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Neuro Flashcards

neuro- you can do it!

0
Q

Name 2 Cause of 2nd order horner

A
  1. Apical lung ca

2. Thor ao aneurysm

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1
Q

4 Causes of 1st order horners

A
  1. Wallenberg syndrome
  2. Stroke
  3. Demyalinating disease of cervical spine
  4. Cervical disc dz
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2
Q

Name 3 causes of 3rd order horners

A
  1. Ica dissection
  2. Cav sinus thrombosis
  3. Cluster ha
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3
Q

Whats wallenberg syndrome?

A

Infarct of lateral medulla 2/2 pica stroke affects ipsilateral horners (1st order)

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4
Q

What male color blindness called

A

Deuteranomalous

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5
Q

What are the normal limits of a visual field?

A

60 degrees sup
60 nasal
75 infrior
110 temporal

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6
Q

What does homonomous mean?

A

Is it on the same side of the vertical meridien?

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7
Q

What are the two lhon genes

A

11778 worse prog

14484 better prog

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8
Q

Whats behrs syndrome?

A

Infant hereditary optic neuropathy autosomal recess
Mr
Incontinence

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9
Q

What is tensilon?

A

Ach-ase inhibitor

Therefore puts ach there

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10
Q

Whats lambert eaton?

A

Mg-like syndrome

But problem is no release of ach from presynaptic terminal

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11
Q

How does lambert eaton present?

A

Fatigue in the am that gets better over the day

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12
Q

What malignancy is lambert eaton associated with?

A

Sc lung ca

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13
Q

Whats kerns sayre?

A

Cpeo
Pigmentary retinopathy
Heart block

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14
Q

Order of muscles effected by thyroid

A

Imslo

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15
Q

Whats oculopharyngeal dyatrophy?

A

Cpeo w dysphagia in french canadians

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16
Q

Whats the #1 modifiable risk factor for thyroid orbitopathy?

A

Quit smoking

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17
Q

Whats the pathway of a horizontal saccade if you want to look right?

A

Left frontal eyefields–> parietal eye fields–> superior colliculus of midbr–> pprf that connects cn3 and 6

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18
Q

What part of the brain are you testing w an okn drum?

A

Parietal lobe bc youre checking the horizontal saccade pathway

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19
Q

Whats the pathway for vertical saccades?

A

Frontal eye fields–> ipsilateral rostral interstitial nucleus of the mlf

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20
Q

Whats the interstitial nucleua of cajal?

A

Integrates the saccadic signals for upgaze and downgaze

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21
Q

Name 4 causes of slow saccades

A

1) pprf lesion
2) ino
3) anticonvulsants
4) paraneoplastic sx

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22
Q

What causes an ino?

A

Disruption of mlf extending from midbr to pons

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23
Q

What are two causes of ino

A

Ms

Stroke

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24
Q

How does ino present?

A

Ipsilateral adduction deficit w contralateral abduction nystagmus

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25
Q

Whats one and a half syndrome? (Right side)

A

Right mlf = cannot adduct od
Ipsilateral cn6 or pprf= cannot abduct od and yoke cannot adduct os bc pprf controls total gaze to the right

All thats left is contralateral cn6 abduction

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26
Q

What does “supranuclear” mean?

A

Involuntary control centers in the cortex

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27
Q

What would a stroke of the right frontal eye fields cause?

A

Eyes deviate toward the lesion (to the right) bc of unopposed signaling from left frontal eye fields

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28
Q

What are the 4 signs of dorsal midbrain syndrome?

A

1) upgaze palsy
2) colliers sign(bl lid retraction)
3) light near dissociation
4) convergence retraction nystagmus (on attempt to look up eyes nystagmus)

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29
Q

Whats the ddx of light near dissociation?

A

1) adies pupil (decr parasymp inn to pupil)
2) syphillis
3) dorsal midbr syndrome

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30
Q

What are 4 findings in psp?

A

1) slow saccades esp DOWNwARD
2) rigidity
3) dysphagia
4) apraxia of lid opening ( cant open eyes)

Fatal in 6 yrs

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31
Q

What are the findings in convergence spasm?

A

Miosis
Blurry vision
Et

Rx w cyclogyl and weak minus lenses

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32
Q

Whats the 1 finding in convergence insufficiency?

A

**Exotropia greater at near than distance of at least 10 pd **
Cannot bring eyes in

Rx w pencil pushups

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33
Q

Whats a skew deviation?

A

A hyper or hypo that doesnt fit into cn4 palsy. Its caused by vestibular issue

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34
Q

Whats miller fisher syndrome?

A

Variant of guillian barre
Goes from top down
Causes cn6 palsy
Anti Gq1b

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35
Q

Whats pendular nystagmus?

A

Both phases of the nystagmus are slow

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36
Q

Whats jerk nystagmus?

A

Type of nystagmus that has a slow and fast phase

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37
Q

Whats infantile nystagmus syndrome?o

A

Starts in first mnths of life
Can be jerk or pendular
Picks up w monocular occlusion
Can treat w kestenbaum procedure

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38
Q

Whats latent nystagmus?

A

Occurs w infantile et

Quick phase toward the fixing eye

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39
Q

4 causes of downbeat nystagmus

A

1) ms
2) lithium
3) arnold chiari (malformation of posterior fossa allows downward herniation thru foramen magnum)
4) mag deficiency

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40
Q

What causes upbeat nystagmus?

A

Midbr or cerebellar lesion
Ms
Tumor

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41
Q

What type of nystagmus does ms cause?

A

Any type!!’

Bc there can be demyelinating lasions in any part of brain

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42
Q

What area of brain does torsional nystagmus localize to?

A

Ponto-medullary junction

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43
Q

Where does see saw nystagmus localize to?

A

Sella

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44
Q

Whats periodic alternating nystagmus and how to treat?

A

Nystagmus switches directions q minute.
Seen in ms
Rx w baclofen

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45
Q

Where does ocular bobbing localize to?

A

Pons

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46
Q

Whats see saw nystagmus?

A

One eye goes down and the other goes up

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47
Q

What drugs can you use for oscillopsia from nystgmus?

A

Baclofen
Gabapentin
Memantine

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48
Q

Whats opsoclonus (very testable)

A

Saccadomania!!

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49
Q

What are causes of opsoclonus?

A

Infectious
Paraneoplastic (neuroblastoma in kids!!!!)
Drugs

Get mri

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50
Q

Whats superior oblique myokymia?

A

Spasm of cn4

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51
Q

How do you treat sup oblique myokymia? 3 possibilities

A

Propranolol
Ganapentin
Superior oblique tenectomy

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52
Q

What should u suspect w pain and cn3 signs?

A

Pcom aneurysm

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53
Q

Whats webers syndrome

A

Cn3 w contralat hemiparesis

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54
Q

Whats benedicts syndrome

A

Cn3 palsy w contalateral tremor

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55
Q

Whats the ddx of multiple cn palsy?

A

Pituitary apoplexy
Cav sinus
Growing tumor
Tolosa hunt(inflamm of cav sinus)

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56
Q

How does pituitary apoplexy present?

A

Labile bp
Adrenal insuff
Give hydrocortisone immediatly

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57
Q

Findings in iih?

A 
Opening pressure >250 mm h2o
Normal neuroimaging
Empty sella
Nausea 
Enlarged bs
Papilledema
Tinnitus
Choroidal folds
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58
Q

How do you work up iih?

A

Check mri and mrv ( thrombosis of cerebral sinus) and LP

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59
Q

How would a lesion of superior optic disc present of vf?

A

Inf altitudnal defect

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60
Q

How does a lesion of the papillomacular bundle present on vf?

A

Cecocentral scotoma or central scotoma

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61
Q

How does infarct of nfl present on vf?

A

Arcuate scotoma

62
Q

Whats cecocentral scotoma?

A

Connecta blond spot to center

63
Q

Whats the most common cause of an altitudnal defect on vf?

A

Naaion

64
Q

Whats the ddx of enlarged bs (4 things)

A
  1. Mewds
  2. Papilledema
  3. Od drusen
  4. Tilted nerve
65
Q

Most common cause of cecocentral or central scotoma?

A

Compressive lesion
toxic
nutritional
optic neuritis

66
Q

Most common cause of superior alt defect?

A

Optic neuritis

67
Q

Whats the ddx of bl optic neuropathy 4 things

A

1) nutritional
2) toxic
3) lhon
4) compressive

68
Q

What types of vf do you think “its an on problem?”

A

Cecocentral scotoma
Central scotoma
Altitudnal
Arcuate

69
Q

Most common vf in naaion?

A

Inferior altitudnal defect

70
Q

If the defect respects the vertical meridian what does that mean?

A

Defect is behind chiasm

71
Q

Vf respects the horizontal meridian what does that mean?

A

Its an on problem

72
Q

Whats the ddx of atypical optic neuritis?

A

Lyme

Sarcoid

73
Q

What to think of w papilledema?

A

Tumor

Pseudotumor

74
Q

What imaging study to get w bitemporal hemianopsia?

A

Mri w gad

75
Q

Why get gad on a scan?

A

Enhances tumors

76
Q

What kind of vf do you get w willibrands knee lesion?

A

Unilat complete scotoma and otherside temporal scotoma (bc of crossing nasal fibers)

77
Q

If you get a unilateral temporal defect respexting vertical midline wheres the defect?

A

Pituitary tumor until proven otherwise!

78
Q

Where is meyers loop?

A

Temporal lobe

79
Q

Where does inferior quadrantopia localize to?

A

Parietal lobe

80
Q

You see left sides bilat homon hemianopsia which tract effected and which eye has apd?

A

Right optic tract

Left apd

81
Q

What does incomplete third mean?

A

Not all muscles involved

82
Q

How do you charterize cn3 palsy?

A
  1. Complete vs incomplete

2. Pupil involved vs not involved

83
Q

What causes abbarent regeneration of cn3?

A

Tumor

NOT vascular

84
Q

How is superior rectus innervated?

A

Contralat cn3 nuc

85
Q

How is levator innervated?

A

Single midline subnucleus innervates both levators

86
Q

Name 4 causes of pupil sparing 3rd

A

1) vascular
2) mg
3) gca
4) ms

87
Q

What innervates so?

A

Contralateral cn4 nucleus

88
Q

Whats in the cavernous sinus?

A

3,4,51,52,6,ica w sympathetics on it

89
Q

Whats the three step test

A

1) which is hyper
2) gaze
3) tilt test

90
Q

Name 3 causes of cn4 palsy?

A

1) mg
2) trauma
3) ichemia

91
Q

What can a lesion of the clivus bone cause?

A

Cn6 palsy

92
Q

Whats gradinegos syndrome

A

6th n palsy from mastoiditis

93
Q

How does cn6 palsy get worked up if pt less than 60 w no ischemia signs?

A

Mri look for cav sinus tumor, compression, ms

94
Q

Whats the finding when u put cocaine in horners person?

A

Normal pupil dilates

Abnormal pupil does not dilate

95
Q

Whats millard grubler syndrome?

A

6th nerve nuclear syndrome- lesion in pons
Ipsilat 6th
contralateral hemiplegia
ipsilateral facial palsy

96
Q

What happens when u put apraclonidine in horners

A

Normal pupil does not dilate

Abnormal pupil does dilate

97
Q

Ddx of choroidal folds

A

Tao
IIH
Posterior scleritis

98
Q

How is the mr lr io ir innervated?

A

Ipsilateral cn3 nuc

99
Q

Triad of spasmus nutans and w/u

A

1) low amp high freq nystagmus
2) head bobbing
3) torticollis

Get mri

100
Q

What % of pple will have naion in OThER eye?

A

15%

101
Q

What % of pple w optic neuritis have pain?

A

90%

102
Q

Whats a defining feature of congenital nystagmus?

A

Increase slow phase velocity over time

103
Q

whats the finding in a CN6 NUCLEUS deficit?

A

1) ipsilateral gaze palsy- eg right 6th nuc out = unable to look right both eyes
2) ipsilateral facial palsy

104
Q

what type of nystagmus has a VF deficit?

A

see saw bc localizes to sella

105
Q

what type of nystagmus with defect of central tegmental tract? (midbr and pons)

A

oculopalatal myoclonus

106
Q

a lesion to the MLF can cause INO and what else?

A

skew deviation

107
Q

which cn palsy can you get in IIH?

A

CN6- causes horiz diplopia 2/2 incr intracran pressure. They should not get vertical diplopia bc cn3 should not be involved.

108
Q

what are 2 types of vf defects you can get in IIH?

A

1) enlarged BS

2) arcuate glaucoma-like defects

109
Q

an you get an APD in IIH?

A

Yes, if papilledema is asymmetric

110
Q

what type of nystagmus do you get with lesion of the central tegmental tract (runs from pons to medulla)?

A

oculopalatal myoclonus

111
Q

early male balding, difficulty releasing grip, cardiac conduction defects- which disease?

A

myotonic dystrophy

112
Q

what else can cause optic neuritis besides MS?

A

sarcoid, lupus, syphillis

this is “atypical” ON- consider it esp when there florid papilledema w heme

113
Q

who gets ophthalmoplegic migraines and how does it present?

A

children

migraine w cn3 palsy

114
Q

why can a right INO cause a right hyper w right incyclotorsion (in addition to adduction deficit on that side?)

A

it causes a skew deviation b/c the MLF also gets vestibular input from the ear

115
Q

if a young woman comes in c/o scotoma w/o retinal dz or onh dz, but on hvf has an enlarged BS, how should you work up?

A

mfERG

could be IBS (idiopathic blind spot syndrome) may show focal retinal problem

116
Q

what causes oculopalatal myoclonus?

A

brainstem stroke. The nystagus usually presents years after the stroke

117
Q

pt presents with normal eye exam and numb chin, what should you ask about?

A

h/o of cancer-

malignancies associated with mental neuropathy are lymphoma and breast ca

118
Q

injection of intracameral moxifloxacin at the end of cataract surgery has been asscoaited with what type of inflammation?

A

TASS

119
Q

when there is ONH swelling, whats the next question you should ask?

A

are there disc hemorrhage
hemorrhages- most likely NAION (infarction of the ONH)
No heme- more likely optic neuritis

120
Q

optic neuritis- how long does it take to recover to baseline vision?

A

85% return to baseline within 3 months

121
Q

what would make optic neuritis atypical?

A

bilateral
age >50
no pain

122
Q

if you have optic neuritis w no white matter lesion- whats the chance you will dev MS in 15 years?

A

25%

123
Q

if you have optic neuritis and 1 white matter lesion whats the chance you will dev MS in 15 years?

A

75%

124
Q

what should you never give to a pt w optic neuritis?

A

oral prednisone

125
Q

what MUST you have on exam to dx NAAION?

A

ONH swelling (hyperemic)

126
Q

Whats the visual prognosis in NAION?

A

1/3 get better, 1/3 stay the same and 1/3 get worse

127
Q

whats the typical vision in NAION?

A

20/40

if they are LP or worse think AION

128
Q

Why does disk and risk cause NAION?

A

crowding of structures in ONH, decreased axoplasmic flow

129
Q

what type of VF defect in NAION?

A

inferior alt defect or central scotoma

130
Q

NAION in one eye whats the chance of getting it in the other eye?

A

20%

131
Q

how do you treat AION if they have visual loss

A

1g solumedrol x 3 days

followed by prednisone 1mg/kg/day

132
Q

how do you treat AION if they don’t have visual loss?

A

prednisone 1mg/kg/day and order TA biopsy (increased your yield by 5%)

133
Q

whats the ddx of bilateral ONH edema?

A

malig HTN- headache, double vision (6th), check BP
ONH drusen->do bscan
papilledema-

134
Q

papilledema VF

A

Enlarged BS

135
Q

pale nerve must rule out infiltrative dz or mass cannot say naion wo seeing onh edema

A

n/a

136
Q

if pt c/o worsening vision over months w pale nerve and decr color vision whats next step?

A

image

137
Q

how does LHON present? who gets it

A

mitochondrial
high-school aged male
bilateral hyperemic discs
gradual loss of vision in one eye then the other
may get worse symptoms with hot bath or exercise (uthoff phenomenon)
vision 20/200
bilateral central or cecocentral scotoma

138
Q

which LHON gene has better/worse prognosis

A

14484- better

11778- worse

139
Q

What do you do w pupil involving 3rd?

A

Image

140
Q

What do you do in a complete pupil sparing 3rd?

A

Nothing

141
Q

What do you do in an incomplete (not all muscle effected) and pupil sparing 3rd?

A

Image

142
Q

Where does benedicts localize to?

A

Redn in midbr

143
Q

Where does claude sx (3rd w ataxia) localize to?

A

Area between red n and cerebral peduncle

144
Q

Where does webers (3rd w hemiparasis) localize to?

A

Cerebral peduncle (top of micky ear) in midbrain

145
Q

Blown pupil who walks into office and cn3 otherwise fine likely dx

A

Adies

146
Q

after damage to the nnfl how long does it take for ON atrophy to appear?

A

1 month

147
Q

what plt count is suspicious for GCA?

A

> 400,000

148
Q

where is the pprf located?

A

pons

149
Q

wheres the interstitial nuc of cajal?

A

midbrain

150
Q

according to the ontt, what % of pts w ON present with PAIN

A

92%

151
Q

whats the biggest difference between papilledema from mass and onh swelling from other causes

A

papilledema tends to have good vision until late in the course.
ONH edema from other causes tends to have shit vision right from the start

152
Q

whats a good way of distinguishing between foster kennedy and pseudo foster kennedy?

A

foster kennedy- papilledema due to a mass will have a gvf of EBS 2/2 papilledema
pseudo foster kennedy 2/2 sequential naion should have gvf looks like naion (ie inferior arcuate)

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