Neuro Flashcards
Man loses consciousness during coughing fit / during micturition at night
Situational Syncope
Dix-Hallpike maneuver shows upward beating torsional nystagmus, with the upper poles of the eye beating toward the floor, lasting 30 seconds
Benign paroxysmal positional vertigo (BPPV).
Asterixis, increased BUN, MS changes, distended abd w/ shifting dullness; dx/rx?
Hepatic Encephalopathy from increased ammonia due to cirrhosis/liver dysfunction (ascites); rx Lactulose
MS CSF finding
Oligoclonal bands increased IgG, normal total protein
20yof p/w urinary distention; cystometry w/ bethanicol produces exaggerated detrusor contraction; dx?
Upper motor neuron dysfnction, probably MS
Internuclear ophthalmoplegia, lesion?
Medial Longitudinal Fasciculus, common in MS
Lesion in abducens n?
Convergent strabismus, horizontal diplopia
Lesion in medial lemniscus?
Touch and vibration sensations b/l
Lesion in trochlear n?
Vertical diplopia and eye torsion
Lesion in oculomotor n?
ptosis and down and out eye (unopposed LR and SO)
Headache, vomiting, bilateral eyelid edema and extraocular movement restriction; dx?
Cavernous sinus thrombosis, may cause CN 3,4,5,6 deficits
Painful red eye, opacification and ulceration of the cornea, yellow discharge, contact lense use; dx?
Contact lense-associated infective keratitis, most commonly Pseudomonas
Acute bacterial meningitis CSF?
elevated opening pressure (100–300 mm H2O), 100–10,000 WBCs, Protein elevated (100–500 mg/dL), glucose decreased to
3-Hz spike-and-wave pattern EEG dx?
Absence seizures, lasting only a few seconds, and occur many times per day in affected children
triphasic discharge pattern in sporadic fashion on EEG?
Creutzfeldt-Jakob disease.
high-frequency electrographic discharge in the β frequency (“beta buzz”) with relatively low amplitude, an evolve into slow spike-and-wave complexes or diffuse polyspikes.
Tonic seizures consist of sudden-onset tonic extension or flexion of the head, trunk, and/or extremities
Fluent speech, good comprehension, can’t repeat sentences, dx?
Conductive aphasia, the lesion occurs at the arcuate fasciculus between Broca’s and Wernicke’s area.
Stroke w/ coma, cranial nerve palsies, apnea, visual symptoms, drop attacks, or dysphagia?
Basilar stroke
Loss of pain/temp sensation ipsilateral in face contralaterl body, vestibullocerebellar signs (vertigo, nystagmus), ipsilateral bulbar weakness (dysphagia, hoarseness), horner’s sx (ipsilateral autonomics); dx/location?
Wallenberg’s sx, lesion in lateral Medulla, occlusion on vertebral artery or PICA
Contralateral hemiparesis UE/LE (lateral corticospinal tract), decreased proproception (Medial lemniscus, later sign), ipsilateral hypoglossal dysfunction (tongue deviates ipsi); dx/location?
Medial Medullary sx occlusion of paramedian branches of ASA or vertebral artery
Ipsilateral facial n palsy w/ contralateral ataxia or hemiplegia
“alternate syndrome” facial nerve nucleus of the (lateral) Pons lesion/stroke, AICA occlusion
Ipsilateral oculomotor n palsy w/ contralateral ataxia or hemiplegia
“alternate syndrome” Vertibro basilar (midbrain/brainstem) lesion/stroke
Stroke w/ leg paresis, amnesia, personality changes, foot drop, gait dysfunction, also may show urinary incontince, cognitive changes, sensory deficits; dx?
Anterior cerebral artery strokes, c/l motor and/or sensory deficits more pronounced in LE
Stroke w/ pure motor (subcoritcal white matter/brainstem) with more face and UE than leg weakness, some dysarthria; dx?
Lacunar stroke; contralateral pure motor via lipohyalinosis of small vessels at post internal capsule
Hemisensory loss with severe dysesthasia and athetosis or hemibalismus; dx/ location of lesion?
VPL Thalamus stroke (Dejerine-Roussy sx) w/ contralateral hemi-anaesthesia
Weakness more prominent in the legs with poor ipsi leg arm coordination; dx?
Ataxic-sensory Lacunar stroke in the anterior limb of the internal capsule
Unilateral numbness, paresthesias, hemisensory deficits of arm, trunk legs and face; dx/location?
Pure sensory lacunar stroke at the ventroposterolateral limb of the thalamus
Pure motor dysarthria with hand weakness, No sensory deficits; dx location?
Dysarthria-Clumsy hand syndrome, lacunar stroke at the basis pontis
Stroke w/ homonymous hemianopsia, memory deficits, alexia w/o agraphia (dom hemisphere), visual hallucination (calcarine cortex), sensory sx (thalamus); dx?
Posterior cerebral artery strokes; also may p/w 3rd N palsy w/ paresis of horizontal/ vertical eye movements, c/l motor deficits (cerebral peduncle)
Stroke w/ aphasia (dominant hemisphere), neglect (non-dominant), contralateral hemiparesis, gaze preference, or homonymous hemianopsia.
Middle cerebral artery (MCA) stroke; conjugate eye deviates towards side of stroke
Hemorrhage location? Contralateral hempiparesis and hemisensory loss, homonymous hemianopsia, gaze palsy
Basal Ganglia
Hemorrhage location? Contralateral hempiparesis and hemisensory loss, nonreactive pupils, upward gaze, eyes deviate Towards hemiparesis
Thalamus
Hemorrhage location? Facial weakness, nystagmus, ataxia, occipital headache
Cerebellum
Immigrant p/w recent L sided weakness, hx of nocturnal cough, hemoptysis, exersional dyspnea, hrt palpitations; dx?
Rheumatic heart dz -> mitral stenosis -> pulm HTN (hemoptysis, dyspnea) and LA dilatation -> aFib -> atrial thrombus embolizes causing stroke
Hypertensive brain bleed, location?
The basal ganglia and thalamus are the classic sites of a hypertensive bleed.
Papilledema; dilated ipsilateral pupil; palsies of CN3 (most common), CN4 and 6; nuchal rigidity. Dx/ late signs?
Increased ICP; Hemiparesis, hypertonia, hyperreflexia, or Cushing’s triad (HTN, bradycardia, and respiratory depression) are late signs
Damage to lateral spinothalamic tract?
Loss of pain and temp contralaterally 2 levels bellow lesion
Ipsilateral ataxia, nystagmus, intentional tremor, loss of coordination?
Cerebellar tumor; sways towards affected side,
Elder w/ impaired gait, cognitive difficulties, urinary incontinence; dx
NPH Normal Pressure Hydrocephalus; enlarged ventricles on CT
20yof p/w headache, N&V, papilledema, vision loss, pulsatile tinitus, normal CSF except P>250, taking isoretinoin for acne; dx?
IIH Idiopathic Intracranial Htn (pseudotumor cerebri); meds (vit A derivatives, tetracyclines, GH); rx wt loss, Acetazolomide
60yo p/w sudden rt sided weakness and hemiplegia, then vomiting and headache, has uncontrolled HTN, dx?
Intraparenchymal hemorrhage in the Putamen, involving the internal capsule (corticospinal tract)
Personality changes, memory deficits, compulsive behaviors; dx?
Pick’s dz (Fronto-temporal dementia)
Fluctuating cognition and attention, parkinsonian motor sx, hallucinations?
Lewy-Body Dementia
Diabetic p/w sudden onset loss of vision, floaters, poorly visualized fundus; dx?
Vitreous hemorrhage; a/w diabetic retinopathy
Ascending symmetric weakness (polyneuropathy) post GI or UR infection
Guillain Barre (campylobacter sequele) w/ peripheral nerve demyelination (motor, sensory, autonomic)
55yoM p/w parkinsonism features, orthostatic hypotension, incontinence, impotence; dx?
Multiple system atrophy (shy-drager sx); autonomic dysfunction, widespread neural signs and parkinsonism; rx fludricortisol
30yoF p/w central scotoma, decreased vision acuity and color changes, afferent pupillary defect, pain on eye movement; dx?
Optic neuritis a/w MS
Unilateral violent hand swinging?
Hemiballismus; damage to contralateral subthalamic nuclei
Funduscopy shows AV nicking, copper/silver wiring, exudates, hemorrhage, dx?
Hypertensive retinopathy
Fundoscopy shows tortuos dilated veins, cotton whool spots, diffuse hemorrhage “blood and thunder”, swelling of the optic disk; dx?
Central vein occlusion, acute or subacute vision loss/haze
Essential tremor, gets worst with intentional movement, rx?
Propanolol (BB) or Primidone (SE include abd pain, neuro/psychiatric disturbances)
Down and out gaze with normal light and accomodation reaction, dx?
CN3 oculomotor somatic damage with entact parasympathetic component indicates DM ischemic injury
Down and out gaze with fixed dilated pupil dx?
CN3 oculomotor somatic and parasympathetic components involved, as in Nerve Compression
Earfullness, vertigo (20min-24h), tinnitis, hearing loss; dx?
Menierre’s disease, endolymph in inner ear; rx lifestyle mod (low salt), diuretics, antihistamine, anticholinergics
Cranial mass, truncal dystaxia; dx/location?
Cerebellar Vermis, most likely Medulloblastoma
Cranial mass, arm/leg/gait ataxia; dx/location?
Cerebellar hemispheres, most likely Astrocytoma
Post seizure, pt holding shoulder adducted and internally rotated; dx?
Posterior shoulder dislocation
Limited upward gaze, b/l ptosis and upper eye lid retraction, pupils minimal reactive to light but accommodate; dx?
Perinaud’s syndrome, pressure in pretectal midbrain near CN3 and superior colliculus
2YO boy p/w headaches, vomiting, papilledema, limited upward gaze, b/l ptosis and upper eye lid retraction, pupils minimal reactive to light but accommodate; dx?
Pineal Gland tumur, (hydrocephalus from sylvian duct obstruction), beta-HCG may be produced showing precocious puberty
