Neurology #4 Precision and Pearls

Question 1

An epidural hematoma is bleeding between _______ and the ______. This is MC due to ….

Answer 1

The skull and dura

MC due to rupture of middle meningeal artery and associated with temporal bone fracture

Question 2

What are the symptoms of an epidural hematoma (there are three phases)

Answer 2

-Brief LOC
-Lucid Interval
-Neuro deterioration

Question 3

What are other symptoms of an epidural hematoma-

Answer 3

-CNIII palsy: fixed, dilated, blown pupil
-Cushing Reflex: hypertension + bradycardia + respirations irregular

Question 4

What is the diagnostic of choice for an epidural hematoma and what is seen (this is unique)

Answer 4

-CT head without contrast: biconvex (lens shaped) and doesn’t cross suture lines

Question 5

Treatment for an epidural hematoma

Answer 5

-Hematoma evacuation or craniotomy

Question 6

On the other hand, a subdural hematoma is bleeding between the _____ and the ________.

This is MC due to

Answer 6

Dura and arachnoid membranes

MC due to rupture of cortical bridging veins

Question 7

What are some risk factors for a subdural hematoma?

Answer 7

Elderly, alcoholics
Shaken baby syndrome

Question 8

Symptoms of a subdural hematoma

Answer 8

-Develop over a longer period of time
-Gradual increase in neuro symptoms

Question 9

What is the diagnostic of choice for a subdural hematoma and what is seen?

Answer 9

Ct head without contrast

-Concave (crescent shaped) density that can cross suture lines

Question 10

Management of a subdural hematoma

Answer 10

-Surgery if > 5 mm or greater midline shift (craniotomy, etc.)

Question 11

An astrocytoma, the MC brain tumor in adults, has a few different types.

-Pilocytic Astrocytoma (Grade I) is MC in ______

-Glioblastoma Multiforme (Grade II) is MC in _____

Answer 11

Kids

Adults. MC primary CNS tumor in adults

Question 12

Symptoms of an astrocytoma

Answer 12

-Focal deficits (frontal and temporal MC)
-Headache
-May wake patient up at night due to headache
-Increased ICP, AMS, neuro deficits

Question 13

Even though a CT or MRI with contrast is the best diagnostic for an astrocytoma, what is seen on a brain biopsy if the patient has a pilocytic astrocytoma?

Answer 13

Rosenthal fibers (Corkscrew)

Question 14

Management for an astrocytoma

Answer 14

-Surgical excision

-If Grade IV = surgery + radiation + chemo

Question 15

Glioblastoma Multiforme is the MC and most aggressive CNS tumor in adults. What are some risk factors?

What is seen on brain MRI with contrast?

Answer 15

-Males, Age > 50, HHV-6, CMV infections

-Lesion with variable ring of enhancement

Question 16

On the other hand, a meningioma is a benign, slow growing tumor MC in the _________

Although often asymptomatic, what is seen on MRI with contrast

Answer 16

-MC in the dura

-Intensely enhancing, well-defined lesion attached to the dura

Question 17

An oligodendroglioma, a tumor of the oligodendrocytes, which are cells that make up the glial tissue of the brain, appears how on a histologic study?

Answer 17

-Soft, gray-pink calcified tumors (fried egg shape)

Question 18

Ependymal cells line the ventricles and the spinal cord. An ependymoma is MC in kids and is MC where?

Answer 18

4th ventricle, spinal cord, medulla

Question 19

What is seen on brain biopsy for an ependymoma?

Answer 19

-Perivascular pseudo rosettes (tumor cells surrounding a blood vessel)

Question 20

Subcalvian Steal Syndrome is due to reversed (retrograde) blood flow from vertebral artery to ipsilateral arm due to decreased blood flow in the subclavian artery. What is the MCC?

What are some symptoms?

Answer 20

Subclavian artery stenosis or occlusion

-Most asymptomatic
-Arm claudication with exercise, paresthesias
-Syncope, dizziness, nystagmus, vertigo, gait problems
-BP difference between arms (>15 mmHg in affected arm)

Question 21

Treatment for subclavian steal syndrome

Answer 21

-Revascularization or percutaneous transluminal angioplasty

Question 22

Regarding Spinal Cord Syndrome, Anterior Cord problems occur MC after a blowout vertebral fracture. Other etiologies are…

Answer 22

Aortic Dissection, SLE, AIDS

Question 23

Symptoms of Anterior Cord Syndrome

Answer 23

-Motor Deficits: Lower Extremity > Upper
-Sensory Deficit: Pain, temperature, bladder dysfunction

-Preserved: Vibration, Proprioception

Question 24

Central Cord Syndrome occurs after

Answer 24

Hyperextension injuries, falls, gun-shot wounds

Question 25

Symptoms of Central Cord Syndrome

Answer 25

-Motor Deficits: Upper extremity > LE (hands MC)
-Sensory Deficits: Pain, Temperature in UE (shawl distribution)

-Preserved: Vibration, Pressure, Proprioception

Question 26

Posterior Cord Syndrome is rare, but what are the symptoms?

Answer 26

-Loss of proprioception and vibration ONLY

-Preserved: Pain, Touch, NO MOTOR DEFICITS

Question 27

What is Brown-Sequard Syndrome?

What is it MC after?

Answer 27

MC after a penetrating trauma

Deficits:
-Ipsilateral: Motor, Vibration, Proprioception
-Contralateral: Pain & Temperature 2 levels below injury