Clinical neurology Flashcards
1
Q
What are the ophtalmologic clinical manifestations of MS?
A
- Pain with eye movement
- Visual loss/decreased acuity
- Ccotoma
- RAPD
- Red desaturation
2
Q
What is Neuropathic gait?
A
Foot scrapes ground when leg swings forward –> exaggeration of hip and knee flexion (‘steppage gait’) and goot also slaps down as it lands (‘foot drop’)
3
Q
- Sensory level
- Dissociated sensory findings
- Lhermitte’s phenomenon
Where is the problem?
A
Spinal cord
4
Q
- Female
- Developmental regression since 18 months old
- Stereotypic hand movements such as hand squeezing and washing/rubbing
What is your diagnosis?
A
Rett syndrome
5
Q
What are the hereditary causes of cerebellar ataxia?
A
- Recessive (Freidrich’s ataxia, ataxia-telangiectasia, autosomal recessive ataxia of Charlevoix-Saguenay)
- Dominant (Spinocerebellar ataxias or SCAs)
6
Q
What are the types of elder abuse?
A
- Physical
- Psychological
- Financial
- Sexual
- Neglect
7
Q
What can be the cause of multiple mononeuropathies?
A
Vasculitis
8
Q
Cluster and ataxic breathing in a coma patient indicates a lesion where?
A
Ponto-medullary
9
Q
Burning, tingling pain in the dermatome of an affected nerve root exacerbated by Valsalva maneuvers. Where is the problem?
A
Nerve ROOT
10
Q
What are the characteristics of CENTRAL vertigo?
A
- Neurological Exam: Abnormal
- Nystagmus: vertical
- Time course (vertigo): Constant
- Gait: cannot walk
11
Q
How do we treat BPPV?
A
“Epley” maneuver
12
Q
If vibration, proprioception, two-point discrimination and fine touch are affected, where is the problem?
A
Dorsal column/Medial lemniscal
13
Q
- New-onset psychosis
- Seizures
- Abnormal movements
What do you suspect?
A
Anti-NMDA Receptor Encephalitis: paraneoplastic syndrome
14
Q
- 12 years old
- Psychotic symptoms
- Congenital heart disease
- Renal agenesis
- Recurent infections
- Learning difficulties
- Squared nasal nose
What’s your diagnosis?
A
22q11 deletion (DiGeorge syndrome)
15
Q
What are the top predictor factors of prognosis after a TBI?
A
- GCS
- Age
- Pupils
- Hypotension: CAN BE MANAGED MEDICALLY
- Ct-scan
16
Q
What are the non-neurological causes of paresthesia?
A
- Anxiety/Panic disorder
- Hyperventilation
- Hypercalcemia
- Somatization
- Malingering
17
Q
What are the characteristics of PERIPHERAL vertigo?
A
Neurological Exam: normal
Nystagmus: Only horizontal/torsional
Gait: can walk
18
Q
What are the aquired causes of cerebellar ataxia?
A
- Alcohol
- Drugs (phenytoin, chemotherapy eg. 5-FU)
- Vitamin E deficiency
- Viral (varicella zoster virus in children)
- Multiple sclerosis
- Stroke
- Paraneoplastic
19
Q
What are the brainstem clinical manifestations of MS?
A
- Internuclear ophthalmoplegia
- Ataxia
- “Bell’s Palsy”
- “Trigeminal neuralgia”
20
Q
What are the diagnosis criteria of MS?
A
- Two clinical attacks separated in time and affecting different parts of the nervous system
Or
- One clinical attack, plus MRI evidence for dissemination in time and space
21
Q
Midbrain/oculomotor lesion in the brain in a coma patient, how will the pupils react?
A
Large and “fixed” (unreactive)
22
Q
Central neurogenic hyperventilation breathing in a coma patient indicates a lesion where?
A
Diffuse or midbrain
23
Q
What is Clinically-isolated syndrome of MS
A
A patient with a single attack suggestive of MS but who does not yet meet full diagnostic criteria for MS
24
Q
What is Hemiplegic/diplegic gait?
A
Cannot prevent pelvis from sagging toward swing-leg side –> pelvis tilts with each step (‘Trendelenberg’ gait)
25
What structures can be injured if you are in a coma?
Reticular activating system in the brainstem (consciousness)
Or
**Bilateral** thalamus
Or
**Bilateral** cerebral hemispheres
26
What are the criteria to become an organ donor?
1. be in a hospital
2. be determined dead
3. no contraindications
4. organ/tissue worth donating
27
How do we treat acute attacks of MS?
IV steroids:
* Usually methylprednisolone (SoluMedrol)
* 1 g iv
* Daily
* For 3-5 days
28
* 25 year old
* Psychotic symptoms
* Ataxia
* Dyasthria
* Vertical supranuclear gaze palsy
* Hepatomegaly
What's your diagnosis?
Nieman Pick C
29
Seizure with:
* eyes closed tightly
* lack of tonic phase
* very rhythmic jerking
* grabbing/holding with hands
* pelvic thrusting
What's your diagnosis?
Pseudo-seizures (or non-epileptic seizures) from conversion disorder
30
What are the red flags of sensory problems that justify URGENT referral for investigation?
* Sudden onset/offset suggests TIA or seizure
* Radiculopathy with focal neurological deficits (weakness, loss of reflexes) is present
* Deficits rapidly worsen, ascend, or evolve to include motor signs and symptoms
* Acute deficit localizes to the spinal cord
31
What type of memory loss happens after a TBI?
Anterograde amnesia (cannot make new memories)
32
Which Disorders of Consciousness has complete absence of brain-stem reflexes?
Brain death
33
Diffuse lesion in the brain in a coma patient, how will the pupils react?
Small and reactive to light
34
* Patient not from Canada
* Normal development for 6–9 months
* 9–12 months signs of slowing in developmental progress, head growth slows
* 1 year developmentally delayed
* Light hair
* Eczema
* Smells terribly of an unfamiliar odor
What's your diagnosis?
PKU (Phenylketonuria)
35
What are the degenerative causes of cerebellar ataxia?
* Olivopontocerebellar atrophy
* Multiple system atrophy
36
What is Parkinsonian gait?
Gait is slow, steps are small, arm swing reduced, posture is stooped, Turns by multiple small steps (‘en bloc’), rather than a fluid pivot
37
* Gynecomastia, Hypogenitalism (small penis & testes)
* Hypogonadism (low testosterone, high FSH, LH)
* Infertility
* Typically long limbs, relatively tall, slim
* Specific behaviour profil: passive behaviour, immaturity, insecurity, shyness, poor judgment, and unrealistic boastful behavior
What's your diagnosis?
Klinefelter (XXY)
38
1. 1Nystagmus (the uncontrolled movement of the eyes from in a lateral motion)
2. Intention tremor
3. Staccato (scaning) speech
What's your diagnosis?
MS
39
What are the spinal cord manifestations of MS?
Partial motor and/or sensory loss below the lesion
40
What are the criteria for brain death?
1. Unresponsive coma with a **known proximate cause** and absence of reversible conditions
2. Absence of centrally-mediated **motor responses**
3. Absent **brainstem reflexes** & the capacity to **breathe**
41
Family history of
* Premature ovarian failure
* Mood and anxiety difficulties
* Tremor/ataxia syndrome or atypical parkison
is a sign of what?
Fragile X syndrome
42
Pons lesion in the brain in a coma patient, how will the pupils react?
Small and reactive
43
Why is used Glasgow Coma Scale?
* Developed for trauma
* A snapshot of patient’s level of consciousness
* Useful for communication
* **NOT USED TO DETERMINE ETIOLOGY OF COMA**
44
What are the clues for referral to medical genetics?
* Positive family history
* Unusual imaging or laboratory findings
* Atypical presentation of a psychiatric disorder
* Congenital malformations
* Medical comorbidity / multisystemic problems unrelated to the
psychiatric morbidity
* Physical examination findings: dysmorphology, hepatosplenomegaly, neurological/neuromuscular abnormalities
* Ophthalmology
45
What is Myopathic gait?
Foot cannot clear ground when swinging forward --\> leg moves forward by making a semi-circle laterally (‘circumduction’ gait; if bilateral: ‘scissoring’)
46
What are the clinical signs of CNS tumor?
* Nehavior changes
* Cognitive changes
* Dizziness or unsteadiness
* Double or blurred vision
* Frequent headaches
* Hearing impairment
* Nausea and vomiting (increased intracranial pressure) • Seizures
* Weakness or paralysis
47
Apneustic (inspiratory pause) breathing in a coma patient indicates a lesion where?
Pons
48
What is Ataxic gait?
Base is wide, movement of legs is erratic and arrhythmic
49
What are the DDX of MS?
* Optic neuritis
* Transverse myelitis
* ADEM
* B12
* PML
* Leukodystrophy
* Lupus/anti-phospholipid
* Vasculitis
* Sjogren’s syndrome
* Lyme disease
* Behçet’s disease
* Sarcoidosis
* HIV (myelopathy)
* Lymphoma
50
What is *Radiologically-isolated syndrome* of MS?
The incidental finding of MRI lesions typical of MS in a patient who has not yet had any symptoms of MS
51
What are the possible causes of INTERMITTENT sensory findings?
* Transient ischemic attack
* Seizure
* Migraine aura
* Activity-related mechanical nerve or root compression
* Multiple sclerosis
* Hyperventilation
* Anxiety
52
What tests can you order to confim/infirm MS?
* **MRI never makes the diagnosis alone BECAUSE MS IS A CLINICAL DIAGNOSIS**, but the presence of white matter lesions that have a typical appearance and are in typical locations is very suggestive of MS
* One hallmark of MS is the presence of oligoclonal bands in the cerebrospinal fluid
* We often check for B12 deficiency, but test for other possibilities only if clinical suspicion
53
What are the atypical presentations of MS?
* Language difficulty (aphasia)
* Dementia
* Hemianopsia/quadrantanopsia
* Fatigue alone
54
What are the charactesitics of patients with MS?
* Young
* Otherwise healthy
* Has dissemination in space and time
* Has an MRI typical for MS
55
Which Disorders of Consciousness is irreversible?
Brain death
56
How do we diagnose BPPV?
“Dix-Hallpike” maneuver
57
Cheyne-Stokes breathing in a coma patient indicates a lesion where?
Diffuse: metabolic or cerebral
58
If pain and temperature are affected, where is the problem?
Spinothalamic pathways
59
What are the 3 components of the Glasgow Coma Scale score (GCS)?
1. Eye opening
2. Verbal response
3. Motor response
60
What happens when you have repetitive TBI?
Chronic Traumatic Encephalopathy (CTE)
(Football players)
61
What is the definition of a dementia?
1. Acquired, irreversible deficit in cognition
2. Involves 2+ cognitive domains
3. Sufficient to interfere with actives of daily living (ADL)
62
How does a Anterior Spinal Artery Infarction present?
* Bilateral loss of pain and temperature sensation and motor function
* Spares the dorsal columns
