Neuro Review Session - Sheet1 Flashcards
(87 cards)
1
Q
lesion location - monocular vision loss
A
pre chiasm
2
Q
lesion location - homonymous hemianopsia
A
anywhere behind chiasm, though optic tract lesions often are incongruous
3
Q
lesion location - bitemporal hemianopsia
A
suprasellar pituitary, craniopharyngioma
4
Q
lesion location - upper quadrant vision loss
A
meyer’s loop
5
Q
lesion location - lower quadrant vision loss
A
parietal
6
Q
lesion location - macular sparing
A
dual mca/pca blood supply to macula
7
Q
visual field in papilledema
A
peripheral construction, enlarged blind spot
8
Q
visual field in optic neuritis
A
central scotoma
9
Q
fundus optic neuritis
A
may be normal (retrobulbar) or sometimes swollen
10
Q
altitudinal deficit
A
upper or lower half of one eye - ischemic optic neuropathy
11
Q
RPLS/PRES - visual deficit
A
cortical blindness with bilateral occipital lesions
12
Q
68 yo M c/o blindness for one hour after 4 episodes of decreased vision in the past 8 hours. history of hypertension and emphysema requiring home O2. last Hb 17.5. funduscopic exam showed edema of disc with enlarged retinal veins and several hemorrhages
A
central retinal vein occlusion - can present with TIA - like episodes. this patient’s blood is likely hyperviscous. causes: sepsis, neoplasia, hypercoagulability; pizza fundus
13
Q
23 yo F with migraine with aura was found to have a small left occipital infarct. her only med is an ocp. she has a patent foramen ovale on TEE with left to right shunting. what is risk of stroke?
A
OR 2.0-3.0. risk is higher in smokers and those on ocps. some groups consider migraine with aura an absolute contraindication to combined ocps.
14
Q
prevalence of PFO in the general population
A
25% - PFO is found in a higher percentage of patients with unexplained stroke vs. general population
15
Q
at the nursing facility where he resides, 75 yo M slumps over at the breakfast table is unresponsive. non con CT shows a hyperdense area in the pons.
A
pontine hemorrhage - rapid unresponsiveness suggests coma of brainstem origin.
16
Q
74 yo F comes to the office 2 weeks s/p TIA involving aphasia and weakness of the hand. normal neuro exam, BP is normal. carotids normal. she was started on ASA. what is the next step in management?
A
continue current regimen
17
Q
74 yo F arrives in the ER 5 hours after onset of dizziness, numbness of R face, and dysphagia. she sees a chiropractor weekly for cervical manipulation. Head CT nl. Exam: nystagmus on lateral gaze, r palate does not elevate, r face numb, L body hypesthesia, no babinski’s. what treatment?
A
lateral medullary syndrome on the right (crossed sensory deficit) - most common vessel occluded is the vertebral (more than pica). because of risk of proximal propagation, heparin is used.
18
Q
indications for heparin
A
lateral medullary syndrome, ventral venous sinus thrombosis, stuttering TIA, basilar artery thrombosis, low EF, mural thrombus, acute large vessel occlusion, dvt
19
Q
brainstem - clues to diagnosis
A
crossed sensory deficits imply lateral brainstem, crossed motor more medial; consciousness impaired with reticular activating formation involvement; cranial nerves and crossed sensory and/or motor long tract signs
20
Q
spinal cord - clues to diagnosis
A
deficits usually bilateral, UMN signs from lesions rostral to lumbar spine, may have LMN signs at lesion level and UMN below lesion level, bowel/bladder dysfunction
21
Q
L4/L5 disc herniation
A
loss
22
Q
38 yo HIV+ patient with lower limb weakness and pain down the back of both legs and incontinence of bowel and bladder. sacral numbness and decreased sphincter tone
A
cauda equina
23
Q
39 yo F with 2 weeks of severe neck and arm pain, weak triceps, absent triceps reflex, hyperreflexic legs; Sagittal T2 MRI - large C6-C7 disc catching the C7 nerve root
A
early signs of myelopathy and lots of pain and weakness - needs urgent operation!
24
Q
78 yo M with h/o 6 months of neck pain radiating to his left had with difficulty with balance when walking. he has osteoarthritis, crohn’s disease, and GERD. decreased range of motion of neck, mild weakness/atrophy of hands, increased tone in legs, bilateral babinski’s, gait stiff and broad based
A
cervical spondylotic myelopathy - the most common cause of myelopathy in older people, results from disk dessection with narrowing of intervertebral space and consequent bony overgrowth with some facet and ligamentum flavum hypertrophy, often at several levels. weakness and atrophy of hands with increased tone in legs puts this lesion in the cervical area. likely this person needs surgery.
25
57 yo M has lost 30 pounds in 3 months. he feels generally weak, but right leg is particularly weak and he cannot climb stairs. he takes sulfonylurea for diabetes. looks depressed, weakness and atrophy of right thigh muscles, no patellar response on right, Hba1c = 15%, glucose 440
diabetic amyotrophy - a patients with poorly controlled DM may develop a syndrome so bad that the clinician often thinks of neoplasia. can include pain, muscle wasting, and by EMG paraspinous muscle involvement, as well as prominent denervation of the gradricepts. treatment - diabetes control.
26
femoral neuropathy
- can come on suddenly as in a nerve infarct with a great deal of pain and numbness in the medial leg (saphenous nerve distribution)
27
top ten causes of neuropathy
diabetes (small fiber, proximal amyotrophy, mononeuropathies single and multiplex, pupil sparing 3rd nerve; AIDP (GBS), CIDP (treated with steroids unlike GBS), mechanical neuropathies (carpal tunnel, ulnar, radial, peroneal), ALS; nutritional (B12, copper); chemotherapy; AIDS neuropathy (CIDP, CMV, VZV, haart related); paraneoplastic (sensory neuropathy anti-Hu, severe imbalance, sometimes pruritus or pain)
28
following a stab wound to the upper arm a patient complains of arm weakness and numbness. exam - weakness of biceps, absence of biceps reflex, sensory loss of the lateral aspect. What nerve is injured?
musculocutaneous nerve - innervates the biceps and terminates as the lateral antebrachial cutaneous nerve with a sensory territory that is consistent with this patient's exam
29
24 yo used cocaine yesterday and awakened 10 hours later with R arm weakness. after cocaine two weeks earlier he broke his ankle and is using crutches. he was neurologically normal when he fell asleep. stable since then. decreased wrist and finger extension, normal delt, bi, BR
radial nerve injury below the spiral groove. since his triceps are not involved, the crutches are probably not the issue, but falling asleep while intoxicated probably is. thus, below the spiral groove is likely the compressive site
30
patient c/o bilateral hand numbness. symmetric bilateral loss of sensation on the dorsum of the hand from the thumb to the dorsal aspect of digit 2, above the PIP joint. what question should you ask the patient?
were you recently arrested? compression or trauma to the superficial branch of the radial nerve; aka handcuff neuropathy
31
32 yo F has a 3 month h/o weakness and numbness of both legs. muscle strength 4/5, numbness to pain/temp/vibration up to ankles, no reflexes in any limb. CSF: glu 60, protein 120, WOB, nerve conduction velocities very slowed. which is the most likely structure involved?
myelin - this patient has albuminocytologic dissociation and decreased nerve conduction velocities. the course is too slow for GBS, but chronic inflammatory demyelinating polyneuropathy (CIDP) would fit this picture. unlike gbs, this syndrome can respond to steroids. ivig is used as well
32
27 yo M injured his R hand in a machinery accident. following the injury 1 year previously he had extensive ecchymosis and swelling. hand is warm and dry, unable to tolerate light touch or any motion of wrist or finger joints. what is the most likely explanation?
abnormal sympathetic response - this patient has complex regional pain syndrome. bone scan might be positive in this area. treat for neuropathic pain, although often very unsuccessful. sympathetically mediated pain may follow mild blunt trauma, burns, frostbite, or immobility. a regional sympathetic ganglion nerve block is tried as early as possible in the patients course. can also try propranolol, prazosin, AED's, and TCAs
33
59 yo M c/o four months of progressive leg weakness. he has had a 14kg weight loss, a dry mouth, and constipation. he has smoked 1 pack of ciggs per day for 30 years. exam shows weak hip flexion and knee extension, improving slightly with repetitive activity. reflexes and babinski signs are absent. sensory exam is normal. CXR shows an upper lobe mass. where is the pathology?
NMJ - most likely lambert-eaton syndrome with small cell lung cancer. presynaptic. bulbar muscles usually not involved. classically gets better with repetitive activity unlike MG
34
88 yo M is seen because of increasingly frequent episodes of loud snoring over the past 19 months. he has a 10 year h/o insomnia and mild low back pain. he takes no medications and drinks one glass of wine with dinner. neuro exam - mild loss of vibration sense over the toes, DTRs decreased at the ankles, unable to tandem walk, BP wnl. what is most likely cause?
normal aging - diminished ankle reflexes ok in geriatrics, probably can't tandem because of milk vibrator loss and some arthritis dz. should at least check a fasting glucose/ HbA1c
35
75 yo F comes to the ER comatose. she had vague dizziness and slurred speech earlier that day. unresponsive, ocular bobbing, pinpoint reactive pupils, absent vestibulo-ocular reflexes, quadriplegic. diagnosis?
basilar artery thrombosis - this patient had some sort of posterior circulation TIA. now she has all signs of basilar artery thrombosis. if she were locked in she would be awake but de-efferented (unable to communicate except by looking up)
36
the declaration of brain death requires
established cause of trauma
37
12 hours after cardiac arrest a patient has unreactive pupils, absent corneals, and no response to caloric testing or purposeful motor activity. his most likely prognosis is ...
death or vegetative state
38
43 yo woman comes to the ER 1 hour after losing consciousness. on awakening she has severe HA and photophobia. she is afebrile. normal exam, CT shows no bleeding. next step?
LP, concern for SAH. you will want to do an LP because you can't trust the CT. however, you may want to admit her. she may need an mra or cta as well. on lp you would look for xanthochromia, evident as early as 12 hours after a bleed
39
intra-axial mass lesion that enhances heterogeneously (necrotic center) + HA
glioblastoma
40
extra-axial mass lesion that enhances homogeneously + HA
meningioma - full of Calcium, so that it would look much the same on an unenhanced CT. meningiomas of the subfrontal region can affect olfactory nerve and present with decreased test + HA
41
45 yo F gives a six month h/o worsening bioccipital throbbing HAs precipitated by running, coughing, sneezing, bending or lifting. she feels slightly unsteady on romberg testing, rest of PE is normal.
chiari malformation and syrinx. she will need decompression of posterior fossa - the syrinx at the moment is asymptomatic. the headache is a cough headache.
42
bacterial meningitis
don't wait for diagnostic tests. treatment order: dexamethasone, antibiotics, CT, LP (if done within 4 hours of abx, unlikely to lose culture)
43
patient on steroids for lupus develops pain radiating from shoulder into middle finger
C7 dermatome zoster eruption. patient should be treated with iV meds because she is immunocompromised
44
30 yo F with acute onset of severe HA and somnolence 2 hours ago. temp 100.6, BP wnl, lethargic but responds to questions, CT normal, CSF: OP 250, pink, glucose 53, protein 85, WBC 400 65% pmns. likely diagnosis
SAH. the patient is mildly febrile but has WBC commensurate with blood in the CSF. one can also worry about bacterial infection, but it is not offered as an answer
45
63 yo M with colon cancer is treated with 5-FU, leucovorin, oxaliplatin, and bevacizumab. two days later he is unable to see and quite agitated. discs pupils and eye movements are normal but he is NLP OU. MRI - Bilateral occipital abnormalities
PRES 0 the MRI shows bilateral occipital abnormalities and the patient is cortically blind. culprit was probably bevacizumab (avastin), a VEGF receptor inhibitor
46
25 yo F comes to the ED with 12 other victims of an aerial toxic exposure. diplopia, dysphagia, dysphonia, unsteady gait --> flaccid motor paralysis progressing downward from shoulders, sensory exam and LP are normal. explanation?
exposure to soman nerve gas, which inhibits cholinesterase - this patient has cholinergic toxicity. fentanyl was used to anesthetize terrorists who held hostages in a moscow theatre a couple of years ago. unfortunately the opiate killed hostages and captors. they would not have flaccid paralysis
47
45 yo F admitted for cholecystectomy. she has a long h/o alcohol misuse as well as daily use of diazepam and lorazepam. one week after surgery she becomes agitated and a day later has a seizure. explanation?
benzo withdrawal - benzos have a long half-life with the exception of lorazepam. alcohol withdrawal is within the first 24 hours or so. cocaine use doesn't cause withdrawal seizure
48
19 yo found unresponsive. two days ago he began risperidone treatment. temp 104, CK 1500, urine + for myoglobin, rigidity in all extremities. what neurotransmitter system is most likely responsible for these symptoms?
dopamine - both atypical and typical neuroleptics can cause this dopaminergic system problem, neuroleptic malignant syndrome. both increase sudden cardiac death, probably QR interval
49
which of the following meds is a common cause of action tremor? haldol, lithium, topiramate, cytarabine, atorvastatin
lithium can cause a nasty tremor and cerebellar toxicity. lithium toxicity is treated with hemodialysis . haldol - extrapyramidal signs, topiramate is actually used to treat action tremor, cytarabine produces cerebellar toxicity and atorvastatin can produce a myopathy
50
familial essential tremor - treated with
propranolol or mysoline (very sedating) or topiramate
51
which of the following (gabapentin, nortriptyline, duloxetine, carbamazepine, pregabalin) is used for neuropathic pain and associated with urinary retention in the diabetic male
nortriptyline. although anticholinergic effects are worse with amitriptyline.
52
24 yo F has a single nocturnal GTC seizure from sleep. she has no epilepsy risk factors and normal PE, EEG, and MRI. she is quite upset at being told she can't drive for 6 months. what is her risk of seizure recurrence over the next two years
20-30%
53
which antiepileptic drug has no drug interactions with ocps: lamotrigine, gabapentin, oxcarbazepine, topiramate, carbamazepine
gabapentin. lamotrigine levels are decreased by ocps. oxcarbazepine, topiramate, carbamazepine are enzyme reducers.
54
major drug associated with seizure
cocaine
55
30 yo M with known epilepsy p/w several GTC seizures. he has been off AEDs for 3 months. he has no other known seizure types. normal PE and head CT, and he is allergic to phenytoin. would like to start an aed that can be rapidly initiated and titrated up to therapeutic dose
valproate - while it has obvious problems in women of childbearing age, this man's epilepsy syndrome is unclear. therefore a broad spectrum drug would be reasonable. valproate, topiramate, and lamotrigine are all broad spectrum. but of these only valproate can be loaded IV rapidly.
56
75 yo M who lives in a snf comes to the ED because of ams. refuses to eat, refuses to get out of bed. h/o hypertension, bipolar dz, and depression. his meds are risperidone, valproic acid, and hctz. exam - course tremor at both hands, cogwheeling at elbows and wrists, tongue briefly protrudes from mouth when he speaks. mmse 25. next step?
decrease valproate dose - remember valproate can also produce a parkinsonian syndrome. since it isn't helping his behavior, should d/c it
57
70 yo F found to be seizing and continues to seize in the ED. bp 160/80, P 100, T 37, glu 85. the most likely cause of status epilepticus in the patient is:
cerebrovascular disease - stroke, including remote and acute hemorrhagic and ischemic, account for 60& of all status epilepticus, with other less common causes: encephalitis, metabolic derangement. her bp is not in the hypertensive encephalopathy range
58
8 yo M thought to have ADD has an eeg showing 3hz spike and wave activity. best treatment
ethosuximide. kids with early onset absence epilepsy have the best prognosis, but up to 1/3 may develop gtc seizures in their adolescent or young adult years
59
65 yo m p.w the story that he has fallen out of bed three times and has struck his wife while dreaming that he was defending his home from a burglar. what is the best initial tx?
clonazepam - first line tx for REM behavior disorder. works 90% of patients. 2nd line - amantadine and ropinirole. rem behavior disorder - increased risk of developing PD.
60
64 yo L handed man c/o 6 months of weakness in left arm and LHeadedness when he plays tennis. his arm and hand are cool 15 min. during these episodes. 30 pack year smoker, but stopped 10 years ago. BP right arm 150/90, L arm 134/79. left radial pulse is diminished. next step in diagnosis?
mra - diagnosis is likely subclavian steal syndrome. smoking may contribute to vascular diz. want to look at aortic arch, etc.
61
what condition is associated with cerebral aneurysm?
autosomal dominant polycystic kidney dz
62
7 yo F has HA's, vomiting, and visual problems. she is 4th percentile in height and weight. bilateral temporal hemianopia, pupils errl, CT cystic and solid mass in sella turcica region. after surgery, long term mgmt?
hormone replacement therapy. likely a craniopharyngioma
63
78 yo M is brought in by his family with a 4 year ho progressive memory loss. he cannot balance his checkbook and has become withdrawn. workup should include
screening questions for depression. this is probably AD, and evaluation should focus on reversible causes of dementia
64
which area of cognition might improve with normal aging?
vocabulary
65
55 yo M p/w personality changes and language changes for 6 months. he spends money recklessly, quit his job, effortful speech consisting of largely stock phrases with poor word retrieval. memory is good. mri shows focal left temporal atrophy
FTD - prominent behavior changes with early preservation of memory
66
65 yo M c/o 4 weeks of being in a fog. got lost on the way to his home. short term memory impaired. remainder of exam wnl. blood work wnl. Mri- bilateral hippocampal abnormalities
paraneoplastic syndrome - the actual antibody could be an anti-nmda receptor (unlikely given gender/age), anti-hu or anti-ma. tumor is likely in lung but could be testicular. point is that the discovery of an antibody should trigger a neoplasia search. PET scan could search the body for a hypermetabolic focus to direct biopsy.
67
61 yo M c/o severe left leg pain and weakness for 3 months. he has had two stem cell transplantations for multiple myeloma. he was on extended prednisone tx at these times but has had none for two years. no known myeloma recurrence. exam wnl except for left leg 4/5 strength. next step
left hip mri -likely avascular necrosis of the hip. refer to ortho
68
55 yo F c/o 6 months progressive right hearing loss. five years ago a left vestibular schwannoma (acoustic neuroma) was removed. general exam is normal. Rinne lateralizes to the left. likely diagnosis?
NF2
69
75 yo M reports that her husband has had six months of urinary incontinence and 4 months of memory loss. he seems to urinate in his pants and doesn't care. gait slow, shuffling with feet glued to the floor. what is the cause of the patient's urologic dysfunction?
failure to inhibit voiding reflex. think NPH - with this he would have indifference to the voiding urge. he might well have some prostatic dz as well.
70
13 yo F brought to the ER on a 95 degree day 20 minutes after being hit on the head by a baseball. she got up to run but 10 min later lost consciousness. BP is 154/104, HR 45. likely problem?
increased ICP - she has a cushings signs of increased BP and decreased pulse - significant risk of raised ICP, possibly an epidural hematoma here. acute treatment would be mannitol infusion and emergent operation - no time for dexamethasone infusion to do much acutely.
71
44 yo M develops behavioral changes and odd movements. his mother died at a nursing home from a progressive neuro dz and his uncle is in a mental institution. what will the CT show?
caudate atrophy. this is a family with huntington's disease. genetic testing for number of CAG repeats on chromosome 4. there is degeneration of striatal gamma aminobutyric acid neurons
72
75 yo F is admitted to the hospital for a broken hip. at 1am on the POD 3 she begins screaming that there are robbers in the room and pulls her out her IB while wandering down the hall. first line management:
reorient patient, encourage family presence.
73
78 yo F with metastatic breast CA involving many vertebral bodies and ribs as well as lungs is on hospice. she asks for more pain medication, even though increasing narcotic doses impairs her respiratory function
give whatever oral dose is necessary, for this patient relief of pain is the main goal
74
30 yo F develops complicated partial seizures. 2 AED's provide suboptimal control. what is the likelihood that the addition of 3 AEDs will provide adequate seizure control?
less than 5%. this patient should be evaluated early for alternative therapy including epilepsy surgery
75
65 yo M comes to the ED with a 3 day h/o left leg and back pain after lifting a heavy suitcase. numbness in right groin, urinary urgency, incontinence. decreased pp over buttocks, posterior thighs, perineum, decreased anal tone. diagnosis?
cauda equina
76
30 yo F has low back pain radiating down the back of her right leg after moving furniture. pain on flexion of the thigh. DTR and strength normal. decreased sensation along right lateral foot. bowel/bladder normal. next step
analgesic therapy and activity as tolerated. no imaging is needed..
77
50 yo M comes to the ER with 2 hours of confusion and hallucinations. ETOH abuse for 27 years with seizures and traumatic injuries. stopped drinking 3 days ago. fever, tachycardia, htn disheveled/malnourished. resting tremor of hands, uncooperative, disoriented x 3, visual hallucinations
delirium tremens. GIVE SOME THIAMINE while you are thinking. you can't tell at this point if the patient has korsakoff psychosis and possibly you will prevent it. withdrawal seizures are within the first 24 hours after ETOH cessation. alcoholic hallucinosis is usually earlier.
78
12 yo boy with hemophilia A has headaches. he fell ice skating 2 weeks ago without loss of consciousness and remembers striking his head. CT a the time was normal and was discharged. exam - bilateral papilledema, slight ocular abduction weakness bilaterally, left babinski, hyperreflexia on left
subdural hematoma. there has been a long delay between trauma and presentation. don't call this a post concussive state - there is evidence of raised ICP
79
54 yo M with alcoholism comes to the ED because of inability to move his leg for the past 4 hours. he was last seen 48 hours earlier. slight bilateral lower extremity swelling, no voluntary movement, oliguria - bladder catheterization yields 40 cc urine + for blood by dipstick. diagnosis?
rhabdomyolysis. the blood and the swelling indicate muscle issues. hyperkalemia associated with rhabdo should be treated acutely when there are EKG changes with calcium.
80
75 yo M consults a physician for 15 month h/o progressive difficulty walking with 3 months of urinary incontinence. oriented X 3, but speaks infrequently. patient has bilateral grasp reflexes and increased muscle tone. seems stuck to the floor - needs assistance to walk. what will you see on CT?
increased ventricular size. NPH.
81
17 yo F brought in by her parents because of a 1 year h/o excessive daytime sleepiness. she falls asleep during class and was involved in a MVC when she fell asleep while driving. occasionally she has fallen to the ground after laughing or being startled. multiple sleep latency tests shows REM episodes at sleep onset. explanation?
narcolepsy + cataplexy - early REM onset after sleep.. treat with provigil or ritalin for excessive daytime sleepiness. cataplexy can be treated with sodium oxybate.
82
58 yo M whose only pmh is for 30 pack year smoking, has increasing problems walking for 4 months, particularly on stairs. he has lost 10 pounds during this period. he has difficulty touching his nose with his eyes closed but can do so with the eyes open. profound loss of vibration and position sense. can't stand with feet together with eyes closed. diagnosis?
sensory ataxia - patient has + romberg, poor proprioception.this could all be posterior column problems. likely anti-hu antibody associated with small cell lung cancer.
83
35 yo F has noticed a gradual loss of vision in the corners of both eyes. during the same several week period she has been gaining weight, has decreased libido, increased soe size, can't remove wedding ring. she has been amenorrheic for 8 months. likely diagnosis?
acromegaly - this patient is growing! ACTH secreting adenomas and cushing syndrome can make one gain weight and develop strae. prolactin producing adenomas also produce bitemporal hemianopsia but would cause galactorrhea and be treated with bromocriptine
84
12 yo M arrives to the ED 1 hour s/p MVC. he as a tibial open fracture with severe pain around the fracture site. he has weakness of toe flexion and much pain on passive extension of the toes with hyperesthesia in his sole
compartment syndrome - with acute swelling and fracture there is a risk of compartment syndrome which can cause tissue necrosis that can --> vigorous decompression
85
72 yo M has a two day history of horizontal diplopia. pain behind the R eye and difficulty keeping the eye open. he has a 50 year h/o T1DM with polyneuropathy htn and renal insufficiency. he takes aspirin and insulin. diplopia on L lateral gaze and incomplete elevation and depression of the R eye. prognosis?
good - recovery of right eye movement. this is a diabetic pupil sparing third nerve palsy whose pathophysiology is micro-infarction and whose prognosis is quite good (just like diabetic abducens palsy)
86
48 yo F with secondary progressive MS stops all her medicines because of diarrhea. she had been taking paroxetine, tolterodine, interferon beta, modafinil, levothyroxine, and amantadine. she has continued taking baclofen. one week later she is irritable, anxious, and has labile affect and loose associations with vivid dreams. abrupt cessation of which med caused these symptoms?
paroxetine - ssri withdrawal syndrome. modafinil absence would make the patient sleepy. baclofen should not be d/c'd abruptly from doses in excess of 40 mg per day as seizures may ensue
87
27 year old F comes to you with 3 month h/o HA and blurred vision. she takes no medications. menses are irregular and she has had a 40 lb weight gain in the past 6 months. blurred optic discs, remainder of exam is normal. CT showed small lateral ventricles. LP opening pressure 300. CSF normal studies. what is the diagnosis?
lateral venous sinus thrombosis. although story is also consistent with pseudotumor cerebri, it should be remembered that one of the causes of this problem is cerebral venous sinus thrombosis. next step is mrv. transverse sinus thrombosis contributes to intracranial hypertension via venous hypertension when the stenosis is bilateral and severe enough to compromise cerebral venous outflow.
