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[2b] A- step 2 CK > Med-Neuro > Flashcards

Med-Neuro Flashcards

1
Q

Cerebral Salt Wasting etx

A

⬇︎Brain adrenergic output to Kidney –> ⬇︎PCT Na+ Reabsorption–> hypOvolemic hypONatremia

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2
Q

[Wernicke Korsakoff Syndrome] Clinical Presentation (3)

A

Wernicke problems come in a CAN of beer!

[Confusion & Confabulation]

Ataxia (Gait & Postural)

[Nystagmus + Oculomotor Dyf] (Opthalmoplegia)

beer = chronic alcoholism is most common cause

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3
Q

Causes of [Wernicke Korsakoff Syndrome] (2)

A

Wernicke Problems come in a CAN of beer!

[Thiamine B1 Deficiency] from (below) –> BL circuit dysfunction between mammillary bodies & ANT Thalamus:

  1. Chronic Alcoholism = MOST COMMON
  2. Giving [Glucose that doesn’t have B1] to a B1-deficient pt (i.e. homeless malnutrition pt)
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4
Q

Tx for [Wernicke Korsakoff Syndrome] (2)

A
  1. IV [Thiamine B1]
  2. Glucose administration
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5
Q

What’s the major complication of [SubArachnoid Hemorrhage] during recovery? How do you tx this?

Usually in the Suprasellar Cistern

A

Severe Cerebral Vasospasm 4-12 days post SAH onset –> morbidity vs. mortality. Prevent with [Nimodipine CCB]

Other complications: Rebleeding, SIADH, Seizures

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6
Q

Describe the Demographic for the HA:

Migraine-2

Tension

Cluster

A

Migraine = Female and Kids(will be bifrontal)

Tension = Female

Cluster = Male (100% O2 tx)

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7
Q

Describe the Onset for the HA:

Migraine

Cluster

Tension

A

Migraine = Variable but possibly during menstruation

Cluster = During Sleep (100% O2 tx)

Tension = When Stressed “think tense”

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8
Q

Describe the Location for the HA:

Migraine

Cluster

Tension

A

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = Behind 1 eye (100% O2 tx)

Tension = [Bilateral & Band-like around the head]

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9
Q

Describe the Character for the HA:

Migraine

Cluster (3)

Tension (2)

A

Migraine = POUND = [Pounding/One Day-3 day Duration/Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = [Excruciating, sharp & steady] (100% O2 tx)

Tension = Dull & tight

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10
Q

Describe the Duration for the HA:

Migraine

Cluster

Tension

A

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = 15 - 90 MINUTES (100% O2 tx)

Tension = 30 min to 7 DAYS!!!! (Tammy’s Entire Work Week)

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11
Q

Describe the Associated Sx for the HA:

Migraine

Cluster - 4

Tension

A

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = [Sweating/ Pupil Change / Lacrimation / Rhinorrhea]

Tension = [Muscle “Tension” in Head, Neck or Shoulders]

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12
Q

Which vessels are affected by [TUMTL-Transtentorial Uncal Medial Temporal lobe] Herniation? (3) What manifestations result from this?

A

[TUMTL Hernation–> Compression of [POP- PCA / Oculomotor CN3 / Paramedian Pontine vessels] –>

  1. [PCA compression] –> Occipital lobe infarct –> CTL homonymous hemianopsia w/Macular sparing
  2. Oculomotor CN3 compression –> [Ipsilateral “Down & Out” Eye + Ptosis + Dilated Pupil]
  3. Paramedian Pontine vessel compression –> Duret Hemorrhage
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13
Q

Which bone is associated with Epidural Hematoma?

A

Sphenoid

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14
Q

Violent Infant Shaking —> ________. This is characterized by what 3 things?

B: How is this differentiated from similar conditions?

A

Violent Infant Shaking –> [AHT- Abusive Head Trauma]! =

  1. Subdural Hemorrhage (from tearing bridging veins between Dura and Arachnoid)
  2. Retinal Hemorrhages Bilaterally (from congested retinal vein ruptures)
  3. POSTERIOR rib fractures

B: Usually Accidental Fall is not sufficient for Subdural Hemorrhage OR [BL Retinal Hemorrhage]

AHT is formely known as Shaken Baby Syndrome

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15
Q

What lab values differentiate seminomatous vs. NonSeminomatous Germ cell tumors?

A

seminomatous = ⬆︎bHCG

NonSeminomatous(yolk sac/choriocarcinoma/embryonal) = [⬆︎bHCG AND AFP]

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16
Q

[Thiamine B1] deficiency causes ____ and BeriBeri.

Describe BeriBeri (2)

A

[Wernicke Korsakoff Syndrome] and [BeriBeri]

BeriBeri (Wet vs. Dry vs. BOTH) is associated with…

  1. Heart involvement = WET
  2. Symmetrical Peripheral Neuropathy = DRY

[Thiamine B1] is needed to Decarboxylate a-ketoacids (carb metabolism)

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17
Q

Clinical Presentation for [Bells Palsy] (4)

A

​Bells Palsy = Facial CN7 paralysis from inflammatory edema

Loss of F –> Entire half Unilateral Paralysis

Loss of A –> Hyperacusis

Loss of C–> DEC Eye lacrimation (tearing)

Loss of E –> Loss of ANT 2/3 Tongue Taste

FACE

  1. Facial Muscles
  2. Afferents(Somatic) from [External Auditory Canal (stapedius m.)] & [Ear Pinna (Pain/Temp)]
  3. Cry: Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular/]
  4. Eat: Taste from ANT 2/3 Tongue
    * Note: Forehead sparing = Intracranial lesion and NOT Bells Palsy*
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18
Q

Early Findings of Alzheimer’s - 4

A

CLAV –> HANDU

Cognitive PROGRESSIVE ⬇︎

Language ⬇︎

Anterograde immediate memory loss

Visualspatial disorientation (loss in ur own neighborhood)

Onsets after 60 yo

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19
Q

Clinical Criteria for diagnosing Alzheimer’s -5

A

CLAV –> HANDU

  1. GOE 2 Cognitive deficits
  2. Worsening Memory
  3. Consciousness intact
  4. Onsets after 60 yo
  5. No other Systemic/Neuro DO to cause cognitive defects
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20
Q

Normal Pressure Hydrocephalus Sx (3); Which is earliest to present?

A

⬇︎CSF absorption –> Wacky, Wobbly & Wet!

Wacky (memory loss)

Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)

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21
Q

Normal Pressure Hydrocephalus characteristics - 4

A

Wacky, Wobbly & Wet!

  1. Idiopathic
  2. Episodic
  3. Elderly
  4. Does not ⬆︎ SubArachnoid space volume

Etx: ⬇︎Arachnoid villi CSF Absorption vs obstruction

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22
Q

ANY Clinical Suspicion of Stroke warrants _____. Why?-2

A

NonContrast Head CT; Ischemic stroke benefits from Thrombolytics vs ICH requires neurosurgery

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23
Q

How do ICH (IntraCranial Hemorrhage) stroke appear on NonContrast Head CT? How long does this take?

A

[HYPERdense White]; IMMEDIATELY!

Ischemic Stroke = [hypOdense dark] and takes >24 hrs to appear

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24
Q

Clinical Presentation for Diabetic Ophthalmoplegia (3); Etx?

A

DM –> Oculomotor CN3 Central ISCHEMIA

  1. Ipsilateral Down & Out Eye
  2. Ptosis (from Levator Palpebrae paralysis)
  3. NORMAL PERRL (since Parasympathetic fibers are spared)
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25
Q

Ethosuximide Indication

A

Sux to have Silent Seizures

Silent (Absent) Seizures

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26
Q

Features of Absence Seizures -5

A
  1. Staring spells mid-activity
  2. Patient PAUSES activity
  3. Last < 20 seconds
  4. Not responsive to tactile/vocal stimulation
  5. NO recollection or postictal

  • Provoked by Hyperventilation or photic stimulation / Dx = 3 Hz EEG spike*
  • ADHD staring spells occur only DURING BOREDOM!*
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27
Q

Name a common trigger for Absence Seizures-2 ; Dx?

A
  1. Hyperventilation
  2. photic stimulation

; 3 Hz EEG spike

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28
Q

Why is it so important to recognize ____ in children with epilepsy?

A

ADHD; ADHD is common in Peds Epilepsy (includes Absence seizures) and if treated will ⬆︎ life quality

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29
Q

Newborn Galactosemia etx

A

inability of [(GALT) Galactose 1 Phosphate Uridyl Transferase] to convert Galactose1P –> Glucose, so Galactose accumulates

Susceptible to E.Coli !!!

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30
Q

S/S of newborn Galactosemia -7

A
  1. BL Cataracts
  2. Jaundice
  3. Vomiting
  4. Convulsions
  5. Failure to Thrive
  6. Hepatomegaly
  7. Irritability

Susceptible to E.Coli!!

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31
Q

[Cavernous Sinus Thrombosis] Presentation (3)

A

Infection of face vs teeth spreads thru facial veins –> cavernous sinus

  • [CN3 / 4 / 6 / CN5B1 and B2] ipsilateral involvement
  • Proptosis (protrusion of eye)
  • HA
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32
Q

[Cavernous Sinus Thrombosis] etx

A

Infection of face vs teeth spreads thru facial veins –> cavernous sinus

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33
Q

Lacunar Stroke etx

A

lenticulostriate vessels perfuse [Be TIPC] (not Pons)

Lacunar Stroke= [Thrombotic HTN Arteriolosclerosis & Thrombotic microatheromas] of lenticulostriate vessels –> [cystic infarcts < 15 mm] –> Lacunar Syndrome

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34
Q

Describe the Lacunar Syndrome CP

A

lenticulostriate vessels perfuse [Be TIPC] (not Pons)

Lacunar Stroke= [Thrombotic HTN Arteriolosclerosis & Thrombotic microatheromas] of lenticulostriate vessels –> [cystic infarcts < 15 mm] –> Lacunar Syndrome

1A: Basal Ganglia–>Hemiballismus & involuntary writhing

1B: [Internal Capsule-POST limb/Pons/Corona Radiata]–> pure Motor stroke vs ataxia vs. clumsy hand-dysarthria

1C: ThalamuS VPL –> CTL Sensory Stroke

VPL=VentroPosteroLateral nc

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35
Q

What is Dejerine Roussy Syndrome

A

lenticulostriate vessels perfuse [Be I C]

S/p Lacunar Thalamus Sensory stroke eventually –> Severe Paroxysmal BURNING worst w/light touch = Allodynia

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36
Q

Clinical Presentation of Congenital Syphilis -7

A
  1. Frontal Bossing
  2. Deaf
  3. Saddle nose
  4. Rhinitis
  5. Hutchinson Mulberry Molars
  6. Liver/Spleen Dz
  7. Saber Shins
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37
Q

Clinical Presentation for Fetal Hydantoin Syndrome -6

A

Etx = Exposure to Phenytoin vs Carbamazepine during utero

  1. Microcephaly
  2. Cleft Lip / Palate
  3. Digital and Facial hypOplasia
  4. Hirsuitism
  5. Retardation
  6. Neonatal bleeding (Phenytoin ⬇︎ Neonate VitK)
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38
Q

Classic signs of Fetal Alcohol Syndrome - 4

A
  1. Microcephaly
  2. Small Palpebral fissures
  3. Long Smooth Philtrum
  4. Thin Upper Lip
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39
Q

Sturge Weber Syndrome Clinical Presentation -5

A
  1. Seizures
  2. Port Wine Stain vs Red Nevus along CN5 territory = congenital UL cavernous hemangioma
  3. CTL Homonoymous Hemianopsia
  4. Hemiparesis
  5. Ipsilateral Glaucoma

Tramline Gyriform Calcifications on CT

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40
Q

Sturge Weber Syndrome Dx

A

Tramline Gyriform Calcifications on CT

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41
Q

Sturge Weber Syndrome Tx -3

A
  1. Control Seizures
  2. ⬇︎ Intraocular pressure from Glaucoma
  3. Argon laser for [Port wine stain vs Red nevus along CN5 territory]

Tramline Gyriform Calcifications on CT

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42
Q

Tuberous Sclerosis Clinical Presentation (12)

A

HAMARTOMASSS

[Hamartomas benign]

[Angiofibroma on Face-triad] - image

Mitral Regurgitation

[Ash Leaf Macules]

[Rhabdomyoma Cardiac –> Valvular Obstruction]

Tuberous Sclerosis

AUTO DOM

Mental Retard-triad

[AngioMyoLipoma Kidney]

Seizures-triad

SEGA (SubEpendymal Giantcell Astrocytoma)

[Shagreen forehead patches]

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43
Q

Genetic Cause of Neurofibromatosis Type 1

A

[chromo 17 mutation]–> [NeurofibroMin loss]. NeurofibroMin tumor suppresses (RAS GTPase activating protein

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44
Q

Characteristics of Neurofibromatosis Type 1 (6)

A

CLAP ON type 1!”

  1. Neurofibroma PLEXIFORM
  2. Acoustic Schwannoma-Unilateral (HA/Tinnitus/Vertigo)
  3. [Optic n. Glioma]
  4. Lisch nodules
  5. [Cafe Au Lait Spots]
  6. Pheochromocytoma
    * Note: NF1 in Newborns will present w/Macrocephaly, ⬇︎Feeding ,learning idsabilities*
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45
Q

Neurofibromatosis Type 2

Clinical Presentation - 3

A
  • [Bilateral Acoustic Schwannomas] (HA/Tinnitus/Vertigo)
  • Multiple Meningiomas benign
  • BL Cataracts

Bilateral Acoustic Schwannomas @ Cerebellopontine angle

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46
Q

In [Neurofibromatosis Type 1], Fleshy cutaneous neurofibromas are made of ______ which embryologically come from _____. These pts may also have hyperpigmented spots known as ____

A

In NF1, Fleshy cutaneous neurofibromas are made of Schwann cells, which are embryologically from Neural Crest. May also have [Cafe Au Lait Spots (image)]

Image: Cutaneous Neurofibromas & Cafe Au Lait Spots

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47
Q

Main features of Narcolepsy -4

A
  1. > [3x/week for more than 3 mo.] of sudden entry into REM sleep
  2. hypnagogic/hypnopompic hallucinations
  3. Sleep Paralysis (temporary paralysis after sleeping)
  4. Cataplexy

hypnogogic = when going to sleep

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48
Q

Cataplexy may be treated with ___-suppressing drugs. Name 2 examples

A

REM Sleep-Suppressing drugs; Antidepressants and Sodium Oxybate

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49
Q

List the 3 main causes of HemipLegia in Kids

A
  1. Seizure w/Todds Paralysis
  2. Hemorrhagic Stroke 2/2 AVM
  3. HemipLegic Migraine (Teens w/Fam hx, self-resolving)
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50
Q

Describe Todds Paralysis

A

Self-limited focal (ipsilateral UE and LE) paralysis after seizure that resolves naturally within 36 hours

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51
Q

What Dz occurs from [Tetrahydrobiopterin BH4] deficiency? Explain the etx

A

(PKU) Phenylketonuria; Dihydropteridine Reductase becomes deficient w/out [Tetrahydrobiopterin BHF] cofactor –> Inability to convert Phenylalanine –> Tyrosine

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52
Q

Phenylketonuria tx (2) ; Why is Newborn screening important for these?

A
  1. low phenylalanine diet
  2. BH4 supplementation

NEWBORN SCREENING–> early dx –> early tx –> Normal lives!!

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53
Q

PKU-Phenylketonuria S/S (4)

A
  1. Musty Odor
  2. Seizures (look for upward eye deviation)
  3. Eczema
  4. Retard
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54
Q

Newborn screening is ESSENTIAL for early dx of PKU

How do you diagnose PKU?

A

Tandem mass spectrometry of dried blood spots –> detects PKU products

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55
Q

Name the classic complaint pts with Presbycusis will give regarding conversations - 2

A

Can hear one-on-one BUT can not hear if there’s ANY background noise + BL tinnitus

Sensorineural hearing loss secondary to age

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56
Q

What conditions are associated with [Berry Saccular Aneurysm]? (5)

A

“Eating AppleBerries Can Sound Heavenly”

  1. ADPKD**
  2. [Ehlers Danlos Syndrome]
  3. HTN
  4. SAH (from Trauma > Berry Saccular Aneurysm)
  5. Coarctation of Aorta (associated w/HTN)

Image: Blood around Brainstem & Basal Cisterns

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57
Q

[Communicating Hydrocephalus] cause

A

[Meningitis vs. SAH/Intraventricular Hemorrhage] –>Disrupts communication of CSF with [Arachnoid Granulation Villi] ReAbsorption

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58
Q

[SubArachnoid Hemorrhage] Dx-3? Tx-2?

Usually in Suprasellar Cistern

A

Dx:

  1. NonContrast Head CT
  2. Lumbar Puncture revealing Xanthochromia (6 hrs after onset)
  3. Cerebral Angiography

Tx: [Endovascular Coiling/Stenting to stabilize aneurysm] + Nimodipine

Xanthochromia comes from Blood breakdown products

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59
Q

What’s the major complication of [SubArachnoid Hemorrhage] 24 hrs post onset?

A

REBLEEDING WITHIN 6 HRS –> MAJOR CAUSE OF DEATH!

Other complications: Rebleeding, SIADH, Seizures

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60
Q

What are Risk factors for PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] - 4

A
  1. Overweight Women taking OCP (will usually have Empty Sella Turcica)
  2. Tetracyclines
  3. Vitamin A OD (Isotretinoin)
  4. Growth Hormone

This HA will make you go Blind!

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61
Q

Lumbar puncture with CSF pressure of _____ = Intracranial HTN

A

> 250 mmH20

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62
Q

PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] Tx - 3

A

Big Girl with PCiiH just SAT on her problems

  1. Surgery (Shunt vs Optic N sheath fenestration)
  2. Acetazolamide (inhibits Choroid Plexus Carbonic Anhydrase)
  3. Topiramate (will also –> Wt loss :-) )

This HA will make you go Blind!

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63
Q

PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] Dx - 2

A
  1. Lumbar Puncture with opening pressure >250 mmH20 (from ⬇︎Arachnoid villi CSF absorption)
  2. MRI +/- MRV revealing BL tortuous Optic N

This HA will make you go Blind!

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64
Q

Papilledema is typically a ctx to Lumbar puncture. When is it not a ctx to Lumbar puncture? Explain

A

[PCiiH (Pseudotumor Cerebri Idiopathic Intracranial HTN)]; As long as there are no signs of obstructive/noncommunicating hydrocephalus or mass, then it is ok

LP with CSF opening pressure > 250 mmH20 = PCIIH

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65
Q

[Pseudotumor Cerebri Idiopathic Intracranial HTN] Clinical Presentation - 4

A
  1. [HA worst at sleep times (night/morning) & with head position ∆]
  2. Vision changes +/- Papilledema
  3. Pulsatile Tinnitus
  4. CN6 Abducens Palsy

This HA will make you go Blind!

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66
Q

[Syringomyelia central cord syndrome] etx ; CP-2?

A

Formation of [CSF filled syrinx cavity] in C8-T1 region of spinal cord –> damages [Ventral white commissure (crossing fibers for STT)] –> 1. [BL Cape distribution Pain/Temp Loss in Arms & Hands]

  1. ***Eventually Ventral Horns are also destroyed –> LMN signs (FAAW) - Fasciculations / Atrophy & Areflexia / Weakness
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67
Q

Parkinsonism Clinical signs (8)

A

PARK & hamp

[Pill Rolling Resting 4-6 Hz unilateral Tremor] worst with Rest & Mental Task

[Rigidity Cogwheel]

BradyKinesia

[AReflexia posturally] –>Shuffling Gait/Fall when turning or stopping

+

  • hypOphonic speech
  • Autonomic ⬇︎ (constipation / bladder problems / orthostatic hypOtension)
  • micrographia
  • poker masked face
  • PARK = primary signs*
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68
Q

Name the Major UMN signs (5)

A

UMN signs = Weak MESH

Weakness

[Spastic Gait & Paralysis] (partially from disproportionate Extensor weakness)

[Exaggerated Reflexes (Babinski)]

Mental Status change

HemipLegia

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69
Q

Name the Lower Motor Neuron signs - 4

A

LMN signs (FAAW) - Fasciculations / Atrophy & Areflexia / Weakness

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70
Q

3 Main causes of Spinal Cord Compression

A
  1. DJD Disc Herniation (Smoking risk factor)
  2. [Epidural Staph a. Abscess (think IV drug user vs DM)]
  3. Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets)

Dx = MRI, Positive Straight Leg, Classic S/S

DJD=Degenerative Joint Disease

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71
Q

Causes of [Anterior Spinal Cord Syndrome] - 2

A

Thoracic AAA Repair vs Vertebra Burst Fracture

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72
Q

Describe the 3 main sx for [Brown Sequard Syndrome]

A
  1. Contralateral STT Loss of Pain/Temp 2 LEVELS BELOW ORIGINAL LESION
  2. Ipsilateral DCP Loss of 2TVP-2point/Touch/Vibration/[Position Proprioreception]

3. Ipsilateral CST Loss –> Muscle Weakness

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73
Q

Causes of [Brown Sequard Syndrome] - 3

A
  1. [(Extramedullary Tumor]
  2. Trauma
  3. [DJD Disc Hernation (Smoking risk factor)]
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74
Q

[Cauda Equina Syndrome] etx ; Clinical Presentation - 5

A

(Compression of S2 - S4 n. roots) –>

  1. Saddle Anesthesia (image)
  2. ⬇︎ Anocutaneous Reflex (perianal pinpoint does NOT cause anal sphincter contraction)
  3. Incontinence (urinary AND fecal)
  4. uL (uniLateral) Radiculopathy
  5. hypOreflexia (Conus Medullaris syndrome has HYPEReflexia)

Decompression required within 72 hours!!!

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75
Q

Where does Charcot Bouchard Aneurysms occur (4)

A

Charcot Bouchard Tears Pink

  • Basal Ganglia
  • Cerebellum
  • Thalamus (shown in image below)
  • Pons

Acute ICHH [Intraparenchymal CharcotBouchard HTN Hemorrhage] in image

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76
Q

What causes Hemiballismus

A

Damage (i.e. lacunar stroke) to Subthalamic nc., important in modulating basal ganglia output –> CTL Hemiballismus

Note: Basal Ganglia is in Subcortical nuclei

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77
Q

Etx of Huntington’s Disease

A

[AUTO DOM [Chromo 4 CAG repeats]] —> Degeneration of (Caudate nc. inside the ((I)ndirect Striatum w/ [Gross Caudate atrophy] ) –> [⬇︎ GABA release]

“Hunting 4 food is way too aggressive & dancey”

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78
Q

Huntington’s Dz Clinical Presentation (2)

A
  • “Hunting 4​ food is way too aggressive & dancey”*
    1st: Aggressive Dementia w/ strange behavior
    2nd: Dance-like Chorea mvmnts
  • AUTO DOM = Affects BOTH sexes equally!!*
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79
Q

When does Huntington’s Dz onset

A

30 - 50 y/o

AUTO DOM = Affects BOTH Sexes Equally!!

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80
Q

Describe Essential Tremor-2 ; What is it relieved by

A
  1. BUE Action Tremor worst w/Action (can also affect head & voice)
  2. No additional neuro ∆ present

relieved with EtOH

Onsets at 45 yo and 50% cases are AUTO DOM

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81
Q

Tx for Essential Tremor - 6

A

Propranolol > [PAT - Primodone vs Anticonvulsants vs Topiramate] > Benzo > Surgery

Onsets at 45 yo and 50% cases are AUTO DOM

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82
Q

Parkinson’s Dz Tx - 6

A

“Eat SALADS after you Park”

  1. [Levodopa (Dopamine Precursor) + Carbidopa]
  2. Amantidine
  3. Anticholinergics
  4. [Dopamine PostSynaptic Agonist] (NonErgot: Ropinirole vs. Pramipexole) & (Ergot:Bromocriptine)
  5. Selegiline
  6. Surgery
    - Pallidotomy: Destructive of [Globus Pallidus:internal]
    - SubThalamic nuc. inhibition with electrode
    - ANT Choroidal a ligation
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83
Q

Lesch Nyhan etx

A

MALE DO in which HGPRT deficiency –> ⬆︎ Purine –> Uric Acid accumulation

Presents in Males 6 mo. old with hypOtonia + vomiting eventually –> CROUG ( UE Self-Injury (Biting) / Choreoathetosis / Retardation / Gout / Obstructive Nephropathy

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84
Q

Lesch Nyhan Clinical Presentation - 7

A

Presents in Males 6 mo. old with hypOtonia + vomiting eventually –> CROUG ( UE Self-Injury (Biting) / Choreoathetosis / Retardation / Gout / Obstructive Nephropathy

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85
Q

Dx for Multiple Sclerosis - 5

A
  1. Clinical (SLUM SiiiN)
  2. T2 MRI: [Periventricular white matter demyelinating plaques with lipid laden macrophages]
  3. T1 MRI Black holes
  4. CSF Oligoclonal IgG bands
  5. Visual conduction velocity test

Sx will be disseminated in time and space

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86
Q

CP for [MIOS-MLF Internuclear Ophthalmoplegia Syndrome] (3)

A

[MIOS-MLF Internuclear Ophthalmoplegia Syndrome]

*[Impaired ADDuction of affected eye]

+

[Normal ADDuction of affected eye during [near reflex convergence]

+

*[Nystagmus of UNaffected eye when attempting to ABduct]

Image: L MIOS

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87
Q

Clinical Manifestation of Multiple Sclerosis (9)

A

Charcot classic triad of MS is a [SLUM SiiiN] !

Sensory sx (think BL Trigeminal Neuralgia)

Lhermittes sign = “electric tingling” down spine into arm & legs when chin is touched to chest

Uhthoff phenomenon (sx ⬆︎ during heat)

Motor sx

Scanning Speech

[Internuclear Ophthalmoplegia (MIOS)] / Intention Tremor / Incontinence

Neuritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR

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88
Q

Which drugs are used to treat Multiple Sclerosis Exacerbation?-2 ;

Which are used for maintenance?-3

A

1st: High Dose IV Methylprednisolone
2nd: (Refractory): Plasmapharesis

Maintenance:

  1. β-interferon
  2. Glatiramer acetate
  3. Natalizumab
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89
Q

Myotonia Dystrophy Clinical Manifestation - 6

A

My Tonia, My Toupee, My TV Viewers, My Throat, My Ticker, My Testicles,

Tonia = MyoTonia = [⬇︎ relaxation after volitional muscle contraction with Weakness & Atrophy] (cant let go of doorknob)

Toupee = Frontal Balding

TV viewer = Cataracts

Throat = SEVERE DYSPHAGIA –> Aspiration PNA

Ticker = Arrhythmia

Testicle = Testicular Atrophy

Auto DOM CTG Repeat

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90
Q

Main features of Duchenne Muscular Dystrophy - 5

A
  1. CALF PSEUDOHYPERTROPHY requiring gower manuever
  2. Scoliosis**
  3. Cardiomyopathy
  4. Wheelchair by Teenage years
  5. Death by 20-30 yo 2/2 Cardiopulm failure**

  • Onsets at 2 yo / X-Link Recessive deletion on Chromo Xp21*
  • ** = also seen in Becker Muscular Dystrophy*
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91
Q

Main features of Becker Muscular Dystrophy - 2

A
  1. Scoliosis**
  2. Death by 40-50 yo 2/2 Cardiopulm failure**

  • Onsets at 5 yo / X-Link Recessive deletion on Chromo Xp21*
  • ** = also seen in Duchenne Muscular Dystrophy*
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92
Q

What are the Risk Factors for Alzheimer’s Dz - 6

A

CLAV–> HANDU

  1. > 60 yo
  2. Female
  3. Family hx
  4. Head Trauma
  5. Apolipoprotein E positive
  6. Down’s Syndrome (they have ⬆︎ [chromo 21 transmembrane amyloid precursor glycoprotein])
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93
Q

Frontotemporal Pick’s Dementia

Sx -2

A

Prounouced Frontal & Temporal lobe atrophy –>

[Socially inappropriate Behavior] + aphasia

OCCURS MORE IN FEMALES!!!

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94
Q

A: Demographic of Frontotemporal Pick’s Dementia?

B: Mode Of Inheritance

A

A: 50-60 yo Females (Alzheimer = > 60)

B: Auto Dominant

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95
Q

Dementia with Lewy Bodies (DLB) CP - 3

A

DLB at the DMV

  1. Dementia confusion periodically
  2. MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
  3. Visual Hallucinations

Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations

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96
Q

Tick Paralysis and Gullain Barre both present with ascending paralysis

What differentiates Tick Paralysis? - 3

A

Tick Paralysis has…

  1. NO Autonomic Dysfunction
  2. Normal CSF (GBS CSF=High Protein > 40)
  3. Can be Asymmetrical (GBS=Symmetrical)
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97
Q

CP of Cerebellar Damage - 7

A

Cere is def on GRINDRR

Gait Ataxia IPSILATERAL

Rapid alternating mvmnt impairment

Intention tremor/Dysmetria IPSILATERAL

Nystagmus IPSILATERAL (medial AND Lateral Vermis)

Dysarthria (Lateral Vermis only)

Rebound phenomenon (pt hits themself in face if flexing bicep and examiner releases arm-image)

Reflex Pendular (knee swings >4x after Deep tendon reflex is elicited)

Vermis is midline

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98
Q

Describe the “Clasp Knife” phenomenon ; What disease is this related to?

A

Rapid SPASTIC RESISTANCE to passive mvmnt of limb; UMN (Weak MESH) Pyramidal Tract dz

  • Pyramidal Tract = Corticospinal and Corticobulbar*
  • Pronator Drift also indicates Pyramidal Tract Dz*
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99
Q

Dx for Creutzfeldt Jakob disease - 6

A
  1. [PRNP prion protein] genetic testing
  2. EEG Biphasic vs Triphasic sharp wave complexes
  3. Postmortem brain biopsy
  4. ⬆︎CSF 14-3-3 proteins
  5. MRI Cortical Ribbons
  6. MRI basal ganglia hyperintensity
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100
Q

[Creutzfeldt Jakob Dz] etx

A

PrP (prion protein), normally in neurons as [a-helical structure] converts–> [INFECTIOUS Beta pleated sheets] –> Protease resistance –>

Vacuoles in [Gray Matter Neurons & Neutrophils] develop –> Cyst = [Spongiform Gray Matter]

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101
Q

[Creutzfeldt Jakob Dz] CP - 2

A

[RAPIDLY Progressive Dementia] + [STARTLE Myoclonus] –> DEATH

Can be Acquired vs. Inherited

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102
Q

[Amyotrophic Lateral Sclerosis] (Lou Gehrig’s) etx - 2

A
  1. Rare = [Superoxide Dismutase gene mutation] –> copper-zinc dysfunction —>[Upper AND Lower Motor Neuron Disease!]
  2. Common = Idiopathic

UMN Dz includes loss of neurons in motor nc. 5/9/10/12

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103
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Upper Motor Neuron causes of Neuromuscular weakness - 4

A
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104
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Anterior Horn Cell causes of Neuromuscular weakness - 4

A
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105
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Peripheral Nerves causes of Neuromuscular weakness - 5

A
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106
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Neuromuscular JUNCTION causes of Neuromuscular weakness - 4

A
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107
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Muscle Fibers causes of Neuromuscular weakness - 5

A
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108
Q

Guillain Barre Tx - 2

A

IVIG vs Plasmapheresis

Guillain Barre CSF = HIGHLY ELEVATED Protein > 40

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109
Q

What Spinal Columns are affected in [Subacute Combined Degeneration]?-3 ; How does this manifest?-3

A

[SuBACute Combined Degeneration]

[Demyelinating lesions] in 3 Thoracic Spinal Columns:

  1. [Dorsal–> Loss of 2TVP]
  2. [Lateral CST –> UMN Weak MESH + Ataxia]
  3. Spinocerebellar
    * FriEdreich Ataxia affects the SAME 3 columns*
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110
Q

Causes of [Subacute Combined Degeneration] (3)

A

[SuBACute Combined Degeneration]

1) B12 Deficiency
2) Copper Deficiency
3) AIDS/HIV
* Affects Dorsal / Lateral CST / Spinocerebellar Tracts (Combined)*

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111
Q

Postconcussive syndrome can occur __(length of time)__ after any TBI (Traumatic Brain Injury).

Describe CP for Postconcussive Syndrome - 4

A

hours-days;

  1. Continued Confusion/Amnesia
  2. HA
  3. Mood changes
  4. Vertigo

This is Self-Resolving

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112
Q

In pts with Traumatic Brain Injury (TBI), what’s the major cause of morbidity?

A

Diffuse axonal injury at Gray-White matter junction (since this is where density difference is highest​)

USE MRI FOR DX

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113
Q

How long does it take Toradol to reach Max efficacy

A

3 hours

Dose = q4-6 hrs

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114
Q

You suspect a baby has ingested Botulinum spores

What’s the Clinical Presentation? - 4

A
  1. Descending Flaccid Paralysis (Floppy Baby)
  2. Ptosis
  3. Poor Suck & Gag Reflex w/drooling
  4. Constipation

Tx = IMMEDIATE Botulinum Ig

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115
Q

Spinal Muscular Atrophy etx and CP ; What’s the difference between Infant type and Adult type

A

[Spinal muscular atrophy] = specifically [ANT Horn Cell degeneration] from [Chromo 5 SMN1 and 2 gene mutations]–> LMN signs of FAW- Weakness/[atrophy & areflexia] /Fasciculations

*Infantile onset = (Werdnig Hoffman) –> [Auto Recessive FATAL condition –> Floppy Baby from defuse [Distal muscle atrophy]

*Milder childhood/adult onset types –> [Non-fatal Chronic Disability]

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116
Q

Why are Multiple Sclerosis pts at risk for BL Trigeminal Neuralgia

A

Demyelination may occur at Trigeminal nucleus –> BILATERAL neuralgia

Sx will be disseminated in space and time

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117
Q

After Getting Labs, NonContrast Head CT is next for dx unprovoked seizures

When would MRI be the better option? Name structural causes of epilepsy?-7

A

Use MRI in NONEmergent/elective situations;

  1. Temporal Sclerosis-shown in image
  2. Cortical Dysplasia
  3. TBI (Traumatic Brain Injury)
  4. Vascular Malformation
  5. Infection
  6. Tumor
  7. Infarction
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118
Q

[LEMS - Lambert Eaton Myasthenic Syndrome] etx

A

[Autoimmune attack against (Presynpatic Ca+ channel)–> No ACh release]

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119
Q

What other condition is [LEMS​ - Lambert Eaton Myasthenic Syndrome] associated with?

A

“LEMS has a good SOLC(soul)”

SOLC-Small Oat cell Lung Carcinoma

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120
Q

Name 4 Differentiating Factors for Myasthenia Gravis vs. [Lambert Eaton Myasthenic Syndrome]

A
  1. [LEMS] improves with exercise/exertion during the day!
  2. [LEMS] will show no imprvmnt with [Tensilon Edrophonium] injection OR ice pack
  3. [LEMS] nerve testing shows INC muscle responses
  4. [LEMS] has autonomic dysfunction (orthostasis, dry mouth, impotence)
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121
Q

What other condition is [Myasthenia Gravis] associated with?

A

May cause Thymoma (thymic hyperplasia)

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122
Q

[Myasthenia Gravis] etx ; Demographic?-2

A

Autoantibodies block and degrade [postsynpatic nicotinic ACh Receptors]] –> [⬇︎ motor end plate potential]

Presents in [Women 20-30] and [Men 60-80]

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123
Q

[Myasthenia Gravis] Clinical Presentation (6)

A

P DDD WF

[Ptosis

[Diplopia from Disconjugate gaze]

Dysarthria-bulbar dysfunction

Dysphagia w/nasal regurgitation-bulbar dysfunction

[Weakness Muscularly (Extraocular/RESPIRATORY/Proximal/ limbs /)]

[FATIGABLE Weakness Muscularly (worst w/repetition)]

Tx: Pyridostigmine AChesterase inhibitor

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124
Q

[LEMS - Lambert Eaton Myasthenic Syndrome] Clinical Presentation - 3

A
  1. Weakness of [Proximal limbs and trunk] mimicking myopathy, better with exercise
  2. Autonomic sx (Dry mouth /Orthostasis / Impotence)
  3. ⬇︎Deep Tendon Reflexes
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125
Q

You suspect a pt had a Stroke

After FIRST, ruling out Hemorrhagic stroke with _____, when should thrombolytic therapy be given? What should be given?

A

NonContrast Head CT; WITHIN 4.5 HOURS OF SX ONSET! ; IV Alteplase

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126
Q

How are HTN and DM mngmnt related to Acute CVA/TIA - 2

A

BP > 185/110 in setting of stroke can –> ICH - so Use Labetalol

&

Hyperglycemia augments brain injuries (so ONLY use NonDextrose IVF)

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127
Q

What is Therapeutic hypOthermia often used for? ; How low of temp can you go? ; SE of this?-4

A

Prevents hypoxic Brain injury in pts with [out of hospital cardiac arrest] ; 32C ;

  1. HYPERKalemia
  2. ⬇︎Cardiac Output
  3. ⬆︎Coagulation
  4. Immunosuppression
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128
Q

Homocystinuria Clinical presentation-5 ; tx-2?

A

auto recessive [Cystathionine synthase] deficiency –> Thromboembolism–> Stroke

  1. Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis)
  2. Stroke
  3. Fair Hair & Eyes
  4. Ectopia Lentis
  5. Retarded

tx = [Pyridoxine B6] + AntiCoag

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129
Q

Homocystinuria dx-2

A

auto recessive [Cystathionine synthase] deficiency –> Thromboembolism–> Stroke

⬆︎ Homocysteine and Methionine

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130
Q

Name the Differences in CP between Marfan and Homocystinuria - 3

A
  1. Marfan are not retarded
  2. Marfan has no Stroke Risk
  3. Marfan are not fair complexion
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131
Q

Tay-Sachs etx ; CP-3

A

auto recessive B-hexosaminidase A deficiency –>

  1. Cherry Red Macula
  2. Seizures
  3. Retarded
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132
Q

Pronator Drift is a good indicator of what type of disease?

A

UMN Pyramidal Tract Dz (think stroke)

  • Pyramidal Tract = Corticospinal and Corticobulbar*
  • Clasp Knife phenomenon also indicates Pyramidal Tract Dz*
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133
Q

Etx of Parkinsons Disease

A

[LABS (Lewy α-synucleinBodieS)] accumulation in [substantia nigra pars compacta] –>degeneration –> ⬇︎Dopamine release and ⬇︎ stimulation of Striatum which –> allows Globus pallidus internal to continuously inhibit [VA/VL Thalamus from stimulating motor cortex]

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134
Q

There are 3 Dopamine D2 pathways in the brain

Name the pathways ; what overall effect do they have when activated?

A

Stimulation of….

Mesolimbic = Psychosis

Nigrostriatal = Mvmnt Coordination

Tuberoinfundibular = INHIBITS Prolactin when activated (if blocked –> infertility from hyperprolactinemia)

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135
Q

How is [Apolipoprotein E] related to Alzheimers

A

Apo E –> impaired synthesis and clearance of AB-amyloid —> INC risk for LATE onset Alzheimers

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136
Q

Alzheimer’s Dz etx (3)

A

Alzheimers etx = CHA

**Cleavage, Hemorrhage, (ACh⬇︎) **

  1. Cleavage of [chromo 21 transmembrane amyloid precursor glycoprotein] –> β-amyloid which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.
  2. Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from β-amyloid deposition in cerebral vessels
  3. ACh ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 β-amyloid accumulation –> defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx (CLAV–>HANDU)
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137
Q

What type of Hemorrhage is shown in image ; What is this typically associated with?

A

Lobar Hemorrhage (parietal) ; Amyloid Angiopathy 2/2 Alzheimers

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138
Q

Hypokalemic periodic paralysis CP-2

Occurs right after vigorous activity

A
  1. SUDDEN generalized muscle weakness +
  2. ⬇︎ Deep Tendon Reflexes

Occurs right after vigorous activity

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139
Q

Benzos can cause an uncommon SE known as Paradoxical Agitation. Describe this

A

[⬆︎Agitation, confusion and disinhibition] within a hour of benzo admin. GIVING MORE BENZOS WILL WORSEN THIS!

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140
Q

What is a Cephalohematoma? Tx?

A

Neonatal SubPeriosteal Hemorrhage limited to 1 cranial bone (i.e. does NOT cross suture lines) that onsets hours after birth and presents as scalp swelling +/- ⬆︎jaundice;

Tx = Nothing, since it self-resorbs within 2 weeks-3 mo.

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141
Q

Cerebellar infarction of medial vermis presents as _____-2

A
  1. Nystagmus
  2. Vertigo
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142
Q

Cerebellar infarction of Lateral vermis presents as _____-6

A

Cere is def on GRINDRR

Gait & Coordination Ataxia - IPSILATERAL

Rapid alternating mvmnt impairment

Intention tremor/Dysmetria - IPSILATERAL

Nystagmus (medial AND Lateral Vermis infarcts)

Dysarthria (Lateral Vermis only)

Rebound phenomenon

Reflex Pendular (knee swings >4x after Deep tendon reflex is elicited)

Intention tremor = worst as finger moves closer to target

​

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143
Q

Describe Features of BENA (Brocas Expressive NonFluent Aphasia) -4

A
  1. Right Hemiparesis
  2. Nonfluent speech
  3. Impaired Repetition
  4. Impaired Naming

BENA = Dominant Inferior Frontal

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144
Q

Describe Features of Wernickes Aphasia - 3

A
  1. R SUP homonymous quadrantanopia
  2. Comprehension problems
  3. Impaired Repetition

Conductive AND Wernicke Area = Dominant SUP Temporal

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145
Q

Describe Features of CONDUCTION Aphasia

A

VERY POOR Repetition

This is in addition to Fluent but many phonemic errors

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146
Q

Status Epilepticus clinical criteria?-2

A
  1. Single seizure > 5 min OR
  2. Cluster of Seizures w/ no return to baseline in between episodes

Image showing Cortical Laminar Necrosis s/p Status Epilepticus

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147
Q

What is the long term outcome of status epilepticus on the brain? ; Dx for this?

A

Cortical laminar necrosis ; MRI w/cortical hyperintensity

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148
Q

What is the most common cause of ICH in kids?

A

ArterioVenous Malformation

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149
Q

Identify ; Which are Lenticulate and which are Striatum?

A

“Gay People Cook!” = Basal Ganglia

Gay People=Lenticulate // People Cook= Striatum

  • eg = Globus Pallidus
  • es = Putamen
  • d = Caudate
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150
Q

Tx for Cluster HA - 1st, 2nd and 3rd choice

A

1st = 100% O2 Nasal Canula

2nd = Sumatriptan

3rd = NSAIDs

Px = Verapamil

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151
Q

Px for Cluster HA

A

Verapamil

Also Px for Migraines

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152
Q

Describe CSF analysis for Guillain Barre

Glucose

Protein

WBC count

A

GPW

Normal Glucose / ⬆︎⬆︎Protein / Normal WBC

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153
Q

What are the Normal CSF lab ranges

Glucose

Protein

WBC count

A

GPW

Glucose: 40-70

Protein: <40

WBC: 0-5

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154
Q

Describe CSF analysis for Bacterial Meningitis

Glucose

Protein

WBC

A

GPW

⬇︎Glucose / ⬆︎Protein / ⬆︎WBC >1000

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155
Q

Describe CSF analysis for TB meningitis

Glucose

Protein

WBC count

A

GPW

⬇︎Glucose / ⬆︎Protein / ⬆︎WBC

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156
Q

Describe CSF analysis for Viral meningitis

Glucose

Protein

WBC count

A

GPW

Normal Glucose / ⬇︎ Protein / ⬆︎WBC (Lymphocytes)

Note: HSV actually has⬆︎Protein and ⬆︎ RBC also from temporal lobe destruction

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157
Q

Neonatal Intraventricular Hemorrhage occurs in premies less than ___ weeks gestation or less than ___ grams. Px?

A

< 30 weeks vs 1500g ; Antenatal Maternal Corticosteroids

  • Normal Gestation = 40 weeks*
  • Image: BL IVH & Dilated Vt*
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158
Q

Etx of Intraventricular Hemorrhage in premature babies less than _____ weeks or ___ grams

A

< 30 weeks vs 1500g ; Subependymal germinal matrix contains thin-walled vessels that easily rupture. Normally, these migrate before birth, but in premies they never have the chance which –> IVH –> ⬇︎Arachnoid CSF absorption –> Communicating Hydrocephalus

  • Normal Gestation = 40 weeks*
  • Image: BL IVH & Dilated Vt*
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159
Q

Choroid plexus cyst are identified ___ trimester and a marker for ____ in babies. How do they affect the baby?

A

second; Aneuploidy; They don’t affect baby. Regressess spontaneously and is benign

Dark holes = Cyst

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160
Q

What are the 7 major complications of Newborn Prematurity

Less than 32 weeks gestation specfically

A

BURPPIN

Bronchopulmonary Dysplasia

UcantBreathe (Neonatal Respiratory Distress Syndrome)

Retinopathy

  • *P**atent Ductus Arteriosus
  • *P**alsy CEREBRAL

Intraventricular Hemorrhage

Necrotizing Enterocolitis (⬆︎gastric residual volume with abd distension)

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161
Q

How do Traumatic Carotid Injuries occur?-3 ; Dx-2

Image: Carotid Dissection

A
  1. Penetrating Trauma
  2. Oropharyngeal trauma (falling w/object in mouth)
  3. Neck Strain (yoga, sports)

Dx = CT angio vs MR angio

These will present like Strokes

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162
Q

Lewy Body Dementia Tx

A

Rivastigmine AChinesterase inhibitor

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163
Q

What are the hallmark pathological findings for Alzheimers-2

A

[Tau Neurofibrillary tangles] & [Neuritic Senile Plaques]

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164
Q

Most serious complication of Guillain Barre? How do you determine when this complication gets really bad?

A

Respiratory Failure; FVC ≤ 20 mL/kg via SPIROMETRY means intubate!

HR, BP, Quadriparesis, FACIAL palsy are other serious complications

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165
Q

Levodopa is used to treat Parkinson’s Disease

Early SE?-3 ; Late SE

A

Early SE (HAD) = Hallucinations/Agitation/Dizziness

Late SE (5-10 yrs post tx) = Involuntary mvmnts

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166
Q

Dx for VitB12 deficiency - 3

A
  1. [⬆︎ Methylmalonic Acid levels]
  2. CBC showing Macrocytic Anemia
  3. Serum Vitamin levels
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167
Q

There are 3 Main causes of Spinal Cord Compression

Dx for Spinal Cord Compression-3

A
  1. MRI
  2. Classic S/S (BLE weakness, Worst w/spinal extension, better w/flexion, UMN signs)
  3. Positive Straight Leg

Note: In Acute Cord Compression, pts will have spinal SHOCK x3days = AReflexia and Flaccid paralysis

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168
Q

Brain Death is a clinical diagnosis and involves absent cortical and brain stem functions

T or F: Positive Deep Tendon Reflexes excludes a patient from being Brain Dead

A

FALSE! - Brain Death is limited to Cortex and Brainstem. Spinal Cord can still be functioning in Brain Death

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169
Q

[Myasthenia Gravis] Tx-4

A

P DDD WF

1st: Pyridostigmine AChesterase inhibitor
2nd: Cyclosporine
3rd: Thymectomy

**[Intubate + Plasmapharesis + IVIG + Steroids] if Crisis **

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170
Q

HemiNeglect Syndrome

A

Stroke in R Parietal Cortex (NonDominant hemisphere) –> Neglect of anything on the Left side

This is only in R handed people. It’s opposite for L handed

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171
Q

Usually Partial Seizures originate in a single hemisphere

Simple Partial Seizures may present as what 3 things?

A
  1. Motor ∆ (head turning) - no LOC
  2. Sensory ∆ (paresthesias)- no LOC
  3. Autonomic ∆ (sweating)- no LOC
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172
Q

Juvenile Myoclonic Epilepsy CP ; When do they occur mostly? ; Demographic?

A

Generalized Seizures +/- Absence seizures, most frequently in 1st hour after waking ; Teens

173
Q

Lennox Gastaut CP-2 ; Dx?

A

Lennox Gastaut

  1. Lala Land Retarded
  2. Generalized Tonic Clonic Seizures SEVERE

Presents by 5 yo ; Slow Spike-Wave EEG

174
Q

Most common [1° CNS Tumors] in Adults (3)

A

GMS

Glioblastoma astrocytoma (GRADE 4 - MALIGNANT - 2nd MOST COMMON to Metastasis)

MeninGioma benign

SChWannoma

Brain Metastasis=MOST COMMON ADULT BRAIN CA

175
Q

Glioblastoma Radiographic Findings - 2

A
  1. Butterfly lesion from crossing Corpus Collosum
  2. Midline shift from Lateral Vt Compression
    * GBM is usually a HIGH GRADE Astrocytoma*
176
Q

What’s the marker for Glioblastoma astrocytoma?

A

GFAP

177
Q

List the n. roots associated with Common Peroneal n.

A

L4-S2

foot is dropPED (Peroneal Everts & Dorsiflexes)

  • Commonly caused by L5 Radiculopathy*
  • Dx: Knee MRI vs EMG*
178
Q

List the n. roots associated with Tibial n.

A

L4-S3 (Three)

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

Commonly caused by L5 Radiculopathy

179
Q

A: List the n. roots associated with [SUP Gluteal n.]

B: Associated Injury (2)

C: Sensory deficit

D: Motor Deficit (2)

A

[SUP Gluteal nerve]

A: L4-S1

B: [Superomedial Butt injection] vs. POST Hip dislocation

C: none :-)

D: [Trendelenburg gait] & [No Thigh ABduction]

180
Q

A: List the n. roots associated with [inferior Gluteal n.]

B: Associated Injury (2)

C: Sensory deficit

D: Motor Deficit

A

[inferior Gluteal nerve]

A: L4-S2

B: Butt injection vs. POST Hip dislocation

C: none :-)

D: [No Thigh Extension]

181
Q

Most common [1° CNS Tumors] in Pediatrics-3 ; what’s the only one that’s supratentorial?

A

PEDs

Pilocytic Astrocytoma = MOST COMMON and can be Supratentorial OR infratentorial

Ependymoma (found in 4th Vt)

meDulloblastoma PNET = 2nd most common

Ependymoma and meDulloblastoma are infratentorial POST fossa(image)

182
Q

Where are Brain Metastasis typically found? - 2

A

Gray White Junction vs Watershed Zones

  • Brain metastases are multifocal and spherical*
  • Most common= [LUNG NonSOLC] > Breast/Colon/Kidney/Melanoma*
183
Q

Which grade Astrocytoma is this? How can you tell? CP?

A

LOW grade astrocytoma; it has NO CONTRAST ENHANCEMENT ; Seizures

184
Q

Which disorder results in a Waddling gait and why?

A

Muscular dystrophy; Gluteal m weakness

Waddling Gait = walks like Penguin from Batman

185
Q

Describe En-Bloc Gait ; What type of ataxia is this?

A

Minimal mvmnt of head while walking w/staggering gait; Vestibular Ataxia

Will be accompanied w/Vertigo & Nystagmus

186
Q

What is Pseudodementia?

A

Severe Depression in Elderly tht mimics Alzheimers dementia. Elderly come in c/o SLEEP PROBLEMS, memory loss and attention problem, but really have depression

Tx = SSRI

187
Q

How does hypOthyroidism affect Neuro system - 4

A
  1. it causes ⬇︎ in DTR
  2. ⬇︎ motor relaxation phase
  3. Mood ∆
  4. Dementia
188
Q

Long term SE of resolved Bacterial Meningitis - 3

A
  1. ⬇︎ Cognition (Retardation, Milestone regression)
  2. Hearing loss
  3. Seizures
189
Q

What is the main factor for differentiating Seizure vs Syncope

A

Seizure will have DELAYED RETURN to baseline 2/2 postictal state (confusion, focal neuro deficits, lethargy)

Seizure may also have olfactory aura & tongue lacerations

190
Q

Pts with Myasthenia Gravis may develop Myasthenia CRISIS, which presents clinically as ______ !!! What are precipitants of this?-3

A

P DDD WF

Respiratory Failure!

Precipitants = FIS:

  1. Fluoroquinolones
  2. Infection
  3. Surgery

Crisis Tx: [Intubate + Plasmapharesis + IVIG + Steroids]

191
Q

Memantine MOA ; Indication

A

Blocks Glutamate from binding to NMDA Receptor; Moderate to Severe Alzheimer’s

192
Q

Vascular Dementia presents with ⬇︎executive function and dementia just like other Neuro Disorders

What is the differentiating factor for separating Vascular Dementia from other Neuro Disorders? - 2

A

VaD has [asymmetric, focal neuro ⬇︎]and is abrupt

193
Q

What causes Charcot Bouchard Aneurysms? Rupture of these leads to what?

A

Charcot Bouchard Tears Pink

Uncontrolled HTN ; [Intraparenchymal HTN Hemorrhage]

194
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Basal Ganglia? - 3

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Basal Ganglia

  1. CTL Hemiparesis
  2. CTL ⬇︎ Sensory
  3. Eye Deviation TOWARD side of lesion

Acute [Intraparenchymal HTN Hemorrhage] in image

195
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Cerebellum? - 7

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Cerebellum

Cere is def on GRINDRR

Gait & Coordination Ataxia - IPSILATERAL

Rapid alternating mvmnt impairment

Intention tremor/Dysmetria - IPSILATERAL

Nystagmus (medial AND Lateral Vermis)

Dysarthria (Lateral Vermis only)

Rebound phenomenon

Reflex Pendular (knee swings >4x after Deep tendon reflex is elicited

Acute [Intraparenchymal HTN Hemorrhage] in image

196
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Thalamus? - 3

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Thalamus

  1. CTL Hemiparesis
  2. **Eye Deviation Toward Hemiparesis**
  3. Nonreactive Miosis

Acute [Intraparenchymal HTN Hemorrhage] in image

197
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Pons? - 3

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Pons

  1. Pinpoint REACTIVE pupils (damaged descending sympathetic fibers)
  2. Coma
  3. Total Paralysis

Acute [Intraparenchymal HTN Hemorrhage] in image

198
Q

[Cauda Equina Syndrome] etx ; Clinical Presentation - 5

A

(Compression of S2 - S4 n. roots @ Cauda Equina) –>

  1. hypOreflexia (Conus Medullaris syndrome has HYPEReflexia)
  2. LATE onset incontinence
  3. Asymmetrical Motor weakness
  4. Radiculpathy
  5. Saddle Anesthesia w/loss of Anocutaneous reflex

Tx: MRI, IV Corticosteroids, Neurosurg consult

199
Q

[Conus Medullaris Syndrome] etx ; Clinical Presentation - 5

A

(Compression of S2 - S4 n. roots @ Conus Medullaris) –>

  1. HYPEReflexia (Cauda Equina syndrome has hypOreflexia)
  2. EARLY onset incontinence
  3. SYMMETRICAL Motor weakness
  4. Radiculpathy
  5. Saddle Anesthesia w/loss of Anocutaneous reflex

Tx: MRI, IV Corticosteroids, Neurosurg Consult

200
Q

Genetic cause for [Fragile X]

A

[CGG repeat] –>[FMR1 gene Methylation] on [X Chromo long arm] –>small gap near tip of [X Chromo long arm]

201
Q

Fragile X CP - 5

A

X-Large…

  1. Personality (Autism, ADHD)
  2. Ears
  3. Forehead
  4. Chin (long face)
  5. Testes

Etx: C-GG repeat

202
Q

Friedreich Ataxia involves Degeneration of the ______, [____ and ____ spinal columns]

A

FriEdreich Ataxia involves Degeneration of the [Dorsal, Lateral CST and Spinocerebellar spinal columns]

  • FriEdrecih is Fratastic! He’s your fav. twisted frat brother, always studdering and falling, but has a sweet, big heart*
  • SuBACute Combined Degeneration affects SAME 3 columns*
203
Q

Deficency of what Vitamin mimics Friedreich Ataxia

A

FriEdreich Ataxia

Vitamin E (will also have Hemolytic anemia)

  • [Chromo 9 Auto Recessive]*
  • SuBACute Combined Degeneration affects SAME 3 columns*
204
Q

Describe Friedreich Ataxia (8)

A

FriEdreich is Fratastic! He’s your fav., twisted, frat brother, always studdering and falling, but has a sweet, big heart

FriEdreich = [Vitamin E Deficiency] mimics it

Fratastic has 9 letters = [Chromo 9 Auto Recessive]

twisted = Kyphoscoliosis @ childhood

frat = [frataxin (iron binding protein) defect]

studdering = Dysarthria

falling = [Falls & Ataxia + (Pes Cavus High Foot Arch)]

sweet = DM

big heart = Hypertrophic Cardiomyopathy

Involves Degeneration of [Dorsal, Lateral CST & Spinocerebellar]

205
Q

Friedreich Ataxia Mode of Inheritance

A

FriEdreich Ataxia

[Chromo 9 Auto Recessive]

SuBACute Combined Degeneration affects SAME 3 columns

206
Q

[Shy Drager Multiple System Atrophy] CP - 3

A
  1. Multiple System Atrophy
  2. [Parkinsonism tht doesnt respond to dopaminergic rx]
  3. [Autonomic Dysfunction (orthostasis, impotence, incontinence)]

  • Tx = intravascular volume expansion to treat orthostasis*
  • DO NOT CONFUSE WITH [RILEY DAY FAMILIAL DYSAUTONOMIA] WHICH HAS NO PARKINSONISM*
207
Q

[Riley Day Familial Dysautonomia] CP

A

Autonomic Dysfunction (orthostasis, impotence, incontinence)

auto recessive in kids of Ashkenazi Jewish decent

208
Q

[Riley Day Familial Dysautonomia] Mode of inheritance ; demographic

A

auto recessive ; kids of Ashkenazi Jewish decent

209
Q

[Myasthenia Gravis] Dx-5

A

P DDD WF

  1. ACh R Ab Assay
  2. MuSK (Muscle-Specific tyrosine Kinase) Ab Assay (only if #1 is neg)
  3. [Tensilon Edrophonium]–> Improves all sx
  4. Ice Pack to eyelids –> Improves Ptosis by inhibiting ACh breakdown at NMJ
  5. BE SURE TO GET CT CHEST AFTER DX TO COVER FOR THYMOMA, POSSIBLE THYMECTOMY!!!!
210
Q

What are the causes of Oculomotor CN3 palsy?-5 ; CP?-3

A
  1. POST communicating artery aneurysm
  2. TUMTL herniation
  3. PCA occlusion
  4. Cavernous Sinus Thrombosis
  5. DM n. central ischemia (will NOT have Dilated Eye)

DOP + Dilated: Down & Out Eye + Ptosis + Dilated Eye

211
Q

Amaurosis Fugax CP ; etx

A

Painless, transient ( < 10 min) monocular vision loss characterized as curtain being descended over eye ; Carotid Artery atherosclerotic emobil

212
Q

Ocular Tonometry indication

A

Measuring intraocular pressure in acute angle-closure glaucoma

Image: Acute Closed Angle Glaucoma

213
Q

Name the 3 components of EPS-ExtraPyramidalSymptoms

A

EPS = DAD

[Drug-induced Parkinsonism]

Akathisia (restlessness)

Dystonia (sudden twisted posture worst with activity)

Tx = Benztropine vs Diphenhydramine

214
Q

What is EPS caused by, and which drugs are the most likely to cause it?

A

[Blocking Nigrostriatal D2]; [1st generation Antipsychotics (Haloperidol/Fluphenazine)]

215
Q

Congenital Torticollis etx

A

Malpositioning of Head in Utero vs During birth –> constant contraction of SCM–>Lateral Neck swelling

Torticollis also possible in Adults

216
Q

Describe Athetosis ; What disease is it seen in?

A

Slow, writhing mvmnts of hands & feet often occuring with Chorea (Choreoathetosis) ; Huntington’s

217
Q

Tourette Syndrome CP

A

Tics - BOTH MOTOR AND VOCAL AT SAME TIME !

(Vocal and Motor-shoulder shrugs/blinking/grimacing/[coprolalia swearing])​

218
Q

Neonate comes in with Hydrocephalus, delineated by bulging fontanelles

Dx? Tx?

A

Dx: Head CT ; Tx: Ventricular Shunt

219
Q

Describe the difference between Cyanotic and Pallid [Breath Holding Spells]. ; Demographic for these?

A

Cyanotic: Crying –> Breath Holding, Cyanosis, [LOC 2/2 syncope]

Pallid: Pain from minor trauma –> Breath Holding, pallor, diaphoresis & [LOC 2/2 syncope]

6 mo - 2 yo

sometimes associated w/ iron deficiency anemia

220
Q

ACA occlusion CP-3

A
  1. CTL Weakness worst in LE
  2. CTL Numb worst in LE
  3. Urinary Incontinence
221
Q

ASA occlusion CP-2 ; Which syndrome is this?

A

AKA MEDIAL Medullary Syndrome

  1. CTL UE & LE Weakness
  2. Ipsilateral hypoglossal loss
222
Q

AICA occlusion CP-4

A

Somewhat like PICA Lateral Medullary Syndrome of Wallenberg

  1. FACE Paralysis (Similar to Bells Palsy)
  2. Ipsilateral ⬇︎Facial Pain/Temp
  3. CTL ⬇︎BODY Pain/Temp
  4. Hearing Loss
223
Q

Basilar Artery occlusion CP

A

Locked In Syndrome!!! (preserved consciousness but with quadriplegia)

224
Q

PICA occlusion CP-8

what other vessel abnormality can cause the same CP?

A

This is AKA Lateral Medullary Syndrome of Wallenberg

  1. Ipsilateral ⬇︎Facial Pain/Temp
  2. CTL ⬇︎BODY Pain/Temp
  3. Ipsilateral Horner (ptosis/anhidrosis/miosis)
  4. Vertigo
  5. Nystagmus
  6. Ataxia
  7. Dysphagia
  8. Dysphonia w/vocal tics

Intracranial Vertebral A occlusion = MOST COMMON CAUSE OF THIS!

225
Q

PCA occlusion CP-3

A
  1. CTL Homonymous Hemianopia + Visual hallucinations
  2. Alexia only (NO agraphia) (Dominant Hemisphere involved)
  3. Down & Out Eye + Ptosis (Oculomotor CN3 involved)
226
Q

What are the most common origins of Brain Metastasis?-5 ;

Which of these present as MULTIPLE (not solitary) brain metastasis?-2

A

Most common= [LUNG NonSOLC]>Breast/Colon/Kidney/Melanoma

[Lung NonSOLC] & Melanoma –> multiple

rare = Oropharyngeal

227
Q

In comparing Ischemic Stroke to Hemorrhagic Stroke CP, both have _____. What are the differentiating factors?-2

A

Both = Focal neuro ∆

Hemorrhagic Stroke ALSO has [worsening HA + AMS from ⬆︎ICP]

Remember: ANY Suspicion of Stroke warrants NonContrast Head CT

228
Q

Benztropine & Trihexyphenidyl are in what class of drugs?

How can pts on these develop Retro-Orbital HA during OD?

A

Anticholinergics; OD can –> Acute Glaucoma –> RetroOrbital HA

  • Red as a beet, Dry as a bone, Hot as a hare, Blind as a bat, Mad as a hatter, Full as a flask*
  • Image: Acute Closed Angle Glaucoma*
229
Q

Bromocriptine MOA ; Indication

A

Dopamine PostSynaptic R Agonist ; Parkinson’s

230
Q

Serotonin Syndrome Clinical Presentation (8)

A

“Serotonin gave me the SHIVERS!”

Shivering

[Hyperreflexia & Myoclonus]

INC Temp

[Vitals instability] (tachycardia vs. tachypnea vs. HTN)

Encephalopathy (Confusion vs. Agitation)

Restlessness

Sweating

Italicized = Triad Sx

231
Q

How do you treat Refractory Serotonin Syndrome

A

Cyproheptadine

(antihistamine with anti-serotonergic properties)

232
Q

Describe Neuroleptic Malignant Syndrome - 5

A

RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that –> FEVER

  • [Fever > 40C]
  • Encephalopathy (Confusion)
  • Vitals unstable (INC HR / RR / BP from autonomic dysfunction)
  • Enzymes ⬆︎ (CPK)
  • [Rigitidy lead pipe] (Tremor)
233
Q

What’s the best way to approach treatment for [Neuroleptic Malignant Syndrome]-2

A

Treat [Rigiditiy lead pipe] with Dantrolene (inhibits Ca+ release from sk. muscle sarcoplasmic reticulum)

+

supportive care

234
Q

Stiff Person Syndrome etx

A

RARE autoimmune Disorder

235
Q

Identify disease

A

Lisch nodules seen in Neurofibromatosis TYPE 1

CLAP ON type 1!

236
Q

Ulnar Nerve Syndrome typically occurs at the _____, usually from what scenario? CP-3?

A

ELBOW (where ulnar n lies at medial epicondylar groove before passing thru cubital tunnel) ; Leaning on Elbows at desk

  1. numbness over medial forearm
  2. numbness over 4th and 5th digits
  3. Weak Grip of ipsilateral hand (Atrophy of hypothenar vs 1st dorsal interosseous m)

May also occur at forearm in DM pts

237
Q

What is the most common cause of Fatal Sporadic Encephalitis in the U.S.? Should you use CT or MRI for dx?

A

Herpes Encephalitis ; MRI (and then CSF PCR=Gold Standard Dx)

238
Q

Tx for Single Brain Metastasis (likely from ____ primary) - 3

A

Surgery –> [(SRS) Stereotactic RadioSurgery] vs Whole Brain Radio

  • Likely from [Lung NonSOLC] primary*
  • Use SRS first in non-surgical candidates*
239
Q

Tx for Multiple Brain Metastasis (likely from ____ primary)

A

Whole Brain Radio

Likely from [Lung NonSOLC] primary

240
Q

Between DM, Smoking and HTN, which carries the GREATEST STROKE Risk?

A

HTN

241
Q

A: Describe Opsoclonus-Myoclonus Syndrome

B: What Childhood tumor is it associated with?

A

A: [Non-Rhythmic Conjugate Eye mvmnts] with myoclonus= “Dancing Eyes and Feet”

B: Neuroblastoma (onset 2 y/o)

Arises from Neural crest

242
Q

Neuroblastoma Dx - 3

A
  1. Calcifications on Radioimaging (Xray/CT)
  2. ⬆︎ VMA and Homovanillic acid catecholamines
  3. Amplification of N-myc protoOncogene
243
Q

Metanephros is the precursor of the ___. What tumor is associated with this?

A

MeTanephros

Renal Parenchyma Tissue ; Wilms’ tumor

244
Q

MeSonephros is the precursor of the ___ - 3

A

Seminal Vesicles / Ejaculatory ducts / Vas Ductus Deferens

245
Q

ParaMesonephron is the precursor of the ___ - 3

A

Fallopian Tubes / Uterus / Part of Vagina

246
Q

Name the classic sx of ICH (IntraCranial HTN) - 4

A
  1. Positional HA worst at night/morning
  2. NV
  3. AMS
  4. Papilledema/Vision ∆
247
Q

S/S of Acute Angle Closure Glaucoma - 3

A
  1. RetroOrbital HA w/⬇︎Vision
  2. Conjunctival Erythema
  3. Dilated pupil poorly responsive to light

Occurs in Pts > 60 yo

248
Q

Pts with Cerebellum lesions have _____ (ContraLateral vs Ipsilateral) Hemiataxia. Why is this? ; Why are Cerebellar hemorrhages so dangerous?

A

IPSILATERAL ; CorticoPontoCerebellar fibers decussate TWICE ; May extend down into brainstem –> Coma & Death

Image: L Cerebellar hemorrhage –> L hemiataxia

249
Q

Identify

A

image

250
Q

Identify

A

A: Thalamus

B: Dorsal Midbrain

C: Pons

D: Dorsal Medulla

E: Cerebellum

251
Q

Diagnostic Criteria for Febrile Seizure - 5

A
  1. 6 mo - 6 yo
  2. Temp > 100.4 F
  3. No hx of Afebrile seizures
  4. No CNS infection
  5. No acute metabolic cause of seizure (pt would have dehydration)

Tx = Reassurance only!

252
Q

Late Findings of Alzheimer’s - 5

A

CLAV –> HANDU

Hallucinations

Agnosia (unable to recognize things via 5 senses)

Neuro ∆ (seizure/myoclonus)

Dyspraxia (unable to do things from before)

Urinary Incontinence

Onsets after 60 yo

253
Q

Sx of mild hypOkalemia?-2 ;

Sx of SEVERE hypOkalemia?-5

A

Mild: Weakness + Muscle Cramps

SEVERE ( < 2.5):

  1. Flaccid Paralysis
  2. hypOreflexia
  3. tetany
  4. Rhabdo
  5. Arrhythmia
254
Q

Meniere’s Disease etx

A

⬆︎endolymphatic fluid in inner ear–> Membranous labyrinth swelling and rupture –> [KRE- K+ Rich Endolymph] leak into [Na+ rich perilymph] –> abnormal hair cell function –> VTH sx

**Very Terrible Hearing **

255
Q

Indication of Head Thrust Test ; Describe how to do the test

A

differentiates in nystagmus pts between peripheral & central vertigo;

pt looks at fixed target and their head is rapidly turned from the target. Normally, eyes remained fix on target, but in [Peripheral vestibular dysfunction pts] eyes move w/head and then horizontal saccade back to target after

256
Q

BPPV (Benign Paroxysmal Positional Vertigo) etx and CP-3

A

Ca+ otoliths accumulated within semicircular canals –> Dizzines, Nystagmus and Nausea only

257
Q

Normal Pressure Hydrocephalus etx-2

A

Wacky, WOBBLY & Wet!

[⬇︎Arachnoid villi CSF absorption vs Obstructive Hydrocephalus] –> transient ⬆︎in Vt pressure –> Enlarges Vt –> After while, Vt Pressure NORMALIZES to the enlarged Vt

258
Q

Mngmt for Myasthenia Crisis - 4

A

P DDD WF

Myasthenia Crisis (Precipitants=FIS) presents as Respiratory Failure!

  1. Intubate +
  2. Plasmapharesis +
  3. IVIG +
  4. Steroids
259
Q

Riluzole MOA ; Indication

A

Inhibits release of Glutamate ; ALS

SE: ⬆︎Transaminases, Wt loss, Dizziness

260
Q

Identify disease process

A

Central Retinal A. occlusion

Note the Retinal Whitening!

261
Q

Px for Migraine HA - 4

A

VTAP the migraine BEFORE it gets BAD, and SEND it away when it comes!

  1. Verapamil
  2. Topiramate
  3. Amitryptyline
  4. Propranolol
262
Q

Tx for Acute Migraine HA - 4

A

VTAP the migraine BEFORE it gets BAD, and SEND it away when it comes!

  1. Sumatriptan
  2. Ergots (Bromocriptine)
  3. NSAIDs
  4. D2 Blockers (Metaclopramide/Prochlorperazine)
263
Q

Cerebral Palsy is a group of clinical syndromes generally characterized as ______

What are the 3 types? What’s the greatest risk factor for Cerebral Palsy?

A

Nonprogressive motor dysfunction ;

Cerebral Palsy is just SAD

  1. Spastic
  2. Ataxic
  3. Dyskinetic

Greatest RF = prematurity ( < 32 wks gestation) but EtOH is second

264
Q

Cerebral Palsy is a group of clinical syndromes generally characterized as ______

How does it present? - 3

A

Nonprogressive motor dysfunction (Prematurity>EtOH = RF) ;

Cerebral Palsy is SAD

  1. BL equinovarus club feet (image)
  2. UMN signs LE >UE
  3. Mental Retardation

Greatest RF = prematurity ( < 32 wks gestation)

265
Q

CP for Chemotherapy Peripheral Neuropathy - 4

A
  1. Stocking Glove symmetrical paresthesias starting at toes/fingers and spreading proximal
  2. Early loss of ankle jerk reflex
  3. Loss of Pain/Temp
  4. Motor weakness

Drug Culprits: Cisplatin / Paclitaxel / Vincristine

266
Q

SIDS is sudden infant death that can’t be explained

What are 4 major ways to ⬇︎ risk of SIDS?

A
  1. Supine Sleeping position
  2. NO second hand smoke
  3. Use Pacifier during sleep
  4. ROOM sharing (NOT bed sharing)
267
Q

Causes of [Magnetic “Frontal” Gait Apraxia] ? - 2

Inability to walk on command and feels like feet are magnets

A
  1. Normal Pressure Hydrocephalus
  2. Frontal Lobe Degeneration
268
Q

CP of Conversion Disorder -2; Demographic-3?

A

[Sudden Vision Loss] + PseudoSeizures that’s idiopathic! ;

  1. Teens WITH WITNESSES AROUND
  2. Physically abused
  3. Depressed pts
269
Q

Edinger Westphal nucleus provides ______ to the _____ ganglion

CP of a pt with R damaged EW nucleus

A

PreGanglionic ParaSympathetic outflow to ciliary ganglion

R (Ipsilateral) FIXED DILATED pupil not reactive to light

270
Q

What are the major functions of Vagus CN10 - 6

A
  1. Swallowing
  2. Palate Elevation (Image)
  3. Vocal Cord Phonation
  4. Cough Reflex - Afferent
  5. Gag Reflex - EFFerent (loss of Gag = CN9 problem)
  6. ParaSympathetics (Aortic baro/chemoreceptors)

Image: Left Ipsilateral CN10 palate dysfunction

271
Q

Tx for Clostridium Botulinum poisoning - 3

A
  1. Equine Heptavalent Antitoxin (passive immunity)
  2. Botulinum Ig
  3. Guanidine
272
Q

Describe Physiologic Tremors

A

benign [12-14 Hz high freq] tremor that occurs posturally (i.e. when holdings arms out), activated w/emotion or caffeine

273
Q

A lesion in the Upper Thoracic Spinal Cord produces what CP - 4

A
  1. Sensory loss nipples downward
  2. Paraplegia
  3. Bladder Incontinence
  4. Fecal Incontinence
274
Q

A lesion in the Lower Thoracic Spinal Cord produces what CP

A

Sensory loss Umbilicus downward

275
Q

A: What are Craniopharyngiomas

B: What type of tissue do they arise from

A

A: Suprasellar tumors (Mostly in Kids but NOT ALWAYS)

B: Remnants of Rathke’s Pouch (Embryonic Precursor of ANT Pituitary)

276
Q

Loss of Gag Reflex indicates what cranial nerve damage

A

Glossopharyngeal CN9 Ipsilateral

277
Q

Dysphagia indicates what n. damage (2)

A

CN9 and 10

278
Q

Dysphonia/Hoarseness indicates what n. damage

A

CN 10

279
Q

Atomoxetine Indication

A

NonStimulant ADHD Rx

280
Q

Major risk factors for VitB12 deficiency - 3

A
  1. Crohn’s Dz
  2. Pernicious Anemia
  3. Vegans (no animal protein intake)
281
Q

Explain why a child presenting with Migraine s/s is no major concern ; Where do these occur in kids?

A

Migraine HA are most common HA in peds and occur before 20 yo in 50% ; Bifrontal (if occipital, be suspicious!)

282
Q

Tx of Pediatric Migraine - 3

A
  1. Dark Quiet Room +
  2. NSAID
  3. Triptans (refractory)

Triggers = stress/lights/odors/foods

283
Q

Parkinson’s Disease Dx

A

PHYSICAL EXAM! revealing at least 2/4 of PARK

284
Q

How is Carotid Artery Dissection associated with Horner Syndrome?

A

Carotid A Dissection –> Partial Horner (Ptosis + Miosis only) 2/2 postganglionic sympathetic fiber damage

285
Q

CP of Craniopharyngiomas - 3; Demographic?-2

A
  1. BiTemporal Hemianopsia
  2. HA
  3. Pituitary Hormonal Deficiencies (i.e. ⬇︎Libido)

Demographic: MOSTLY KIDS, but some adults

286
Q

How long does it take pts with Subdural hematoma to have sx? Why is this a problem for elderly?

A

1-2 days; Elderly may have insidious subdural bleeds for weeks after injury –> Confusion/Somnolence/HA/FOCAL Neuro ∆

Image: L Chronic Subdural Hematoma

287
Q

Step-Wise Tx to Restless Leg Syndrome - 4

A

1st: NonPharm (Leg Massage/Heat/Exercise/Iron Supplement)
2nd: Dopamine Agonist NonErgots (Pramipexole/Ropinirole)
3rd: Gabapentin (if pt also has insomina vs chronic pain)
4th: Opioids

288
Q

Which medications should be given to a pt with stroke and no prior antiplatelet tx?-2 ; When should it be given?

A

ASA + Statin ; Within 24 hrs of onset

289
Q

Which medications should be given to a pt with acute ischemic stroke and on ASA already? - 2

Give within 24 hr of onset

A

Make sure ASA is first

[Clopidogrel 75 QD vs Dipyridamole 200 BID]

290
Q

Why is Heparin NOT USED in pts with Acute Stroke?

A

⬆︎Bleeding Risk if stroke turns out to be Hemorrhagic

291
Q

Which disease process does this patient have?

Keeps R arm ADDucted and swings R leg outward in semicircle as they walk

A

Hemiparesis 2/2 stroke

292
Q

What are the Afferent and Efferent nerves for Corneal Reflex?

A
293
Q

What are the Afferent and Efferent nerves for Lacrimal Reflex?

A
294
Q

A: Primary CNS Lymphoma is the ___ most common cause of _____ in HIV pts

B: What virus is this associated with?

C: What WBCs would you expect to see in the brain tissue

A

A: 2nd most common cause of ring enhancing lesions in HIV pts (1st = Toxoplasmosis Gondi)

B: EBV

C: B-lymphocytes

295
Q

What is [Hydrocephalus Ex Vacuo] and which pts do you see it in?

A

Ventricular Enlargement only because of cortical atrophy, typically found in HIV pts (cortical atrophy is normal sequelae in HIV)

True Hydrocephalus is actual build up of CSF (obstruction vs. hyperproduction**)

296
Q

PML Clinically Presents like Multiple Sclerosis

Describe PML-Progressive Multifocal Leukoencephalopathy

A

Opportunistic infection 2º to [John Cunningham PolyomaVirus]—-> [multiple white matter lesions] (Hyperintense Flair signal on radiology) –> Death vs. Severe Neuro injury

297
Q

Describe 2 neuro conditions associated with HIV ; What Dx should you suspect in a Young HIV Pt witih Dementia? Pgn?

A
  1. HIV Encephalopathy which = [microglial nodule GREY MATTER ENCEPHALITIS] in pts with ~CD4 < 200 —> Subactue HIV associated Dementia (HAD) + parkinsonism
  2. HIV Meningitis–>Persistent Pleocytosis, neuro sx and Dementia via Direct Viral invasion vs. inDirect inflammation

C: AIDS Dementia= slow cognitive & behavioral decline with poor pgn. Note: This presentation is Similar to [SubAcute Combined Degeneration]

HIV LeukoEncephalopathy is the same thing but with White matter instead

298
Q

PML (Progressive Multifocal Leukoencephalopathy) Clinically Presents like Multiple Sclerosis

Where does PML typically occur in the brain? - 2

A

[SubCortical White Matter] or [Cerebellar Peduncles]

Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)

299
Q

PML (Progressive Multifocal Leukoencephalopathy) Clinically Presents like Multiple Sclerosis

How is PML related to the drug, Natalizumab?

A

Also can be a Rare Side Effect of Natalizumab (MS drug) in pts who are also JC Virus positive

Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)

300
Q

[Carpal Tunnel Syndrome] etx

A

BILATERAL Median n Compression by the [Flexor Retinacular Transverse carpal ligament] –> Peripheral mononeuropathy + [ABductor pollicis brevis atrophy]

  • [Flexor Retinaculum Transverse Carpal ligament] can be surgically incised for relief*
  • CARPEL TUNNEL STARTS uL and –> BL*
301
Q

Carpal Tunnel Syndrome Clinical Presentation - 4

A
  1. Paresthesia vs Pain with Median n. Distribution worst at night
  2. [ABductor pollicis brevis] and sometimes Thenar Atrophy (⬇︎flexion/ABduction/Opposition)
  3. Tinel Sign (tapping over flexor surface ⬆︎ sx)
  4. Phalen Sign (flexing Wrist ⬆︎ sx)

CARPEL TUNNEL STARTS uL and –> BL

302
Q

In regards to Carpal Tunnel, the ______ n. courses between the _____ and ____ muscles before crossing under the _____ inside carpal tunnel

A

In regards to Carpal Tunnel, the Median n. courses between the [Flexor Digitorum superficialis] and [Flexor Digitorum Profundus] before crossing under the [Flexor Retinaculum transverse carpal ligament] inside carpal tunnel

303
Q

Name the most common pineal gland tumor and how it clinically manifest (3)

A

Germinoma

  • Obstructive Hydrocephalus
  • [Parinaud Dorsal Midbrain syndrome]
  • [Pituitaryhypothalamic dysfunction (if in suprasellar region)
304
Q

Parinaud Syndrome etx ; How does it clinically present?-3

A

“Parinaud loved his PUP”

Direct Compresion of [Midbrain Pretectum SUP Colliculi] (possibly from Gemrinoma) –>

  1. Ptosis
  2. Upward Gaze paralysis (can NOT look up)
  3. Pupil ∆

these can also cause obstructive hydrocephalus

305
Q

Pt comes in with Foot Drop

What are the 2 main DDx?

A

Common Peroneal n compression vs L5 Radiculopathy(will be accompanied with shooting back pain)

Dx: Knee MRI vs EMG

306
Q

Status Epilepticus Mngmt - 5

A

1st: ABCs!
2nd: Ativan IV bolus 0.1mg/kg = 4-8 mg (repeat in 5-10 min if needed)
3rd: FosPhenytoin IV 20 units/kg (no faster than 150 mg/min) (Continuous IV Phenytoin –>Purple Glove Syndrome and so is alternative)

4th (if still status): Alternate Diazepam Keppra

5th (if still status): Pentobarb coma

Image showing Cortical Laminar Necrosis s/p Status Epilepticus

307
Q

DDx for Intracerebral Hemorrhage - 5

A
  1. HTN (Charcot Bouchard aneurysm vs Cocaine)
  2. Warfarin OD
  3. Tumor Metz (Papillary Thyroid/Renal/Melanoma/Testicular)
  4. AVM
  5. Hemorrhagic Conversion of [Ischemic infarct 3-5 days prior]
308
Q

Key points for mngmt of Intracerebral Hemorrhage - 5

A
  1. BP < 140 (Use Labetalol & Nifedipine, not Hydralazine)
  2. ⬇︎ICP with Mannitol vs [23% Hypertonic Saline] vs Hyperventilate
  3. Osm Goal = 300-320
  4. Na+ >>>>>> 145
  5. Repeat CT after 6 hours
309
Q

Pregnancy is associated with Carpal Tunnel

What should these particular pts also be worked up for?

A

Preeclampsia

CARPEL TUNNEL starts uL and then –> BL

310
Q

[Carpal Tunnel Syndrome] dx

A

Nerve Conduction studies

EMG is not necessary for Carpal Tunnel Syndrome

311
Q

[Carpal Tunnel Syndrome] tx - 4

A
  1. Wrist Splint
  2. Remove exacerbating factors
  3. NSAIDs
  4. [Flexor Retinaculum Transverse Carpal ligament] can be surgically incised for relief - IF SEVERE
312
Q

Ulnar Nerve Syndrome tx-3

A
  1. Elbow Protectors
  2. Avoid direct elbow pressure or mvmnt
  3. Surgery

May also occur at forearm in DM pts

313
Q

Ulnar Nerve Syndrome Risk Factors - 3

A
  1. Surgery Malpositioning
  2. Male
  3. DM

May also occur at forearm in DM pts

314
Q

Tx for Bell’s Palsy - 4

A
  1. PO Steroids within 3 days of onset (self resolves within 6 mo.)
  2. Valacyclovir 500 mg BID (HSV may be inciting factor)
  3. Artificial Tear to affected eye during day
  4. Ophthalmic ointment to affected eye at night
315
Q

Where is the hypoglossal nucleus located?

A

Dorsomedial Medulla

316
Q

Isolated Hypoglossal CN12 palsy is not common

What’s the most common cause of this when it’s isolated? What are other causes?-6

A
  1. TUMOR
  2. Guillain Barre
  3. Multiple Sclerosis
  4. Surgery
  5. Infection
  6. Trauma
317
Q

Pt has CHRONIC burning tingling dysthesia

Tx? - 3

A
  1. TCA (Amitriptyline or Nortriptyline)
  2. Gabapentin
  3. Carbamazepine

dysthesia = unpleasant sensation

318
Q

Top DDx for CHRONIC Sensory Neuropathy - 5

A
  1. VitB12 deficiency
  2. Sjogren’s Syndrome (check SSA Ro and SSB La)
  3. [Pyridoxine B6] toxicity
  4. Cisplatin toxicity
  5. Inflammatory ganglionopathy (viral vs immune)
319
Q

Where do most disc herniations occur? - 2 ; Risk factor for disc hernation?

A

between

  • L4 - L5 OR
  • L5 - S1

SMOKING = Risk factor

Positive Crossed Straight Leg = Lumbar Disc hernation

320
Q

What 4 locations is pain radiated to in L5 Radiculopathy?

A
  1. Lower Back
  2. Butt
  3. Lateral Thigh
  4. LateralAntero Calf

L5 Radiculopathy can also cause Foot dropPED

321
Q

Which reflexes are spared in L5 Radiculpathy? - 2

A

Patellar and Ankle Jerk

322
Q

DDx for an expanding intramedullary mass? - 6

Image: Intramedullary mass + expanding edema

A
  1. Sarcoidosis
  2. Ependymoma (usually in 4th vt)
  3. Meningioma benign
  4. Demyeliating Disease (Multiple Sclerosis)
  5. Metastasis
  6. Transverse Myelitis

Image: Intramedullary mass + expanding edema

323
Q

Tx for Sarcoid Myelopathy

Image: Intramedullary mass + expanding edema

A

Corticosteroids

Image: Intramedullary mass + expanding edema

324
Q

What regions of the spinal cord does the Anterior Spinal Artery perfuse? - 3

A
  1. ANT horns
  2. Lateral Corticospinal Tract
  3. Lateral Spinothalamic Tract

POST Spinal Artery perfuses Dorsal Column

325
Q

What is Aphasia?

A

⬇︎Language Processing (speech/writing vs comprehension + repetition)

326
Q

HYPERdensity on CT represents what? - 3

A
  1. Blood
  2. Bone
  3. Calcification (normal and often seen in choroid plexus)
327
Q

Most common cause of Spinal Cord Ischemia?-2 ; Other causes?-3

A

[Aortic Disease (thromboembolic)] or [Aortic Surgery]

Others= Hematomyelia, AVM, Fracture/Dislocation

328
Q

When is [CEA-Carotid Endarterectomy] indicated?

A

Only when pt has a [SYMPTOMATIC 70-99% Stenosis]

329
Q

Essential Tremor is a BUE Action Tremor worst w/Action, and can affect head & voice

What are the exacerbants of Essential Tremor? - 3

A
  1. Hyperthyroid
  2. Lithium
  3. Valproic Acid
330
Q

The VertebroBasilar arterial system (Posterior Circulation) perfuses which major structures? - 4

A
  1. Brainstem
  2. Cerebellum
  3. Spinal Cord
  4. Labyrinths
331
Q

What areas of the brain are involved in CONDUCTION Aphasia? - 4

A

VERY POOR Repetition

  1. Arcuate Fasciculus = MOST COMMON
  2. Supramarginal Gyrus
  3. Auditory Cortex
  4. Large Posterior Perisylvian area
332
Q

Main Features of TIA - 2

A
  1. Transient ( No more than 1 day long but typically < 20 min)
  2. Leaves NO residual deficits or radiomanifestations
333
Q

CP of VertebroBasilar TIA - 4

A

Brainstem: Diplopia, Dysarthria

Cerebellum: BL Clumsiness

Spinal Cord: BL Weakness

Labyrinths

334
Q

What is the most common cause of Lateral Medullary Syndrome of Wallenberg? 2nd most common?

A

Intracranial Vertebral a occlusion ; PICA occlusion

335
Q

Surgery is a LAST OPTION for treating Essential Tremor

List the Surgical Procedures available-2 ; What is the goal of the surgery?

A
  1. Stereotactic VIM Thalamotomy
  2. VIM Thalamic Stimulation

Goal = VIM (Ventralis InterMedius) thalamic nc

Onsets at 45 yo and 50% cases are AUTO DOM

336
Q

What should you suspect in a pt who has Down & Out Eye with Miosis and Ptosis?

A

DOP + miosis = Oculosympathetic Cavernous Sinus Compression! - There will also be Horners

Oculosympathetic fibers cross thru Cavernous Sinus

Image: Sympathetic Pathway

337
Q

Both Mannitol and [Hypertonic Saline (3%/5%/23%)] are used to ⬇︎ ICP

List advantages of using Hypertonic saline? - 3

A
  1. Anti-Inflammatory
  2. Does NOT cross into interstitial space like Mannitol does eventually (Mannitol causes rebound edema!)
  3. Expands systemic volume

Hypertonic Saline can ONLY be given via Central line :-(

338
Q

Myasthenia Gravis, LEMS and [Myopathies (polymyositis/dermatomyositis)] can be similar

How can you differentiate these based on reflexes?

A

Myopathies[polymyositis/dermatomyositis] and LEMS have ⬇︎ Reflexes.

Myasthenia is normal

339
Q

How are migraines associated with Pregnancy?

A

Migraines commonly start 2nd trimester of Pregnancy

But also be suspicious of [Pseudotumor Cerebrii]

340
Q

Memory depends on a BL 4-way circuit

What is this circuit?-4

A

“Having Fun Memories Around”

[Hippocampus temporal lobe] –> Fornix –> Mammillary Bodies —> ANT Thalamus

341
Q

Memory depends on a BL 4 way-circuit

How is this Memory circuit often damaged?-3

A

“Having Fun Memories Around”

[Hippocampus temporal lobe] –> Fornix –> Mammillary Bodies –> ANT Thalamus

  1. [Thiamine B1 deficiency] –> disruption between Mammillary Body ANT Thalamus
  2. Anoxia –> BL [Hippocampus temporal lobe] damage
  3. HSV –> BL [Hippocampus temporal lobe] damage
342
Q

Describe Constructional Apraxia ; Describe Dressing Apraxia ; What causes both of these?

A
  • Constructional = Can’t Draw or Copy a House
  • Dressing = Can’t get Dressed

Both caused by Parietal Lobe lesion

343
Q

Name 2 examples of Frontal Lobe release signs? When is this normal? When is it abnormal?

A

Findings normal during infancy when descending inhibitory pathway myelination was incomplete; Abnormal in Adults and is 2/2 Frontal lobe damage

  1. Sucking examiner finger when corner mouth is lightly stroked
  2. Toes latching onto examiner finger when rubbed
344
Q

What is Anton’s syndrome

A

Unawareness of Vision loss from Occipital lobe damage –> Denial of vision loss

345
Q

A pt complains of inabilty to recognize previously known faces

What is this called? ; Where is the lesion?

A

[ProsoPagnosia visual agnosia] ; BL Temporo-Occipital

346
Q

What’s the only imaging modality for diagnosing Alzheimer’s Disease? What does it reveal?

A

CLAV –> HANDU

PET scan revealing [PIB-Pittsburgh Compound B] binding to β-amyloid and being uptaken in

  1. PreFrontal
  2. Temporal
  3. Parietal
347
Q

Which 3 Neuro Diseases Cross the Corpus Callosum?

A
  1. Gliomas (AGE - i.e. Glioblastoma)
  2. Multiple Sclerosis
  3. CNS Lymphoma
348
Q

20% of patients with ______ go on to develop Multiple Sclerosis

A

[SLUM SiiiN]

Neuritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR

Image: T1 MRI Black Holes Dx

349
Q
A

SAH usually occur in Suprasellar Cistern

350
Q

Usually Partial Seizures originate in a single hemisphere

What happens when Partial seizures involve BOTH hemispheres (i.e. COMPLEX Partial Seizure)? - 2

A

ONLY If BOTH hemispheres become involved –>

  1. IMPAIRED BUT NOT LOST OF consciousness (won’t follow commands and will have postictal amnesia)
  2. +/-automatisms (repetitive chewing, sucking, swallowing)

=COMPLEX Partial Seizure

351
Q

Usually Partial Seizures originate in a single hemisphere

What happens when Partial seizures spread DIFFUSELY to bilateral cortex areas - 3

A

= Secondary GENERALIZED TONIC CLONIC

  1. Generalized Convulsions
  2. LOST of Consciousness may occur
  3. Postictal Amnesia
352
Q

List the difference between Primary and Secondary Generalized Tonic Clonic Seizures

A

Primary GTC occur when electrical discharge simultaneously comes from diffuse bilateral cortical areas (i.e. Absence)

vs

Secondary GTC comes from the spread of a partial focal seizure

353
Q

List the sequence of events for a Seizure - 5

A

Seizure ATTCK

1st: Aura (nausea/dizziness) vs Simple Partial
2nd: Tonic: Sudden Stiffness–>Falling and cry out
3rd: Time Out: APNEA –> Cyanotic, dusky face
4th: Clonic convulsions + oral involvement
5th: Krazed: Postictal Amnesia & Lethargy (pt only recalls aura) + incontinence

354
Q

What are some triggers of Primary GTC Seizure? - 8

A

Seizure ATTCK

  1. Flashing lights
  2. Sleep Deprivation
  3. Hyperventilation
  4. EtOH
  5. Infection
  6. Cocaine
  7. Whole Brain Anoxia
  8. Rapid Na+ or Glucose ⬇︎
355
Q

Describe NonEpileptic Pseudoseizures ; Demographic-2?

A

Episodic jerking movements that occur WITH NO cortical discharge (falls under conversion disorder);

  1. Teens WITH WITNESSES AROUND
  2. Physically abused pts
  3. Depressed pts
356
Q

What are the major triggers of [Partial Seizures and Secondary GTC] - 3

A
  1. Infarct
  2. Tumor
  3. Viral Encephalitis
357
Q

Pt just fell and started GTC seizing right in front of you!

How should you manage them? - 4

A

Seizure ATTCK

1st: Roll pt onto side
2nd: Stabilize Head BUT NOT THEIR MVMNTS
3rd: KEEP THINGS OUT OF MOUTH OR AROUND PT
4th: ER if > 5 min

358
Q

Carbamazepine, Phenytoin, Gabapentin are only used to treat what type of seizures? - 3

A
  1. Simple Partial
  2. Complex Partial
  3. Simple/Complex Partial convert –> Secondary GTC
359
Q

Name the CNS Neoplasms that are of Glial Origin (i.e. Glioma) - 3

A

AGE comes from Glia

  1. Astrocytoma (i.e. Glioblastoma)
  2. OligodendroGlioma (adult frontal lobe)
  3. Ependymoma (ependymal cells line ventricles)

These stain positive for GFAP

360
Q

What should be used to treat edema surrounding brain tumors?

Image: MRI showing Tumor with Hyperdense surrounding edema

A

Dexamethasone

NOT effective in ⬇︎ICP during Stroke

361
Q

What is Meningeal Carcinomatosis? Tx?

A

Spread of CA to CSF which diseminates to Meninges, Cortex, Cranial n, spinal nerve roots

Tx = Intrathecal Chemo

362
Q

Which CNS tumors affect Spinal Cord?-3 ; Tx?-2

A
  1. Meningioma benign
  2. Ependymoma (usually 4th Vt)
  3. Metastasis (Prostate/Renal/Lung/Breast/Multiple Myeloma)

​Tx = Radio + Dexamethasone

363
Q

Explain how collateral blood flow to a “complete” circle of willis help prevent ischemic CVA/TIA?

A

[External Carotid: Opthalmic A] can retrogradedly perfuse Circle of Willis when Internal Carotid is blocked

364
Q

What structures does the lenticulostriate vessels perfuse (4)

A

lenticulostriate vessels perfuse everything in [Be TIPC] EXCEPT PONS!

Basal Ganglia

Thalamus = pure sensory stroke

[Internal Capsule / / Corona Radiata] = pure motor stroke

365
Q

Describe the likely regions involved for the following deficits

A: Weakness of Face and UE

B: Weakness of LE

C: Numbness of Face and UE

D: Numbness of LE

A

A: CTL Precentral MCA territory (Face and UE weak)

B: CTL Precentral ACA territory (LE weak)

C: CTL PostCentral MCA terrtory (Face and UE numb)

D: CTL PostCentral ACA territory (LE numb)

366
Q

Which imaging should be obtained for CVA/TIA w/u and why? - 4

A
  1. NonContrast Head CT
  2. TTEchocardiography (evaluate for cardioembolism)
  3. Carotid cervical US
  4. CTA/MRA (CTA shown in image-evaluate for Vertebrobasilar abnormalities)
367
Q

Why is Altered mental status in a pt who had a large ischemic stroke 4 days prior alarming? - 2

A

Within 3-5 days (below) can develop:

  1. Hemorrhagic conversion of infarct
  2. Brain Edema
368
Q

What’s the most common cause of SubArachnoid Hemorrhage? What’s the 2nd?

Usually in the Suprasellar Cistern

A

Trauma > Berry Saccular Aneurysm

369
Q

In order from Most to least common, name sites of Berry Saccular Aneurysm? - 4

SAH occur usually in Suprasellar Cistern

A

ANT communicating > [POST communicating (will result in CN3 palsy)] > MCA > POST Circulation

370
Q

What is Prosody? ; A stroke in what part of the brain creates Aprosody?

A

Using changes in vocal pitch/inflection to convey language (i.e. You gave this to me? vs You gave this to me) ; [NonDominant Cortex opposite to Wernicke’s area]

example: Sensory receptive Aprosody

371
Q

What is Sensory receptive aprosody? ; How does it occur?

A

Inability of pt to understand prosody/vocal inflections by other people; Damage to [NonDominant Cortex opposite to Wernicke’s area]

372
Q

What is the action of the Inferior Oblique m? ; Superior Oblique m?

A

IOUO SODO

InferiorOblique = Up and Out

SuperiorOblique (innervated by CN4) = Down and Out

373
Q

What is unique about Trochlear CN4?

A

Only cranial nerve to exit DORSAL midbrain and then decussate and innervate CTL Superior Oblique muscle

IOUO SODO

374
Q

What is the difference in clinical presentation between [neuro nystagmus (cerebellum/vestibular)] vs drug nystagmus? -2

A

neuro nystagmus = asymmetrical(slow jerk toward side of lesion) & occurs only with certain eye positions

vs

drug nystagmus = symmetrical & occurs all the time

375
Q

What does the PPRF have to do for Right Horizontal Gaze

A
  • Activate Right Abducens nc in Pons
  • Activate Left EdingerWestphal in Dorsal Midbrain
  • MLF connects all this, leaving R PPRF, decussating and then joining L oculomotor nc*
  • Image: Left MIOS*
376
Q

A: MIOS seen in Younger pts indicates _____

B: MIOS seen in OLDER pts indicates ______

C: What is the purpose of the MLF

A

[MIOS-MLF Internuclear Ophthalmoplegia Syndrome]

1) Younger pts= Multiple Sclerosis
2) Older pts= Pontine a. lacunar stroke

D: MLF coordinates CN3 with CN6

Image: Left MIOS

377
Q

Explain [Relative Afferent Pupillary Defect]

A

partial optic n vs retinal lesion –> pupils BOTH constrict when light is shown in normal eye BUT when light is swung to lesioned eye BOTH eyes Dilates since lesioned eye has ⬇︎ afferent input

378
Q

Recall the Oculosympathetic Horner’s pathway - 9

A
  1. Hypothalamus
  2. Passes as hypothalamospinal tract in lateral medulla
  3. [IML C8-T1 Cilospinal Center of Budge]
  4. Under Subclavian Artery as sympathetic trunk
  5. Lung Apex
  6. SUP cervical ganglion near carotid bifurcation

6A. Facial Sweat Glands

6B. carried with CN5B1 thru cavernous sinus & then SUP orbital fissure to Pupil Dilator

6C. Innervates [Muller’s superior tarsal muscle]

2 / 5 / 6 / 6B are most common sites of Horner’s syndrome

379
Q

What are the most common causes of Horner’s Syndrome? - 4

A
  • Lateral Medullary syndrome of Wallenberg
  • Lung Apex tumor
  • Neck Carotid Trauma
  • Cavernous Sinus Thrombosis

2 / 5 / 6 / 6B are most common sites of Horner’s syndrome

380
Q

Medial Midbrain Syndrome of Weber etx ; CP-2

A

PCA infarct with CN3 and Crus Cerebri(CST/corticobular) involvement–>

  1. [Ipsilateral DOP + Dilation] (Down & Out eye + Ptosis + Dilated Pupil) = CN3 involved
  2. CTL Hemiparesis (Face, UE, LE) = Crus Cerebri involved
381
Q

What would a [R Partial Retinal lesion] manifest as

A

R Monocular scotoma

382
Q

Lesion at which letter would result in [R Nasal Hemianopia]

A

D

383
Q

Lesion at which letter would result in [L Pie on the Floor (Homonymous INF quadrantanopia)] lesion

A

G

384
Q

Parkinsonism is often caused by ____ or _____

Name 2 rare causes of Parkinsonism

A

Common = [Substantia nigra pars compacta degeneration] vs [D2 Blocker Drugs]

rare = Toxic levels of CO2 or ManGanese

PARK & hamp

385
Q

What causes [Lateral ventricle frontal horn] enlargement in Huntington’s disease?

A

**Gross Caudate atrophy**

[AUTO DOM [Chromo 4 CAG repeats]] —> Degeneration of (Caudate nc. inside the ((I)ndirect Striatum w/ [Gross Caudate atrophy] ) –> [⬇︎ GABA release]

“Hunting 4 food is way too aggressive & dancey”

386
Q

Risk Factors for Migraines - 2

A
  1. Fam Hx
  2. Menstruation (hormones during cycle ⬆︎ risk)
387
Q

Migraine etx ; How are the Trigeminal nerves associated-2

A

Genetic [GainOfFunction mutation in excitatory NMDA receptor]–>burst of cerebral activity when triggered—>hyperemia (usually occipital lobe)–> sx. Burst is followed by Cortical Depolarization tht has slow but deliberate forward advance –> Triggers Trigeminal pathway

Trigeminal afferents :

  1. send impulses–>[Brain Stem APCTZ] & hypothalamus–> Nausea/Photophobia/Phonophobia
  2. retroactively depolarize–>release of substance P –> neurogenic inflammatory pain + vasoDilation
388
Q

Pt has advancing foot crossing over opposite foot similar to closing scissor blades

What causes Scissors Gait?

A

UMN (Corticospinal Tract spasticity) lesions

Spasticity causes Scissors Gait

389
Q

What causes a Broad based Ataxic gait? - 2

A

Cerebellar vs [Dorsal Column Pathway] dysfunction

390
Q

Tx for EPS-ExtraPyramidalSymptoms - 2

A

EPS = DAD

Benztropine vs Diphenhydramine

391
Q

How do you differentiate Tunnel Vision 2/2 [Glaucoma or Retinal Degeneration] from Psychiatric etiology?

A

As examiner moves further away …

[Glaucoma or Retinal degeneration] = Tunnel Vision enlarges in cone pattern

vs

Psychiatric = Tunnel vision stays Tunnel

392
Q

Which Artery of the Base of Brain can cause unilateral hearing loss if occluded?

A

AICA

Other causes: [Petrous bone trauma]

393
Q

Meniere’s Disease CP-3?

A

**Very Terrible Hearing ** that is recurrent

  1. Vertigo
  2. Tinnitus
  3. Hearing loss which –> Permanent eventually
394
Q

Acute Labyrinthitis CP - 4?

A

**Very Terrible Nystagmus & Hearing **

  1. Vertigo
  2. Tinnitus
  3. Nystagmus
  4. Hearing loss which –> Permanent eventually
395
Q

What is the ARAS - Ascending Reticular Activating System important for? ; Lesions of the ____ where ARAS is located leads to what? - 2

A

ARAS(AlwaysRetainingAwakeState) = keeps you awake! ; lesions ofupper brain stem –> Somnolence or Coma

396
Q

DSM5 Criteria For Narcolepsy (2)

A

[Recurrent and sudden entry into REM sleep at least (3 x/week) x 3 mo.]

+

1 of the following:

a. Cataplexy
b. [Low CSF hypOcretin1 orexin A]
c. [REM latency ≤ 15 min] (goes into REM in less than 15 min)

397
Q

What is Hypocretin 1 and 2 also known as, and what is their function?

A

[Hypocretin 1 (Orexin A)[and [Hypocretin 2 (Orexin B)] are [Lateral hypothalamus neuropeptides] that promote wakefullness & inhibit [REM sleep-related phenomena]

These are deficient in Narcolepsy

398
Q

Tetanus takes __ days to onset after exposure to endospores ; Tx? - 4

A

2 days;

  1. Mechanical ventilation ICU
  2. Human Tetanus Immune Globulin
  3. Abx
  4. Diazepam

Comes from puncture wound vs burn

399
Q

DDx for Clostridium Botulinum - 4

A

Also consider…

  1. Myasthenia Gravis
  2. Atypical Guillain Barre
  3. Tick Paralysis
  4. Brain Stem infarct

Adult tx: Equine Heptavalent Antitoxin (passive immunity)

400
Q

How do Adults present after Lead Poisoning? ; How do Children present after Lead Poisoning?-2

A

A:

Adults: [Workplace paint vs. lead battery] –> Peripheral neuropathy

B: Children: [ingeting lead paint flakes] –> [Encephalopathy + Abd pain]

401
Q

What part of the cerebellum is affected by Alcoholic degeneration?

A

ANT SUP vermis

Explains Dysmetria of LE > UE

402
Q

Which areas of the brain are affected by [HSE-Herpes Simplex Encephalitis]? - 2

A
  1. Medial temporal
  2. Inferior frontal
403
Q

Brain Contusions are superficial hemorrhages that usually occur where? - 2 ; What type of motion causes these?-2

A

Basal or Ventral [Frontal and ANT Temporal lobes] ; Angular or Rotational (NOT LINEAR)

404
Q

Define Concussion

A

TBI that causes Brief Confusion and Amnesia +/- loss of consciousness

Repetitive Concussions –> Permanent Cognitive Decline

405
Q

Define Coma

A

Unarousable, Unresponsive Sleep State in which only brainstem reflexes are testable.

2/2 diffuse cortical depression

Can progress to vegetation, full recovery or brain death

406
Q

A: What is Cheyne-Stokes Breathing?

B: What is this breathing associated with? - 3

A

A: Cyclic breathing in which apnea is followed by [INC and then DEC tidal volumes] all the way up until the next apneic period

B:

  1. [Advanced CHF]
  2. [Comatosed BL metabolic encephalopathy]
  3. Elderly during sleep
407
Q

Dorsal tectal midbrain lesions selectively involve _____(Sympathetic vs Parasympathetic) fibers. How does this affect Pupils?

A

ParaSympathetic ;FIXED Dilated BL Pupils from unopposed Sympathetics

408
Q

3 main causes of pinpoint pupils

A
  1. Opiate OD
  2. Pontine lesion destroying sympathetic fibers
  3. Cholinergic eyedrops for Glaucoma
409
Q

How is the [Oculocephalic Dolls eye Reflex] used to assess brainstem function?

A

Eyes should remain stationary and fixed as head is rotated = normal brain stem function

410
Q

What is the confirmatory test for diagnosing Brain Death?

A

Radioisotope brain scan revealing NO cerebral blood flow > 10 min (typically 2/2 brain edema)

411
Q

What is Wallerian Degeneration?

A

Degeneration of Axons after trauma, but in the setting of preserved peri and epineurium which later acts as scaffolding to allow axonal sprouting and regeneration within the PNS

412
Q

Describe Pseudoexacerbation of Multiple Sclerosis

A

[SLUM SiiiN]

Infection in MS pt –>⬆︎ Body temp –> ⬇︎Conduction in [Remyeliated healed CNS areas] –> clinical APPEARS to be MS exacerbation BUT REALLY ISN’T!

Image: T1 MRI Black Holes Dx

413
Q

Nerve roots for Ankle Jerk Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

S1 - S2

414
Q

Nerve roots for Patellar Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

L3 - L4

415
Q

Nerve roots for Biceps Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

C5 - C6

416
Q

Nerve roots for Triceps Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

C7 - C8

417
Q

Sciatica etx ; Clinical Presentation - 3

A

“Having Sciatica makes you break LAWS”

  • [Lower Back pain w/radiation down POSTERIOR thigh –> lateral foot]
  • Ankle jerk reflex ABSENT (this can occur naturally with age!)
  • Weak Hip Extension
  • [S1 n PosteroLateral compression at L4-5 or L5-S1] –> UMN signs
418
Q

Alzheimer’s tx - 7 ; Which medication should be used last?

A

CLAV –> HANDU

  1. Donepezil - AChnesterase inhibitor
  2. Tacrine - AChnesterase inhibitor
  3. Rivastigmine - AChnesterase inhibitor
  4. Galantamine - AChnesterase inhibitor
  5. Memantine - NMDA R Blocker: USE LAST
  6. Respite Care for Caregivers (ex: Adult day program)
  7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis)
419
Q

Neonatal Abstinence Syndrome

Classic Signs - 5

A

TYT Does Heroin

  1. Tremors
  2. Yawning
  3. Tachypnea
  4. Diarrhea
  5. High Pitched Cry

Caused by maternal opioid (Heroin) use during pregnancy

420
Q

Major causes of Altered Mental Status-20

A

AEIOU TIPS

421
Q

Where do most Medulloblastomas occur? ; How does this present clinically?

A

Cerebellar VERMIS ; Truncal ataxia

422
Q

Risk factors for Carpal Tunnel Syndrome - 4

A
  1. Obesity
  2. Pregnancy
  3. DM
  4. hypOthyroidism

CARPEL TUNNEL STARTS uL and –> BL

423
Q

Meniere’s Disease tx - 5

A

1st: Diet change (restrict Na+, caffeine, Nicotine, EtOH)
2nd: Benzo, antihistamines, antiemetics
3rd: Diuretics for long term

Sx = VTH (Vertigo, Tinnitus, Hearing loss)

424
Q

Alcoholic cerebellar degeneration causes damage to the ______

How can you differentiate Alcoholic cerebellar damage from other causes of cerebellar damage?

A

Purkinje cells of cerebellar vermis

Alcoholic cerebellar damage LEAVES LIMB COORDINATION INTACT (no intention tremor)

Cere is def on GRINDRR

425
Q

What are the neurological manifestations of DM in the extremities

A

Symmetrical loss of 2TVP (2point,Touch,Vibration,Proprioception) distally

GAIT IS INTACT

426
Q

Sciatica tx ; dx?

A

“Having Sciatica makes you break LAWS”

NSAIDs + APAP = 1st line as Sciatica sx are self limited

Dx = CLINICAL (Only use MRI for confirmation of disc herniation if sensory/motor deficit, cauda equina syndrome sx or epidural abscess r/o)

427
Q

Brain Death is a clinical diagnosis and involves absent cortical and brain stem functions

What are the legal complications of disabling articial life support for a pt who is newly diagnosed with Brain Death?

A

None - Brain death is a legally acceptable definition of death

428
Q

How does Papilledema present in pts with Pseudotumor Cerebrii Idiopathic Intracranial HTN?

A

transient vision loss when changing head positions that last a few seconds

Can –> Vision Loss!

[2b] A- step 2 CK (16 decks)

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