Neurology Flashcards
Carries a risk of permanent visual loss in 20-50% if untreated. Associated s/sx include polymyalgia rheumatica, headache (in 40% to 90%), weight loss (16% to 76%), scalp tenderness (28% to 91%), anorexia (14% to 69%), fever, leg claudication (2% to 43%), and jaw claudication (4% to 67%)
Giant Cell Arteritis
Headaches associated with ___ may be unilateral or bilateral and are often temporal; Seldom throbbing and more often dull or boring with superimposed episodic icepick-like, lancinating pain. The headaches are often worse at night and often aggravated by exposure to cold. Scalp tenderness is often present
Giant Cell Arteritis
Hemisection of the spinal cord, most often produced by an extra medullary lesion, results in ___ which consists of s/sx: loss of pain and temperature sensation contralateral to the hemisection, ipsilateral loss of proprioceptive, ipsilateral spastic weakness, and segmental lower motor neuron and sensory signs
Brown-Sequard syndrome
____ most likely presents with variable quadriparesis with the upper extremities more severely involved than the lower extremities, and with some degree of sensory sparing
Central Cord Syndrome
Compression of the third nerve by ___ characteristically causes dilatation and unresponsiveness of the pupil. Oculomotor paresis may be incomplete with at least one element of nerve dysfunction (i.e., ptosis, mydriasis, or extraocular muscle weakness) absent
Aneurysm
___ is characterized by macular degeneration with visual hallucinations
Charles-Bonnet Syndrome
Indicated for the tx of Crohn’s and MS; There is an increased risk of the development of progressive multifocal leukoencephalopathy (due to JC virus infection) with its use
Natalizumab
A 20 y/o man p/w acute onset of HA, and pain surrounding his left eye; also w/ nasal stuffiness, rhinorrhea, and redness of the sclera of the left eye. He has about 1-2 headaches per day. In addition to sumatriptan and steroids, what is effective in acute tx?
High-flow oxygen treatment (Cluster headache)
The 3 classes of medications that are most effective for migraine prevention are ___
antiepileptics, antidepressants, and antihypertensives
___ result in an inability to depress either eye fully in adduction; a positive Bielschowsky test on tilt to either shoulder
Bilateral fourth nerve palsies
___ results in weakness and atrophy of the quadriceps and sensory loss of the anteromedial thigh
Femoral neuropathy
___ typically involves variable motor loss in the lower extremities with loss of bowel and bladder function
Conus medullaris syndrome
Patients with ___ develop unilateral or bilateral asymmetric buttock, thigh, or leg pain, and occasionally neurologic signs (e.g., numbness, loss of reflexes, or paresis) after exertion
Lumbar stenosis
___ p/w inability to walk, gaze palsy without hemiplegia, and absence of unilateral limb paresis
cerebellar infarct or hemorrhage
In acute ischemic stroke, aspirin, if not contraindicated, should be given within ___
first 48 hours
In acute ischemic stroke, IV rt-PA should be given within ___
first 3 hours
Drunk person, compressing the ___; p/w severe wrist drop with marked paresis of elbow and wrist extension, supination of the forearm, extension of all 5 metacarpophalangeal joints, and extension and abduction of the thumb + sensory loss over the entire extensor
radial nerve
Severe unilateral head or eye pain lasting minutes and associated with autonomic manifestations with frequent attacks per day, more likely in women
Paroxysmal hemicrania
Most characteristic visual aura of migraine is a ___ (occurring in about 64% of cases), beginning as a hazy spot from the center of a visual hemifield followed by shimmering light of different patterns expanding peripherally
Scintillating scotoma
Pain due to nociceptor dysfunction that persists after the rash subsides in a region affected by herpes zoster (HZ) virus reactivation (i.e., shingles).
Postherpetic neuralgia
A 42 y/o man initially complained of tingling of the feet and fingers. Over the next 1-2 weeks –> progressive symmetrical weakness of the legs and then the arms, both proximally and distally, accompanied by pain in the low back and legs. Reflexes were diffusely absent and toe signs are flexor. What is dx and tx?
GBS; tx/ IV immunoglobulin or plasma exchange
SOD-1 protein is abnormally deposited in ___
Amyotrophic lateral sclerosis
Degeneration of the large anterior horn cells of the spinal cord is seen in ___
Amyotrophic lateral sclerosis
The pattern of subacute, progressive proximal and symmetric limb muscle weakness, without involvement of the cranial nerves and preservation of sensation and reflexes, should raise the possibility of ___. The diagnosis is supported by an increase in the serum level of creatine kinase and EMG findings for an inflammatory myopathy
Polymyositis
Polymyositis dx is confirmed by ___; Tx is ___
Muscle biopsy; tx w/ high dose PO corticosteroids
CSF in viral meningitis is often characterized by ___
elevated protein levels, clear CSF, normal glucose, normal opening pressure
Laboratory CSF findings suggestive of bacterial meningitis are ___
high WBC count (especially neutrophils), high protein level, low glucose level.
A 75 y/o man presents with recent right fronto-temporal headaches and sudden, persistent loss of vision in his R eye. Exam shows severe visual impairment in all 4 quadrants and relative afferent pupillary defect of the right eye. Fundoscopy of the right eye shows that the optic disc is not swollen or pale, however the retina appears white and there is a cherry-red spot. What is dx?
Central retinal artery occlusion
Which one of the following antiepileptic drugs (AEDs) can cause aplastic anemia and liver failure, and is therefore a last resort medication?
Felbamate
A 75-year-old man states that when he is exposed to bright light, his right eye will go blind for several minutes. Monocular transient visual loss (TVL) lasting 5 to 60 minutes (usually up to 30 minutes) is strongly suggestive of ___
Carotid occlusive disease
Pt p/w mild weakness and decreased sensation in all extremities. The neurological examination demonstrates decreased proprioception and vibration sensation, hyperreflexia, and mild weakness, but normal tone, in all extremities. Dx?
subacute combined degeneration, which is demyelination of the dorsal and lateral spinal cord
The FDA also has approved ___ for the treatment of relapsing-remitting MS
a synthetic form of myelin basic protein, called glatiramer acetate
A 42-year-old woman presents with acute onset of headache, vertigo, nausea, and vomiting. Neurologic exam reveals left-beating nystagmus, left Horner syndrome, absent left gag reflex, left arm ataxia, and anesthesia to pinprick in the left face and right upper extremity.
vertebral artery dissection
The subacute onset of ataxia in a woman with normal MRI findings should strongly suggest a ___
paraneoplastic disorder
___ occur especially with ovarian, fallopian tube, endometrial, surface capillary, and breast carcinomas, and occasionally with lymphoma. They cause paraneoplastic cerebellar degeneration with a subacute ataxia that may be associated with downbeat nystagmus.
Anti-Purkinje cell antibodies (anti-Yo antibodies)
Most common cause of bitemporal hemianopsia
pituitary tumor
Right-side homonous hemianopsia is due to damage to ___
left optic tract
Damage to ___ leads to dilated pupil, lid ptosis, and eye stays lateral (abducted)
3rd cranial nerve
Damage to ___ leads to contralateral lower face paralysis
upper motor neurons of CN 7
Damage to ___ leads to ipsilateral upper and lower face paralysis
lower motor neurons of CN 7
___ is one of the most common etiologies of episodic vertigo and is brought on by head movements or changes in posture and often associated with nausea and nystagmus. It is due to abnormal stimulation of the semicircular canals by otoliths from the utricle. Diagnosis may be aided by provoking nystagmus and vertigo with ___
Benign paroxysmal positional vertigo (BPPV); the Dix-Hallpike maneuver
___ may also result in episodic vertigo, but is typically associated with tinnitus, sensation of ear fullness, and low-frequency hearing loss.
Meniere’s disease
Episodes of transient visual loss (TVL) lasting less than 60 seconds in an older patient is concerning for ___
amarousis fugax (embolus from cardiac source)
Paroxysmal hemicranias (a subtype of trigeminal-autonomic cephalgias), hemicrania continua, valsalva-induced headaches, and primary stabbing headache are responsive to ___
Indomethacin
___ is a degenerative neurologic disorder characterized by a combination of cognitive, behavioral, balance, and visual symptoms. Among the most common signs are difficulty in the voluntary movement of the eyes in the vertical plane and impairment in voluntary eye saccades. Both difficulties with eye movement and balance are thought to contribute to sudden falls
progressive supranuclear palsy (PSP)
___ is due to destruction of the acetylcholine receptors at neuro-muscular junctions
myasthenia gravis
Progressive multifocal leukoencephalopathy (PML) is caused by the opportunitistic and ubiquitous ___ in immunodeficient individuals (e.g., those with HIV/AIDs) and involves destruction of ___, which create myelin in the central nervous system, leading to progressive demyelination of subcortical white matter.
JC virus (Polyomavirus JC);
Which one of the following frontal lobe areas would most likely be involved with a seizure semiology of swallowing, salivation, mastication, epigastric aura, and speech arrest often associated with clonic facial movements?
Operculum
Which one of the following findings of brainstem auditory evoked potentials (BAEPs) is consistent with a peripheral hearing disorder?
Absent wave 1 with normal 3 and 5
Clinical characteristics include: patients are usually middle aged men; proximal weakness of limbs, especially in the legs, which may improve with exercise; absent or decreased tendon reflexes; cranial nerve tends to be spared (vs. myasthenia gravis), except mild ptosis; often autonomic impairment-impotence, urinary dysfunction, dry mouth, orthostasis; repetitive stimulation study reveals a decremental response at low rates of nerve stimulation and an incremental response at high rates; often associated with small cell lung cancer
Lambert-Eaton myasthenic syndrome
___ should be considered for people with tremor where essential tremor cannot be clinically differentiated from Parkinsonism.
Single-photon emission computed tomography (SPECT)
___ occurs in children and is defined by the following triad: multiple seizure types (usually including generalized tonic-clonic, atonic, and atypical absence seizures); EEG showing slow (3 Hz) spike-and-wave discharges. impaired cognitive function in most but not all cases This syndrome is associated with CNS disease or dysfunction from a variety of causes, including developmental abnormalities, perinatal hypoxia/ischemia, trauma, infection, and other acquired lesions.
Lennox-Gastaut Syndrome
___ is a disorder of copper transport that is characterized by inadequate biliary copper excretion. This inadequacy leads to accumulation of copper in liver, brain, kidneys, and corneas. Neurologic presentation includes movement disorders such as tremors and ataxia, and spastic dystonia such as masklike face, rigidity, gait disturbance, dysarthria, drooling, and dysphasia.
Wilson’s disease
A 52-year-old woman has a 3- to 4-week history of progressive, asymmetrical, mainly distal more than proximal sensory loss and weakness of the legs, with pain in the back, buttocks, and thighs. The knee reflexes are absent and the ankle reflexes are reduced, with flexor toe signs. Dx?
Inflammatory polyradiculoneuropathy
Spinal cord neoplasms frequently affect the ___, leading to areflexia and extensor plantar responses
Pyramidal tract
“Pseudobulbar or suprabulbar palsy that occur due to interruption of the ___ as they descend through the corona radiata and internal capsule, and present with deficits in cranial nerve function and, additionally, can present with ““emotional incontinence.”””
corticobulbar tracts
Corticobulbar tract carries upper motor neuron input to motor nuclei of trigeminal, facial, glossopharyngeal, vagus, accessory, and hypoglossal nerves. The motor component of trigeminal nerves supplies muscles of mastication. The facial nerve supplies the muscles of facial expression.
___: clinical characteristics of this entity: usually middle aged men; proximal weakness of limbs, especially in the legs which may improve with exercise; reduced or absent reflexes; cranial nerve tend to be spared (vs. myasthenia gravis) except mild ptosis; often autonomic impairment-impotence, urinary dysfunction, dry mouth, orthostasis; repetitive stimulation study reveals a decremental response at low rates of nerve stimulation and an incremental response at high rates; often associated with ___
Lambert Eaton Myasthenic Syndrome; associated w/ small cell lung cancer
Mesial temporal lobe epilepsy syndrome (MTLE) is the most common epilepsy syndrome associated with ___. High-resolution MRI characteristically reveals ___ that appears essential in the pathophysiology of MTLE for many patients.
Complex partial seizures; hippocampal sclerosis
___ was the first drug approved in the US for ALS since it modestly protracted ALS progression. In 2017, ___, the second-drug for ALS treatment, was approved by the US FDA.
Riluzole; Edaravone
Bilateral lesions of the ___ cause Klüver-Bucy syndrome leading to hypersexuality, hyperorality (fixation on oral exploration), and disinhibited behavior, but primitive reflexes will be absent.
amygdala
Lacunar infarct of subthalamic nucleus leads to ___
hemiballismus
___ is also very short-acting cholinesterase inhibitor that is used for diagnosing myasthenia gravis
Edrophonium
___ is an acetylcholinesterase inhibitor that does not cross the blood-brain barrier and is used largely for treating myasthenia gravis.
Pyridostigmine
__ is the test of choice to examine ___ to diagnose Huntington’s disease. The HD gene resides on the short arm of ___
PCR; trinucleotide repeats (CAG); Chromosome 4 at 4p16.3
Huntington’s disease is transmitted by ___ pattern. If one parent is an affected carrier, the likelihood of transmission to any given child is ___
autosomal dominant inheritance; 50%
The clinical hallmark of Guillain-Barre is ___. Test of choice are ___
loss of deep tendon reflexes in the extremities; EMG and nerve conduction studies
___ presents with classic tetrad of acalculia, agraphia (without alexia), R and L confusion, and finger agnosia (inability to name fingers). Lesion localizes to ___
Gerstmann’s syndrome; left angular gyrus (in left parietal lobe)
___ is when a patient gets up from the floor/chair by using hands bc of muscle weakness in the legs. It is a classive indicator of ___
Gower’s maneuver; Duchenne’s muscular dystrophy
Tx for trigeminal neuralgia (lancinating, brief sharp pain, usually unilateral)
Carbamazepine (Tegretol) or Oxycarbazepine (Trileptal)
About 25% pts with temporal arteritis also have comorbid ___
polymalgia rheumatica
Patient with ___ p/w with progressive proximal muscle weakness, generalized fatigue, and red nonpruritic rash on the face and body, esp on the knees and elbows
Dermatomyositis
Intoxicated man p/w limp right wrist and fingers (cannot lift them) and weakness when trying to extend arm from a bent to straight position. He has trouble turning his forearm over when placed palm down on a flat surface. The lesion is most like to the ___
Radial nerve due to entrapment from prolonged compression of axilla
Compression of ___ leads to weakness of flexor carpi ulnaris, intrinsic hande muscles, and 4th/5th finger deep flexor weakness
Ulnar nerve
Compresion of ___ leads to classic carpal tunnel syndrome. There is sensory loss, thenar atrophy and + percussion of nerve over wrist leading to paresthesia (=___) in 60% cases
Median Nerve; Tinel’s sign
Biceps and brachialis weakness is the hallmark of injury to ___
Musculocutaneous nerve
musculocutaneous nerve originates from the lateral cord of the brachial plexus (C5-C7) at the inferior border of pectoralis minor muscle.
___ is screening test for Sarcoidosis
Serum ACE level
32 y/o man with HIV p/w fever (101 F), headache, stiff neck, photophobia, and lethargy. CD4 count is 0. Dx is __, most useful immediate dx test would be ___
Cryptococcal meningitis; LP for CSF analysis and India ink staining
Diagnostic test of choice for Creutzfeldt-Jakob disease (CJD)/Prion Disease:
LP with CSF assay of 14-3-3 and tau proteins’
Lesion to ___ of brain stem leads to internuclear ophthalmoplegia in multiple sclerosis, p/w abnormal horizontal ocular movements with absence/delayed adduction of the eye ipsilateral and coarse horizontal nystagmus in the abducting eye
Medial longitudinal fasciculus
___ is a sensation of an electric shock descending down the spine or the extremities upon neck flexion. It is most often suggestive of ___.
Lhermitte’s sign; Multiple sclerosis
IV Immunoglobulin therapy and plasmapharesis are treatments for what two neurological conditions?
Myasthenia gravis and Guillain-Barre Syndrome
MRI scan for patient with ___ revelas numerous subcortical white matter demyelinating lesions
Multiple sclerosis
Locked-in syndrome is the result of a ___ lesion that is clinically devastating, producing quadriplegia, mutism, and lower cranial nerve palsy
pontine
34 y/o AAF p/w 6 weeks of intermittent bifrontal headache and vague visual obscurations. Immediate dx test is ___
LP, showing elevated opening pressure; Dx: Pseudotumor cerebri
Inclusion criteria for use of r-TPA:
ischemic stroke with onset <3 hrs prior; neuro deficits measurable on NIH stroke scale; CT scan showing no intracranial hemorrhage
Exclusion criteria for use of r-TPA:
rapidly improving/minor stroke sx; seizure at onset of stroke; prior intracranial hemorrhage; pretreatment BP > 185/110; major surgery within 14 days; prior stroke or head injury w/in 3 months, recent MI
Patient p/w ipsilateral Horner syndrome, ipsilateral loss of pain and temperature sensation in face, cerebellar ataxia, weakness of vocal cords/pharynx, contralateral loss of pain and temperature sensation to the hemibody; Dx is ___ due to location___and vessel__
Lateral Medullary Syndrome; occlusion of one of vertebral arteries (infarct of lateral medulla)
___ is the most common offending infectious agent in AIDS-related retinopathy. It accounts for 30% cases of HIV-related retinopathy
Cytomegalovirus
Lesion at ___ causes a foot drop from dorsiflexor muscle weakness
L5
Leg extension is a function of the quadriceps muscles, which are innervated by nerves emanating from the ___ nerve roots
L3, L4
Hip flexion (raising knee in the air) is a function of the iliopsoas muscles, which are innervated by ___ nerve roots
L1, L2, L3
The Achilles or ankle jerk motor reflex is a function of the ___ motor nerve root
S1
Classic Brown-Sequard syndrome presents as ___
ipsilateral loss motor control, propioception, and vibration——-contralateral loss of pain and temperature
The ___ irrigates the medial frontal lobes; when affected, causes preferential leg greater than arm and face weakness contralateral to the side of the lesion
Anterior cerebral artery
___ is one of the classic lacunar stroke syndromes and would be expected from an infarct in the area of the ___
Pure motor hemiparesis; internal capsule
Lesion to ___ will produce hemiballismus. Most often results from an acute stroke
contralateral subthalamic nucleus
