high yield final review Flashcards
MCA stroke
Contralateral sensory loss
Contralateral weakness
Gaze deviates toward the side of infarction
Contralateral homonymous hemianopia without macular sparing
Aphasia if in dominant hemisphere - Broca, Wernicke, Conduction
Hemineglect if in nondominant hemisphere
ACA stroke
Contralateral weakness lower limbs > upper limbs
Contralateral sensory loss lower limbs > upper limbs
Abulia
Urinary incontinence
Dysarthria
Transcortical motor aphasia
Limb apraxia
Symptoms of Thalamic Stroke, PCA
Decreased arousal Variable sensory loss Aphasia Visual field losses Apathy, agitation, personality changes
Sudden HA, focal deficits meningeal irritation (neck pain, photophobia)
subarachnoid hemorrhage secondary to berry aneursym
PICA stroke, ie Lateral Medullary Syndrome
Can also be seen with vertebral artery infarction
Dysphagia, hoarseness, hiccups, decreased gag reflex: specific to posterior inferior cerebellar artery lesions (vs. vertebral artery)
Nystagmus, vertigo
Body: contralateral decrease in pain and temperature sensations
Face: ipsilateral decrease in pain and temperature sensations
Ipsilateral limb ataxia and dysmetria
Autonomic dysfunction: ipsilateral Horner syndrome
Horner Syndrome
decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face
Infarction of the posterior limb of the internal capsule is the most common type of_____ stroke and may manifest clinically with pure motor stroke, pure sensory stroke (rare), sensorimotor stroke, dysarthria-clumsy hand syndrome, and/or ataxic hemiparesis.
lacunar, it lenticulostriate
Menierre Disease
impaired resorption of endolymphatic fluid caussing backup in inner with, w/ sx of vertigo, hearing loss, and tinnitus + usually N/V and nystagmus
What is Weber and Rinne of Menierre’s Disease?
Weber test: lateralization to the healthy ear (sensorineural hearing loss in affected ear)
Rinne test: bilaterally positive
Vestibular Neuritis
following viral infections of the upper airways, acute-onset vertigo, nausea, vomiting, and gait instability in otherwise healthy patients; tx w/ steroids to preserve hearing
Does vestibular neuritis have cochlear sx?
NO! No hearing loss, No tinnitus
Typical temporal lobe epilepsy presentation
Aura + complex partial seizure
Motor symptoms: typically oral alimentary automatisms like lip-smacking; fidgeting, stretching, walking in place
Autonomic symptoms: tachycardia, urge to void the bladder, mydriasis, sweating, salivating
Altered mental status: appear absent minded but no LOC
Typical frontal lobe epilepsy presentation
simple partial seizures featuring various motor symptoms (muscle tension, vocalization, gaze deviation, or head directed towards the unaffected side )
Infantile spasms/ west syndrome 2/2 tuberous sclerosis, perinatal infxn, HIE
Sudden symmetric, synchronous spasms, usually in clusters of 5–10
Jerking flexion (jackknife movement) or extension of the neck, torso, and extremities
Followed by a tonic phase
Infantile spasm EEG
high-voltage delta waves with irregular multifocal spikes and slow waves
most common primary tumor of childhood
pilocytic astrocytoma
most common malignant brain tumor of childhood
medulloblastoma
malignant tumor in kids, blocks CSF flow, anaplastic small round blue cells that surround a central neuropil (Homer-Wright rosettes)
medulloblatoma
This childhood tumor can appear like medulloblastoma but actually lives in the 4th ventircle not the cerebellum
ependymoma
suprasellar, rathke pouch, bitemporal hemianopsia, can affect pituitary hormones through compression
craniopharyngioma
Hearing test of bilateral scwhannoma
Audiometry - Hearing loss with greater deficit for higher frequencies
Weber test: lateralization to the normal ear; no lateralization if NO problem or if BOTH w/ symmetrical schwannoma
Rinne test: air conduction > bone conduction in both ears
how to treat prolactin secreting pituitary adenoma?
bromocriptine, cabergoline
A life-threatening complication of bacterial meningitis (especially meningococcal meningitis) is
Waterhouse-Friderichsen syndrome, which is characterized by disseminated intravascular coagulation and acute adrenal gland insufficienc
meningitis gram + rods
listeria
meningitis gram + diplococci
pneumococci
meningitis gram - diplococci
meningitidis
meningitis gram - coccobacilli
haem influ
CSF cloudy w/ pleocytosis of leukocytes, low glucose, high protein
suggestive of bacterial; viral would be near normal
empiric meningitis tx 1-50 y/o
vanc + ceph (cefotaxime or ceftriaxone)
empiric mengitis tx > 50
vanc + amp + ceph
ring enhancing lesions
Brain metastases Tuberculomas Neurocysticercosis Subacute hemorrhage and/or infarction Toxoplasmosis Primary CNS lymphoma
Neurocysticercosis
A tapeworm infection that affects the brain, muscle, and other tissues.
Cysticercosis is spread by contact with tapeworm-infected human feces. Contaminated food, water, and dirty hands are all sources.
Cysticercosis may cause lumps under the skin. When it spreads to the brain or spinal cord, headaches and seizures may occur.
Tx of HIV pt with cerebral toxo (ring-enhancing lesion)
Pyrimethamine, sulfadiazine, and leucovorin
Demyelinating disease of the CNS caused by reactivation of the JC virus
PML
encephalopathic sx associated with HSV encephalitis
Focal neurological deficits (primarily affects the medial temporal lobe) [5]
Altered sense of smell and loss of vision
Aphasia
Memory loss
Hemiparesis
Ataxia
Hyperreflexia
Seizures (focal or generalized)
Altered mental status (e.g., confusion, disorientation, lowered level of consciousness)
Behavioral changes (e.g., hypersexuality, hypomania, agitation)
Meningeal signs (e.g., nuchal rigidity, photophobia) may occur.
Coma
How to differentiate HSV encephalitis from meningitis?
combination of altered mental status, seizures, and focal neurological deficits is more common for HSE!
HSE imaging findings
Hyperintense temporal lobe lesions and signal abnormalities (usually in the hippocampus)
rapidly progressive dementia and myoclonus, neuron‑specific enolase, S100 protein, tau protein, 14-3-3 protein, EEG with triphasic periodic sharp wave complexes with a frequency of 1–2 Hz, definitive diagnosis with biopsy, die within 12 mo
CJD
How does clostridium tetanus lead to sustained muscle contractions?
Tetanospasmin reaches the CNS through retrograde axonal transport. Toxin binds to receptors of peripheral nerves and is then transported to interneurons (Renshaw cells) in the CNS via vesicles. Acts as protease that cleaves synaptobrevin, a SNARE protein → prevents the release of inhibitory neurotransmitters (i.e., GABA and glycine) from Renshaw cells → uninhibited activation of alpha motor neurons → muscle spasms, rigidity, and autonomic instability
Tetanus in a neonate
unsterilized cutting of umbilical cord; Difficulty opening the mouth and feeding due to trismus and risus sardonicus, Muscle stiffness and opisthotonus, Clenched hands
are but lethal late complication of measles
subacute sclerosing panencephalitis (SSPE) - A lethal, generalized, demyelinating inflammation of the brain caused by persistent measles virus infection. SSPE is characterized by dementia, myoclonus, and epilepsy, leading to coma and death. It is a very rare complication that develops several years after initial infection with measles.
tertiary syphillis affects on CNS
pupillary defect + dementia + tabes dorsalis (Tabes dorsalis - demyelination of the dorsal columns and the dorsal root ganglia; Broad-based ataxia + pains and loss of sensation)
tabes dorsalis and SCD due to vitamin B12 deficiency are similar in that they BOTH lead to degeneration of the ___
dorsal columns! can be seen as hyperintensity on imaging
this virus replicates in the gastrointestinal tract following oral ingestion → enters the bloodstream → potential invasion of the grey matter of the spinal cord (particularly the anterior horn cells) → myelitis w/ sx weakness, decreased muscle tone, and hyporeflexia
polio
how to differentiate coma vs brain death
coma (no sleep-wake cycles) and brain death (no sleep-wake cycles or brainstem function)
Examples of dyssomnias (trouble falling asleep or staying asleep)
Insomnia disorder Hypersomnolence disorder Obstructive sleep apnea Central sleep apnea Narcolepsy Circadian rhythm sleep wake disorder
Examples of parasomnias: abnormal behaviors or experiences that occur while falling asleep, during sleep, or while waking up
Non-REM sleep arousal disorder (Sleepwalking, Sleep terrors)
REM sleep arousal disorder (REM sleep behavior disorder, Nightmare disorder)
Restless legs syndrome
A non-REM sleep arousal disorder characterized by episodes of apparent nightmares, during which patients will show signs of stress (including tachycardia or diaphoresis), are difficult to rouse, and do not recall what they dreamed after awakening.
sleep terror disorder
A parasomnia characterized by dream enactment (e.g., purposeful movements, such as reaching for objects) due to loss of REM sleep atonia. Associated with Parkinson disease, multiple system atrophy, and dementia with Lewy bodies.
REM sleep behavior disorder
REM sleep EEG
Beta Waves
Non-REM sleep EEG
Theta and Delta
When do Beta Waves (> 13 hz) occur?
Awake and when in REM sleep
sleepwalking, night terror disorder, bedwetting occur during this part of sleep
deep N3 Non-Rem sleep
imaging findings with alzheimers disease
Diffuse cortical atrophy
Hippocampal atrophy
dementia + hallucinations + act out dreams + parkinsonism
lewy body dementia
alcoholic + Confusion
Ataxia
Ophthalmoplegia + chronic will see atrophy of mamillary bodies
Wernicke encephalopathy
drugs used in dementia treatment
cholinesterase inhibitors (donepezil, rivastigmine, galantamine) + NMDA antagonism (memantine)
looks like PD (slow, rigid, tremor) but also has autonomic sx (ED, bladder control, bp and hr issues) +/- cerebellar issues (balance, eye, speech)
multiple systems atrophy
postural instability (easy falls) + frontal lobe abnormalities (apathy, disinhibition, impaired reasoning + gaze palsy + dementia and PD-like symptoms
progressive supranuclear palsy
MRI finding consistent with PSP
atrophy of midbrain structures with a relatively intact pons region
PD+ w/ Lewy bodies and Autonomic dysfunction with urogenital problems
MSA
PD+ w/ Vertical gaze palsy and Frontal lobe disturbances
PSP
PD+ w/ Asymmetric motor symptoms and Alien limb phenomenon
Corticobasilar Degeneration
PD+ w/ Lewy bodies and Visual hallucinations
LBD
trauma, middle meningeal artery, initially lucid then onset sx 2/2 + of ICP, biconvex hyperintensity
EPI dural hematoma (think above is TOUGH and needs artery to MAKE SPACE)
crescent shaped, bridging vein, Increasing headache over days or weeks
Changes in mental status
subdural hematoma
ipsilateral Horner syndrome, palate weakness, hemiataxia, and contralateral sensory disturbances
PICA or vertebral artery, lateral medulla
bilateral damage to the ventral pons characterized by quadriplegia and bulbar palsy
locked in syndrome
woman of child-bearing age on OCP w/ HA, worsened to seizures and focal neuro sx, papilledema, N/V + tx w/ heparin
venous thrombosis
pathogenesis of venous thrombosis
Thrombogenesis occurs in the cerebral venous system, including the dural sinuses → ↓ cerebral drainage → ↑ intracranial pressure → clinical features
