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Neurology > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

How does increased ICP affect heart rate?

A

Can cause bradycardia

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2
Q

What is the Cushing triad?

A

Hypertension, bradycardia, and irregular respirations

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3
Q

What are risk factors for pseudotumor cerbri?

A

Obesity, tetracycline, growth hormone, and excess vitamin A

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4
Q

What structure absorbs CSF?

A

Arachnoid granulations - project into the dural venous sinuses

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5
Q

At what level does the spinal cord end?

A

L1-L2 (why LPs are done at L3-4 or L4-5)

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6
Q

What is the definition of a persistent vegetative state?

A

May follow prolonged coma and is characterized by preserved sleep-wake cycles and maintenance of autonomic functions, with absence of awareness and cognition

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7
Q

What is Foster Kennedy syndrome?

A

Ipsilateral optic disc atrophy due to compression of the optic nerve by a space-occupying lesion in the frontal lobe and papilledema in the contralateral optic disc due to increased ICP

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8
Q

What is Uhthoff’s phenomenon?

A

Seen with optic neuritis - worsening visual function when the body gets overheated (e.g. during exercise, hot baths, saunas, fever)

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9
Q

What is the difference between phoria and tropia?

A

Phoria - misalignment of the eyes when binocular vision is absent (cover-uncover test)
Tropia - misalignment of the eyes when both eyes are open

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10
Q

What is Parinaud’s syndrome?

A

Characterized by upgaze disturbance, convergence-retraction nystagmus on attempted upgaze, and light-near dissociation

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11
Q

What part of the brain is responsible for horizontal saccades (fast eye movements that redirect the fovea to a new target)?

A

Contralateral frontal eye field or superior colliculus

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12
Q

What part of the brain is responsible for vertical saccades?

A

Bilateral frontal eye fields or the superior colliculus

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13
Q

What is diabetic amyotrophy?

A

Type of neuropathy - It is characterized by weakness followed by wasting of pelvifemoral muscles, either unilaterally or bilaterally, with associated pain.

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14
Q

How is pain and temperature information sent to the brain?

A

Through A-delta (thinly myelinated) and C (unmyelinated) fibers that synapse at the dorsal horn. Then 2nd order neurons cross at the ventral white commissure and continue up the spinothalamic tract (STT) (anterolateral system). These neurons synapse in the brainstem in the periaqueductal gray matter and in the VPL nucleus of the thalamus. From the VPL, 3rd order neurons relay information to the postcentral gyrus.
Note that in the STT, sacral segments are located laterally and cervical segments are located medially.

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15
Q

How is proprioception, vibration, and light touch information sent to the brain?

A

Through A-alpha and A-beta (heavily myelinated) fibers to the fasciculus gracilis (lower body) and fasciculus cuneatus (upper body) up through the dorsal column system. These neurons reach second order neurons at the level of the medulla in the nuclei gracilis and cuneatus. Axons from these nuclei cross at the lower medulla to form the medial lemniscus. These neurons synapse in the VPL and 3rd order neurons terminate in the postcentral gyrus. Note that in the dorsal column/medial lemniscus, sacral segments are located medially and cervical segments are located laterally.

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16
Q

What part of the brain controls micturition?

A

The dorsomedial frontal lobe and the pontine micturition center (PMC) (involved in voluntary control). The medial portion of the PMC is involved in voiding and the lateral region in urine storage (causes contraction of the urethral sphincter).

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17
Q

What is the innervation to the penis and clitoris?

A

Motor and sensory fibers in pudendal nerves, parasympathetic in the sacral spinal cord (S2-4), and sympathetic from T11-12 in the hypogastric nerve

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18
Q

What is alexia?

A

The inability to read despite a preserved ability to write - due to a dominant occipital lobe + splenium of the corpus callosum lesion. Prevents the input of language through visual means

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19
Q

What is apraxia?

A

The inability to carry out a learned motor task despite preservation of the primary functions needed to carry out the task (e.g. comprehension, motor ability, sensation, and coordination). Usually associated with frontal or parietal lesions in the dominant hemisphere

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20
Q

What is prosopagnosia?

A

The inability to recognize faces. Due to damage to the right or bilateral visual association area (in the occipototemporal region).

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21
Q

What is Gerstmann’s syndrome?

A

Agraphia, acalculia, right-left confusion, and finger agnosia. Due to lesions to the dominant angular gyrus in the parietal lobe

22
Q

What is prosody?

A

The ability to use and understand inflection. Usually this function resides in the non-dominant hemisphere

23
Q

What is anosognosia?

A

Usually due to a right hemisphere lesion. It is when a patient is unaware of their deficits

24
Q

When do hypnagogic hallucinations occur?

A

When GOing to sleep (word “go” is in hypnagogic)

25
Q

When do hyponopomic hallucinations occur?

A

When transitioning frOM sleep (“om” in hyponopomic)

26
Q

What is REM sleep behavior disorder?

A

Characterized by complex motor behaviors during REM sleep. Dream enactment can occur if the atonia that normally accompanies REM sleep is absent or decreased. It can be a prodromal symptom of Parkinson disease or dementia with Lewy bodies and is more common in older adult men

27
Q

How does REM sleep change in narcolepsy?

A

Shortened latency to REM

28
Q

What test is used to diagnose narcolepsy?

A

The multiple sleep latency test (MSLT) - will show rapid onset of REM sleep

29
Q

What is stiff-person syndrome?

A

Characterized by chronic axial muscle rigidity and stiffness with superimposed painful muscle spasms. It may be associated with antibodies directed against glutamic acid decarboxylase (GAD) or amphiphysin. Patients may have hyperlordosis of the lumbar spine and stiff hips and spine. Benzodiazepines and baclofen are most useful for treatment. Although steroids, plasmapheresis or IVIG can be used if autoantibodies are found

30
Q

What type of tremor improves with alcohol consumption?

A

Essential (type of postural tremor, ie gets worse with maintenance of posture)

31
Q

What is blepharospasm?

A

Sustained, involuntary closure of the eyelids

32
Q

What is idiopathic torsion dystonia?

A

A familial condition that may manifest as torticollis, writer’s cramp, blepharospasm, or spasmodic dysphonia

33
Q

What is geste antagoniste?

A

Gently touching the body part affected by dystonia leading to relaxation

34
Q

What is myoclonus?

A

Sudden lightning-like movements produced by abrupt and brief muscle contraction or inhibition. Patients may see improvement with alcohol consumption

35
Q

What are characteristics of central (transtentorial herniation)?

A

Downward herniation of the diencephalon through the tentorial notch. Heralded by a decrease in the level of alertness, followed by small, reactive pupils (disruption of sympathetic pathways from hypothalamus). As it progresses, the patient may assume a decorticate posture. As the midbrain is compressed, the pupils may become fixed in the midposition and the patient will have decerebrate posturing. The final stage shows an unresponsive, motionless patient with eventual progression to death

36
Q

What are characteristics of uncal herniation?

A

May be preceded by hemiparesis. The first clinical deficit is often an ipsilateral (to the lesion) IIIrd nerve palsy (dilated pupil), followed by impairment of consciousness. Continued herniations produces compression of the contralateral cerebral peduncle against the free edge of the tentorium with resulting hemiplegia ipsilateral to the herniating uncus and lesion (Kernohan’s notch phenomenon). May get compression of the PCA leading to temporal and occipital lobe infarction.

37
Q

What are characteristics of subfalcine herniation?

A

Herniation of the cingulate gyrus beneath the falx cerbri due to expansive frontal lobe mass. Symptoms are not always appreciable because there are already symptoms from the frontal lobe mass although the ACA may be compressed leading to leg weakness

38
Q

What do different Glasgow Coma Scale number indicate?

A

13-15 is mild
8-12 is moderate
3-7 is severe

39
Q

What are short term measures for reducing ICP?

A

Elevation of the head of the bed, hyperventilation, and use of mannitol or hypertonic saline

40
Q

What are the causes of peripheral neuropathy?

A
  • Vitamin deficiency/vasculitis
  • Infections (TB, leprosy)
  • Toxic (amiodarone, lead, vincristine, chemotherapeutic agents)
  • Amyloid
  • Metabolic (alcohol, diabetes, porphyria, hyperthyroidism, liver and renal failure)
  • Idiopathic/inherited (hereditary neuropathy with liability to pressure palsies)
  • Neoplasm
  • Systemic (SLE, polyarteritis nodosa, MS)
41
Q

What is chronic inflammatory demyelinating polyradiculopathy (CIDP)?

A

It is similar to GBS and sometimes is referred to as chronic GBS (although it isn’t). It is a chronic, relapsing inflammatory polyradiculopathy characterized by weakness and areflexia. There is elevated CSF protein. Unlike GBS, it responds well to steroids. IVIG is also effective

42
Q

What is multifocal motor neuropathy (MMN)?

A

Weakness develops in the distribution of individual nerves rather than spinal myotomes. Reflexes are spared. There is often high levels of IgM anti-GM1. Responds to IVIG, rituximab, and immunosuppressive drugs (e.g. cyclophosphamide)

43
Q

What systemic disease is a common cause of bilateral LMN facial weakness?

A

Sarcoidosis. It also can cause optic neuritis

44
Q

What mechanism of injury is most likely to lead to diffuse axonal injury?

A

Rotational acceleration and deceleration injuries

45
Q

What is Meige syndrome?

A

A form of focal dystonia characterized by blepharospasm, forceful jaw opening, lip retraction, neck contractions, and tongue thrusting. Can be idiopathic. Treated most effectively with Botox

46
Q

What area of the CNS does Wilson disease damage?

A

Also called hepatolenticular degeneration - leads to atrophy of the putamen and globus pallidus.

47
Q

What are CNS symptoms of Wilson disease?

A

Tremor, rigidity in arms (little arm swing with walk), reduced blinking

48
Q

How can papillitis be distinguished from papilledema?

A

Papillitis causes a characteristic vision loss and papilledema does not

49
Q

What is benign tonic pupillary dilation (Adie tonic pupil)?

A

Usually in healthy young women and the bilateral dilation may occur in isolation or in association with absent tendon reflexes. It is usually a benign phenomenon

50
Q

What type of hearing is most affected by Méniere disease?

A

Low frequency

51
Q

Inducing hypothermia is shown to improve outcomes in what condition?

A

Following severe traumatic head injury

Neurology (16 decks)

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