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Neurosurgery Board Review > 8. Neurology > Flashcards

8. Neurology Flashcards

1
Q

Dandy maneuver

A

(CSF leak)

Hold head below waist for several minutes in sitting position

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2
Q

Quadriplegia, anarthria and preserved consciousness

A

Locked in syndrome (upper brainstem infarction)

Can involve 3rd nerve nucleus

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3
Q

Adam triad

A

NPH triad (apraxia, incontinence, dementia)

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4
Q

Failure of ventriculoperitoneal shunting in patients with idiopathic NPH

A

Likely vascular or Alzheimers

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5
Q

Top 3 causes of dementia

A

Alzheimers, Lewy body, multiinfarct

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6
Q

Main differentiating between Alzheimer and LB dementia

A

Alzheimer: cortical neuritic plaques and neurofibrillary tangles; early impairment in STM; women

LW: preserved memory with impairment in executive fx; parkinsonian/autonomic features; men

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7
Q

Pseudobulbar affect

A

Intermittent emotional expression disorder

Involuntary displays of crying/laughing, typically w/o assoc. of sadness/depression/euphoria

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8
Q

What is pseudobulbar assoc with?

A

MS, ALS, Alzheimers, Huntington, Parkinson, stroke, traumatic brain injury

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9
Q

Hearing loss from meniere vs acoustic tumor

A

Meniere: fluctuates
Tumor: progressive

Brainstem auditory evoked potentials normal in meniere

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10
Q

Most common cause of cushing syndrome

A

Iatrogenic administration of exogenous steroids

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11
Q

Classic symptoms of parkinson

A

resting tremor, cogwheel rigidity, bradykinesia

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12
Q

Abduction relief sign

A

Relief of radicular symptom when shoulder abducted and placing hand ipsilateral to radiculopathy on top of head
Worsening may point to thoracic outlet

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13
Q

Baclofen withdrawal

A

Rebound spasticity, hemodynamic lability, severe hyperthermia, altered mental status, pruritis, diaphoresis, intravascular coagulopathy, rhabdo, multiorgan system failure

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14
Q

Early vs late posttraumatic seizure

A

Early 7 days

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15
Q

Status epilepticus definition

A

> 30m continuous seizure or multiple without full recovery of consciousness between seizures

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16
Q

Most common cause of status epilepticus

A

Subtherapeutic antiepileptic drug in known seizure

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17
Q

Pharm tx of status epilepticus

A 
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
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18
Q

Common causes of changes in mental status/coma

A 
AEIOU TIPS
Alcohol (drugs/toxins)
Endocrine, exocrine, electrolytes
Insulin
Opiates/overdose
Uremia
Trauma, temperature
Infection
Psych
Seizure, stroke, shock, space-occupying lesion
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19
Q

Sudden unexpected death in epileptic patient

A

Seizure-related cardiac arrhythmia

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20
Q

Long-term outcome of patient with prolonged refractory status epilepticus?

A

50% mortality. Only 1/2-2/3 surviving will have functional cognitive status

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21
Q

When for hemispherectomy?

A 
Intractable epilepsy in unilateral hemisphere damage
Congenital hemiplegia
Chronic encephalitis
Hemimegalencephaly
Sturge-Weber
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22
Q

Sturge-Weber syndrome: port-wine stains in distribution of which cranial nerve?

A

Trigeminal nerve

Intracranial findings only in lesions involving first division of trigeminal nerve

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23
Q

Most common type of seizure

A

Febrile convulsions

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24
Q

West syndrome: seizures?

A

infantile spasms

+MR and hyparrhythmia on EEG

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25
Tx of infantile spasms
ACTH
26
Aicardi syndrome
Callosal agenesis, ocular abnormalities, infantile spasm
27
Most common cause of complex partial seizures
Mesial temporal lobe epilepsy (70-80% temporal, 65% mesial structures, esp. hippocampus, amygdala, parahippocampal gyrus)
28
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
29
Most common agents that cause transplacental infections?
TORCHeS | Toxo, Other agents (HIV), Rubella, CMV, Herpes, Syphilis
30
Most common viral meningitis
Enterovirus (~80%)
31
Cryptococcis histologic stain
India ink stain shows single budding yeast with thick capsule
32
Most common CNS fungal infection
Candidiasis from albicans
33
Cause of neurocysticerosis
Larval stage of pork tapeworm Taenia solium (most common parasitic infection involving CNS)
34
Antihelmintic for neurocysticerosis
Praziquantel and albendazole | Steroids to reduce edema
35
Opening pressure (mm H2O) for infectious meningitis?
Bacteria: High (>200) Viral/Aseptic: Normal (<200) TB: Mild (180-300) Fungal: Mild (180-300)
36
Glucose (mg/dL) for infectious meningitis?
Bacteria: Low (<40)
37
Protein (mg/dL) for infectious meningitis?
Bacteria: High (>100) Viral/Aseptic: Normal/Mild (15-40) TB: High (>100) Fungal: Mild (50-200)
38
WBC for infectious meningitis?
Bacteria: Neutrophilic Viral/Aseptic: Lymphocytic TB: Pleocytosis Fungal: Lymphocytic
39
Gradenigo syndrome
Petrous apex osteomyelitis with CN6 palsy and retroorbital pain Children from extension of severe otitis
40
Negri bodies
Intracytoplasmic eosinophilic collections in neurons (Rabies)
41
Rabies virus reach CNS?
Retrograde through peripheral nerves to reach CNS
42
Treatment of rabies
Passive immunization 10-20 days with rabies IgG
43
Causative agent of Lyme
Borrelia burgdoferi
44
Tx for Lyme
Ceftriaxone
45
Sydenham chorea
GAS | Main criteria for rheumatic fever
46
Criteria for rheumatic fever
Joints (arthritis) Endocarditis Erythema marginatum Sydenham chorea
47
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 ```
48
Hutchinson triad
Notched teeth Deafness Interstitial keratitis (congenital syphilis)
49
"Owl's eye" intranuclear inclusion - which infection?
CMV | Cowdry type A intranuclear inclusions
50
Aspergillus on silver stain looks like?
Branching septate hyphae
51
Mucor on histology?
Nonseptate right angle branching hyphae
52
What patients are at risk from mucormycosis?
Diabetic (fatal within few days unless treated aggressively)
53
Most common pathogen of brain abscess
Strep | At gray-white matter junction and multiple in 30% cases
54
How is brain abscess acquired?
Local spread from ear/sinus infection Heme spread (lung) Trauma Iatrogenic
55
Histoplasmosis - which US states/area?
Ohio and Mississippi
56
Blastomycosis - which US states/area?
Eastern US
57
Coccidioidomycosis - which US states/area?
Southwest (California, Arizona)
58
Intermediate host in hydatid disease
Sheep. Echinococcus granulose (dog tapeworm); cysts in liver, lung and brain
59
Intermediate host in schistosomiasis
Snail | Live in blod vessels
60
Cell origin of primary CNS lymphoma in HIV
B-cell
61
Most common cause of myelopathy in HIV
Vacuolar myelopathy (diagnosis of exclusion)
62
Which part of spinal cord does AIDS-associated vacuolar myelopathy involve?
Posterior/lateral columns of thoracic spinal cord
63
Measles can develop what encephalitis?
Subacute sclerosing panencephalitis several years after measles (usually before 2yo) Death within 1-3 y
64
Pathogen of cat scratch disease
Bartonella henselae Can progress to encephalitis assoc. with status epilepticus (immunocompromised) MRI may show hyperintensity in pulvinar region
65
Tx of ADEM
High dose steroids, plasmapheresis, IVIG
66
What viruses are assoc. with ADEM?
Paramyxo, varicella, rubella, EBV
67
CSF studies of ADEM
slightly elevated protein with lymphocytic pleocytosis
68
Triad of neurologic manifestation of lyme
Cranial neuritis (like bell palsy) Meningitis Radiculopathy
69
Pathogen of progressive multifocal leukoencephalopathy
JC virus (papovirus)
70
Tx for HSV encephalitis?
Acyclovir (start empirically)
71
Most common organism in hematogenous pyogenic vertebral osteomyelitis?
S. aureus
72
Most common ganglia involved in herpes zoster
Trigeminal and thoracic ganglia
73
Most common human prion disease
CJD (~85%)
74
What type of inflammatory response seen in CJD histology?
None
75
What CSF finding in CJD?
14-3-3 protein
76
Most frequent chronic neurologic disease of young adults
MS
77
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
78
Criteria for an acute MS attack
lasting >24h | separated from another one by at least 1 month
79
What spinal level for diagnosis of tethered cord
Conus medullaris below L2 | Bladder dysfunction, lower extremities deficits, abnl gait, pain in back/extremities
80
Most common assoc. with syringomyelia
Chiari I
81
Recommended folate for open neural tube defect
400ug folate, 600 in pregnant women
82
Most common malignant brain tumor in children
Medulloblastoma
83
Lifetime risk of cancer when patient in early childhood gets head CT
0.5% lifetime risk of fatal cancer + reduced cognitive capacities
84
ALARA?
As low as reasonably achievable (radiation dose and children)
85
Most common pediatric CNS tumor
Pilocytic astrocytoma
86
Most common cause of shunt failure
``` Mechanical obstruction (1/2 fail within 2y) ```
87
Tuberous sclerosis: cerebral lesions
1. cortical tubers (harmatomatous) 2. subependymal nodules (harmatomatous) 3. subependymal giant cell astrocytoma (benign neoplastic)
88
When does anterior neuropore close?
24 days of gestation
89
When does posterior neuropore close
26 days of gestation
90
Developmental pathology that causes neural tube defects
Failure of disjunction of neural and cutaneous ectoderm during neurulation
91
Myelomeningocele assoc. with what developmental syndrome
Chiari II

Neurosurgery Board Review (16 decks)

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