415 Approach To Neurologic Disease Flashcards
combination of optic neuritis and spastic ataxic paraparesis suggests optic nerve and spinal cord disease which may include
multiple sclerosis (MS), CNS syphilis, and vitamin B 12 deficiency
Lhermitte symptom
electric shock–like sensations evoked by neck flexion
due to ectopic impulse generation in white matter pathways and occurs with demyelination in the cervical spinal cord; among many possible causes, this symptom may indicate MS in a young adult or compressive cervical spondylosis in an older person.
Primary neuronal (gray matter) disorders
Versus white matter involvement
Primary neuronal (gray matter) disorders may present as early cognitive disturbances, movement disorders, or seizures, whereas white matter involvement produces predominantly “long tract” disorders of motor, sensory, visual, and cerebellar pathways.
Slowly advancing visual scotoma with luminous edges, termed ___________. indicates spreading cortical depression, typically with migraine.
fortification spectra
Tests of walking a 7.5-m (25ft) distance (normal, _____ note assistance, if any), repetitive finger or toe tapping (normal is:
5-6s
20–25 taps in 5 s
MMSE sensitivoty and specificity
Using age-adjusted values for defining normal performance, the test is ~85% sensitive and 85% specific for making the diagnosis of dementia that is moderate or severe, especially in educated patients.
Reaction of spinal origin
Triple flexion response
flexion at the ankle, knee, and hip in response to a painful stimulus to the foot
the changes in pitch and accentuation of syllables and words
Prosody
Vincristine side effect
Pwripheral neuropathy
SE Cyclosporine
Encephalopathy
SE Aminoglycoside
May exacerbate neuromuscular disorders
Pseudotumor cerebri
Viramin Aa
biceps (C5, C6), brachioradialis (C5, C6), and triceps (C7, C8) reflexes in the upper limbs and the patellar or quadriceps (L3, L4) and Achilles (S1, S2) reflexes in the lower limbs
Notes
Reflexes may be enhanced by asking the patient to voluntarily contract other, distant muscle groups
Jendrassik maneuver
ipsilateral elevation of the testicle following stroking of the medial thigh; mediated by L1 and L2
cremasteric reflex
Contraction of the anal sphincter when the perianal skin is scratched; mediated by S2, S3, S4
Anal reflex
decreased arm swing on one side (corticospinal tract disease), a stooped posture and short-stepped gait (parkinsonism), a broad-based unstable gait (ataxia), scissoring (spasticity), or a high-stepped, slapping gait (posterior column or peripheral nerve disease), or the patient may appear to be stuck in place (apraxia with frontal lobe disease).
Notes
Nonlocalizing EEG in focal seizures
Medial temporal lobe or inferior frontal lobe
