weakness, diminished patellar reflex.
Won't lose adduction - if lose adduction, think L3 root
79
Sensory deficit in medial thigh
Obturator nerve
Adduction of thigh
80
posteror-lateral leg, plantar foot sensory deficit
Posterior-lateral leg = sural
Plantar foot = Tibial
Flexion of the knee, plantar flexion of foot
S1 nerve root
81
Sensory deficit in lateral leg, dorsal foot
Superficial peroneal nerve
Foot eversion
82
Dorsal foot around big/2nd toe sensory deficit
Deep peroneal nerve
L4-L5
Foot dorsiflexion, toe extension
83
Carbon monoxide poisoning
Sx red skin, confusion, headache
H/o smoke inhalation, automobile exhaust
Dx serum carboxyhemoglobin level
CT: Low attenuation in globus pallidus
MRI findings: high signal in T2 and flair in globus pallidus
Tx 100% O2, hyperbaric O2
84
Ecstasy and seizure
Ecstasy induces SIADH --> Hyponatremia --> cerebral edema, seizure --> herniation
May be febrile, high CK, HTN
H/o partying, drinking lots of water
85
Spinal symptoms in a person with local extremity infection?
If immunosuppressed or risk factor, possibly spinal abscess.
86
What is used to treat sleep phase disorder?
Melatonin or phototherapy
87
Lithium toxicity
Drowsy, hyperreflexia, confused, leukocytosis, course tremor, tinnitus, polyuria
Tx discontinue lithium, hemodialysis
88
Acute treatment for GCA
Corticosteroid therapy
89
Neurofibromatosis Type 1
AD, ch17
Benign skin tumors, learning disability, cafe au lait spots, plexiform neurofibromas (incl schwannoma), Lisch nodules (spots in colored part of iris), associated with optic glioma, freckles in axilla or inguinal (Crowe's sign)
90
Neurofibromatosis Type 2
```
AD, 22q12
Bilateral schwannoma (acoustic neuroma), ependymoma, meningioma, juvenile cataract, glioma
```
91
ethylene glycol
Sweet odor, crystals in urine, anion gap acidosis
92
CJD
Myoclonus, dementia
14-3-3 protein in CSF
Imaging: T2/Flair hyperintensity on basal ganglia, thalamus
93
Syringomyelia
C8-T1
Cystic = hydromyelia
Loss of pain/temperature first, progress to weakness, bilateral
seen with Chiari 1 malformations
94
Tabes dorsalis
Progressive demyelination of dorsal columns
| Later sensory ataxia
95
What is the treatment for GBS?
What infections most likely cause GBS?
IVIG, plasmapheresis
Campylobacter and Mycoplasma
CMV, EBV
96
What drugs are used to treat alzheimers?
Acetylcholinesterase inhibitors
Donezepil
Rivastigmine
Galantamine
After that, Memantine (NMDA receptor antagonist)
97
BPPV Tests
Dix-Hallpike - to diagnose
Epley Maneuver - to fix
Mechanism: loose otolith
98
Four causes of optic chiasm compression?
Pituitary adenoma, craniopharyngioma, meningioma, aneurysm at the anterior communicating artery
99
How do you treat cauda equina secondary to tumor invasion of the epidural space?
Immediate corticosteroids
| Followed by surgery or radiation therapy
100
What class of drug do you use to treat acute dystonia?
Anticholinergic
101
Ciguatoxin
Dinoflagellates consumed by reef fish
Acts on voltage-gated Na channels, increasing permeability
Sx abd pain, n/v/d, parasthesia, headache, fatigue, myalgia, temperature reversal (cold objects feel hot)
102
Lathyrism
Slow onset spastic paraperesis
| Excess of chickling pea, in famine,
103
Tick paralysis
holocyclotoxin, acts at presynaptic release of neuromuscular junction
no elevated spinal fluid protein (compared to GBS)
remove tick and dramatic improvement
104
Manganese poisoning
Inhalation
Sx parkinsonism, axial rigidity, dystonia
Neuronal loss in globus pallidus, putamen, caudate
105
Ergot poisoning
associated with rye fungus Claviceps purpurea
Vasoconstricting agent
Degeneration of posterior column, peripheral neuropathy
106
Mercury poisoning
Personality changes, tremor, ataxia
Used in paper, pulp, electrochemical manufacturing
107
Lead poisoning
Bilateral neuropathy, esp at radial nerve (wrist drop, finger drop)
abdominal pain, constipation, anemia, basophilic stippling of erythrocyte precursors, linear discoloration of gingival margin
May cause ataxia and tremor in chidlren exposed to low levels, chronic exposure leads to impaired psychomotor dev, retardation, brain edema (with herniation risk)
tx penicillamine
108
Arsenic poisoning
Sc encephalopathy, tonic-clonic seizures, peripheral neuropathy, hemolysis/anemia, white lines transverse across fingernails
109
Tay Sachs
Hexosaminidase A deficiency
Ch 15, AR
Disease of ganglioside storage
Sx cherry macula, macrocephaly, retardation, seizures, blindness
110
Gaucher disease
beta-glucosidase deficiency
Ch 11, AR
hepatomegaly, splenomegaly, low platelets, anemia
May have acute infantile form, causing spasticity, bulbar weakness, fatal by ~3yo
111
Neurologic complications of end-stage renal disease
Peripheral neuropathy -- tx with dialysis
Restless leg syndrome -- tx with doapminergic agonist or l dopa
112
What is the visual symptom of tobacco/alcohol abuse?
Enlarged blind spot / amylopia
113
Pellagra
Nicotinic acid deficiency
Irritability, memory loss, dermatitis, anemia
114
Vitamin E deficiency
Ataxia / spinocerebellar degeneration, polyneuropathy, pigementary retinopathy
High CK, high bilirubin 22/2 cholestatic hepatobiliary disorder
115
What four drugs can be used to treat essential tremor?
Propranolol, primidone, topimax, gabapentin
116
Wernicke's encephalopathy classic triad
Confusion, ataxia, opthalmoplegia
Tx with thiamine, then glucose
117
Criteria for depression (9)
```
Appetite or changes in weight
Sleep disturbances
Anhedonia
Depressed mood / irritability
Changes in energy
Changes in concentration or executive function
Guilt or worthlessness
Suicidal ideation
Psychomotor retardation
```
118
Parsonage-Turner Syndrome
Acute brachial neuropathy
May be post-infectious
Arm pain, weakness, numbness, atrophy, may be unilateral
119
Hypokalemic periodic paralysis
Autosomal dominant channelopathy
Muscle weakness or paralysis with fall in K levels
Adolescence
Occur on awakening of after sleep, associated with high carb or high sodium meals, sudden temperature changes, noise, flashing lights
120
Hemiballismus - where is the lesion?
Subthalamic nucleus
121
Status epilepticus management
1) diazepam IV push
2) fosphenytoin or valproate IV push
3) refractory, with EEG monitoring --> infusion propofol, midazolam, or phenobarbitol
122
Anti-emetics that are dopamine antagonists
```
Domperidone
Metoclopramide
Alizapride
Prochlorperazine
Promethazine
Trimethobenzamide
```
123
What anti-emetic does not affect dopamine?
Odansetron. It is a serotonin antagonist.
124
What disease is associated with predominantly medial temporal lobe atrophy on MRI?
Alzheimers vs MCI (more atrophy = alzheimer's dementia)
125
What disease is associated with predominant occipital hypometabolism on PET?
Lewy Body Dementia
126
What is the most common cause of cerebellar hemorrhage? And what are the symptoms?
Hypertension
Sx nausea, vomiting, acute onset of occipital headache, , truncal ataxia (inability to walk), dizziness, vertigo
127
Myesthenia Gravis tx
1st - acetylcholinesterase inhibitors (pyridostigmine)
If remain symptomatic, then go to immunosuppression (steroids, azathioprine, mycophenalate mofetil)
128
Infant with failure to thrive, bilateral cataract, jaundice, hypoglycemia -- what does he have?
Galactose-1-phosphate uridyl transferase deficiency (galactosemia)
Tx by eliminating galactose from the diet
129
What neurological reaction can metoclopramide induce?
Dystonia
| or tardive dyskinesia, or parkinsonism
130
What tumors most often metastasize to the brain?
Lung > Breast > unknown primary > melanoma > colon
If multiple mets: lung cancer, malignant melanoma
If solitary met: breast, colon, renal cell carcinoma
If it's easily bleeding: melanoma, renal cell, choriocarcinoma
131
Lhermitte's sign
Increased "electrical" sensation down spine or limbs with flexion of the neck. Suggests MS.
132
Paraneoplastic cerebellar syndrome - what antibody is associated?
Anti-Yo, purkinje cell cytoplasmic antibody Type 1
133
Alcohol abuse is associated with what damage in the cerebellum?
Vermal midline cerebellar ataxia
134
What antibodies are associated with small cell lung cancer?
Anti-Hu
As well as Lambert-Eaton syndrome
135
What antibody is associated with seronegative myesthenia gravis?
Anti-MUSK
136
What antibody is associated with polymyositis?
Anti-Jo
137
Tourette's
Motor and verbal tics, with no tic-free period for 3 months
Comorbid with OCD, ADD, depression
Tics peak just before puberty, usually resolve after puberty. Comorbid anxiety, OCD, ADD do not improve.
tx tics with alpha-2 antagonists (clonidine)
138
What post-infectious condition is associated with VZV?
Acute postinfectious cerebellar ataxia
25% have had chicken pox, 80% have had some preceding infection
139
Meralgia paresthetica
burning sensation and loss of sensation over anterolateral thigh. Comes from entrapment of lateral femoral cutaneous nerve near inguinal ligament. Tender palpation of inguinal ligament.
140
Compression of ulnar nerve
parasthesia in pain in 5th/4th digits, weakness in dorsal interossei and abductor digiti minimi. From compression at elbow.
From C8-T1
141
Radial nerve entrapment
Wrist drop, sensory loss on dorsum of hand. Weakness of triceps, brachioradialis, supinator, and wrist/finger extensors.
Compression at axilla, spiral groove or forearm
From C5-T1
142
Name the reflexes and their nerve roots (use the song)
Achilles - S1/2
Patellar - L3/4
Biceps - C5/C6
Triceps - C7/8
Cremaster - L1/L2
Anal wink - S3/S4
143
What feature differentiates loss of C5 vs C6?
In both, lose or impair biceps reflex.
In C5, sensory loss and weakness of deltoid and supraspinatus
In C6, sensory loss extends to thumb, weakness of biceps and brachioradiatlis
144
What differentiates loss of L3 and L4?
Both lose patellar reflex
L3 - medial thigh sensory loss, adduction (differentiate from femoral nerve) loss and quadriceps
L4 - medial leg sensory loss, quadriceps and anterior tibial weakness
145
What does triceps weakness indicate?
C7 nerve root syndrome
146
What does deltoid weakness indicate?
C5 nerve root syndrome or axillary nerve
147
Gerstmann Syndrome
AFAR: Agraphia, Finger agnosia, Acalculia, Right-left confusion
Due to MCA stroke damaging dominant parietal lobe
148
MCA stroke
Contralateral motor and sensory deficit of upper limb and face
If dominant hemisphere - aphasia
If nondominant hemisphere - hemineglect
149
Lacunar stroke
Hypertension + small penetrating arteries
May affect cerebellum, pons, internal capsule/basal ganglia, thalamus
Most frequent sx: mute motor hemiparesis (posterior internal capsule) also pure sensory, dysarthria-clumsy hand (pons or internal capsule), and ataxic hemiparesis (basis pontis, ipsilateral motor and cerebellar sx)
150
ACA stroke
Contralateral lower limb paralysis and loss of sensation
151
Medial medullary syndrome
Contralateral hemiparesis, decreased contralateral proprioception, tongue deviates ipsilaterally
Artery: ASA
152
Lateral Medullary Syndrome
Artery: PICA
Vomiting, vertigo, nystagmus, ataxia, dysmetria
Dysphagia, hoarseness
Loss of little three in ipsilateral face and contralateral body
Ipsilateral horner's syndrome
153
Lateral pontine syndrome
Paralysis of face, decreased taste, lacrimation, salivation
Loss of little three in ipsilateral face and contralateral body
Artery: AICA
154
Locked in syndrome
Basilar artery stroke
| Preserved consciousness and blinking, quadriplegia, loss of voluntary facial/mouth/tongue movements
155
Weber syndrome
PCA / base of mibrain
Contralateral Weakness – upper and lower extremity Corticospinal tract
Ipsilateral Lateral gaze weakness CN 3
156
Thalamic pain syndrome
PCA to thalamus
Contralateral Hemisensory loss – all modalities
Contralateral Hemi-body pain
157
Cortical blindness
PCA / bilateral occipital
Visual loss – bilateral
Unawareness or denial of blindness
158
Homocystinuria
Marfan habitus (tall, pectus deformity, skin and joint hyperelasticity)
Cerebrovascular event (thrombus)
Intellectual disability
Fair hair / eyes, eye problems
159
Where is broca's area?
Inferior frontal gyrus, fed by MCA
160
Where is wernicke's area?
Superior temporal gyrus, MCA
161
What do the Rinne Test and Weber Test say?
Weber test - tuning fork to forehead. If sound is heard better to the right: conductive hearing loss on the right or sensorineural loss on the left
Rinne - tuning fork to mastoid process then air. If sound still heard, normal. If cannot be heard, bone conduction > air conduction, and that ear has conductive hearing loss.
162
What are types of ring-enhancing lesions?
Brain abscess (toxoplasmosis if CD4
163
Meperidine
Anticholinergic AND Analgesic
164
Von Hippel Lindau syndrome - what inheritance pattern is it, and what are four commonly associated tumors?
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Autosomal dominant, ch3
Cerebellar hemangioblastomas (resect ASAP, they bleed)
Renal cell carcinoma
Angiomatosis
Pheochromocytoma
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Plus hepatosplenomegaly, cerebellar dysfunction
May have cafe au lait spots
165
Fragile X Syndrome
Elongated face, protruding ears, large testicles, stereotypic movements (hand flapping), intellectual disability, social anxiety, hypotonia
Inheritance: x linked dominant
Men: hyperextensible joints, prominent thumbs
Women: mild retardation in half
166
Metachromatic leukodystrophy
Autosomal recessive, deficiency of arylsulfatase A
Ch 22, AR
Late infant: Spasticity, ataxia, blindness, seizures, coma
Pediatric: impaired school, dementia --> spasticity, seizures, coma
May also have cherry red spot
Adult: schizophrenia, psychosis
Nerve conduction shows slowed motor and sensory
Biopsy of nerve shows sulfatide in Schwann cells or positive urine sulfatides
167
What is hartnup disease, and what is the therapy?
Malabsorption of tryptophan
Sx red scaly rash, episodic cerebellar ataxia, dev delay, emotional lability
Tx Nicotinamide
168
Sturge Weber Syndrome
Port-wine stain in V1 distribution, glaucoma, seizures, retardation, leptomeningeal angioma
Calcifications in cortex in "railroad track" pattern reflecting calcified subependymal glial nodules
169
Tuberous sclerosis - what are the characteristic features, cutaneous findings, and CNS tumors?
Autosomal dominant
TSC1 on ch9, TSC2 on ch16
Hamartia (cortical tubers)
Hamartomas (subependymal nodules, facial angiofibroma/adenoma sebaceum)
CNS: cortical tubers, subependymal nodules, giant cell astrocytoma
Cutaneous: adenoma sebaceum, ash-leaf spots, shagreen patches
Also associated with retinal phakomas (astrocytic hamartomas), 65% have mental retardation, also cardiac rhabdomyoma or angiomyolipoma of kidneys
170
Niemann-Pick Disease
Sphingomyelinase defiency
Ch 11, AR
Cherry red spot
Self-mutilation
171
Krabbe disease
Defect in galactosylceramide P-galactosidase
Ch 14, AR
Positive PAS (periodic-acid Schiff) granules in globoid cells
172
Hurler syndrome
Defect in a-L-iduronidase
Ch 4, AR
Clouding of cornea, facies, dwarfism
173
Hunter's syndrome
Defect in iduronate sulfatase
X-linked
Facies, dwarfism, no corneal clouding
174
Leigh syndrome
Mitochondiral defect
X linked or AR
MRI shows bilateral putamen hyperintensity
175
Rett's syndrome
Defect in methyl-CpG-biding protein 2
X linked
Exclusively occurs in girls
Microcephaly, autism, hand-wringing
176
Ataxia telangiectasia
Ch 11, AR
Truncal ataxia, progressive dementia, telangiectasia
Susceptibility to infeciton, high leukemia/lymphoma rates
177
Down syndrome
Trisomy 21
| upslanting palpebral fissues, protruding tongue, simian crease, brushfield spots
178
Prader-Willi
Paternal ch15
| Mental retardation, emotional lability, insatiable appetite
179
Angelman's syndrome
Maternal ch15
| Mental retardation, inappropriate happy behavior, seizures
180
What is empiric therapy for bacterial meningitis?
Ceftriaxone and vancomycin, + ampicillin for elderly
| Possibly just ampicillin for infants
181
What are the common causes of bacterial meningitis?
Newborns: group B strep, listeria, e. coli, strep pneumo
Adults: N meningitidis, strep pneumo
Elderly: N meningitidis, strep pneumo, listeria, HiB, group B strep
182
Wernicke encephalopathy
Thiamine deficiency
Triad of ataxia, confusion, ophthalmoplegia, developing over days-weeks
Progresses to Korsakoff's syndrome, with anterograde amnesia and confabulation
183
Subacute combined degeneration
B12 deficiency
Disease in dorsal columns and lateral corticospinal tract
Parasthesia in hand/feet, weakness and spasticity, macrocytic anemia.
Elevated homocystine and MMA
184
How do you differentiate steroid-induce myopathy, PMR, statin induced myopathy nad inflammatory myopathy?
Steroid-induced: normal ESR and CK, less pain
PMR: pain and stiffness in shoulder and pelvic girdle, high ESR but normal CK. Responds to steroids quickly.
Statin: Normal ESR, high CK, prominently pain/tenderness
Inflammatory: high ESR and high CK, may have skin rash/arthritis
185
Tabes dorsalis
Sensory ataxia
Lancinating pains
Argyll-Robertson pupil (accomodates but does not respond to light)
186
Medial pontine syndrome
contralateral ataxia of face, trunk, and lims
