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Behaviour_Part2 > Clinical neurology > Flashcards

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
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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’)

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3
Q
  • Sensory level
  • Dissociated sensory findings
  • Lhermitte’s phenomenon

Where is the problem?

A

Spinal cord

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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

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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)
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6
Q

What are the types of elder abuse?

A
  1. Physical
  2. Psychological
  3. Financial
  4. Sexual
  5. Neglect
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7
Q

What can be the cause of multiple mononeuropathies?

A

Vasculitis

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8
Q

Cluster and ataxic breathing in a coma patient indicates a lesion where?

A

Ponto-medullary

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9
Q

Burning, tingling pain in the dermatome of an affected nerve root exacerbated by Valsalva maneuvers. Where is the problem?

A

Nerve ROOT

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10
Q

What are the characteristics of CENTRAL vertigo?

A
  • Neurological Exam: Abnormal
  • Nystagmus: vertical
  • Time course (vertigo): Constant
  • Gait: cannot walk
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11
Q

How do we treat BPPV?

A

“Epley” maneuver

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12
Q

If vibration, proprioception, two-point discrimination and fine touch are affected, where is the problem?

A

Dorsal column/Medial lemniscal

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13
Q
  1. New-onset psychosis
  2. Seizures
  3. Abnormal movements

What do you suspect?

A

Anti-NMDA Receptor Encephalitis: paraneoplastic syndrome

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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)

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15
Q

What are the top predictor factors of prognosis after a TBI?

A
  1. GCS
  2. Age
  3. Pupils
  4. Hypotension: CAN BE MANAGED MEDICALLY
  5. Ct-scan
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16
Q

What are the non-neurological causes of paresthesia?

A
  • Anxiety/Panic disorder
  • Hyperventilation
  • Hypercalcemia
  • Somatization
  • Malingering
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17
Q

What are the characteristics of PERIPHERAL vertigo?

A

Neurological Exam: normal

Nystagmus: Only horizontal/torsional

Gait: can walk

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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
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19
Q

What are the brainstem clinical manifestations of MS?

A
  • Internuclear ophthalmoplegia
  • Ataxia
  • “Bell’s Palsy”
  • “Trigeminal neuralgia”
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20
Q

What are the diagnosis criteria of MS?

A
  1. Two clinical attacks separated in time and affecting different parts of the nervous system

Or

  1. One clinical attack, plus MRI evidence for dissemination in time and space
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21
Q

Midbrain/oculomotor lesion in the brain in a coma patient, how will the pupils react?

A

Large and “fixed” (unreactive)

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22
Q

Central neurogenic hyperventilation breathing in a coma patient indicates a lesion where?

A

Diffuse or midbrain

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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

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24
Q

What is Hemiplegic/diplegic gait?

A

Cannot prevent pelvis from sagging toward swing-leg side –> pelvis tilts with each step (‘Trendelenberg’ gait)

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25
Q

What structures can be injured if you are in a coma?

A

Reticular activating system in the brainstem (consciousness)

Or

Bilateral thalamus

Or

Bilateral cerebral hemispheres

26
Q

What are the criteria to become an organ donor?

A
  1. be in a hospital
  2. be determined dead
  3. no contraindications
  4. organ/tissue worth donating
27
Q

How do we treat acute attacks of MS?

A

IV steroids:

  • Usually methylprednisolone (SoluMedrol)
  • 1 g iv
  • Daily
  • For 3-5 days
28
Q
  • 25 year old
  • Psychotic symptoms
  • Ataxia
  • Dyasthria
  • Vertical supranuclear gaze palsy
  • Hepatomegaly

What’s your diagnosis?

A

Nieman Pick C

29
Q

Seizure with:

  • eyes closed tightly
  • lack of tonic phase
  • very rhythmic jerking
  • grabbing/holding with hands
  • pelvic thrusting

What’s your diagnosis?

A

Pseudo-seizures (or non-epileptic seizures) from conversion disorder

30
Q

What are the red flags of sensory problems that justify URGENT referral for investigation?

A
  • 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
Q

What type of memory loss happens after a TBI?

A

Anterograde amnesia (cannot make new memories)

32
Q

Which Disorders of Consciousness has complete absence of brain-stem reflexes?

A

Brain death

33
Q

Diffuse lesion in the brain in a coma patient, how will the pupils react?

A

Small and reactive to light

34
Q
  • 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?

A

PKU (Phenylketonuria)

35
Q

What are the degenerative causes of cerebellar ataxia?

A
  • Olivopontocerebellar atrophy
  • Multiple system atrophy
36
Q

What is Parkinsonian gait?

A

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
Q
  • 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?

A

Klinefelter (XXY)

38
Q
  1. 1Nystagmus (the uncontrolled movement of the eyes from in a lateral motion)
  2. Intention tremor
  3. Staccato (scaning) speech

What’s your diagnosis?

A

MS

39
Q

What are the spinal cord manifestations of MS?

A

Partial motor and/or sensory loss below the lesion

40
Q

What are the criteria for brain death?

A
  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
Q

Family history of

  • Premature ovarian failure
  • Mood and anxiety difficulties
  • Tremor/ataxia syndrome or atypical parkison

is a sign of what?

A

Fragile X syndrome

42
Q

Pons lesion in the brain in a coma patient, how will the pupils react?

A

Small and reactive

43
Q

Why is used Glasgow Coma Scale?

A
  • Developed for trauma
  • A snapshot of patient’s level of consciousness
  • Useful for communication
  • NOT USED TO DETERMINE ETIOLOGY OF COMA
44
Q

What are the clues for referral to medical genetics?

A
  • 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
Q

What is Myopathic gait?

A

Foot cannot clear ground when swinging forward –> leg moves forward by making a semi-circle laterally (‘circumduction’ gait; if bilateral: ‘scissoring’)

46
Q

What are the clinical signs of CNS tumor?

A
  • 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
Q

Apneustic (inspiratory pause) breathing in a coma patient indicates a lesion where?

A

Pons

48
Q

What is Ataxic gait?

A

Base is wide, movement of legs is erratic and arrhythmic

49
Q

What are the DDX of MS?

A
  • 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
Q

What is Radiologically-isolated syndrome of MS?

A

The incidental finding of MRI lesions typical of MS in a patient who has not yet had any symptoms of MS

51
Q

What are the possible causes of INTERMITTENT sensory findings?

A
  • Transient ischemic attack
  • Seizure
  • Migraine aura
  • Activity-related mechanical nerve or root compression
  • Multiple sclerosis
  • Hyperventilation
  • Anxiety
52
Q

What tests can you order to confim/infirm MS?

A
  • 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
Q

What are the atypical presentations of MS?

A
  • Language difficulty (aphasia)
  • Dementia
  • Hemianopsia/quadrantanopsia
  • Fatigue alone
54
Q

What are the charactesitics of patients with MS?

A
  • Young
  • Otherwise healthy
  • Has dissemination in space and time
  • Has an MRI typical for MS
55
Q

Which Disorders of Consciousness is irreversible?

A

Brain death

56
Q

How do we diagnose BPPV?

A

“Dix-Hallpike” maneuver

57
Q

Cheyne-Stokes breathing in a coma patient indicates a lesion where?

A

Diffuse: metabolic or cerebral

58
Q

If pain and temperature are affected, where is the problem?

A

Spinothalamic pathways

59
Q

What are the 3 components of the Glasgow Coma Scale score (GCS)?

A
  1. Eye opening
  2. Verbal response
  3. Motor response
60
Q

What happens when you have repetitive TBI?

A

Chronic Traumatic Encephalopathy (CTE)

(Football players)

61
Q

What is the definition of a dementia?

A
  1. Acquired, irreversible deficit in cognition
  2. Involves 2+ cognitive domains
  3. Sufficient to interfere with actives of daily living (ADL)
62
Q

How does a Anterior Spinal Artery Infarction present?

A
  • Bilateral loss of pain and temperature sensation and motor function
  • Spares the dorsal columns

Behaviour_Part2 (11 decks)

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