Neuro Flashcards
What condition presents with:
unilateral, severe periorbital headache with tearing and conjunctival erythema
Cluster headache
What is the prophylactic treatment for migraine?
Antihypertensives, antidepressants, anticonvulsants, dietary changes
What is the most common pituitary tumor?
Prolactinoma
What is the treatment for prolactinoma?
Dopamine agonists (bromocriptine)
A 55 year old patient presents with acute “broken speech”. What type of aphasia is this?
Broca’s aphasia
What lobe and vascular distribution are affected in Broca’s aphasia?
Frontal lobe, left MCA distribution
What is the most common cause of SAH?
Trauma (second most common cause is berry aneurysm)
A crescent-shaped hyper density on CT that does not cross the midline. What is the diagnosis?
Subdural hematoma
What causes a subdural hematoma?
Torn bridging veins
A patient presents with a history significant for initial altered mental status, with an intervening lucid interval. What is the diagnosis?
Epidural hematoma
What causes epidural hematoma?
Middle meningeal artery damage
What is the treatment for epidural hematoma?
Neurosurgical evacuation
What are the CSF findings with SAH?
1) Increased ICP
2) RBCs
3) Xanthochromia
What condition is associated with:
Albuminocytologic dissociation
Guillain-Barre syndrome (increased protein in CSF without a significant increase in cell count)
Cold water is flushed into a patient’s ear, and the fast phase of the nystagmus is toward the opposite side. Is this normal or pathologic?
Normal
What are the most common primary sources of metastases to the brain?
1) Lung
2) Breast
3) Skin (melanoma)
4) Kidney
5) GI tract
What may be seen in children who are accused of inattention in class and are often confused with ADHD?
Absence seizures
What is the most frequent presentation of intracranial neoplasm?
Headache.
Primary neoplasms are much less common than brain metastases
What are the most common causes of seizure in children (2-10 years)?
1) Infection
2) Febrile seizures
3) Trauma
4) Idiopathic
What are the most common causes of seizures in young adults (18-35 years)?
1) Trauma
2) Alcohol withdrawal
3) Brain tumor
What is the first line medication for status epilepticus?
IV benzodiazepine
What presents with confusion, ophthalmoplegia, and ataxia?
Wernicke encephalopathy due to a deficiency of thiamine
___ % lesion in a symptomatic patient is an indication for carotid endarterectomy?
70 %
What are the most common causes of dementia?
Alzheimer disease and vascualr/multi-infarct
What condition presents with a combine upper motor neuron (UMN) and lower motor neuron (LMN) disorder?
ALS (amyotrophic lateral sclerosis)
What condition presents with rigidity and stiffness with unilateral resting tremor and masked facies?
Parkinson disease
What is the mainstay of Parkinson therapy?
Levodopa/ carbidopa
What is the treatment for Guillain-Barre syndrome?
IVIG or plasmapheresis
What should be avoided in the treatment of Guillain-Barre syndrome?
Steroids
What condition presents with rigidity and stiffness that progress to choreiform movements, accompanies by moodiness and altered behaviour?
Huntington disease
A 6 year old girl presents with a port-wine stain int he V1 distribution, intellectual disability, seizures, and ipsilateral leptomeningeal angioma. What is the condition?
Sturge-Weber syndrome
What is the treatment for Sturge-Weber syndrome?
Treat symptomatically; possible local cerebral resection of the affected lobe
What condition presents with multiple cafe-au-alit spots on the skin?
Neurofibromatosis type 1
What condition presents with hyperphagia, hyper sexuality, hyperoroality, hyperdocility?
Kluver-Bucy syndrome (amygdala)
What drug may be administered to a symptomatic patient to diagnose myasthenia gravis?
Edrophonium
Denervation on EMG, fibrillations
ALS
Motor neuron disease, but sparing of sensation, ocular muscles, and sphincters
ALS
Red Flags INCONSISTENT with ALS
sensory sx, predominant pain, bowel or bladder incontinence, cognitive impairment, ocular muscle weakness
Post-polio syndrome - how does it present
motor neuron disease - asymmetric muscle weakness, atrophy
What is the most common cause of symmetrical distal stocking-glove pattern?
DM neuropathy
How does glaucoma cause blindness?
Optic neuropathy (CRN II)
How does a CN II defect present?
Blindness
How does a CN III defect present?
Eye deviated down and out (superior oblique and abducens paralysis) - diplopia
Ptosis
*spares the pupil
How does a CN V defect present?
Loss of facial sensation
Loss of corneal reflex
Weakness and wasting of muscles of mastication
Deviation of jaw to ipsilateral side when open
Trigeminal neuralgia
How does a CN VIII defect present?
Sensorineural hearing loss
Vertigo
*consider acoustic neuroma
How does a CN IX defect present?
Loss of taste in posterior 1/3 of tongue
How does a CN X defect present?
Failed palate elevation (uvular deviation)
How does a CN XI defect present?
Ipsilateral shoulder weakness
How does a CN XII defect present?
Deviation of tongue to ipsilateral side
How do axonal neuropathies present on NCS?
Decreased amplitude
Axon - Amplitude
Ex: DM, B12 def
How do demyelinating neuropathies present on NCS?
Decreased velocity
EX: Guillain-Barre Syndrome
CSF: high pr, normal WBC
GBS
Most common antecedent infection in GBS?
Campylobacter jejuni
What do these diseases have in common:
Myasthenia Gravis
Lambert-Eaton
Botulism
All affect the neuromuscular junction
How can you differentiate Myasthenia Gravis from Lambert-Eaton?
Myasthenia Gravis: won’t get better with exercise
Lambert-Eaton: will improve with exercise (“Eaton” = “exercise”)
Like cause of Lambert-Easton?
Small Cell Carcinoma of the lung
Associated symptoms when botulism?
GI (since from honey, canned food)
Where is the issue in the neuromuscular junction in Myasthenia Gravis? vs Labert Eaton?
MG - Post synaptic channel receptors (autoimmune antibodies anti-AChR or anti-MuSK)
Lambert Eaton - presynaptic (autoimmune due to antibodies against presynaptic voltage-gated calcium channels, causing decreaed ACh release)
Investigation for myasthenia gravis
Endorphonium (Tension) test
*assess for improvement over 2 mins following injection
it inhibits the enzyme that breaks down AcH
Treatment options for MG?
Thymectomy
Acetylcholinesterase inhibitors (pyridostigmine)
Steroids
Treatment for Lambert-EAton?
Remove tumor (small cell carcinoma)
Treatment for botulism
Botulism anti-toxin
What conditions are characterized by symmetric proximal weakness, absent sensory changes, high CK?
Myopathies
poly and dermatomyositis
Endomysial infiltrates, necrosis on biopsy
Polymyositis
Perifascicular atrophy
Dermatomyositis
Grottron’s papule and Groton’s sign are pathognomonic of what condition?
Dermatomyocytis
What malignancies are associated with dermatomyocytis?
Breast
Lung
Colon
Ovarian
What its he most common cause of intracerebral hemorrhage (stroke)?
HTN (most common site is brain stem)
different than most common cause of subarachnoid hem - aneurysm
DDX of stroke
Stroke
Hypertensive encephalopathy
Cerebral venous sinus thrombosis
Key feature of hypertensive encephalopathy
HTN
Papilledema
Focal neurological symptoms (not seen in malignant HTN)
How do you diagnose cerebral venous sinus thrombosis?
MRV or CTV
Door to needle time from time patient was last seen normal for treatment of ischemic stroke?
(tPA candidate)
4.5 hrs
CT has to be negative before giving tPA
What territory is the stroke:
Contralateral leg paralysis
Anterior Cerebral Artery
What territory is the stroke:
Contralateral weakness and sensory loss of face and arm If dominant (usually left) aphasia If non dominant (usually right) neglect
(all contralateral)
Middle Cerebral Artery
What way does eye deviation go in a Middle Cerebral Artery stroke?
eye deviation TOWARDS the side of the brain lesion in MCA
What territory is the stroke:
Contralateral hemianopsia or quadrantanopia
Midbrain findings CN III, IV palsy
Posterior Cerebral Artery
What territory is the stroke:
Vertigo Ataxia Horner's ipsilateral Ipsilateral facial sensory loss Contralateral hemiparesis Can't swallow
Posterior Inferior Cerebellar Artery (PICA) or Wallenberg Syndrome
- lateral medulla - supplies CN IX, X
Time from onset of symptoms to tpa
<4.5h
Post stroke management
ASA High dose statin (80mg atorvastatin) HTN management - <140/90 (ramipril) HBA1C <7% No smoking, exercise
Carotid endarterectomy clearly benefits who?
symptomatic severe stenosis 70-99%
How do you stratify the stroke risk for patients with a fib?
CHADS2
CHF (1) HTN SBP > 160 or treated HTN (1) Age > 75 (1) DM (1) Prior stroke or TIA (2)
How do you predict/identify patients at high risk of stroke following TIA?
ABCD2 Score
Age >60 (1) BP HTN >140/90 (1) Clinical Features: unilateral weakness (2), speech disturbance no weakness (1) Duration: 10-59 min (1), >60 min (2) DM (1)
Risk: 0-3 low; 4-5 mod; 6-7 high
What is the most common type of MS?
Relapsing Remitting (RRMS)
can go onto become Secondary Progressive (SPMS)
What is Lhermitte’s sign in MS?
flexion of neck causes electric shock sensation down back into limbs indicating cervical cord lesion
What is Uhthoff’s phenomenon?
worsening of symptoms (usually optic neuritis) in heat
How do you manage MS acutely?
high dose methylprednisolone (1000mg IV daily 3-7 days)
Drugs to decrease MS relapse rate long term?
Disease Modifying Therapy (DMT)
Terifluonmide
Interferon-B
What cranial nerves are typically affected with cavernous sinus thrombosis?
III, IV, VI, V1, V2 as well as orbital pain and proptosis
How do you differentiate optic neuritis and papilledema?
Vision loss: rapid in optic neuritis, central, colour vision loss (vs late visual loss in papilledema)
RAPD: RAPD in optic neuritis (not in papilledema)
Note: Absent of pailledema in retro-orbital papilledema
Wrist drop
Radial nerve palsy
Saturday night palsy; mid shaft humorous fracture
Polymyalgia Rheumatica vs Polymyositis
no elevated CK in polymyalgia rheumatic
