neuro

Question 1

how to use the VAN tool to identify LVOs

Answer 1

Pt must have extremity weakness + at least 1 of the V/A/N to be VAN positive

• visual disturbance: field cut, diplopia, blindness
• aphasia: expressive or receptive
• neglect: inability to track, extinction, hemineglect

Question 2

tonic gaze deviation toward lesion (2 options)

Answer 2

internal carotid or MCA

Question 3

contralateral lower extremity motor/sensory deficits (spares hands/face), urinary incontinence
WITH
- mute, transcortical motor aphasia (understand and can repeat but can’t speak well)

Answer 3

L ACA

Question 4

LLE motor/sensory deficits (spares hands/face), urinary incontinence
WITH
hemimotor neglect

Answer 4

R ACA

Question 5

hemiparesis, facial plegia, contralateral sensory loss
- usually face/upper extremity > lower extremity
- gaze toward lesion
WITH
- aphasia

Answer 5

L MCA

Question 6

hemiparesis, facial plegia, contralateral sensory loss
- usually face/upper extremity > lower extremity
- gaze toward lesion
WITH
- dysarthria w/o aphasia, contralateral neglect

Answer 6

R MCA

Question 7

posterior circulation stroke: 5 Ds

Answer 7

dizziness, dysarthria, dystaxia, diplopia, dysphagia

- must have multiple simultaneous complaints

Question 8

crossed neuro deficits should make you think of

Answer 8

a posterior circulation stroke

- example: ipsilateral CN deficit, contralateral motor deficit

Question 9

quadriplegic stroke

Answer 9

basilar artery

Question 10

unilateral headache w/visual agnosia (can’t recognize objects)

Answer 10

PCA

Question 11

pure contralateral motor deficits

Answer 11

posterior limb of internal capsule

Question 12

pure contralateral sensory deficits

Answer 12

thalamus

Question 13

contralateral motor + sensory deficits

Answer 13

internal capsule + thalamus

Question 14

how to age a stroke on MRI

Answer 14

I be iddy biddy baby doodoo

T1/T2 when compared to brain: I = isointense, B = bright, D = dark

hyperacute: IB
acute: ID
early subacute: BD
late subacute: BB
chronic: DD

Question 15

bright areas on DWI: DDx

Answer 15

• ischemic brain: if also dark on ADC (if ADC is also bright, it’s shine-through)
• cerebral abscess: if also dark on ADC
• active MS plaque (old plaques aren’t bright)
• some tumors

Question 16

7 dangerous causes of dizziness

Answer 16

posterior fossa stroke
posterior fossa tumor
dysrhythmia
hypoglycemia
ACS
anemia
drug toxicity

Question 17

length of a typical post-ictal period

Answer 17

20-30m

Question 18

immediate action post-sz

Answer 18

CTH (unless you have a clear explanation otherwise by hx)

Question 19

Fentanyl dose for neurointubation

Answer 19

2-5 mcg/kg

Question 20

Keppra dosing in neuroemergencies

- exception

Answer 20

60 mg/kg

- exception: 30 mg/kg for HD pts

Question 21

avoid benzos in

Answer 21

cirrhotics

elderly

Question 22

ischemic stroke BP thresholds

Answer 22

< 220/120

after tPA < 185/110

Question 23

hemorrhagic stroke SBP threshold

Answer 23

< 140

Question 24

Explain the HINTS exam.

Answer 24

all 3 must suggest a peripheral cause to r/o central cause

1. head impulse: saccade = peripheral
2. nystagmus: unilateral/nonrotary = peripheral
3. test of skew: no deviation to realign eyes = peripheral

Question 25

CN IV palsy and compensatory head position

Answer 25

eye drifts superomedially > vertical diplopia > head tilts contralaterally and down

Question 26

diabetic CN III palsy

Answer 26

down and out w/pupillary sparing

Question 27

expected nystagmus during caloric testing

Answer 27

COWS (if the pt follows these rules, it's peripheral) if not, consider vestibular dysfunction

Question 28

sudden hearing loss

Answer 28

develops over 3d or less 1. conducteive: OM, cerumen 2. sensorineural: infx, autoimmune, neoplasm, CVA, ototoxic meds tx: prednisone

Question 29

Meniere disease

Answer 29

vertigo, tinnitus, hearing loss

Question 30

Alport syndrome

Answer 30

hearing loss, glomerulonephritis

Question 31

cavernous sinus thrombosis

Answer 31

S. aureus > fever, periorbital edea, chemosis, CN VI palsy

Question 32

GCS

Answer 32

``` E 4 = normal 3 = to speech 2 = to pain 1 = nothing ``` ``` V 5 = normal 4 = confused 3 = inappropriate 2 = incomprehensible 1 = nothing ``` ``` M 6 = normal 5 = to pain 4 = withdraws 3 = decorticate 2 = decerebrate 1 = nothing ```

Question 33

pulsatile tinnitus

Answer 33

idiopathic intracranial hypertension

Question 34

mechanism of central cord syndrome

Answer 34

forced hyperextension makes the ligamentum flavum buckle into the spinal cod, causing contusion or hemorrhage in the central portion of the cord

Question 35

Guillain-Barre: tx

Answer 35

IVIG

Question 36

most common secondary condition to hypoK periodic paralysis

Answer 36

hyperthyroidism (and ultimately, thyrotoxicosis)

Question 37

VP shunt failure

Answer 37

usually proximal 2/2 choroid plexus or CSF protein in catheter distal is usually 2/2 thrombus sx: bulging fontanelle, sundown eyes, HA, nausea

Question 38

most common focal encephalitis in AIDS

Answer 38

toxoplasmosis | - prefers the basal ganglia

Question 39

toxo tx

Answer 39

pyrimethamine, sulfadiazine, folinic acid

Question 40

presentation of primary CNS lymphoma

Answer 40

progressive altered mental status