Case study Neurology Flashcards
- 33 Female
- 1 week R-sided weakness
- L-sided inability to feel temperature & pain
- R-sided Babinski sign
- R-sided brisk reflex
- Diminished sensation over R foot
Dx ?
Brown-Sequard syndrome secondary to viral infection.
1.42 Female
2.Insomnia - 3 month
3.Discomfort while lying in bed
Management ???
Serum Fe & Ferritin level
Restless leg syndrome caused by Fe deficiency
Restless leg syndrome mnext Management?
D2 agonist
Pramipexole + Ropinirole
Restless leg syndrome - increased risk of——————
Parkinson disease
- 58 MALE
- Shaving-loses consciousness
- Tilt table test - Normal
Dx ?
Carotid sinus hypersensitivity
- 58 MALE
- Shaving-loses consciousness
- Tilt table test - (+)
Dx ?
Vasovagal syncope
- 45 Female
- Fundoscopy-Hard exudates
- Cotton wool spot
- Scattered hemorrhage
Dx ?
Diabetic retinopathy
Frontal lobe injury in car accident; NBME asks which deficit is most likely to ensue ?
Conceptual planning
- 56 Male
- Alcoholism
- Acutely intoxicated
- B1 administrated
what Dec later ?
Anterograde amnesia
- 50 FEMALE
- high ESR
- high Creatine kinase (CK)
- Muscle pain
- Muscle stiffness
- Proximal muscle weakness
Dx ?
Polymyositis
- 50 FEMALE
- high ESR
- [ Normal Creatine kinase (CK) ]
- Muscle pain
- Muscle stiffness
- NO Proximal muscle weakness
Dx ?
Polymyalgia Rheumatica PMR
Polymyositis vs Polymyalgia rheumatica ?
Main difference between PMR and polymyositis? à PMR has no proximal muscle weakness + a
normal creatine kinase; polymyositis has high CK and weakness; pain + stiffness of muscles can be
seen in both conditions, but classically PMR. For USMLE vignettes + neuro shelf, focus on whether
there’s weakness or elevated CK.
- 50 FEMALE
- high ESR
- high Creatine kinase (CK)
- Muscle pain
- Muscle stiffness
- Proximal muscle weakness
Next best step in Dx ??
“anti-Jo1 / -Mi2 antibodies” or “electromyography and nerve conduction studies”
Polymyositis
After these, do muscle biopsy can be
performed for definitive Dx. In contrast, no specific Dx test is used for PMR.
- 59 Female
- Temporal headache
- Muscle pain + Stiffness
- High ESR
Dx ?
Temporal arteritis + PMR
Next best step ?
= IV methylprednisolone first, followed by temporal artery
biopsy
- 65 FEMALE
- Breast cancer
- Neurological findings
Next best step ?
“intravenous
high-dose dexamethasone.”
- 72 MALE
- Prostate cancer
- Neurological findings
nEXT best step ?
“epidural spinal cord compression” due
to spinal mets do steroids first (if listed), then MRI.
Patient has brain cancer; next best step?
Steroids
How to Dx brain cancer?
contrast head CT (done for cancer and abscess).
How to Dx brain bleed?
non-contrast CT (always done for intracranial bleeds)
Epidural hematoma; next best step after CT confirms?
intubation and hyperventilation
on Neuro NBME. After this is done, craniotomy is the answer
Subdural hematoma; next best step after CT?
craniotomy on NBME, not observation.
What do you see on non-contrast CT with epidural vs subdural?
epidural hematoma = lens-shaped
bleed;
subdural = crescent-shaped.
- B.P.=220/120
- Confusion
Dx + Tx ?
Dx-HTN encephalopathy
Tx- IV sodium
nitroprusside
BP of 220/120 + sodium nitroprusside administered; now patient has confusion; Dx?
cyanide
toxicity caused by nitroprusside.
Drug that can be given to prevent vasospasm after a subarachnoid hemorrhage (SAH)?
nimodipine
(dihydropyridine CCB).
- Severe headache
- Stiff neck
Dx ?
Subarachnoid heamorrhage
Brain bleed in patient with Alzheimer ?
amyloid angiopathy (intracerebral hemorrhage).
- 87 FEMALE
- Low grade fever
- Delirium
next best step ?
do urinalysis to look for UTI
as cause of delirium.
Viral infection + tinnitus + vertigo +/- neurosensory hearing loss
labyrinthitis.
Viral infection + vertigo
vestibular neuritis.
Tx for acute flare of Multiple sclerosis ?
IV steroids (oral is wrong and can make flares worse)
Tx between flares of MS (the patient must by asymptomatic)
IFN-beta (interferon beta)
Tx for spasticity in MS ?
baclofen (GABA-B receptor agonist)
Incontinence in MS ?
urge (hyperactive detrusor; detrusor instability).
Mechanism for MS?
T cell-mediated attack against oligodendrocytes.
How to Dx MS?
MRI is gold standard; choose MRI over CSF IgG oligoclonal bands
- 27 FEMALE
- Intermittent headache
- Blurry vision
optic neuritis (multiple sclerosis)
change in color
vision, or Marcus Gunn pupil (relative afferent pupillary defect)
Most specific eye finding in MS
medial longitudinal fasciculus (MLF) syndrome à aka internuclear
ophthalmoplegia (INO) à when you abduct to one side, you activate CN VI on that side, which
requires the contralateral CN III to activate in order to adduct à the side that cannot adduct is the
side that’s fucked up; the normal side will have nystagmus.
