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ChicKen Review > 8. Neurology > Flashcards

8. Neurology Flashcards

1
Q

Best next step in management in a patient suspected of multiple sclerosis?

A

MRI of brain and spine - T2 shows multifocal, ovoid, subcortical white matter in periventricular, juxtacortical, infratentorial, or spinal cord areas

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2
Q

What can cause seizures, fever, headache, and focal neurologic deficits in an infant? Note: congenital heart disease and recurrent sinusitis are important predisposing factors.

A

Brain abscesses

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3
Q

Patient with giant cell arteritis is treated with glucocorticoids and develops painless proximal mm weakness in lower extremities. No mm inflam or tenderness, and Cr and ESR normal. Dx?

A

Glucocorticoid-induced myopathy
Note: polymyalgia rheumatic is assoc with temporal arteritis, but have normal mm strength, elevated ESR, and improves with glucocorticoids.

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4
Q

How do you manage myasthenic crisis with respiratory failure?

A

Endotracheal intubation –> plasmapheresis/therapeutic plasma exchange (or IVIG) and corticosteroids

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5
Q

3yo with freckles on face and axilla and flat, uniformly hyperpigmented macules on back, abdomen, and extremities, with blurry vision, fatigue, and headaches. Dx?

A

NF1 - AD
Cafe-au-lait macules and tumors of the skin and CNS.
Diagnose with brain and orbit MRI for soft-tissue anatomy eval. Optic gliomas MC intracranial lesion

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6
Q

Patients with Afib PLUS existing structural heart diseae have inc risk of what type of stroke?

A 
Cardioembolic strokes (acute aphasia, agnosia, apraxia seen)
Note: subcortical lacunar strokes MC present with pure motor sx and develop in a short period, but slowly
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7
Q

Patients with Creutzfeldt-Jakob disease have what EEG findings?

A

Sharp, triphasic, synchronous discharges

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8
Q

Patient with resting tremor of 4-6 Hz that is asymmetric and assoc with rigidity. Tremor disappears with purposeful activity and worsens with emotional stress. Dx? Tx?

A

Parkinson’s
Trihexyphenidyl - tx Parkinson’s disease generally in younger patients where tremor is the primary sx
Note: essential tremor disappears with rest and is worse with activity.

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9
Q

Best tool to confirm Parkinson disease?

A

Physical exam

3 cardinal signs of PD: rest tremor, rigidity, bradykinesia

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10
Q

Idiopathic intracranial HTN (pseudotumor cerebri) presents with headache, blurry/double vision, papilledema, and/or CN palsies. CSF shows inc opening pressure and normal studies. Cause? What is the most significant complication if not treated?

A

MC in young obese women
GH, tetracyclines, and excess vit A and its derivatives (eg isotretinoin, all-trans-retinoic acid) can cause IIH.
Complication: blindness
- tx:wt reduction, acetazolamide, shunting or optic n sheath fenestration. Avoid tetracyclines and isotretinoin
Note: LP is considered. Communicating hydrocephalus

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11
Q

Sudden focal neurologic deficits that gradually worsen over minutes to hours is a sign of intraparenchymal brain hemorrhage. The absence of cortical signs (aphasia, agnosia), and pure motor hemiparesis or pure sensory stroke. What is this typically caused by?

A

Hypertensive vasculopathy involving the penetrating branches of the major cerebral arteries.
Common locations include basal ganglia (putamen), cerebellar nuclei, thalamus, and pons.

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12
Q

Lambert-Eaton myasthenic syndrome is freq associated with what underlying malignancy?

A

LEMS - small cell lung cancer. Autoantibodies to voltage-gated ca channels.
Note: myasthenia gravies can be assoc with thymomas. Autoantibodies to post-synaptic Ach receptors in the NMJ.

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13
Q

Patients with suspected acute stroke should initially have what imaging?

A

CT WITHOUT contrast to rule out hemorrhage - highly sensitive.

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14
Q

Is decreased or absent Achilles tendon reflex normal with age?

A

Yes

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15
Q

Warfarin-associated intracerebral hemorrhage should be managed how?

A

Immediatley reverse anticoagulation with IV vit K and prothrombin complex concentrate to reduce the risk fo death and permanent disability

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16
Q

Elderly patient with progressive bilateral symmetric hearing loss with subjective tinnitus and absence of other neuro signs?

A

Presbycusis

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17
Q

MCC of spontaneous lobar (eg parietal, occipital) hemorrhage

A

cerebral amyloid angiopathy. Assoc with Alzheimer’s dementia

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18
Q

Foot drop is assoc with what radiculopathy and nerve?

A

L5 radiculopathy (common peroneal nerve)

19
Q

What are the MC sites for hypertensive hemorrhage in descending order?
Dx?

A 
Basal ganglia (putamen) > cerebellar nuclei > thalamus > pons > cerebral cortex
Early dx with noncontrast head CT
20
Q

pinpoint pupils from a neuro etiology is from what?

A

large pontine hemorrhage d/t damage to descending sympathetic fibers

21
Q

WIlson’s disease is diagnosed by dec serum ceruloplasmin, inc urinary copper, and Kayser-Fleischer rings on slit lamp exam. What causes the neuro sx of this disease?

A

Copper deposition in the basal ganglia - tremor rigidity, depression, paranoia, catatonia

22
Q

What is the MCC of acute and recurrent headaches in the peds population?
Management?

A

Migraines?

First line tx = acetaminophen, NSAIDs, and supportive management. Triptans if this isnt effective

23
Q

Patients with mild TBI with repeated vomiting, HA and lost of consciousness should undergo what type of imaging?

A

Head CT scan without contrast or observation for 4-6 h

24
Q

Elderly patient with HTN, decline in executive fcn, mild forgetfulness, and objective neuro deficits (hemiparesis, pronator drift, Romberg sign) is consistent with what?

A

Ischemic stroke and subsequent vascular dementia. Can result from cerebral infarctions. Focal neuro findings are common in Vascular dementia.
Patients typically have sudden or stepwise decline in exec fcn and mild memory problems early on.

25
Q

Broca’s aphasia (can understand, but cant articulate) is located in what part of the brain

A

Dominant frontal lobe. Majority of individuals are L hemisphere dominant for verbal and written language
Note: non-dominant frontal lobe is involved in conveying emotion through speech

26
Q

What do the following brain areas control?

  1. Dominant parietal lobe
  2. Nondominant parietal lobe
  3. Dominant temporal lobe
  4. Nondominant temporal lobe
A
  1. contralateral sensory
  2. anosognosia (deny one’s disabilities), purposeful movements
  3. comprehension, ability to speak nouns, repetition, contralateral superior homonymous quadrantoopsia
  4. comprehend emotional gestures.
27
Q

What neuro finding is the hallmark of prolonged seizures (>5min) and can lead to persistent neuro deficits and recurrent seizures?

A

Cortical laminar necrosis (Hyperintense regions on MRI)

D/t excitatory cytotoxicity

28
Q

Corneal abrasion can cause severe eye pain, photophobia, and sensation of a foreign body in the eye. If there is no eye pain, this suggests dysfunction of what nerve?

A 
Trigeminal nerve (ophthalmic branch V1) controls corneal sensation. Afferent limb of corneal reflex. 
Common causes are tumor, trauma, or prior herpes zoster infx
29
Q

Manifestations of CNS tumor by location:

  1. inc ICP, seizures
  2. Inc ICP, ataxia, clumsy
  3. Ataxia, clumsy, CN palsies
  4. Back pain, weakness, abnormal gait
A
  1. supratentorial (pilocytic astrocytoma, craniopharyngoma, glioblastoma, epndymoma)
  2. posterior fossa (medulloblastoma)
  3. Brainstem
  4. Spinal cord
30
Q

Transtentorial (uncal) herniation, can cause pressure on what nerve? Sx? What other structures can this type of herniation compress and what sx does it cause?

A
  1. Oculomotor nerve (CNIII) - loss of parasymp innervation –> mydriasis, ptosis (down and out of ipsilateral)
  2. ipsilateral posterior cerebral artery - contralateral homonymous hemianopsia
  3. Reticular formation - coma/altered mental status
  4. contralateral crus cerebri - ipsilateral hemiparesis
31
Q

What are 4 causes of acute hemiplegia in children?

A
  1. Seizure (hx of LOC or limb jerking - Todd paralysis), sx self resolve
  2. Intracranial hemorrhage - hx of trauma/bleeding, signs of inc ICP (vomit, brady)
  3. Ischemic stroke - hx of prothrombotic d/o or cardiac dz (focal neuro deficit)
  4. hemiplegic migraine - adolescent onset, Fhx, HA, aura, sx self resolve
32
Q

How can uncontrolled infx of the skin result in cavernous sinus thrombosis? Sx? What nerves pass through the cavernous sinus? Imaging? Tx?

A

Cause: facial/ophthalmic venous system is VALVELESS
Sx: severe headache, bilateral periorbital edema
Nerves: 3, 4, 5, 6 –> CN deficits
Imaging: MRI
Tx: Broad-spec IV abx and prevent/reverse cerebral herniation

33
Q

Headache worse at night, N/V, mental status changes, papilledema, with sx worsening with leaning forward, cough, or valsalva is concerning for what?

A

Intracranial HTN

Note: HTN, brady, resp depression (cushings reflex) is worrisome for brainstem compression

34
Q

Metastatic brain cancer usually presents with multiple lesions located where in the brain? Incidence of primary from highest to lowest?

A

Gray and white matter junction
Lung > breast > unknown primary > melanoma > colon cancer
Note: Lacunar infarcts occur deeper; MS has inflammation at white matter, neurocysticercosis has cysts at various stages. Primary CNS lymphoma is periventricular

35
Q

Bell’s palsy is a condition that affects CN7. Where is CN7 nucleus located? Is the forehead affected?

A

Pons
No, cant raise eyebrow or close the eye.
Note: lesions in the CNS above the facial nucleus causes contralateral lower facial weakness that SPARES the forehead

36
Q

What type of brain dysfunction is common among chronic alcohol abusers? Sx?

A

Cerebellar dysfunction - gait instability, truncal ataxia, difficulty with rapid alternating movements, hypotonia, and intention tremor.

37
Q

How does hemiplegia, facial droop, and aphasia occur after a posterior oropharyngeal injury (eg fall with object in mouth)

A

Internal carotid artery dissection/thrombus formation
Note: can extend into MCA and ACA. Can be assoc with thunderclap headache.
Confirm with CT or MR angiography

38
Q

What are signs of increased ICP? How can you differentiate hypertensive intracerebral hemorrhage from lacunar strokes?

A

Vomiting, HA, brady, dec alertness.

Both occur in hypertensive patients and focal neuro sx. Hemorrhage is followed by inc ICP sx in HIH.

39
Q

What is the most significant cause of morbidity in patients with TBIs? Sx? Classic CT findings?

A

Diffuse axonal injury
LOC instantaneously –> persistent vegetative state.
CT: numerous minute punctate hemorrhages with blurring of grey white interface.

40
Q

Which dementia?

  1. Stepwise decline
  2. early personality changes, disinhibition and compulsive behavior
  3. early insidious short term memory loss
  4. visual hallucinations, spontaneous parkinsonism
  5. ataxia, incontinence, dilated ventricles
  6. rapid progression, myoclonus
A
  1. vascular dementia
  2. frontotemporal
  3. Alzheimer’s
  4. Lewy body
  5. NPH
  6. prion
41
Q

What eye complication may be associated with anticholinergics (eg for parkinsons - trihexyphenidyl)?

A

Acute angle-closure glaucoma - vision-threatening. Sudden onset severe eye pain, N/V, unilateral conjunctival injection. 2-5h can result in vision loss

42
Q

Differentiate alcoholic cerebellar degeneration from Wernicke encephalopathy

A

Alcoholic: caused by damage to Purkinje cells of the cerebellar vermis. Slowly progressive wide-based gait and postural instability, but limb coordination intact
Wernicke: thiamine def-induced thalamic neuronal loss –> gait ataxia, oculomotor dysfunction, encephalopathy.

43
Q

What is the major cause of delayed morbidity and mortality in SAH and can result in cerebral infarction?

A

Vasospasm - can be prevented with initiation of nimodipine

44
Q

Lacunar stroke of the posterolateral thalamus typically presents with sudden-onset contralateral SENSORY loss involving all sensory modalities (ie pure sensory stroke). Weeks to months later they can develop what syndrome? What is it characterized by?

A

Thalamic pain syndrome - severe paroxysmal burning pain over the affect area that is exacerbated by light touch (allodynia)

ChicKen Review (21 decks)

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