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
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
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
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
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
6
Q
CNS viral infection associated w/ retinitis
A
CMV
-can also cause encephalitis in the immunosuppressed
7
Q
Most common cause of bacterial meningitis in neonates
A
Strep agalactiae (group B strep)
8
Q
CNS manifestations of HSV encephalitis
A
Devastating temporal/frontal lobe hemorrhage
9
Q
Neurologic complications of moderate HIV (CD4 200-500)
A
- HIV associated dementia
- Mononeuritis multiplex
- HIV-associated myopathy or neuropathy
10
Q
2 causes for paraneoplastic limbic encephalitis
A
MC = small-cell lung carcinoma
In 22 yo healthy F, also can be ovarian tumor
11
Q
What is the empiric tx for toxo?
A
Sulfadiazine and pyrimethamine
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
13
Q
4 features of Kluver-Bucy syndrome
A
Kluver-Bucy syndrome = damage to b/l amygdala
- hypersexuality
- placidity- diminished fear response of things that used to or normally trigger fear
- hyphagia and hyperorality: overeat, exacmine objects w/ mouth, pica
- visual agnosia: difficulty recognizing familiar faces or objects
14
Q
In what genetic disease is Alzheimer’s disease an inevitability?
A
Down’s syndrome
-considered to be a neurodevelopmental model for AD
15
Q
Name 3 inherited stroke d/o
A
- CADASIL = cerebral autosomal dominant arteriopathy w/ subcortical infarcts and leukoencephalopathy
- p/w migraines, dementia, multiple lacunar strokes - MELAS = mitochondrial (maternal inheritance) encephalopathy w/ lactic acidosis and stroke
- p/w seizures and dementia in adolescence, stroke-like episodes of occipital region - Sickle-cell
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
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
18
Q
LP findings of Guillain-Barre syndrome
A
Normal opening pressure and glucose
Albuminocytologic dissociation = elevated protein (over 45) w/ normal WBC
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
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
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
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
23
Q
Buzzword: lucid phase
A
Epidural hematoma
- lens shaped
- 2/2 injury of middle meningeal artery
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
25
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
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
26
76 yo M w/ HTN c/o HA and slurred speech
- gradual r. sided weakness
- arousable but stuporous
Location of hemorrhage?
Intracerebral hemorrhage
27
Risk of VP shunt placement
-subdural hematoma
28
What factor best predicts pts w/ aneurysmal SAH?
Pts level of consciousness in the ER
- not the location or size of the aneurysm
- not the age of the pt or PMH
29
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
Dx = frontotemporal degeneration
| -apathy, abulia (absence of will or inability to act decisively)
30
What is transient global amnesia?
(a) Tx
(b) Ppx of future events
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
31
Elderly pt w/ repeated ICH in many lobes of the brain
Suspected dx?
Cerebral amyloidosis = amyloid deposition in walls of CNS vessels
32
As a pt w/ Wernicke's aphasia improves, what type of aphasia may they subsequently develop
Aphasias exist on a spectrum
Transcortical sensory aphasia = Wernicke's w/ intact repetition
33
Abnormalities in what part of the brain causes akinetic mutism?
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)
34
80 yo M 1 mo s/p MCA p/w headaches and forgetfulness, initial CT was normal
Dx?
(b) mechanism
Dx = subdural hematoma
-crescent shaped
(b) 2/2 damage to bridging veins draining into venous sinuses
35
General difference in symptoms of right vs. left brain ACA/MCA strokes
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
36
64 yo w/ tumor causing right/left confusion and difficulty subtracting serial 7s
(a) Locate the tumor
(b) Other likely finding
(a) Dominant parietal lobe
| (b) Agraphia = can't write
37
What area of the brain is typically damaged in Wernicke-Korsakoff syndrome?
Mamillary bodies (2/2 B1 (thiamine) deficiency)
38
36 yo F w/ acute left sided weakness, MRI confirms stroke
h/o several miscarriages and positive lupus anticoagulant
Best next step?
Pt has anti-phospholipid syndrome: hypercoagulable, h/o multiple miscarriages, positive lupus anticoagulant
Best prevention for another stroke in antiphospholipid syndrome = warfarin
39
Most common cause of sporadic encephalitis in the US
HSV encephalitis
40
3 key features of Wernicke-Korsakoff syndrome
Thiamine (B1) deficiency
1. ataxia, primarily of gait
2. encephalopathy
3. eye movement abnormalities
- nystagmus
- opthalmoparesis (paralysis of eye mov't)
41
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
Dx = Anton's syndrome = denial of blindness due to damage in b/l occipital lobes
42
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) Dx = Strep pnemoniae (pnuemococcus) meningitis
| (b) Gram positive spherical cells
43
2 days s/p VP shunt placement pt is confused and has HA, unable to walk
Cause of symptoms?
Subdural hematoma
-risk 2/2 reduction if ICP that pulls brain away from the meninges and tears the veins
44
54 yo F p/w new gambling problem- you suspect she may be taking which medication?
Ropinirole (Requip) = dopamine agonist used in tx of Parkinsons
-possible side effect = impulsivity (gambling, hypersexual behavior)
45
What is restricted diffusion characteristic of?
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
46
(a) What is tabes dorsalis?
| (b) Clinical presentation
(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
47
Locate the lesion causing global aphasia
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
48
Name the 4 major clinical presentations of lacunar strokes and the correlate location of the lesion
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
49
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
Atrophy of dorsal columns (vibration/discriminative touch/ proprioception)
50
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
Dx = transient global amnesia
Not TIA b/c no focal findings on neuro exam
51
HSV encephalitis
(a) Location- prefers which lobes?
(b) LP results
(c) How to confirm dx
(d) EEG results
(e) Tx
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
52
Main clinical feature of cerebellar strokes
(a) Lateral vs. medial
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
53
What is zoster ophthalmicus?
When zoster occurs in V1 distribution (opthalmic branch) of the trigeminal nerve
-more likely VZV usually occurs in a thoracic dermatome
54
Tx for cystercercosis
Albendazole + steroids (to reduce inflammation)
55
3 key features of Lewy Body Dementia
1. pronounced fluctuations in alertness and attention
| - big differentiating factor from Parkinson's
56
Most common cause of ICH
Most common cause = HTN
| -or not intrinsically: most common cause may be trauma
57
Wernicke's vs. Broca's- which one is aware of the difficulties?
Wernicke's = can't comprehend => not annoyed/frustrated by their lack of sensical speech
Broca's = very frustrated by inability to speak
58
Most likely psychiatric symptom s/p stroke
Depression
59
Pt HM unable to form new, conscious memories after epilepsy surgery left him w/ lesion to what area?
B/l hippocampi
60
Classify vasculitis d/o based on size of vessel affected
Where does primary CNS vasculitis lie in this?
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
Name 3 pathologies in which there is mesial temporal sclerosis
Mesial temporal sclerosis = atrophied hippocampus
Big one = Alzheimer's
- also commonly atrophied in epilepsy
- area can be abnormal in transient global amnesia
62
Neurologic complications of early HIV (CD4 over 500)
- HIV meningitis
| - acute inflammatory demyelinating syndrome
63
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) Abnormal prosidy
| (b) Right inferior frontal gyrus
64
Main distinguishing factor btwn delirium and Alzheimer's disease
Delirium- fluctuates in levels of arousal
Distinguish delirium from dementia by delirium's fluctuating course
65
Describe the clinical findings after an ACA stroke
- 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
RF for NPH
Previous pathology of the subarachnoid space (meningitis, subarachnoid blood) that interferes w/ CSF resabsorbtion in arachnoid granulations
67
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
Dx = Limbic encephalitis
68
Prognosis of cerebellar strokes
(a) Possible complication
Prognosis generally very good
(a) Risk for hydrocephalus 2/2 occlusion of 4th ventricle as swelling peaks on days 3-5 after stroke
69
Differentiate clinical findings of occlusion of the superior vs. inferior division of the MCA
Superior division infarct => Broca's (expressive) aphasia and prominent weakness
Inferior division infarct => Wernicke's (receptive) aphasia and mild to no weakness
70
4 parts of downwards hemorrhagic syndrome
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
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) Broca's/expressive aphasia
| (b) Left inferior frontal gyrus
72
CNS infection w/ buzzword: paralysis of facial muscles
2nd stage of Lyme disease (borrelia burgdorferi)
73
In familial Alzheimer's what protein is mutated?
Amyloid precursor
74
Encephalitis w/ psychiatric disturbance, seizures, possibly fatal paralysis 2/2 spinal cord infection
Dx
Dx = rabies
75
Vascular supply of Broca's vs. Wernicke's
Both are supplied by MCA
76
2 things that appear bright on NCHCT
Bright w/o contrast on CT = blood and calcium
77
What is akinetic mutism?
(a) Seen after which kind of stroke?
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
Name 2 spirochetes
Lyme disease and syphillis- both gram negative bacteria w/ long, spiral-shaped cells
79
Left side neglect, quite weak on left side but denies any problem
Locate the lesion
Lesion = right parietal lobe
80
Diseases associated w/ pseudobulbar palsy
Psuedobulbar palsy- inability to control facial movements, often difficulty swallowing or speaking, often labile affect
MS, ALS, Alzheimer's disease
81
Classic cause of alien hand syndrome
When corpus callosum is severed during surgery to prevent generalization of seizures
82
Ddx for ring-enhancing intracerebral lesion in AIDs pt
Toxo vs. primary CNS lymphoma
83
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
Dx = alien hand syndrome
84
Most likely kind of storke seen in pt w/ inherited coagulation cascade d/o
Venous infarct before the age of 30
85
Damage to what areas of the brain causes problems w/ prosody
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
IVDU p/w severe lower back pain, LE weakness, incontinence
- febrile
- severe point tenderness at T10
Dx
Dx = spinal epidural abscess
87
Clinical picture of MCA strokes
- 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
16 yo w/ new onset abnormal behavior x2 weeks
- sleeping 18 hrs a day, spacey child like behavior
- ravenously hungry and hypersexual
Dx
Kleine-Levin syndrome = sleeping beauty syndrome- episodic hypersomnia w/ mood changes, often hyperphagia and hypersexuality
-usually s/p viral infection but etiology unknown
89
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) Dx = Kluver-Bucy syndrome
| (b) 2/2 injury to bilateral amygdalae
90
LP findings of bacterial meningitis
Low glucose, high protein, elevated opening pressure, cloudy CSF, neutrophilia
-while lymphocytic pleocytosis would be viral
91
What is anomic aphasia
Trouble naming objects
92
S/p stroke, 45 yo F w/ h/o multiple miscarriages found to have positive lupus anticoagulant
Tx?
Warfarin = tx (stroke ppx) for antiphospholipid syndrome
93
56 yo smoker develops R hemiparalysis (face, arm, leg) w/o sensory loss or cognitive dysfunction. Normal NCHCT
Locate the lesion
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
Long term tx for pt after TIA
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
LP finding of SAH
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
As a pt w/ Broca's aphasia improves, what type of aphasia may they subsequently develop
Aphasias exist on a spectrum
Transcortical motor aphasia = Broca's (expressive) but w/ intact repetition
97
2 category of drugs for Alzheimer's
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
Chiropractor twists pts head in a rapid fashion- this is a risk factor for?
Vertebral artery dissection
99
Etiology of lateral medullary syndrome
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
Two patterns of behavior seen in frontal lobe damage
1. apathy, abulia (absence of willpower), mutism (not speaking)
2. Disinhibition, poor judgement, antisocial behavior
101
75 yo M notices r. body weakness x7 hrs, normal NCHCT, preferred tx?
Assuming stroke- past the window (4.5 hrs) for tPa => preferred tx is aspirin
102
55 yo Jamaican man p/w LE weakness, UE intact
-hyperreflexic legs, upgoing toes b/l
(a) Dx
(b) Associated malignancy
(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
Differentiate Broca's and Wernicke's aphasia
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
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?
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
Clinical presentation of PRES
(a) MRI
PRES: HA, confusion (encephalopathy), seizures, visual loss
-seizure, visual disturbance, HA, mental status
(a) MRI showing edema
106
Key feature of conduction aphasia
Inability to repeat phrases
| -can sometimes even paraphrase but can't repeat
107
Clinical feature of brainstem stroke
Crossed findings- ipsilateral CN findings w/ motor/sensory findings contralaterally
Typical general signs: dizziness/vertigo, ataxia, nausea, imbalance, diplopia, nystagmus, dysarthria, dysphagia
108
Diagnostic test for
(a) Syphilis
(b) Neurosyphilis
(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
Buzzword: myelopathy in pt from the Caribbean
HTLV = Human T-lymphotropic virus type I
110
What type of stroke presents in the most indolent manner
Venous infarcts- still count as stroke! backs up enough over time to cause obstruction of perfusion
111
26 yo Mexican man p/w seizure
- no h/o seizures, trauma, infxn
- CT shows multiple small hyperdense spots in the basal ganglia
Dx
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
Neurologic complications of severe HIV (CD4 under 200)
- CNS toxo
- PML (progressive multifocal leukoencephalopathy)
- Primary CNS lymphoma
- cryptococcal meningitis
- HIV vaculoar myelopathy
- CMV ventriculitis
- VZV vasculitis
113
What is locked-in syndrome?
(a) Location of the lesion
(b) Locate the occlusion
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
What type of memory is primarily affected in AD?
Alzheimer's: generally affects episodic memory = memory of personal experiences (not of facts or how to do things)
115
Etiology of PRES
PRES = posterior reversible encephalopathy syndrome
Etiology = sudden, drastic increase in BP
116
Name the spongiform encephalopathy formerly seen in New Guinea due to consumption of human brain tissue
Ew...Kuru
117
Tx of venous infarct
Immediate heparin
| -even w/ bleeding the correct tx is GIVE HEPARIN
118
Pick's disease
(a) Age of onset
(b) Features
(c) Memory
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
What does contrast on MRI tell you?
(a) What types of MRI get contrast?
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
Feared complication of subarachnoid hemorrhage
(b) Prevention
Vasospasm = common complication of SAH
| b) Prevent by monitoring closely and ppx Nimodipine (cerebrally selective CCB
121
NPH
(a) Definitive tx
(b) Gold standard dx test
NPH
(a) Ventriculoperitoneal shunt
(b) Continuous lumbar drain = most sensitive/specific diagnostic test
122
How to differentiate toxo and primary CNS lymphoma
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
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) Wernicke's/receptive aphasia
| (b) Left superior temporal gyrus
124
Distinguish aphasia, dysarthria, dysphonia and apraxia of speech
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
2 viruses that affect the anterior horn cells
1. Polio
| 2. West Nile
126
Tx for Lyme's disease w/ neurological symptoms
Tx starts w/ oral doxycycline, but if neurologic signs use IV ceftriaxone
127
Tx options for SAH
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
CNS manifestations of PML
Slowly progressive demyelination of CNS in HIV
| -progressive damage to white matter 2/2 JC virus seen in immunosuppression
129
Differentiate dementia from mild cognitive impairment
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
Inherited stroke d/o w/ maternal inheritance
MELAS = mitochondrial encephalopathy w/ lactic acidosis and stroke
p/w stroke-like episodes of occipital region, presents w/ seizures and dementia in adolescence
131
Chronic use of which medication is associated w/ a lower rate of developing Alzheimer's?
Chronic NSAID use is associated w/ lower rate of AD development
-but not accepted as ppx
132
Long term tx for pt after a stroke
Most importantly is BP control, goal of 120/80
All pts s/p stroke started on high dose statin regardless of lipid profile
133
Wernicke's vs. Broca's aphasia- which one presents w/ motor weakness
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
Inherited stroke d/o in AA descent
Sickle cell (aut dom)
135
Tx for confirmed neurosyphilis
Penicillin
- IV or IM penicillin x14 days
- CSF check q6m x3 yrs
136
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) Pseudobulbar palsy
| b) Dextromethorphan/quinidine (nuedexta
137
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
Dx = CADASIL = cerebral autosomal dominant arteriopathy w/ subcortical infarcts and leukoencephalopathy
- aut dom
- p/w migraines, dementia, and multiple lacunar strokes
138
How to determine if after stroke pt should be put on ppx anticoagulation or antiplatelet
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
Empiric tx for bacterial meningitis
3rd gen cephalosporin + ampicillin in neonates and adults over 50
140
Causes of ICH besides HTN
- bleeding into ischemic infarct (hemorrhagic conversion)
- bleeding into a tumor
- AVM (bleeding into vascular malformation)
- bleeding in cavernomas (cavernous malformation)
- trauma
141
Risk factors for venous infarct
Hypercoagulable state: cancer, pregnancy/postpartum, infxns, some meds (OCPs)
142
Buzzword for location if pt has post-stroke mania
Post-stroke mania is most likely due to a right-sided stroke
143
Main distinguishing factor btwn Lewy Body dementia and Parkinson's
Both are alpha-synucleinopathies
LBD has fluctuating cognition = good distinguishing factor
-variations in attention and alertness
Overlap: Parkinsonism symptoms: bradykinesia, shuffling gait, rigidity
144
Alexia w/o agraphia- what is it?
(a) Locate the lesion?
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
What is transcortical motor aphasia?
(a) Associated w/ what kind of stroke?
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
45 yo F noticed left facial droop, right facial droop develops 1 week later
-can't fully close eyes or raise eyebrows
Dx
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
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?
Apraxia = d/o of skilled movement not caused by weakness
