Neuro Uwrold Qs Flashcards
Focal back pain, with progressive radiculopathy, motor and sensory weakness, bowel and bladder dysfunction. Dx? Next step in management? Rx?
Epidural Abscess. MRI of Spine. Immediate decompression to avoid cord compresison and/or cauda equina syndrome.
What is the CSF profile for GBS? Protein, WBC, RBC, Glucose.
Protein is High and everything else is normal
Parkinsonism, Autonomic dysfunction( orthostatic hypotension, sweating, disturbance of bowel and bladder) and widespread neurological signs (cerebellar, pyramidal, LMN) Dx?
Multiple System Atrophy
Name that stroke: Unilateral motor deficit (face, arm, hand.) Mild dysarthia, NO sensory, visual or higher cortical dysfunction.
Pure motor hemiparesis. Infarction in the posterior limb of the internal capsule.
Unilateral numbness, parasthesias, hemisensory deficit involving the face arm, trunk and leg. What type of lacunar stroke is this? Pathology?
Pure sensory stroke. Stroke in VPL of thalamus.
Weakness that is more prominent in the lower ext, along with ipsilateral arm and leg incoordination. What type of lacunar stroke is this? Pathology?
Ataxic- hemiparesis. Lacunar infarction of the anterior limb of the internal capsule.
Hand weakness, mild motor aphasia, NO sensory abnormalities. What type of lacunar stroke is this? Pathology?
Dysarthia clumsy hand syndrome. Lacunar stroke at the basis of the pontis.
Transient monocular blindness that lasts a few seconds. Curtrain coming down. Vascular in origin. Dx? Next step in management?
Amaurosis fugax. Carotid duplex US.
Name the site of hemorrhage: Hemiparesis, hemi-sensory loss, up gaze palsy, non reactive miotic pupils. Eyes deviate towards hemiparesis.
Thalamus
Name the site of hemorrhage: Can be associated with seizures, contralateral homonymous hemianopsia (occipital), contralateral plegia/paresi (frontal lobe), contralateral hemiparesis (parietal lobe) Eyes deviated toward lesion and opposite the hemiparesis.
Cerebral lobe
Name the site of hemorrhage: Deep coma and total paralysis within minutes after hemorrhage. pinpoint reactive pupils.
Pons
Described the speech, comprehension and repetition in Broca’s aphasia and wernicke’s aphasia.
Brocas: Sparse non fluent, comprehension preserved and repetition poor Wernicke: fluent but doesnt make sense, comprehension poor, repetition poor.
Butterfly appearance with central necrosis. Tumor?
Glioblastoma multiforme.
Name diseases that require MRI.
Spine Epidural Abscess, Acoustic neuroma, MS
Name the 4 criteria for brain death.
- Absent cranial nerves reflexes (gag and corneal) 2. dilated and fixed pupils. 3. No spontaneous breathing 4. Confirm with another physician.
Occipital HA with repeated vomiting and gait ataxia. Where is the region of hemorrahge?
Cerebellar Hemorrahge.
Rapidly progressing ascending paralysis over hours. 18 hrs. Dx?
Tick-Borne Paraylsis
Entrapment of the posterior tibial nerve. Pt feels numbness of the plantar aspect of the foot.
Tarsal Tunnel Syndrome.
After diagnosing Eaton-Lambert on a person from physical exam. What is the next step in management?
Get a CT to check for lung nodule (small cell lung cancer)
After diagnosing some one with cord compression and they present with neurological findings. What is the next best step in management?
IV dexamethasone then do MRI. Need to decrease the inflammation first if they are presenting with symptoms.
Loss of control of lower extremities and hypotension. Dx?
Spinal Shock syndrome.
Fracture then pt develops severe pain, swelling, redness, then atrophy of the appendages then atrophy of the skin. Dx? Test? Rx?
Complex pain syndrome (Reflex sympathetic Dystrophy.) Sympathetic block. Sympathectomy.
Small posterior fossa, downward displacement of the cerebellar vermis and medulla through the forament magnum. What other 2 findings is this associated with? Dx?
Arnold Chiari Type 2 malformation. Myelomeningocele and syringomyelia.
More common then Arnold-Chiari type 2 malformation but presents symptomatically. More common in adults and adolescents. Dx?
Arnold Chiari type 1 malformation.
Abnormally large posterior fossa, absent cerebellar vermis, ependyma-lined cysts that expands the 4th ventricle. Dx?
Dandy-Walker Malformation.
Rx for tension type HA?
Ibuprofen trial or OTC with caffeine.
Tumor presents with bugling of the brain stem. Dx
Brainstem glioma (contralateral hemiparesis and ipsilateral cranial nerve deficits) Common in children.
Only place where you have lost of consciousness from stroke?
PCA
What can cause seizures?
Hypo or hypernatremia, Hypocalemia, hypomag, uremia/hepatic failure, withdrawal from alcohol, barbs, benzo, cocaine and alcohol toxicity. Alcohol can cause withdrawals and toxicity seizures, infection, anatomic dz : stroke, tumor, abscess.
What test is done to determine the recurrence of seizures?
Deprivation sleep EEG - like a stress test for brain. This occurs after 2 years.
How do you tell the difference btw meningitis and subarachnoid hemorrhage? Both cause HA, fever, neck stiffness and photophobia.
Subarachnoid is more sudden onset of HA and there’s is LOC.
What are the side effects of Topamax, valproate, carbamazepine, levatreceitem.
Topomax - weightloss, hair loss, kidney stones
Valproate- LFTs, spinal bifida
Levetraticem- mood, Stevens Johnson
Carbamazepine - spinal bifida, decrease warfarin, agranulocytosis
Differnce btw CMV and MS when they both cause periventriuclar calcifications
CMV is an encephalitis so they would have more HA and AMS. MS they present with INO, transverse myelitis (weakness, no reflexes, loss of sensation) loss of bladder control, scanning speech
Young pregnant pt with progressive hearing loss and family members with progressive hearing loss. Dx?
Otosclerosis (immature bone with vascualr channels that causes ankylosis of the stapeidal foot plate) can also progress with pregnancy and OCP use.
Name 4 main drugs to treat neuropathic pain/diabetic peripheral neuropathy.
- Pregablin (lyrica). 2. TCA 3. Duexlotine (SNRI) 4. Controlled release oxycodone
Beta 2 transferin in nasal discharge is indicative of what?
CSF leak.
Pt has difficulty breathing for 6 days. 3 year hx of fluctuating weakness and fatigability. Weakness worse at night and improves with rest. Has droopy eyelids. Is intubated due to respiratory failure. Dx? Next step in management?
Myasthenic Crisis. Plasmapherisis.
Descending paralyssis with bilaeral ptosis, dysphagia, . Dx? Rx?
Botulinism toxin from canned foods. Antitoxin and abx.
