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CNS Flashcards

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1
Q

Describe cervical myelopathy signs

A

Myelopathy (UMN signs below the level of lesion) - due to cord compression

Radiculopathy (LMN signs at level of lesion) - due to nerve root compression

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2
Q

Elevated 14-3-3 protein

A

Creutzfeldt-Jakob disease

Nonspecific marker of neuronal cell death

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3
Q

Anti-Hu antibody

A

Paraneoplastic syndrome (SCLC, patients who smoke)

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4
Q

Anti-NMDA receptor antibody

A

Anti-NMDA receptor encephalitis - associated with ovarian teratomas
Median age 21, 4x greater in women

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5
Q

Low alpha-synuclein; round, eosinophilic inclusions of it

A

Parkinson dementia if in basal ganglia/midbrain, dementia with Lewy bodies if in cerebral cortex

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6
Q

Low hypocretin/orexin

A

Narcolepsy type 1

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7
Q

Creutzfeldt-Jakob disease - signs

A
  1. Rapidly progressive dementia
  2. Myoclonus provoked by startle
  3. Mood symptoms (e.g. depression)
  4. Hypersomnia

CSF noninflammatory, contains elevated 14-3-3 protein (marker of neuronal cell death), elevated tau

Test for abnormally folded proteins using real-time quaking induced conversion (RT-QuIC) assay - mix abnormally folded proteins with normally folded proteins and watch for increased fluorescence following conformational changes in normal proteins

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8
Q

Most common sites of hypertensive hemorrhage in descending order

A
  1. Basal ganglia (putamen)
  2. Cerebellar nuclei
  3. Thalamus
  4. Pons
  5. Cerebral cortex
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9
Q

Cerebellar hemorrhage - signs

A
  1. Occipital headache (may radiate to neck/shoulders
  2. Neck stiffness (extension of blood into 4th ventricle)
  3. Nausea/vomiting
  4. Nystagmus
  5. Ipsilateral hemiataxia of trunk (vermis) and/or limbs (hemispheres) as corticopontocerebellar fibers decussate twice
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10
Q

What hemorrhage and damage would cause pinpoint pupils?

A

Large pontine hemorrhage - damage to descending sympathetic fibers

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11
Q

What is a useful screening test for hemineglect?

A

Drawing a clock - requires both sensory and motor components

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12
Q

Malignant hemispheric infarction

A

When an ischemic stroke causes:
1. Massive cerebral edema - from enthothelial dysfunction and breakdown of BBB –> mass effect, ICP, brain herniation
2. And/or hemorrhagic transformation - from blood extravasation from injured cerebral vessels into brain parenchyma (larger infarcts –> greater risk)

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13
Q

What is the difference between viral and fungal (Cryptococcus)/tuberculous meningitis on CSF?

A

Both have slightly elevated protein and lymphocytic predominance, but viral has normal glucose

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14
Q

Diagnostic confirmation of Cryptococcus

A

After CSF, India ink stain or polysaccharide antigen testing

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15
Q

How does Botulinum toxin work?

A

Cleaves SNARE proteins, preventing ACh release from neuron at neuromuscular junction

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16
Q

Botulinum vs myasthenia gravis

A

Myasthenia gravis spares pupillary function, autonomic dysfunction is less prominent, and symptom progression typically less rapid

Both are descending weakness

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17
Q

Cauda equina vertebral levels and corresponding effect

A

L2-sacrum + coccygeal nerve:
S1-S2: absence ankle reflex
S2-S4: saddle anesthesia
S3-S5: bowel, bladder, or sexual dysfunction (e.g. urinary straining)

Can have asymmetric lower extremity weakness/sensory loss

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18
Q

Conus medullaris vs cauda equina

A
  1. Conus medullaris is L1-L2
  2. Severe pain limited to lower back (vs radiating into leg)
  3. Numbness symmetric and limited to perianal area
  4. Weakness symmetric
  5. UMN findings such as hyperreflexia (vs absent ankle reflex)
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19
Q

Who is at increased risk of internal carotid artery dissection?

A
  1. Connective tissue disease (Ehlers-Danlos)
  2. Smoker
  3. Uncontrolled HTN
  4. Oral contraceptives
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20
Q

Why does internal carotid artery dissection only present with partial Horner syndrome?

A

Ptosis and miosis but not anhidrosis - sympathetic fibers for facial diaphoresis travel along the external carotid artery

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21
Q

Dementia with Lewy bodies

A

Dementia plus >=2 of the following:
1. Visual hallucinations
2. Parkinsonism
3. Fluctuating cognition
4. REM sleep behavior disorder

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22
Q

Blurred optic disc margins

A

Papilledema

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23
Q

Jervell and Lange-Nielsen syndrome - presentation

A

Congenital long QT syndrome
Inheritable sensorineural hearing loss due to mutations affecting endolymph production
Presents in childhood with profound bilateral deafness and episodes of arrhythmia-induced syncope during stress

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24
Q

What causes relative afferent pupillary defect?

A

Optic nerve injury - most often caused by indirect high-intensity force to orbit and transmission of shearing forces

Vision improves with conservative management in half of patient
Surgical decompression may be required
Loss of light perception is associated with worse prognosis

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25
Q

Abnormal red reflex is seen with what traumatic injury?

A

Vitreous hemorrhage from head trauma –> decreased visual acuity, relative afferent pupillary defect, and abnormal red reflex

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26
Q

Peripheral vertigo nystagmus

A
  1. Never purely vertical
  2. Inhibited by gaze fixation
  3. Fatigable (<1 min duration)
  4. Latency period (2-40 seconds)
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27
Q

How are patients predisposed to acute-closure glaucoma?

A

Lens is located more forward against the iris, impairing flow of aqueous humor through pupil into anterior chamber, increasing IOP

Women >40 yo, Asians and Inuits, farsightedness

Exacerbation can be due to pupillary dilation:
1. Anticholinergics (e.g. tolterodine)
2. Sympathomimetics
3. Low ambient light

Sulfonamides can trigger ACG due to swelling of structures in posterior chamber

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28
Q

Tourette syndrome - treatment

A

Counseling unless severe, disabling, or distressing:

Behavioral therapy - habit reversal training

Pharmacological:
1. Vesicular monoamine transporter 2 (VMAT2) inhibitors (e.g. tetrabenazine)
2. Antipsychotic
3. Alpha-agonist (e.g. guanfacine, clonidine) - helpful when ADHD or behavioral issues are also present

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29
Q

Central vertigo from posterior circulation ischemia - signs

A
  1. Limb ataxia or dysmetria (e.g. abnormal finger-to-nose or heel-to-shin)
  2. Postural instability - falling to side of lesion
  3. Headache - due to trigeminal innervation of much of cerebral arterial vasculature
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30
Q

Subarachnoid hemorrhage - timeline of complications

A

First day - rebleeding with rapid neurologic deterioration (urgent repair by coiling or clipping will reduce risk of rebleeding)

3-14 days - delayed cerebral ischemia due to vasospasm (caused by vasogenic metabolites from degraded blood) presenting with stroke-like symptoms - reduce risk via nimodipine

2 weeks - communicating hydrocephalus due to degraded blood products interfering with CSF reabsorption

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31
Q

Idiopathic intracranial hypertension - epi, signs, diag

A

Obese women of childbearing age
Excessive weight gain

Positional headaches worse when flat
Pulsatile tinnitus (due to increased vascular pulsations)
Blurry vision (due to increased pressure on optic nerves)

MRI often with MR venography to rule out cerebral vein thrombosis
Lumbar puncture reveals elevated opening pressure (>250)

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32
Q

Guillian-Barre syndrome

A

After acute infection (e.g. GI, resp, HIV)
Ascending motor deficits, hyporeflexia, back pain
Sensation classically unaffected (although paresthesias are common)

Dx with clinical, CSF analysis, and nerve conduction studies showing demyelination

CSF - albuminocytologic dissociation (increased total protein, normal CSF cell count)

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33
Q

Guillain-Barre treatment

A

IVIG or plasmapheresis

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34
Q

Most common artery causing Wernicke (receptive) aphasia

A

Inferior division of MCA - dominant temporal lobe

Also affects:
1. Right upper visual field
2. Somatosensory association cortex (processing of somatosensory information)
3. Lateral parietal and temporal heteromodal association cortex (integration of different sensory modalities - visual, somatosensory, etc)

These thus lead to difficulty using objects

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35
Q

Most common artery causing Broca (expressive) aphasia

A

Superior division of MCA - dominant frontal lobe

Also affects:
Contralateral hemiparesis

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36
Q

Nondominant frontal lobe lesion affects…

A

how a patient conveys emotion through speech (motor aprosodia)
Contralateral weakness due to impact on primary motor cortex

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37
Q

Nondominant temporal lobe lesion affects…

A
  1. Ability to comprehend emotional gestures (sensory aprosodia)
  2. Contralateral homonymous quadrantanopia due to impact on optic radiations
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38
Q

Dominant parietal lobe lesion affects…

A
  1. Contralateral sensory loss
  2. Contralateral inferior homonymous quadrantanopia - involvement of superior optic radiations
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39
Q

Nondominant parietal lobe lesion affects…

A

Anosognosia - denial of one’s disabilities
Apraxia - inability to carry out learned, purposeful movements

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40
Q

Spinal muscular atrophy affects which cells?

A

Anterior horn cells

As do poliomyelitis and ALS

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41
Q

Organophosphate poisoning - signs

A

Weakness accompanied by multisystem cholinergic symptoms

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42
Q

Diseases of neuromuscular junction

A
  1. Botulism
  2. Organophosphate poisoning
  3. Myasthenia gravis (improves with rest)
  4. Lambert-Eaton
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43
Q

Labyrinthitis

A

Inflammation of labyrinth and vestibular nerve –> acute-onset hearing loss and vertigo, +/- nausea/vomiting

If no hearing loss, it is called vestibular neuritis

Usually follows viral syndrome, may last few days

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44
Q

Main manifestation of vestibular schwannoma

A

Sensorineural hearing loss

Sometimes imbalance and tinnitus
True vertigo not typical because slow growth allows for development of compensation

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45
Q

Foramen magnum meningioma - signs

A
  1. Compression of brainstem at level of medulla - hypoglossal nerve dysfunction (tongue deviates toward side of lesion between strong part pushes weak side); bilateral corticospinal tracts run through medulla –> UMN signs (Babinski, spastic gait)
  2. Impaired CSF outflow –> increased ICP
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46
Q

Time course of following strokes:
Cardiogenic emboli
Flow limitation or embolization from carotid artery atherosclerosis
Lacunar stroke
Hemorrhagic

A

Cardiogenic emboli: multiple infarcts cause patchy neurologic findings - onset abrupt and maximal at start

Flow limitation or embolization from carotid: ipsilateral ocular and/or cerebral hemisphere ischemia - cerebral edema over hours-days, not rapid

Lacunar stroke: quite small, severe focal symptoms depending on area, not global

Hemorrhagic: minutes-hours, initially focal but soon ICP –> decreased consciousness

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47
Q

Dandy-Walker syndrome

A

Congenital atresia of foramina of Luschka and Magendie –> prevents CSF outflow into subarachnoid space –> hydrocephalus

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48
Q

Flattened gyri and sulci indicate…

A

Generalized cerebral edema due to increased hydrostatic pressure of hydrocephalus, allowing CSF to flow to parenchyma

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49
Q

Atypical Parkinsonian disorders (Parkinson-plus)

A
  1. Multiple system atrophy
  2. Progressive supranuclear palsy
  3. Corticobasal degeneration
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50
Q

Wide-based gait

A

Cerebellar or sensory ataxia
1. Cerebellar - stumbling/lurching ipsilaterally
2. Sensory - high-stepping, stamping gait; worsens in dark

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51
Q

Narrow-based, scissoring gait

A

Bilateral leg weakness with spasticity from UMN lesion (e.g. cerebral palsy, spinal cord injury)

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52
Q

Waddling gait

A

Myopathic weakness - proximal more than distal usually
Weakness of pelvic girdle muscles –> excessive pelvic tilt that shifts with each step

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53
Q

Putaminal hemorrhage

A

Involves adjacent internal capsule:
1. Contralateral hemiparesis and hemianesthesia (corticospinal and somatosensory fibers in posterior limb)
2, Conjugate gaze deviation toward side of lesion (damage of frontal eye efferents in anterior limb)

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54
Q

Brainstem stroke

A

Contralateral motor deficits with ipsilateral cranial nerve deficits (i.e. crossed signs)
Medulla involvement: tongue deviation, contralateral paralysis, contralateral loss of position sense (dorsal column medial lemniscus)

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55
Q

Saccular aneurysms vs Charcot-Bouchard

A

Saccular - spontaneous subarachnoid hemorrhage - severe headache with maximal intensity within hour + meningeal irritation

Charcot-Bouchard - Intraparenchymal hemorrhage of small penetrating arteries (same places as lacunar infarcts)

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56
Q

Elevated ICP tends to cause what eye palsy?

A

Bilateral abducens nerve palsies - long intracranial course makes it vulnerable to compression or stretching at skull base

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57
Q

Parinaud syndrome

A

Seen with pinealoma

  1. Limitation of upward gaze
  2. Light-near dissociation (pupillary light reaction impaired while the near reaction (accommodation) remains intact)
  3. Eyelid retraction
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58
Q

Who has carotid sinus hypersensitivity? Dx and treatment

A

Elderly men with atherosclerotic disease - baroreceptors are overly sensitive and trigger exaggerated vagal response from minimal tactile stimulus (e.g. shaving, rubbing of shirt color)

Dx - carotid massage + tilt table (note: avoid with suspected carotid artery stenosis)

Treat - permanent pacemaker

59
Q

Who has hyperkyphosis?

A

Ankylosing spondylitis

60
Q

Ankylosing spondylitis complications

A
  1. Osteopenia/osteoporosis - increased osteoclast activity iso chronic inflammation
  2. Spinal rigidity increases risk of vertebral fracture
  3. Aortic regurgitation
  4. Cauda equina syndrome

Signs:
1. Thoracic wedging
2. Hyperkyphosis

61
Q

Which nucleus carries pain and temperature from face?

A

Spinal trigeminal nucleus

62
Q

Descending sympathetic fibers travel close to what tract?

A

Spinothalamic tract (pain and temperature)

63
Q

Midbrain stroke signs

A

Ipsilateral oculomotor (CN III) palsy
Contralateral hemiparesis (corticospinal tract)
Ataxia - dysfunction of red nucleus

64
Q

Parkinson disease dementia - timeframe

A

Parkinsonism predates cognitive impairment by >1 year (as opposed to Lewy body, where cognitive impairment is before or at same time)

65
Q

Progressive supranuclear palsy

A
  1. Parkinsonism
  2. Impaired vertical gaze
  3. Falls
66
Q

White matter edema in bilateral posterior cerebral hemispheres with sparing of cortical gray matter

A

Reversible posterior leukoencephalopathy syndrome (RPLS)

Most often caused by hypertensive emergency or rapid fluctuations in BP
Failure of cerebral autoregulation results in brain hyperperfusion and extravasation of fluid and blood products

Treat with gradual BP reduction; antiepileptics if seizures present

67
Q

Uremic encephalopathy signs

A

Tremor, asterixis and/or myoclonus
Widespread edema on neuroimaging (white + gray)
Confusion + seizures

68
Q

Red flags of Parkinson

A
  1. Early postural instability (pull test)
  2. Early bulbar dysfunction (e.g. dysarthria, dysphagia)
  3. Absence of nonmotor signs (e.g. sleep disturbance, constipation)
  4. Severe orthostatic hypotension (>=30 systolic drop)
  5. Symmetric symptoms, hyperreflexia
69
Q

Huntington disease - where is atrophy?

A

Caudate

Characterized by chorea, dementia, and psychiatric symptoms

70
Q

Autism brain findings

A

Accelerated head growth during infancy, increased total brain volume

71
Q

OCD brain findings

A

Structural abnormalities in orbitofrontal cortex and basal ganglia

72
Q

Thalamic pain syndrome

A

Stroke (lacunar) in thalamus –> burning pain (allodynia) and hyperesthesia (extreme sensitivity)

73
Q

Internal capsule stroke affects…

A

Motor deficits (alone or with sensory) from disruption of corticospinal fibers in posterior limb

74
Q

T2 hypersensitivity of spinal cord without compressive lesion

A

Transverse myelitis - inflammatory infiltrates increases water content of spinal cord

Lumbar puncture shows lymphocytosis, elevated IgG

Treat with glucocorticoids; plasmapheresis for significant motor symptoms or poor response to steroids

75
Q
  1. Vesicular rash on auditory canal
  2. Ipsilateral facial paralysis
A

Herpes zoster oticus (Ramsay Hunt syndrome) - reactivation from geniculate ganglion affects motor fibers of CN VII and spread to CN VIII

76
Q

Leading cause of Bell palsy

A

Reactivation of HSV-1

Acute-onset, unilateral facial paralysis

77
Q

Dietary treatment for drug-resistant epilepsy

A

Ketogenic (high-fat, low-carb) - due to downstream ketosis (anticonvulsant effects of fatty acids, altered GABA metabolism, vagal nerve stimulator)

78
Q

Management of migraines in pregnancy

A

Nonpharmacological interventions –> acetaminophen –> antiemetics (e.g. promethazine), codeine, caffeine –> NSAIDS (e.g. naproxen; only in 2nd trimester) –> opioids (e.g. oxycodone)

Parenteral antiemetics (e.g. metoclopramide are used acutely

79
Q

Eyelids, grip tightness slow to relax

A

Myotonic dystrophy - myotonia of muscles, as well as atrophy and weakness

Involves distal musculature

80
Q

Frontal (apraxic) gait is seen in what?

A

Normal pressure hydrocephalus
Frontal lobe degeneration

Magnetic gait - gait (Bruns) ataxia - caused by damage to corticocortical white matter tracts of frontal lobe

81
Q

Magnetic gait with slow, wide-based steps

A

Characteristic in NPH

82
Q

Gait in cerebellar degeneration (e.g. alcoholic)

A

Wide-based, shuffling gait

Also dysarthria, postural instability

83
Q

Spastic gait

A

Pyramidal or corticospinal tract lesions

Gait appears stiff or rigid with circumduction (spastic leg abducted and advanced while in extension and internal rotation) and plantar flexion of affected limb

84
Q

Internal capsule stroke should show what?

A

Contralateral hemiparesis of arms and legs, plus UMN facial palsy (spares upper face)

85
Q

Precentral gyrus stroke signs

A

Contralateral hemiparesis plus VANS:
Visual disturbances
Aphasia
Neglect
Sensory disturbances

86
Q

Facial weakness sparing upper face (UMN) indicates lesion above what levels?

A

Above the pons

87
Q

CN III palsy is lesion at what level?

A

Midbrain

Results in ptosis, cannot constrict pupil, down-and-out

88
Q

Vitamin A toxicity causes what ICP increase?

A

Idiopathic intracranial hypertension

89
Q

Which absorbs CSF?

A

Cerebral venous sinus - blockage can cause ICP increase and diffuse edema

Both cerebral venous sinus and cerebral vein thrombosis can cause increase in venule/capillary pressure, causing hemorrhage or local ischemia and edema

90
Q

C5/C6 facet dislocation

A

C6 radiculopathy: weakness of wrist extension, numbness of forearm and thumb

91
Q

C6/C7 facet dislocation

A

C7 radiculopathy: weakness of triceps extension and wrist flexion; numbness of index and middle finger

92
Q

Capelike loss of pain and temperature sensation, possibly flaccid paralysis

A

Syringomyelia - fluid-filled cavity in spinal cord

93
Q

Generalized slowing with periodic sharp wave complexes

A

Creutzfeldt-Jakob

Also see increased 14-3-3 protein in CSF

94
Q

Progressive supranuclear palsy

A

Vertical supranuclear palsy (inability to look up)
Dementia
Parkinsonism
Postural instability

95
Q

Traumatic brain injury leads to risk of secondary injury from…

A

Acute traumatic coagulopathy:
1. Hypocoagulability from consumptive coagulopathy
2. Hyperfibrinolysis - breaks down necessary clots

These can worsen or cause delayed intracranial hemorrhage

96
Q

Where can MRI pick up stroke better than CT?

A

Brainstem or cerebellum pathology

97
Q

Who more commonly gets subdural hematoma?

A

Those with cerebral atrophy (elderly, chronic alcohol use) - bridging veins must traverse longer distance and are more susceptible to tears

Symptoms classically occur gradually (e.g. over 1-2 days)

98
Q

Subdural hematoma - what is torn?

A

Tearing of bridging veins –> slow bleeding into subdural space

99
Q

Describe uncal herniation progression

A

Ipsilateral pupillary dilation (CN III compression) + contralateral hemiparesis (compression of ipsilateral cerebral peduncle) –> ipsilateral hemiparesis (compression of contralateral cerebral peduncle)

100
Q

Above what level cord compression does urinary retention occur?

A

Above S2 (autonomic descending motor tract involvement)

101
Q

What causes most cases of trigeminal neuralgia?

A

Vascular compression as nerve root enters the pons

MS, in contrast, has inflammatory plaques that affect the nuclei or compress the nerve roots

102
Q

What are causes of bilateral trigeminal neuralgia?

A
  1. MS (trigeminal sensory nuclei close to midline)
  2. Internuclear ophthalmoplegia (medial longitudinal fasciculus is close to midline
103
Q

Sleep-onset insomnia - pathophysiology, treatment

A

ACh dysregulation may play role

Treatment: Dual orexin receptor antagonists (e.g. lemborexant)

104
Q

Central cord syndrome - pathophysiology, diagnosis

A

Older individual with stenotic cervical spinal canal (e..g. due to cervical spondylosis) experiences hyperextension injury to neck –> compression –> damage to grey matter of central spinal cord (generally sparing lateral spinal tracts running to sacrum)

Diagnose with cervical myelogram

105
Q

Internal capsule components

A

Posterior limb: corticospinal tract
Genu: Corticobulbar tract

106
Q

Partial ipsilateral Horner syndrome seen with…

A

Carotid artery dissection (i.e. intimal tear)

Ptosis and miosis without anhidrosis

107
Q

Greatest risk factors for TIA or stroke

A
  1. Hypertension
  2. Smoking
  3. Diabetes
  4. Hypercholesterolemia
108
Q

Pons cranial nerves

A

VI-VIII

109
Q

How to improve muscle spasticity in multiple sclerosis?

A
  1. Baclofen - GABA-B receptor agonist
  2. Tizanidine - a2 agonist - perhaps by decreasing alpha motor neuron excitability
110
Q

Autonomic dysreflexia; above what level would there be continued vasoconstriction involving both splanchnic and peripheral vasculatures, causing severe hypertension?

A

Spinal cord injury:
Noxious stimulus below lesion triggers sympathetic activity but without parasympathetic modulation

Lesions at or above T6: prolonged, severe HTN may cause headache, intracranial hemorrhage

111
Q

Where is norepinephrine produced in brain?

A

Locus coeruleus

112
Q

Where is serotonin produced in brain?

A

Raphe nuclei

113
Q

Acute dystonia - treatment

A

Benztropine (anticholinergic)

Not used for tardive dyskinesia

114
Q

Akithisia - treatment

A

Propranolol

Not used for tardive dyskinesia

115
Q

Frontotemporal dementia gene

A

TDP-43: TAR (transactive response) DNA-binding protein

116
Q

Tardive dyskinesia - treatment

A

Valentine or deutetrabenazine (vesicular monoamine transporter 2 (VMAT2) reversible inhibitor)

117
Q

When is trihexyphenidyl preferred for Parkinson disease?

A

Anticholinergic:
Tremor predominant symptom
Younger age (fewer side effects)

118
Q

Catatonia

A
  1. Immobility or excessive purposeless activity
  2. Mutism, stupor
  3. Negativism (resistance to instructions and movement)
  4. Posturing (against gravity)
  5. Waxy flexibility
  6. Echolalia, echopraxia

Treat with benzos (lorazepam), ECT

119
Q

Akinetic mutism vs catatonia

A

Lesions in frontal cortex vs syndrome associated with mood disorders, psychotic, autism, general medical illnesses
No echophenomena

120
Q

REM sleep behavior disorder is associated with what neuro disorder?

A

Parkinson disease - development of alpha-synuclein neurodegenerative disorders

121
Q

MS - treatment

A

Acute attacks: High-dose glucocorticoid
Disease-modifying (requires having met diagnostic criteria): dimethyl fumarate

122
Q

Cerebellar drift

A

Ipsilateral upward arm drift

Pyramidal lesion leads to downward arm drift

123
Q

Clasp-knife phenomenon

A

Velocity-dependent resistance to passive movement of limb

Seen in hypertonia dur to pyramidal tract disease

124
Q

Signs of anti-NMDAR autoimmune encephalitis

A

Psychiatric symptoms
Cognitive impairment
Autonomic instability
Rigidity
Hyperreflexia
Dystonia
Focal seizure

125
Q

Temporal arteritis is associated with…

A

Polymyalgia rheumatica

126
Q

Temporal arteritis commonly presents with what specific optic symptoms?

A

Anterior ischemic optic neuropathy
Amaurosis fugax

127
Q

Blepharospasm - signs, treatment

A

Forceful contraction of eyelid muscles; form of focal dystonia
If associated with spasm of lower face: Meige syndrome

Triggered by bright lights, terminated by touching/brushing skin around eye (sensory trick)

Treatment: botulinum toxin for more significant symptoms

128
Q

How does multiple system atrophy add to Parkinson? Management?

A

Early falls
Autonomic dysfunction
Pyramidal (eg hyperreflexia)
Cerebellar (eg wide based gait)

Supportive:
Intravascular volume expansion with fludrocortisone, salt supplementation, alpha agonists, compression stockings

129
Q

Shoulder abduction relief test

A

For cervical radiculopathy - both diagnostic and therapeutic

130
Q

ALS treatment

A

Riluzole - glutamate inhibitor

Edaravone - antioxidant

131
Q

How does anterior cord syndrome differ in limbs affected compared to central or posterior?

A

Think about how the lateral corticospinal react is arranged radially (arm, trunk, leg from inside to outside)

Anterior: upper and lower extremities affected equally
Central: mostly upper
Posterior: lower, if involved

132
Q

“Dancing eyes and feet”

A

Opsoclonus-myoclonus syndrome; antibody-mediated from neuroblastoma

133
Q

Where is anterior spinal cord ischemia most likely?

A

T10-T12, aortic dissection causes interruption of arteries that feed anterior spinal cord

134
Q

What is subacute sclerosing panencephalitis?

A

Fatal complication of measles, personality changes -> dementia -> death

135
Q

Aquaporin-4 autoantibody

A

Neuromyelitis optica

136
Q

Neuromyelitis optica vs multiple sclerosis

A

> =3 spinal cord involvement, negative oligoclonal bands, gray matter affected, aquaporin-4 autoantibody

Optic nerves, spinal cord, area postrema of brainstem affected, causing optic neuritis, transverse myelitis, and vomiting/hiccups, respectively

137
Q

How does Parkinson’s lead to orthostatic hypotension?

A

Autonomic dysfunction due to degenerative changes -> impaired norepinephrine release -> drop in BP with standing without compensatory increase in HR

138
Q

Miller Fisher syndrome

A

Variant of GBS with only ophthalmoplegia, ataxia, and areflexia

139
Q

Finger to nose vs heel shin tests

A

Finger to nose tests limb coordination, while heel shin tests postural

In alcoholic cerebellar degeneration, postural is affected but not limb

140
Q

Bell palsy typically due to what virus?

A

HSV reactivation

141
Q

Cremasteric reflex - spinal cord levels

A

L1-L2

142
Q

Dexamethasone should be added to bacterial meningitis treatment for which bacteria?

A

S pneumo and Hib - decreases complications

143
Q

Toxoplasmosis - treatment

A

Pyrimethamine (high-dose, PO) + sulfadiazine and leucovorin (folic acid analog to prevent hematologic toxicity)

Clindamycin if sulfa allergy

Neuro/Psych (7 decks)

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