Neuro 8 Flashcards
What is transverse myelitis and what disease is it associated with
Multiple sclerosis
- Area of inflammatory demyelination in the spinal cord
- Motor and sensory loss below the level of the lesion with bowel and bladder dysfuntion
- Initially flaccid paralysis followed by spastic paralysis with hyperreflexia
- Patients may report a band of tingling or pain around the torso at the level of the lesion
What is Lhermitte’s sign
• Tingling, electric sensation down the spine when the patient flexes the neck
MRI findings in MS
♣ Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
♣ T2 hyperintense areas in the white matter of the brain or spinal cord
CSF findings in MS
♣ Increased protein
♣ Oligoclonal IgG bands
Tx of acute MS flares
corticosteroids
Chronic tx of MS
interferon beta
Sx of multiple sclerosis
Triad of sx (SIN):
• Scanning speech
• Intention tremor, Incontinence, Internuclear ophthalmoplegia
• Nystagmus
♣ Lhermitte sign
• Tingling, electric sensation down the spine when the patient flexes the neck
♣ Transverse myelitis
• Area of inflammatory demyelination in the spinal cord
• Motor and sensory loss below the level of the lesion with bowel and bladder dysfuntion
• Initially flaccid paralysis followed by spastic paralysis with hyperreflexia
• Patients may report a band of tingling or pain around the torso at the level of the lesion
♣ Sensory symptoms (numbness and paresthesia)
♣ Motor symptoms (paraparesis and spasticity)
♣ Bowel/bladder dysfunction
What are the 2 components of presentation of neuromyeltiis optica (NMO)
♣ Transverse myelitis:
• Area of inflammatory demyelination in the spinal cord
• Motor and sensory loss below the level of the lesion with bowel and bladder dysfuntion
• Initially flaccid paralysis followed by spastic paralysis with hyperreflexia
• Patients may report a band of tingling or pain around the torso at the level of the lesion
♣ Opitc Neuritis:
• Mildly painful loss of visual acuity in one eye
• Pain most prominent with eye movement
• Vision may be blurry with loss of color discrimination
Diagnosis of NMO
♣ Antibodies to aquaporin-4 channel
Treatment of NMO
♣ Steroids
♣ Chemotherapeutic agents
Pathophys of progressive multifocal leukoencephalopathy
o Caused by JC virus
o Leads to demyelination by infecting oligodendrocytes
Presentation of PML
o Characterized by dementia, focal cortical dysfunction, cerebellar abnormalities
Non-enhancing multifocal brain lesions
Causes of posterior reversible encephalopathy syndrome (PRES)
o Usualy develops in the context of rapidly developing HTN and eclampsia or due to immunosuppressants used in organ transplant
Presentation of Posterior reversible encephalopathy syndrome (PRES)
♣ Headache
♣ Altered consciousness (acute confusional state)
♣ Visual disturbances (cortical visual loss – blindness with preserved pupillary reactivity)
♣ Seizures
Presentation of PSP
- Supranuclear ocular palsy (failure of vertical gaze), dysarthria, dysphagia, extrapyramidal rigidity, gait ataxia, dementia, pseudobulbar palsy, bradykinesia, cognitive and behavioral abnormalities
- Earliest signs are falls and gait abnormality
Diagnose: acute painless monocular vision loss with cherry red spot
Central retinal artery occlusion
Diagnose: light flashes, floaters, or curtain across visual field
Detached retina
Presentation of central retinal vein occlusion
Painless, sudden vision loss
Presentation of myasthenic crisis
♣ Precipitating factors • Infection or sugery • Pregnancy or childbirth • Tapering immunosuppressive drugs • Medications ♣ Signs/symptoms • Increased generalized and oropharyngeal weakness • Respiratory insufficiency/dyspnea
Tx of syphilis
Penicillin
What are features of TB meningitis (other than CSF) that differentiate it from bacterial meningitis
Usually affects the basal meninges (at base of brain) - so more likely to present with CN palsies
Slower onset
Describe CSF findings of TB meningitis
Cells = lymphocytes Protein = high Glucose = very low
CSF of viral meningitis
Cells = lymphocytes Protein = high Glucose = normal
What are the 2 things to think of with ring-enhancing lesions in AIDs patients
Toxoplasmosis
CNS lymphoma
Neurocysticercosis is caused by what?
Eating EGGS of taenia solium
Tx of neurocysticercosis
Albendazole
What is spinal shock?
Flaccid weakness and absent DTRs immediately after spinal cord injury
Spasticity and other UMN signs will develop over the next few days to weeks
Hemispatial neglect is caused by damage to what?
Non-dominant parietal cortex (usually R side)
What is 1st, 2nd, and 3rd line tx for pseudotumor cerebri
o 1. Acetazolamide
o 2. Surgical intervention for patients refractory to medications
♣ Lumboperitoneal shunting
♣ Optic nerve sheath decompression
o 3. Serial lumbar punturs as a bridge for patients awaiting surgery
Enzyme deficient in Lesch Nyhan syndrome
HGPRT (hypoxanthine-guanine phosphoribosyl transferase)
Clinical features of post-concussive syndrome
♣ HA, dizziness, sleep disturbance, cognitive impairment, behavioral abnormalities (e.g. irritability)
Tx of post-concussive syndrome
♣ Focus on individual components of syndrome with tx of each separately
Describe presentation of Guillain-Barre
♣ Ascending symmetrical paralysis over days to weeks
♣ Absent/depressed deep tendon reflexes
♣ Paresthesias
♣ Autonomic dysfuction (e.g tachycardia, urinary retention, and arrhythmias) occur in 70% of patients
♣ Respiratory compromise
CSF for Guillain Barre
♣ High protein with few cells
Tx of Guillain Barre
♣ IV immunoglobulin or plasmapheresis
What do you think when you see periodic sharp waves on EEG in a demented patient
CJD
What will you see in CSF of CJD patient
protein 14-3-3
Other than dementia, what are the other clinical features of CJD
• Rapidly progressive dementia + ataxia + startle myoclonus
What 2 diseases are associated with transverse myelitis
MS and NMO
What is Gerstmann syndrome and damage to what part of the brain is it caused by
Damage to dominant parietal lobe
♣ 1. Agraphia (inability to write)
♣ 2. Acalculia (inability to calculate)
♣ 3. Finger agnosia (inability to distinguish fingers)
♣ 4. Left-right disorientation
Damage to PPRF causes what?
Eyes look away from side of the lesion
Tx of tension HA
NSAIDs, Acetaminophen
Tx of cluster HA
100% O2, sumatriptan
Presentation of fetal hydantoin syndrome
o Caused by exposure to anticonvulsants (e.g. Phenytoin and Carbamazepine)
o Midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism, and developmental delay
What is the reticular activating system and where is it located
Located in the midbrain
Mediates consciousness and alertness
Tx of status epilepticus
IV Benzos
Phenytoin
IV Phenobarbital
What is Fioricet
Caffeine, Acetaminophen, Butalbital
Used for tension or muscle contraction HA
What part of CNS does pronator drift test for?
Pyramidal/corticospinal tract - UMN lesions cause more weakness in supinator muscles compared to pronator muscles
