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MS3 > Neuro 8 > Flashcards

Neuro 8 Flashcards

1
Q

What is transverse myelitis and what disease is it associated with

A

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
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2
Q

What is Lhermitte’s sign

A

• Tingling, electric sensation down the spine when the patient flexes the neck

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3
Q

MRI findings in MS

A

♣ Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
♣ T2 hyperintense areas in the white matter of the brain or spinal cord

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4
Q

CSF findings in MS

A

♣ Increased protein

♣ Oligoclonal IgG bands

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5
Q

Tx of acute MS flares

A

corticosteroids

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6
Q

Chronic tx of MS

A

interferon beta

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7
Q

Sx of multiple sclerosis

A

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

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8
Q

What are the 2 components of presentation of neuromyeltiis optica (NMO)

A

♣ 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

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9
Q

Diagnosis of NMO

A

♣ Antibodies to aquaporin-4 channel

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10
Q

Treatment of NMO

A

♣ Steroids

♣ Chemotherapeutic agents

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11
Q

Pathophys of progressive multifocal leukoencephalopathy

A

o Caused by JC virus

o Leads to demyelination by infecting oligodendrocytes

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12
Q

Presentation of PML

A

o Characterized by dementia, focal cortical dysfunction, cerebellar abnormalities

Non-enhancing multifocal brain lesions

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13
Q

Causes of posterior reversible encephalopathy syndrome (PRES)

A

o Usualy develops in the context of rapidly developing HTN and eclampsia or due to immunosuppressants used in organ transplant

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14
Q

Presentation of Posterior reversible encephalopathy syndrome (PRES)

A

♣ Headache
♣ Altered consciousness (acute confusional state)
♣ Visual disturbances (cortical visual loss – blindness with preserved pupillary reactivity)
♣ Seizures

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15
Q

Presentation of PSP

A
  • 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
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16
Q

Diagnose: acute painless monocular vision loss with cherry red spot

A

Central retinal artery occlusion

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17
Q

Diagnose: light flashes, floaters, or curtain across visual field

A

Detached retina

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18
Q

Presentation of central retinal vein occlusion

A

Painless, sudden vision loss

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19
Q

Presentation of myasthenic crisis

A 
♣	Precipitating factors
•	Infection or sugery
•	Pregnancy or childbirth
•	Tapering immunosuppressive drugs
•	Medications 
♣	Signs/symptoms
•	Increased generalized and oropharyngeal weakness
•	Respiratory insufficiency/dyspnea
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20
Q

Tx of syphilis

A

Penicillin

21
Q

What are features of TB meningitis (other than CSF) that differentiate it from bacterial meningitis

A

Usually affects the basal meninges (at base of brain) - so more likely to present with CN palsies

Slower onset

22
Q

Describe CSF findings of TB meningitis

A 
Cells = lymphocytes
Protein = high
Glucose = very low
23
Q

CSF of viral meningitis

A 
Cells = lymphocytes
Protein = high
Glucose = normal
24
Q

What are the 2 things to think of with ring-enhancing lesions in AIDs patients

A

Toxoplasmosis

CNS lymphoma

25
Q

Neurocysticercosis is caused by what?

A

Eating EGGS of taenia solium

26
Q

Tx of neurocysticercosis

A

Albendazole

27
Q

What is spinal shock?

A

Flaccid weakness and absent DTRs immediately after spinal cord injury

Spasticity and other UMN signs will develop over the next few days to weeks

28
Q

Hemispatial neglect is caused by damage to what?

A

Non-dominant parietal cortex (usually R side)

29
Q

What is 1st, 2nd, and 3rd line tx for pseudotumor cerebri

A

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

30
Q

Enzyme deficient in Lesch Nyhan syndrome

A

HGPRT (hypoxanthine-guanine phosphoribosyl transferase)

31
Q

Clinical features of post-concussive syndrome

A

♣ HA, dizziness, sleep disturbance, cognitive impairment, behavioral abnormalities (e.g. irritability)

32
Q

Tx of post-concussive syndrome

A

♣ Focus on individual components of syndrome with tx of each separately

33
Q

Describe presentation of Guillain-Barre

A

♣ 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

34
Q

CSF for Guillain Barre

A

♣ High protein with few cells

35
Q

Tx of Guillain Barre

A

♣ IV immunoglobulin or plasmapheresis

36
Q

What do you think when you see periodic sharp waves on EEG in a demented patient

A

CJD

37
Q

What will you see in CSF of CJD patient

A

protein 14-3-3

38
Q

Other than dementia, what are the other clinical features of CJD

A

• Rapidly progressive dementia + ataxia + startle myoclonus

39
Q

What 2 diseases are associated with transverse myelitis

A

MS and NMO

40
Q

What is Gerstmann syndrome and damage to what part of the brain is it caused by

A

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

41
Q

Damage to PPRF causes what?

A

Eyes look away from side of the lesion

42
Q

Tx of tension HA

A

NSAIDs, Acetaminophen

43
Q

Tx of cluster HA

A

100% O2, sumatriptan

44
Q

Presentation of fetal hydantoin syndrome

A

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

45
Q

What is the reticular activating system and where is it located

A

Located in the midbrain

Mediates consciousness and alertness

46
Q

Tx of status epilepticus

A

IV Benzos
Phenytoin
IV Phenobarbital

47
Q

What is Fioricet

A

Caffeine, Acetaminophen, Butalbital

Used for tension or muscle contraction HA

48
Q

What part of CNS does pronator drift test for?

A

Pyramidal/corticospinal tract - UMN lesions cause more weakness in supinator muscles compared to pronator muscles

MS3 (88 decks)

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