Neuro Shelf Flashcards
1
Q
26 yo female patient presents with altered mentation, focal cranial nerve deficits, hemiparesis, seizures, aphasia, ataxia, and fever
A
HSV-1 encephalitis
2
Q
What are some symptoms of herpes encephalitis?
A
- altered mentation
- focal cranial nerve
- hemiparesis
- dysphasia
- aphasia
- ataxia
- focal seizures
- FEVER
- seizures
3
Q
What lobe does herpes encephalitis attack?
A
temporal
4
Q
treatment of choice for herpes encephalitis?
A
IV acyclovir
5
Q
CSF characteristics of herpes encephalitis
A
- lymphocytosis
- increased erythrocytes
- elevated protein levels
- low CSF glucose levels
6
Q
What does imaging show in herpes encephalitis?
A
temporal lobe lesions- use MRI
7
Q
what is the gold standard for diagnosis of herpes encephalitis?
A
PCR analysis of HSV DNA in the CSF
8
Q
What is the hallmark sign of myasthenia gravis?
A
resolution of muscular weakness with rest
9
Q
What is acute steroid myopathy and how soon does it occur?
A
- occurs w/in 1 week of drug initiation and
- diffuse muscle weakness and rhabdpmyolysis
- pts present w proximal mm weakness, difficulty rising from chair, combing hair, climbing stairs
10
Q
Symptoms ofpolymyalgia rheumatica?
A
- seen in 50% of patients with temporal arteritis
- present with aching and morning stiffness, pain in shoulders, hip girdle, and neck
- increased ESR
- sx improve w steroids
11
Q
What are some typical causes of vestibulopathy?
A
- Meniere’s disease
- perilymphatic fistulas
- benign positional vertigo
- labrynthitis
- acoustic neuromas
12
Q
what is anisocoria?
A
unequal size of the eys oupils
13
Q
what nerve lesion results in impaired corneal sensation?
A
Trigeminal Nerve- V1 specifically
14
Q
What might you find on CT scans of pts w alzheimers dementia?
A
- cortical and subcortical arophy, specifically in the parietal and temporal lobes (hippocampi)
15
Q
What are the clinical signs of cerebellar hemorrhage? What else would you see in a large hemorrhage?
A
- Acute onset
- Occipital headache
- repeated vomiting
- Gait ataxia
Large:
- 6th nerve palsy
- conjugate deviation
- blepharospasm
16
Q
What are the clinical signs of cerebellar hemorrhage? What else would you see in a large hemorrhage?
A
- Acute onset
- Occipital headache
- repeated vomiting
- Gait ataxia
Large:
- 6th nerve palsy
- conjugate deviation
- blepharospasm
17
Q
What medication can slow the long-term progression of relapsing-remitting MS? what about progressive MS?
A
RR: IFN-beta
Progressive: immunosuppressive agents (cyclosporine, methrotrexate, mitoxantrone)
18
Q
Areflexic weakness in the upper extremities + anesthesia (loss of pain and temp) with preserved position and vibration in a cape like distribution
A
syringomyelia
19
Q
what is the pathology behind syringomyelia?
A
cavitary expansion of the spinal cord destroying gray and white matter adjacent to the central canal
20
Q
What does neuroimaging show in Arnold-Chiari malformation?
A
caudal displacement of the fourth ventrical due to displacement of the cerebellar tonsils through the foramen magnum
21
Q
what are some risk factors for pseudotumor cerebri? aka idiopathic intracranial HTN
A
- Meds: corticosteroids, OCPs
- Trauma
- Obesity
22
Q
What are some initial symptoms of pseudotumor cerebri? (aka IIH)
A
- pulsatile HA that usually awakens pt from sleep and is assoc with pulsatile tinnitus (whooshing sound in ears)
23
Q
MRI reveals an empty sella tursica and slit like ventricles
A
pseudotumor cerebri
24
Q
What is Dejerine Roussy syndrome?
A
- stroke involving the VPL nucleus of the thalamus which transmits sensory information from the contralateral side o the body
25
What is Dejerine Roussy syndrome?
- stroke involving the VPL nucleus of the thalamus
26
what is the clinical presentation of a VPL thalamic stroke?
- hemianesthesia accompanied by transient hemiparesis, athetosis or ballistic movements
- thalamic pain phenomenon: dysesthesia of the area affected by the sensory loss
27
what is the most significant complication of IIH?
blindness!
28
What are some characteristics of an MCA stroke?
- contralateral motor and/or sensory deficits that are more pronounced in the upper limb than the lower
- dominant lobe= aphasia, nondominant lobe= neglect and/or anosognosia
29
What are some characteristics of an MCA stroke?
- contralateral motor and/or sensory deficits that are more pronounced in the upper limb than the lower
- dominant lobe= aphasia, nondominant lobe= neglect and/or anosognosia
30
What is anosognosia?
deficit of self-awareness, don't acknowledge that theres a neurologic problem
31
Chatacteristics of a PCA stroke?
homonymous hemianopia
- alexia (loses ability to read) without agraphia
- Visial hallucinations (calcarine cortex)
- sensory symptoms
- third nerve palsy w pareses of vertical eye mvmt
- motor deficits (cerebral peduncle, midbrain)
32
what is Amaurosis fugax??
Temporary monocular blindness
33
What are some syndromes of lacunar infarcts?
- pure motor hemiparesis
- pure sensory stroke
- dysarthria- clumsry hand
- ataxic hemiparesis
34
What is glatiramer acetate?
- tx for MS
- decreases disease frequency and severity of MS exacerbations
- induces suppressor T cells that downregulate the T cell mediated immune response to myelin antigens that underlies MS
35
What is the standard concoction for pts with confusion?
1. Thiamine for Wernicke's
2. Dextrose for hypoglycemia
3. Supplemental Oxygen for hypoxia
4. Naloxone for opiate overdose
36
What injury to the brain occurs in prolonged seizures?
- cortical laminar necrosis: can lead to persistent neurologic deficits and recurrent seizures
37
What injury to the brain occurs in prolonged seizures?
- cortical laminar necrosis: can lead to persistent neurologic deficits and recurrent seizures
38
What are some characteristics of brain metastasis?
- duration of symptoms of less than 2 months
| - occur in the gray-white junction or watershed zones
39
What are some characteristics of brain metastasis?
- duration of symptoms of less than 2 months
| - occur in the gray-white junction or watershed zones
40
what is the pathogenesis of CN III neuropathy in diabetic mononeuropathy?
- ischemic! but only of somatic fibers bc somatic and parasympathetic fibers have separate blood supplies
- this leads to down and out gaze
41
young patient + myoclonus + dementia
CJD
42
young patient + myoclonus + dementia
CJD
43
what is anisocoria?
unequal pupils
44
Visual field defects usually means a problem with what?
the retina or optic nerve (pre-chiasm)
45
What is RAPD?
marcus gunn pupil- pupil doesn't constrict to direct light but constricts to direct accommodation
46
where do CN II fibers synapse?
pretectal midbrain nuclei aka the Edinger-Westphal nuclei in the rostral portion of the third nerve nucleus
47
What are the characteristics of a third nerve palsy?
- ptosis
- dilated pupil
- ophthalmoplegia
eye is down and out
48
What are the characteristics of a third nerve palsy?
- ptosis
- dilated pupil
- ophthalmoplegia
49
What is Adie's pupil? How do you confirm it?
- a tonic pupil that results from interruption of the PSNS supply from the ciliary ganglion
Sx =
1. Anisocoria
2. Photophobia
3. Blurred near vision
-Confirmed via 0.1% pilocarpine which will produce more contraction in the affected pupil than in the normal pupil
50
What is Adie's pupil? How do you confirm it?
- a tonic pupil that results from interruption of the PSNS supply from the ciliary ganglion
Sx =
1. Anisocoria
2. Photophobia
3. Blurred near vision
-Confirmed via 0.1% pilocarpine which will produce more contraction in the affected pupil than in the normal pupil
51
Sudden painless vision loss in HTN and DBM pt >50
Anterior ischemic optic neurpathy (AION)
52
What is the etiology of AION?
vascular: carotid occlusion, embolic TIAs
Inflammatory: temporal arteritis
53
what do you see on fundoscopic exam of AION?
unilateral segmental disc edema
54
what is Foster Kennedy syndrome?
Ipsilateral optic disc atrophy due to compression by a space occupying lesion in the frontal lobe and papilledema in the contralateral optic disc due to increased ICP
55
What is the treatment for IIH?
Acetazolamide
Nerve decompression
Shunt
56
What does fundoscopic exam show in drusens?
glistening hyaline bodies + VP
57
What does fundoscopic exam show in drusens?
glistening hyaline bodies + VP
58
What is Uhthoff's phenomenon?
worsening visual function during exercise, hot baths, etc.
| seen in optic neuritis- usually from MS
59
Central scotoma is classic for what?
Optic neuritis
60
what is phoria?
misalignment of the eyes when binocular vision is absent
61
what is tropia?
misalignment of the eyes when both eyes are opened and binocular vision is possible
62
what is strabismus?
misalignment of the eyes
63
lesion to CN IV causes what?
oblique diplopia- worse on downgaze when affected eye is adducted (pt complains of diplopia when reading or going down stairs)
64
What does the MLF connect specifically? what happens when there is a lesion to the right MLF?
the abducens nucleus with the contralateral third nerve
| R MLF = inability to adduct the right eye in left lateral gaze plus nystagmus of the abducting left eye
65
What is one and a half syndrome?
Lesion to the PPRF, sixth nerve palsy, and adjacent ipsilateral MLF
- ipsilateral gaze palsy and INO on the contralateral side
66
Abnormal vertical gaze movements can be found in what syndromes?
Dorsal midbrain
67
What is parinaud syndrome?
1. Upgaze disturbance,
2. Convergence-retraction nystagmus on attempted upgaze
3. Light near dissociation of the pupils
(usually produced by pineal tumor compressing the dorsal midbrain)
68
what are exotropia and esotropia?
```
exotropia = eyes turned outward (third nerve palsy)
esotropia = eyes turned inward (abducens palsy)
```
69
What is oculomotor apraxia?
inability to produce saccades
70
What is oculomotor apraxia?
inability to produce saccades
71
What are some characteristics of NMJ disorders?
- decree of weakness fluctuates from hour to hour
| - no sensory loss
72
What are some characteristics of NMJ disorders?
- decree of weakness fluctuates from hour to hour
| - no sensory loss
73
Name the nerve root of the reflex:
| Biceps
C5
74
Name the nerve root of the reflex:
| Finger Flexor
C8/T1
75
Name the nerve root of the reflex:
| Hip adductor
L3
76
Name the nerve root of the reflex:
| Triceps
C7
77
Name the nerve root of the reflex:
| Patellar
L4
78
Name the nerve root of the reflex:
| Brachioradialis
C6
79
Ankle jerk
S1
80
in UMN lesions, what happens to upper extremity muscles versus lower?
Upper: extensors and abductors become weaker than flexors and adductors
Lower: mm that shorten the leg (flexion) are weaker than the extensors
81
in UMN lesions, what happens to upper extremity muscles versus lower?
Upper: extensors and abductors become weaker than flexors and adductors
Lower: mm that shorten the leg (flexion) are weaker than the extensors
82
lesions in the internal capsule may lead to weakness where?
in the contralateral face, arm, and leg
83
lesions in the base of the pons may lead to weakness where?
ipsilateral face, contralateral arm and leg
84
Where does the spinalthalamic pathway decussate?
at the level of the spinal cord in the dorsal horn
85
Where does the dorsal column medial lemniscus pathway decussate?
lower medulla in the nuclei gracilis and cuneatus, cross to form the medial lemniscus
86
What is the somatotopic arrangement of the dorsal column pathway?
legs medially in the fasciculus gracilis
| arms laterally in the fasciculus cuneatus
87
What is the somatotopic arrangement of the dorsal column pathway?
legs medially in the fasciculus gracilis
| arms laterally in the fasciculus cuneatus
88
where does the spinothalamic tract terminate?
VPL of the thalamus
89
where does the trigeminal tract terminate?
VPM of the thalamus
90
What is the etiology of menieres disease?
an intermittent increase in endolymphtic volume
91
What is the etiology of menieres disease?
an intermittent increase in endolymphtic volume
92
What is dysdiadochokinesia?
abnormality of ther ate and rhythm of a movement demonstrated by asking the pt to perform a rapid alternating movement
93
What is dysarthria?
slow scanning and monotonous speech
94
Pt is 4yo child with recent URI shows signs of gait ataxia and dysarthria?
Postinfectious cerebellitis
| (affects kids aged 2-7) lasts a few weeks, diagnosis of exclusion
95
pancerebellar syndrome that evolves to its maximum in weeks and then stabilizes?
Paraneoplastic cerebellar degeneration: assoc with underlying gynecologic, SCLC
- MRI normal CSF may show elevated protein or lymphocytic pleo but mostly normal
96
what autoantibodies are assoc with Paraneoplastic cerebellar degeneration?
anti-yo and anti-hu
97
loss of reflexes, spasticity and extensor plantar responses and impaired vibration/position sense in a child
friedreich ataxia
98
loss of reflexes, spasticity and extensor plantar responses and impaired vibration/position sense in a child
friedreich ataxia
99
Insidious onset of progressive impairment of gait and dysarthria in early adult life with associated neurologic abnormalities + family history
Autosomal Dominant Spinocerebellar Degenerations (many cause a trinucleotide expansion)
100
what is detected in the serum of patients w Miller Fisher Syndrome?
IgG anti-GQ1b antibodies
101
what is detected in the serum of patients w Miller Fisher Syndrome?
IgG anti-GQ1b antibodies
102
What is astasia-abasia?
acrobatic psychogenic gait
103
What is astasia-abasia?
acrobatic psychogenic gait
104
What type of urinary issues do parkinsons pts have?
voiding dysfunction- sphincter bradykinesia as well as BPH assoc
105
What type of urinary issues do parkinsons pts have?
voiding dysfunction- sphincter bradykinesia as well as BPH assoc
106
what is the treatment of trigeminal neuralgia?
Carbamazepine (then other AEDs)
| Refractory cases= percutaneous radiofrequency ablation and microvascular decompresison
107
what is the pathophys of trigeminal neuralgia?
compression of the trigeminal nerve root at the cerebellopontine angle, most often by an aberrant vascular loops
108
what is PHN? treatment?
- neuropathic pain that accompanies and follows an acute attack of shingles
tx: acyclovir for shingles, then TCAs and gabapentin for PHN
109
what is one feature of almost all aphasias?
anomia! inability to name things
110
what are neologisms?
nonexistent words
111
how are wernickes and brocas different?
- ppl with wernices seem unaware of their deficit initially and can become quite angry with others having difficulty understanding them, unlike Brocas
112
where is wernickes area located?
posterior part of the superior temporal gyrus in the dominant hemisphere
113
what is alexia without agraphia aka pure alexia? what lesion causes it?
inability to read despite a preserved ability to write- lesion in the dominant occipital lobe (also can involve the splenium of the corpus callosum)
114
what kind of apraxias do lesions to the parietal lobe cause?
pts cannot recognize the task being done correctly
115
what kind of apraxias do lesions to the parietal lobe cause?
pts cannot recognize the task being done correcty
116
what is prosopagnosia and where is the lesion?
- inability to recognize faces
| - R hemispheric or bilateral lesions in the visual association area
117
What is Gerstmann's syndrome?
- lesion in the inferior parietal lobule of the dominant hemisphere (angular gyrus)
1. Agraphia (inability to write)
2. Acalculi
3. Right-Left confusion
4. Finger agnosia
118
What is anosognosia?
pts with right hemisphere lesions have a tendency to be unaway of their deficits
119
what gene (and chromosome) is assoc with both early and late onset AD?
ApoE4 on chromosome 19
120
Early onset AD is assoc with what mutation on what chromosome?
APP on chromosome 21
PS1 on chromosome 14
PS2 on chromosome 1
121
what does sundowning mean in terms of AD?
psychiatric manifestations are worse during the evening and night
122
What is a rare side effect of donepezil and rivastigmine?
hepatic toxicity
| common: diarrhea and abdominal cramps
123
What is a rare side effect of donepezil and rivastigmine?
hepatic toxicity
| common: diarrhea and abdominal cramps
124
what is a side effect of clopidogrel?
Can produce TTP
125
What drugs are used to treat lewy body dementia?
Low doses of atypical neuroleptics:
| - Risperidone and clozapine
126
what is the genetic dysfxn in huntingtons dx?
>40 CAG repeats on chromosome 4
127
what is the genetic dysfxn in huntingtons dx?
>40 CAG repeats on chromosome 4
128
what are the characteristic pathologic changes seen in Picks disease?
pick bodies- argyrophilic round intraneuronal inclusions
129
presence of protein 14-3-3 in the CSF?
CJD!
130
What is the most common cause of nontraumatic SAH?
saccular aneurysms!
131
Tx of choice for agitation in the eldery?
Haloperidol
132
What is the treatment for Shy-Drager syndrome aka multiple system atrophy?
1. Fludrocortisone
2. Salt supplementation
3. Alpha adrenergic agonists
133
What are the characteristics of multiple system atrophy?
1. Parkinsonism
2. Autonomic dysfunction
3. Widespread neurological signs
134
What is familial dysautonomia?
autosomal recessive disease
- children of ashkenazi jewish ancestry
- gross dysfunction of the ANS with severe orthostatic hypotension
135
What is horner's syndrome?
- regional dysautonomia
1. Anhydrosis
2. Miosis
3. Ptosis
136
what is torticollis?
a focal dystonia of the SCM muscle
137
what medications can cause torticollis?
1. typical antipsychotics
2. Metoclopramide
3. Prochlorperazine
138
what is akathisia?
sensation of restlessness that causes pt to move frequently
139
what is the most common cause of myasthenia crisis?
intercurrent infection
140
what reflex can be seen in a pt with brain death?
deep tendon reflexes
141
why do people suffering from heat stroke have blood in their urine?
rhabdomyolysis- the increased body temperature can cause it and organ system damage
142
Where are plaques of MS most commonly located? (4)
1. Periventricular regions
2. Corpus callosum
3. Deep white matter
4. Basal ganglia
143
What causes a Subdural hematoma?
tearing of the bridging veins from minor trauma (crescent shaped)
144
what causes a biconvex hematoma on ct?
epidural hematoma- tearing of the middle meningeal artery
145
what causes a subarachnoid hemorrhage?
rupture of an aneurysm
146
where do most of the emboli come from in amaurosis fugax?
(painless vision loss from emboli) from the carotid bifurcation
147
what is a good distinguishing factor between alzheimers dementia and pseudodementia?
ppl w pseudodementia are seem generally concerned about their memory loss, alzheimers seem unconcerned
148
tx of choice for NPH?
surgical bypass shunting
149
what are two medical tx of essential tremor?
1. Beta blockers
2. Primidone- anticonvulsant that can cause porphyria, which manifests as abdominal pain, neurologic and psychiatric abnormalities
150
what is trihexyphenidyl?
anticholinergic- used for parkinsons disease and drug induced extrapyramidal symptoms
- benztropine is another agent in this class
- causes anticholinergic side effects and closed angle glaucoma
- typically used in younger patients where tremor is predominant
151
Brown-seguard syndrome is assoc w damage to the lateral spinothalamic tracts- where do the symptoms show up?
contalateral loss of pain and temperature sensation beginning to levels below the level of the lesion
152
what is the underlying genetic mutation in NF2?
also-
1. Wishart version (severe variant)
2. Gardner (milder varint)
Autosomal dominant cause by a mutation in the tumor suppressor gene on chromosome 22-
1. Wishart = frameshift or nonsense
2. Gardner = missense or splice site
153
Atrophy of the lenticular nucleus is most common in what?
Wilson's disease!
154
What is the imaging modality of choice for diagnosis of CST?
MRI with MRV
155
What is metoclopramide? what is it used for? side effects?
- DA receptor antagonist
- used for nausea, vomiting and gastroparesis
- se = agitation, loose stools, EPSEs and NMS
156
what is the tx for a dystonic reaction?
- discontinuation of the medication
| - administration of benztropine or diphenhydramine
157
sharp, triphasic synchronous discharges on EEG
CJD
158
EBV DNA in the CSF + ring enhancing mass that is solitary and periventricular
Primary CNS lymphoma
159
multiple ring enhancing spherical lesions in the BG
toxoplasmosis
160
what is titubation?
forward and backward motion of the trunk
161
pt has ipsilateral ataxia and falls towards one side, also exhibits titubation, nystagmus, intention tremor
cerebellar tumor
162
loss of proprioception + pt walks w legs wide apart, feet are lifted higher than usual and make a slapping sound when come in contact with the floor, romberg +
tabes dorsalis
163
restless leg syndrome is more common in what population?
CKD and or iron deficiency anemia
164
MOA of restless leg syndrome?
abnormalities in dopaminergic transmission in the CNS- use DA agonists (pramipexole and ropinerole) or levodopa)
165
What are the most common causes of foot drop?
1. Neuropathy
2. L5 radiculopathy
3. Traumatic damage to the common peroneal nerve
166
CSF shows elevated protein and normal cell count (albumino-cytologic dissociation)
GBS
167
What is wallenberg syndrome?
lesion of the lateral medulla:
- ipsilateral Horner syndrome
- loss of pain and temperature sensation of the face
- weakness of the palate, pharynx, and vocal cords
- cerebellar ataxia
- loss of pain and temp on contralateral side of the body
168
pathophys of NPH?
transient increase in ICP that causes ventricular enlargement
169
Symptoms of Cauda equina syndrome?
- a serious disorder of spinal nerve roots
- low back pain
- bowel and bladder dysfunction
- saddle anesthesia
- sciatica
- lower extremity sensory and motor loss
170
thenar eminence atrophy?
median nerve involvement
171
what is the major cause of morbidity and mortality in subarachnoid hemorrhage? how do you prevent it?
vasospasm with symptomatic ischemia and infarction
| - prevented with Ca channel blockers
172
what is an expected electrolyte abnormality iwth subarachnoid hemorrhage?
hyponatremia = cerebral salt wasting syndrome
