Clerkships-NEUROLOGY Flashcards
What is the characteristic sign of an uncal herniation?
“blown pupil” 2/2 compressed 3rd nerve
ppx for post-traumatic seizures
phenytoin
Foster-Kennedy syndrome is caused by? Expound
Optic groove meningioma, ipsilateral optic atrophy and contralateral papilledema, anosmia
[frontal lobe!]
What else can produce ALS-type symptoms? What must be done to rule this condition out before dx with ALS?
cervical myelopathy 2/2 cervical spondylosis/midline disc protrusion
MRI C-spine
Comment on CN hearing pathology for the following CN lesions
V
VII
VIII
V - hypOacusis???? asymptomatic
VII - hyeracuity 2/2 stapedius muscle paralysis, leading to undampened sound
VIII - auditory acuity loss
Progressive Multifocal Leukoencephalopathy
Path? Features? Tx?
JC virus, seeing in immunocompromised, affects subcortical white matter/ occipital and parietal regions, can see visual complaints and “alien hand syndrome” ; treat with HAART
Arnold Chiari Type 2 assoc?
Spina Bifida w/ meningomyelocele
Reccurrent meningitis occurs in patients with what?
CSF leaks, which px as otorrhea/rhinorrhea
Sensorineural vs conductive hearing loss. PE test?
Sensorineural - damage to receptor cells or cochlear division of the auditory nerve
Conductive - damage to ossicles and membranes designed to focus the sound on the cochlea
Webber Test. Place fork on midline:
if equal BL, then it’s normal
if sound is louder in one ear, then it’s EITHER sensorineural in OPPOSITE ear or conductive in THAT ear
For Rinne, AC>BC
Densely enhancing Brain tumor near surface of the brain, near the falx cerebri
Meningioma, most common CNS tumor
Tx - monitor with serial CT scans…. surgery???
Which ocular muscle is usually damaged in facial/orbital trauma? Why? Which CN? Compensation?
Superior Oblique, it is the most anterior in the orbit, CN4 (trochlear)
Patient will head tilt to compensate for impaired intorsion of the eye
What 2 types of tumors are HIV patients at risk for? Are either of these a CNS risk? Lesions?
Kaposi Sarcoma vs Lymphomas
Kaposi can metastasize to CNS vs lymphomas will be primary CNS lymphomas
CNS lymphoma can produce blindness through invasion of the optic nerve
CSF FINDINGS FOR THE FOLLOWING
1) Guillan-Barre
2) Pseudotumor cerebri (idiopathic intracranial htn)
3) MS?
4) HSV-1 encephalitis
1) elevated protein
2) normal except for increased opening pressure (no risk for herniation bc there is no mass effect)
3) !multiple oligoclonal bands!, increased protein, increased leukocyte, increased myelin basic protein
4) elevated protein, leukocytosis, erythrocytosis (RBC), elevated opening pressure, increased % gamma globlulin,, may be cloudy
What is a discouraging/annoying LONG TERM CN deficit that can arise after a head-striking accident? Path? Px?
Ageusia (loss of taste) and anosmia 2/2 acceleration-deceleration injury to the olfactory nerve rootlets at the cribriform plate
volar aspect definition
xerostomia definition
referring to palm or sole (carpal tunnel: tension on volar aspect of wrist)
dry mouth
tx for painful spasticity that interferes with sleep?
spasticity that doesn’t interfere with sleep?
MOA of both interventions? What can you see this spasticity in?
Baclofen, GABA-B agonist, considerable sedation so good for nighttime symptoms
Tizanidine, central alpha-2 agonist, reduces spasticity without compromising strength
Multiple Sclerosis
Offer features of abetalipoproteinemia and explain the pathophys of each. 3 major bullets. Start with genetics.
- AR mut. in microsomal triglyceride transfer protein (MTTP) which impairs VLDL and chylomicron formation/secretion, leading to decreased vit E delivery to nervous system, leading to peripheral neuropathy, ataxia, night blindness, etc.
- lipid profiles are abnormal and fat absorption is affected, leading to fat accumulation in enterocytes. The abnormal lipid profile can deform RBC membranes into star-shaped morphology (acanthocytosis)
- fatty liver and lactose intolerance can also develop
What is a major post-op risk factor following AAA repair? define
arteria radicularis magna (artery of adamkiewicz), which enters T10-L1, may get occluded
1) Steppage gait
2) Antalgic gait
3) Spastic Hemiparetic Gait
4) Spastic Diplegia Gait (scissor gait)
1) Peroneal nerve injury which results in foot drop, patient raises this leg higher during walking to avoid dragging the foot. Foot is brought down with a slap.
2) Limp caused by patient avoiding weight bearing on the affected side
3) may be seen in patients after strokes—the leg is stiff with a foot drop and the arm is held flexed and adducted. The lower limb is dragged or moved forward by abduction and circumduction with the arm not swinging from its abnormal position
4) occurs with extrapyramidal disorders. The patient uses short steps and drags the foot; the legs are extended and stiff and cross on each other
Sclerotic hippocampus causing intractable complex partial seizures. Dx and tx?
Mesial Temporal Sclerosis (MTS)
Neurosurgery
Other than copper, what can produces parkinsonism similar to the picture seen in Wilson’s disease?
Anemia and white lines transversely across fingernails. What is the toxin?
Personality changes, irritability, tremor, ataxia, often seen in felt, pulp, or paper processing factories. What is the toxin?
Painless motor neuropathy, wrist drop. What is the toxin?
Hair loss, stupor, GI distress, seizures, painful symmetric sensory neuropathy, headaches
Manganese (miners)
Arsenic
Mercury
Lead
Thallium
Rye fungus Claviceps Purpuria can lead to what?
Ergotism: vasoconstriction, degeneration of the posterior columns and dorsal roots
CSF finding in herpes encephalitis (most common cause of acute encephalitis?)
Increased lymphocytes
Mnemonic for migraines
POUND
Pulsatile Once a day Unilateral Nausea Daily activities, interferes with
Reversible posterior leukoencephalopathy
Caused by cyclosporine and tacrolimus (and ecclampsia)
edema
Polymyalgia rheumatica
Arteritis of the elderly characterized by an elevated ESR and normal CPK, also affording anemia, weight loss, and malaise.
Name the def. and expound
Sandoff and Tay Sach’s
arylsulfatase A def. (define path)
Krabbe disease (define path)
Adrenoleukodystrophy
hexosaminidase
metachromatic leukodystrophy (arylsulfatase needed to break down myelin for turnover; def. of this leads to build up in lysosomes)
galactocerebroside beta-galactosidase (galactocerebroside accumulates in macrophages)
impaired addition of coenzyme A to long-chain fatty acids (fatty acids accumulate, damaging adrenal glad and white matter)
Cerebellar signs, ataxia, nystagmus in a patient with breast cancer. Pathophys?
Which primary cancer met to the brain has worst prog.?
Paraneoplastic Cerebellar Degeneration
anti-purkinje cell (anti-Yo)
Malig melanoma
What causes lumbar fracture in automobile accidents?
extreme flexion of spine
Meige syndrome
a form of focal dystonia characterized by blepharospasm, forceful jaw opening, lip retraction, neck contractions, and tongue thrusting. Sometimes these features are produced by phenothiazine or butyrophenone use, but they may also occur idiopathically, more often in women than men, with onset in the sixth decade. Botulinum toxin injection has been more effective in treatment than any oral medication.
Person goes swimming and then develops pruritic skin, followed by parasthesias and loss of bladder control. Dx? NBS? Path?
Schistosomiasis
(S. Mansoni can release eggs into veins that drain into the spinal cord area; granulomas form around these Ova which compress the spinal cord)
MRI to rule out emergent shit
Normal Pressure Hydrocephalus
wet, wacky, wobbly
(gait disturbance, don’t think Parkinson’s or Alzheimer’s in this case)
CT/MRI shows enlargement of the temporal and frontal horns of the lateral ventricles out of proportion to cortical atrophy
Lennox-Gastaut
mental dysfunction, multiple seizure types, and 1- to 2-Hz generalized spike-wave discharges on EEG
UMN disease vs myelopathy
UMN: spasticity, hyperreflexia, +Babinski
Myelopathy: UMN+ loss of position and vibration (posterior column)
Background posterior-dominant rhythm on EEG?
alzhemiers?
spongiform encephalopathy (crueztfield-jacob)?
8-12 Hz,
generalized background slowing
periodic changes in the form of sharp waves or spikes
Subacute Sclerosis Pan-Encephalitis (SSPE)
demyelinating condition s/p measles infection
What happens to handwriting and speech volume as parkinson’s disease progresses?
Smaller and quieter
Innervation of interosseus and lumbricals?
All interossei innervated by ulnar,
two of the lumbricals by ulnar, two by median
What are some drugs that can cause parkinsonism?
Butyrophenones (haloperidol, etc.) and metoclopramide (which also can cause tardive dyskinesia)
Postconcussion syndrome triad
Personality changes, dizziness, headache
CT negative, but then xanthochromia of CSF, NBS?
It’s SAH, do 4 vessel cerebral angiogram to confirm
Pregnant woman with pseudotumor cerebri, NBS?
Don’t use diuretics unless not pregnant; serial lumbar punctures is best.
Reduced ROM in neck and cervical tenderness. Which type of headache
Tension headache
ESR, and lateral headache?
Temporal Arteritis
What class of medication to avoid in the dementia with lewy body crowd?
Antipsychotics, can lead to neural damange
Best test to confirm Guillain Barre Syndrome
LPC
Cystic lesions in the cerebellum in a patient with AD VHL syndrome. Dx and NBS?
What else can you see in AD VHL? (4)
Hemangioblastomas
Surgical resection asap bc of the risk of bleeding
HSM, retinal angioma/telangiectasia, cerebellar tumors, polycystic kidney/liver disease,
What CNS cell type is the source of most primary tumors?
Glial Cells
What causes “down and out” pupil? What comorbidity?
3rd nerve palsy 2/2 DM
What is a gumma?
Avascular granuloma that forms in the brain that resembles a tumor on imaging and typically occurs in the setting of syphillis
Gradenigo syndrome
petrous pyramidal osteomyelitis; abducens and facial nerve travel close to the tip of the petrous bone so you may see these sequelae.
Pathophys of paraneoplastic cerebellar degeneration
Tumor such as SSLcancer causes anti-neuronal antibodies that lead to ataxia
What kind of visual loss (lateralization) would you see in
middle and posterior cerebral artery ischemia
central retinal artery ischemia
middle/post - some sort of bilateral
central retinal - unilateral
Lead poisoning neuropathy, which nerve is most likely to be affected
radial
Progression of herpes encephalitis in an immunocompetent person
Which virus affects adults and which virus affects kids?
First psychiatric, then seizures can follow
Adults - HSV-1
Kids - HSV-2
Where is the seizure if the patient has olfactory hallucinations during the prodrome
Mesial temporal lobe (typically hippocampus)
Time for DTs vs alcohol withdrawls
1-2 DT
2-4 AQ
Patients who use analgesia 2 or more times a week are at risk for what?
Medication overuse headache. Even triptans can cause this.
Explain the sequence by which you follow to avoid herniation in the setting of LP
IF YOU SEE signs of elevated ICP, THEN you need imaging to r/o mass effect before doing LP.
If, say, it’s pseudotumor cerebri (idiopathic intracranial hypertension), then don’t worry about herniation. it’s just ICP^, no risk for herniation.
If baby presents with neck stiffness and fever, and infectious signs, just do LP.
Describe 4 clinical findings in the setting of elevated ICP and describe whether they’re acute or chronic. Comment on pathophys for each.
Irregular respirations (hypoperfusion of brainstem) Bradycardia (increased stimulation of baroreceptors from the hypertension) Hypertension (decreased cerebral perfusion induces peripheral vasoconstriction)
above are acute (cushing’s triad), PAPILLEDEMA IS CHRONIC
