Incorrect Flashcards
Carotid dissection classic symptom
Horner syndrome
Eye movments in Pons damage
Downward gaze, NO NYSTAGMUS
Eye movements in cervicomedullary damage
Downard gaze WITH NYSTAGMUS
Hollenhorst plaques
cholesterol on fundoscopic exam
Which physical exam finding localizes a lesion to CNIII vs Superior cervical ganglion
Pupil diameter in affected eye
CNIII palsy –> lost constriction–> mydrasis
Superior ganglion –> loss of SNS –> miosis
Most common compliation of bells palsy after recovery
Aberrant regeneration of the facial nerve leads to involuntary facial movements (mouth twitch every time the ipsilateral eye blinks)
How to determine if RBCs in the CSF after LP are from traumatic procedure or from true CNS hemorrhage?
If true hemorrhage, RBCs will be equal in all the tubes
If traumatic LP, RBC count will decrease from tubes 1–>4
Next and best test after a positive LP for SAH
CT angio to look for aneurysm
Dandy walker MRI findings
Tiny cerebellar tonsil (leaves a cavern that you can WALK around in)
Chiari II malformation findings
downward herniation of the cerbellar vermis leading to aqueductal stenosis and noncommunicating hydrocephalus
what does hyperdense lesion mean on contrast vs non contrast enhanced CT?
Hyperdense on nonCon means CALCIFIED
Hyperdense on contrast enhanced means VASCULAR
“Brain tumor that appears to arise from the bone”
Meningioma (because the meninges are so closely adhered to the bone
telangectasias in the setting of proximal muscle weakness suggests?
Dermatomyositis
If you have myopathy, what does EMG show?
Brief low voltage action potentials or fibrillation potentials
Muscle bx findings in dermatomyositis vs polymyositis
dermato = perifasicular atrophy with perimysial inflammation
polymyositis= inflammatory cells within the actual fiber
CSF analysis in seizure patients
totally normal
nucleus ambiguous location and components
In the medulla, contains nuclei for CN9 and 10
dmg to it causes dysphagia
nucleus solitarius location and components
medulla, contains 7,8,9
2 most common arteries that cause lateral medullary syndrome
Vertebral and PICA
Artery supplying the medial medulla
Anterior spinal artery
Artery supplying lateral pons
AICA
Artery supplying medial pons
Basilar
Artery supplying the entire midbrain
Posterior cerebral artery
Mycotic aneurysm (appearance on CT and cause)
Small, multiple lesions that are contrast enhancing
Caused by BACTERIAL seeding from IV drug use –> aneurysm forms in the wall and then ruptures –> SAH
Intracerebral manifestation of Sturge Weber
Leptomeningeal angiomas
vision change seen in MCA vs ACA stroke
MCA –> contralateral homonymous hemianopsia 2/2 dmg of the optic radiations
ACA–> No vision change!
First imaging study to get in new seizure? EEG or MRI?
MRI because it will help point you to the etiology whereas EEG will simply confirm that they had a seizure
Timeline of alcohol withdrawal seizures vs. DT
Seizures 1-2 days
DTs 3-4days
Classic EEG finding for infantile spasms
Hypsarrhythmia
Psychiatric symptoms w/ bizzare psychotic behaviors AND an aura
Complex generalized seizure…don’t necessarily need motor symptoms
Symptoms of basilar migraine
Weakness/paralysis
Vision changes
Transient LOC
HEADACHE FOLLOWS the above symptoms
how to differentiate between trigeminal neuralgia and atypical facial pain? both are unilateral…
Trigeminal neuralgia is PAROXYSMAL lanciating pain and is triggered
Atypical facial pain is constant and deep pain
What should you suspect if a patient with preexisting neuro deficits develops NEW onset unilateral facial pain?
MS–> trigeminal neuralgia is a common manifestation in MS, as demyelination can affect CN V
Pope sign (inability to extend 4th/5th digits) is caused by damage to which nerve
Ulnar nerve at the elbow –> ulnar nerve innrvates intrinsic hand muscles
Nerve responsible for flexion of the arm at the elbow. When is it classically damaged?
Musculocutaneous nerve –> also gives sensory to volar aspect of arm
Classically damaged in humerus fractures
2 lobes of brain most commonly injured in direct blow to the front of head (hit head on windshield)
Anterior temporal lobes
Inferior frontal lobes
These are the two most anterior parts of the brain
Most common long term side effect of a frontal head trauma?
Anosmia/Aguesia –> severing of the olfactory roots
First step in management of spinal cord injuries
IV Steroids!
Most common CN affected by neurosarcoid
CN VII –> patients often complain of unilateral facial weakness
Cystic brain lesion filled with multiple smaller cysts
Echicnococcus
Routine CSF finding in CJD
Typically normal…maybe mildly elevated protein
2 MCC of ring enhancing lesion in AIDS patient? Next test after identification of that lesion?
CNS lymphoma and toxoplasmosis
Next test is to get a LP with CSF analysis for EBV (to rule out CNS lymphoma)
Treatment for JC virus
HAART…not a cure but may improve prognosis
What must absolutely be done prior to LP in patient with concern for encephalitis?
Head imaging to r/o swelling or elevated ICP…if ICP is increased, LP could lead to herniation
buzzword: microglial nodules (2DDx)
HIV encephalitis
CMV
Early complication of HSV encephalitis
Seizures originating from the temporal lobes
MCC of fungal vs bacterial CNS abscess
Fungal- aspergillius
Bacterial- strep viridins/ staph
how to differentiate meningoencephalitis vs rhomboencephalitis
Meningoencephalitis –> dysarthria, seizures, UMN signs
Rhomboencephalitis –> localized brain stem signs (CN deficits)
PML histology
Dark staining inclusions iwthin the oligodendrocytes
Autonomic symptoms + distal weakness
Guillan Barre
Increase IgG and oligoclonal bands in csf ddx (2)
MS
SSPE
Unique meningoma PE finding
Hyperosteosis on the skull –> increased thickness
Cysts in multiple organs with brain lesion. What is the disease and brain lesion
VHL –> hemangioblastoma
Brain mets w/o known primary. MCC cause?
Lung CA
Highest risk associated with posterior fossa tumors
Brainstem herniation
Child with ataxia, hydrocephalus w/ posterior fossa tumor
Medulloblastoma
Tay Sachs deficiency
hexaminidase A
tAAAy sachs = hex A
Gaucher disease defective enzyme and toxic metabolite
Glucosidase deficiency –> glucosylceramide accumulation
Hypertensive encephalopathy CSF finding
Elevated protein
Most common neuro finding in CKD patients.Why? How to improve it?
Peripheral neuropathy 2/2 loss of B vitamins…. improves with dialysis or renal transplant
B12 def labs
High MMA, high homocystine, low methionine
Classic B12 def visual disturbance
Enlarged blind spot that obscures central vision
