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Flashcards in Neurology Deck (62):
1

Flaccid paralysis

LMN injury = anterior horn cell destruction

seen in Polio and werdnig hoffman dz

2

What is the only area spared in an anterior spinal artery occlusion?

The Dorsal Columns

3

What areas are affected in B12 neuropathy and Friedricks atacia?

demyelination of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts

4

symptoms of strokes in territory:
MCA-
ACA-
PCA-
Basilar artery-
Basal ganglia lacunar-
TIA-

MCA- aphasia, contra neglect, paresis, and sensory loss in face and arm. GAZE TOWARDS THE LESION w/ homo hemi

ACA- Contra paresis and sensory loss in leg. Cognitive defects

PCA- homo hemi, memory deficits, dyslexia/alexia

Basilar artery- locked in syndrome, weakness/sensory deficits to ipsi face and contra body!

Basal ganglia lacunar- pure motor or sensory w/ ataxic hemiparesis

TIA-

5

Strokes

For strokes that just happened, do MRI first

6

Acute HA w/ CN III palsy and pupillary involvement?

Think berry aneurysm

7

Most likely occurance

8

Marfans, Ehlers Danlos, and ADPKD all associated with...

berry aneurysms

9

Cavernous hemangiomas associated with...

Intracerebral hemorrhage

10

What type of herniation?

Flexor/extensor posturing, small reactive pupils, cheyne-stokes respirations

downward transtentorial (central) herniation

11

Subdural hematoma is crescent shaped and does NOT cross midline

Epidural hematoma has luccid interval, is lens shaped and does NOT cross sutures

12

If a headache with acute ocular disease, what 2 things are on your diff?

Cluster vs Angle closure glaucoma. For ACG - look for a FIXED PUPIL!

13

What is the headache after an LP due to?

Intracranial hypotension

14

Tx for migraine headaches:
Ppx for migraine headaches:

Tx = NSIADs -> triptans or metaclopramide
Ppx = gabapentin, topiramate, amitriptyline, BBs, CCBs

15

What protocol screening should you follow for pts who present with their FIRST cluster headache ever?

exclude Horners syndrome (carotid artery dissection, cavernous sinus infection

16

Tx for cluster headaches
PPx for cluster headaches

Tx = high flow O2, DHE, octreotide/sumatriptan
PPx = prednisone, verapamil, lithium

17

Tx for cavernous sinus thrombosis (can present as headache)

Naf/Oxacillin + Ceftriaxone or cefepime

If anearobe (dental/sinus) use metronidazole

18

What hormone is elevated after epileptic seizures in postictal period?

Prolactin

19

Simple partial seizures
Complex partial seizures

Simple = motor and sensory features w/ hallucinations but is NOT ASSOCIATED WITH LOC

Complex = temporal lobe. b/l motor/sensory features (LIP SMACKING) w/ LOC

Be aware of postictal confusion or todd's paralysis

20

Tx for an active seizing pt?

Benzos and Phenytoin

21

What to use in kids as a first line anticonvulsant?

Phenobarbital.

In adults can use phenytoin, oxcarb, carbamaz, phenobarb, or valproate

22

Teen w/ a family history of "seizures" stares out the window alot in class. Dx? Tx? Will he recover?

Petit Mal (Absence) seizures (EEG shows 3mg blah blah)
Ethosuximide or Valproate
Pts usually recover before adulthood

23

Pt w/PKU or tuberous sclerosis and a FAMILY HISTORY starts to have seizures at 6 months of birth where she jerks her head and trunk in 5-10s bursts. Mental retardation. Dx? Tx?

Infantile Spasms (West Syndrome)

(EEG while seizing shows hypsarrhythmia)

Tx = ACTH, prednisone, clonazepam

24

Kid w/ mental retardation has multiple seizures per day (lots of nocturnal ones.) Dx? What does the EEG look like?

Lennox-Gastaut Syndrome

Slow spike and wave complexes

Resistant to treatment :(

25

What causes BPP Vertigo?

a dislodged otolith causing semicircular canal (posterior) disturbances

Tx = Epley maneuver or will go away on its own

26

Labrynthitis vs Vestibular Neuritis?

Laby = auditory and aural symptoms (tinnitus, ear fullness)
Vestibular Neuritis = No auditory or aural symptoms

Tx = meclizine and corticosteroids

27

What strokes mimic labyrinthitis and vestibular neuritis?

Laby = AICA stroke (lateral pontine/cerebellar)
VN = PICA stroke (lateral medullary/cerebellar)

28

Pts with MG who have a thymoma will have autoAbs towards what?

ACh receptors, but also probably antibodies against striated muscle (anti-MuSK Abs)

29

How does repetitive nerve stimulation differ in MG and LE syndromes?

MG - decremental response
LE - incremental response

30

What is the viral link that is believed to somehow cause MS?

T-cell mediated viral infections

31

What area of the CNS is affected in Guillain Barre? Tx?

THe myelin. It is an acute inflammatory demyelinating polyneuropathy

It can cause arrhythmias as well. WORST THING WOULD BE RESP FAILURE

Tx = plasmapheresis and IVIG. NO STEROIDS

32

What is the main cause of death for alzheimers pts?

Aspiration pneumonia

33

What is a key feature between alz dementia and pseudodementia?

alz dementia pts are NOT concerned about their symptoms and will be brought in by family members. Pseudodementia pts are concerned about their symptoms

34

What will imaging look like for:
Alz dementia
Vascular dementia
Picks
NPH
CJD

Alz dementia = b/l temporoparietal hypometabolism
Vascular dementia = old infarcts, white matter changes
Picks = frontotemporal atrophy
NPH = ventricular enlargement
CJD = increased T2 and FLAIR in putamen and caudate. EEG shows pyramidal signs and periodic sharp waves

35

Tx for alz dementia?

Cholinesterase inhibitors (increase the ACh levels) = donepezil, rivastigmine, galantamine, tacrine

36

What does the gait look like in NPH?

"Magnetic" or "Glued to the floor."

37

What CSF labs are seen in CJD?

elevated CSF 14-3-3 and tau protein. Make Dx w/ brain bx

38

What genetic phenomena is seen in Huntingtons dz?

What will imaging look like?

Tx?

Anticipation (number of CAG repeats expands in subsequent generations leading to earlier expression and more severe dz.)

CT/MRI shows caudate/putamen atrophy

Tx = Reserpine or Tetrabenazine (decrease movement)

39

Adjectives to describe parkinson gait:

Tx?

Slow, wide stance w/ short accelerated steps, no arm swing
Festinating
Hypokinetic

Tx = levodopa/carbidopa (carb blocks peripheral conversion of levo (D precursor) to prevent side effects of levodopa (N/V)
-Bromocriptine (D)
-Selegiline (MAO-B blocker can be neuroprotective)

40

What are the most common primary brain tumors in adults? kids?

Glio Multiforme and Meningioma (the only brain tumor that is more common in women)

kids = Astrocytoma, Medulloblastoma

NOTE: 2* TUMORS FROM METZ ARE WAY MORE COMMON IN CNS THAN 1*

41

What type of tumor is a GBM?

It is a grade IV astrocytoma. Causes ring enhanced lesions on MRI

42

What type of cells spawns a meningioma?

Dura mater or arachnoid cells. Can leave a dural tail

43

What cells span an acoustic neuroma?

Schwann cells

44

What tissue spawns a medulloblastoma?

Neuroectodermal tissue. These are popular in kids and come from the 4th ventricle

45

What is the most common supracellular tumor in kids? Signs?

Craniopharyngioma. Calcification is common

2/3 adult tumors are supratentorial
1/3 kid tumors are supratentorial

46

NF1 vs NF2

Both are AD

NF1 = Age 15; cafe au lait spots, neurofibromas, freckling axilla, OPTIC GLIOMAS, kyphoscoliosis

NF2 = Age 20; B/l acoustic neuromas, some sort of neurofibroma, meningiomoa, gliomas...

47

Tuberous Sclerosis

What 1 test do you want to do?

ash-leaf hypopigmentations on skin, mental retardation, seizures, RETINAL HAMARTOMAS, sebaceous adenomas (shaped like butterflies) and orange peel rash on lumbosacral area.

Must evaluate for rhabdomyoma of heart. Also want to check the kidneys forangiomyolipoas

48

No resp drive = brain death

Resp drive but eyes closed and unconscious = coma
resp drive, but eyes open, seemingly awake = PVS
Resp drive w/ eye/lid control = Locked In Syndrome (caused by CPM, stem stroke, or advanced ALS

49

Artificial life support can be discontinued only after 2 physicians have declared the patient legally brain dead

yep

50

when does korsakoff's dementia occur?

Typically in the resolution phase of wernicke's syndrome that was treated too late/incorrectly

51

When does glaucoma occur?

When the natural flow of aqueous humor is disrupted and IOP is increased

Open angle = flow through trabecula is messed up
Closed angle = angle is too narrow to let fluid out of posterior chamber

52

WHAT medication should you avoid like crazy in pts with acute angle glaucoma? What tx instead?

Atropine or anything that will dilate the eye (this would cause a higher IOP and would be really bad

tx = timolol, pilocarpine, apraclonidine

53

tx for open angle glaucoma?

BBs to decrease aqueous fluid
Pilocarpine to increase aqueous outflow

54

Signs of macular degeneration?

painless loss of central vision and distortion of straight lines.

55

Central retinal artery occlusion, Tx?
Central retinal vein occlusion, Tx?

CRA = painless unilateral blindness w/ cherry-red spot on the fovea and swelling. Tx = thrombolysis

CRV = fast painless blindness w/ swollen optic disk w/ hemorrhages and cotton wool spots. Tx = photocoagulation

56

What area of the brain corresponds to a lacunar infarct?

What would the symptoms be?

= basal ganglia (putamen, GP, thalamus, caudate) or Subcortical white matter (internal capsul, corona radiata) or Pons.

They are small, due to HTN, and may not show on CT

symptoms = unilateral motor impairment, NO SENSORY/CORTICAL DEFICITS, no visual field abnormalities

57

What would a stroke in the vertebrobasilar area look like?

This would affect the brainstem

CROSSED syndrome (contra hemiplegia and ipsi CN involvement.)

58

Central Cord Syndrome

selective damage to the central portion of the anterior spinal cord - causes weakness in UE and can cause decreased pain/temp due to STT damage.

This will happen due to HYPEREXTENSION in a pt who already has degenerative changes in the spinal cord

59

Anterior (Ventral) Cord Syndrome

b/l spastic motor paresis any area distal to the lesion

usually due to occlusion of the anterior spinal artery

60

Posterior (Dorsal) Cord Syndrome

b/l loss of vibratory/proprioceptive sensation, may have URINARY RETENTION/INCONTINENCE.

Often due to MS or vascular injury (vertebral artery dissection)

61

Gait where you flex the hip and knee and slap your foot on the ground =

Steppage gait

Peroneal nerve injury

62

Wide based gait w/ instability and stomping of feet =

Slap gait

Sensory Neuropathy