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Flashcards in Neurology Deck (99):
1

Anterior Cerebral Artery (ACA)

Contralateral lower extremity and face

2

Middle Cerebral Artery (MCA)

Aphasia, contralateral hemiparesis, sensory loss and hyperreflexia

3

Vertebral/basilar (Posterior fossa, pons)

Ipsilateral: ataxia, diplopia, dysphagia, dysarthria, and vertigo. Contralateral: homonymous hemianopsia with basilar - PCA lesions

4

Lacunar - Internal capsule

Pure motor hemiparesis

5

Lacunar - thalamus

Pure sensory deficit

6

Lacunar - pons

dysarthria, clumsy hand

7

Stroke: Best initial test

CT scan head without contrast

8

Degree of carotid stenosis

carotid duplex U/S

9

Definitive test for identifying stenosis of vessels of H and N, and for aneurysms?

MRA - magnetic resonance arteriogram

10

Screen all patients with carotid duplex U/S who have --

Carotid bruit, PVD, and CAD

11

Stroke in young patients < 50 yr old

look for vasculitis, hypercoagulable state, thrombophilia, H/o cocaine addiction

12

Tx within 3 h of stroke

tPA; do not give aspirin for the first 24 h if the patient received tPA

13

Tx after 3 h of stroke

Aspirin only

14

If patient cannot take apsirin

Give clopidogrel

15

If patient cannot take either aspirin or clopidogrel, the next option is --->

Ticlopidine

16

If carotid artery stenosis > 70% and symptomatic-Tx

carotid endarterectomy

17

In carotid stenosis and asymptomatic patient-Tx

reduction of atherosclerotic risk factors and aspirin

18

CT scan head with no contrast in stroke -

Ischemic stroke - dark area; Hemorrhagic stroke - white area

19

CT scan head with no contrast in stroke -

differentiates ischemic from hemorrhagic infarction

20

Pupillary findings in intracerebral hemorrhage and corresponding level of involvement -->

pinpoint pupils- pons; poorly reactive pupils - thalamus; dilated pupils - putamen

21

Polycystic kidney disease is associated with -->

Berry/saccular aneurysms

22

SAH

"the worst headache of my life!" - extremely rapid onset, presents like meningitis (fever, photophobia, and neck stiffness), loss of consciousness

23

SAH - best initial test

CT scan head no contrast

24

SAH - immediate next step after CT scan

Ophthalmic exam to rule out papilledema before doing a Lumbar puncture (to prevent herniation)

25

If no papilledema -- the most appropriate next test

Lumbar puncture - blood in the CSF is a hallmark of SAH; Xanthochromia (yellow color of the CSF) is the gold standard for the diagnosis of SAH.

26

Definitive test to detect the site of bleeding in SAH

Cerebral angiogram

27

Progressive Supranuclear Palsy (PSP)

A degenerative condition of the brainstem, basal ganglia, and cerebellum

28

PSP - s/s

Like Parkinson disease - bradykinesia, limb rigidity, and cognitive decline; Unlike Parkinson - does NOT cause tremor and does cause ophthalmoplegia

29

Huntington chorea

CAG leads to a loss of GABA-producing neurons in the striatum

30

Huntington chorea MRI finding -

atrophy of the head of Caudate nuclei

31

Essential tremor is markedly decreased by

Alcohol use

32

Normal Pressure Hydrocephalus (NPH)

Dementia, gait disturbance, and urinary incontinence

33

Bilateral, fixed, dilated pupils

severe anoxia

34

Unilateral, fixed, dilated pupils

herniation with CN III compression

35

Pinpoint pupils

Narcotics, Intracerebral hypertension (ICH)

36

Locked in Syndrome

Infarction or hemorrhage of the ventral pons; basilar artery stroke

37

Locked in Syndrome

fully aware of the surroundings BUT completely paralyzed with sparing of muscles of respiration, blinking and vertical eye movement, feel pain.

38

Clinically Definite MS

2 episodes of symptoms + evidence of 2 white matter lesions (imaging or clinical)

39

Lab-supported Definite MS

2 episodes of symptoms + evidence of at least 1 white matter lesion on MRI + abnormal CSF (oligoclonal bands in CSF)

40

Probable MS

2 episodes of symptoms + either 1 white matter lesion or oligoclonal bands in CSF

41

Abrupt onset with rapidly ascending weakness/paralysis of all four extremities with h/o infection (e.g. Compylobacter jejuni, CMV, hepatitis, and HIV) -->

Guillian-Barre Syndrome (GBS)

42

GBS - diagnostic tets

CSF analysis, Nerve conduction studies

43

Myasthenia gravis - pathophysiology?

autoantibodies against muscle-type nAChRs within the NM junction

44

Myasthenia gravis (MG) - s/s

muscle weakness exacerbated by use and improved by rest (i.e. symptoms worsen toward the end of the day)

45

Myasthenia gravis (MG) - most common initial symptoms --

ptosis, diplopia, and blurred vision

46

Myasthenia gravis (MG) -- preserved modalities

sensation and reflexes

47

Lambert-Eaton Myasthenic Syndrome - pathology

autoantibodies against presynaptic Ca channels

48

Lambert-Eaton Myasthenic Syndrome - CF?

proximal muscle weakness and hyporeflexia (unlike MG where Reflexes are Normal)

49

Lambert-Eaton Myasthenic Syndrome -- key CF

Symptoms improve with repeated muscle stimulation (but worsen in MG)

50

Medications that exacerbate S/o MG --->

Antibiotics - aminoglycosides and tetracyclines; B-blockers; Antiarrhythmics - quinidine, procainamide, and lidocaine

51

Tuberous sclerosis - CF

cognitive impairment, epilepsy, and skin lesions (facial angiofibromas, adenoma sebaceum), retinal hamartomas, renal angiomyolipomas, cardiac rhabdomyoma.

52

Sturge-Weber Syndrome -CF

Facial vascular nevi (Port-wine stain), capillary angiomatoses of the pia mater, epilepsy, and mental retardation.

53

von Hippel-Lindau Disease - CF

cavernous hemangiomas of the brain or brainstem, renal angiomas, and cysts in multiple organs. Associated with renal cell carcinoma, pheochromocytoma

54

GBS - imp. drug contraindication ---

NO STEROIDS for GBS!!!!!!!!!

55

Syringomyelia - pathology

central cavitation of the cervical spinal cord involving lateral spinothalamic tract

56

Syringomyelia - CF

bilateral loss of pain and temperature sensation over the shoulders in a cape-like distribution

57

Brown - Sequard Syndrome - pathology

spinal cord hemisection

58

Brown - Sequard Syndrome - CF

contralateral loss of pain and temperature; ipsilateral hemiparesis, and ipsilateral loss of position/vibration

59

Horner Syndrome -

Ipsilateral Ptosis, Anhydrosis, and Miosis (PAM is Horny!)

60

Meniere Disease - CF

Vertigo, tinnitus, and hearing loss

61

Meniere Disease - Tx

Sodium restriction and diuretics

62

Syncope is uncommon in setting of stroke, unless -->

--- the vertebrobasilar system is involved.

63

If the patient has no heart disease and syncope is unexplained, the most important test is --->

--- Tilt-table testing (for evaluation of vasovagal syncope)

64

Status epilepticus - Drug Tx

IV diazepam, IV phenytoin, IV dextrose. Treat resistant cases with IV phenobarbital

65

Wallenberg Syndrome is characterized by --

severe hiccups

66

Wallenberg Syndrome - CF

Contralateral sensory (pain/temp) loss of the trunk, ipsilateral sensory loss of the face, dysphagia, slurred speech, loss of gag reflex, ataxia, vertigo, diplopia, nystagmus, vomiting, Horner syndrome

67

Weber syndrome -CF

Ipsilateral CN III palsy + contralateral hemiplegia

68

Benedikt syndrome - CF

Ipsilateral CN III palsy + cotralateral ataxia

69

Cerebral vein thrombosis (sagittal venous sinus occlusion) pathology

pregnancy, hypercoagulable states

70

Cerebral vein thrombosis - most accurate test

Magnetic Resonance Venography

71

Cerebral vein thrombosis - the most effective therapy

Heparin

72

A drug given routinely to all patients with SAH to prevent ischemic stroke due to vasospasm --

Nimodipine (CCB)

73

Standard care for SAH is --

Platinum wire coiling, Nimodipine, and Shunting if hydrocephalus

74

In SAH --

steroids and anti-epileptics are INCORRECT answers

75

If cord compression is clearly present - the most appropriate next step in management is ---

to give steroids such as dexamethasone without waiting for the next step i.e. MRI

76

The most common cause of spinal epidural abscess is --

Staphylococcus aureus

77

Anterior spinal artery infarction

loss of everything (sensory + motor) except position and vibration (dorsal column preserved)

78

Tropical spastic paraparesis

HTLV-1 infection that mimics MS; Caribbean patient; weakness exclusively of the lower extremities, hyperreflexia, painful spasticity; unlike MS absent optic neuritis.

79

If migraine occur 4 or more time a month ---

Prophylactic Propranolol

80

Cluster headache - best initial therapy -

Sumatriptan or ergotamine

81

Cluster headache - most appropriate next step in management if initial therapy fails --

100 % Oxygen

82

Pseudotumor cerebri (idiopathic intracranial hypetension) - CF

Severe headache, diplopia with papilledema, normal CT scan of head; elevated CSF pressure on LP with normal cell count, glucose and protein

83

Pseudotumor cerebri - CN involvement

CN VI (Abducens) palsy (LR-6)

84

Pseudotumor cerebri - best initial therapy --

carbonic anhydrase inhibitor - acetazolamide

85

Pseudotumor cerebri - if acetazolamide fails - the most appropriate next step is ---

Prednisone

86

Bell (CN VII) palsy - best initial therapy --

Prednisone

87

Myasthenia gravis - best initial tests ---

anti-nAChRs antibodies, if negative then, antibodies against muscle specific tyrosine kinase

88

Myasthenia gravis - best initial test-- if anti-nAChRs antibodies are not in the choice ---

Edrophonium test (observe improvement in muscle strength)

89

MG - the most accurate test --

Single fiber electromyography

90

MG - what imaging study is most likely to benefit patient?

Chest X-ray/CT/MRI (to look for thymoma)

91

MG - best initial therapy ---

anti-cholinesterase medications - pyridostigmine, neostigmine

92

MG - if anti-cholinesterase medications do not control -- the most appropriate next step in management is --

Thymectomy (if age < 60 yr), or Prednisone (if age > 60 yr; thymectomy in older patients will not work) until other immunosuppressive drugs have time to take effect.

93

MS - the best initial and most accurate test -->

MRI

94

Mild Parkinsonism - Tx

If younger (< 60 yr): anticholinergics - benztropine, trihexyphenidyl, or procyclidine OR DA agonists - Ropinirole or pramipexole; If older (> 60 yr): Amantadine

95

Tx for psychosis with hallucinations in PD --

Quetiapine or olanzapine or clozapine

96

Antipsychotic drug with smallest risk in Parkinson's --

Quetiapine

97

Clozapine caution --

Neutropenia

98

Essential tremor - characteristics -

worsened by beta-agonists and caffeine and is improved with alcohol

99

Restless leg syndrome -- best therapy --

Direct-acting DA agonists: Ropinirole or Pramipexole (r/o iron deficiency with a serum ferritin test).