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Neurology > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

Aphasia vs dysarthria

A

Aphasia is higher order inability to speak (language deficit)

Dysarthria is motor inability to speak (movement deficit)

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2
Q

Where are broca’s and wernicke’s?

A

In dominant hemisphere (if R handed, your dom hemisphere is L)

Motor speech is Broca - Frontal lobe above sylvian fissure

Associative auditory cortex is Wernicke - temporal below sylvian. Borders parietal too. Behind primary auditory cortex.

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3
Q

Broca’s aphasia

A

1) No fluency
2) Yes comprehension
3) No repetition

Inferior frontal gyrus

Broca is Broken Boca

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4
Q

Wernicke aphasia

A

1) Yes fluency
2) No comprehension
3) No repetition

Superior temporal gyrus

Wernicke is Wordy but makes not sense. Wernicke is What???

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5
Q

Conduction aphasia

A

1) Yes fluency
2) Yes comprehension
3) No repetition

Arcuate fasciculus

Can’t repeat phrases such as No ifs, ands, or buts

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6
Q

Global aphasia

A

1) No fluency
2) No comprehension
3) No repetition

AF, Brocas and Wernicke affected

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7
Q

Transcortical motor aphasia

A

1) No fluency
2) Yes comprehension
3) Yes repetition

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8
Q

Transcortical sensory aphasia

A

1) Yes fluency
2) No comprehension
3) Yes repetition

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9
Q

Mixed transcortical aphasia

A

1) No fluency
2) No comprehension
3) Yes repetition

Broca and Wernicke involved. AF spared.

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10
Q

Kluver-Bucy Syndrome

A

Bilateral amygdala lesion

disinhibited behavior (hyperphagia, hypersexuality, hyperorality)

Associated with HSV1

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11
Q

Frontal lobe lesion

A

Disinhibition and deficits in concentration, orientation, judgment. May have reemergence of primitive reflexes

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12
Q

Nondominant parietal-temporal cortex lesion

A

Hemispatial neglect syndrome (agnosia of contralateral side of the world)

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13
Q

lesion to dominant parietal-temporal cortex

A

Agraphia, acalculia, finger agnosia, L-R disorientation

Gerstmann Syndrome

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14
Q

Lesion to reticular activation system (midbrain)

A

Reduced levels of arousal and wakefulness (coma)

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15
Q

Mammilary body lesion bilateral

A

WKS - confusion, ophthalmoplegia, ataxia; memory loss (anterograde and retrograde amnesia), confabulation, personality changes

Associated with thiamine deficiency and excessive EtOH use. Can be precipitated by giving glucose without B1 to a B1 deficient patient

CAN of beer - Confusion, Ataxia, Nystagmus

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16
Q

Basal ganglia lesion

A

May cause tremor at rest, chorea, athetosis

PD, HD

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17
Q

Cerebellar hemisphere lesion

A

Intention tremor, limb ataxia, loss of balance; damage to cerebellum leading to ipsilateral deficits. Fall toward side of lesion

Cerebellar hemispheres are laterally located - affect lateral limbs

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18
Q

Cerebellar vermis lesion

A

Trunctal ataxia, dysarthria

Vermis is centrally located - affected central body

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19
Q

STN lesion

A

Contralateral hemiballismus

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20
Q

Hippocampus lesion bilateral

A

Anterograde amnesia - inability to make new memories

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21
Q

Paramedian pontine reticular formation lesion

A

Eyes look away from side of lesion

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22
Q

Frontal eye field lesion

A

Eyes look towards lesion

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23
Q

MCA stroke

A

1) Motor cortex - upper limb and face: Contralateral paralysis of upper limb and face
2) Sensory cortex - upper limb and face: Contralateral loss of sensation of upper limb and face
3) Temporal lobe (Wernicke), Frontal lobe (Broca): Aphasia if in dominant (usually left) hemisphere. Hemineglect if lesion affects nondominant (usually Right) hemisphere

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24
Q

ACA stroke

A

1) Motor cortex - lower limb: Contralateral paralysis of lower limb
2) Sensory cortex - lower limb: Contralateral loss of sensation of lower limb

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25
Q

Lenticulo-striate artery stroke

A

Striatum, internal capsule: Contralateral hemiparesis/hemiplegia

Common location of lacunar infarcts secondary to unmanaged HTN

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26
Q

Anterior Spinal Artery stroke

A

1) Lateral corticospinal tract - Contralateral hemiapresis of upper and lower limbs
2) Medial lemniscus - reduced contralateral proprioception
3) Caudal medulla, hypoglossal nerve - ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)

Stroke is commonly bilateral

Medial Medullary Syndrome - Caused by infarct of paramedian branches of ASA and vertebral arteries

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27
Q

PICA stroke

A

Lateral medulla - vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle

Vomiting, vertigo, nystagmus; reduced pain and temp senseation from ipsilateral face and contralateral body; DYSPHAGIA, HOARSENESS, lower gag reflex; ipsilateral Horner; ataxia, dysmetria

Lateral Medullary (Wallenburg) Syndrome - Nucleus Ambiguus effects are specific to PICA. Don’t PICK A (PICA) HORSE (horseness) that CANT EAT (dysphagia)

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28
Q

AICA stroke

A

1) Lateral pons - cranial nerve nuclei; vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers

Vomiting, vertigo, nystagmus. PARALYSIS OF FACE. reduced lacrimation, salivation. Reduced taste from anterior two thirds of tongue

Ipsilateral reduced pain and temp of the face, contralateral loss of pain and temp of body

2) Middle and inferior cerebellar peduncles - ataxia, dysmetria

Lateral Pontine Syndrome - facial nucleus effects are specific to AICA lesions. Facial droop means AICA’s pooped.

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29
Q

PCA stroke

A

Occipital cortex, visual cortex - Contralateral hemianopia with macular sparing

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30
Q

Basilar stroke

A

Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, PPRF

Preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements

“locked in”

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31
Q

ACom lesion

A

Most common lesion is aneurysm. Can lead to stroke. Saccular (berry) aneurysm can impinge cranial nerves

Visual field defects

Lesions are typically aneurysms not strokes

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32
Q

PCom lesion

A

Common site of saccular aneurysm

CN3 palsy - eye is down and out with ptosis and mydriasis

Lesions are typically aneurysms not strokes

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33
Q

Where does most CSF drain?

A

Superior sagittal sinus via arachnoid granulations

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34
Q

CSF route

A

Lateral ventricle to 3rd ventricle via R and L interventricular foramina of Monro

3rd to 4th via cerebral aqueduct of Sylvius

4th to subarachnoid space via Foramina of Luschka (lateral) and Magendie (medial)

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35
Q

Communicating hydrocephalus

A

Lower CSF absorption by arachnoid granulations leads to higher ICP, papilledema, herniation (think arachnoid scar post meningitis)

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36
Q

NPH

A

Type of communicating hydrocephalus

Affects the elderly; idiopathic; CSF pressure elevated only episodically; does not result in increased subarachnoid space volume.

Expansion of ventricles distorts the fibers of the corona radiata (nerve fibers running along ventricles) leading to triad of urinary incontinence, ataxia and cognitive dysfunction (sometimes reversible)

LP improves symptoms

Tx = VP Shunt (shunt CSF from ventricles into peritoneum)

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37
Q

Noncommunicating (obstructive) hydrocephalus

A

Caused by structural blockage of CSF circulation within ventricular system (stenosis of aqueduct of Sylvius; colloid cyst blocking foramen of Monro)

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38
Q

Ex vacuo ventriculomegaly

A

Appearance of increased CSF on imaging, is actually due to decreased brain tissue (neuronal atrophy)

Ex = AD, advanced HIV, Pick Disease

ICP normal. Triad not seen.

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39
Q

ALS lesion pattern

A

Coritcospinal (UMN signs) and ant motor horn (LMN signs)

No sensory (distinguishes from syringomyelia) or oculomotor deficits. Can be caused by defect in superoxide dismutase I.

Fasciculations with eventual atrophy and weakness of hands; fatal

Riluzole modestly increases survival by lowering presynaptic glutamate release (it’s a glut antag)

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40
Q

Complete occlusion of ASA

A

Spares dorsal column and Lissauer tract; upper thoracic ASA territory is watershed area as artery of Adamkiewicz supplies ASA below T8

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41
Q

Tabes Dorsalis

A

Caused by tertiary syphilis. From degeneration (demyelination) of dorsal columns and roots leading to impaired sensation and proprioception, progressive sensory ataxia (inability to sense or feel the legs leading to poor coordination)

Associated with Charcot joints, shooting pain, Argyll pupils

Exam shows no DTRs and positive Romberg

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42
Q

Syringomyelia

A

Syrinx expands and damages anterior white commissure of spinothalamic tract (second order neurons) leading to bilateral loss of pain and temperature sensation (C8-T1)

Seen with Chiari I malformation

Can expand and affect other tracts

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43
Q

Brown Sequard

A

Hemisection of spinal cord

1) Ipsilateral UMN signs below level of lesion (due to corticospinal tract damage)
2) Ipsilateral loss of tactile, vibration, proprioception sense below level of lesion (dorsal column damage)
3) Contralateral pain and temp loss below level of lesion (spinothalamic lesion)
4) Ipsilateral loss of all sensation at level of lesion
5) Ipsilateral LMN signs (flaccid paralysis) at level of lesion

If lesion is above T1 you might see Horner due to damage of oculosympathetic pathway

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44
Q

Friedreich Ataxia

A

Auto recessive GAA repeat disorder on chromosome 9 in gene that encodes frataxin (iron binding protein)

Leads to impairment in mitochondrial functioning. Degeneration of multiple spinal cord tracts leads to muscle weakness and loss of DTRs, vibratory sense, proprioception

Staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, diabetes mellitus, hypertrophic cardiomyopathy (cause of death). Present in childhood with kyphoscoliosis

If you cant regulate Fe right you get more ROS due to Fentin reaction

Friedrich is Fratastic (frataxin); he’s your favorite frat brother, always staggering and falling but he as a sweet, big heart.

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45
Q

Dermatome landmarks

A

C2 - posterior half of a skull cap
C3 - high turtleneck shirt
C4 - low collar shirt

T4 - at nipple
T7 - xyphoid
T10 - umbilicus

L1 - inguinal ligament
L4 - includes kneecaps

S2,3,4 - erection and sensation of penile and anal zones

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46
Q

Clinical reflexes

A

Biceps - C5 nerve root
Triceps - C7 nerve root
Patella - L4 nerve root
Achilles - S1 nerve root

S1,2 - buckle my shoe (Achilles)
L3,4 - kick the door (patellar)
C5,6 - pick up sticks (biceps)
C7,8 - lay them straight (triceps)

L1,L2 testicles move (cremaster)
S3,S4 winks galore (anal wink)

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47
Q

Cranial nerve nuclei locations

A

Midbrain - 3,4
Pons - 5,6,7,8
Medulla - 9,10,12
Spinal cord - 11

Lateral nuclei are sensory (alar plate). Medial are motor (basal plate)

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48
Q

CN 1 exit

A

Cribiform plate

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49
Q

CN 2-6 exit

A

Middle cranial fossa through sphenoid bone

Optic canal = 2

Superior orbital fissure = 3, 4, V1, 6

Foramen Rotundum = V2

Foramen Ovale = V3

Foramen spinosum = middle meningeal artery

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50
Q

CN 7-12 exit

A

Posterior cranial fossa through temporal or occipital bone

Internal auditory meatus = 7, 8

Jugular foramen = 9, 10, 11, jugular vein

Hypoglossal canal = 12

Foramen magnum = spinal roots of 11, brain stem, vertebral arteries

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51
Q

Vagal nuclei

A

1) Nucleus Solitarius - Visceral sensory information (taste, baroreceptors, gut distention) 7, 9, 10
2) Nucleus ambiguus - Motor innervation of pharynx, larynx, upper esophagus (swallowing, palate elevation) 9, 10, 11 (cranial portion)
3) Dorsal motor nucleus - sends autonomic (parasympathetic) fibers to heart, lungs, upper GI - 10 only

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52
Q

CN V lesion

A

Jaw deviates toward side of lesion due to unopposed force from the opposite pterygoid muscle

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53
Q

CN X lesion

A

Uvula deviates away from side of lesion. Weak side collapses and uvula pulls away

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54
Q

CN XI lesion

A

Weakness turning head to contralateral side of lesion (SCM). Shoulder drop on side of lesion (trap).

Left SCM contracts to help turn the head to the right.

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55
Q

CN XII lesion (LMN)

A

Tongue deviates toward side of lesion (“lick your wounds”) due to weakened tongue muscles on affected side

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56
Q

Cavernous Sinus Syndrome

A

Presents with variable ophthalmoplegia, lower corneal sensation, Horner and occasional decreased maxillary sensation. Secondary to pit tumor mass effect, carotid-cavernous fistula, or cavernous sinus thrombosis related to infection.

CN 6 is most susceptible to injury

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57
Q

Cavernous sinus

A

Collection of venous sinuses on either side of pit. Blood from eye and superficial cortex leads to cavernous sinus then IJ vein

CN 3, 4, V1, 6 and sometimes V2 plus postganglionic sympathetic pupillary fibers enroute to orbit all pass through it

Cavernous portion of internal carotid is here too.

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58
Q

Hearing loss types

A

1) Conductive - Rinne is abnormal ( bone is more than air). Weber localizes to affected ear
2) Sensorineural - Normal rinne (air is more than bone). Weber localizes to unaffected ear.

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59
Q

UMN facial lesion

A

Lesions of motor cortex or connection btw cortex and facial nucleus .

Contralateral paralysis of lower face

Forehead spared due to bilateral UMN innervation

60
Q

LMN facial lesion

A

Ipsilateral paralysis of upper AND lower face

61
Q

Facial nerve palsy

A

Complete destruction of the facial nucleus itself or its branchial efferent fibers (facial nerve proper)

Peripheral ipsilateral facial paralysis (absent forehead creases and drooping smile) with inability to close eye on involved side

Can occur idiopathically (bell’s) - gradual recovery in most cases

Associated with Lyme, herpes simplex and zoster (Ramsay Hunt), sarcoid, tumors, diabetes

Tx = steroids

62
Q

Conditions associated with facial nerve palsy

A

Lyme

herpes

Zoster

Sarcoid

Tumors

Diabetes

Bells

63
Q

Familial AD altered proteins

A

ApoE2 - lower risk

ApoE4 - higher risk

APP, Presenilin1, presenilin2 - higher risk of early onset

64
Q

FTD

A

AKA Pick Disease

Dementia, aphasia, parkinsonian aspects; change in personality

Spares parietal lobe and posterior two thirds of superior temporal gyrus (AD is diffuse cortex)

Pick Bodies - silver staining spherical tau protein (round not neurofibrillary) aggregates

65
Q

AD pathology

A

Widespread cortical atrophy. Narrow gyri, wider sulci

Less ACh

Seniles plaques in gray matter. Extracellular B-amyloid core. May cause amyloid angipathy (weakens vessels) leading to intracranial hemorrhage.

AB made by cleaving APP

Neurofibrillary tangles intracellularly

Hyperphosphorylated tau - insoluble cytoskeletal elements. Number of tangles correlates with degree of dementia

Confirmed with pathology at autopsy

66
Q

CJD

A

Rapidly progressive (wks to months) dementia with myoclonus (startle myoclonus)

Spongiform cortex

Prions (PrPc becomes PrPsc which is a B pleated sheet resistant to proteases)

Ataxia. Spike complexes on EEG.

67
Q

PML

A

Demyelination of CNS due to destruction of oligodendrocytes. Associated with JC virus. Seen in 2-4% of AIDS patients (reactivation of latent virus). Rapidly progressive, usually fatal.

Increased risk with natalizumab and rituximab

68
Q

Charcot-Marie-Tooth Disease

A

AKA hereditary motor and sensory neuropathy (HMSN)

Group of progressive hereditary nerve disorders related to defective production of proteins involved in structure and function of peripheral nerves or myelin sheath

Autosomal dominant.

Scoliosis and foot deformities (high or flat arches)

69
Q

Metachromatic leukodystrophy

A

Auto recessive lysosomal storage disease (myelin built up in lysosomes)

Arylsulfatase A deficiency

Buildup of sulfatides leads to impaired production and destruction of myelin sheath

Central/peripheral demyelination with ataxia, dementia

70
Q

Krabbe Disease

A

Auto recessive LSD from def in galactocerebrosidase

Buildup of galactocerebroside and psychosine in macrophages destroys myelin sheath

Peripheral neuropathy, developmental delay, optic atrophy, globoid cells

71
Q

What vaccines most associated with ADEM?

A

smallpox and rabies

72
Q

Subacute sclerosing panencephalitis

A

Gray AND white matter

Slowly progressing, persistent infection of brain by measles virus.

Infection in infancy leads to neuro signs years later

Viral inclusion bodies within neurons (gray matter) and oligodendrocytes (white matter)

Leads to death

73
Q

Adrenoleukodystrophy

A

X-linked - affects males usually

Disrupted metabolism of VLC fatty acids

Buildup in nervous system, adrenal gland, testes

Progressive disease that can lead to long-term coma/death and adrenal gland crisis

74
Q

Sturge-Weber Syndrome

A

Neurocutaneous disorder

Congenital, non-inherited, developmental anomaly of neural crest derivatives (mesoderm/ectoderm) due to activating mutation of GNAQ gene.

Affects small (capillary sized) blood vessels leading to port wine stain of the face (nevus flammeus, non-neoplastic birthmark in V1, V2 distribution)

Ipsilateral leptomeningeal angioma leading to seizures/epilepsy

Intellectual disability

Episcleral hemangioma leading to increased IOP leading to early-onset glaucoma

SSTURGGE: Sporadic, port wine Stain, Tram track calcifications (opposing gyri), Unilateral; Retarded; Glaucoma; GNAQ: Epilepsy

75
Q

Tuberous Sclerosis

A

neurocutaneous

HAMARTOMAS:

Hamartomas in CNS and skin
Angiofibromas 
Mitral Regurg
Ash-leaf spots
Rhabdo
Tuberous sclerosis
autosomal dOminant
Mental retardation
renal Angiomyolipoma 
Seizures
Shagreen patches

Increased incidence of subependymal astrocytoma and ungual fibromas

76
Q

NF1

A

Von Recklinghausen Disease

Cafe-au-lait spots
Lisch nodules (pigmented iris hamartomas) 
Cutaneous neurofibromas
Optic gliomas
Pheochromocytoma

Mutated NF1 tumor suppressor gene (neurofibromin is a negative regulator of RAS) on chromosome 17

Skin tumors of NF1 are derived from neural crest cells

77
Q

Von Hippel Lindau Disease

A

neurocutaneous

Hamangioblastomas (high vascularity with hyperchromatic nuclei) in retina, brain stem, cerebellum, spine

Angiomatosis (cavernous hemangiomas in skin, mucosa, organs)

Bilateral renal cell carcinomas

Pheochromocytomas

78
Q

Peripheral vertigo

A

More common. Inner ear etiology (semicircular canal debris, vestibular nerve infection, meniere disease)

Positional testing leads to delayed horizontal nystagmus

79
Q

Central vertigo

A

Brain stem or cerebellar lesion (stroke affecting vestibular nuclei or posterior fossa tumor)

Findings: directional change of nystagmus, skew deviation, diplopia, dysmetria. Positional testing leads to immediate nystagmus in any direction; may change directions
Focal neuro findings

80
Q

GBM

A

AKA Grade 4 astrocytoma

Common. Most common CNS tumor in adults. Highly malignant primary brain tumor with 1 year median survival.

Found in cerebral hemispheres. Can cross corpus (butterfly)

Stain astrocytes for GFAP

Histo: Pseudopalisading pleomorphic tumor cells - border central areas of necrosis and hemorrhage

81
Q

Meningioma

A

Females more than Males

Common. Usually benign primary brain tumor

Most often in convexities of hemispheres (near surfaces of brain) and parasagital region

Arises from arachnoid cells, is extra-axial (external to brain parenchyma) and may have a dural attachment (tail)

often asymptomatic

May present with seizures or focal neuro signs

Resection and/or radiosurgery

Histo: Spindle cells in a whorled pattern with psammoma bodies

Expresses estrogen receptor

82
Q

Hemangioblastoma

A

Most often cerebellar

Associated with von-hippel lindau when found with retinal angiomas.

Can produce EPO causing secondary polycythemia

Histo: Close, thin walled capillaries with little intervening parenchyma

83
Q

Schwannoma

A

Classically at cerebellopontine angle, but can be along any peripheral nerve. Benign

Schwann cell origin. S-100 positive.

Often localized to CN8 leading to vestibular schwannoma.

Resectable or treated with stereotactic radiosurgery

Bilateral vestibular schwannomas are found in NF2

84
Q

Oligodendroglioma

A

malignant

Rare. Slow growing. Frontal lobes. Chicken wire capillary pattern

Histo: oligodendrocytes = fried egg cells. they’re often calcified here.

85
Q

Low grade (pilocytic) astrocytoma

A

Kid brain tumor. #1 in kids.

Usually well circumscribed. In children, most often found in posterior fossa/cerebellum. May be supratentorial. GFAP positive.

Benign with good prognosis.

Rosenthal fibers - eosinophils, corkscrew fibers

86
Q

Medulloblastoma

A

Kids

Highly malignant. A form of primitive neuroectodermal tumor. Can compress 4th ventricle, causing hydro.

Can send “drop mets” to spinal cord

Homer-Wright rosettes. Solid. small blue cells.

87
Q

Ependymoma

A

Ependymal cell tumors most commonly found in 4th ventricle. Can cause hydro. Poor prognosis

Perivascular rosettes. Rod-shaped blepharoplasts found near nucleus.

Kids

88
Q

Craniopharyngioma

A

Benign kid tumor that may be confused for pit adenoma (can both cause bitemporal hemianopsia). Most common kid supratentorial tumor.

Can recur after resection

From epithelial remnants of Rathke’s pouch.

89
Q

Polymyalgia rheumatica

A

Does NOT cause weakness

Pain and stiffness in shoulders and hips

Often with fever and malaise and weight loss

More in women over 50.

Associated with temporal arteritis

High ESR, High CRP, normal CK

Tx = steroids

90
Q

Axillary nerve

A

C5-C6

Injury from: Fractured surgical neck of humerus; anterior dislocation of humerus

Flattened deltoid

Loss of arm abduction at shoulder

Loss of sensation over deltoid muscle and lateral arm

91
Q

Musculocutaneous nerve

A

C5-C7

Injury: Upper trunk compression

Loss of forearm flexion and supination

Loss of sensation over lateral forearm

92
Q

Radial nerve

A

C5-T1

Injury: Midshaft fracture of humerus, compression of axilla (crutches or sleeping with arm over chair)

Wrist drop: loss of elbow, wrist and finger extension

Reduced grip strength (wrist extension necessary for maximal action of flexors)

Loss of sensation over posterior arm/forearm and dorsal hand

93
Q

Median nerve

A

C5-T1

Injury: Supracondylar fracture of humerus (prox lesion); carpel tunnel and wrist laceration (distal lesions)

“Ape Hand” and “pope blessing”

Loss of wrist flexion, flexion of lateral fingers, thumb opposition, lumbricals of 2nd and 3rd digits

Loss of sensation over thenar eminance and dorsal and palmar aspects of lateral 3.5 fingers with prox lesion

Tinel sign (tingling on percussion) in carpal tunnel syndrome

94
Q

Ulnar nerve

A

C8-T1

Injury: Fracture of medial epicondyle of humerus (proximal lesion) or fractured hook of hamate (distal lesion)

“Ulnar claw” on digit extension

Radial deviation of wrist upon flexion (prox)

Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers (interossei), actions of medial 2 lumbrical muscles

Loss of sensation over medial 1.5 fingers including hypothenar eminence

95
Q

Recurrent branch of median nerve

A

C5-T1

Injury: Superficial laceration of palm

“Ape hand”

Loss of thenar muscle group: opposition, abduction, and flexion of thumb

No loss of sensation

96
Q

Erb Palsy

A

“waiter tip”

Injury: Traction or tear of upper trunk c5-c6 roots

Causes: infants - lateral traction on neck during delivery. Adults - trauma

Deltoid, supraspinatus - abduction (arm hangs by side)

Infraspinatus - lateral rotation (arm is medially rotated)

Biceps brachii - flexion, supination (arm extended and pronated)

97
Q

Klumpke palsy

A

Injury: Traction or tear of lower trunk C8-T1 root

Infants - upward force on arm during delivery. Adults - trauma like grabbing tree branch to break a fall

Intrinsic hand muscles: Lumbricals, interossei, thenar, hypothenar - total claw hand: lumbricals normally flex MCP joints and extend DIP and PIP joints

98
Q

Thoracic outlet syndrome

A

Injury: Compression of lower trunk and subclavian vessels

Causes: cervical rib, pancoast tumor

Same as Klumpke palsy - atrophy of intrinsic hand muscles, ischemia, pain, edema due to vascular compression

99
Q

Winged scapula

A

Lesion of long thoracic nerve

Axillary node dissection after mastectomy, stab wounds

Serratus anterior - inability to anchor scapula to thoracic cage leading to inability to abduct arm above horizontal position

100
Q

Ulnar claw vs pope blessing

A

Look the same. Context is different.

Extending fingers/at rest - distal ulnar nerve, ulnar claw

While making a fist - prox median nerve, pope blessing

101
Q

Median claw vs OK gesture

A

Look the same. Context is different

Extending fingers/at rest - distal median nerve, median claw

While making a fist - prox ulnar nerve, OK gesture (digits 1-3 flexed)

102
Q

Interossei muscles

A

DAB and PAD

Dorsals ABduct the fingers

Palmars ADduct the fingers

103
Q

Hand muscles

A

Thanar - Opponens, Abductor pollicis brevis, Flexor pollicis brevis (deep head of ulnar nerve)

Oppose, Abduct, Flex (OAF) - same for hypothenar

Hypothenar - Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi

104
Q

Obturator nerve

A

L2-L4

Cause of injury: pelvic surgery

Reduced thigh sensation (medial) and reduced adduction

105
Q

Femoral nerve

A

L2-L4

Cause of injury: Pelvic fracture

Reduced thigh flexion and leg extension

106
Q

Common peroneal nerve

A

L4-S2

Cause of injury: Trauma or compression of lateral aspect of leg, fibular neck fracture

Foot drop - inverted and plantarflexed at rest, loss of eversion and dorsiflection.

“steppage gait”

Loss of sensation on dorsum of foot

107
Q

Tibial nerve

A

L4-S3

Cause of injury: Knee trauma, Baker cyst (prox lesion); tarsal tunnel syndrome (distal lesion)

Inability to curl toes and loss of sensation on sole of foot

In prox lesions, foot everted at rest with loss of inversion and plantarflexion

108
Q

Superior gluteal nerve

A

L4-S1

Cause of injury: Iatrogenic injury during intramuscular injection to upper medial gluteal region

Trandelenburg gait - pelvis tilts bc weight-bearing leg cannot maintain alignment of pelvis through hip abduction (superior nerve leads to medius and minimus)

Lesion is contralateral to side of the hip that drops, ipsilateral to extremity on which the patient stands

109
Q

Inferior gluteal nerve

A

L5-S2

Cause of injury: Posterior hip dislocation

Difficulty climbing stairs, rising from seated position

Loss of hip extension (inferior nerve is to maximus)

110
Q

Peroneal vs Tibial

A

PED TIP

Peroneal Everts and Dorsiflexes. If injured, foot DropPED

Tibial Inverts and Plantarflexes. If injured, cant stand on TIP toes.

111
Q

Branches of sciatic nerve

A

Sciatic nerve (L4-S3) branches into common peroneal and tibial nerves

112
Q

Signs of L3-L4 disc level radiculopathy

A

Affects L4 spinal nerve

Weakness of knee extension. Reduced patellar reflex.

113
Q

Signs of L4-L5 disc level radiculopathy

A

Affects L5

Weakness of dorsiflexion, difficulty in heel-walking

114
Q

Signs of L5-S1 disc level radiculopathy

A

Affects S1

Weakness of plantarflexion, difficulty in toe walking. Reduced achilles reflex.

115
Q

Ddx of vertigo (9)

A

1) BPPV
2) Vestibular migraine
3) Vestibular epilepsy
4) Vertebrobasilar insufficiency
5) Meniere Disease
6) Viral vestibular neuronitis
7) Acute suppurative labyrinthitis
8) Acute serous labyrinthitis
9) Herpes zoster oticus (Ramsay Hunt)

116
Q

BPPV

A

Duration of vertigo attacks: 5-30s

Duration of Symptoms: Repeated attacks over weeks, months, or even years

Associated Symptoms: None

Principle Physical finding: Latent, geotropic nystagmus with reversibility and fatigue* on Dix-Hallpike

Tx: Canalith repositioning procedure, Brandt-Daroff exercises

117
Q

Vestibular migraine

A

Duration of vertigo attacks: Seconds - minutes

Duration of Symptoms: Minutes - hours, recurrent attacks

Associated Symptoms: HA, scintillations, other neurologic symptoms (weakness or numbness of extremity), changes in speech, etc

Principle Physical finding: Usually normal physical exam

Tx: Either suppressive or abortive tx for migraines, refer to neurologist

118
Q

Vestibular epilepsy

A

Duration of vertigo attacks: Seconds - minutes

Duration of Symptoms: Minutes, recurrent episodes

Associated Symptoms: Loss of consciousness, other neuro symptoms

Principle Physical finding: Usually normal PE

Tx: AEDs, refer to neuro

119
Q

Vertebrobasilar insufficiency

A

Duration of vertigo attacks: Seconds to minutes

Duration of Symptoms: Repeated episodes or evolving symptoms over weeks

Associated Symptoms: Changes in speech or swallowing, cerebellar symptoms, history consistent with atherosclerosis

Principle Physical finding: Can be normal, might have cranial nerve findings, cerebellar signs, or carotid bruit

Tx: Antiplatelet therapy, management of risk factors

120
Q

Meniere Disease

A

Duration of vertigo attacks: 20mins to 24h

Duration of Symptoms: Repeated episodes over weeks to months to years

Associated Symptoms: Aural pressure, low pitch (roaring) tinnitus, low frequency hearing loss

Principle Physical finding: Nystagmus during an attack, normal ear exam, might have hearing loss on audiogram, vestibular weakness on ENG

Tx: Low salt diet and diuretic therapy. Might need vestibular suppressants, might need vestibular ablative therapy or nerve section

121
Q

Viral vestibular neuritis

A

Duration of vertigo attacks: 24h or more

Duration of Symptoms: Several days, resolving over a few weeks as vestibular compensation occurs

Associated Symptoms: n/v

Principle Physical finding: horizontal nystagmus when patient is seen early in course, otherwise normal exam, vestibular weakness on ENG

Tx: Supportive care, anti-emetics, possibly vestibular suppressants, might need vestibular rehab therapy

122
Q

Acute suppurative labyrinthitis

A

Duration of vertigo attacks: 2-3d

Duration of Symptoms: Several days, resolving over a few weeks as vestibular compensation occurs

Associated Symptoms: Severely ill with nausea and vomiting, hearing loss, tinnitus, otorrhea

Principle Physical finding: Otitis media or cholesteatoma, nystagmus early in presentation, possible facial paralysis from cholesteatoma

Tx: IV ABx and possibly surgery

123
Q

Acute serous labyrinthitis

A

Duration of vertigo attacks: 2-3d

Duration of Symptoms: Several days, resolving over a few weeks as vestibular compensation occurs

Associated Symptoms: Hearing loss, tinnitus, nausea and vomiting

Principle Physical finding: History of past otologic surgery, nystagmus early in presentation

Tx: Supportive care with anti-emetics, possible vestibular suppressants, might need vestibular rehab, use steroids if hearing loss is present

124
Q

Herpes zoster oticus (Ramsay Hunt)

A

Duration: 2-3d

Duration of symptoms: Acute illness lasts approx 7-10d, residual symptoms can be long lasting

Associated symptoms: Herpetic rash in ear, retro-auricular pain, hearing loss

Principle Physical finding: Facial paralysis, hearing loss

Tx: Antiviral medications, steroids, might need vestibular rehab

125
Q

NE anomalies

A

High in anxiety

Low in depression

Made in locus ceruleus (pons)

126
Q

Dopamine anomalies

A

High in HD

Low in PD

Low in Depression

Made in ventral tegmentum and substantia nigra pars compacta (midbrain)

127
Q

5-HT anomalies

A

Low in anxiety and depression

Made in Raphe nucleus (pons, medulla, midbrain)

128
Q

ACh anomalies

A

High in PD

Low in AD

Low in HD

Made in basal nucleus of meynert

129
Q

GABA anomalies

A

Low in anxiety and HD

Made in nucleus accumbens

130
Q

ADH and oxytocin source

A

hypothalamus to posterior pit

ADH - supraoptic nucleus

Oxytocin - Paraventricular nucleus

131
Q

Lateral hypo

A

Hunger. Destruction leads to anorexia, failure to thrive (infants)

Inhibited by leptin

132
Q

Ventromedial hypo

A

Satiety. Destruction (craniopharyngioma) leads to hyperphagia

Stimulated by leptin

133
Q

Anterior hypo

A

Cooling, parasympathetic

Think AC. Ant Cool

134
Q

Posterior hypo

A

Heating, sympathetic

Lesion makes you cold

135
Q

Suprachiasmatic nucleus of hypo

A

Circadian rhythm

136
Q

Circadian rhythm

A

Driven by SCN. Controls nocturnal release of ACTH, prolactin, melatonin, NE

SCN releases NE causing pineal gland to release melatonin. SCN is regulated by environment (light)

137
Q

Stages of sleep

A

Awake (eyes open) - alert, active mental concentration - Beta (highest freq, low amp) waves on EEG

Awake (eyes closed) - Alpha waves

Non-REM

1) Stage N1 (5%) - light sleep - Theta waves
2) Stage N2 (45%) - deeper sleep, when bruxism occurs - Sleep spindles and K complexes
3) N3 (25%) - Deepest non-REM (slow wave sleep). When sleepwalking, night terrors, and bedwetting occur. Delta waves (lowest freq, highest Amp)

REM - loss of motor tone. Increased brain O2. Increased and variable pulse and blood pressure. When dreaming and penile/clit tumescence occur. May serve memory processing function. beta waves (like being awake and eyes open)

At night BATS Drink Blood (Beta, Alpha, Theta, Spindles, Delta, Beta)

138
Q

Bedwetting

A

Treat with oral desmopressin (ADH). Preferred over imipramine bc of side effects

139
Q

Night terrors and sleepwalking

A

Treat with benzos

140
Q

Benzos and sleep

A

Benzos, alcohol, and barbs reduce REM sleep and delta wave sleep. NE also lowers REM sleep.

141
Q

REM frequency

A

Every 90 minutes. Duration of each time increases throughout the night.

142
Q

Osmotic demyelination syndrome

A

Acute paralysis, dysarthria, dysphagia, diplopia, LOC

Can cause locked in syndrome.

Massive axonal demyelination in pontine white matter secondary to osmotic changes. Commonly iatrogenic, caused by overly rapid correction of hypoNa

Correcting hyperNa too quickly causes cerebral edema/herniation

ODS can also occur in severely malnourished patients (alocholic or liver disease)

Correcting Na: From low to high your pons will die. From high to low your brain will blow.

143
Q

VPL nuc of thalamus

A

Gets input from spinothalamic and dorsal column/ML pathways.

Pain, temp, pressure, touch, vibration, proprioception.

Destination to primary somatosensory cortex

144
Q

VPM nuc of thalamus

A

From trigeminal and gustatory pathway

Face sensation, taste

Goes to primary somatosensory cortex

“M-akeup goes on the Face”

145
Q

LGN of thalamus

A

From CN2

To Calcarine sulcus

Vision

L-ateral = Light

146
Q

MGN of thalamus

A

From superior olive and inferior colliculus of tectum

To Auditory cortex of temporal lobe

Hearing

M-edial = Music

147
Q

VL nuc of thalamus

A

From basal ganglia and cerebellum

To motor cortex

Motor

Neurology (14 decks)

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