Misc Neuropsychiatry/Neuropsychology Flashcards
What commonly used neuropsychological test is used to objectify mental flexibility/perseveration?
Wisconsin Card Sorting Test
What test can be used to elicit field dependence as well as defects in frontal lobe function?
Stroop Test
What do dorsolateral prefrontal cortex lesions yield?
Pseudo-depression - flattened affect, unresponsiveness and defects in higher-order cortical function
What do orbitofrontal prefrontal cortex lesions yield?
Pseudo-psychopathy; like a drunk teenager
Failure to modulate limbic structures leading to disinhibition and jollyness/anger bordering on mania
What 3 structures are thought to comprise the pain matrix?
Thalamus
Insula
Anterior cingulate cortex
What is thought to be the relationship between the prefrontal cortex, periaqueductal grey and pain matrix in perception of pain?
Increased prefrontal cortex activity -> increased opiate release from periaqueductal grey structures -> reduced activity and perception of pain in pain matrix
Who described utilisation behaviour?
Lhermitte
What is thought to be the malfunctioning region in utilisation behaviour?
Basal ganglia
What are the 3 major dopaminergic pathways?
Mesolimbic
Mesocortical
Nigrostriatal
Where does the mesolimbic tract project?
Nucleus accumbens
What does the nucleus accumbens integrate? What loop is it probably a part of?
Dopaminergic function from mesolimbic tract
Prefrontal cortex fibres
Amygdala and hippocampus
Part of the cortico-basal-thalamic loop
What is the sole source of histaminergic pathways in the brain? Where is it found?
Tuberomammilary nucleus
In the posterior hypothalamus
What is the main role of the tuberomammilary nucleus and where is it found?
In the posterior hypothalamus - produces histaminergic pathways
What affect do histaminergic pathways have on arousal and cortical activation?
They increase it directly via cortical projections and indirectly via acetylcholine release from forebrain/pons
Where do the major dopaminergic pathways originate?
Ventral tegmental area
What is Anton-Babinski syndrome?
Cortical blindness + visual anosognosia
What are the 2 most common disease causing VGKC antibodies?
LGI1
Caspr2
What is the third type of VGKC antibody not associated with tumours?
Anti-DDPX
What CSF changes are seen in VGKC disease?
Often none
What is the typical presentation of LGI-1 disease?
Cognitive impairment and seizures
Hyponatraemia
Sleep disorder
Movement disorder
What phenomenon is the hallmark of VGKC disease?
Peripheral nerve hyperexcitability
Or central nerve hyperexcitability presenting with limbic encephalitis
What VGKC antibody classically causes cognitive impairment and seizures?
LGI-1
What is the classical presentation of CASPR-2 disease?
Morvan’s syndrome
Neuromyotonia
What 3 conditions fall under the umbrella of peripheral nerve hyperexcitability?
Benign fasciculation syndrome
Mild cramp fasciculation syndrome
Neuromyotonia
What is neuromyotonia?
Peripheral nerve hyperexcitability with muscle twitching, cramps, sweating, dysaesthesia, dystonia
Often muscle hypertrophy and myokymia
What is myokymia?
Involuntary spontaneous localised muscle twitching e.g. Lower eyelid spasm
What is the name for the peripheral nerve hyperexcitability phenomenon of muscle twitching, cramps, sweating, dysaesthesia in association with muscle hypertrophy and myokymia?
Neuromyotonia
What is suggestive of Neuromyotonia in terms of the presence of myokymia?
Present in unrelated muscle groups
What is Morvan’s syndrome/Morvan’s Fibrillary Chorea?
Florid Neuromyotonia
Cognitive impairment
Sleep disorder
Autonomic dysfunction - sweating, cardiac arrythmias
What syndrome is suggested by neuromytonia, autonomic dysfunction, cognitive impairment and sleep disorder?
Morvan syndrome
What is the pathology underlying Morvan syndrome? Specific Ab?
VGKC antibodies causing peripheral nerve hyperexcitability
Often CASPR-2
What tumour is occasionally seen in VGKC disease?
Thymoma
What virus can cause an indolent, slowly progressive limbic encephalitis?
HSV6
What is the nature of a classical amyloidosis neuropathy?
Painful, with autonomic involvement
What are the 3 classical features of POEMS?
Plasma cell proliferative disorder (myeloma)
Polyneuropathy
Multi organ damage
What is interesting about the myeloma seen in POEMS?
Tends to be osteosclerotic rather than osteolytic, which is common in normal myeloma
What does POEMS stand for?
P- Papilloedema, pulmonary disease and peripheral Polyneuropathy O- organomegaly (liver), oedema E- endocrinopathy (mostly sex hormones) M- monoclonal paraprotein (IgG, lambda) S- skin changes
What is the paraprotein type in most paraproteinaemic Neuropathies? What about POEMS?
IgM Usually IgG (occasionally A) in POEMS
3 abnormal blood results seen in POEMS?
Thrombocytosis
Polycythaemia
Increased blood VEGF
What stain is best for observing amyloidosis on biopsy tissue?
Conga Red
