Neuro Flashcards
Une femme de 52 ans consulte pour une diminution de la vision de son oeil droit de façon assez subite. La vision de son oeil gauche est à 20/20 et celle de son oeil droit est à 20/200. À l’examen physique, lorsque vous mettez de la lumière dans l’oeil droit, aucune des deux pupilles ne réagit. Lorsque vous mettez la lumière dans l’oeil gauche, les deux pupilles se rétrécissent. Lorsque vous remettez la lumière dans l’oeil droit, la pupille D se dilate. Comment expliquez- vous ce phénomène?
A - Pupilles d’Argyll-Robertson
B - Ophtalmoplégie internucléaire
C - Névrite optique
D - Syndrome de Horner
C) nevrite optique
Defaut pupillaire afferent indique atteinte de la retine ou nerf optique
45F recently returned from Japan presents after an episode of transient left facial droop and arm weakness with left neglect lasting 30 minutes. BP is 108/66. She was started on dual antiplatelets. Over the two weeks she completes her stroke investigations. MRI
Head was normal. CTA shows no signi
shows a 2.5cm PFO. Leg dopplers show no DVT. A 14d holter is unremarkable. LDL is 2.1, HbA1c is 5.2%. APLA testing is negative. What is the next step in management?
a) complete 21d of ASA & clopidogrel and refer for PFO closure
b) complete 21d of ASA & clopidogrel and atorvastatin 80mg
c) Atorvastatin 80mg and refer for PFO closure
d) ASA and refer for PFO closure
e) ASA and clopidogrel x 3 months and atorvastatin 80mg
D)
stroke in young so PFO is possible cause especially as other investigations negative
-no dual antiplatelet as this appears to be a cardioembolic phenomenon (from PFO)
- LDL is not perfect, but in young pt with no athero on CTA, this is unlikely to be the main issue
45M presents with unilateral headache, photophobia, and nausea. He is known for having recurrent headaches. His past medical history is notable for HTA, diabetes, CKD, and CAD with an inferior wall stemi 2 years ago. He is currently on ASA, metformin, monocor, insulin, ramipril. His blood pressure is 162/85. You perform a fundoscopic exam which shows AV nicking, cotton wool spots, and hard exudates. There is no disc edema. Which of the following would be most appropriate.
a) IV sumatriptan
b) IV labetalol
c) Metoclopramide
d) Subcutaneous ergotamine
Metoclopramide car 1e ligne en migraine et triptan CI si MCAS / HTA non controlée
Ergo CI aussi pour les memes raisons
46F presents with a right foot drop. She has been renovating her bathroom recently and reports back pain. On exam, tone is normal throughout and strength is normal in the arms and left leg. Strength of right leg: hip fl
exion and extension 5, hip abduction and adduction 5, knee flex 4, ankle inversion 5. right lateral calf and dorsum of the foot and involving the lateral ankle.
What is the most likely localization?
a) motor neuron disease (ALS)
b) right L5 radiculopathy
c) right sciatic neuropathy
d) right common peroneal neuropathy at the knee
e) thoracic spinal cord
d) right common peroneal neuropathy at the knee
70M with Parkinson’s well controlled on levodopa over the last 5 years but has now developed dyskinesia. You start him on another drug, and he then develops compulsive behaviour including hoarding and repetitive pacing. Which of the following drugs is responsible?
A. Pramipexole B. Levodopa C. Selegiline D. Entacapone
Pramipexole = DA agonist
76M with sudden onset shuffling gait. Found to have postural hypotension ++ new executive dysfunction. CT reveals extensive microangiopathic changes. Quel est le diagnostic le plus probable?
A. DÉmence à cors de Lewy
B. Démence vasculaire
C. Atrophie multisystème
D. Maladie de Parkinson
C) atrophie multisysteme
car dysautonomie typique tout comme la dysfonction cerebelleuse et executive.
la dysautonomie devrait nous ecarter d’une demence vasculaire
85F with history of presents with 5 days of new confusion and drowsiness. Her husband noted that when he tried to speak with her, she appeared to stare blankly with poor comprehension. She asked repeatedly where they were going that day. She also appeared much more irritable and had decreased need for sleep at night. She comes in with an episode of tongue biting. On exam, she is febrile at 38.5°C, BP 180/100, HR 95. She has no meningismus. She has a right complete ptosis with mydriasis and weakly opens her left eye to pain. She has a left hemiparesis. What is the most important tx to initiate ?
- tPA
- Prednisone
- Labetalol
- IvIG
- Acyclovir
Acyclovir : treat herpes encephalitis early
A 33-year-old pregnant woman G3P0A2 presents at 22 weeks gestation with a thunderclap headache and a first tonic-clonic seizure for 1 minute. CT angiogram of the brain shows a superior sagittal sinus thrombosis, and bilateral frontal intracranial hemorrhages. What is the most appropriate treatment?
A) Tranexamic acid
B) Magnesium Sulphate 4 g IV and consult OB
C) Low molecular weight heparin
D) Lorazepam
C) Cerebral venous sinus thrombosis, even with secondary hemorrhage due to venous reflux, is treated with anticoagulation.
A 45yM Sommelier is diagnosed with early parkinson’s disease and has predominantly mild bradykinesia and mild rigidity on exam, minimal tremor. He is counselled about treatment options and is very concerned regarding side effects of medications such as dyskinesias due to his profession. Which is the best option for treatment?
a) ropinirole
b) trihexyphenidyl
c) levodopa/carbidopa
d) selegiline
levodopa
ropinorole is a dopamine agonist so has same risk of dyskinesia and is sedation so wouldn’t be ideal.
We used to think the longer you are on L-Dopa, the more likely to get dyskinesias. However, it is more likely that the longer you have PD, more likely to get dyskinesia from L-Dopa (correlation, not causation). Additionally, he drinks wine for a living, so risk of hypertensive crisis if tyramine rich diet.
A 60-year-old man with melanoma on pembrolizumab developed progressive proximal arm and leg weakness over 2 weeks, CK 6500, and ptosis. Which of the following treatments would be first-line for this condition?
A) Methylprednisolone
B) Intravenousimmunoglobulin
C) Plasmapheresis
D) Stereotacticradiotherapy
A) Methylprednisolone as here : immune checkpoint inhibitor induced myasthenia gravis and myositis.
If usual myasthenic crisis : PLASMAPHERESIS 1st choice or IvIG
CAUTION with high dose prednisone as <50% transient worsening of respiratory status in 5-10d
A 70-year-old man with a 50 pack year smoking history presented with a fall, and then a day later he developed clumsiness and tingling in the hands and urinary incontinence with a normal gait. What is the name of his syndrome?
A) Posterior cord syndrome
B) Central cord syndrome
C) Anterior cord syndrome
D) Hemicord syndrome
B) central cord syndrome
The central cord syndrome damages crossing fibres in the spinothalamic tract resulting in a cape-like or suspended sensory loss.
A 75-year-old man post renal transplant on cyclosporine presented with blurred vision and disorientation. Temperature 37.1C, BP 179/85, HR 95. What is the acute management of this patient?
- tPA
- Lower blood pressure
- Dialysis
- Mg
- Tranexamic acid
Lower blood pressure in PRES and consider removing offending drugs like cyclosporine
AFIB and ICH : when to restart anticoagulation ?
7 to 8 weeks after ICH
After first seizure, risk of recurrence ?
21-45% risk of recurrence, greatest in first 2y
Tx lowers 2y recurrence risk but not longterm risk
AVC cerebelleux : sx controlat ou ipsi ?
Sx IPSI a la lesion
Concernant l’anatomie durant une ponction lombaire:
a) la moelle épinière se termine à L3
b) L’épine iliaque postéro-supérieure se situe au niveau de L4
c) apophyse épineuse de L4 se situe au même niveau que la crête iliaque
d) le conus médullaire se termine au niveau de l’espace L3-L4
C)
Critère de temps pour thrombolyse ou thrombectomie ?
Thrombolyse < 4.5h
Thrombectomie < 6h
Critères pour tPA en AVC ?
AVC ischémique qvec NIHSS ≥ 6, <4.5h et sans CI
if TPA : attendre 24h avant de débuter ASA (mais pas une CI a la thrombolyse si recu)
Si pas de tPA et CT sans saign : ASA 160
Dame de 85 ans se présente avec tremblement. Bradykinésie, rigidité, on suspecte un nouveau diagnostic de Parkinson. On veut exclure une cause médicamenteuse. Quel médicament est-il le plus sécuritaire de CONTINUER?
A- Maxeran
B- Stemetil
C-Haldol
D- Domperidone (motilium)
Domperidone
Diabétique de 50 ans, se présente avec céphalée hémicrânienne droite et ptose droite, réflexe pupillaire normal bilatéralement. Quelle est la cause de son malaise ?
A) Ischémie du mésencéphale
B) Ischémie du nerf oculomoteur
C) Anévrysme de l’artère cérébrale postérieure
D) Hernie temporale (?… qqchose qui avait pas rapport)
C) Anévrysme
Ischémie du nerf oculomoteur : cause la plus fréauente : dysfonction externe COMPLETE (ptose, att MEO) sans dysfonction interne (pupille N)
Anévrysme : paralysie NC III par compression par un anévrysme intracrânien qui s’agrandit, souvent artère comm post. Généralement pupille atteinte et céphalée. Si dédicit externe incomplet : a R/O
Diagnosis headache + hypertension + cyclosporine/tacrolimus ?
PRES
Diagnosis headache + recurrent thunderclap + pregnant + cannabis/decongestant use ?
RCVS recersible cerebral vasoconstriction syndrome
Elective intubation for GBS ?
Elective intubation if
- FVC < 20
- MIP 0 to -30cm H2O
- MEP < 40cm H2O
Femme de 38 ans qui a quatre enfants. Elle présente une faiblesse musculaire principalement au bras gauche et une difficulté à relâcher les objets surtout les balles de neige. Elle présente aussi une dysphagie. Quel structure est atteinte ?
A) Mitochondrie
B) Muscle
C) Jonction neuromusculaire
D) Nerfs (SX Paryngo-cervico-brachial aurait pu être considéré) mais pas de myotonie
Muscle
Description ici de sx de dystrophie myotonique
Femme de 40 ans qui consulte pour diplopie, paralysie du regard latéral et vertiges transitoires. À l’examen, paralysie de l’adduction de l’œil gauche, nystagmus vertical et skew deviation. Quel est le diagnostic le plus probable?
a) SEP
b) Tumeur pontique primaire
c) AVC lacunaire
a)
Les 3 lesions decrites pourraient donner ce tableau mais vu age et pas de FDR : SEP + prob
