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Flashcards in Neurology 6% Deck (121):
1

Name the syndrome:
- Bilateral upper + lower extremity weakness
- Sensory loss of pain and temp in "shawl-like distribution over extremities of upper shoulders"
- Preservation of position, light touch, proprioception

Central Cord Syndrome
Hyperflexion of neck

2

Name the syndrome:
- Hemiparesis greater in lower extremity than upper
- Urinary incontinence
- Personality changes
- Speech preservation

Anterior Cerebral Artery Infarct Syndrome

3

Name the syndrome:
- Complete paralysis in lower extremities
- Sensory loss of pain and temp, especially in lower extremities
- Preservation of position, proprioception

Anterior Cord Syndrome

4

Name the syndrome:
- Loss of proprioception and vibratory sense only
- Pain, light touch, motor sensation preserved

Posterior Cord Syndrome

5

Name the syndrome:
- Ipsilateral proprioception, vibratory, light touch, motor loss
-Contralateral pain and temp loss

Brown Sequard Syndrome
(Unilateral chord lesion)

6

T/F: In Bell's Palsy, one still has the ability to raise/wrinkle the forehead/eyebrow in the affected side.

False. Bell's Palsy = idiopathic palsy of FACIAL NERVE (CN 7).
Think STROKE if ability to move forehead is retained.

7

VDRL tests for ____

Syphilis

"Venereal Disease Research Laboratory"

8

Recommended imaging modality in acute phase of stroke

Nonconstrast CT
Differentiate b/w ischemic and hemorrhagic stroke

9

____ therapy initiated for ischemic stroke and TIA.
____ therapy initiated for cardiac emboli/MI.

ANTIPLATELET therapy initiated for ischemic stroke and TIA.
ANTICOAGULANT therapy initiated for cardiac emboli/MI.

10

MC type of stroke

Ischemic stroke (80%)
--> Thrombotic (49%) emboli (31%) Cerebrovascular occlusion

11

Stroke of the _____ artery is the most common type.

Middle Cerebral Artery (70%)

12

T/F: Patients w/ strokes w/ facial involvement will NOT be able to raise their eyebrows.

False. Only involve lower half of face

13

Lacunar Infarct = Penetrating branches of ____

Symptoms (4)

CT scan shows ___

Tx:

Cerebral arteries in pons, basal ganglia

1. Pure motor (hemiparesis, hemiplegia)
2. Ataxic hemiparesis (weakness, clumsiness leg > arms)
3. Dysarthria (clumsy hand syndrome)
4. Pure sensory loss (numbness, parasthesias)

Small punched out hypodense areas

Aspirin
Control risk factors (HTN, DM)
Resolves in hours - 6 weeks

14

Middle Cerebral Artery Stroke causes (Ipsilateral/contralateral) sensory/motor loss/hemiparesis, greater in ____.
Visual disturbance:
(Ipsilateral/contralateral) (homo/heteronymous) hemianopsia. Gaze preference (towards/away from) side of lesion.

Middle Cerebral Artery Stroke causes CONTRALATERAL sensory/motor loss/hemiparesis, greater in FACE, ARMS > leg/foot.
Visual disturbance:
CONTRALATERAL HOMOnymous hemianopsia. Gaze preference TOWARD side of lesion.

15

LEFT or RIGHT -side dominant MCA stroke?
Broca (expressive), Wernicke (sensory) Aphasia

(Define each)

LEFT

Broca's aphasia = sparse output, comprehension PRESERVED

Wernicke's aphasia = fluent, voluminous, meaningless. Markedly IMPAIRED comprehension

16

LEFT or RIGHT -side dominant MCA stroke?
Spatial deficits, LEFT side neglect

RIGHT

17

LEFT or RIGHT -side dominant MCA stroke?
Math comprehension, agraphia

LEFT
Agraphia = loss in the ability to communicate through writing

18

LEFT or RIGHT -side dominant MCA stroke?
Dysarthria, anosognosia

RIGHT
Anosognosia = deficit of self-awareness
Dysarthria = difficult or unclear articulation of speech

19

Anterior Cerebral Artery Stroke causes
(Ipsilateral/contralateral) sensory/motor loss/hemiparesis, greater in ____.
T/F: Face affected.
T/F: Speech preserved.
T/F: Lower motor neuron weakness
T/F: Urinary retention
T/F: Personality changes (flat affect)

CONTRALATERAL greater in LOWER (leg/foot) > UE --> abnormal gait

F: Face SPARED
TRUE: Speech preserved.
F: UPPER motor neuron weakness
F: Urinary INCONTIENCE
TRUE: Personality changes (flat affect)

20

Posterior circulation of brain (3)

Posterior cerebral artery
Basilar artery
Vertebral artery

21

Only rTPA effective in ischemic stroke

Alteplase

22

Posterior Cerebral Artery Stroke causes
(Ipsilateral/contralateral) (homo/heteronymous) hemianopsia.
(Ipsilateral/contralateral) CN deficits
(Ipsilateral/contralateral) muscle weakness

Other symptoms (3)

CONTRALATERAL HOMOnymous hemianopsia.
IPSILATERAL CN deficits + CONTRALATERAL muscle weakness ("Crossed sx")

Visual hallucinations
Coma
Drop attacks = sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes

23

Basilar Artery Stroke causes (4)

Cerebellar dysfunction
CN palsies
Decreased vision
BILATERAL sensory

24

Vertebral Artery causes (5)

Vertigo
N/V
Nystagmus
Diplopia
ISPLATERAL ataxia

25

MC cause of Subarachnoid Hemorrhage

2ry to rupture of berry aneurysm (MC Circle of Willis)
OR
Arteriovenous Malformation (AVM)

26

"Worst HA of my life"

What other symptoms?

Subarachnoid hemorrhage

Meningeal sx: Stiff neck, photophobia, delirium

27

Dx of Subarachnoid hemorrhage

T/F: No focal neuro symptoms

CT scan
If CT scan negative --> LP: xanthochromia (RBCs), increased CSF pressure

TRUE

28

Epidural Hematoma
MC (arterial/venous) bleed
Clinical manifestation:
CT shows ___
(Does/doesn't) cross suture line

ARTERIAL bleed

Brief LOC --> LUCID interval --> coma

CONVEX (lens-shaped)
Does NOT cross suture line

29

Subdural Hematoma
MC (arterial/venous) bleed
Clinical manifestation:
CT shows ___
(Does/doesn't) cross suture line

VENOUS bleed d/t tearing of bridging veins

MC in elderly. May have focal neuro sx.

CONCAVE (crescent-shaped)
DOES cross suture lines

30

Amaurosis Fugax

Occurs when:

MONOcular vision loss ("lamp shade down on one eye")

TIA of Internal Carotid Artery

31

Carotid endarterectomy recommended for ___ in the setting of TIA

pts who have internal or common carotid artery stenosis 70-99%

32

Tx of TIA

Aspirin +/- dipyridamole or clopidogrel (Plavix)

Thrombolytics CONTRAINDICATED!

33

Definitive Dx of TIA

Angiography

34

TIA may present with (ipsilateral/contralateral) hand-arm weakness w/ sensory loss, (ipsilateral/contralateral) visual symptoms

CONTRALATERAL hand-arm weakness w/ sensory loss, IPSILATERAL visual symptoms

35

Tx of Subarachnoid Hemorrhage

Supportive: bed rest, mild sedation, stool softeners (prevent straining)

36

Felbamate

SE:

Anticonvulsant used in pts with seizures unresponsive to other medications

SE: aplastic anemia, hepatic failiure

37

Tx of absence seizures

Ethosuximide
Valproic acid

38

Type of seizure characterized by an AURAS and AUTOMATISMS

Complex partial (temporal lobe)

39

Type of seizure where consciousness is fully maintained

Simple partial

40

____ levels are increased in seizures

Prolactin

41

Marcus Gunn pupil =

Bilateral pupil constriction when light in normal eye BUT pupils dilate when like shone quickly in affected eye

Seen in Optic Neuritis, associated with MS

42

Uhthoff's phenomenon =

Worsening of symptoms w/ heat (exercise, fever, hot tub)

Seen in MS

43

Suspect MS in any young paitents who present with ____.

trigeminal neuralgia

44

Charcot's Neurologic Triad =

nystagmus
stacatto speech
intentional tremor

Seen in MS

45

Dx of MS

MRI w/ gadolinium --> white matter plaques (hyperdensities)

46

Tx of MS
Acute exacerbations:
Relapse-remitting/progressive disease:
Fatigue sx:

Acute exacerbations: STEROIDS, Plasma exchange if unresponsive
Relapse-remitting/progressive disease: Beta-interferon
Fatigue sx: Amantadine

47

CSF finding in MS

Increased IgG (oligoclonal bands)

48

CSF findings in Guillain Barre Syndrome

High protein
NORMAL WBC

49

CSF findings in Bacterial Meningitis

High protein
INCREASED WBC (polymorphonuclear neutrophils) (100-100,000**)
DECREASED glucose

50

CSF findings in Aseptic Viral Meningitis

Normal glucose
INCREASED WBC (lymphocytes) (10-300)

51

CSF findings in Fungal Meningitis

Increased WBCs (lymphocytes)
Decreased glucose

52

Lhermitte's Sign

Neck flexion causes lighting-shock pain radiating from spine down the leg w/ neck flexion

Seen in MS

53

Amyloid depositions (senile plaques) and neurofibrillary tangles (tau protein) seen in ___

Alzheimer Disease

54

Tx of Alzheimer Disease

Acetycholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine
NMDA antagonist: Memantine

55

MOA of NMDA antagonists

reduces glutamate excitotoxicity

56

Frontotemporal dementia (a.k.a. ___) presents with ___

A.k.a Pick's Disease
Marked personality changes
Primitive reflexes = frontal release signs --> palmar grasp, rooting reflexes

57

Vascular dementia presents as

forgetfulness in absence f depression and inattentiveness

58

Prophylactic tx of choice for cluster HA

verapamil

59

Triptans are ____ that cause ____

serotonin 5HT-1 agonists
vasoconstriction

60

Tx of benign essential tremor

Propranolol: beta blocker
Primidone: if propranolol fails

61

Parkinson disease: Degeneration of cells in the ___, causing deficiency of ____ and imbalance of ____ and ____.

Degeneration of cells in the SUBSTANTIA NIGRA, causing deficiency of DOPAMINE and imbalance of DOPAMINE and ACETYLCHOLINE.

62

Parkinson Disease features (4)

RESTING tremor: pill rolling
Bradykinesia: slow, shuffling gait, masklike facies
Rigidity (Cogwheel)
Postural instability

63

Tx of Parkinson disease:
Mild anticholinergic used for mild symptoms but no disability

Amantadine

64

Tx of Parkinson disease:
Anticholinergic drugs

Benzotropine
Trihexyphenidyl

65

Levodopa

Converts to dopamine

Tx of Parkinson

66

Carbidopa

Used in combination with Levodopa, allows lower doses of levodopa and reduce side effects

Tx of Parkinson

67

Bromocriptine

Dopamine agonist
Used for refractory Parkinson to levodopa/carbidopa therapy

68

Selegiline

Monoamine oxidase B inhibitors
Inhibits breakdown of dopamine

69

Tolcapone
Entacapone

Cetecholamine-O-Methyltransferase inhibitors (COMT)
Reduce metabolism of levodopa to 3-O-methyldopa
Allows lower doses of levodopa and reduce side effects

70

Huntington Disease is autosomal ___ d/o. The gene is on ___ chromosome.

Autosomal dominant
Short arm of chromosome 4

71

Huntington Disease characterized by ___
CT shows ____ & ____ atrophy.
Treatment:

Progressive chorea and dementia

Caudate nucleus and cerebral atrophy

Treatment:
Phenothiazine: dyskinesia
Haloperidol, clozapine: behavioral disturbances

72

Tourette syndrome characterized by ___

Dx: Volumertric MRI shows ____

Motor tics (80%) and phonic tics

Volume loss in caudate nucleus
CT, MRI are normal. EEG not helpful.

73

Coprolalia =

Involuntary obscene word tic

Seen in Tourette syndrome in 40%

74

Treatment of Tourette syndrome

Fluphenazine
Pimozide
Haloperidol
Tetrabenazine

Clonazepam, clonidine used to minimize SE of long term haloperidol use.

75

Cerebral palsy is characterized by ____

(Hyper/hypo)reflexia?

chronic impairment of muscle tone, strength, coordination or movement

Hyperreflexia

76

Tx of Restless leg syndrome

1st line: Dopamine agonists (pramipexole, ropinirole)
2nd line: Benzos (clonazepam)

Trial of iron therapy recommended if ALL pts w/ RLS (those w/o iron overload)

77

Bell palsy affects CN ___. Thought to be caused by ___, resulting in ____.
Paralysis involves ____.
Weakness peaks in about ___. Recovery usually within ___.
Treatment:

CN 7
Herpes simplex virus activation
Damage to myelin layer of facial nerve

FOREHEAD, lower face
Pain around ipsilateral ear

21 days
6 months

Oral prednisone begun at onset of symptoms shows increased % of pts with complete recovery

78

Guillain-Barre Syndrome =

MC precipitant of Guillain-Barre Syndrome =

Muscle weakness progresses (asymmetrically/symmetrically) (ascending/decending) pattern. (Decreased/increased) DTR.

CSF findings =

Post infection immune mediated demyelination & axonal degeneration slows impulses

Campylobacter jejuni

Symmetrically ASCENDING
DECREASED DTR

CSF = High protein w/ NORMAL WBC

79

Tx of Guillain-Barre Syndrome

Plasmapheresis ASAP
IVIG = good for cadiovascular instability pts and children

80

75% of pts w/ Myasthenia Gravis also have ____

thymic abnormalities (hyperplasia or thymoma)

81

Clinical manifestations of Myasthenia Gravis

1. Ocular weakness:
Extraocular muscle weakness --> diplopia
Ptosis

2.
-Generalized mm weakness worsening w/ repeated muscle use, relieved by rest
-Weakness w/ prolonged chewing, dysphagia
-Respiratory failure --> Myasthenic crisis!!

82

Edrophonium/ Tensilon test

Rapid response to short acting IV edrophonium

Dx of Myasthenia Gravis

83

Serum tests for Myasthenia Gravis

Ach-receptor Ab
MuSK Ab (ab to muscle specific tyrosine kinase)

84

Treatment of Myasthenia Gravis

Pyridostigmine, Neostigmine = acetylcholinesterase inhibitors
-MOA: increase acetylcholine by decreasing Ach breakdown

85

Cholinergic crisis =

How to tell difference from myasthenic crisis?

d/t excess Ach d/t Ach-esterase inhibition

-weakness, N/V, pallor, sweating, salivation, diarrhea, miosis, bradycardia, respiratory failure

If flaccid paralysis improves with Tensilon = Myasthenic crisis
If worsens w/ Tensilon = Cholinergic crisis

86

Myasthenic syndrome (Lambert-Eaton)

Ab preventing Ach release
Associated w/ small cell lung CA

Weakness IMPROVED w/ continued use (unlike Myasthenia Gravis)

87

Kernig's sign

Brudzinski's sign

Kernig's sign = inability to straighten knee w/ hip flexion

Brudzinski's sign = neck flexion produces knee/hip flexion

88

MC pathogen in bacterial meningitis in < 1 month old

Treatment:

Group B strep (Streptococcus agalactiae)

Tx: Ampicillin + (Cefotaxime or Aminoglycoside)

89

MC pathogen in bacterial meningitis in 1 month - 18 y/o

Treatment:

N. meningitidis*, S. pneumo

Tx: Ceftriaxone + Vancomycin

90

MC pathogen in bacterial meningitis in 18 y/o - 50 y/o

Treatment:

S. pneumo*, N. menigitidis

Tx: Ceftriaxone + Vancomycin

91

Petechial rash associated with what pathogen in bacterial meningitis?

N. meningitidis

92

MC pathogen in bacterial meningitis in > 50 y/o

Treatment:

S. pneumo
Listeria monocytogenes

Tx: Ampicillin + Ceftriaxone (+/- Vancomycin)

93

MC pathogen of viral meningitis

Enterovirus (Echovirus, Coxsackie)

94

MC pathogen of viral encephalitis

HSV-1

95

Tx of brain abscess

IV PCN G
OR Ceftriaxone + Metronidazole
+ Vancomycin if suspect Staph Aureus

96

Lowest - highest score on the Glasgow Coma Scale

3-15

97

Where's the brain tumor?
Progressive intellectual decline
Slowing mental activity
Personality changes
(Ipsilateral/contralateral) grasp reflexes
Expressive Aphasia

Frontal lobe

Contralateral grasp reflexes

98

Where's the brain tumor?
Seizures
Olfactory/gustatory hallucinations
Licking/smacking of lips
Depersonalization
Emotional, behavioral changes
Visual field defects
Auditory illusions

Temporal lobe

99

Where's the brain tumor?
(Ipsilateral/contralateral) disturbances of sensation
Cortical sensory loss (impaired stereognosis)
Inattention

Parietal lobe

Contralateral disturbances of sensation

100

Where's the brain tumor?
Crossed (homo/hetero)nymous hemianopia
Partial field defect
Visual agnosia
Unformed visual hallucinations

Occipital lobe

Crossed homonymous hemianopia

101

MC type of primary intracranial neoplasms?

Glioma (50%)

102

CSF of brain neoplasm shows

Xanthochromia
Increased protein
Normal WBC
Normal Glucose

103

Nightmares occur during ___

REM sleep

104

Sleep terrors occur during ____

stage 3 and 4 delta sleep

105

Sleep walking occurs during ____ in 1st 1/3 of night and with ____ later in night.

3 or 4 delta sleep

REM sleep

106

Tx of narcolepsy

Stimulants: dextroamphetamine, modafinil

107

Tx of nocturnal myclonus

clonazepam

108

Tx of Sleep terror and sleepwalking

Benzodiazepines

109

Dreaming occurs during ___

REM sleep

110

Delta sleep =

stage 3 and 4 of sleep

111

Dx of Narcolepsy

Multiple sleep latency test

112

Carbamazepine SE

Monitor w/:

Aplastic anemia, agranulocytosis, hyponatremia


CBC, LFT, Na testing

113

UPPER motor neuron lesions cause (spastic/flaccid) paralysis (hypertonia/hypotonia), (decreased/increased) DTR, (with/without) fasciculations, (upward/downward) Babinski, (with/without) muscle atrophy.

UPPER motor neuron lesions cause SPASTIC paralysis, HYPERTONIA, INCREASED DTR, WITHOUT fasciculations, UPWARD Babinski, WITHOUT muscle atrophy.

114

LOWER motor neuron lesions cause (spastic/flaccid) paralysis (hypertonia/hypotonia), (decreased/increased) DTR, (with/without) fasciculations, (upward/downward) Babinski, (with/without) muscle atrophy.

LOWER motor neuron lesions cause FLACCID paralysis HYPOTONIA, DECREASED DTR, WITH fasciculations, DOWNWARD Babinski, WITHmuscle atrophy.

115

3 cardinal features of Normal pressure hydrocephalus

dementia + gait disturbance + urinary incontinence

116

Myerson sign (a.k.a glabellar reflex)

Seen in ____

reflexive, sustained eye blinking in response to repetitive tapping above the nasal bridge between eyes

Parkinson disease

117

Diabetes mellitus is a common cause of CN ___ palsy. Pupil sizes are (constricted/normal/dilated) in diabetics.

CN 3 (also 4, 6)
BUT NORMAL (other CN 3 palsy will have dilated pupils)

118

Multiple sclerosis associated with CN ___ palsy, causing diplopia.

CN 6 (Abducens nerve)

119

Cerebral aneurysm associated with CN ___ palsy

CN 3

120

Sarcoidosis associated with CN ___ palsy

CN 7

121

Lyme disease associated with CN ___ palsy

CN 7