What happens to resting tremors in Parkinson’s when sleeping?
What brain structure in responsible for intention tremors?
How does a blood clot appear on T1-weight images?
What muscles are first affected by polymyositis?
Proximal - pelvic and shoulder girdles
With sensorineural hearing loss, the patient will hear midline fork more loudly in which ear?
In conductive hearing loss, the vibrations of the midline fork are perceived as louder in what ear?
Patient develops increased sensitivity to sound in left year; this symptom may develop in one ear with damage to which ipsilateral CN?
VII - facial nerve innervates stapedius muscle of middle ear; paralysis of this muscle allows undampened transmission of acoustic signals
If SAH is suspected but the CT is normal, what is the next diagnostic test?
Women with breast cancer and other gynecologic cancers are also at increased risk of what brain tumor?
Meningioma (thought to be due to the sex steroid receptors on these tumors)
What type of tumors are seen in NF-2?
Meningiomas and bilateral acoustic neuromas
What kind of wave and wave frequency is seen in a relaxed adult?
Alpha waves; 8-13 Hz
What is Wernicke’s aphasia?
Impaired naming, comprehension, and repetition with fluent speech
What is the CSF profile in a seizure?
What is the CSF profile in bacterial meningitis?
Elevated protein, no/few RBSc, elevated opening pressure, milk/xanthochromic fluid, normal/slightly elevated gamma globulin content, elevated WBCs, VERY LOW glucose
What is the CSF profile in Guillain-Barre syndrome?
Normal except for high protein and xanthochromic
What is the CSF profile in viral encephalitis?
Some RBCs, increase WBCs, elevated protein, glucose is normal, increase in IgG %
What is the pathophysiology of atherosclerosis?
Plaque involves subintimal proliferation of smooth muscle, fatty deposits in the intima, inflammatory cells, and excessive elaboration of the connective tissue matrix in the vessel wall
Stroke to the posteroventral nucleus of the lateral thalamus leads to what symptoms?
Sensory sxs; contralateral numbness and tingling
Most cases of lateral medullary infarcts are causes by occlusion of what?
Vertebral artery (some cases PICA)
What is the most common cause of lobar hemorrhage in elderly patients without HTN?
Cerebral amyloid angiopathy
Why must lamotrigine be slowly titrated?
Risk of severe rash
What intracranial abnormalities are seen in Sturge Weber syndrome (encephalofacial angiomatosis)?
When do Charcot-Bouchard aneurysms form?
Chronic HTN; lenticulostriate arteries most commonly affected
An aneurysm of what artery is most likely to compress the third (oculomotor) nerve?
What is an early sign of a saccular aneurysm of the PCom artery?
Pupillary activity problems; Pupilloconstrictor fibers lie superficial
How is vasospasm after a SAH prevented?
What is Lennox-Gastaut syndrome characterized by?
Characterized by mental dysfunction, multiple seizure types, and 1- to 2- Hz generalized spike-wave discharges on EEG
Children affected by Lennox-Gastaut syndrome usually have a history of what?
Infantile spasms (West syndrome); paroxysmal flexions of body, waist, or neck and disorganized EEG pattern (hypsarrhythmia)
What symptoms/signs are seen in Landau-Kleffner syndrome?
Loss of language and an abnormal EEG during sleep
An aura of olfactory hallucination prior to a seizure is usually due to a lesion where?
The mesial temporal lobe (hippocampus or parahippocampus)
What are the complications of status epilepticus?
Resp failure, aspiration, acidosis, hypotension, rhabdo, renal failure and cognitive impairment
What is epilepsia partialis continua?
Focal motor status epilepticus
What is the dosing for magnesium sulfate in preeclampsia?
4 or 5 grams IV, followed by a 1 g/h IV infusion
How is trigeminal neuralgia treated?
What are triptans used for? What is the MOA?
Abort headaches; agonists at serotonergic receptors (5-HT1)
What is hypesthesia?
Decrease in the accurate perception of stimuli
15 yo M with multiple angiomatoses of the retina and cysts of the kidney and pancreas. What is the disease? What brain tumor may be present?
Von Hippel-Lindau syndrome; hemangioblastomas tumors may arise in cerebellum or brainstem
What type of brain herniations are seen in epidural hematoma?
Transfalcial herniation (frontal lobe across midline or below falx cerebri)
What patients do you see chronic subdural hematomas in?
Elderly and renal dialysis patients
What are the characteristics of encephalitis lethargica? What is a sequalae of the disease?
characterized by high fever, headache, double vision, delayed physical and mental response, and lethargy. In acute cases, patients may enter coma. Patients may also experience abnormal eye movements, upper body weakness, muscular pains, tremors, neck rigidity, and behavioral changes including psychosis. Postencephalitic Parkinson's disease may develop after a bout of encephalitis-sometimes as long as a year after the illness.
What cells are attacked in polio?
Anterior horn cells
What cranial nerves are affected by sarcoidosis?
VII - facial paralysis; also II, III, IV, VI, VIII
What is the pathophysiology of an infection with Schistosoma mansi?
Parasite lays eggs in valveless veins of Batson, which drain the intestines and communicate with the drainage from the lumbosacral spinal cord. The patient develops granulomas around the ova that lodge in the spinal cord, and these granulomatous lesions crush the cord.
Echinococcosis causes what kind of CNS problem?
encephalic hydatidosis - hydatid cysts in the CNS
What is the CSF profile of a patient with Creutzfeldt-Jakob disease?
The spinal fluid examination in a patient with spongiform encephalopathy, or Creutzfeldt-Jakob disease, is typically normal. On occasion, the protein level may be mildly elevated, and, in up to 20% of cases, there may be an increase in the ratio of immunoglobulin G to total protein, occasionally with oligoclonal bands. In many, but not all patients, a somewhat specific protein (14-3-3 proteinase inhibitor) may be present.
What protein is often seen in Creutzfeldt-Jakob disease?
14-3-3 proteinase inhibitor
What are the major causes of rim-enhancing CNS lesions in a patient with HIV?
Lymphoma (EBV cause) and Toxoplasma gondii
How is Toxoplasma gondii treated?
Sulfadiazine and pyrimethamine
A 9-year-old boy presents with bilateral CN VII deficits. Serum and CSF analysis suggests B burgdorferi is the etiology. What is the treatment?
10-14 days of IV penicillin or ceftriaxone; if allergic 30 days of tetracycline
A 38-year-old man, who is immunocompromised because of HIV, presents with 1 month of worsening right headache, ear pain, and fever. He is determined to have malignant external otitis and osteomyelitis of the base of the skull. Culture of the lesion reveals a fungal etiology. What is the most likely causative organism?
What is the most common cause of brain abscess formation in patients with HIV?
How do patients with brain abscesses present?
First symptom is headache
A 91-year-old woman has 3 days of gradually worsening fever and headache. She then develops blurry vision and a stiff neck. Her granddaughter becomes concerned and brings her to the emergency room. MRI with contrast has an enhancement pattern suggesting rhombencephalitis. CSF shows a mild pleocytosis with no organisms. All blood and CSF cultures are negative. What is the likely organism? How is it treated?
Lysteria monocytogenes; ampicillin and gentamicin
What variant of Guillain-Barre Syndrome affects the eye muscles?
What is characteristically seen on MRI of a patient with B henselae meningitis?
increased signal intensity in the pulvinar
What skin lesions are seen in B henselae infections?
skin lesions composed of neovascular proliferation (bacillary angiomatosis)
A 37-year-old female navy officer presents with 3 days of confusion and seizures. Her colleagues report that she has been acting strangely for 3 days. This is followed by generalized status epilepticus. The woman has previously been well. She has traveled to the Caribbean several times annually, and she has a new pet cat. General examination discloses epitrochlear lymphadenopathy. Neurological examination shows the woman to be in status epilepticus. CSF is negative; MRI shows increased signal in the pulvinar bilaterally. What is the likely causative organism?
What enzyme is deficient in Tay-Sachs disease?
What enzyme is deficient in Gaucher's disease?
What is the protein content in the CSF in hypertensive encephalopathy?
elevated but <100
What is the most common neurological complication of chronic renal failure?
How is restless leg syndrome treated?
clonazepam, gabapentin, l-dopa, dopamine agonists
65 yo M with lung cancer and new onset proximal muscle weakness. What inflammatory disease does he most likely have?
What kind of granulomas are seen in sarcoidosis?
What are signs/symptoms of myotonic dystrophy?
Problem relaxing grip, hypersomnolence, premature baldness, testicular atrophy and cataracts
What is the diagnosis?
Proliferative (diabetic) retinopathy
What is Gardenigo syndrome?
Osteomyelitis of petrous pyramid, affecting trigeminal and abducens nerves; results in facial pain and blurry vision; seen in kids with chronic ear infections
What is seen on this fundoscopic exam?
Retinal vein occlusion; "flame hemorrhages"
What fibers run through meyers loop?
Upper visual field; in temporal lobe
Mastoiditis can spread to what regions of the brain?
Temporal lobe or cerebellum; temporal lobe leads to fluent aphasia (Wernicke area); cerebellum leads to ataxia, vertigo, nausea, vomiting, morning headache
What tones are affected early in Meniere's disease?
What drugs are known to cause toxic labrynthitis?
Salicylates, alcohol, quinine, aminoglycoside antibiotics produce toxic labyrinthitis
What is Foster-Kennedy syndrome? What is it usually caused by?
True Foster Kennedy syndrome is the combination of papilledema in contralateral eye and pallor in ipsilateral eye due to a large mass lesion causing compressive optic neuropathy and increasing intracranial pressure. True Foster Kennedy syndrome is very rare, and is typically caused by an olfactory groove meningioma.
What chromosome is responsible for Freidreich ataxia?