Neuro Flashcards
Hemianopia and stroke
MCA : homonymous hemianopsia controlateral (look towards the side of lesion
PCA: contra lateral with macular sparing
Contraindications of tissue plasminogens activator
1-stroke or head trauma within 3 months
2- haemorrhage within 21 days
3- surgery 21 days
4- histories of cranial haemorrhage
5- Bp > 180/110
Aphasia types
1 broca: follow commands but unable to verbalize or write
2 - wenrnikie : the inverse of broca
3 - conduction aphasia : affects th
Lacunar stroke
Subcortical necrosis ( small penetrating arteries)
- basal ganglia- pons
Pure motor hemiparesis without sensory deficits or higher cortical function
Stroke of the posterior limb of the internal capsule
Thalamic pain syndrome
Severe paroxysmal burning pain over the affected area which is exacerbated by light touch (allodynia)
CN III ipsilateral + hemiplegia
Weber
CN III ipsilateral + ataxia
Benedikt
Facial sensory loss + body sensory loss
Wallenberg
Quadriplegia + preserved consciousness + communicate through blinking
Looked in syndrome
Cause of death in subarachnoid hemorrhage
1 - rebleeding within the first 24 hours
2- vasospasm 3-10 days : arterial narrowing due to degradation of the blood and its metabolites
Upper motor neurons lesion
1 - spastic paralysis
2- hyperreflexia
3- no muscle wasting if present ( due to disuse atrophy
4- absent fasciculation
5- babinski sign ( fanning or the other toes)
Lower motor neurons lesion
1- flaccid paralysis
2- hypo or areflexia
3- early and marked muscle wasting
4- twitches of group of muscles
5- normal plantar response
6- always ipsilateral and at the level of the lesion
Pronator drift
Relatively sensitive and specific for upper motor neuron or pyramidal
Weakness in the supination compared to the pronator muscles of thr upper limb
The result: the affected arm drifts downward and the palm turns towards the floor
Spinal discord
1 - anterior spinal artery infarction
2- subacute combined degeneration
3- tabes dorsalis
4- brown sequard syndrome
5- syringomyelia
Romberg sign
Sways with eyes closed: sensory ataxia
Sways with closed eyes: cerebellar ataxia
Argyll Robertson pupil
Accommodate to the near object but not to the light
Loss of pain and temperature bilaterally across the upper back and both arms
Bubble in the cord
Syringomyelia
Key : frequent burns in both of her hands while cooking or packing
Amyotrophic lateral sclerosis (lou gehrigs disease
Pure motor disease upper and lower Motor neurons lesion while at the same time preserving bowel bladder sensory
Bradykinesia ( slow movement)
Rigidity ( cogwheel rigidity) : slowing of movement on passive flexion of an extremity
Instability tendency to fall
Tremor at rest
Parkinson
Parkinson trt
Mild : age > 60 amantadine ( release the dopamine
Age <60 anticholinergic
Sever disease:
Initial: carbidopa/levodopa
Side effects early:hallucinations
Late : dyskinesia (abnormal movements) akathisia (restlessness) off on phenomena trt; adding maob or comt or dopamine agonists
Multiple system atrophy shy drager syndrome
- Parkinson
- autonomic dysfunction
- widespread neurological signs
Trt : volume expansion( fludrocortisone salt supplements
Optic neuritis
Transverse myelitis
Inter nuclear ophthalmollegia
Multiple sclerosis
Charcot Marie tooth disease
Mutation of myelins synthesis ( peroneal and tibial nerves)
Weakness + wasting muscle ( inverted champagne bottle)
Foot drop
Tremors
Fluctuating fatigable muscles worsens with repetitive motions ( extra ocular ptosis + diplopia + bulbar ( chewing nasal speech
Tenslion test
Myasthenia
Pseudo tumor cerebrei
Young obese female with headache and normal image and elevated CSF pressure
*impaired absorption of CSF by the arachnoid villi
* provoking agents corticosteroids and vitamin A
Hearing loss + tinnitus + vertigo
Meniere disease
Indications for treatment
Seizures
1 - abnormal neurological exam
2-presented with status epileptic
3- strong family history of seizures
4- abnormal EEG
Todd paralysis
Self limited focal weakness that occurs after a focal or generalised seizure
Trt : supportive resolves within 36 hours
Exhaustion and inhibition in the neurons
Causes of dementia
1- alzheimer disease
2- Frontotemporal dementia ( pick’s disease)
3- dementia with Lewy body
4- Creutzfeldt Jakob disease
5- vascular dementia
6- normal pressure hydrocephalus
Vascular dementia caused by subcortical type ischemia
- focal motor deficit
- abnormal gait
- urinary symptoms
- psychiatric symptoms
- gradual declining course
Wacky ( dementia)
Wet ( urinary incontinence )
Apraxic gait wobbly
Ventriculomegaly
Normal pressure hydrocephalus
Normal opening pressure and transient clinical improvement following high volume CSF
Wernicke encephalopathy
Chronic form : korsakoff syndrome
Confusion
Ataxia
Ophthalmoplegia
Kosakoff syndrome
- anterograde and retre amnesia
- confabulation ( fill the memory by fabricated story
- apathy
- lack of insight
Ataxia + teleangiectasias + IgA deficiency
B and T cells disorder
Eczema + thrombocytopenia + recurrent infections
Wiskott-Aldrich syndrome
Huntington disease
CAG trinucleotide expansion results in the formation of an abnormal Huntington protein that is toxic to caudate and striatum which are responsible for producing GABA
Huntington disease
CAG trinucleotide expansion results in the formation of an abnormal Huntington protein that is toxic to caudate and striatum which are responsible for producing GABA
Miller fisher syndrome a variant of guillan barre syndrome
Cerebellar like ataxia and areflexia and rapid onset ophthalmoplegia
Neurocutanous disease
1- tuberous sclerosis
2- neurofibromatosis type 1
3- Sturge Weber syndrome
Tuberous sclerosis
Mutation suppressor genes TSC1 which code for the protein hamartin and tuberin
- cortical tubers and subependymal hamartomas in the brain ( seizure and mental retardation
- leaf shaped patches of skin lacking pigment ( ash leaf patches)
- renal angio myo lipoma
Neurofibromatosis type 1
Mutation gene suppressor NF1
- neurofibromas : sessile or pedunculated
- skin cafe au lait spots
- eye : optic nerve gliomas and visual loss and lisch nodules are pigmented hamartomas
Sturge Weber
S : sporadic T : Tram track calcification U : unilateral R : retardation G : glaucoma E : epilepsy
Cluster headache
Begin during sleep , peak rapidly, last approximately 90 minutes with men 8 times daily for 6-8 weeks followed by a remission lasting up to a year
