NEUROLOGY Flashcards by Bao Truong

Which CN innervates superior oblique muscle?

CN 4

(SO4-LR6-All the rest 3)

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Which CN innervates lateral rectus muscle?

CN 6

(SO4-LR6-All the rest 3)

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Which CN innervates inferiour oblique muscle?

CN 3

(SO4-LR6-All the rest 3)

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Which CN innervates medial rectus muscle?

CN 3

(SO4-LR6-All the rest 3)

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Abrupt onset of progressive weakness and sensory abnormalities in lower extremities, several weeks after a cold

What is going on?

Transverse myelitis

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Which conditions that should be evaluated in patients with transverse myelitis, besides postinfectious and rheumatologic disorders? (4)

1 - Multiple sclerosis
2 - Neuromyelitis optica

(demyelinating disorders)

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Trauma, left pupil smaller than right, left eyelid dropping.

What is going ? What are these findings called?

Carotid artery dissection

can cause Horner syndrome (miosis, ptosis, anhidrosis)

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Twitches of extremities, EEG with 4-6Hz generalized polyspike and slow wave discharge

What is the condition?

Juvenile myoclonic epilepsy

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Short neck due to fused cervical vertebrae, failure of scapula to descend to its normal position

What is the syndrome? What is the most common associated abnormaly besides these orthopedic findings?

Klippel-Feil syndrome

Associated with renal / GU tract abnormalities

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Weakness, calf muscle enlargement

What is the congenital condition? Mode of inheritance? Age of onset?

Duchenne muscular dystrophy

X-linked recessive

2-6 years old

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How Becker muscular dystrophy differ from Duchenne? (3)

1 - Later onset (7-8 years)
2 - Milder form
3 - Usually normal IQ

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What are typic findings in CSF in transverse myelitis?

1 - Mild lymphocyte pleocytosis
2 - Normal / slightly elevated protein

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3Hz generalized spike and wave on EEG

What is the condition?

Absence seizures

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Centrotemporal sharp waves on EEG

What is the condition?

Benigh rolandic epilepsy

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Night time episodes of facial twitching and difficulty talking - sometimes evolve into generalized shaking in a 5-year-old. Developmentally normal

What is the condition? Associated EEG finding?

Benign rolandic epilepsy

Centrotemporal sharp waves on EEG

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Fasciculations of the tongue in an infant

What is this sign concerning for ?

SMA type 1

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1st line therapy for absence seizure?

Ethosuximide

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What is this finding on the back ?

Which malformation is associated with this finding? What is another finding that arises as the consequence of this malformation?

Myelomeningocele

Associated with Chiari-Type II malformation (Arnold-Chiari)
-> expect hydrocephalus as a consequence

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Hypodensity on brain CT

What is it ?

Ischemic stroke

(as opposed to hemorrhage, which shows as hyperdensity)

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Etiology that causes stroke in trisomy 21 patients

Moyamoya disease

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Eye pain, swelling, redness while taking an antiseizure med

What is going on? What is the medication that causes such side effect?

Acute-angle closure glaucoma

Caused by topiramate

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3 main side effects of phenobarbital

1 - Hepatotoxicity
2 - Impairment of cognition
3 - Sedation

What is the antiseizure medication that if used in early pregnancy can caused significant defects? What are the defects? (3)

Valproate

Spina bifida (if use in first 30 days after conception)
Craniofacial abnormalities (if use in 1st trimester)
Long-term cognitive impairment in child

Anti-seizure medications that do NOT have hepatic enzyme induction (not interferes with OCP)

Levetiracetam
Ethosuximide
Gabapentin
Zonisamide
Valproate

Which spinal cord disorders associated with each type of Chiari malformation?

1. Syringomyelia (for type 1) 2. Myelomeningocele (for type 2)

Besides Asian ethnicity, what are other conditions that increase risk of moyamoya disease? (4)

1. NF-1 2. Trisomy 21 3. Sickle cell 4. Cranial radiation

Hemisphertic atrophy associated with serpiginous parenchymal calcifications on non-contrast CT brain What is the condition?

Sturge-Weber syndrome

Purplish-red, non-elevated vascular malformation in the trigeminal distribution What is the condition?

Sturge-Weber syndrome

Baby with simultaneous eye blinking during sucking-jaw movements What is the problem?

Abnormal innervation of the trigeminal and oculomotor nerves

Progressive distal extremity weakness, high-arched feet, muscle atrophy What is the condition?

Charcot-Marie-Tooth (CMT) (aka hereditary motor-sensory neuropathy)

What might trigger an absence seizure?

Hyperventilation

What is another name of Vitamin B6?

Pyridoxine

What nutrient deficiency associated with neonatal seizures that are difficult to treat?

Vitamin B6 (pyridoxine) deficiency

Infant with sudden flexion of neck, trunk, arms followed by abrupt extension of the next / trunk, with abduction/adduction of arms/legs. What is the condition? What is the typic EEG finding?

Infantile spasm **hypsarrhythmia** (high voltage, random, slow waves and spikes in all cortical areas)

Sudden ataxia, nystagmus, pallor,"walking like drunk" in a young child, but the child has retained consciousness during the episode What is the condition?

Benign paroxysmal vertigo of childhood (BPVC)

What is the condition associated with benign paroxysmal vertigo of childhood (BPVC)?

Migraine

Retinal angiomas Which condition are these associated with ?

von Hippel-Lindau syndrome

What is going on? What is it associated with?

CN6 palsy Associated with increased ICP

What is going on?

CN3 palsy (down-and-out)

What are 2 first-line acute treatment for cluster headache? What is the first-line prophylactic treatment?

1. Oxygen therapy; 2. Triptans Prophylactic treatment = **verapamil**

Most common presentation for infants with neonatal stroke?

Seizure

First line prophylaxis treatment of migraine

Topiramate

Cardiomyopathy, eye issues, unsteady gait, positive Babinski What is the condition?

Friedreich ataxia

When to discontinue antiseizure medications in neonatal seizures due to HIE?

After 1-3 months of therapy (most neonatal seizures resolve by 1 month of age)

Sleep study shows central sleep apnea. What is the next step of evaluation?

Brain MRI

What is the pattern of weakness development in Botulism?

Descending (startes with cranial nerves (dysphonia, blurred vision etc.) -> muscle weaknesses)

Which medication may cause encephalopathy secondary to high serum ammonia

Valproate

Treatment of infantile spasms (4 possible drugs)

1. ACTH 2. Prednisolone 3. Vigabatrin (especially if has TB) 4. Pyridoxine (vit B6)

Which drug used to treat bipolar disorder might cause hyponatremia?

Oxcarbazepine

Treatment of infantile botulism

Botulism immunoglobulin antitoxin

Triptan that is recommended for children between 6 - 12 yo

Rizatriptan

Triptans that are recommended for children between 12 - 17 yo (2)

1 - Rizatriptan (can be given to as young as 6-yo) 2 - Almotriptan (only for > 12yo)

Truncal ataxia, horizontal nystagmus, dysarthria after some viral infection What is going on?

Acute cerebellar ataxia