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Neuro Flashcards

1
Q

Younger pt, asymmetric resting tremor, 4-5Hz

A

Early Parkinson –> trihexyphenidyl

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2
Q

Chorea, behavior disturbances, irritable, withdrawn disease and CT findings

A

Huntington = atrophy of caudate, large lateral ventricles

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3
Q

Broad-based gait, dysmetria, nystagmus, intention tremor, etOH abuse

A

cerebellar dysfunction/atrophy

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4
Q

Tremor when moving limb, goes away when relaxed

A

Essential tremor –> etOH, propanolol, primidone, gabapentin

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5
Q

Resting tremor, rigidity, bradykinesia, postural instability, asymmetric onset, inaudible speech

A

Parkinson

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6
Q

Tx Parkinson tremor

A

DA - levodopa

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7
Q

Tx Parkinson motor fluctuations, dyskinesia

A

Selegiline (MAOB), entacapone, tolcapone (COMT)

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8
Q

Tx Tourette syndrome

A

1 = Clonidine –> guanfacine, pimozide, haldol, fluphenazine, trifluroperazine

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9
Q

Co-morbidity w/ Huntington

A

Depression –> suicide

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10
Q

Tx helpful for Huntington chorea

A

Tetrabenazine delplete DA

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11
Q

Sx Tx for Huntington

A

Haldol

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12
Q

Twisting, repetitive, abnormal posture

A

Dystonia - metaclopramide, prochlorperazine

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13
Q

Unilateral, violent arm movements

A

Hemiballismus - CL subthalamic nucleus

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14
Q

Broad-shuffling gait, memory loss, urinary incontinence, ventricular enlargement

A

NPH - dec CSF abs

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15
Q

Tremor in legs immediately when standing, gone with sitting, 14-18hz

A

Orthostatic tremor

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16
Q

Multiple, B/L periventricular plaques, heat sensitivity, new hemiplegia, incontinence tx?

A

MS exacerbation = steroids

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17
Q

Tx in relapsing-remitting or secondary MS

A

Glatiramer or beta-interferon

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18
Q

Inc IgG index, paraplegia, incontinence, dec vibratory and proprioception, spastic reflexes

A

MS - oligoclonal bands

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19
Q

Tx that Dec frequency, slow progression of RR form of MS

A

IF-beta; steroids if acute

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20
Q

Tx of progressive MS

A

Cyclosporine, MTX, Mitoxantrone

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21
Q

R UE, L LE weakness, ataxia, central vision defect, eye pain worse w/ movement

A

MS –> MRI w/ cerebral & cerebellar plaques

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22
Q

Fluctuating MS, visual hallicunations, spontaneous parkinsonism but dopa not helpful

A

Lewy body dementia (eosinophilic intracytoplasmic inclusions of alpha synuclein)

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23
Q

Memory loss, language difficulties, cortical atrophy

A

Alzheimer dementia

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24
Q

Euphoria, dis-inhibition, apathy, compulsive, hyperorality, poor memory

A

Pick’s disease/Fronto-temporal dementia

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25
Q

Cognitive, motor, sensory dysfxn, step-wise worsening

A

Multi-infarct dementia

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26
Q

Dementia CT findings

A

Diffuse cortical, subcortical atrophy

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27
Q

Early Personality changes –> memory loss

A

Fronto-temporal dementia/atrophy

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28
Q

Pt complains of memory loss, sign of depression

A

Pseudodementia - assoc w/ depression

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29
Q

Risks and Tx for idiopathic intracranial HTN

A

Obese (female, tetracyclines, hyperVit A (isotretinoin) –> weight loss, acetazolamide

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30
Q

Young obese female w/ HA, normal MRI, papilledema

A

Benign IC HTN - causes: steroids, vit A, OCP –> blindness

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31
Q

HA - worse lying flat, pulsatile tinnitus, transient vision loss, papilledema, LP >250mmHg Dx?

A

Idiopathic Intracranial HTN

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32
Q

Trauma –> HA, old person, gradual LOC, crescent shape on CT

A

Subdural hematoma - bridging veins —> craniotomy

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33
Q

Side of head, lucid interval –> coma, CT LENS shaped

A

Epidural hematoma –> middle meningeal —> craniotomy

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34
Q

Blunt head trauma w/ hypotn –> HTN, brady, dec resp + IL hemiparesis, mydriasis, ptosis, coma

A

Epidural hematoma –> uncal herniation –>CN III, PCA, cerebral peduncle

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35
Q

“Thunder clap” HA = instant max intenstiy, worst HA ever, CT scan, ateriogram show bleed

A

Subarachnoid hemorrhage –> coil or clip w/in 48hrs OR after 6 weeks + CCBs, SBP <150

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36
Q

Instant severe HA, may return in 10days with same sx

A

SAH d/t aneurysm –> CT, spinal, ateriogram –> clipping or coil

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37
Q

Neuro deficit/stroke, HA, coma CT bleed in caudate, putamen

A

Intraparenchymal bleed –> dec SBP craniotomy & VP shunt ultimately

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38
Q

Acute HA worse when lying flat, vision changes, slit-like ventricles

A

Idiopathic Intracranial HTN

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39
Q

Holocranial HA, diplopia, pusatile tinnitus, young obese woman, empty sella, LR palsy

A

Idiopathic Intracranial HTN –> MRI –> LP + pressure

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40
Q

50, new HA, jaw claudication, scalp pain, polymyalgia rheumatica

A

Temporal arteritis –> High dose steroids –> Bx and ESR

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41
Q

Intense UL retroorbital pain, wakes up from sleep, ptosis, miosis

A

Cluster HA –> 100% O2

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42
Q

Prophylaxis for cluster HA

A

Verapamil, lithium, ergotamine

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43
Q

Progressive HA, worse in morning, blurred vision, vomiting –> bradycardia, HTN (Cushing reflex)

A

Brain tumor –> MRI + high dose steroids (decadron)

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44
Q

No growth in kids, sexual dyfxn in adult, bitemporal blindness, HA

A

Craniophrayngioma

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45
Q

1 CNS lesion in AIDS

A

Toxo = sulfadiazine + pyrimethamine, TMP-SMX for prophylaxis only

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46
Q

Multiple ring enhancing lesions on CT

A

Toxo

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47
Q

Multiple hypodense, non-enhanced lesions in cortical white matter, focal neuro deficits, HIV +

A

PML - speech, gait, vision

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48
Q

Single periventricular ring weakly enhancing lesion, + EBV DNA

A

Primary CNS Lymphoma —> + EBV DNA

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49
Q

Single ring-enhancing lesion in frontal lobe, neuro deficits, sinusitis, mastoiditis, lung abscess

A

Anaerobic bacteria (bacteroides)

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50
Q

Non-enhancing brain lesion

A

PML

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51
Q

Inappropriate behavior, optic nerve atrophy + papilledema on C/L side, anosmia

A

Frontal lobe tumor

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52
Q

Amenorrhea, galactorrhea, HA

A

Prolactinoma –> r/o pregnancy, hypothyroidism, prolactin level –> MRI –> bromocriptine

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53
Q

Solitary butterfly mass w/ central necrosis, vasogenic edema

A

Glioblastoma multiforme

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54
Q

Ataxia, truncal dystaxia, HA, nystagmus, papilledema

A

Medulloblastoma = VERMIS

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55
Q

Arm & leg dystaxia, IL falling/cerebellar signs

A

Astrocytoma = cerebellar hemisphere/parietal lobe

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56
Q

Paralysis of vertical gaze, retraction of eyelid, IC HTN, coarse face, axillary hair

A

Pinealoma

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57
Q

Short for age kid, HA, inc ICP, vomiting, visual defect, calcifications above sella, NDI

A

Craniopharyngioma

58
Q

Concentric whorls, psamomma bodies

A

Meningioma

59
Q

Waking up with HA, vomiting, sinusitis, mastoiditis, fever and sx developing over only 1-2wks

A

Brain abscess –> CT or MRI

60
Q

Progressive U/L vision loss in 5 y/o, exopthalmos, café-au-lait spots

A

NF-1(optic glioma)

61
Q

Pigmented spots on lips, B/L deafness, fam hx, Chr 22

A

NF-2 –> Frameshift or NON-sense mutation

62
Q

cafe au lait + hearing loss

A

NF-2 –> MRI + Gadolinium

63
Q

CSF high WBC, RBC, normal protein, glucose

A

Herpes encephalitis

64
Q

Short term memory loss, amnestic, confabbulation

A

Korsakoff - thiamine deficiency

65
Q

Nystagmus, ataxia, unable to move eyes, confusion

A

Wenicke’s encephalopathy

66
Q

Rapid dementia, sharp triphasic synchronous discharges/periodic sharp waves on EEG

A

Creutzfeld-Jacob disease (prion)

67
Q

Benign IC HTN path

A

Impaired reabs of CSF –> weight reduction, acetazolamide

68
Q

Burning smell, NO LOC, deja-vu feeling, pt remembers well

A

Simple partial seizure –> Phenytoin for Parital seizures

69
Q

Burning smell, LOC, tonic-clonic activity, incontinence

A

Partial w/ secondary generalization

70
Q

Burning smell, LOC or staring + chewing, swallowing, sucking, lip smacking

A

Complex partial

71
Q

<7 y/o, MR + seizure, slow spike and wave on EEG

A

Lenox-Gaustaut

72
Q

Hyperventilation during EEG –> 3Hz spike and wave

A

Absence, 2.5Hz = atypical

73
Q

Daydreaming, staring, decline school performance, no memory of event

A

Absence –> Valproic or ethosuximide

74
Q

Sudden LOC, hemiparesis, slow to come around, restored movement in 24hrs

A

Todd’s (post-ictal) paralysis

75
Q

Prolonged seizures —> ?

A

Cortical necrosis/hyperintensity on MRI

76
Q

Causes of cerebellar atrophy

A

Anti-epileptics like phenytoin, etOH

77
Q

Tx for myoclonus

A

Clonazepam and Depakote (valproic acid)

78
Q

Hemianesthesia w/ transient hemiparesis, athetosis

A

Thalamic stroke (VPL) / Dejerene-Roussy

79
Q

Avoid these drugs in Lewy body dementia

A

Typical anti-psych

80
Q

Vertigo - feeling of head movement/spinning

A

Labyrinth disorders

81
Q

Head spinning when getting out of bead, laying down, turning, looking up

82
Q

Differences in blood pressure standing vs. laying down cause

A

Orthostasis - Loss of extracellular Na/dehydration

83
Q

Lightheadedness, blurry vision, syncope

A

Global ischemia d/t AS, arrhthymia, TIA

84
Q

High frequency (voices) hearing loss w/ age

A

Presbycusis

85
Q

Types of conductive hearing loss

A

Impaction (#1), otitis externa, bony growth (swimmers, scuba), Perf, infection, otosclerosis

86
Q

Types of sensorineural hearing loss

A

Presbycusis (#1), noise, infection, drugs, skull fx, TORCH, Menieres, neuroma, MS

87
Q

U/L sensorineural loss, fullness/pressure, vertigo better w/ Na restriction

A

Meniere’s disease

88
Q

Conductive, Low frequency hearing loss d/t overgrowth

A

Otoslcerosis

89
Q

Receptive aphasia lesion

A

Left temporal lobe

90
Q

Unexplained xanthochromia on LP

91
Q

> 75 y/o, lobar cranial bleed

A

Amyloid angiopathy

92
Q

CL hemiparesis, sensation, tongue deviates to lesion side

A

Medial medullary

93
Q

Imparied sensory and motor of CN V and limb ataxia lesion

A

Lateral Pontine

94
Q

Limb ataxia, CL eye deviation, paralysis of face arm, leg lesion

A

Medial pons

95
Q

IL Horner’s, face, CL pain and temp lesion

A

Lateral medulla

96
Q

Ocular paresis, ataxia, CL hemiplegia

A

Central midbrain

97
Q

Hemiplegia, hemi-sensory loss, gaze palsy, homnomynous hemianopsia

A

Putamen/ Basal ganglia

98
Q

Hemiplegia, hemi-sensory loss, upgaze palsy, eyes toward lesions, non-rx mitotic pupils

A

Thalamus hemorrhage

99
Q

Deep coma, paralysis w/in minutes, pinpoint pupils

A

Pons hemorrhage

100
Q

UL upper and lower facial paralysis lesions location?

A

Peripheral CN VII - below pons

101
Q

Areflexia and anesthesia over shoulders and arms

A

Syringomyelia (Cord cavitation)

102
Q

Knife stabbing/”blot of lightning” pain in cheek that comes and go’s, unshaven area

A

Trigeminal neuralgia = Carbamazapine –> CBC for aplstic anemia

103
Q

Nonfluent speech, intact comprehension, R hemiparesis, impaired repetition

A

Broca’s area - frontal lobe MCA

104
Q

Fluent, meaningless words, no comprehension, R superior visual defect, impared repetition

A

Wernicke’s area - temporal lobe MCA

105
Q

Fluent w/ pheonmic erros, intact comprehension, very poor repetition, no other deficits

A

Arcuate fasiculus - Parietal lobe MCA

106
Q

Hyperreflexia, bulbar reflexes dec, spacticity, fasiculations, muscle wasting, dysphagia

A

ALS - both upper and lower motor neuron –> Riluzole for tx (glutamate inhibitor)

107
Q

1st step in first unprovoked seizure

A

CT w/o contrast

108
Q

Confusion, fever, rigidity, diaphoresis, recently admitted for hallucinations

A

NMS - Haldol

109
Q

Upward pronator drift, RAMs

A

Cerebellar dysfxn

110
Q

Downward + supination of pronator drift

A

UMN lesion - often STROKE

111
Q

Acute occipital HA, repeated vomiting, ataxia, fever

A

Cerebellar hemorrhage

112
Q

Saddle anesthesia, asymmetric motor weakness, hypo/areflexia, late bowel-bladder loss

A

Cauda equina syndrome - spinal nerve roots

113
Q

Perianal anesthesia, symmetric motor weakness, hyperreflexia, early bowel-bladder loss

A

Conus medullaris syndrome

114
Q

Hemi-neglect lesion

A

Opposite PARIETAL lobe

115
Q

Hemi-paresis, aphasia lesion

A

Frontal cortex

116
Q

Adult onset distal muscle weakness, atrophy, dysphagia

A

Inclusion body myositis

117
Q

Macrocytic anemia (folate), inc GGT, high TG, uric acid, dec thiamine, dec testosterone

A

etOH abuse

118
Q

Warfarin + cerebral hemorrhage next step

A

FFP & avoid drops in BP

119
Q

Isolated symmetric B/L LE weakness, loss of sensation, UMN injury 1st step?

A

MRI of spine - disk, abscess, malignancy

120
Q

Rigidity, bradykinesia, postural hypotension, impotence, incontinence, dry mouth

A

Shy-Drager (multiple system atrophy)

121
Q

DM neuropathy pain tx

A

TCAs (not in cystopathy or orthostasis) NSAIDs (not w/ renal dysfxn), gabapentin

122
Q

Progressive ascending paralysis over hrs-days, no prodrome or autonomic dysfxn

A

Tick-borne paralysis

123
Q

REM sleep dysreg, daytime sleepiness, loss of muscle tone w/ laughing, vivid awake hallucinations

A

Narcolepsy –> Ritalin, planned naps

124
Q

Ascending paralysis over days-wks, tachy, urine retention

A

Guillan-Barre –> IV plasmaphoresis & immunoglobulin

125
Q

Albumino-cytologic dissociation (CSF inc protein, normal WBC, RBC, glucose)

A

Guillan-Barre

126
Q

Numbness In toes –> LE weakness, URI 4 wks ago, elevated CSF protein, 3 WBC, no DTRs

A

Guillan-Barre –> IV plasmaphoresis & immunoglobulin

127
Q

Split sutures, bluging fontanelle, vomiting

128
Q

Earliest neuro/CNS injury sign

A

Fisting >3mo, stronger, more sustained primitive reflexes

129
Q

1 blindness

130
Q

Night terrors

A

NON-REM stage 4, glass-eyed, NO memory, autonomic

131
Q

Delayed growth rate + early morning emesis

A

CNS mass lesion

132
Q

Pallor, cyanosis, hypoTN, seizures, apnea, tense fontanel, brady

A

IVH –> prevent pre-term labor, maternal steroids

133
Q

Risk factors for IVH

A

1 = pre-mature & LBW

134
Q

Obsessive thoughts, intrusive images

A

OCD = CBT + SSRI –> clomipramine or anti-psych –> deep brain stim

135
Q

Behavior changes, urinary incontinence, torticollis, vertigo, ataxia, babinski

A

AA instability from Down syndrome

136
Q

Assoc w/ CP

A

IUGR, TORCH, apgar <3, IVH, trauma

137
Q

Risk factors

A

PRE-ME, IUGR, infection, hemorrhage, etOH, tobacco use

138
Q

Co-morbidities

A

Intellect, MR, strabismus, scoliosis

139
Q

Diurnal enuresis tx

A

bladder stretch and timed void

140
Q

No anal wink cause

A

SC compression

141
Q

Secondary enuresis causes

A

Stressors - birth, divorce, moving –> counseling

142
Q

Vasomotor instability, skin changes, dec ROM, patchy bone demineralization + severe pain, burning throbbing after trauma

A

Complex regional pain syndrome

- NO paralysis

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