Neurology Flashcards
pt presenting w/ aphasia, contralateral weakness, hemisensory loss, & facial droop is consistent with a stroke located to the ___
LEFT MCA
- usually left (bc that is the dominant hemisphere for right handed pts)
what are the clinical findings in posterior inferior cerebellar artery (PICA) occlusion
= Wallenberg syndrome
(Lateral medullary syndrome, Posterior inferior cerebellar artery syndrome)
- contralateral decrease in limb pain & temp (lateral spinothalamic tract)
- ipsilateral decrease in FACIAL pain & temp
- horner syndrome
- hoarseness, dysphasia
- vertigo, ataxia,
Postherpetic neuralgia always shows up where?
location of previous shingles flare.
compared to trigeminal neuralgia which is always on the face!
Young woman with muscle aches, depression, and NORMAL labs has _______.
Fibromyalgia
HYPERTENSION > rupture of what types of vessels in the basal ganglia/internal capsule
rupture of small PENETRATING arteries
what vessels is ruptured after a TBI & clx presents with passing out/lucid interval?
what does it look like on non contrast CT?
middle meningeal artery
Epidural hematoma==biconvex bleed (looks like a lemon cut in half)
What is the purpose of the Rinne hearing test?
what does a + vs - Rinne test indicate?
Rinne identifies a conduction problem, ie when bone»_space;> air
+ = can hear at bone AND at air = no conduction problem
- = can hear at bone NOT at air = YES conduction problem
what are common causes of conduction hearing loss?
anything that affects the outer & middle ear
ear wax
otosclerosis in young ppl (stapes in middle ear)
pagets in older ppl
What is the purpose of the Weber hearing test?
what does lateralization in the Weber test indicate?
Weber is done after Rinne to determine which ear(s) is affected
no lateralization = bilateral hearing loss
lateralization:
- Sound lateralizes to the affected ear in patients with conductive hearing loss (bc bone on top of head is felt by bone on mastoid)
- and to the healthy ear in patients with sensorineural hearing loss (cant hear shit so goes to good ear)
what vessels is ruptured after a TBI & clx presents in older pts/alcoholics?
what does it look like on non contrast CT?
bridging veins
crescent shaped (looks like a banana) old ppl love bananas
midbrain atrophy with an intact pons (hummingbird sign) is mnemonic for what palsy?
progressive supranuclear palsy
- lose balance
- can’t focus with eyes
- Parkinsonism
a pt with parkinsonism, gait instability, and vertical gaze palsy has what neuro palsy?
progressive supranuclear palsy
which form of neurofibromatous presents with BILATERAL vestibular schwannomas?
NF2. vestibular schwannomas are bilateral = 2 = NF2
** NF1, 1st you SEE, then you hear (NF2) **
what eye problems arise in NF1?
optic glioma, lisch nodules
what arteries would cause CN 3/occulomotor palsy if they had growing aneurysms?
think of the anatomy
Posterior communicating artery***
Posterior cerebral artery
Superior cerebellar artery
3 reasons to give ECT
anorexia from food refusal
suicidal
psychosis
> > do ECT bc it works faster & this pt could die without it
what is the order of events for Conduct disorder, Oppositional defiant disorder, and Antisocial personality disorder?
begins in childhood with oppositional defiant disorder (deliberately ignores/opposes adult control) for >6 months
pt gets older and develops Conduct disorder for 1 YEAR (a menace to society w/ criminal behaviors)
once legally adult (18yo) = antisocial personality disorder
anytime you read about a rapidly progressive malignant brain lesion (weeks) the answer is
Astrocytoma = glioma
where are astrocytomas/gliomas located in the brain on imaging?
Supra-tentorial (aka above the cerebellum & in the cerebrum) & crosses midline (butterfly glioma)
a ring enhancing, malignant lesion on brain MRI =
astrocytoma/gliomas are ring enhancing butterfly lesions
what age do people have gliomas/astrocytomas?
mid life/older
what age do people have medulloblastomas?
YOUNG children
what do meningiomas look like on MRI?
are meningiomas complicated or asymptomatic?
a homogenous white ball of meningeal fluid :)
asymptomatic an usually found incidentally on brain imaging :)
where are medulloblastomas located in the brain on imaging?
what do they normally compress?
INFRA-tentorial region of the CEREBELLUM
they compress the 4th ventricle/medulla (thats why its called medulloblastoma)
what are the symptoms that a child has with medulloblastoma?
intracranial pressure (e.g., papilledema, vomiting, headache) from non-communicating hydrocephalus (the 4th ventricle is obstructed by the tumor that arises from the cerebellum)
ataxia/gait probs (cerebellar vermis obstructed)
where are hemangioblastomas usually located in the brain on imaging?
cerebellum
what age group gets hemangioblastomas ?
HE-man == middle aged ppl w/ von-hipple-lindau
what do hemangioblastomas look like on brain MRI?
small, nodular, hyperintense (bc of bright blood) lesions
hemangioblastomas produce what hormone?
EPO»_space;> secondary polycythemia
what is the mnemonic fr von hippel lindau syndrome?
Hemangioblastomas ↑ risk for RCC Pheochromocytoma Pancreatic lessions Eye Lesions
Idiopathic intracranial hypertension is in what gender & age group?
young females (premenopausal)
How do you know a patient has had a PURE motor stroke?
pt will have WEAKNESS WITHOUT SENSATION LOSS
or other stroke sym like hemi-neglect, aphasia, etc
what arteries are infarcted during a pure motor stroke?
what area of the brain do these arteries supply?
leticulostriate arteries
leticulostriate arteries supply the internal capsule
what is the roadmap to the dead ending leticulostriate arteries located in the internal capsule?
internal carotid > MCA > leticulostriate arteries
what is the cause of leticulostriate lacunar infarcts/strokes?
HTNNNNNNNNN HYPERTENSION HTNNNNNNN!
Cerebral vasospasm only occurs after what brain complication?
cerebral vasospasm increases the risk of what brain complication?
3-21 days after SAH, there is a constriction of affected blood vessels> cerebral vasospasm
communicating hydrocephalus (CSF is trapped in the sub arachnoid space)
what are the 4 major criteria for Dissociative Identity Disorder (DID)?
1) Hx of physical/sexual abuse or childhood neglect
2) 2 or more completely different identities
3) Pt cant recall identity changes = severe memory gaps
4) derealization (feel like they aren’t real/aren’t a part of the world)
what tonicity of solution will cause cerebral edema?
Hypotonic solution (5% dextrose or 0.45% saline)
giving a pt a hypotonic solution» fluid travels into brain > cerebral edema
WATER follows solute
what is the first line treatment for pts with mild SIADH?
FLUID RESTRICTION!!!!!!
what is the 1st line treatment for a pt with symptommatic/acute (lethargic/hyporeflexia/AMS) SIADH?
hypertonic saline solution (then fluid restriction; restoring sodium takes priority in pts w/ symptomatic SIADH)
what are the characteristics of the tremor in Huntingtons disease?
A-rrhythmic, myoclonic, jerky
a patient acting out his dreams =
what disease is it associated with?
REM sleep disturbance == Parkinsons disease
What is the meaning of “aseptic” meningitis?
what is the most common cause?
Gram staining of the CSF is negative in viral meningitis, hence the name “aseptic” meningitis.
Most common cause of aseptic/viral meningitis = Coxsackievirus (Enteroviruses)
does HSV cause meningitis?
what are the CSF findings specific to HSV?
NOOOOO ; HSV causes encephalitis!! And it is the most common cause of viral encephalitis!
HSV CSF:
lymphocytic pleocytosis (>75-95%)
RBCs
what are the Clx of HSV encephalitis
- seizures
- AMS & personality changes
- Focal neuro DEFICITS (of the medial temporal lobe; aphasia, hemiparesis, ataxia, hyperreflexia)
tingling sensation in the arms and hands is pathognomonic for:
what malformation is it associated with?
Syringomyelia (a syrinx= abnormal fluid filled cavity that forms in the spinal cord as a result of noncommunicating hydrocephalus)
Chiari malformations (both)
which Chiari malformation ALWAYS has Myelo-mening-ocele at birth?
why?
Chiari 2
The Myelo-mening-ocele kicks off start of events in Chiari 2:
- Myelomeningocele (severe spina bifida) is a sac filled with spinal cord & meninges that has been DRAGGED caudally/downward
- the caudal displacement from the Myelomeningocele causes caudal displacement of EVERYTHING above (brainstem, 4th ventricle, & cerebellum)
- > > non communicating hydrocephalus»_space;> Syrinx formation»_space; Syringomyelia
onset of symptoms in Chiari malformation 1 vs 2
Chiari 1= not symptomatic until adolescence
Chiari 2 = immediately symptomatic in infancy
when is the onset of symptoms in NF 1&2
both onset in adolescents!!
what other brain tumors are commonly associated/seen with the bilateral schwannomas of NF2?
Meningiomas (benign)
Ependymoma (deadly, die in 5 yrs)
NF2= u & ME (meningioma + ependymoma)
Ependymoma
- path ✓
- epidemiology
- MRI dx findings
- path dx findings ✓
- path: tumor of the ependymal cells that line the ventricles> COMMUNICATING hydrocephalus
- epidemiology: children & young adults
- MRI: intra-parenchymal tumor with CALCIFICATIONS and CYSTIC components due to necrosis and/or hemorrhage
- Biopsy: Perivascular pseudorosettes
Dandy-Walker malformation
- patho
- MRI findings
- extracranial findings
- patho: the 4th ventricle never closes. It takes over the posterior fossa= LARGE empty space in back of brain w/ very tiny cerebellum
- MRI: LARGE hyperechoic (bc IV fluid) CYSTIC space in the posterior fossa + non communicating hydrocephalus
- facial defects, cardiac defects, spina bifida, ataxia
finger to nose/heel to shin test diagnoses a lesion/problem in what part of the cerebellum?
what form of ataxia is this?
lateral cerebellar hemispheres
LIMB ataxia
tuncal ataxia presents with what PE findings?
damage to what part of the cerebellum> truncal ataxia?
inability to SIT UP or STAND up straight
cerebellar VERMIS
what are the diagnostic clinical features in alcoholic cerebellar degeneration?
CHRONIC alcohol use (>10 yrs)
TRUNCAL ataxia
Gaze-evoked nystagmus
Wernicke encephalopathy and Korsakoff syndrome are often grouped together bc they share etiology of Thiamine deficiency, BUT they are completely different conditions!!
Which condition is reversible vs irreversible?
wernicke = reversible bc its an ACUTE thiamine deficiency
korsakoff = irreversible bc its a CHRONIC deficiency of thiamine
mnemonic for wernicke encephalopathy
Wernickes COAT
C= confusion O= oculomotor dysfunction via gaze induced (nystagmus when you stare) or conjugate (nyastagmus when you try to look laterally), + diplopia A= ataxia T= admin thiamine then glucose
mnemonic for Korsakoff syndrome?
Korsakoff’s KART
K- Konfabulation (fabricated memories)
A- Anterograde amnesia
R- Retrograde amnesia
T- temper changes
what direction do the EYES usually go during a STROKE?
eyes always deviate to the side of the lesion (ie left sided weakness = eyes deviate to the right where brain lesion is)
what direction do the eyes deviate during a THALAMIC stroke?
thalamic stroke== “wrong way eyes”
eyes will deviate away from the side the lesion is on!
what classic pupil findings are in a thalamic (“wrong way eyes”) stroke?
pupils = MIOTIC and NONREACTIVE
thalamic = eyes look in wrong direction & are wrong size (miotic)
what type of meningitis has a CSF fluid analysis just like viral/aseptic meningitis, BUT has NORMAL WBC count?
GBS meningitis ==== albumino-cytologic dissociation (PROTEIN—CELL dissociation)
has viral CSF findings (high protein) with a NORMAL WBC count!
Uncal herniation (midline shift) compresses the ipsilateral oculomotor nerve leads to:
Ipsilateral oculomotor nerve palsy → FIXED & DILATED pupil
Uncal herniation (midline shift) compressing the ipsilateral posterior cerebral artery leads to what type of vision loss?
Ipsilateral posterior cerebral artery → CONTRALATERAL homonymous hemianopia
Uncal herniation (midline shift) compressing the contralateral cerebral peduncle leads to:
Contralateral cerebral peduncle → ipsilateral paralysis (aka Kernohan notch phenomenon):
- a paradoxical ipsilateral weakness (due to contralateral cerebral peduncle compression).
- This is unusual because commonly, an ipsilateral brain lesion results in contralateral motor symptoms. It occurs in patients with increased ICP caused by intracranial hemorrhage or cerebral edema.*
skull xray showing: Periosteal trabeculations with radiolucent marrow hyperplasia
Thalassemia or SCD
skull 3 xray findings for dx of Pagets?
- cortical bone is thickened
- lytic lesions
- sclerotic lesions
Presbycusis is always ________ sensorineural hearing loss
BILATERAL!
early vs late symptoms of an acoustic neuroma
Early: compression of the vestibulocochlear nerve (CN VIII) in the cerebellopontine angle
- cochlear: unilateral tinnitus & sensorineural hearing loss
- vestibular: dizziness
Late: compression of more nerves located in the cerebellopontine angle
- CNV- facial pain
- CNVII- facial weakness/paralysis
- Cerebellum- ataxia
- 4th ventricle- hydrocephalus
what are the clinical features of HIV associated encephalopathy?
subacute onset:
- MEMORY impairment
- DEPRESSION symptoms, and
- MOVEMENTTTTTT disorders (ataxia, dysdiadochokinesia).
ALL encephalopathy has a change in
MOOD (depression, affect, personality)
differentiate between onset & clinical findings in
Medullaris
vs
Cauda equina
Medullaris = SYMMETRIC , UMN & LMN signs + early bladder/bowel problems
cauda equina = ASYmmetric , LMN signs only + LATE bladder/bowel probs
malingering is the answer if a pt :
gains/benefits in the question stem. (ignore the symptoms and LOOK for the gain!)
(ex. doesnt want to return to work, hx of lying in past, avoiding/attention seeking)
conversion disorder is the answer if a pt:
Is in a stressful situation & that stress manifests as REAL symptoms that dont make sense!!!
(will have proof from someone else who is worried about them)
mastoiditis is a complication of :
what are the clx findings?
prolonged otitis media infection
swelling & erythema behind the ear (mastoid) that displaces the actual ear
+/- neck mass (severe)
what is imaging & tx for mastoiditis
only image w/ CT of temporal bone/mastoid if theres a mass (neck)
tx: vancomycin (covers staph and strep)
pts w/ a recent stroke will experience what type of dysphagia?
how do you dx?
oropharyngeal dysphagia (cant initiate a swallow bc of weak mouth/throat muscles)
dx: Videofluoroscopy (direct visualization of the entire swallowing process using continuous x-rays and barium contrast. This diagnostic test evaluates the patient’s risk of aspiration and determines whether the patient might benefit from supervised feedings, swallow rehabilitation therapy, and/or enteral nutrition)
Bells palsy is a PERIPHERAL facial palsy (complete ipsilateral weakness) that most commonly occurs:
what is the prodrome sensation of the ear?
idiopathic == just a clinical diagnosis
prodrome = Painful sensation around or behind the ear , Impairment of taste in the anterior tongue
Hyperacusis
