Approach to Neurological Syndromes

Question 1

General approach

Answer 1

• Localize dysfunction based on signs / sxs
• Diff diagnosis based on location and syndrome time course
• Narrow diff diagnosis based on px risk factors

Question 2

Cytotoxic edema

Answer 2

Intracellular

Question 3

Vasogenic edema

Answer 3

Extracellular

Question 4

Gliosis / astrogliosis / astrocytosis

Answer 4

Astrocytes multiply, get bigger / longer / thicker process and forms a glial scar

Question 5

Acronym for categories of neuropathology

Answer 5

GIVE MAN MINT

Genetic, idiopathic, vascular, epileptic, mechanical, autoimmune, neoplastic, metabolic, infectious, nutritional, toxic

Question 6

What are most common areas for vascular NS problems?

Answer 6

Mainly affect brain and retina, rarely SC, and very rarely PNS.

Question 7

What part of NS do seizures normally effect?

Answer 7

Seizures are mainly a manifestation of the cerebral cortex (gray matter). Rare to see subcortical and brainstem seizures.

Question 8

In what population are febrile seizures common?

Answer 8

Little kids. Usually outgrow them.

Question 9

Symptomatic vs idiopathic epilepsy

Answer 9

• Symptomatic epilepsy has identifiable features, such as brain tissue scarring from trauma.
• Idiopathic seizures / epilepsy = recurrent unprovoked seizures w/o known cause.

Question 10

Things that provoke seizures

Answer 10

Fever, structural brain abnormalities, toxins, metabolites, infections.

Question 11

Characteristics of absence seizures

Answer 11

• Generalized at onset, but pxs usually can still stand / sit.
• Most common in kids. Usually grow out of it.
• Usually no aura or post-ictal state (snap right into / out of it).

Question 12

Todd’s paresis / paralysis

Answer 12

AKA postictal paresis/paralysis or “after seizure”
Focal weakness in a part of the body after a seizure. Think of the neurons as being “exhausted”. Usually only lasts a couple minutes.
May be provoked by hyperventilation.

Question 13

Co-morbidities w/ epilepsy

Answer 13

Mood disorders or cognitive deficits

Question 14

What change in brain anatomy may occur w/ chronic epilepsy?

Answer 14

Hippocampal sclerosis

Question 15

Laceration

Answer 15

Torn tissue

Question 16

Spondylosis

Answer 16

Spinal degeneration, including hernation of discs. May cause compression of SC or roots. Other problems include degeneration / thickening of ligamentum flavum (bind laminae of adjacent vertebrae), facet joints (bone spurs)

Question 17

Spondylolysis

Answer 17

Defect in pars interarticularis of vertebrae

Question 18

Spondylolisthesis

Answer 18

Displacement of vertebrae relative to neighbor

Question 19

What parts of NS are most common to get tumors?

Answer 19

Brain is most common site in NS to get tumors, followed by SC, then PNS

Question 20

Intra-axial tumor

Answer 20

Located in CNS

Question 21

Extra-axial tumor

Answer 21

Located in skull / spine, but NOT in CNS. Causes compression.

Question 22

Meningitis
WBCs
Glucose
Protein

Answer 22

• Usually an elevated WBC count, w/ predominance of neutrophils in bacterial, or lymphocytes for other pathogens.
• Glucose concentration is low in bacterial meningitis. Glucose is normal for other pathogens.
• Protein concentration is high w/ any cause of meningitis (but highest w/ bacterial) due to exudation from circulation as part of normal inflammatory response.

Question 23

Precautions w/ lumbar puncture

Answer 23

•May cause brain herniation if there is focal mass effect, such as intracranial tumor, by increasing pressure diff b/w cranial and spinal areas. Not true for high pressure that is equally distributed. If focal CNS sxs are present, or if arousal is diminished, cranial imaging is required prior to tap to rule out mass.

Question 24

When is a lumbar puncture mandatory?

Answer 24

•When there is high clinical suspicion for subarachnoid hemorrhage and imaging is neg. Look for continuous bleeding. Emergency.

Question 25

Xanthochromia

Answer 25

Yellow tinge caused by RBC breakdown from subarachnoid hemorrhage that has been present for hours.

Question 26

Carcinomatous meningitis

Answer 26

Metastatic cancer to CSF. Do CSF cytology to diagnose.

Question 27

EMG changes w/ demyelination

Answer 27

Normal, but contraction is reduced.

Question 28

EMG changes w/ axonal loss (denervation)

Answer 28

Abnormal. Fibrillation potentials may occur, representing spontaneous APs of myocytes at rest.

Question 29

When is biopsy required?

Answer 29

• Brain tumors that aren’t obviously metastases
• Autoimmune disorders that cause inflammation of blood vessels, meninges, or brain.
• Polyneuropathies / myopathies