Neurology Flashcards by Sam Biniazan

Unilateral pupillary dilation
Compression of CN3

Uncal herniation

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Headache that gets worse when lying flat and/or with Valsalva
Papilledema
Optic disc atrophy
Blindness

Idiopathic intracranial hypertension

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Management for idiopathic intracranial hypertension

Acetazolamide
Diuretics

Seriously LP
CSF shunt
Steroids

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Most common childhood malignant brain tumor

Medulloblastoma

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Brain tumor
Headache
Ataxia
Obstructive hydrocephalus

Medulloblastoma

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Headache
Vomiting
Ataxia
Afebrile
Head tilt
Torticollis

Infrantentorial/posterior fossa tumors

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Headache
Seizure
Hemiparesis

Supratentorial tumors

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Endocrinopathies
Behavioral changes
Visual disturbances
3rd ventricle obstruction
Hydrocephalus
Calcification in the sella turcica

Craniopharyngioma

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Sinusitis
Headache
Vomiting
Focal neuro deficits
Brain enhancing lesion

Brain abscess

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Neonate
Cranial bruit
Hydrocephalus
CHF

Vein of Galen malformation

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Red blotches on skin/eyes
CNS effects
Intellectual disability
Decreased IgA and IgG
Respiratory tract infections
Hodgkin’s lymphoma (elevated AFP)
Autosomal recessive

Ataxia Telangiectasia

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Slow/clumsy gait
Decreased strength
Decreased reflexes
Elevated plantar arch
Cardiomyopathy/CHF
Glucose intolerance (DM)
Autosomal recessive

Friedreich ataxia

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Clumsiness
Distal muscles weakness
Absence of Lower DTRs
High plantar arch
Weakness
Distal calf muscle atrophy
Autosomal dominant

Charcot-Marie-Tooth disease

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Syndeham chorea

Acute rheumatic fever

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Chorea
Hypotonia
Emotional lability
Autosomal dominant

Huntington chorea

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Treatment for chorea

Supportive
Haloperidol

Fluphenazine
Risperidone
Tetrabenazine

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Neck hyperextension
Decreased extraocular movement

Treatment

Acute dystonic reaction

Benadryl

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Specific repetitive movement
Improves/disappears with purposeful movement
Voluntarily suppressed

Tic

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Weakness
Paresthesias
Localized back pain
Fever
Reduced LE sensation and bowel/bladder tone

Treatment

Epidural abscess

Abx
Steroids
Surgical decompression

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Virus
Fever
Weakness then hypertonia/hyperreflexia
Bowel/bladder dysfunction
Lymphocytic infiltration and demyelination

Acute transverse myelitis

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Treatment for extrinsic spinal cord lesion

High dose IV dexamethasone

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Degeneration of anterior horn cells
Only motor dysfunction
Infancy
Poor suck
Tongue fasciculations

Spinal muscular atrophy (SMA) type 1

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Minimal vertebral opening
Spinal cord and nerves intact
Asymptomatic

Spina bifida occulta

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Larger vertebral opening
Herniation if CSF and meninges
Intact spinal cord
Asymptomatic

Meningocele

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Widely split vertebral opening Herniation of CSF, meninges, spinal cord Paralysis Ortho and uro problems

Myelomeningocele

Steroid choice for spinal trauma

IV methylprednisolone 30mg/kg

Decreased forehead wrinkling Decreased smiling on affected side Treatment

Bell’s palsy Supportive Prednisone +/- acyclovir/valacyclovir

Increase protein in CSF with normal cell count Campylobacter jejuni Proximal muscle weakness

Guillain barre syndrome

Descending paralysis Poor suck Ptosis Constipation, urinary retention Disconjugate gaze Diplopia Dysphagia Dysarthria

Botulism Blocks ACh release

Proximal muscle weakness worsens with activity Ptosis Thymoma

Myasthenia gravis ACh receptor antibodies

Diagnosis and management of myasthenia gravis

Tensilon test - edrophonium (ACh inhibitor) Pyridostigmine (ACh inhibitor) PLEX Prednisone Thymectomy

X-linked recessive Absence of dystrophin protein Gower sign Pseudohypertrophied calves Elevated CPK Xp21 abnormality

Duchenne muscular dystrophy

Autosomal dominant Striated and smooth muscle affected Distal muscle weakness Slow relaxation after contraction

Myotonic muscular dystrophy

Marcus Gunn phenomenon

Abnormal interaction of trigeminal and oculomotor nerves

Seizures 6mo to 6 yr Most common Febrile illness

Febrile seizures

Simple febrile seizure

Generalized < 15 min 1 episode in 24 hr

Complex febrile seizure

Focal > 15 min > 1 episode in 24 hr

3 hz per second spike and wave

Absence seizure

Seizure caused by hyperventilation

Absence seizure

Treatment for absence seizure

Ethosuximide Lamotrigine Valproic acid

Side effects of valproic acid

Thrombocytopenia Elevated LFTs and pancreatic enzyme levels Teratogenic (meningomyelocele) Hyperammonemia

Side effect of Topiramate

Glaucoma

Side effect of Lamotrigine

Steven Johnson syndrome

Side effect of phenytoin

Teratogenic (fetal hydantoin syndrome)

Myoclonic jerks of bilateral UE upon awakening Generalized tonic clonic seizure Absence seizure in 1/3 of patients

Juvenile Myoclonic epilepsy

4-6 hz polyspike and wave discharges

Juvenile Myoclonic epilepsy

Infantile spasms Hypsarrhytmia (inferictal on EEG) Developmental delay 3-9 mo Repetitive flexing of head, trunk, extremities

Infantile spasm (west syndrome)

Periventricular or cortical tubers Infantile spasms, seizures Cardiac rhabdomyomas Renal angiomyolipoma Shagreen patches Ash leaf spots Angiofibromas Autosomal dominant

Tuberous sclerosis

Treatment for tuberous sclerosis

ACTH Vigabatrin

Treatment for simple partial complex seizure

Carbamazepine

Twitching, grunting, tongue rolling, choking sensation Often cannot speak if occurs during wakefulness Most common type of partial seizure in childhood Autosomal dominant Biphasic focal centrotemporal spikes and slow waves on EEG

Benign Rolandic epilepsy (Benign childhood epilepsy with centrotemporal spikes) Spontaneous remission by 12 yo

Most common risk factor for cerebral palsy in premature newborns

Perinatal infection

Spastic diplegic CP

Bilateral spasticity of legs Delayed walking Tip toe walking g Normal cognition No Seizures

Spastic hemiplegic CP

Ipsilateral spasticity 1/4 cognitively impaired

Spastic quadriplegic CP

Increased tone in all extremities Intellectual disability Seizures

Dyskinetic (athetoid) CP

Spastic quadriplegia + Dystonic and strange movements

Ataxic CP

Hypotonia Delay in motor and language milestones Retention of primitive reflexes and or hyperactive reflexes

Most common cause of hemorrhagic stroke in children

AV and cavernous malformations

Next diagnostic step after presented with CVA on head CT

Cerebral angiography

Stroke Lactic acidosis Sensorineural deafness Best diagnostic study

MELAS Mitochondrial encephalopathy, Lactic Acidosis, Stroke-like episodes Molecular analysis of mitochondrial DNA

Prophylaxis for cluster headache

Verapamil

1st line treatment for infantile spasms

ACTH Prednsolone Vigabatrin

Prophylaxis for migraine headache

Topiramate

Impaired upward gaze Dilated pupils Better reactivity to accommodation than light Retraction/conversion nystagmus with lid retraction Compression or infiltration of midbrain rectum (pineal tumors)

Parinaud syndrome