Neuro Flashcards
Benign brain tumor that pushes on the brain tissue without invading it. seen parasaggital or at edges
Meningioma
“fried-egg appearance”, can have calcifications
oligodendroglioma
perivascular rosettes, hydrocephalus, 4th ventricle
Ependymoma (ependymal cells line ventricles)
degeneration of anterior motor horn
Poliomyelitis or Werdnig Hoffman
Synringomyelia (anterior white commisure)
LMN sx i.e. weakness + loss of P/T from UE (because usually at c8-t1)
Can expand to hit Anterior motor horn, as well as lateral horn t1 (horners)
UMN and LMN signs
ALS
Hypertrophic cardiomyopathy + degen of several neural tracks
Friedreich ataxia
where do you do lumbar puncture
L4-L5. spinal cord stops at L2 but cauda equina til s2. subarachnoid space
most common cause of Subarachnoid Hemorrhage (bleed on bottom of the brain)
Rupture of berry aneurysm (anterior circle of willis –> ACom branch points)
why is a Berry aneurysm susceptible to rupture?
Lacks a media layer
whats the AFP level in neural tube defect
HIGH as a fuckin KITE
most common cause of hydrocephalus in new born
Cerebral aqueduct stenosis (blocks 3–>4)
Foramen of Monro
Lateral ventricles –> 3rd
4th ventricle through Foramen meagendie/luschka into:
subarachnoid space
Define dandy-walker formation
congenital failure of cerebrellar vermis –> presents with absent cerebrelleum and massively dilated 4th ventricle (posterior fossa)
massivelyd dilated 4th ventricle
Dandy walker formation
downward displacement of cerebellar vermis and tonsils through foramen magnum
Arnold Chiari (2)
name 3 common associations with Arnold-Chiari malformation (type 2)
(cerebellar herniation)
Hydrocephalus, Synringomyelia, Meningomyelocele
Cystic degeneration of the spinal cord
Syringomyelia
lose pain and temp in UE
Syringomyelia
Lateral horn of hypothalamospinal tract
Synringomyelia can expand and knock this out = horners (t1)
muscle atrophy and weakness in syringomyelia
expands to knock out Anterior Horn (LMNs)
Polio damages:
Anterior motor horn–> LMN signs
Floppy baby, autosomal recessive
Werdnig-Hoffman; degen of anterior motor horn
ALS: Degen of ________
UMN and LMN of Corticospinal tract
Corticospinal tract is damaged in
ALS
Enzyme mutation that can cause ALS
Superoxide dismutase
_____ increases survival in ALS pt by ______
Riluzole (“Lou gehrigs”) increases survival by decreasing presynaptic glutamate release
Glutamate antagonist
Riluzole used to treat ALS (Lou Gehrigs)
What are the neural components of Friedreich Ataxia
Degenerative disorder of the cerebellum: ataxia
and Spinal cord: loss of MVP, deep tendon reflex, LE muscle strength
describe the frataxin gene (lost in freidreich)
Mitochondrial iron regulation…loss = iron buildup and thus free radical damage
first sign of friedreich ataxia
clumsyness
Neisseria menigitidis meningitis
through the NOSE nigga.
signs of meingitis
headache, nuchal rigidity, fever; Photophobia, vomiting, altered mental status.
where does lumbar puncture sample
Subarachnoid space
what ischemic neural effects can an Insulinoma have?
Repeated bouts of hypoglycemia –> global cerebral ischemia (brai needs glucose)
Pt has a stroke…whats the protocol for tx
give tPA–> have to do CT (noncontrast) to RULE OUT HEMORRHAGE!! tPA within 1st 4 hours
aspirin/clopidogrel can be given to reduce risk
does TIA register on MIA?
Nope, its a reversible thang less than 15 minutes of focal neuro dysf(x)
hypoxia and irreversible damage
irreversible damage after 5 minutes of hypoxia.
Hippocampus (pyramidal neurons/temporal lobe), Cerebral cortex (laminar necrosis layers 3 5 6)
Cerebellum (purkinje layer)
hyaline arteriolosclerosis (HTN) leads to what type of stroke?
Lacunar stroke
Describe lacunar stroke
involves lenticulostriate vessels = small lacunar infarcts (cystic areas)
Thalamus: pure sensory
Internal capsule: pure motor
earliest change in ischemic stroke
Liquefactive necrosis 1st sign = red neuron = eosinophilic change of neuron cytoplasm
which cells are responsible for gliosis post storke
astrocytes
in stroke, neutrophils are day 1-3, which cell is day 4-7?
Microglia (MQ of the brain)
what are the 2 aneurysms in the brain?
Berry aneurysm (subarachnoid space) and Charcot-Bouchard (parenchymal space)
Describe charcot-bouchard aneurysm
due to HYPERTENSION.
LENTICULOSTRIATE vessels going to BASAL GANGLIA (look in the center where the cord would attach)
intracerebral hemorrhage/bleeding into PARENCHYMA (so not lobar)
sudden headache + nuchal rigidity
subarachnoid hemorrhage
LP indicating SAH
Xanthochromia (yellow due to bilirubin)
what does yellowish LP indicate
Subarachnoid Hemorrhage.
Can be a bloody or yellowish tap = SAH
Berry aneurysm can cause
Bitemporal hemianopia by compressing optic chiasm
Subarachnoid hemorrhage
Hemorrhagic stroke
lens shaped lesion on CT
Epidural hematoma
lucid interval after bleed
Epidural hematoma
crescent shaped lesion on CT
subdural hematoma
Uncal herniation
- CNIII: eye moves down and out + dilated pupil
- PCA: contralat homonymous hemianopsia – infarction of occipital lobe
- Paramedian artery: Duret (brainstem) hem
deficiency of Arylsulfatase
Metachromatic Leukodystrophy (demyelination) -->sulfatides accumulate in lysosomes. ataxia/dementia
defeciency of galactocerebrosidase
Krabbe (buildup of galactocerebrosidase and psychosine). demyelination. Peripheral neuropathy, optic atrophy, developmental delay
Leukodystrophies (inherited mutations fuck up myelin)
AR: Metachromatic leukodystrophy (arylsulfatase) and Krabbe (galactocerebrosidase)
X-linked: Adrenoleukodystrophy (long chain fatty acids–> brain and adrenals)
Clining features of MS
Blurred vision in one eye (optic nerve)
vertigo and scanning speech (brainstem)
internuclear opthalmoplegia (MLF)
Hemiparesis (periventricular white matter)
Bowel bladder and sexual dysfunction (ANS)
Lumbar puncture MS
Increased lymphocytes, increased Ig’s with OLIGOCLONAL IgG bands on electrophoresis
Myelin basic protein (because destroyed myelin)
Astrocytes
Neuroectoderm
GFAP = astrocyte marker
Microglia vs macroglia
Microglia: phagocytes. mesodermal
Macroglia: astrocytes, oligo, ependymal. Neuroectoderm
Guillain Barre: injury to
schwann cells!!
Endoneural inflammation
endomysial inflammation
GBS
polymyositis
ADH and oxytocin synthesis
made in hypothalamus but stored in PP
Lateral hypothalamus
Lose lateral = lose weight
Ventromedial hypothalamus
Satiety. Lose ventromedial = verymuch hungry
Tau protein
Neurofibrillary tangle: Alzheimer
Round aggregates = pick bodies: Pick disease
Sx of Pick disease
Language (temporal) and behavior (frontal) deficits
Parkinsons, loss of ________ neurons in the _________ of the basal ganglia
dopaminergic
substantia nigra
Sx of Parkinsons
Tremor (pill rolling) at rest, disappears with movement
Rigidity (cogwheel) in extremities
Akinesia is slowing of voluntary movement
Postural instability/shuffling gait
Expressionless face and tremor that disappears with movement
Parkinsons: Akinesia = expressionless face. Pill rolling tremor.
dementia in Parkinsons vs Lewy body
Lewy body: early dementia
Parkinsons: late dementia
Subtantia nigra vs caudate nucleus disorder
SN: Parkinsons (dopaminergic)
CN: Huntington’s (GABAergic. trinucleotide = anticipation)
When and why do you see Chorea (disorder)
See it in Huntingtons (loss of GABAergic neurons in caudate nucleus)
Normally, GABA from BG to Cortex has an inhibitory hold on neurons. loss of GABA = random firing/movement = chorea
Increased CSF = expanded/dilated ventrilces = sretching of the _________ fibers = Normal P Hydrocephalus
Corona radiata fibers
Sx of NPH
Wet, wobbly, wacky
Lumbar puncture improves Sx
NPH (because removes some csf)
intracellular vacuoles
Spongiform encephalopathy
Dementia + ataxia + startle myoclonus (involuntary contractions with mild stimuli)
Spongiform encephalopathy
layer of gray matter in between internal capsule and ventricle
Caudate –> lost in Huntington = hydrocephalus ex vacuo
striatum
Caudate + Putamen (internal capsule in between them)
name a tumor that can cross the corpus callosum
GBM “butterfly lesion”
pseudopalisading and GFAP +
GBM (also, endothelial cell prolif)
benign tumor of ARACHNOID Villi/Cells
Meningioma
psamomma bodies + may present as seizure/focal neuro deficits
Meningioma
spindle cells in a concentrically whorled pattern
Meningioma
loss of hearing, tinnitis, s-100 +
schwannoma = benign tumor of schwann cells
neurofibromatous 2 brain tumor
bilateral schwannomas
calcified tumor in white matter, usually frontal lobe, seizures
Oligodendroglioma
where do you see a Pilocytic astrocytoma
posterior fossa/cerebellum
Cystic and solid components to neural tumor
Pilocytic astrocytoma: cystic lesion + mural nodule
Eosinophilic fibers of astrocytes on brain tumor biopsy
Rosenthal fibers –> Pilocytic Astrocytoma
Primitive neuroectodermal tumor (PNET): Name + Histo
Medulloblastoma: small blue cells
Homer-wright rosettes vs perivascular pseudorosettes
Homer-wright: Medulloblastoma, Neuroblastoma (AM)
Perivascular: Ependymoma
high mitotic index child brain tumor (posterior fossa)
Medulloblastoma = highly malignant
neuroblastoma
tumor of adrenal medulla in kids
neural crest origin
homer wright rosettes
brain tumor from epithelial origin
epithelial remnants of Rathke’s pouch = Craniopharyngioma
Bitemporal hemianopsia in a child vs adult
child: consider Craniopharyngioma
adults: Pituitary adenoma
how dos ectoderm become neuroectodorm = neural plate
Notochord (which becomes Nucleus polposus)
Neural plate gives rise to
Notochord and neural crest cells
Telencephalon and Diencephalon
Part of Forebrain (Football has TDs)
Telencephalon: cerebral hem/lateral ventricles
Diencephalon: thalamus/3rd ventricle
Midbrain/aqueduct come from which layer
Mesencephalon
AFP in spina bifida occulta
no structural herniation, just failure of bony spinal to close. intact dura. hair/skin simple.
NORMAL AFP
maternal diabetes and messed up brain development
Anencephaly
Clinical findings of anencephaly
Polyhdramnios, increased AFP, no forebrain.
failure of L and R hemispheres to separate
Holoprosenchepaly
Conditions that cause Holoprosencephaly (failure R/L sep)
Patau, Fetal alcohol syndrome, Sonic hedgehog signaling pathway
Lumbosacral myelomeningocele
Arnold Chairi II (herniation through foramen magnum)
aquedecutal stenosis + hydrocephalus after cerebellar tonsillar herniation
Arnold Chiari II
cystic dilation of the 4th ventricle (posterior fossa)
Dandy walker
congenital hydrocephalus
structural: Aqueductal stenosis, Dandy walker, Chairi
infectious: CMV, toxoplasmosis, meningitis
Sx of infantile hydrocephalus
Macrocephaly
Poor feeding ("trouble latching while breast feeding")
Muscle hypertonicity
Hyperreflexia
Seizures/developmental delaywhy does infantile hydrocephalus cause hyperreflexia and hypertonicity (muscular)
UMN damage –> stretching of the periventricular pyramidal tracts
sensation/taste anterior 2/3 tongue
1/2 branchial arches
Sensation: V
Taste: VII
sensation/taste posterior 1/3 tongue
3/4 branchial arches
IX (CN 9 = Glossopharyngeal)
role of Glossopharyngeal (CN9) and Hypoglossal (CN12) to tongue
9: taste and sensation of posterior 1/3
12 (Hypoglossal): Motor innervation to everything except for
palatoglossus (X; elevates posterior tongue during swallowing)
Locus ceruleus (pons)
Norepinephrine
Increased in anxiety
Decreased in depression
Ventral tegmentum and Substantia nigra pars compacts (midbrain)
Dopamine
Basal nucleus of Meynert
ACh
Increased in Parkinson
Decreased in Alzheimers (AD = low ACh)
GABA (Nucleus Accumbens) levels in
anxiety and hungtingtons
Decreased in both
Stress and panic
Locus Ceruleus (NE)
Nucleus accumbens
GABA. Reward/pleasure/addiction/fear
Thalamic fibers going to primary somatosensory cortex
VPL (pain temp, MVP)
VPM (face…sensation and taste)
Damage to either = complete contralateral sensory loss
dont be a peasant –> my impulse is “ventral” so has to be motor and not sensory
VPL nucleus of thalamus
vs in hypothalamus its like “ventromedial area”
Spinothalamic tract: Pain and temp
DC/ML: MVP (proprioception, touch, vibration, pressure)
Patient has unsteady gait/difficulty walking. which track/nucleus of thalamus
VPL –> DC/ML = MVP = lost proprioception
VPM nucleus of thalamus
VPM –> Makeup goes on the Face
Face sensation and taste
LGN and MGN of thalamus
LGN: “Light” = vision
MGN: “Music” = hearing
VL nucleus of thalamus
Motor to Basal ganglia/cerebellum
The famous 5 F’s = Limbic system
Feeding, Fleeing, Fighting, Feeling, Fucking
emotion, long term memory, behavior, ANS
structures of Limbic System
Hippocampus Amygdala Mammillary Body Fornix Cingulate Gyrus
Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness
Osmotic demyelination syndrome aka central pontine myelinolysis
Cerebral edema/herniation related to Sodium
High to low, your brain will blow
Romberg
+: Ataxia is sensory = DC-ML fucked up
-: Ataxia is cerebellar
alpha synuclen intracellular eosinophilic inclusions
Lewy bodies –> Parkinsons and Lewy body dementia
resting tremor, shuffling gait
Parkinsons
Angry man with choreo (dancing movements), wheres the damage?
Caudate nucleus –> huntingtons
Neuronal death via NMDA-R binding and glutamate toxicity
Huntingstons: NMDA - Hunt with Glutamatate gun (NRA)
CAG Repeats and loss of ACh and GABA
Caudate loses ACh and GABA = Hungtingtons
No ifs, ands or buts (can’t repeat)
Conduction Aphasia: damage to Arcuate Fasciculus. (poor repetition)
Disinhibited behavior: Hyperphagia, hypersexuality
Kluver-bucy –> amygdala lesion
Frontal lobe damage (R side = disinhibited behavior)
Reemergence of primitive reflex, difficulty concentration, poor judgement
Frontal lobe damage
Eye looks toward side of lesion
FEF
Eye looks away from lesion
PPRF
Stroke: Motor/Sensory to Upper Limb and Face
MCA
temporal lobe (wernicke) and frontal lobe (Broca) stroke
MCA
Lower limb motor and sensory loss
ACA
after stroke, can’t walk
ACA (lower limb sensorimotor)
dysphagia, hoaseness, woming, decreased pain and temp from ipsilat face and cl body
PICA: lateral medulla (wallenberg)
Paralysis of face
AICA: Facial droop means AICAs pooped
intracranial hemorrhage that can cross suture lines
Subdural hematoma
i.e. shaken baby, alcoholics, blunt trauma/whiplash
intracranial hemorrhage that cross falx/tentorium
epidural hematoma
hemorrhagic stroke/intracerebral hemorrhage
Basal ganglia
lateral corticospinal tract (UMN)
voluntary movement of contralateral limbs
positive Romberg, absence of deep tendon reflexes, Latent bacteria
Tabes dorsalis
Tracts affected by vit b12 def
Subacute combined degeneration:
DC-ML (lose mvp)
Lateral corticospinal tract (UMN signs)
Spinocerebellar tract
Ataxic gait, parestheia, impaired position and vibration
KYPHOSCOLIOSIS, HCM, Staggering gait, frequent falling, PES CAVUS (high plantar arches)
Friedreich ataxia (trinucleotide repeat GAA) -->death by cardiomyopathy
Brown Sequard syndrome
hemisection of spinal cord
CL pain and temp loss
Ipsilateral loss of MVP, and UMN signs
Ipsilateral loss of all sensation at level of lesion
UMN vs LMN face lesion
UMN: CL lower face paralysis
LMN: ipsilat paralysis of upper and lower face
Neuroleptic Malignant Syndrome (after antipsychotic overdose)
diffuse muscle rigitidity
high fever/ANS instability
High Creatine kinase (rhabdomyolysis)
Tx = Dantrolene (block Ca rel from RyR of SR) or Bromocriptine (dopamine agonist)
2 most common causes of intellectual disability
Down syndrome (most common overall) Fragile X (most common inherited)
CNIII is motor/sensory/both?
Pure MOTOR
Some Say Marry Money But My Brother Says Big Boobs Matter Most
Radial Nerve Damage (include vs spare triceps reflex)
In Axilla (crutches/saturday night palsy) = Proximal injury = lose finger extensors, get wrist drop, absent triceps reflex
Injury to proximal radial nerve as it crosses posterior humerus (MIDSHAFT HUMERUS) spares triceps reflex, lose extensors of hand.
Finger/thumb drop (loss of extension) without wrist or tricep deficits = damage in supinator canal, i.e. mechanic doing lots of screwdriving
B12 deficiency rxns
MMA —MMA CoA mutase –> Succinyl-CoA (not succinylcholine)
Homocysteine –Methionine synthase/THF–>Methionine
rxn in PKU
lose PH or its cofactors tetrahydroBiopterin (BH4)
Phenylalanine–Phenylalanine Hydroxylase (PH) –>Tyrosine
Cerebellar lesions are different from cerebral because:
the cerebellum double crosses you! so ends up being ipsilateral.
- ->dysdiadochokinesia (loss of rapidly alt movements)
- ->limb dysmetria (over/undershoot)
- ->intention tremor (tremor during movement)
2 CAN pneumonics
Whipples: Cardiac, Arthralgia, Neuro sx
Wernicke: Confusion, Ataxia, Nystagmus
(this is wernicke encephalopathy, not aphasia; and nystagmus interhcangable with opthalmoplegia. due to Thiamine b1 def)
Note: Thiamine def = periph neuropathy, high-output cardiac failure, and Wernickes (ataxia, confusion, nystagmus)
Dx of Thiamine deficiency
periph neuropathy + cardiac failure aka wet beri beri DCM + Wernicke encephalopathy aka confusion ataxia nystagmus
Increased rbc TRANSKETOLASE activity after giving thiamine
Synaptophysin vs GFAP
GFAP = Astrocytes (NeuroGlia–>hence responsible for reactive GLIOSIS)
–>Gliomas (non-neuronal tissue) =
Astrocytoma, Ependymoma, Oligodendroglioma
(still part of brain so still all neuroectoderm)
Synaptophysin = neurons, neuroectodermal cells, neuroendocrine
Von Hippel Lindau (4)
- Hemangioblastoma of cerebellum/retina (vascular)
- Renal Cell Carcinoma (bilateral)
- Pheochromocytomas
- Angiomatosis (Cavernous hemangiomas all over)
difficulty removing hand from handshake
Myotonia (seen in myotonic dystrophy)
Frontal balding, cataracts, myotonia, testicular atrophy, arrythmia
Myotonic Dystrophy (type 1 fibers. auto dom trinuc rpt)
AICA vs PICA
Both: Ips P/T Face, CL P/T Body. Vomit/vertigo/nystag
AICA: Lateral Pons. Facial paralysis. Taste ant 2/3 tongue
(Facial droop means AICA pooped)
PICA: Lateral Medulla. Dysphagia/hoarseness
(dont pica horse that can’t eat)
Locked-in syndrome
- Osmotic Demyelination (central pontine myelinolysis)
- ->correct hyponatremia (low to high pons will die) rapid - Basilar artery stroke
Osmotic demyelination more likely to present with loss of consciousness
ACom or PCom: CNIII palsy
PCom.
Both can cause visual defects.
Both sites are more likely to be aneurysm than stroke. Both sites = Berry (saccular) aneyrums, with ACom #1
Motor and PNS component of CNIII
Motor in Middle: Affected by ischemia/ vascular dx (DM)
–>Ptosis, Down-and-out gaze, Horizontal/vert diplopia
PNS outside: Affected by compression (PCA aneurysm)
–>dec Pupillary light reflex, Blown pupil with down/out
Vertical diplopia (can't go down the stairs) "With Cranial Nerve \_\_\_\_\_ its hard to walk down to the bottom floor"
CN IV (Trochlear = SO4) head tilts toward side of lesion, can compensatory tilt in other direction while going down stairs
Kid has MVP, autism, and intellectual disability. He has a problem in gene ________
Methylation ( Fragile X)
Kid has ASD, duodenal atresia, palmar crease, sandal gap. His b-HCG is ________, and his condition is a result of ______ _______
bHCG INCREASED in Down (dec in 18 and 13)
Meiotic Nondisjunction
Elderly patient comes in with insomnia, can we give him Benzo?
NO!! Drugs to avoid in elderly:
Benzo’s: cognitive impairment/delirium/falls
TCAs (amytriptyline) and antihistamines (Diphenhydramine) due to strong anticholinergic effects and delirium/falls
Temporal lobe herniation =
Uncal aka transtentorial herniation! Uncus = medial temporal lobe;
Uncal Herniation Manifestations
- Ipsilateral CNIII = Ipsilat blown pupil/downandout
- Ipsilateral PCA = contralat homonymous hemianopia
- Compress CL Peduncle = CL Corticospinal tract = IPSILAT HEMIPARESIS
- Duret hemorrhages: brainstem (pons/midbrain) due to stretching of Paramedian Basilar Artery (fatal)
Recurrent Lobar Hemorrhages in Elderly
Cerebral AMYLOID angiopathy
Endomysial inflammatory infiltrate
Endoneural hyaline arteriolization
Endoneural inflammatory infiltrate
Polymyositis (proximal mm weakness)
Diabetic neuropathy
GBS
Headache that gets worse with Valsalva (they will say its worse when he coughs or bears down during MM)
Suggests increased ICP aka tumor (and NOT a migraine)
contralateral Hemiparesis loss
contralateral Hemisensory loss
Corticospinal tract lesion (cortical/brainstem)
Ascending somatosensory = DC-ML and Anterolateral
Posterior Communicating Artery (PCom)
Posterior Cerebral Artery (visual/occipital cortex)
PICA (Lateral medulla)
PCom: saccular Aneurysm = COMPRESSES CNIII so see ipsilateral down and out + ptosis and myDRiasis
PCA: Contralateral homonymous hemianopia w/macular sparing
PICA: Dec P/T ipsilateral face and CL body; dysphagia, hoarseness, ipsilateral Horner; vomiting/vertigo/nystagmus
Parasympathetics vs Sympathetics eye
CNIII has PNS fibers on outside….so damage = MYDRIASIS
(seen with compression= PCA aneurysm/Uncal herniation…won’t really be seen with diabetic/vascular/ischemic damage unless severe)
Horners = SNS damage = MIOSIS, ptosis, anhydrosis ——->any lesion above T1 i.e. Syringomyelia (c8-t1), Pancoast tumor, Brown-Sequard (hemisection resulting in CL P/T and Ipsi
PICA: involves ipsilateral Horner (b/c knocks out SNS fibers)
Cerebellum Peduncles
Input:
Inferior - ipsilateral info
Middle - contralateral cortex info
Output:
Superior - Sends info to contral cortex to modulate movement (via output fibers = Purkinje fibers)
Lateral vs Medial Cerebellar Lesion (Romberg is - b/c cerebellar)
Lateral: Limb dysmetria (fall to ipsilat side)
Medial: Truncal ataxia/nystagmus
lose Rapid alt movements = dysdiadochokinesia
also lose tandem walking in cerebellar lesion
Lesion location :
Chorea (sudden, jerky movements. Huntington)
Hemiballismus (sudden flailing of 1 arm, +/- Ipsi leg)
Intention Tremor (zigzag when extending to target. MS)
Chorea: Basal Ganglia
Hemiballismus: Contralat Subthalamic (Basal Ganglia –>Lacunar STROKE)
Intention Tremor: Cerebellum
- Sudden uncontrolled muscle contraction(hiccups/jerks)
- Sustained, involuntary muscle contraction (writer cramp)
- High freq tremor w/sustained posture (outstretchedarm)
- Tremor alleviated by intentional movement
Myoclonus
Dystonia (also the eyelid thing. can manual suppress)
Essential Tremor (relieve with EtOH)
Resting tremor (parkinson)
Essential tremor tx
“Extremely tiring to keep my arm up”
Have some EToH, bETa - blocker
-pt self medicates with EtOH
-Tx with Beta blocker or primidone
Dementia and visual hallucinations, followed by parkinsonian features
Lewy body dementia (Halewycinations) –> alpha-synuclein defect
Autoimmune myelin destruction (demyelinating)
Guillain Barre (PNS) Multiple Sclerosis (CNS). Can feel fatigue after hot shower
