Flashcards in Neurology Deck (112)
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1
UMN vs LMN lesion
UMN: contralateral paralysis lower face
LMN: ipsilateral paralysis upper and lower face
2
CN XI
Accessory: Head turning, shoulder shrugging
3
CN XII
Hypoglossal: Tongue movement
4
CN XI
Glossopharyngeal: Taste post 2/3 tongue, swallow, salivation (parotid) carotid body, gag reflex
5
Innervation swallowing
CN IX, X
6
Innervation salivation
CN VII (submand, subling), XI (parotid)
7
Innervation tongue
Sensation: V, VII (taste ant 2/3), IX (taste post 1/3)
Movement: XII
8
Innervation carotid body, arch, sinus
CN IX: carotid body and sinus chemo and baro
CN X: cartoid arch chem and baro
9
Lateral corticospinal tract
Movement contralateral limbs
10
Dorsal column
Fine touch, vibration, conscious proprioception
11
Spinothalamic
Pain, temperature (crosses at level of spinal courd)
12
Clinical reflexes:
Biceps
Triceps
Patella
Achilles
Babinski
Biceps: C5, 6
Triceps: C7,8
Patella: L3,4
Achilles: S1,2
Babinski: UMN, normal first year
13
Presents with: Aphasia or neglect, contralateral paresis and sensory loss face and arm, gaze towards lesion, homonymous hemianopsia
MCA infarct
14
Presents with: Contralateral paresis and sensory loss in leg, cognitive or personality changes
ACA infarct
15
Presents with: Homonymous hemianopsia, memory deficit, dyslexia/alexia
PCA infarct
16
Presents with: Coma, "locked in" syndrome, CN palsies, apnea, crossed weakness and sensory loss of face/body
Basilar artery infarct
17
Presents with: Pure motor or sensory stroke, dysarthria-clumsy hand syndrome, ataxic hemiparesis
Basal ganglia lacunar infarct
18
Imaging for stroke
Emergent CT without contrast (rule out bleed)
19
Mnemonic: 4Ds of posterior circulation strokes
Diplopia
Dizziness
Dysphagia
Dysarthria
20
When can tPA and intraarterial thrombolysis be administered?
tPA: within 3 hrs
intraarterial thrombolysis: within 6 hrs
21
What can decr morbidity mortality within 48hrs of stroke
ASA
22
Treatment if incr ICP after stroke
Mannitol, hyperventilation
23
Target INR for AF and prosthetic valve
AF: INR 2-3
Prosthetic valve: INR 3-4
24
Drug for long term prevention after stroke
ASA, clopidogrel
25
Presents as: abrupt-onset, intensely painful thunderclap headache: dx, etiologies
SAH
Trauma, berry aneurysm, AVM
26
When is carotid endarterectomy indicated?
>60% in symptomatic
>70% in asymptomatic
contraindicated in 100% occlusion
27
What is associated with CNIII palsy with pupillary involvement
Berry aneurysm
28
What are first or second diagnostic procedures if SAH suspected?
1. CT without contrast
2. If neg, LP (Look for RBC, xantochromia)
29
Complications after SAH and prevention
Vasospasm: 5-7 days after, Ca channel blockers
Rebleeding: keep BP
30
Definitive treatment for cerebral aneurysm
Surgical clipping
31
What imaging if intracerebral hemorrhage suspected
Noncontrast CT- look for mass effect or edema to predict herniation
32
Subdural vs Epidural: etiology and appearance
Subdural: rupture of bridging vein; elderly and alcoholic; Crescent shape
Epidural: tear of middle meningeal artery, skull fracture; concave/lens shape
33
Presents as trauma then lucid interval followed by altered consciousness
Epidural hematoma
34
Treatment of epidural hematoma
Emergent neurosurgical evacuation
35
What compressed in cingulate herniation
Frontal lobe
36
What compressed and symptoms transtentorial herniation
Midbrain
Rapid change mental status, Bilaterally small reactive pupils, cheyne-strokes, flexor-extensor posturing
37
Presents as Rapid change mental status, Bilaterally small reactive pupils, cheyne-strokes, flexor-extensor posturing
Transtentorial herniation (compression midbrain)
38
What compressed and symptoms uncal herniation
CNIII entrapped (down and out pupil)
Cerebral peduncle: ipsilesional hemiparesis
39
What compressed and symptoms cerebellar tonsillar herniation herniation
Medullary compression
respiratory arrest
40
What aspects of new headache are concerning? How work up?
Abrupt onset: CT and LP, r/o SAH
Focal neuro deficits: CT or MRI
41
Presents with headache, jaw claudication
Temporal arteritis
42
Abortive therapy vs prophylaxis for migraines
Abortive: Triptans, metoclopramide (after NSAID fail)
Ppx:Anticonvulsant (gabapentin, topiramate), TCAs, bblock, CCBs
43
What headache location is concerning?
Posterior headache (esp children)
44
Typical headache length for migraine?
>2, 72hr
45
Presents as headache, orbital pain, edema, diplopia, fever: dx and etiology
Cavernous sinus thrombosis
etiology: Septic thrombosis of cavernous sinus, esp S. aureus
46
Diagnostic studies cavernous sinus thrombosis
CBC, blood culture, LP, MRI (with gad, MR venogram)= confrmatory
47
Treatment cavernous sinus thrombosis
penicillinase-resistant penicillin (nafcillin, oxacillin)
3rd or 4th gen cephalosporin (ceftriaxone, cefepime)
48
What serum marker is consistent with epileptic seizure?
Incr prolactin
49
Simple vs complex partial seizures
Simple: No loss of consciousness
50
Evaluation of focal seizure
EEG
MRI or CT to rule out focal lesion
51
Treatment of acute seizure
>2 min
IV benzo, phenytoin
52
What are 2 hallmarks of tonic-clonic seizure
incontinence, tongue biting
53
How long do tonic-clonic seizures typically last?
1-2min
54
First line anticonvulsant for partial seizure, children
Phenobarbital
55
EEG findings tonic-clonic seizure
10hz during tonic phase, slow waves clonic phase
56
Treatment for primary tonic-clonic seizure
Phenytoin
57
EEG and findings absence seizure
2hz spike and wave discharges
ethosuximide (valproic acid= second line)
58
Definition and dx workup of status epilepticus
lasts > 10 min or repetitive without return to baseline consciousness
EEG, head CT (rule out intracranial hemorrhage)
59
Treatment for status epilepticus
-Initial + if continues
Thiamine, glucose, naloxone
IV benzodiazepine, loading dose fosphenytoin
If continues: intubate + phenobarbital
60
Presents as tonic, bilateral, symmetric jerks of head, trunk and extremeties in clusters within 6mo
West syndrome (infantile spasm)
61
Diagnostic maneuver for BPPV, maneuver to resolve
Dix-Hallpike (turn head + sit to supine)- reproduce nystagmus
Epley: resolve
62
Presents as recurrent episodes of severe vertigo, hearing loss, tinnitus, ear fullness: dx and tx
Menieres
Low-sodium diet, diuretic
63
Vertigo- characteristics concerning for central lesion
last >1 min, gait disturbance, nausea vomiting out of proportion to nystagmus
64
Presents as acute onset of severe vertigo, head-motion intolerance, gait unsteadiness with nausea, vomiting, nystagmus
Acute peripheral vestibulopathy (labyrinthitis, vestibular neuritis)
65
What stroke mimics labyrinthitis
lateral pontine/ cerebellar: AICA territory
66
Treatment of Acute peripheral vestibulopathy
corticosteroids within 72hrs
67
Workup for syncope
telemetry to rule out arrhythmia
ECG and cardiac enzymes to rule out MI
EEG to rule out seizure
68
Presents as fluctuant fatiguable ptosis or double vision, proximal muscle weakness: dx and tx
Myasthenia gravis
Edrophonium: anticholinesterase leads to rapid improvement
Ice test
EMG
Tx: Anticholinesterase (pyridostigmine), Prednisone
69
Etiology of myasthenia gravis, associated disorders
Postsynaptic Ach Receptor antibodies
+ thyrotoxicosis, thymoma
70
Drugs to be avoided in myasthenia gravis
abx (eg aminoglycosides)
b blockers
71
Malignancy associated with lambert-eaton
Small cell lung carcinoma
72
Etiology of Lambert-Eaton
Antibodies against presynaptic calcium channel of NMJ
73
Diagnosis and tx of Lambert-Eaton
Dx: Incremental response after repetitive nerve stimulation
Tx: 3,4-diaminopyridine or guanidine; corticosteroids and azathioprine
74
What is radiologic characteristic of MS?
Enhance with gadolinium
75
Therapy for MS:
-Acute exac
-First line
-Second line
Acute exac: corticosteroids
First line: immunomodulators: ifnb (avonex, betaseron), copolymer (copaxone)
Second line: Natalizumab, Mitoxantrone
76
CSF and tx for GBS
CSF protein >55mg/dL, little or no pleocytosis
plasmapheresis or IVIG
77
Treatment for ALS
Riluzole
78
Characteristic onset of vacular dementia
Abrupt
79
EEG findings show pyramidal signs, periodic sharp waves
CJD
80
What should be ruled out for alzheimers?
Depression
Hypothyroidism
Vit B12 def
Neurosyphilis
81
Treatment alzheimers
Cholinesterase inhib (donepizil, rivastigmine, galantamine, tacrine)
NMDA Rec antag (Memantine)
82
Pick's disease: typical presentation and imaging
Significant early changes in behavior and personality
Atrophy of frontal and temporal lobes
83
Presents with dementia, gait apraxia, urinary incontinence (disease + etiology)
NPH- impaired CSF outflow
84
Presents as subacute dementia with ataxia or startle-induced myclonic jerks: dx and workup
CJD
CSF 14-3-3 and tau protein
85
Presents with chorea, altered behavior, dementia: dx, area affected, tx
Huntington
Caudate and putamen
Reserpine or tetrabenazine for movement, SSRI for depression
86
Parkinson's tetrad
Resting tremor
Rigidity
Bradykinesia
Postural instability
87
Etiology of Parkinson's
Dopamine depletion of substantia nigra
88
NPH vs parkinson's
NPH- preservation of arm swinging
89
Treatment of parkinson's
Levodopa/carbidopa
Dopamine agonist
Selegiline (MAO-B inh)
COMT inhibitors
Amantadine
90
Most common primary locations of brain metastases
Lung
Breast
Kidney
GI
Melanoma
(Lung and Skin go to the BRain)
91
Presents with ipsilateral tinnitus, hearing loss, vertigo
Acoustic neuroma
92
Suprasellar tumor in children, typical presentation
Craniopharyngioma- typically calcified
93
Medulloblastoma vs Ependymoma (Grade and location)
Both typically arise 4th vent
Medulloblastoma- highly malignant
Ependymoma- low grade
94
Workup for neurofobromatosis
MRI brain, brainstem, spine with gad
Optho, derm, auditory testing
95
Malignancy associated with NFI
optic glioma
96
Presents with convulsive seizures, ash leaf lesions, mental retardation
Tuberous sclerosis
97
Workup for Tuberous sclerosis
Head CT (calcified tubers, malignant astrocytoma)
ECG (Rhabdomyoma)
Renal ultrasound
Renal CT
CXR (pulm lesions, rhabdo)
98
Treatment of seizures in tuberous sclerosis
oxcarbazepine or carbamazepine
99
Broca vs Wernicke aphasia (symptom and location)
Broca= expressive aphasia, posterior inferior frontal gyrus
Wernicke= receptive aphasia, left posterior superior temporal gyrus
100
Etiology of broca and wernicke aphasia
Broca: L superior MCA stroke
Wernicke: L inf/post MCA stroke
101
What is the area of dysfunction for coma?
Bilateral dysfunction both cerebral hemispheres or brainstem (pons or higher)
102
Presents as symmetric paresthesias, stocking-glove sensory neuropathy, leg stiffness, spasticity, paraplegia, bowel and bladder dysfxn, sore tongue
B12 deficiency
103
Presents as encephalopathy, ophtalmoplegia, ataxia
Wernicke encephalopathy (thiamine)
104
Upper vs Lower quadrantic anopsia location
upper: contralateral temporal lesion (Meyer's loop)
Lower: Contralateral parietal lesion (dorsal optic radiation)
105
Presents with painful eye, hard read eye, dilated nonreactive pupil
Closed-Angle glaucoma
106
Location closed vs open angle glaucoma
Closed: Iris and lens push together, disrupts flow to ant chamber
Open:Limited flow through trabecular meshwork
107
Presents with gradual loss perpipheral vison, frequent need for lens changes, cupping of optic nerve head
Open angle glaucoma
108
Treatment Closed-angle glaucoma vs open angle glaucoma
Closed: Eye drops (timolol, pilocarpine, apraclonodine)
Systemic (acetoxolamide, mannitol)
Laser peripheral iridotomy
Open:
topical b-blocekers
carbonic anydrase inhib
109
Presents with painless loss of central vision
macular degenration
110
Atrophic vs exudative AMD treatment
Atrophic: no treatment, Vit E
Exudative: VEGF inhib, photodynamic therapy
111
Presents with painless, unilateral blindness; sluggish pupil, cherry-red spot on fovea
Central retinal artery occlusion
112
