Clinical signs Flashcards
What is ocular bobbing?
conjugate eye movements - rhythmic and directed downward
What type of eye movement is caused by a lesion at the cervicomedullary junction?
down-beating nystagmus with both eyes
What does hyperacusis indicate?
lesion of the facial nerve, close the brainstem before the stapedius nerve
Young pt with subacute onset morning headaches -> confusion, hemiparesis, and seizure… think what??
expanding mass
Headache, obtundation, and vomiting may all be signs of…
increased intracranial pressure
What are Hollenhorst plaques?
cholesterol and calcific deposits in retinal arterioles
What are the clinical manifestations of Horner Syndrome?
ptosis, miosis, anhidrosis
Dydiadochokinesia can be identified with what tests?
alternately tapping one side of hand and then the other (coordination tests)
strength/sensation intact
Highly asymmetric dydiadochokinesia may indicate?
focal lesion
What is causalgia?
severe burning pain due to peripheral nerve injury
What is hypesthesia?
decrease in accurate perception of stimuli
What is allodynia?
perception of pain with application of nonpainful stimuli
“Claw hand” is seen from injury to what nerve?
ulnar nerve
impaired extension of ulnar two digits when trying to extend fingers
Wrist drop is commonly seen in ___ nerve palsy.
“Saturday night”
or
radial nerve pressure palsy
What type of migraine (classic or common) is associated with aura of neurologic dysfunction?
Classic
most often visual aura
What clinical signs are common in basilar migraines?
women
aura - visual
more severe neurologic deficits - visual changes to blindness, irritability into psychosis
Trigeminal neuralgia can often be seen in what chronic condition?
MS
basilar artery aneurysms
acoustic schwannomas
posterior fossa meningiomas
What is Tolosa-Hunt syndrome?
inflammatory condition –> ophthalmoplegia associated with HA and loss of sensation on forehead
What are common complaints of atypical facial pain?
constant, deep, bilateral OR unilateral, limited distribution, responsive to antidepressants
What are symptoms associated with optic neuritis?
monocular vision loss, pain with eye movement, “washed-out” color vision
Afferent pupillary defect is found in what diagnosis?
Optic neuritis
What is afferent pupillary defect?
“swinging flashlight test” = paradoxical pupillary dilation of affected eye with swinging flashlight
Gradual painless peripheral vision loss is a characteristic of what?
open-angle glaucoma
Sudden loss of consciousness without prodrome followed by immediate return to baseline after the event is associated with what?
cardiogenic syncope
What age is ultrasound of the brain most useful?
under 6 mo because widely open anterior fontanelle
What symptoms are associated with Wallenberg syndrome?
loss of pain and temp ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vertigo/nystagmus, Horner’s syndrome
Sudden loss of vision “curtain falling over the eyes” is called what?
amaurosis fugax - atherosclerotic emobli from carotid artery in the retinal artery
Patients with homocystinuria are at increased risk of what neuro complication?
thromboembolic events –> cerebrovascular accident
What eye abnormality is seen in patients with homocystinuria?
downward lens dislocation
Focal neurologic deficits that gradually worsen over minutes to hours may indicate___.
intraparenchymal brain hemorrhage
Neurologic symptoms taht progress in a stuttering fashion may indicate ____.
ischemic stroke
Putaminal hemorrhage almost always involves ____.
adjacent internal capsule
What is Dejerine-Roussy syndrome? (thalamic pain syndrome)
paroxysmal burning pain over affected area exacerbated by light touch (allodynia)
Gait dysfunction, truncal ataxia, nystagmus, intention tremor/dysmetria, and impaired dydiadochokinesia are all signs of:
cerebellar degeneration
What is the most common cause of spontaneous lobar hemorrhage, especially in adults >60yo?
amyloid angiopathy - Alzheimer dementia
What are manifestations of NF1?
cafe-au-lait spots clustered freckles Lisch nodules Neurofibromas Optic glioma
Idiopathic intracranial hypertension can present with what symptoms?
headache worse in the morning or awakens from sleep, +/- blurry vision, nausea, vomiting, etc.
What medications worsen IIH?
growth hormone, tetracyclines, excessive vitamin A (isotretinoin)
What symptoms may accompany absence seizures?
simple automatisms –> eyelid fluttering, lip smacking
Port wine stain, glaucoma, seizures, intellectual disability, and leptomeningeal capillary-venous malformation are all clinical features of ___
Sturge-Weber syndrome
Klippel-Trenaunay syndrome is associated with capillary, venous, lymphatic malformations and ___ skin abnormality
port wine stain lower extremity
no neurologic abnormalities
___ is a neurocutaneous disorder that presents with seizures and intellectual disability.
tuberous sclerosis
may also see: retinal hamartomas, ash-leaf spots, angiofibromas, shagreen patches
BPPV is due to ____ in the semicircular canals.
crystaline deposits - canaliths
An acute single episode of vertigo that can last for days following a viral syndrome is called..
vestibular neuritis
Sudden-onset vertigo that doesn’t go away is most likely due to…
brainstem/cerebellar stroke
__ is the most common brain tumor in children.
pilocytic astrocytoma
Supratentorial tumors present with:
seizures, weakness, sensory changes
Pain, fatigue, and parasthesias of one upper extremity (usually the L) can all be signs of symptomatic ___
subclavian steal syndrome or atherosclerosis of the subclavian artery
What are the two differences in clinical presentation between Tay Sachs and Niemann-Pick disease?
NPD - hepatosplenomegaly and areflexia
TSD - hyperreflexia
Febrile seizures are characterized by temperature > ____, lasting ____, in ages ___ to 6 years.
100.4 (38)
<15 min
3 mo
What percentage of febrile seizures turn into epilepsy?
<5%
What risk factor has the strongest association with hemorrhagic and ischemic strokes?
hypertension
What is the “classic triad” of spinal epidural abscess?
fever, back pain, neurologic deficits
What metabolic disorder is characterized by vomiting, poor weight gain, jaundice, hepatomegaly, convulsions and cataracts?
galactosemia
def of galactose-1-phosphate uridyl transferase
Name clinical features of SAH.
severe HA with onset of neuro symptoms, meningeal irritation, NOT common to have focal deficits
___ is common in the first 24 hours after SAH and ____ is common after 3 days.
rebleed
vasospasm
Dysarthria, limb weakness, loss of deep tendon reflexes, progressive gait and limb ataxia are all clinical findings in what genetic disease?
Friedreich ataxia
What are non-neurologic signs of Friedreich ataxia?
kyphoscoliosis, pes cavus, hypertrophic cardiomyopathy and increased risk of arrhythmia/heart failure
It is common to see (unilateral/bilateral) MLF lesions in patients with MS
BILATERAL
Dementia that first presents with confusion + visual hallucinations and parkinsonian motor symptoms is likely …
lewy body dementia
Hypertension, bradycardia, and respiratory depression may indicate…
brainstem compression
Cushing reflex
Cauda equina syndrome or conus medullaris syndrome?
severe radicular pain
cauda equina syndrome
Cauda equina syndrome or conus medullaris syndrome?
asymmetric motor weakness
cauda equina syndrome
Cauda equina syndrome or conus medullaris syndrome?
hyperreflexia
conus medullaris syndrome
Cauda equina syndrome or conus medullaris syndrome?
early-onset bowel and bladder dysfunction
conus medullaris syndrome
A patient with muscle pain and stiffness in the shoulders over age 65, stiffness in the morning, fatigue, malaise, loss of appetite and depression may have…
Polymyalgia rheumatica
“pain in shoulders” is pathomneumonic here
Gradual progression of pain in shoulders, upper arms, hips, thighs, with or without swallowing problems may be….
Polymyositis
Muscle atrophy of the face, shoulder blade, and upper arms is most likely to be …
facioscapulohumeral muscular dystrophy
Muscle atrophy in the temporal region, sternocleidomastoid, and distal extremity muscles may be what disease?
myotonic dystrophy
How do you distinguish MDD from dementia in the elderly?
Time course - if all of the symptoms come on within 1 month, more likely to be MDD
Also - MDD pts will not even try recall questions, dementia patients will try but answer wrong
What is prosopagnosia?
inability to recognize faces of familiar people
problem with fusiform gyrus in occipotemporal lobe
About 50% of people with giant cell arteritis also have ____.
polymyalgia rheumatica
What are diagnostic criteria for transverse myelitis?
bilateral sensorimotor and autonomic spinal cord dysfunction
clearly defined sensory level
progression between 4hr-21 days after sx onset
exclusion of compression, postradiation, neoplastic, vascular
What is Shy-Drager syndrome?
Multiple system atrophy
Parkinsonism + autonomic dysfunction (orthostatic hypotension) + widespread neurological signs
Shy-Drager
aka multiple system atrophy
wide-based gait, urinary incontinence, and dementia…
Normal pressure hydrocephalus
Horizontal nystagmus, ataxia, dysmetria, slurred speech, nausea/vomiting, hyperreflexia… indicate ??
phenytoin toxicity
Young obese female with headache, normal neuroimaging and elevated CSF opening pressure…
pseudotumor cerebri (benign intracranial hypertension)
Where is atrophy seen first in patients with Alzheimer disease?
temporal lobes
REM sleep behavior disorder has a strong association with development of ____
alpha-synuclein neurodegenerative disorders
Encephalopathy, oculomotor dysfunction (horizontal nystagmus), gait ataxia…
Wernicke encephalopatyh
