neuro general Flashcards
(175 cards)
1
Q
anterior dislocation of the humeral head damages what nerve
A
axillary
2
Q
primary motor versus sensory cortex
A
motor is frontal and sensory is parietal; they are separated by the central sulcus
3
Q
angular gyrus
A
makes an upside down U in the parietal lobe
4
Q
olfactory area
A
underside of frontal lobe
5
Q
anterior commisure
A
connects the R and L hemispheres across the midline;
6
Q
what does an ACA infaraction affect?
A
legs
7
Q
what does a PCA infarction affect?
A
visual
8
Q
lesions in the internal capsule
A
contralateral hemiparesis or hemiplegia
9
Q
internal capsule blood supply
A
MCA deep branches or anterior choroidal
10
Q
watershed infarct
A
man in a barrell; affects proximal arms
11
Q
caudate atrophy
A
huntingtons
12
Q
PRES
A
posterior reversible encephalopathy syndrome; can be caused by chemtherapy, preeclampsia, and hypertensive encephalopathy
13
Q
Meyer’s loop
A
part of optic radiations; temporal lobe; lesion causes pie in the sky
14
Q
optic radiations
A
tract from the LGN of the thalamus to the occipital cortex
15
Q
why do you get macular sparing
A
dual blood supply of PCA and MCA to the macula
16
Q
visual field in papilledema
A
peripheral constriction, enlarged blind spot
17
Q
visual field in optic neuritis
A
central scotoma
18
Q
pupil in PRES
A
normal; the blindness is cortical
19
Q
left side neglect
A
right parietal extinction
20
Q
transcortical sensory aphasia
A
like wernicke’s but you can repeat
21
Q
transcortical motor aphasia
A
like broca’s but you can repeat
22
Q
mixed transcortical aphasia
A
like a global aphasia but you can repeat
23
Q
where does global aphasia localize
A
broadly the lateral frontal and lateral temporal lobes
24
Q
where do the transcortical things localize
A
basically where their correlate localizes but more superiorly
25
conduction aphasia localizes where?
arcuate fasciculus, white matter tract between brocas and wernickes
26
huntington's disease movement disorder
chorea
27
midbrain has what CNs
3,4
28
pons has what CNs
5,6,7,8
29
medulla has what CNs
9,10,12
30
you see CN lesion plus crossed motor with what CNs
3,6,12, and maybe 7 because motor is more medial and these are the medial CNs
31
you see CN lesion plus crossed sensory with what CNs
CNs 5,8,10 because these CNs are more lateral
32
landmarks in the midbrain
colliculi, cerebral peduncles, cerebral aqueduct; cns 3 and 4
33
landmarks in the rostral pons
fourth ventricle, cn 5
34
landmarkes in the caudal pons
fourth ventricls, cns 6,7,8
35
landmarks in the rostral medulla
4th ventricle, olic, cns 9,10,12
36
caudal medulla
crossing axons of medial lemniscus, pyramidal decussation
37
cause of lateral medullarysyndrome
infarction due to PICA (post inf cerebellar art) or, more often, vertebral artery disease
38
how to treat lateral medullary syndrome
heparin
39
features of lateral medullary syndrome
crossed AND dissociated sensory loss; medial lemniscus spared/ipsilateral facial pain and temp loss but contalat body pain and temp loss
40
Left MLF lesion
affects the ability of the right eye to move according to what the left does
41
what are the three cerebellar arteries
superior cerebellar; ant inferior; post inferior
42
what supplies the midbrain
posterior cerebral artery
43
INO is named how
for the eye that is having trouble ADDucting
44
INO in young person? In old? Is most likeley caused by what
in young, MS; in old, stroke due to occlusion of the paramedian pontine perferating vessels
45
polio
motor, not sensory
46
the UMN passes through what part of the brain
posterior limb of the internal capsule
47
medial lemniscus
dorsal columns
48
spinal cord versus vertebra
in the cervical cord, the nerves exit ABOVE bones; in thoracic and below, nerves exit BELOW bones;
49
mismatch in the cord and spine
there is a C8 nerve, but not C8 bone
50
dermatome hand
C6 thumb; C7 next two; C8 next two
51
pinky towe
S1
52
cape distibution
C3, C4
53
back of head
C2-3
54
nipples
T4
55
waist
t10
56
groin
L1
57
ankle jerk reflex
s1
58
Lhermitte's symptoms
electric sensation that runs down the back into the limbs
59
no arm deficits below what spinal level
T1
60
conus versus cauda equina pain
conus is mild and symmetric; CE is severe and radicular
61
cauda equina syndrome
bladder dysfunction and saddle anesthesia; emergency
62
conus vs CE onset
conus is subacute and bilateral; CE is gradual and asymm
63
conus vs CE sensory
conus is saddle symmetric; CE is asymmetric
64
conus vs CE motor
conus is mild and symm; CE is severe LMN and asymm
65
conus vs CE bowel/bladder
conus is early, severe; CE is late, mild
66
reflex loss in conus vs CE
conus loss is ankle and knee; cau
67
three neurons involved in Horner's syndrome
brain to synapse at T1; then up from T1 to C2 and synapse; then from C2 to eyelids, sweat glands, and pupil
68
anterior cord syndrome affects what?
everythign except dorsal columns
69
causes of anterior horn lesions
polio, west nile virus encephalomyelitis
70
what does b12 def affect
myelopathy plus polyneuropathy
71
what can cause an isolated spinothalamic tract syndrome
paraneoplastic syndrome
72
what can cause myelopathy plus polyneuropathy
vit B12 def; vit E def
73
myelopathy
pathology of the spinal cord
74
root plus long tract signs
sarcoidosis, spondylosis
75
ascending sensory loss
consider SC lesion, AIDP or CIDP
76
proximal muscle weakness
watershed or myopathy
77
confusion can be caused by what electrolyte abnormalities?
hypo and hypernatremia; hypokalemia; hyper/hypocalcemia; hypomagnesemia, hypermagnesemia
78
how could someone get hyponatremic
SIADH (retaining too much water), adrenal insuff (cortisol is reqd to excrete free water); diarrhea; diuretic
79
what happens if you correct hyponatremia too quickly?
so you give salt back too fast, water rushes out of the cells and this leads to central pontine myelinolysis
80
sx of central pontine myelinosis
acute paralysis, dysphagia, dysarthria, abducens pasies, coma, flaccid quadriplegia
81
when would you see hypernatremia in the medical setting
diabetes insipidus (lack of ADH), dehydration
82
what neuro sx do you see with hypokalemia
myopathy
83
what sx do you see with hypercalcemia
obtundation
84
what neuro sx do yu see with HYPOcalcemia or HYPOmagnesemia
incr DTRs, tetany, seizure
85
what neuro sx do you see with hypermanganesemia
parkinsonisms-MRI hyperintensities in the basal gang
86
anything that damages the brain can cause hyponatremia
mechanism is impacts ADH secretion or storage or something
87
what MRI abnormalities can be seen in hepatic failure
increased signal in basal gang; correlates with manganese deposition
88
anti-epileptic drug metabolism- old drugs
old drugs are phenytoin, carbamazepine, valproate, phenobarbitol, primidone; these are mostly hepatically excreted
89
AED drugs- new; how are these excreted?
gabapentin is 100% renal; the rest (lamotrigine, topiramate, tiagabine, zonisamide, keppra, oxcarbazepine) are mostly hepatic with some renal
90
some AEDs can cause rashes
if this happens, stop the drug
91
what pain meds should be used for postherpetic neuralgia
TCAs, gabapentin, pregabalin, opioids, topical lidocaine patches
92
what causes seizures in the elderly?
about 1/3 have no diagnosis; most frequent cause is stoke; over 90% of seizures in the elderly recur
93
old people get cognitive problems on anticholinergic drugs
right
94
what kind of neuro problems can be seen with renal disease
headache, polyneuropathy, chronic uremia, seizures- beware heavily protein bound AEDs- note free levels
95
bursts of triphasic waves are often seen on EEG of what patients
renal or hepatic failure
96
what to know about renal failure and AEDs
phenytoin/valproate/carabamazepine have altered protein binding- follow free levels; water soluble, low protein bound drugs need dose adjustments;
97
dialysis dementia
caused by aluminum accum; aphasia, dysarthria, myoclonus, atazia, dementia
98
nephrogenic systemic fibrosis
skin induration (can look like scleroderma) and pachymeningitis that may involve dura/CNs; thickened dura on CT; headache, papilledema, lymphocytic CSF rxn
99
PRES sx
seizures, headache, hypertension, altered sensorium, vision
100
what causes PRES?
either hyperperfusion sydnrome or endothelial dysfunction due to drugs
101
which drugs can cause PRES
calcineuron inhib (tacrolimus, cyclosporine), sirolimus, cytarabine, gemcitabine, etc
102
B12 def causes what
subacute combine degeneration (dorsal columns and corticospinal tract)
103
tingling
can be dorsal columns
104
what are the mechanisms of B12 pathology?
B12 is involved in two processes- succinyl coA production and purine metabolism; you measure methylmalonate and homocysteine
105
thiamine deficiency can have what symptoms?
nutritional polyneuropathy; wernicke-korsakoff syndrome; cerebellar degeneration; nutritional amblyopia
106
what parts of the brain are affected in Wernicke-korsakoff syndrome
mamillary bodies, medial dorsal thalamus, periaqueductal gray, suerpior cerebellar vermis
107
what does too little pyridoxine cause?
polyneuropathy
108
what does too much pyridoxine do
sensory ataxia (posterior columns)
109
what does niacin deficiency cause?
pellagra; which can cause an encephalopathy/neuropathy in alcoholics unresp to thiamine
110
On MRI flair you see hyperintensity in mamillary bodies and periaqueductal gray with enhancement
wernickes
111
what are some neuro complicatons of gastric bypass surgery causing B12 def
clinically GBS-like but CSF has normal protein; treat with surgical revision to reduce bypassed jejunum
112
too much vit A
pseudotumor cerebra
113
too little vit A
xeropthalmia (night blindness)
114
too little Vit E
remember absorption requires bile and fat; spinocerebellar degeneration and polyneuropathy
115
vit D def
proximal myopathy that coexists with osteomalacia,
116
paresthesias
localized to dorsal columns
117
tuberous sclerosis is aut dom
right
118
subependymal nodules
seen in tuberous sclerosis; may obstruc at foramen of monro
119
foramen of monro
aka interventricular foramina; connects the lateral ventricles with the third ventricle
120
medications that reduce effectiveness of OCPs
dilantin, phenobarb/primidone; tegretol/carbatrol/trileptal; topamax at high doses; most older and some newer ARDS induce OCP metabolism
121
fourth ventricle on CT
frown
122
quadrigeminal cistern on CT
smile
123
what is the quadrigeminal cistern
opening in the subarachnoid space filled with CSF; quadrigeminal extends from the third ventricle to the great cerebral vein
124
when can you do an LP without CT?
less than 60 yo; ne seizure; no immune deficits; nonfocal exam
125
normal CSF
less than or equal to 4 lymphs; protein less than 15-45; glucose 2/3 of serum
126
traumatic tap
1 extra WBC for every 700 RBCs
127
bacterial vs viral meningitis opening pressure
bacterial has increased opening pressure, viral does not
128
supination
radial nerve
129
treatment for meniere's disease
labrinthe ablation with gentamycin
130
hydrocephalus ex vacuo
when your brain atrophies and ventricles are bigger to fill the space
131
acqueduct
between third and fourth ventricles
132
abnormalities in the posterior hemispheres on diffusion weighted MRI and presence of 14-3-3 protein in CSF
dreutxfeld jacob disease
133
paranoia, hoarding behavior, and visuospatial deficits are characteristic of early alzheimers
yes
134
what AED can change the effectiveness of OCPs
phenytoin
135
side effects of cytosine arabinoside
this is a chemo agent with side effects causing cerebellar issues
136
akathisia (need to move the legs) and fidgety movements most common on what drugs
anti-psychotics
137
how to fix the dystonic reactions that you get from the anti-psychotics
anti-cholinergic like diphenhydramine (benadryl)
138
what other drugs besides the anti-psychotics can cause parkinsonism like reactions
metoclopramide and valproate and amphotericin B
139
steroid psychotic reaction
agitation, sleep disturbance, and paranoia
140
how to treat the steroid psychotic reaction
neuroleptics
141
AED most commonly assoc with teratogenicity
valproate (NTDs and cognitive issues)
142
other side effects of valproate
weight gain, hair loss, parkinsonian like state
143
known interaction between erythromycin and what drugs are bad?
carbamazepine, phenytoin, oxcarbazepine, etc; interactions cause ataxia, nystagmus, and, at higher levels, diplopia
144
CK in statin-induced myopathy
may be normal or elevated
145
AED most assic with hyponatremia
oxcarbamazepine; polypharm in the form of thiazide diuretics or levetiracetam may aggravate the situation
146
what antidepressant is associated with increased risk of seizures and should not be given to patients with epilepsy?
buproprion
147
symptoms of anti-cholinergic excess
tachycardia, blurred vision, fever, mental status changes
148
what drugs cause anti-cholinergic effects
TCAs (amitryptaline, nortriptyline, imipramine)
149
what is serotonin syndrome?
hypertension, tachycardia, tachypnea, hyperthermia, mydriasis (large pupils), hyperactive bowel, hyperreflexia
150
anti-cholinergic toxidrome
hypertension, tachycardia, tachypnea, large pupils, skin is hot and dry; bowls are decreased
151
differences between serotonin syndrome and anti-cholinergic excess
serotonin has hypersalivation and sweaty skin, whereas anticholinergic is dry mucus membranes and dry hot skin; bowels hyperactive in serotonin and decreased in anticholinergic
152
neuroleptic malignant syndrome
RIGIDITY; caused by dopamine ANTAG; htn, tahycardia, tachypnea, hyperthermia; pupils are normal; sweaty skin; bradyreflexia; stupor/alert mutism/coma
153
malignant hyperthermia
caused by inhalatio nal anesthetics; hypertension, tachycardia, tachypnea; pupils normal, skin sweaty; decreaed bowel sounds; rigor-mortis like rigidity; hyporeflexia; mental status is agitated
154
enlarged blind spot
think papilledema
155
cnetral scotoma
think optic neuritis or ischemic optic neuropathy
156
sheehan's syndrome
don't forget adrenal insuff
157
why horner's in cartotid dissection?
sympathetics run along the internal carotid artery
158
What kind of drug cauases INO
paramedian pontine perforating vessel stoke
159
polymyalgia rheumatica
at risk for central retinal artery occlusion due to temporal arteritis; also shoulder, neck and hip pain
160
basilar migraine
seen in kids; dizziness, slurred speech, and double vision; then severe headache
161
third nerve palsy assoc with what
post communicating artery aneurysm
162
patient with pcomm aneurysm and third nerve palsy has the aneurysm clipped but deteriorates three days later
vasospasm (treat with nimodipine)
163
what neuro drug can cause angle closure glaucoma
topamax
164
optic nerve glioma
NF1
165
acoustic shwannoma
NF2
166
ischemic optic neuropathy
can be seen in diabetic patients; painless loss of vision; can be due to temporal arteritis
167
trigeminal neuralgia treatment
carbamazepine
168
jaw claudication
temporal arteritis (also assoc with anemia)
169
lesion is hyperdense on non-contrast CT and then enhances uniformly with contrast s
extra-axial (like meningioma)
170
lesion that enhances heterogeneously with contrast
intra-axial (like GBM)
171
what patients should not receive triptans
those with CAD or uncontrolled hypertension
172
cavernous sinus thrombosis
eye movement abnormalities
173
what runs through the cavernous sinus
3,4,V1, V2, and 6 in the lateral wall
174
Ramsay Hunt syndrome
herpes infection of the facial nerve near the ear; can cause facial palsy and hearing loss on one side;
175
elevated CSF pressure
think crypto in immunosuppressed person
