Neuro/NSx

Question 1

Transverse Myelitits

S/S

Answer 1

• S/S
  
  • LE paresthesia
  • LBP
  • Unil or Bilat LE weakness
  • Urinary retention
• Often insidious onset of paresthesia /weakness day-weeks then replaced wuth sudden stttic paraplefia/quadripelgia, sensory level
  
  • Sensory: usually all modalities : though can have ST tract deficit without dorsal column (proprio)
  • Motor: paresis can be replaced with spasticity overtime

Question 2

Transverse Myelitis

Investigations

Answer 2

• MRI w contrast
• LP: CSF cell count and testing for oligoclonal bands
• IgG: neuromyelitis optica IgG

Question 3

Transverse Myelitis

Mgt

Question 4

Torticollis

Causes

Answer 4

• Infectious/Inflammatory:
  
  • Diskitis
  • Epidural abscess
  • OM of spine
  • Meningitis
  • Cervical LAD
  • RPA
  • viral myositis/myalgia
• Trauma:
  
  • Trauatic AA instabilty
  • cervical sprain/strain (SCM, Trap)
  • clavicular #
  • C-spine # /ligamentous injury (less likely as torticollis only)

Question 6

Migraines:

• Types
• Triggers
• Abortive Tx

Answer 6

• Migraine subtypes:
  
  • Migraine with Aura
  • Migraine without Aura
  • Hemiplegic Migraine
  • Braistem/basilar migraine
  • Retinal Migraine
• Triggers:
  
  • Sleep
  • stress
  • Diet
  • Menses
  • Weather
  • Meds: OCP
  • Caffeine/Alcohol
• Classes Meds to Abort
  
  • NSAIDs
  • Tylenol
  • Triptans
  • Antiemetic

Question 7

Migraine Diagnostic Criteria

Without Aura

Answer 7

• At least 5 episodes fulfilling the following:
• Last 1 – 72 hours (untreated, or unsuccessfully treated)
• Headache has TWO of:
  
  • Bilateral or unilateral location
  • Pulsatile quality
  • Mod to severe headache quality
  • Aggravation by, or causing avoidance of routine physical activity
• During headache, at least ONE of the following:
  
  • Nausea +/- vomiting
  • Photophobia or phonophobia
• Not attributed to another disorder

Question 8

Migraine Diagnostic Criteria

With Aura

Answer 8

• Migraine WITH an AURAAt 2 episodes fulfilling the following:At least ONE of the following:
  
  • Fully reversible visual symptoms including positive features (flickering lights, spots, lines) or negative features (loss of vision)
  • Fully reversible sensory symptoms including positive (pins and needles) or negative features (numbness)
  • Fully reversible dysphasic speech disturbance
• At least TWO of the following:
  
  • Homonymous visual symptoms +/- unilateral sensory symptoms
  • At least one aura symptom develops gradually over 5 min or longer or different aura symptoms occur in succession over 5+ minutes
  • Each symptom lasts between 5 – 60 minutes
• Headache filling ‘migraine’ criteria begins during the aura or within 60 minutes after the aura
• Not attributed to another disorder