8. Neurology Flashcards
Dandy maneuver
(CSF leak)
Hold head below waist for several minutes in sitting position
Quadriplegia, anarthria and preserved consciousness
Locked in syndrome (upper brainstem infarction)
Can involve 3rd nerve nucleus
Adam triad
NPH triad (apraxia, incontinence, dementia)
Failure of ventriculoperitoneal shunting in patients with idiopathic NPH
Likely vascular or Alzheimers
Top 3 causes of dementia
Alzheimers, Lewy body, multiinfarct
Main differentiating between Alzheimer and LB dementia
Alzheimer: cortical neuritic plaques and neurofibrillary tangles; early impairment in STM; women
LW: preserved memory with impairment in executive fx; parkinsonian/autonomic features; men
Pseudobulbar affect
Intermittent emotional expression disorder
Involuntary displays of crying/laughing, typically w/o assoc. of sadness/depression/euphoria
What is pseudobulbar assoc with?
MS, ALS, Alzheimers, Huntington, Parkinson, stroke, traumatic brain injury
Hearing loss from meniere vs acoustic tumor
Meniere: fluctuates
Tumor: progressive
Brainstem auditory evoked potentials normal in meniere
Most common cause of cushing syndrome
Iatrogenic administration of exogenous steroids
Classic symptoms of parkinson
resting tremor, cogwheel rigidity, bradykinesia
Abduction relief sign
Relief of radicular symptom when shoulder abducted and placing hand ipsilateral to radiculopathy on top of head
Worsening may point to thoracic outlet
Baclofen withdrawal
Rebound spasticity, hemodynamic lability, severe hyperthermia, altered mental status, pruritis, diaphoresis, intravascular coagulopathy, rhabdo, multiorgan system failure
Early vs late posttraumatic seizure
Early 7 days
Status epilepticus definition
> 30m continuous seizure or multiple without full recovery of consciousness between seizures
Most common cause of status epilepticus
Subtherapeutic antiepileptic drug in known seizure
Pharm tx of status epilepticus
IV glucose 50% 50mL, IV thiamine 100mg Then in order: Lorazepam 1-2mg/5min up to 9mg (0.1mg/kg) or Diazepam 5mg/5min up to 20mg (0.2mg/kg) Phenytoin loading dose 20mg/kg Phenobarbital drip loading 20mg/kg Pentobarbital drip 20mg/kg if seizure does not arrest in 30 min
Common causes of changes in mental status/coma
AEIOU TIPS Alcohol (drugs/toxins) Endocrine, exocrine, electrolytes Insulin Opiates/overdose Uremia Trauma, temperature Infection Psych Seizure, stroke, shock, space-occupying lesion
Sudden unexpected death in epileptic patient
Seizure-related cardiac arrhythmia
Long-term outcome of patient with prolonged refractory status epilepticus?
50% mortality. Only 1/2-2/3 surviving will have functional cognitive status
When for hemispherectomy?
Intractable epilepsy in unilateral hemisphere damage Congenital hemiplegia Chronic encephalitis Hemimegalencephaly Sturge-Weber
Sturge-Weber syndrome: port-wine stains in distribution of which cranial nerve?
Trigeminal nerve
Intracranial findings only in lesions involving first division of trigeminal nerve
Most common type of seizure
Febrile convulsions
West syndrome: seizures?
infantile spasms
+MR and hyparrhythmia on EEG
Tx of infantile spasms
ACTH
Aicardi syndrome
Callosal agenesis, ocular abnormalities, infantile spasm
Most common cause of complex partial seizures
Mesial temporal lobe epilepsy (70-80% temporal, 65% mesial structures, esp. hippocampus, amygdala, parahippocampal gyrus)
Which region of hippocampus is spared in mesial temporal lobe epilepsy?
CA2 subregion and dentate granule cells
More pronounced in CA1, CA3 and CA4 subregions
Most common agents that cause transplacental infections?
TORCHeS
Toxo, Other agents (HIV), Rubella, CMV, Herpes, Syphilis
Most common viral meningitis
Enterovirus (~80%)
Cryptococcis histologic stain
India ink stain shows single budding yeast with thick capsule
Most common CNS fungal infection
Candidiasis from albicans
Cause of neurocysticerosis
Larval stage of pork tapeworm Taenia solium (most common parasitic infection involving CNS)
Antihelmintic for neurocysticerosis
Praziquantel and albendazole
Steroids to reduce edema
Opening pressure (mm H2O) for infectious meningitis?
Bacteria: High (>200)
Viral/Aseptic: Normal (<200)
TB: Mild (180-300)
Fungal: Mild (180-300)
Glucose (mg/dL) for infectious meningitis?
Bacteria: Low (<40)
Protein (mg/dL) for infectious meningitis?
Bacteria: High (>100)
Viral/Aseptic: Normal/Mild (15-40)
TB: High (>100)
Fungal: Mild (50-200)
WBC for infectious meningitis?
Bacteria: Neutrophilic
Viral/Aseptic: Lymphocytic
TB: Pleocytosis
Fungal: Lymphocytic
Gradenigo syndrome
Petrous apex osteomyelitis with CN6 palsy and retroorbital pain
Children from extension of severe otitis
Negri bodies
Intracytoplasmic eosinophilic collections in neurons (Rabies)
Rabies virus reach CNS?
Retrograde through peripheral nerves to reach CNS
Treatment of rabies
Passive immunization 10-20 days with rabies IgG
Causative agent of Lyme
Borrelia burgdoferi
Tx for Lyme
Ceftriaxone
Sydenham chorea
GAS
Main criteria for rheumatic fever
Criteria for rheumatic fever
Joints (arthritis)
Endocarditis
Erythema marginatum
Sydenham chorea
Major symptoms/signs of tabes dorsalis
Ataxia, lightning pains, urinary incontinence Absent DTR at knee/ankle Impaired vib/position sense Positive Romberg sign Argyll-Robertson pupil
Hutchinson triad
Notched teeth
Deafness
Interstitial keratitis
(congenital syphilis)
“Owl’s eye” intranuclear inclusion - which infection?
CMV
Cowdry type A intranuclear inclusions
Aspergillus on silver stain looks like?
Branching septate hyphae
Mucor on histology?
Nonseptate right angle branching hyphae
What patients are at risk from mucormycosis?
Diabetic (fatal within few days unless treated aggressively)
Most common pathogen of brain abscess
Strep
At gray-white matter junction and multiple in 30% cases
How is brain abscess acquired?
Local spread from ear/sinus infection
Heme spread (lung)
Trauma
Iatrogenic
Histoplasmosis - which US states/area?
Ohio and Mississippi
Blastomycosis - which US states/area?
Eastern US
Coccidioidomycosis - which US states/area?
Southwest (California, Arizona)
Intermediate host in hydatid disease
Sheep. Echinococcus granulose (dog tapeworm); cysts in liver, lung and brain
Intermediate host in schistosomiasis
Snail
Live in blod vessels
Cell origin of primary CNS lymphoma in HIV
B-cell
Most common cause of myelopathy in HIV
Vacuolar myelopathy (diagnosis of exclusion)
Which part of spinal cord does AIDS-associated vacuolar myelopathy involve?
Posterior/lateral columns of thoracic spinal cord
Measles can develop what encephalitis?
Subacute sclerosing panencephalitis
several years after measles (usually before 2yo)
Death within 1-3 y
Pathogen of cat scratch disease
Bartonella henselae
Can progress to encephalitis assoc. with status epilepticus (immunocompromised)
MRI may show hyperintensity in pulvinar region
Tx of ADEM
High dose steroids, plasmapheresis, IVIG
What viruses are assoc. with ADEM?
Paramyxo, varicella, rubella, EBV
CSF studies of ADEM
slightly elevated protein with lymphocytic pleocytosis
Triad of neurologic manifestation of lyme
Cranial neuritis (like bell palsy)
Meningitis
Radiculopathy
Pathogen of progressive multifocal leukoencephalopathy
JC virus (papovirus)
Tx for HSV encephalitis?
Acyclovir (start empirically)
Most common organism in hematogenous pyogenic vertebral osteomyelitis?
S. aureus
Most common ganglia involved in herpes zoster
Trigeminal and thoracic ganglia
Most common human prion disease
CJD (~85%)
What type of inflammatory response seen in CJD histology?
None
What CSF finding in CJD?
14-3-3 protein
Most frequent chronic neurologic disease of young adults
MS
McDonald criteria for diagnosis
=/>2 acute attacks with clinical evidence of =/>2 lesions
=/>2 acute attacks with 1 lesion + CSF findings
=/>1 acute attack with =/>2 lesions with dissemination in time
> 1 attack with =/>2 lesions on MRI with CSF or DIT
Criteria for an acute MS attack
lasting >24h
separated from another one by at least 1 month
What spinal level for diagnosis of tethered cord
Conus medullaris below L2
Bladder dysfunction, lower extremities deficits, abnl gait, pain in back/extremities
Most common assoc. with syringomyelia
Chiari I
Recommended folate for open neural tube defect
400ug folate, 600 in pregnant women
Most common malignant brain tumor in children
Medulloblastoma
Lifetime risk of cancer when patient in early childhood gets head CT
0.5% lifetime risk of fatal cancer + reduced cognitive capacities
ALARA?
As low as reasonably achievable (radiation dose and children)
Most common pediatric CNS tumor
Pilocytic astrocytoma
Most common cause of shunt failure
Mechanical obstruction (1/2 fail within 2y)
Tuberous sclerosis: cerebral lesions
- cortical tubers (harmatomatous)
- subependymal nodules (harmatomatous)
- subependymal giant cell astrocytoma (benign neoplastic)
When does anterior neuropore close?
24 days of gestation
When does posterior neuropore close
26 days of gestation
Developmental pathology that causes neural tube defects
Failure of disjunction of neural and cutaneous ectoderm during neurulation
Myelomeningocele assoc. with what developmental syndrome
Chiari II
