Neurology

Question 1

Feaetures of Lennox-Gastaut syndrome (3)

Answer 1

(1) multiple seizure types (usually including general- ized tonic-clonic, atonic, and atypical absence seizures);

(2) an EEG showing slow (<3 Hz) spike-and-wave discharges and a variety of other abnormalities; and

(3) impaired cognitive function in most but not all cases

Question 2

Most common syndrome associated with focal seizures with impairment of consciousness

Answer 2

Mesial temporal lobe epilepsy

*with characteristic hippocampal sclerosis on MRI

Question 3

Chronic migraine definition

Answer 3

episodes of migraine on 8 or more days per month and with at least 15 total days of headache per month

Question 4

Only proven treatment for chronic tension type headache

Answer 4

Amitryptyline

Question 5

Phases of migraine

Answer 5

Premonitory (prodromal)
Aura
Headache phase
Postdrome

Question 6

Intraneuronal proteinaceous inclusions in cell bodies that stain for alpha synuclein

Answer 6

Lewy bodies
Found in Parkinson’s

Question 7

Approved for on-demand treatment for off periods in Parkinsons (3)

Answer 7

Inhaled levodopa
Subcutaneous injections of apomorphine
Sublingual apomorphine

Question 8

Only drug that has been demonstrated to treat dyskinesia without worsening parkinsonism

Answer 8

Amantadine

Question 9

Most common cause of proximal MCA occlusion

Answer 9

Embolus (»atherothrombosis)

Question 10

Presentation of MCA occlusion at its origin

Answer 10

Contralateral hemiplegia, hemianesthesia, homonymous hemianopia, and a day or two of gaze preference to the IPSILATERAL side

(+) Dysarthria
If dominant hemisphere - global aphsia
If nondominant hemisphere- anosognosia, constructional apraxia, neglect

Question 11

Presentation of proximal SUPERIOR division of MCA occlusion

Answer 11

Sensory disturbance + MOTOR weakness, nonfluent aphasia

Question 12

Presentation of INFERIOR division of MCA occlusion

Answer 12

Fluent (wernicke’s) apasia
Without weakness
Jargon speech and inability to comprehend

Nondominant hemisphere - Hemineglect or spatial agnosia without weakness

Question 13

Presentation of lenticulostriate vessel

Answer 13

Pure motor stroke or sensory-motor contralateral to the lesion

at the genu - Primarily facial weakness –> arm –> leg

*produces small vessel (lacunar) stroke within the internal capsule

Question 14

Presentation of anterior choroidal artery occlusion (arises from ICA, supplies ipsoterior limb of internal capsule and white matter posterolateral to it)

Answer 14

Contralateral hemiplegia
Hemianesthesia (Hypesthesia)
Homonymous hemianopa

*Frequently from in situ thrombosis of the vessel

Question 15

Affected areas in P1 syndrome

Answer 15

Ipsilateral subthalamus and medial thalamus
Ipsilateral cerebral pdeuncle and midbrain

Question 16

Presentations of P1 syndrome

Answer 16

Claude’s syndrome - third nerve palsy with contralateral ataxia

Weber’s syndrome - third nerve palsy with contralateral hemiplegia

Subthalamic nucleus affected (+) contralateral hemiballismus
Occlusion of artery of Percheron (+) paresis of upward gaze and drowsiness and often abulia

Question 17

Thalamic Dejerine-Roussy syndrome

Answer 17

contralateral hemisensory loss followed later by an agonizing, searing, or burning pain in the affected areas

Tx: anticonvulsants - carbamazepine or gabapentin, or TCA

Question 18

Affected areas in P1 syndrome

Answer 18

Medial temporal and occipital lobes

Question 19

Presentation of P2 syndromes

Answer 19

Contralateral homonymous hemianopia WITHOUT macula sparing

*vs MCA stroke which often spare the macula

Question 21

Presentation of embolic occlusion of the top of the basilar artery

Answer 21

Hallmark: Sudden onset of bilateral signs, including ptosis, pupillary asymmetry or lack of reaction to light, and somnolence

+posturing, myoclonic jerking that stimulates the seizure

Question 22

Presentation of bilateral infarction in the distal PCA

Answer 22

Cortical blindness (blindness with preserved pupillary reaction)

Anton’s syndrome - patient unaware of the blindness

Question 23

Features of lateral medullary syndrome (Wallenberg’s syndrome)

Answer 23

Vertigo
Numbness of the ipsilateral face and contralateral limbs
Diplopia
Hoarseness
Dysarthria
Dysphagia
Ipsilateral Horner’s syndrome

Most cases d/t ipsilateral vertebral artery occlusion (V4), PICA occlusion

Question 24

Components of ABCD2 score for TIA

Answer 24

A: Age =/> 60 (1)
B: SBP >140 or DBP >90 (1)
C: Clinical symptoms (unilateral weakness2, speech disturbance without weakness1)
Duration >60 mins (2)
Diabetes (1)

Question 25

Most common sites of hypertensive ICH

Answer 25

Basal ganglia (putamen)
Thalamus
Cerebellum
Pons

Question 26

common cause of lobar hemorrhage in elderly

Answer 26

Cerebral amyloid angiopathy (CAA)

Question 27

Most common locations of giant (>2.5cm) berry aneurysm

Answer 27

Terminal ICA
Bifurcation of MCA
Top of the basilar artery

Question 28

Most common site of rupture of aneurysm

Answer 28

DomeH

Question 29

Hallmark of aneurysmal rupture (lab finding)

Answer 29

Blood in the CSF

Question 30

Four major causes of delayed neurologic deficits in SAH

Answer 30

Rerupture
Hydrocephalus
Delayed cerebral ischemia (vasopasm) - appear 4-14 days after hemorrhage, most often at 7 days
Hyponatremia

Question 31

Treatment of DCI from SAH

Answer 31

Nimodipine 60mg PO every 4 hours

-may case significant hypotension in some patients

Question 32

Management of brain abscess

Answer 32

High dose parenteral antibiotics for minimum of 6-8 weeks
Neurosurgical drainage

Prophylactic anticonvulsants, and continued 3 months after resolution of abscess then EEG

Steroids should NOT be routinely given - only for px wiht substantial periabsccess edema and associated mass effect and increased ICP