Neuro Review Final Flashcards
1
Q
facial droop:
if can’t close eye all the way?
A
cn 7 (if weak eye closing, it could be UMN)
2
Q
facial droop. Location? Anything else involved like ____ or ____?
A
hyperacusis (this would be 7 right at nucleus on ipsilateral side) or taste? (this would be 12)
3
Q
Bell’s Palsey could result in:
A
Blinking reflex abnormal, earache, lacrimation problems, loss of taste in tongue, and seventh cn
4
Q
a cause of Bell’s Palsey could caused by:
A
HSV, diabetes infarction, etc, treat with steroids and antivirals
5
Q
if Bell’s palsey with lesions around the ears:
A
hsv reactivation causing bell’s palsey, use avalcyclovir of steroids (they help all inflammation)
6
Q
don’t give steroids to a diabetis:
A
it’ll raise their blood sugar
7
Q
palate elevation:
A
cn9 and 10
8
Q
pupillary response:
A
cn 2 and 3
9
Q
dystarthia:
A
10 or 9 and 10
10
Q
Tongue and palate 9, 10, 12 always trip you up because they travel on the same side down the _____ until:
A
cortico bulbar tracts from the motor cortex in the brain until they get to the level they want to be and then they cross over (this is why they will show opposite facial side findings from the other problems)
11
Q
if you have a pontine lesion, you will have a bell’s palsey on the ipsi side, and then possibly a:
A
palate elevation on the other side, tongue deviation, hemiparesis, etc on the other side
12
Q
hoarsness:
A
vegal fibers
13
Q
all one side sensory loss, face and body:
A
brain
14
Q
what parts of the brain can only be responsible for sensory loss?
A
thalamus
15
Q
if cortex can be responsible for sensory loss, why can’t a storke in the cortex give you all one sided sensory loss?
A
the motor and sensory cortex share the same blood supply
16
Q
all sensory information (other than smell) has to go through the____
A
thalamus
17
Q
can sensory loss be from cerebellum lesion?
A
no!
18
Q
Note that complete loss of all sensory everything on face and body means a ______ lesion on the _______ side
A
thalamus, opposite side from the loss
19
Q
T12 loss of all pain and temp as well as motor, but still has vibration and sensation:
A
anterior cord syndrome, bilateral at level of t12, and this was caused by a rupture of the anterior spinal artery infarct
20
Q
if hands are weaker than shoulders, it must be:
A
nerve
21
Q
if muscles are weaker than hands:
A
muscle
22
Q
if spinal cord, there can’t be problems:
A
above and below the paralesis
23
Q
distal weakness, areflexia, all points to:
A
nerve problem
24
Q
gradually weaker (subacute) , ascending weakness, areflexia, no sensory loss, POSSIBLY BIFACIAL WEAKNESS:`
A
guillain-Barre
25
acute right-sided weakness, dyarthric but not aphasic, right facial droop that spares the forehead, right side hemiparesis, no sensory loss
everything on one side: brain!
| does not have to be umn or lmn, etc.
26
if nothing in the differential says anything about distal here, proximal there, and everything is affected on one side, it's:
brain, regardless of things like aphasia, reflexes, etc, opposite side internal capsule
27
if you have all sensory loss on one side, it is most always ___ but occasionally it can be a _____
internal capsule stroke (2/3), ventral pontine stroke getting the coricospinal tract above where the facial nucleus is located (1/3)
28
if someone has a stroke that effects the thalamus, they may not be _______ right away
hyperreflexic, espeically diabetics
29
unconscious man with small pupils, minimally reactive, eyes don't move horizontally but intermittently spontaneously deflect downward and come back, no movement horizontally to cold calorics, blink to corneal reflex, no facial grimace to pain, slight gag, no motor movement to pain, increased tone, reflexes are hyperactive and both toes go up, bilateral clonus
unconscious must be brainstem!
| no eye movement
30
if you have no eye movement on exam, the lesion must be:
in the brainstem
31
if eyes don't move horizontally and don't move to cold water it is a problem with :
pprf!
32
if pprf problem, the lesion must be in the:
pons
33
if you had a lesion in the midbrain, the pupils would be:
dilated (3rd nerve pupils)
34
when there is a lesion in the pons, the pupils will be ____
small
35
ocular bobbing and bilateral motor loss
pontine lesion
36
what causes lesions in the pons?
basilar stroke, pontine lesion (high BP)
37
if you have ______ you are not brain dead
any gag, eye constriction, posture i.e. decorticate posturing, babinsky, clonus
38
if you herniate your brain and squish your brainstem, as long as you are ____, you're not brain dead
breathing (last thing to go)
39
first thing to go in a herniation?
eye reflex of cn3, because midbrain is first to go
40
in herniation, your _____ is crushed before you have crushing of the _____, and then you get:
3rd nerve, pprf, big pupil
41
one of the first signs from someone who is suffering a hermorrhagic stroke is:
their pupil enlarging on side you are starting to mash
42
in downward herniation, you would have dysfunction of ____ before ____
midbrain dysfunction before pontine, so at least 1 blown pupil from 3rd nerve compression
43
if weakness in hip, no sensory loss, no dysmetria, and decreased reflexes and symmetric with toes down?
muscle
44
if shouler or hip are weaker than hands and feet, it is:
muscle problem, also symmetric
45
______ is the most common drug-induced myopathy we will see:
statin induced muscle disease, also could be steroids, hiv, etc
46
______ is the most common drug-induced myopathy we will see:
statin!!! induced muscle disease, also could be steroids, hiv, etc
47
pronator drift is a sign of _____
subtle sign of proximal muscle weakness
48
proximal weakness in one limb:
nerve also decreased reflexes in that limb
49
most common moneuropathy?
carpel tunnel (median nerve)
50
if radiculopathy, you have weakness in____ and it is usually accompanied by ______
all muscles supplied by that nerve are affected, and accompanied by neck pain and radiating pain
51
turners syndrome is an infammation of the brachial plexus and can present with:
fasciculations looking like als
52
mixed findings (upper motor neuron findings or hyperreflexia, babinsky signs, lmn signs of muscle atrophy and fasciculations, motor weakness in atrophied and fasciculating limbs, cranial nerve involvement from palatal weakness, tongue atrophy
ALS, lower motor neurons and the origin in brain motor cortex atrophy
53
in als, a spinal cord problem would explain:
some of the muscular findings but not the corticobulbar findings
54
in als, the fasciculations aer a result of:
the motor nerves dying and they have random firing of the muscles they used to innervate (fasciculations are from nerves)
55
On exam he is an elderly gentleman. Speech is mildly hypophonic but mental status appears intact. He has decreased eye blink and facial expression. On extra-ocular testing he has full horizontal excursions but impaired up gaze and he really can’t look down. There are no other cranial nerve findings. His motor strength is normal but he has markedly slowed rapid alternating movements and has diffusely increased tone bilaterally. There is no tremor. Gait is slow and shuffling. He retropulses with the “pull” test
Brain problem, hypophonia, shuffling gate, balance: parkensonian
56
hall mark signs of parkinsons:
bradykanesia with rigidity (you can have it without having a tremor), instability
57
2nd most common cause of dementia after AD (accompanied by halucinations, etc)
lewy body disease
58
multi-system atrophhy parkinsonian type
autonomic disease
59
parkinsonian rigidity, postural instability, vertical problem moving eyes (first can't look down, then can't look up, then frozen) pd medicines don't work, no tremor:
progressive supranuclear palsy often misdiagnosed
60
someone who presents with recent falls all of a sudden___. Someone comes in looking stiff for a few months and starts falling:
probably not pd, pd the falls come after you've had it for several years, progressive supranuclear palsy (or lewy body or sma)
61
71 year old woman with hypertension, hyperlipidemia and coronary artery disease presents with progressive weakness and gait instability and falls. She thinks that she has been having trouble with her balance for a year or two but the last 6 months have progressed to where she is falling almost daily and is now walking with a walker. Her family has also noted trouble with her memory and forgetfulness…
On exam she has mild memory deficits that you are able to elicit on exam. Otherwise mental status and language are normal. There are no cranial nerve abnormalities.
On motor exam she has moderate weakness in the legs at 4/5 throughout. She has mild weakness in her upper extremities. There is mildly increased tone. There is no atrophy. There is no tremor.
On sensory exam she has profound loss of vibration and proprioception in her feet and mild impairment in the limbs. She has a distal, symmetrical loss to pain and temperature in her feet as well.
Reflexes are hyperactive throughout with bilateral Babinski signs
subacute combined degeneration
62
als might give some dementia really late but never:
sensory! Cross it off the list once you see sensory loss
63
subacute combined degeneration is caused by:
b12!!
64
b12 looks like:
slight abnormal finding in the top of the dorsal column on ct
65
what two nutritional deficiencies do we cover?
b12 and copper
66
slow evolution of gait difficulty, bladder dysfunction, apresthesias, hyporeflexia, imparied position and vibration sense, and anemia
vit b 12
67
even with eating a high b12 diet, you can have b 12 deficiency if you hav a lack of
if
68
spastic paraparesis and polymorphonuclear cells on peripheral blood smear help diagnose
b12 deficiency
69
61 yr old develops progressive cramping in the legs and pins and needles sensation in feet over the course of a year. He consults a physician when he noticed paresthesias in his hands and unsteady gait. his family reports some urinary incontinence, and on exam he has spastic paraparesis with severe disturbance of position and vibration sense in his legs. Deep tendon reflex is absent and the knees and ankles
b 12 deficiency
70
copper deficiency looks exactly like:
b12 deficiency
71
subacute combined degeneration
Exam
He is non-fluent on language exam with trouble naming. He can follow simple commands but no multi-step commands. He cannot repeat.
He has a left homonymous hemianopsia
He has a right facial droop
R arm is plegic, right leg has 3/5 strength
Left arm drifts and has 4+/5 strength, left leg has minimal weakness
He has right sided sensory loss
He extinguishes to DSS on the left.
Reflexes are hyperactive everywhere and both toes go up
has to be brain
has to be both sides: aphasic, right side weak: has to be left cortex
left side weak with left field cut, some neglect: has to be right cortex
afib and embolised to both hemispheres
72
aphasic, right side weak: has to be left cortex
left side weak with left field
cut, some neglect: has to be right cortexReflexes are hyperactive everywhere and both toes go up
patient with afib and embolic shower to both hemispheres, multi-focal process
sudden: stroke
73
78 year old man with history of HTN, DM, HLD, CAD and smoking presents to the ED with a 30 minute history of neurological dysfunction that has completely resolved. He said that he was watching the Masters and had sudden onset of complete vision loss in his left eye and right-sided weakness involving arm and leg. His wife noted that the right side of his face was drooping as well. His speech was slurred and he was having trouble speaking. He notes that if he closed his left eye, that the vision was completely normal out of the right eye. He has no symptoms now.
His home medications include aspirin, metformin, metoprolol, lisinopril and atorvastatin
```
cortical signs of vision loss
hemibody weakness
possible aphasia
for 30 min
TIA
```
74
if stroke or tia is caused by left mca, you get:
monocular vision loss in one eye
75
monocular vision loss in one eye
| what artery supplies the eye?
optic nerve, or opthalmic artery, which is the first branch off the ICA
76
tia in territory of carotid, you have to _______, while ____ is never the answer for TIA
get it fixed asap (2 days up to 2 weeks)
| heparin drip for acute stroke
77
if you have a venous sagital venous thrombosis in your head:,
heparin may be the answer, but otherwise, heparin is never the answer
78
arterial ischemic strokes:
heparin is never the answer
