CNS Flashcards
essential tremor
- most commonly diagnosed movement disorder.
- referred to as familial tremor as it often follows autosomal dominant inheritance
- classically worsens while maintaining a particular posture (eg, when holding an object).
- improve with alcohol consumption
- Propranolol is the first-line treatment for essential tremor
Creutzfeldt-Jakob disease
Detection of elevated amounts of 14-3-3 protein in CSF
Alzheimer disease
level of melatonin in CSF has been shown to decrease with the progression of Alzheimer disease.
Altered levels of the primary dopamine metabolite, homovanillic acid
linked to many psychiatric conditions, including substance use disorders, psychosis, and mood disorders.
also decreased in patients with Parkinson disease.
Low CSF 5-hydroxyindole-acetic acid
associated with impulsive, destructive behaviors, particularly aggression, suicide, and violence.
embolic stroke
- history of paroxysmal atrial fibrillation and ischemic stroke off anticoagulation
- Stroke is one of the most common causes of seizure, which occurs due to the release of excitotoxic neurotransmitters in the ischemic brain region.
frontal eye field
- region of the cerebral cortex that controls horizontal eye movement.
- Activation of the left frontal eye field during seizure would cause the eyes to deviate horizontally to the right
- After the seizure, the patient’s eyes may temporarily deviate to the left due to postictal neuroinhibition
motor speech (Broca) area
- located in the posterior inferior frontal gyrus of the dominant (usually left) hemisphere
- responsible for controlling expressive
speech/language. - seizure originating from Broca area would likely result in ictal speech and vocalizations.
sensory speech (Wernicke) area
- located in the posterior superior temporal gyrus of the dominant hemisphere
- responsible for language comprehension.
- A seizure originating from the temporal lobe of the cerebral cortex would likely result in auditory hallucinations.
primary visual cortex in the occipital lobe
- responsible for processing visual information from the contralateral homonymous visual fields
- A seizure originating from the left primary visual cortex would likely result in visual hallucinations affecting the right homonymous visual fields.
ischemic stroke
- patient with multiple cardiovascular risk factors, dizziness/gait instability, and a cerebellar lesion on neuroimaging
- Thrombosis or embolism of atherosclerotic plaques involving the posterior circulation (eg, vertebral arteries) can interrupt blood circulation to the cerebellum, resulting in tissue hypoxia and irreversible neuronal injury with subsequent necrosis, inflammation, and repair.
neuroleptic malignant syndrome (NMS)
potentially life-threatening adverse reaction to neuroleptics (antipsychotic)
- diagnosis of NMS requires a recent history of exposure to a neuroleptic medication. This patient is more likely to have received an antipsychotic rather than a selective serotonin reuptake inhibitor antidepressant (not indicated in acute mania) or lithium (requires gradual up-titration and serum levels).
- predominant cause of NMS appears to be antagonism of central dopaminergic systems involved in thermoregulation and regulation of muscle tone and movement.
- clinical presentation of NMS consists of 4 primary features: hyperthermia, severe generalized “lead-pipe” rigidity, autonomic instability, and altered mental status
Serotonin syndrom
also present with mental status changes, hyperthermia, and autonomic instability, it typically presents with neuromuscular hyperactivity (shivering, clonus, and hyperreflexia) as opposed to the diffuse rigidity and bradyreflexia seen in NMS.
- Nausea, vomiting, and diarrhea are more common in serotonin syndrome
extrapyramidal symptoms)
Antipsychotic D2 receptor antagonism in the nigrostriatal pathway can cause a variety of reactions
Acute dystonic reactions
involve distressing contractions of the neck, mouth, and tongue.
