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Neurosurgery Rounds > 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
Q

Tx of infantile spasms

A

ACTH

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26
Q

Aicardi syndrome

A

Callosal agenesis, ocular abnormalities, infantile spasm

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27
Q

Most common cause of complex partial seizures

A

Mesial temporal lobe epilepsy (70-80% temporal, 65% mesial structures, esp. hippocampus, amygdala, parahippocampal gyrus)

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28
Q

Which region of hippocampus is spared in mesial temporal lobe epilepsy?

A

CA2 subregion and dentate granule cells

More pronounced in CA1, CA3 and CA4 subregions

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29
Q

Most common agents that cause transplacental infections?

A

TORCHeS

Toxo, Other agents (HIV), Rubella, CMV, Herpes, Syphilis

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30
Q

Most common viral meningitis

A

Enterovirus (~80%)

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31
Q

Cryptococcis histologic stain

A

India ink stain shows single budding yeast with thick capsule

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32
Q

Most common CNS fungal infection

A

Candidiasis from albicans

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33
Q

Cause of neurocysticerosis

A

Larval stage of pork tapeworm Taenia solium (most common parasitic infection involving CNS)

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34
Q

Antihelmintic for neurocysticerosis

A

Praziquantel and albendazole

Steroids to reduce edema

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35
Q

Opening pressure (mm H2O) for infectious meningitis?

A

Bacteria: High (>200)
Viral/Aseptic: Normal (<200)
TB: Mild (180-300)
Fungal: Mild (180-300)

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36
Q

Glucose (mg/dL) for infectious meningitis?

A

Bacteria: Low (<40)

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37
Q

Protein (mg/dL) for infectious meningitis?

A

Bacteria: High (>100)
Viral/Aseptic: Normal/Mild (15-40)
TB: High (>100)
Fungal: Mild (50-200)

38
Q

WBC for infectious meningitis?

A

Bacteria: Neutrophilic
Viral/Aseptic: Lymphocytic
TB: Pleocytosis
Fungal: Lymphocytic

39
Q

Gradenigo syndrome

A

Petrous apex osteomyelitis with CN6 palsy and retroorbital pain
Children from extension of severe otitis

40
Q

Negri bodies

A

Intracytoplasmic eosinophilic collections in neurons (Rabies)

41
Q

Rabies virus reach CNS?

A

Retrograde through peripheral nerves to reach CNS

42
Q

Treatment of rabies

A

Passive immunization 10-20 days with rabies IgG

43
Q

Causative agent of Lyme

A

Borrelia burgdoferi

44
Q

Tx for Lyme

A

Ceftriaxone

45
Q

Sydenham chorea

A

GAS

Main criteria for rheumatic fever

46
Q

Criteria for rheumatic fever

A

Joints (arthritis)
Endocarditis
Erythema marginatum
Sydenham chorea

47
Q

Major symptoms/signs of tabes dorsalis

A 
Ataxia, lightning pains, urinary incontinence
Absent DTR at knee/ankle
Impaired vib/position sense
Positive Romberg sign
Argyll-Robertson pupil
48
Q

Hutchinson triad

A

Notched teeth
Deafness
Interstitial keratitis

(congenital syphilis)

49
Q

“Owl’s eye” intranuclear inclusion - which infection?

A

CMV

Cowdry type A intranuclear inclusions

50
Q

Aspergillus on silver stain looks like?

A

Branching septate hyphae

51
Q

Mucor on histology?

A

Nonseptate right angle branching hyphae

52
Q

What patients are at risk from mucormycosis?

A

Diabetic (fatal within few days unless treated aggressively)

53
Q

Most common pathogen of brain abscess

A

Strep

At gray-white matter junction and multiple in 30% cases

54
Q

How is brain abscess acquired?

A

Local spread from ear/sinus infection
Heme spread (lung)
Trauma
Iatrogenic

55
Q

Histoplasmosis - which US states/area?

A

Ohio and Mississippi

56
Q

Blastomycosis - which US states/area?

A

Eastern US

57
Q

Coccidioidomycosis - which US states/area?

A

Southwest (California, Arizona)

58
Q

Intermediate host in hydatid disease

A

Sheep. Echinococcus granulose (dog tapeworm); cysts in liver, lung and brain

59
Q

Intermediate host in schistosomiasis

A

Snail

Live in blod vessels

60
Q

Cell origin of primary CNS lymphoma in HIV

A

B-cell

61
Q

Most common cause of myelopathy in HIV

A

Vacuolar myelopathy (diagnosis of exclusion)

62
Q

Which part of spinal cord does AIDS-associated vacuolar myelopathy involve?

A

Posterior/lateral columns of thoracic spinal cord

63
Q

Measles can develop what encephalitis?

A

Subacute sclerosing panencephalitis
several years after measles (usually before 2yo)
Death within 1-3 y

64
Q

Pathogen of cat scratch disease

A

Bartonella henselae
Can progress to encephalitis assoc. with status epilepticus (immunocompromised)

MRI may show hyperintensity in pulvinar region

65
Q

Tx of ADEM

A

High dose steroids, plasmapheresis, IVIG

66
Q

What viruses are assoc. with ADEM?

A

Paramyxo, varicella, rubella, EBV

67
Q

CSF studies of ADEM

A

slightly elevated protein with lymphocytic pleocytosis

68
Q

Triad of neurologic manifestation of lyme

A

Cranial neuritis (like bell palsy)
Meningitis
Radiculopathy

69
Q

Pathogen of progressive multifocal leukoencephalopathy

A

JC virus (papovirus)

70
Q

Tx for HSV encephalitis?

A

Acyclovir (start empirically)

71
Q

Most common organism in hematogenous pyogenic vertebral osteomyelitis?

A

S. aureus

72
Q

Most common ganglia involved in herpes zoster

A

Trigeminal and thoracic ganglia

73
Q

Most common human prion disease

A

CJD (~85%)

74
Q

What type of inflammatory response seen in CJD histology?

A

None

75
Q

What CSF finding in CJD?

A

14-3-3 protein

76
Q

Most frequent chronic neurologic disease of young adults

A

MS

77
Q

McDonald criteria for diagnosis

A

=/>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
Q

Criteria for an acute MS attack

A

lasting >24h

separated from another one by at least 1 month

79
Q

What spinal level for diagnosis of tethered cord

A

Conus medullaris below L2

Bladder dysfunction, lower extremities deficits, abnl gait, pain in back/extremities

80
Q

Most common assoc. with syringomyelia

A

Chiari I

81
Q

Recommended folate for open neural tube defect

A

400ug folate, 600 in pregnant women

82
Q

Most common malignant brain tumor in children

A

Medulloblastoma

83
Q

Lifetime risk of cancer when patient in early childhood gets head CT

A

0.5% lifetime risk of fatal cancer + reduced cognitive capacities

84
Q

ALARA?

A

As low as reasonably achievable (radiation dose and children)

85
Q

Most common pediatric CNS tumor

A

Pilocytic astrocytoma

86
Q

Most common cause of shunt failure

A 
Mechanical obstruction
(1/2 fail within 2y)
87
Q

Tuberous sclerosis: cerebral lesions

A
  1. cortical tubers (harmatomatous)
  2. subependymal nodules (harmatomatous)
  3. subependymal giant cell astrocytoma (benign neoplastic)
88
Q

When does anterior neuropore close?

A

24 days of gestation

89
Q

When does posterior neuropore close

A

26 days of gestation

90
Q

Developmental pathology that causes neural tube defects

A

Failure of disjunction of neural and cutaneous ectoderm during neurulation

91
Q

Myelomeningocele assoc. with what developmental syndrome

A

Chiari II

Neurosurgery Rounds (10 decks)

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