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MC Qs Flashcards

1
Q

37 yo M says he’s 39 yo, gives name of the hospital up the street, wrong date by 1 month and 1 year, says president is Bush

Dx

A

Dx = Ganser’s syndrome = syndrome of approximate answers

  • pattern of answering questions just off
  • frequently seen in prison inmates, generally considered a form of malingering
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2
Q

67 yo M w/ 1 yr of cognitive deficits w/ difficulty sustaining attention and short-term memory problems

  • h/o bacterial meningitis 5 yrs ago
  • feet seem glued to floor when walks
  • noted to smell of urine

Dx

A 
Dx = NPH (normal pressure hydrocephalus)
'wacky, wobbly, wet'
-dementa
-gait ataxia
-urinary incontinence
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3
Q

Intracerebral hemorrhage in what location is most likely to need neurosurgical intervention

A

Cerebellum b/c any mass lesion or swelling in the cerebellum can cause 4th ventricle occlusion => CSH obstruction => hydrocephalus => death

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4
Q

While on izoniazid and rifampin for Tb tx, what supplement should a pt be on?

A

Pyridoxine (vit B6) supplement to prevent peripheral neuropathy (stocking-glove neuropathy)

-also notable that vit b6 excess can cause peripheral neuropathy

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5
Q

Pt believes pt is speaking a foreign language, can’t understand anyone but can read, write, and speak perfectly. Hearing is intact

(a) Dx
(b) Locate the lesion

A

(a) Dx = Pure Word deafness

(b) Lesion of b/l primary auditory cortex
- b/l damage to posterior superior temporal lobes or disruption of connections btwn the areas

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6
Q

CNS viral infection associated w/ retinitis

A

CMV

-can also cause encephalitis in the immunosuppressed

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7
Q

Most common cause of bacterial meningitis in neonates

A

Strep agalactiae (group B strep)

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8
Q

CNS manifestations of HSV encephalitis

A

Devastating temporal/frontal lobe hemorrhage

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9
Q

Neurologic complications of moderate HIV (CD4 200-500)

A
  • HIV associated dementia
  • Mononeuritis multiplex
  • HIV-associated myopathy or neuropathy
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10
Q

2 causes for paraneoplastic limbic encephalitis

A

MC = small-cell lung carcinoma

In 22 yo healthy F, also can be ovarian tumor

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11
Q

What is the empiric tx for toxo?

A

Sulfadiazine and pyrimethamine

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12
Q

What are lacunar strokes?

A

Lacunar strokes = infarctions of small vessels, one of the penetrating arteries providing blood to the brain’s deep structures

  • account for about 20% of all ischemic strokes
  • once again (like hemorrhagic), HTN is the biggest RF
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13
Q

4 features of Kluver-Bucy syndrome

A

Kluver-Bucy syndrome = damage to b/l amygdala

  1. hypersexuality
  2. placidity- diminished fear response of things that used to or normally trigger fear
  3. hyphagia and hyperorality: overeat, exacmine objects w/ mouth, pica
  4. visual agnosia: difficulty recognizing familiar faces or objects
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14
Q

In what genetic disease is Alzheimer’s disease an inevitability?

A

Down’s syndrome

-considered to be a neurodevelopmental model for AD

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15
Q

Name 3 inherited stroke d/o

A
  1. CADASIL = cerebral autosomal dominant arteriopathy w/ subcortical infarcts and leukoencephalopathy
    - p/w migraines, dementia, multiple lacunar strokes
  2. MELAS = mitochondrial (maternal inheritance) encephalopathy w/ lactic acidosis and stroke
    - p/w seizures and dementia in adolescence, stroke-like episodes of occipital region
  3. Sickle-cell
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16
Q

10 days s/p SAH pt becomes aphasic and weak on the right
-angiogram shows acute narrowing

(a) Dx
(b) Tx

A

(a) Dx = vasospasm

b) Tx = CCB, such as nimodipine (good centrally selective CCB

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17
Q

70 yo F w/ sudden onset R numbness (face, r. arm, r. leg). Motor intact b/l, recently d/c ASA for surgery

Where would MRI show an infarct?

A

Infarct of the thalamus- all sensory signals (both sensory tracts) go thru here, while no motor runs thru the thalamus

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18
Q

LP findings of Guillain-Barre syndrome

A

Normal opening pressure and glucose

Albuminocytologic dissociation = elevated protein (over 45) w/ normal WBC

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19
Q

Use of steroids in tx of bacterial meningitis

A

Should be given prior to first dose of abx, controversial but shown to help prevent hearing loss in pts w/ bacterial meningitis

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20
Q

Borrelia burgdorferi

A

Lyme’s Disease

Stage 1: erythema migrans rash
Stage 2: flu-like symptoms, meningitis, cardiac pathology
-numbness, pain, weakness, Bell’s palsy (numbness of facial muscles)
Stage 3: sensory neuropathy, potentially subtle cognitive changes

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21
Q

45 yo F develops HA and multiple small strokes

Angiogram shows beads on a string appearance of cerebral vessels

Dx

A

Dx = CNS vasculitis

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22
Q

How to determine if after a stroke a pt needs a carotid endarterectomy

A

Carotid Doppler/MRA- if carotid stenosis at or above 70% than do endarectomy, preferably w/in 2 weeks

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23
Q

Buzzword: lucid phase

A

Epidural hematoma

  • lens shaped
  • 2/2 injury of middle meningeal artery
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24
Q

47 yo M w/ sudden onset of severe, diffuse HA

  • vomits then collapses
  • obtunded on exam, groins upon neck flexion

Dx
(b) Mechanism

A 
Dx = subarachnoid hemorrhage
-buzzword = sentinel headache = 'worst headache of life'

(b) 2/2 damage to arterial side
- usually aneurysm rupture

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25
Q

87 yo M w/ caracts reports seeing ppl and animals in his house (bears and small cattle). Knows they’re not real but they don’t bother him much

Dx

A

Dx = Charles Bonnet syndrome

  • hallucinations (typically small animals and ppl)
  • mentally healthy, often w/ significant visual loss
  • understand the hallucinations are not real, typically not bothered by them
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26
Q

76 yo M w/ HTN c/o HA and slurred speech

  • gradual r. sided weakness
  • arousable but stuporous

Location of hemorrhage?

A

Intracerebral hemorrhage

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27
Q

Risk of VP shunt placement

A

-subdural hematoma

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28
Q

What factor best predicts pts w/ aneurysmal SAH?

A

Pts level of consciousness in the ER

  • not the location or size of the aneurysm
  • not the age of the pt or PMH
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29
Q

56 yo F gradually lost attention in daily activities

  • sits all day and does nothing
  • ineffective tx w/ antidepressant
  • no meaningful engagement
  • MMSE 30/30

Dx

A

Dx = frontotemporal degeneration

-apathy, abulia (absence of will or inability to act decisively)

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30
Q

What is transient global amnesia?

(a) Tx
(b) Ppx of future events

A

Transient global amnesia = complete reversible loss of anterograde and retrograde memory lasting up to 24 hrs

(a) No tx needed, but have to r/o
(b) No ppx needed b/c it very rarely recurs

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31
Q

Elderly pt w/ repeated ICH in many lobes of the brain

Suspected dx?

A

Cerebral amyloidosis = amyloid deposition in walls of CNS vessels

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32
Q

As a pt w/ Wernicke’s aphasia improves, what type of aphasia may they subsequently develop

A

Aphasias exist on a spectrum

Transcortical sensory aphasia = Wernicke’s w/ intact repetition

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33
Q

Abnormalities in what part of the brain causes akinetic mutism?

A

Cingulate gyrus = fold superior to corpus callosum involved w/ emotions and regulation of aggressive behavior

Akinetic mutism = lacking the drive to speak but is able to

-cingulate gyrus also implicated in psychiatric diseases (scz, OCD)

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34
Q

80 yo M 1 mo s/p MCA p/w headaches and forgetfulness, initial CT was normal

Dx?
(b) mechanism

A

Dx = subdural hematoma
-crescent shaped

(b) 2/2 damage to bridging veins draining into venous sinuses

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35
Q

General difference in symptoms of right vs. left brain ACA/MCA strokes

A

Left brain strokes => aphasia b/c left hemisphere is (usually) the language dominant hemisphere

Right brain injury => neglect syndrome (don’t perceive stimuli from left side) b/c right brain is responsible for spacial perception and memory

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36
Q

64 yo w/ tumor causing right/left confusion and difficulty subtracting serial 7s

(a) Locate the tumor
(b) Other likely finding

A

(a) Dominant parietal lobe

(b) Agraphia = can’t write

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37
Q

What area of the brain is typically damaged in Wernicke-Korsakoff syndrome?

A

Mamillary bodies (2/2 B1 (thiamine) deficiency)

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38
Q

36 yo F w/ acute left sided weakness, MRI confirms stroke
h/o several miscarriages and positive lupus anticoagulant

Best next step?

A

Pt has anti-phospholipid syndrome: hypercoagulable, h/o multiple miscarriages, positive lupus anticoagulant

Best prevention for another stroke in antiphospholipid syndrome = warfarin

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39
Q

Most common cause of sporadic encephalitis in the US

A

HSV encephalitis

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40
Q

3 key features of Wernicke-Korsakoff syndrome

A

Thiamine (B1) deficiency

  1. ataxia, primarily of gait
  2. encephalopathy
  3. eye movement abnormalities
    - nystagmus
    - opthalmoparesis (paralysis of eye mov’t)
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41
Q

67 yo M developed infarct of b/l occipital lobes that left him completely blind, but he completely denies it saying he bumps into walls b/c he’s clumsy

Dx

A

Dx = Anton’s syndrome = denial of blindness due to damage in b/l occipital lobes

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42
Q

56 yo F p/w headache and mental confusion over a day

  • febrile, nucal rigidity
  • photophobia, phonophobia

LP w/ normal opening pressure, 2000 WBC (90N), 60 RBC

(a) Dx
(b) Expected gram stain

A

(a) Dx = Strep pnemoniae (pnuemococcus) meningitis

(b) Gram positive spherical cells

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43
Q

2 days s/p VP shunt placement pt is confused and has HA, unable to walk

Cause of symptoms?

A

Subdural hematoma

-risk 2/2 reduction if ICP that pulls brain away from the meninges and tears the veins

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44
Q

54 yo F p/w new gambling problem- you suspect she may be taking which medication?

A

Ropinirole (Requip) = dopamine agonist used in tx of Parkinsons
-possible side effect = impulsivity (gambling, hypersexual behavior)

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45
Q

What is restricted diffusion characteristic of?

A

Restricted diffusion (hyperintensity on diffusion MRI w/ corresponding hypointensity on ADC mapping) is characteristic of ischemia

-can also be certain tumors or an active MS lesion

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46
Q

(a) What is tabes dorsalis?

(b) Clinical presentation

A

(a) Tabes dorsalis = syphilitic myelopathy = gradual degeneration/demyelination of the dorsal column

=> reduced proprioception, vibration, discriminative touch

(b) Weakness, diminished reflexes, paresthesias, gait ataxia, loss of coordination, positive Romberg’s

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47
Q

Locate the lesion causing global aphasia

A

Global aphasia- pt essentially mute

  • due to large lesions of the left hemisphere (knock out both Broca’s and Wernicke’s)
  • pts also have significant motor weakness
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48
Q

Name the 4 major clinical presentations of lacunar strokes and the correlate location of the lesion

A
  1. Pure motor- localizes to internal capsule
  2. Pure sensory- localizes to thalamus
  3. Ataxic hemiparesis- combo of cerebellar and motor symptoms (weakness and ataxia ipsilateral to lesion)
    - pons or internal capsule
  4. Clumsy-hand/dysarthria-
    - pontine infarct
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49
Q

65 yo M w/ general weakness and loss of higher mental status for 3 yrs

  • widened gait, positive Romberg’s
  • positive VDRL in serum

Possible spinal cord pathologic finding

A

Atrophy of dorsal columns (vibration/discriminative touch/ proprioception)

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50
Q

45 yo F w/ no PMH BIB husband after repeatedly asking him for desination on a car trip

  • continually asks where she is and why she is there
  • wide awake, fluent speech, remote memory intact, no focal findings on neurologic exam, normal CT
  • symptoms gradually fade, return to normal w/in 12 hrs

Dx

A

Dx = transient global amnesia

Not TIA b/c no focal findings on neuro exam

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51
Q

HSV encephalitis

(a) Location- prefers which lobes?
(b) LP results
(c) How to confirm dx
(d) EEG results
(e) Tx

A

HSV encephalitis

(a) Prefers frontal and temporal lobes
(b) LP: high white count (esp lymphocytes) and gross blood
(c) Confirm dx w/ HSV PCR
(d) EEG may show periodic lateralized epileptiform discharges over the temporal lobes
(e) Immediate tx w/ IV acyclovir

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52
Q

Main clinical feature of cerebellar strokes

(a) Lateral vs. medial

A

Ipsilateral ataxia and nonspecific features: N/V, vertigo, dizziness, dysarthria, nystagmus

(a) Lateral => ataxia of ipsilateral arm/leg
Medial => ataxia of axial muscles => gait and balance problems

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53
Q

What is zoster ophthalmicus?

A

When zoster occurs in V1 distribution (opthalmic branch) of the trigeminal nerve

-more likely VZV usually occurs in a thoracic dermatome

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54
Q

Tx for cystercercosis

A

Albendazole + steroids (to reduce inflammation)

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55
Q

3 key features of Lewy Body Dementia

A
  1. pronounced fluctuations in alertness and attention

- big differentiating factor from Parkinson’s

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56
Q

Most common cause of ICH

A

Most common cause = HTN

-or not intrinsically: most common cause may be trauma

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57
Q

Wernicke’s vs. Broca’s- which one is aware of the difficulties?

A

Wernicke’s = can’t comprehend => not annoyed/frustrated by their lack of sensical speech

Broca’s = very frustrated by inability to speak

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58
Q

Most likely psychiatric symptom s/p stroke

A

Depression

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59
Q

Pt HM unable to form new, conscious memories after epilepsy surgery left him w/ lesion to what area?

A

B/l hippocampi

60
Q

Classify vasculitis d/o based on size of vessel affected

Where does primary CNS vasculitis lie in this?

A

Large vessel = Takayau’s, giant cell/temporal

Medium vessel = PAN (polyarteritis nodosa), Kawasaki’s, primary CNS vasculitis

Small vessel = Microscopic polyagniitis (MPA), Wegener’s granulomatous, Churg Strauss

61
Q

Name 3 pathologies in which there is mesial temporal sclerosis

A

Mesial temporal sclerosis = atrophied hippocampus

Big one = Alzheimer’s

  • also commonly atrophied in epilepsy
  • area can be abnormal in transient global amnesia
62
Q

Neurologic complications of early HIV (CD4 over 500)

A
  • HIV meningitis

- acute inflammatory demyelinating syndrome

63
Q

Sudden onset language difficulty. Fluent speech, comprehension intact, can repeat phrases
-speech is flat, monotone, w/o proper intonation (big change from baseline)

(a) Dx
(b) Locate the lesion

A

(a) Abnormal prosidy

(b) Right inferior frontal gyrus

64
Q

Main distinguishing factor btwn delirium and Alzheimer’s disease

A

Delirium- fluctuates in levels of arousal

Distinguish delirium from dementia by delirium’s fluctuating course

65
Q

Describe the clinical findings after an ACA stroke

A
  • contralateral sensory/motor deficits, leg more than arm/face
  • frontal lobe behavioral abnormalities (sometimes end up in psych ER for AMS), akinetic mutism (dont speak or move)
  • left side: transcortical motor aphasia 2/2 injury of anterior frontal lobe of language-dominant hemisphere
  • right side: neglect syndrome
66
Q

RF for NPH

A

Previous pathology of the subarachnoid space (meningitis, subarachnoid blood) that interferes w/ CSF resabsorbtion in arachnoid granulations

67
Q

62 yo F p/w new onset psychosis and memory loss

  • seizure in the ER
  • MRI: hyperintensity of mesial temporal and frontal lobes b/l
  • CSF analysis: + anti-Hu antibodies

Dx

A

Dx = Limbic encephalitis

68
Q

Prognosis of cerebellar strokes

(a) Possible complication

A

Prognosis generally very good

(a) Risk for hydrocephalus 2/2 occlusion of 4th ventricle as swelling peaks on days 3-5 after stroke

69
Q

Differentiate clinical findings of occlusion of the superior vs. inferior division of the MCA

A

Superior division infarct => Broca’s (expressive) aphasia and prominent weakness

Inferior division infarct => Wernicke’s (receptive) aphasia and mild to no weakness

70
Q

4 parts of downwards hemorrhagic syndrome

A
  1. CN III compression
    => 3rd nerve palsy: ipsilateral pupillary dilation, down and out
  2. PCA compression
    ischemia of ipsilateral visual cortex and contralateral visual field deficit
  3. Duret hemorrhage = small lineal bleeds in midbrain and pons
    2/2 brainstem compression
  4. Compression of contralateral cerebellar peduncle => ipsilateral hemiparesis
71
Q

Pt w/ sudden onset language difficulties, understands but can only say short 2-3 word phrases w/ great effort, cannot repeat phrases. Clearly frustrated

(a) Dx
(b) Locate the lesion

A

(a) Broca’s/expressive aphasia

(b) Left inferior frontal gyrus

72
Q

CNS infection w/ buzzword: paralysis of facial muscles

A

2nd stage of Lyme disease (borrelia burgdorferi)

73
Q

In familial Alzheimer’s what protein is mutated?

A

Amyloid precursor

74
Q

Encephalitis w/ psychiatric disturbance, seizures, possibly fatal paralysis 2/2 spinal cord infection

Dx

A

Dx = rabies

75
Q

Vascular supply of Broca’s vs. Wernicke’s

A

Both are supplied by MCA

76
Q

2 things that appear bright on NCHCT

A

Bright w/o contrast on CT = blood and calcium

77
Q

What is akinetic mutism?

(a) Seen after which kind of stroke?

A

Akinetic mutism = lacking movement (akinesia) and speech (mutism)

  • eyes may follow observer, appear alert
  • not paralyzed, but lack the will to attempt a movement

(a) ACA stroke to b/l frontal lobes (frontal akinetic mutism)

78
Q

Name 2 spirochetes

A

Lyme disease and syphillis- both gram negative bacteria w/ long, spiral-shaped cells

79
Q

Left side neglect, quite weak on left side but denies any problem

Locate the lesion

A

Lesion = right parietal lobe

80
Q

Diseases associated w/ pseudobulbar palsy

A

Psuedobulbar palsy- inability to control facial movements, often difficulty swallowing or speaking, often labile affect

MS, ALS, Alzheimer’s disease

81
Q

Classic cause of alien hand syndrome

A

When corpus callosum is severed during surgery to prevent generalization of seizures

82
Q

Ddx for ring-enhancing intracerebral lesion in AIDs pt

A

Toxo vs. primary CNS lymphoma

83
Q

67 yo F who cant use utensils to eat her food
Left arm has a ‘mind of its own’ and tries to undo actions she has just performed

Dx

A

Dx = alien hand syndrome

84
Q

Most likely kind of storke seen in pt w/ inherited coagulation cascade d/o

A

Venous infarct before the age of 30

85
Q

Damage to what areas of the brain causes problems w/ prosody

A

Damage to areas homologous to Broca’s and Wernicke’s area on the non-dom hemisphere produces problems w/ prosody (rhythm, pitch, tone of normal speech)

86
Q

IVDU p/w severe lower back pain, LE weakness, incontinence

  • febrile
  • severe point tenderness at T10

Dx

A

Dx = spinal epidural abscess

87
Q

Clinical picture of MCA strokes

A
  • contralateral motor/sensory deficits of face/arm over legs
  • visual field deficits (contralateral homonymous hemianopsia)
  • aphasia if left, neglect if right-sided
  • eyes deviate towards the lesion (gaze preference to ipsilateral side)
88
Q

16 yo w/ new onset abnormal behavior x2 weeks

  • sleeping 18 hrs a day, spacey child like behavior
  • ravenously hungry and hypersexual

Dx

A

Kleine-Levin syndrome = sleeping beauty syndrome- episodic hypersomnia w/ mood changes, often hyperphagia and hypersexuality
-usually s/p viral infection but etiology unknown

89
Q

45 yo F making unwanted sexual advances to strangers, putting objects in her mouth, and suddenly unafraid of things that used to terrify her

(a) Dx
(b) Mechanism

A

(a) Dx = Kluver-Bucy syndrome

(b) 2/2 injury to bilateral amygdalae

90
Q

LP findings of bacterial meningitis

A

Low glucose, high protein, elevated opening pressure, cloudy CSF, neutrophilia

-while lymphocytic pleocytosis would be viral

91
Q

What is anomic aphasia

A

Trouble naming objects

92
Q

S/p stroke, 45 yo F w/ h/o multiple miscarriages found to have positive lupus anticoagulant

Tx?

A

Warfarin = tx (stroke ppx) for antiphospholipid syndrome

93
Q

56 yo smoker develops R hemiparalysis (face, arm, leg) w/o sensory loss or cognitive dysfunction. Normal NCHCT

Locate the lesion

A

Lesion is of the posterior limb of the internal capsule- contains all the motor fibers w/o any sensory fibers

-would need a huge and very specific (like impossible) kind of stroke to get total paralysis w/o any sensory findings if it was cortical

94
Q

Long term tx for pt after TIA

A

TIA pts treated the same as stroke pts given high risk for stroke => long term tx includes

  1. BP control, goal 120/80
  2. High dose statin regardless of lipid profile
  3. Anticoagulate if TEE showed clot or EKG shows Afib, if not then antiplatelet (clopidogrel, ASA)
95
Q

LP finding of SAH

A

Negative NCHCT but suspicion for SAH is still super high => do LP
-looking for blood on LP

Xanthochromia = yellow discoloration of CSF due to bilirubin as breakdown broduct of blood
-occurs after 6-12 hrs in pts w/ SAH

96
Q

As a pt w/ Broca’s aphasia improves, what type of aphasia may they subsequently develop

A

Aphasias exist on a spectrum

Transcortical motor aphasia = Broca’s (expressive) but w/ intact repetition

97
Q

2 category of drugs for Alzheimer’s

A

Early tx w/ cholinesterase inhibitors
-don’t delay natural course of disease but have moderate efficacy on cognitive fxn scales and psychiatric symptoms

Later: NMDA receptor antagonist (Donepezil/Aricept)

98
Q

Chiropractor twists pts head in a rapid fashion- this is a risk factor for?

A

Vertebral artery dissection

99
Q

Etiology of lateral medullary syndrome

A

Occlusion of PICA (or one of its branches) or of the vertebral artery, causing infarction fo the lateral part of the medulla

Most commonly the vertebral artery, then PICA, then superior middle and inferior medullary arteries

100
Q

Two patterns of behavior seen in frontal lobe damage

A
  1. apathy, abulia (absence of willpower), mutism (not speaking)
  2. Disinhibition, poor judgement, antisocial behavior
101
Q

75 yo M notices r. body weakness x7 hrs, normal NCHCT, preferred tx?

A

Assuming stroke- past the window (4.5 hrs) for tPa => preferred tx is aspirin

102
Q

55 yo Jamaican man p/w LE weakness, UE intact
-hyperreflexic legs, upgoing toes b/l

(a) Dx
(b) Associated malignancy

A

(a) Dx = human T-lymphotropic virus Type I
- causes tropical spastic paraparesis
- chronic myelopathy common in Caribbean Japan and African, found in IVDU in the US

(b) Associated malignancy = Adult T-cell leukemia/lymphoma

103
Q

Differentiate Broca’s and Wernicke’s aphasia

A

Broca’s = Expressive aphasia- can comprehend but unable to produce language (spoken or written)

Wernicke’s = Receptive aphasia- unable to understand language in written or spoken form

  • but can speak using correct grammar, but difficulty using meaningful speech
  • often unaware they’re speaking weird and don’t realize their speech lacks meaning (b/c they have poor comprehension of even their own speech)
104
Q

Name the 3 types of Intracranial Bleeds

(a) Which may be found incidentally on a scan done for another reason
(b) Which is venous?
(c) Which is most acutely dangerous?

A

Intracranial bleeds: epidural, subdural, subarachnoid

(a) Subdural is venous => can accumulate gradually over time, so sometimes found incidentally
- while the other 2 are acute and would really be found acutely

(b) Subdural is 2/2 injury to bridging veins
(c) Epidural due to high pressure in the arterial beds => bleed out and hemorrhage quickly

105
Q

Clinical presentation of PRES

(a) MRI

A

PRES: HA, confusion (encephalopathy), seizures, visual loss
-seizure, visual disturbance, HA, mental status

(a) MRI showing edema

106
Q

Key feature of conduction aphasia

A

Inability to repeat phrases

-can sometimes even paraphrase but can’t repeat

107
Q

Clinical feature of brainstem stroke

A

Crossed findings- ipsilateral CN findings w/ motor/sensory findings contralaterally

Typical general signs: dizziness/vertigo, ataxia, nausea, imbalance, diplopia, nystagmus, dysarthria, dysphagia

108
Q

Diagnostic test for

(a) Syphilis
(b) Neurosyphilis

A

(a) Syphilis- treponemal (TP-PA) for screening, nontreponemal (RPR, VDRL) for confirmation
(b) Need LP for neurosyphilis: showing high CSF WBC and oligoclonal bands

109
Q

Buzzword: myelopathy in pt from the Caribbean

A

HTLV = Human T-lymphotropic virus type I

110
Q

What type of stroke presents in the most indolent manner

A

Venous infarcts- still count as stroke! backs up enough over time to cause obstruction of perfusion

111
Q

26 yo Mexican man p/w seizure

  • no h/o seizures, trauma, infxn
  • CT shows multiple small hyperdense spots in the basal ganglia

Dx

A

Dx = taenia solium = pork tapeworm = Cysticercosis = ‘brain-eating amoeba)

  • presents as small (can be numerous) cysts in the brain parenchyma
  • oral fecal route

Very bad prognosis

112
Q

Neurologic complications of severe HIV (CD4 under 200)

A
  • CNS toxo
  • PML (progressive multifocal leukoencephalopathy)
  • Primary CNS lymphoma
  • cryptococcal meningitis
  • HIV vaculoar myelopathy
  • CMV ventriculitis
  • VZV vasculitis
113
Q

What is locked-in syndrome?

(a) Location of the lesion
(b) Locate the occlusion

A

Locked-in: pt is awake and aware but can only move eyes

(a) Lesion in the ventral pons
(b) 2/2 occlusion at tip of the basilar artery

114
Q

What type of memory is primarily affected in AD?

A

Alzheimer’s: generally affects episodic memory = memory of personal experiences (not of facts or how to do things)

115
Q

Etiology of PRES

A

PRES = posterior reversible encephalopathy syndrome

Etiology = sudden, drastic increase in BP

116
Q

Name the spongiform encephalopathy formerly seen in New Guinea due to consumption of human brain tissue

A

Ew…Kuru

117
Q

Tx of venous infarct

A

Immediate heparin

-even w/ bleeding the correct tx is GIVE HEPARIN

118
Q

Pick’s disease

(a) Age of onset
(b) Features
(c) Memory

A

Pick’s disease = frontotemporal degeneration

(a) Under age 65, younger age of onset and much more rapid progression than other dementias
(b) Disinhibition, apathy, language disturbance
(c) Memory often relatively unaffected

119
Q

What does contrast on MRI tell you?

(a) What types of MRI get contrast?

A

When you give contrast, enhancement shows you breakdown of the BBB

(a) Only T1-weighted images (where CSF is dark and white matter is white) gets contrast

120
Q

Feared complication of subarachnoid hemorrhage

(b) Prevention

A

Vasospasm = common complication of SAH

b) Prevent by monitoring closely and ppx Nimodipine (cerebrally selective CCB

121
Q

NPH

(a) Definitive tx
(b) Gold standard dx test

A

NPH

(a) Ventriculoperitoneal shunt
(b) Continuous lumbar drain = most sensitive/specific diagnostic test

122
Q

How to differentiate toxo and primary CNS lymphoma

A

Both are ring enhancing lesions on imaging, often can’t differentiate clinically or radiographically

test for antibodies to toxo- but only helpful if negative (b/c then def CNS lymphoma) b/c can be positive in CNS lymphoma b/c many ppl have it

Best test = Do PCR for EBV on the CSF- dx for CNS lymphoma

123
Q

Pt p/w sudden onset language difficulties: able to say phrases in correct grammar but speech is nonsensical. Unable to repeat phrases or follow complex commands

(a) Dx
(b) Locate the lesion

A

(a) Wernicke’s/receptive aphasia

(b) Left superior temporal gyrus

124
Q

Distinguish aphasia, dysarthria, dysphonia and apraxia of speech

A

Aphasia = inability to comprehend or formulate language 2/2 dysfunction of a specific brain region

Dysarthria = inability to control muscles of tongue and mouth to produce speech (muscles of articulation)

Dysphonia = hoarse or breathy-sounding speech 2/2 problem of the vocal cords

Apraxia of speech = inability to create and sequence motor plans for speech

125
Q

2 viruses that affect the anterior horn cells

A
  1. Polio

2. West Nile

126
Q

Tx for Lyme’s disease w/ neurological symptoms

A

Tx starts w/ oral doxycycline, but if neurologic signs use IV ceftriaxone

127
Q

Tx options for SAH

A

Subarachnoid hemorrhage

Acutely depending on size/location: chose neurosurgical clipping vs. endovascular coiling of the aneurysm

Sometimes (small, pt clinically stable), treat medically

  • nimodipine to prevent vasospasm
  • tight BP control to prevent rebleed
128
Q

CNS manifestations of PML

A

Slowly progressive demyelination of CNS in HIV

-progressive damage to white matter 2/2 JC virus seen in immunosuppression

129
Q

Differentiate dementia from mild cognitive impairment

A

Difference is impact on function

Dementia = impairment in 2/5 functional domains: memory, emotion, executive, language, visuospatial, that impact ADLs

MCI- no impairment in fxn

130
Q

Inherited stroke d/o w/ maternal inheritance

A

MELAS = mitochondrial encephalopathy w/ lactic acidosis and stroke

p/w stroke-like episodes of occipital region, presents w/ seizures and dementia in adolescence

131
Q

Chronic use of which medication is associated w/ a lower rate of developing Alzheimer’s?

A

Chronic NSAID use is associated w/ lower rate of AD development
-but not accepted as ppx

132
Q

Long term tx for pt after a stroke

A

Most importantly is BP control, goal of 120/80

All pts s/p stroke started on high dose statin regardless of lipid profile

133
Q

Wernicke’s vs. Broca’s aphasia- which one presents w/ motor weakness

A

Broca’s aphasia- more likely to affect primary motor cortex => often have profound right sided weakness

Wernicke’s aphasia- usually mild or no weakness at all

134
Q

Inherited stroke d/o in AA descent

A

Sickle cell (aut dom)

135
Q

Tx for confirmed neurosyphilis

A

Penicillin

  • IV or IM penicillin x14 days
  • CSF check q6m x3 yrs
136
Q

56 yo M w/ MS intermittently bursts into tears or suddently starts laughing. Denies feeling sad or happy and cannot explain this

(a) Dx
(b) Tx

A

(a) Pseudobulbar palsy

b) Dextromethorphan/quinidine (nuedexta

137
Q

45 w/ h/o migraines p/w multiple small strokes. Same thing in brother and father who developed dementia at early age.

MRI: innumerable old, lacunar strokes and white matter disease

Dx

A

Dx = CADASIL = cerebral autosomal dominant arteriopathy w/ subcortical infarcts and leukoencephalopathy

  • aut dom
  • p/w migraines, dementia, and multiple lacunar strokes
138
Q

How to determine if after stroke pt should be put on ppx anticoagulation or antiplatelet

A

Anticoagulate if TEE shows clot in heart, or EKG shows AFib
-Warfarin (more monitoring but reversible) vs. dabigatran/rivaroxaban, apixaban (less monitoring, cannot be reversed if there is bleeding)

If neither of those two: use antiplatelet: clopidogrel more effective in MI prevention than AASA

139
Q

Empiric tx for bacterial meningitis

A

3rd gen cephalosporin + ampicillin in neonates and adults over 50

140
Q

Causes of ICH besides HTN

A
  • bleeding into ischemic infarct (hemorrhagic conversion)
  • bleeding into a tumor
  • AVM (bleeding into vascular malformation)
  • bleeding in cavernomas (cavernous malformation)
  • trauma
141
Q

Risk factors for venous infarct

A

Hypercoagulable state: cancer, pregnancy/postpartum, infxns, some meds (OCPs)

142
Q

Buzzword for location if pt has post-stroke mania

A

Post-stroke mania is most likely due to a right-sided stroke

143
Q

Main distinguishing factor btwn Lewy Body dementia and Parkinson’s

A

Both are alpha-synucleinopathies

LBD has fluctuating cognition = good distinguishing factor
-variations in attention and alertness

Overlap: Parkinsonism symptoms: bradykinesia, shuffling gait, rigidity

144
Q

Alexia w/o agraphia- what is it?

(a) Locate the lesion?

A

Alexia w/o agraphia- pt can write but cannot read

(a) Lesion to the left occipital lobe, specifically involving the splenium of the corpus callosum

145
Q

What is transcortical motor aphasia?

(a) Associated w/ what kind of stroke?

A

Transcortical motor aphasia- similar to Broca’s (expressive) aphasia where pt can comprehend but has trouble producing speech, however differs from Broca’s b/c repetition (echolalia) is preserved
-not as severe as Broca’s” speech often comprehensible yet very sparse (yes/no answers)

(a) Left ACA stroke- b/c injury is to the anterior superior frontal lobe of the language-dominant hemisphere

146
Q

45 yo F noticed left facial droop, right facial droop develops 1 week later
-can’t fully close eyes or raise eyebrows

Dx

A

Dx = borrelia burgdorferi
Lyme’s

1st stage: erythema migrans rash
2nd stage: meningitis, cardiac pathology
-numbness, pain, weakness, Bell's palsy
-visual disturbances
-fever, stiff neck, severe HA
3rd stage: sensory neuropathy, suble cognitive changes
147
Q

67 yo F referred for hysteria after unable to use utensils to eat food, difficulty using keys to unlock door, began upon awakening 1 wk ago
-exam normal: strength, sensation, and coordination

Term for this d/o?

A

Apraxia = d/o of skilled movement not caused by weakness

Neuro Shelf (12 decks)

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