5 - Nervous, Neuromusc

Question 1

Transient ischemic attacks (TIAs)

• characteristics
• carotid vs vertebrobasilar

Answer 1

Always <24hrs
Most likely due to embolism (e.g. Hollenhorst plaque)

Carotid: IPSI AMAUROSIS FUGAX, contralateral hand/arm weakness
Vertebrobasilar: DIPLOPIA, ataxia, vertigo, dysarthria, uni/bilat vision loss

Question 2

Stroke

• # 1 cause
• testing

Answer 2

HTN

CT scan

Question 3

Macular-sparing homonymous hemianopsia

Macula-only homonymous hemianopsia

Answer 3

Mac-sparing: usually STROKE of EITHER MCA or PCA

Mac-only: usually TUMOR compressing BOTH MCA/PCA

Question 4

Ischemic vs hemorrhagic stroke

Answer 4

I: 80% of all strokes, usually embolism of atherosclerosis

H: most common is subarachnoid hem

Question 5

Subarachnoid hemorrhage

• signs/symp
• causes

Answer 5

Sudden severe HA
PUPIIL-INVOLVING CN 3 palsy
Nuchal rigidity (stiff neck)

1: head trauma
2: aneurysm rupture

Question 6

CoW supply

-anterior cerebral

Answer 6

Frontal lobe

-logic, personality, voluntary movement

Question 7

CoW supply

-middle cerebral

Answer 7

Frontal lobe
Lateral surfaces of Temporal and Parietal lobes
Occipital lobe

Primary motor and sensory of the face, throat, hand, and arm
Areas for speech and vision

Question 8

CoW supply

-posterior cerebral

Answer 8

Temporal and Occipital lobes

Stroke: contralateral hemiplegia, hemianopsia, color blindness, verbal dyslexia, opposite VFDs

Question 9

Seizures

• epilepsy vs status epilepticus
• treatment

Answer 9

S: symptom
E: condition
Status epi: >5min seizure

“Limit Debilitating Seizures”
Luminal
Dilantin
Topamax (myopic shift)

Question 10

Syncope characteristics

Answer 10

Abrupt, transient loss of consciousness

Prompt recovery = no neuro defects

Question 11

Cluster HAs

Answer 11

Men, 30-50
Smokers, drinkers
Unilateral, above eye
Red eye, nasal stuffiness
IPSILATERAL HORNERS

Question 12

Tension HAs

Answer 12

Females, all ages
Worse with stress or precede migraine
Band-like distribution

Question 13

Migraine HAs

Answer 13

Women, 20-30: think hormones, triggers
-rare after menopause (50yo)

4-72 hours
Aggravated by physical activity
Aura

Question 14

Temporal arteritis

• ocular assoc
• blood tests to run
• tx

Answer 14

AAION (SPCA occlusion) -> permanent vision loss

ESR, CRP, CBC
Biopsy

Immediate steroids

Question 15

Brain tumor HAs

Answer 15

No relief, interrupt sleep, worse in AM

Usually more going on clinically than just HA

Question 16

Meningitis

Answer 16

Viral

Triad: fever, HA, neck stiffness (meningismus)

Papilledema due to incr CSF

Question 17

Most common primary malignant brain tumor

Most common benign brain tumor

Answer 17

Glioblastoma multiforme

Meningioma (arachnoid cells, mid-age women)

Question 18

Pituitary adenoma

• most common type
• ocular signs/symp
• tx

Answer 18

Prolactin-secreting (leaky breasts)

Bitemporal hemiopsia or junctional scotoma

Bromocriptine (incr DA, Parkinsons drug)

Question 19

Multiple sclerosis

• who
• what
• dx

Answer 19

Women 20-40yo, North latitudes, White
Genetic, autoimmune

Recurrent inflamm -> demyelination of CNS
Younger you get it = better prognosis

2+ lesions on 2+ MRIs

Question 20

Multiple sclerosis

• most common presenting symptom
• ocular MS

Answer 20

Optic neuritis

Optic neuritis (25%)
Pain on eye movement (90%)
APD
INO (MLF lesion: ipsil (-) adduct, contra nystagmus)
Diplopia
Uthoff’s (incr temp = decr VA)

Question 21

Guillain-Barre syndrome

• what
• ocular

Answer 21

Peripheral demyelination

ADie’s
Diplopia (CN palsies)
Incr CSF protein -> papilledema

Question 22

Myasthenia gravis (MG)

• who
• assoc tumor
• ocular

Answer 22

Young women, old men (“Hugh Heffner dz”)

Thymoma (thymic tumor)

Ptosis and diplopia worse at end of day

Question 23

Parkinson’s

• what
• tx

Answer 23

Deficiency of DA
TRAP:
Tremor at rest
Rigidity (cogwheel)
Akinesia (difficulty start/stopping movements)
Postural instability
Flat affect

Levodopa, bromocriptine, carbidopa, sinemet

Question 24

Head trauma

-blown pupil

Answer 24

May signal impending uncal herniation

Question 25

Horner’s

• examples of pre-ganglionic causes
• examples of post-ganglionic causes

Answer 25

Pre: neck trauma, pancoast tumor

Post: carotid artery dissection, ICA aneurysm, cluster HA

Question 26

Bell’s palsy

• what
• ocular

Answer 26

Idiopathic CN7 palsy

Ectropion, exposure K