Neuro - Esper Flashcards
Clinical features and diagnostic tests for Creutzfeldt - Jakob disease
- CSF: 14-3-3 protein
- MRI: high signal intensity in the caudate nucleus and putamen bilaterally on T2
- EEG: characteristic bi- or triphasic spike wave complexes
- Patient presentation: rapidly progressing dementia and myoclonus
different peripheral nerve manifestations of diabetes
- Mononeuropathy (a single nerve) & Mononeuropathy Multiplex
- Symmetric Sensorimotor Neuropathy. The classic “glove and stocking” neuropathy
- Autonomic: GI and GU symptoms, impotence, and impaired sweating and vascular function
- Thoracoabdominal Radiculopathy
- Amyotrophy: Gradually progressive proximal leg weakness, Painful with NO sensory loss
Which nerves are lost first in diabetic neuropathy?
Small fibers (burning, tingling, numbness, pain) are lost first followed by large fibers (weakness, vibratory and position sense, numbness, areflexia)
Diagnostic tests for Polymyositis
Antinuclear antibody assay: positive in one third of patients with Polymyositis
MRI and ultrasonography: will show abnormalities due to inflammation of muscles
Biopsy: will show evidence of inflammation
Labs: serum creatinine and creatine kinase are commonly increased.
Signs and symptoms include: Symmetrical proximal muscle weakness, aches and cramping, morning stiffness, fatigue, anorexia, fever, weight loss, arrhythmias, dyspnea, dysphagia, aspiration, constipation, and reflux.
A manifestation that is due to the presence of a neoplasm or cancer, however, it is not caused by the local presence of the cancer. When the body mounts an immune response against a tumor, sometimes the antibodies that are formed recognize antigens that are similar to those present elsewhere in the body on healthy tissues. Because of this, these antibodies target the healthy tissues and cause damage to them.
Paraneoplastic syndromes
Lambert-Eaton Syndrome
most commonly due to small cell carcinoma of the lung, where antibodies are formed against presynaptic calcium channels of the neuromuscular junction
Proximal muscle weakness that improves with use. Dry mouth, pupils may not be reactive. No improvement of symptoms with use of anticholinesterase use. Often resolves with the resection of the tumor (commonly a thymoma)
Lambert-Eaton Syndrome clinical findings
Elevated intracranial pressure, headache, papilledema, and CN VI palsy. Spinal tap pressure (>250 mm H2O), MRI
Pseudotumor cerebri
Treatment: Self-limiting, diuretics, surgery (shunting)
- Straw colored/non-purulent CSF
- Increased lymphocytes
- Mildly elevated protein concentration
- Normal glucose concentration
Viral Infection
What signs do patients have to present with for Wernicke Encephalitis
Caine criteria for diagnosis in which patients must present with two of the following four signs: Thiamine dietary deficiency, oculomotor abnormalities, cerebellar dysfunction, either altered mental status or mild memory impairment. The Caine criteria are considered more sensitive for making a diagnosis.
Describe the diagnostic tests and signs and symptoms of Lyme disease
Localized: Bull’s eye rash (painless) lasting 1-30 days
Early Disseminated: meningitis, carditis, radiculoneuropathy, cranial neuropathy lasting weeks to months.
Late Disseminated: persistent arthritis and encephalopathy
- Explain common symptoms and signs of Myasthenia Gravis
Fluctuating weakness affecting facial and pharyngeal muscles, respiratory failure, aspiration, and muscle wasting in 10% of patients. Symptoms are better in the morning and get worse as the day progresses. The disease is usually associated with a thymoma. There are ocular and generalized forms (ocular symptoms in 40% initially and eventually appear in 85%).
Flu shots aggravate MG.
Treatment of Myasthenia Gravis
Pyridostigmine is used to treat MG.
Clinical presentation and treatment of cluster headaches
Cluster headaches are generally found more in men over 19 yo. There will be multiple attacks per day/week lasting 15mins - 3 hrs. Intensity is severe and unilateral in the supraorbital/temporal region. There is no aura but patients can have lacrimation and rhinorrhea. This often occurs at night and can lead to suicide.
Treament of cluster headaches
if symptomatic, Oxygen Dihydroergotamine Sumatriptan Sphenopalatine block Intranasal lidocaine Intranasal capsaicin Indomethacin Opioids
for prophylaxis. Verapamil Steroids Lithium Methysergide Valproic acid Neuroleptics Clonidine Daily triptans or ergots Daily opioids
Adrenoleukodystrophy
X-linked inherited disorder causing atrophy of the adrenal cortex and demyelination of the nervous system. This increases levels of very long chain fatty acids. Affects kids 4-8 years old.
Metachromatic leukodystrophy
Autosomal recessive caused by a defect in Arylsufatase A resulting in the accumulation of sulfatides causing myelin breakdown. Macrophages containing sulfatides bind to certain types of dyes, which change absorbance spectrum.
Alexander disease
Rare neurological disease in infants and kids which involves loss of myelin in the brain and accumulation of irregular extracellular fibers (AKA Rosenthal fibers)
Krabbe disease
Deficiency of Galactocerebroside Beta Galactosidase. Autosomal recessive
