First aid Neuro Path Not In Pathoma

Question 0

Where does a partial seizure MC originate?

Answer 0

Medial temporal lobe, often preceded by a seizure aura

Question 1

What characterizes seizures?

Answer 1

Synchronized high frequency neuronal firing

Question 2

What’s the difference btwn a simple and complex partial seizure?

Answer 2

Simple partial seizure: consciousness is intact

Complex partial seizure: impairs consciousness

Question 3

What are the 5 types of generalized seizures? How does the pt look?

Answer 3

Generalized seizures = diffused

1. Absence seizure: petit mal, no postictal confusion, blank stare
2. Myoclonic seizure: quick repetitive jerk
3. Tonic-clonic seizure: grand mal, alternating stiffening & movement
4. Tonic seizure: stiffening
5. Atonic seizure: “drop” to the floor

Question 4

What can cause seizures in kids?

Answer 4

Genetics
Infection - fever (febrile seizures)
Trauma
Congenital
Metabolic

Question 5

What causes seizures in adults?

Answer 5

Tumors
Trauma
Stroke
Infection

Question 6

What causes seizures in elderly?

Answer 6

Stroke
Tumor 
Trauma
Metabolic 
Infection

Question 7

What’s a migraine? What’s it due to?

Answer 7

4-72 hr pulsating pain with nausea, photophobia or phonophobia w/ or w/out aura before HA

Due to irritation of CN V & release of substance P, CGRP and vasoactive peptides

Question 8

How do u treat a migraine?

Answer 8

Sumatriptan -acute migraines (5-HT 1b/d agonist - vasoconstriction, inhibits CN V activation and vasoactive peptide release)
Propranolol
NSAIDs

Question 9

What’s a tension headache?

Answer 9

Bilateral headache > 30 min steady pain. No aura, photophobia or phonophobia

Question 10

What’s a cluster headache?

Answer 10

Unilateral repetitive brief headaches w/ periorbital pain & ipsilateral lacrimation, rhinorrhea and horners syndrome

More common in males

Question 11

How do you treat a cluster headache?

Answer 11

Inhaled oxygen and sumatriptan (5-HT 1b/d agonist)

Question 12

Wheres the prob in peripheral vertigo? How do u test it?

Answer 12

more common type
Inner ear etiology (semicirc. Canal debris, CN 8 infection, Menieres Dx)

Positional testing: delayed horizontal nystagmus

Question 13

Where’s the prob in central vertigo? How do u test it?

Answer 13

Brainstem or cerebellar lesion (vestibular nuclei, posterior fossa tumor)

Positional testing: immediate nystagmus in any direction l

Question 14

What’s struge-weber syndrome?

Answer 14

Congenital neuro cutaneous dx w/ port-wine stains (nervous flammeus) usu in CN V1 ophthalmic distribution
Ipsilateral leptomeningeal angiomas and phenochromocytoma

Question 15

What can struge-weber syndrome cause?

Answer 15

Glaucoma
Seizures
Hemiparesis
Mental retardation

Question 16

What’s tuberous sclerosis and what are clinical findings?

Answer 16

AD dx (TSC1-9q or 2-16p) Hamartomas in the CNS and skin
"HAMARTOMAS"
H- hamartomas
A- adenoma sebactum (cutaneous angionfibromas on face, butterfly)
M- mitral regurg 
A- ash leaf spots 
R - rhabdomyoma
T- tuberous sclerosis 
O - autOsomal dom
M - mental retardation
A - angiomyolipoma
S- seizures

Question 17

What’s neurofibromastosis 1 (Von Recklinghausen’s dx)? Characteristics?

Answer 17

AD defect in NF-1 gene (chrom 17q; product = neurofibromin; tumor suppressor), 100% penetrant but variable expression
Axiallary and groin cafe-au-lait spots
Lisch nodules - pigmented iris hamartomas
Neurofibromas in skin
Optic gliomas
Pheochromocytoma

Question 18

What’s important to remember about neurofibromastosis II?

Answer 18

Remember the 2s

AD, chrom 22 w/ bilateral (2) vestibular schwannomas

Question 19

What’s Von hippel-lindau disease?

Answer 19

AD mutated tumor suppressor VHL (chrom 3 - 3 letters & words to name)
Cavernous hemangiomas in skin, mucosa, organs
Bilateral renal cell carcinoma hemangioblastoma in retina, brain stem, cerebellum
Pheochromocytoma
Pancreatic islet cell tumors

Question 20

What’s the MC pituitary adenoma? What do u see with it?

Answer 20

Prolactinoma

Signs: bitemporal hemianopsia (compresses optic chiasm) & hyper or hypopituitarism

Question 21

What’s a hemangioblastoma? Histo?

Answer 21

Kid cerebellar tumor, assoc w/ Von Hippel-Lindau syndrome when found w/ retinal angiomas
Can produce EPO ➡️ secondary polycythemia
Histo: foamy cells & highly vascular

Question 22

If see a ring-enhancing lesion in the brain what’s a good differential?

Answer 22

Metastasis (lung > breast > kidney > melanoma > GI), abscess, toxoplasmosis, primary CNS lymphoma (assoc w/ AIDS, EBV)

Question 23

If see a uniformly enhancing lesion in the brain what’s a good differential?

Answer 23

Metastatic lymphoma (usu B-cell non-Hodgkins)
Meningioma
Metastasis (but usu ring enhancing)

Question 24

If see a heterogenously enhancing lesion in the brain what’s a good differential?

Answer 24

Glioblastoma multiforme