Neuro / Neurosurgical Flashcards

Question

Ataxia Types and Features

Answer 1

Motor: Ipsilateral findings. If Vermis involved, more central / trunkal ataxia Sensory: Difficulty ambulating, weakness, falls. - Worse with loss of vision / eyes closed Testing: Rapid alternating movements (motor) - Romberg Test (sensory)

Answer 2

Red Flags: - Diplopia - Dysarthria - Dysmetria - Dysphagia Central vs Peripheral: HINTS Head Impulse: Central = NO corrective saccade Nystagmus: Central - vertical, bidirectional Test of skew: Cover / uncover Acute Vestibular Syndrome: - Spontaneous nystagmus - Continuous vertigo, exacerbated by movement

Answer 3

BPPV Meniere’s - Ear fullness and hearing loss Labrynthitis - Recent URI or AOM. Tinnitis and hearing loss Acute vestibular neuronitis Ramsay Hunt - HSV 8th cranial nerve Ototoxicity CN VIII lesions

Answer 4

III - Levator of eyelid and 4 eye muscles and pupil constriction (down and out eye) - Causes: Congenital, aneurysm (PCOM), Ischemic (DM, HTN), trauma, migraine *if pupil sparing, likely benign IV - Trochlear nerve. Superior oblique muscle. 40% trauma, 30% idiopathic, 20% to vascular, 10% are tumor/aneurysm VI - Abducens nerve. LR. Affected eye cannot abduct past midline. Causes: Tumor, aneurysms, fracture, CVST V: Trigeminal neuralgia - Facial pain - Tx: Carbamazepine and analgesia VII Bell’s Palsy: Most commonly due to HSV, can also be due to Lyme, HIV) - Usually a viral prodrome - Non-forehead sparing - Can have loss of tase on anterior 2/3 of tongue - Bell Phenomenon: Eye rolls back when closing eye DDx: Lyme, Ramsay Hunt, Otitis Externa, Acoustic Neuroma Tx: Steroid and antivirals vs Abx if Lyme suspected

Answer 5

IV drug use Endocarditis Renal Failure Diabetes EtOH Dental Abscess

Answer 6

Lung Breast Lymphoma

Answer 7

1) Guillain-Barre Syndrome - Acute demyelinating polyneuropathy - Preceding viral illness. - Campylobacter jejuni, URI - Ascending symmetric parasthesias and motor weakness - Miller Fisher Variant: Opthalmoplegia, ataxia and decreased reflexes Dx: EMG, CSF (increased protein and lymphocytes) Tx: IVIG, plasmapheresis Diptheria: - Toxin mediated multisystem illness - Respiratory or skin - Toxin release and peripheral neuropathy DM2 Peripheral Neuropathy: - Distal symmetric - Can have CN 3,4,6 ALS: - UMN disease with associated LMN disease - Anterior horn cell neuronopathy Tx: Riluzole, supportive therapy Myesthenia Gravis: - AI disease of the NM junction - Antibodies against the ACh receptors - Associated with thymoma Sx: Fatiguable weakness. Improves with rest. Ocular muscle weakness. Improved with cold - Myesthenic Crisis: Resp failure requiring mechanical ventilation. Triggers include infection and medications Tx: Plasmapheresis, IVIG, Thymectomy Lambert -Eaton: - Anitbodies that reduce ACh at NMJ. Associated with cancers SCC lung - Symptoms improve with repeated movement. (Primarily leg) - Autonomic symptoms to dry mouth and impotence Botulism: - Toxin mediated - Descending flaccid paralysis - Diplopia, dysarthria and dysphagia early Tx: Supportive and horse serum antitoxin Tick Paralysis: - Should find an attached feeding tick Periodic Paralysis: - Muscle ion channelopathy. Hyper and hypo K are most common

Answer 8

CNS Demyelination - Lesions separated by time and space - Optic neuritis most common first presentation - LE > UE: loss of strength, vibration/propriception, increased tone and reflexes - Internuclear opthalmoplegia - Uhthoff phenomenon: symptoms worse with increase temperature - Lhermitte phenomenon: electrical shock with neck flexion

Answer 9

4 main findings: - tremor - rigidity - akinesia - postural instability

Neuro / Neurosurgical Flashcards

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