Neuro 8 Flashcards
(48 cards)
What is transverse myelitis and what disease is it associated with
Multiple sclerosis
- Area of inflammatory demyelination in the spinal cord
- Motor and sensory loss below the level of the lesion with bowel and bladder dysfuntion
- Initially flaccid paralysis followed by spastic paralysis with hyperreflexia
- Patients may report a band of tingling or pain around the torso at the level of the lesion
What is Lhermitte’s sign
• Tingling, electric sensation down the spine when the patient flexes the neck
MRI findings in MS
♣ Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
♣ T2 hyperintense areas in the white matter of the brain or spinal cord
CSF findings in MS
♣ Increased protein
♣ Oligoclonal IgG bands
Tx of acute MS flares
corticosteroids
Chronic tx of MS
interferon beta
Sx of multiple sclerosis
Triad of sx (SIN):
• Scanning speech
• Intention tremor, Incontinence, Internuclear ophthalmoplegia
• Nystagmus
♣ Lhermitte sign
• Tingling, electric sensation down the spine when the patient flexes the neck
♣ Transverse myelitis
• Area of inflammatory demyelination in the spinal cord
• Motor and sensory loss below the level of the lesion with bowel and bladder dysfuntion
• Initially flaccid paralysis followed by spastic paralysis with hyperreflexia
• Patients may report a band of tingling or pain around the torso at the level of the lesion
♣ Sensory symptoms (numbness and paresthesia)
♣ Motor symptoms (paraparesis and spasticity)
♣ Bowel/bladder dysfunction
What are the 2 components of presentation of neuromyeltiis optica (NMO)
♣ Transverse myelitis:
• Area of inflammatory demyelination in the spinal cord
• Motor and sensory loss below the level of the lesion with bowel and bladder dysfuntion
• Initially flaccid paralysis followed by spastic paralysis with hyperreflexia
• Patients may report a band of tingling or pain around the torso at the level of the lesion
♣ Opitc Neuritis:
• Mildly painful loss of visual acuity in one eye
• Pain most prominent with eye movement
• Vision may be blurry with loss of color discrimination
Diagnosis of NMO
♣ Antibodies to aquaporin-4 channel
Treatment of NMO
♣ Steroids
♣ Chemotherapeutic agents
Pathophys of progressive multifocal leukoencephalopathy
o Caused by JC virus
o Leads to demyelination by infecting oligodendrocytes
Presentation of PML
o Characterized by dementia, focal cortical dysfunction, cerebellar abnormalities
Non-enhancing multifocal brain lesions
Causes of posterior reversible encephalopathy syndrome (PRES)
o Usualy develops in the context of rapidly developing HTN and eclampsia or due to immunosuppressants used in organ transplant
Presentation of Posterior reversible encephalopathy syndrome (PRES)
♣ Headache
♣ Altered consciousness (acute confusional state)
♣ Visual disturbances (cortical visual loss – blindness with preserved pupillary reactivity)
♣ Seizures
Presentation of PSP
- Supranuclear ocular palsy (failure of vertical gaze), dysarthria, dysphagia, extrapyramidal rigidity, gait ataxia, dementia, pseudobulbar palsy, bradykinesia, cognitive and behavioral abnormalities
- Earliest signs are falls and gait abnormality
Diagnose: acute painless monocular vision loss with cherry red spot
Central retinal artery occlusion
Diagnose: light flashes, floaters, or curtain across visual field
Detached retina
Presentation of central retinal vein occlusion
Painless, sudden vision loss
Presentation of myasthenic crisis
♣ Precipitating factors • Infection or sugery • Pregnancy or childbirth • Tapering immunosuppressive drugs • Medications ♣ Signs/symptoms • Increased generalized and oropharyngeal weakness • Respiratory insufficiency/dyspnea
Tx of syphilis
Penicillin
What are features of TB meningitis (other than CSF) that differentiate it from bacterial meningitis
Usually affects the basal meninges (at base of brain) - so more likely to present with CN palsies
Slower onset
Describe CSF findings of TB meningitis
Cells = lymphocytes Protein = high Glucose = very low
CSF of viral meningitis
Cells = lymphocytes Protein = high Glucose = normal
What are the 2 things to think of with ring-enhancing lesions in AIDs patients
Toxoplasmosis
CNS lymphoma
