Neuro Flashcards
Wernicke’s Encephalopathy
Alcoholism, severe malnutrition, hyperemesis gravidarum.
Thiamine deficiency
Features: Encephalopathy, horizontal nystagmus (abducens), ataxic gait
Tx IV thiamine and then glucose
Normal Pressure Hydrocephalus
Wet, Wacky, Wobbly. Normal opening pressure. Ventriculomegaly out of proportion to cerebral atrophy.
Mostly idiopathic but can be secondary to neurologic insult.
GBS
Motor and reflex deficits, paresthesias
Tx: IvIG or plasmapharesis
Once patient is stabilized and is in no resp distress, spirometry should be done to assess lung function.
Freidrich Ataxia
Slurring of speech and gain instability in adolescents.
MRI: Medulla and dorsal column
Absent DTRs, scoliosis, cardiac hypertrophy, Diabetes mellitus
Mean survival 30-40
Death due to cardiac arrhythmia or CHF
Akathisia
Restless feeling brought on by certain medications (metoclopramide/other dopamine antagonists)
tx: BB, Benzos, Benztropine
Tardive Dyskinesia
lip smacking, writhing, choreoathetoid movements that occur after prolonged exposure to dopamine antagonists.
Pathophys: increased D2 receptors and sensitivity
Tx: Valbenazine
Acute Dystonia
Sudden sustained contraction of the neck, mouth, and or eyes.
Tx: Benadryl, Benztropine
Charcot-Marie-Tooth
Hereditary lower extremity weakness, foot drop, and eventual tremor.
Myasthenia Gravis
Upon diagnosis they should receive a chest CT to determine if they have a thymoma. Removal of this may improve symptoms long term.
Pronator drift is sensitive/specific for ________ and ________ problems.
Upper Motor Neuron and Pyramidal Tract
INH Polyneuropathy
Isoniazid can cause a deficiency in B6 (Pyridoxine) causing it to be renally excreted. Stocking glove distribution numbness and tingling that may progress to loss of vibratory sense, proprioception, pain, and temp.
Acute MS exacerbation
If there are disabling symptoms: IV methylprednisolone, if refractory then plasmapheresis.
Delayed Sleep Wake Phase Disorder
Circadian rhythm disorder characterized by inability to fall asleep at traditional times and excessive daytime sleepiness.
Advanced Sleep Wake Phase Disorder
Circadian rhythm disorder characterized by inability to stay awake in the evening and inability to fall asleep in the morning.
Anterior Spinal Cord Syndrome
Bilateral Hemiparesis (Lateral cortical spinal tract), Diminished bilateral pain and temp (Lateral spinothalamic)
Intact proprioception, light touch, and vibration (Dorsal columns)
Brown Sequard Syndrome
Hemisection of the spinal cord
Loss of:
Contralateral pain & temp (Lateral spinothalamic(docusate one level below the injury))
Ipsilateral motor (Lateral corticospinal)
Ipsilateral proprioception, light tough, and vibration (Dorsal Column)
Athetosis
Writhing, uncontrollable movements that are commonly seen in cerebral palsy
Pure Sensory Stroke location
Thalamus (VPL & VPM nuclei)
- one type of lacunar stroke
- Atherothrombotic etiology
- Several weeks later may develop thalamic pain syndrome
Pure Motor Stroke location
Internal capsule, although some internal capsule strokes will have both motor and sensory symptoms.
Tabes dorsalis
Late neurosyphilis. Sensory ataxia, lancinating pains, neurogenic bladder, Argyll Robertson pupils.
Tx: Penicllin
Pineal Gland Mass
Limited upward gaze, upward eyelid retraction, pupils not reactive to light, obstructive hydrocephalus.
Metastasis to the CNS
circumscribed lesions at grey-white matter junction. 30% symptomatic. Lung cancer and melanoma are the most common.
Alcohol-Induced Cerebellar Degeneration
10+ years of alcohol abuse causing degeneration of Purkinje fibers in the cerebellar vermis. Leads to truncal ataxia and wide gait. Peripheral coordination generally remains intact.
Achilles Tendon Reflex
Often decreases as we age, may be absent in elderly.
Blepharospasm
Bilaterally spasm of the eyelids usually in response to stimuli such as a bright light. May also happen in the jaw and tongue, when combined it is called Meige Syndrome. Usually idiopathic but can be associated with Parkinsons or antipsychotics.
Tx: avoid stimuli, if the problem persists can do botulinum toxin.
Trigeminal Neuralgia Tx
Carbamazepine
Syringomyelia
Formation of a syrinx within the spinal cord. Usually associated with Arnold-Chiari I, but can also present after meningitis, tumors, inflammatory processes, and trauma.
Loss of pain and temp
Pseudotumor cerebri/Idiopathic Intracranial Htn
Overweight women Signs of ICP (papilledema) Impaired CSF reabsorption by arachnoid villi. Tx: Wt loss and acetazolamide Risks: Blindness
Meniere’s Dz
Elevated endolymphatic pressure
Patients present with episodic vertigo, sensorineural hearing loss, and low-frequency tinnitus.
Tx: decrease Na, caffeine, nicotine, and alcohol. Diuretics can help long term. Antihistamines and antiemetics can help with acute symptoms.
Transtentorial/Uncal Herniation
ipsilateral hemiparesis, compression of CNIII (Down, out, and dilated), contralateral homonymous hemianopia, altered level of consciousness.
Erb Duchenne Palsy
C5 C6 injury
“Waiters tip” Extended elbow, pronated forearm, flexed wrist and fingers.
Intact grasp reflex
Klumpke Palsy
C8 T1 injury
“Claw hand” extended wrist, extended MCP, flex PIPs and DIPs, absent grasp reflex
Horner syndrome
High 14-3-3 CSF Titer
CJD
Diabetic Ophthalmoplegia
Ischemia to CNIII, the inner fibers which control the eyelid levators and EOMs are more susceptible, which usually means preserved pupillary responses.
Anticholinesterases used for dementia
Rivastigmine, donepezil, galantamine
Amantadine
Parkinsons
Causes of pediatric stroke
Sickle cell, cardiac abnormalities, meningitis, vasculitis
Status epilepticus
more than 5 minutes of continuous seizure or two or more seizures where the patient does not regain consciousness in between.
Post traumatic neuromas
After transection of nerves in surgery or injury, increased proliferation of unmyelinated nerves causes pain with pressure on the site.
Subdural hematoma
Crescent on CT
Tearing of bridging veins
Subarachnoid hemorrhage
Bleed between arachnoid and pia mater on CT
Rupture of aneurysm
Thunderclap headache
Epidural hematoma
MMA rupture usually
Biconvex on CT
Morton Neuroma
Running injury, compression of digital nerves in foot results in a false neuroma. Usually between 3rd and 4th digits. Clicking sound when toes are squeezed together.
REM sleep behavior disorder
Patient enacts dreams. They remember the dream. Able to be awoken. More common in older men
Bilateral enhancement of the globus pallidus on MRI
Hypoxic brain injury
Heat stroke vs dehydration
Heat stroke temp >104 and altered mental status
New brain mass in adult
Brain mets are the most common new brain mass, usually multiple, well-circumscribed lesions.
Gliomas are the most common primary brain mass in adults. Usually a single, irregularly shaped mass.
Most common brain tumor in adults and prognosis
Astrocytoma (glioma) prognosis depends on degree of anaplasia
Mild Cognitive Impairment
No interference in activities of daily living
Critical illness polyneuropathy
Sepsis-related damage to peripheral nerves. LMN signs only.
Cavernous sinus thrombosis
Usually due to cellulitis or sinusitis that enters the venous circulation.
Intracranial HTN leading to headache, facial edema, nausea, ocular palsy, and vomiting.
Rapid Eye Movement Sleep Behavior Disorder
Enacting dreams, muscle atonia, men over 50
Strong association with alpha-synuclein diseases (Parkisons)
Central cord syndrome
Hyperextension injury, damage to corticospinal and lateral spinothalamic tracts. Weakness, diminished pain, and diminished temp in the upper extremities.
Pediatric brain tumors
Pilocytic astrocytoma > Medulloblastoma
Pilocytic astrocytoma
The most common brain tumor in children. Generally occurs in the cerebellar hemispheres where it affects coordination. Commonly impinge the 4th ventricle and cause symptoms of ICP.
Medulloblastoma
The second most common brain tumor in children. Found at the cerebellar vermis. Causes truncal and gait ataxia.
Narcolepsy somnography findings
Decreased REM latency
Lambert Eaton Syndrome
Antibodies to presynaptic voltage-gated calcium channels. Proximal muscle weakness, significantly diminished reflexes, and autonomic dysfunction. Muscle strength is recovered with use.
Associated with small cell lung cancer
