Neurology Flashcards
Face pain, lancinating pain, worse with chewing
Trigeminal Neuralgia
PD is progressive loss of dopaminergic neurons in the ____ interrupting neuralgic connections from ____ to the thalamus and motor cortex
Basal Ganglia
Fatiguable muscle weakness + diplopia/ptosis + Bulbar dysfunction + Respiratory muscle weakness
Myasthenia Gravis
Most common cause of CN III Palsy in adults (down-and-out gaze + ptosis)
Ischemic neuropathy 2/2 poorly controlled diabetes
Spontaneous lobar hemorrhage in elderly w/ Alzheimers
Cerebral amyloid angiopathy
(most often occipital or parietal lobes)
“High stepping” + UL foot drop
Common Peroneal Neuropathy
Amaurosis fugax
Painless, rapid, transient monocular vision loss
- Retinal ischemia 2/2 atherosclerotic emboli from ipsi carotid artery
- “Curtain descending over visual field”
- Duplex US of neck for that presentation
Pronator drift on exam
UMN lesion/Pyramidal tract lesion
(due to more weakness in supinator muscles than in pronators)
Calcium crystals (canaliths) within the semicircular canals
BPPV
Diabetic neuropathy is a ____ motor neuron process
Lower Motor Neuron
Amyloid plaques & neurofibrillary tangles
Alzheimer’s Dementia
(+Loss of cholinergic neurons)
AD defect in chromosome 4
Huntington Disease
(Huntington Dementia)
- Striatal neurodegeneration
- Early-onset dementia (35-50yo)
- Grimacing, ataxic gait, progressive choreiform movements
Progressive loss of nigrostriatal dopaminergic neurons
Parkinson’s Disease (BPRT:
Bradykinesia, Postural instability, Rigidity, Tremors [resting])
Rapidly progressive dementia, myoclonus, & sharp, triphasic synchronous discharges on EEG
Creutzfeldt-Jakob Disease
Highest risk complication of prolonged seizures or status epilepticus
Cortical laminar necrosis
(permanent injury due to excitatory cytotoxicity)
Mallory bodies on liver biopsy
Alcoholic hepatitis or Wilson’s Disease
Copper deposition in liver, basal ganglia and cornea
Wilson’s Disease
Young adult w/ tremor, rigidity, neuropsychiatric Sx, & hepatomegaly
Wilson’s Disease
- Check serum ceruloplasmin and slit lamp examination
Single brain metastasis Tx
Surgical resection
(Whole brain radiation if multiple mets)
Brain mass at gray-white junction
Metastasis
(Lung > Breast > Unknown > Melanoma > Colon)
First-line Tx to abort cluster HA (male w/ rtetroorbital pain awoken from sleep)
100% Oxygen
Unilateral acute painless vision loss. Dx & Tx?
Central Retinal Artery Occlusion; Orbital massage
AMS + Autonomic instability + Neuromuscular excitability (tremor, hyperreflexia, myoclonus)
Serotonin Syndrome
AMS + Rigidity + Fever + Autonomic dysregulation
NMS
(Neuroleptic malignant syndrome; ADR to dopamine antagonists)
- Tx: Withdraw drug +/- dantrolene
Small pupils that constrict poorly to light but with normal accommodation
Argyll Robertson pupils
(neurosyphilis)
Small pupils that constrict poorly to light + poor vibration/position sense
Tabes dorsalis
(neurosyphilis)
Pt is ignoring left side of space
Right parietal lobe lesion
(non-dominant; hemi-neglect syndrome)
Hemineglect syndrome. Lesion?
Right parietal lobe
(non-dominant)
Right (non-dominant) parietal lobe lesion
Hemi-neglect syndrome
Anosognosia
Deficit in self-awareness due to brain injury or mental illness
Gait instability, truncal ataxia, hypotonia, nystagmus, intention tremor
Cerebellar dysfunction
(2/2 chronic alcoholism)
Broad-based gait
Cerebellar dysfunction or NPH (Wet/Wacky/Wobbly)
Trihexyphenidyl
Anticholinergic used to treat Parkinsonian (resting) tremor when PD is first presenting
Monotherapy for Parkinsonian tremor
(resting)
Trihexyphenidyl
(anticholinergic)
Abs against voltage-gated calcium channels
Lambert Eaton Myasthenic Syndrome
(50% are associated with underlying cancer such as SCLC)
Ptosis improved with ice pack applied over eyelids for several mins
MG
(cold temp improves muscle strength by inhibiting breakdown of ACh at NMJ)
Neurocardiogenic syncope
Vasovagal syncope
(2/2 excessive vagal tone)
Syncope triggered by prolonged standing
Vasovagal syncope
(Neurogenic)
Feelings of nausea, dizziness, & warmth prior to syncope
Neurogenic syncope
(vasovagal)
Single ring-enhancing lesion w/ central necrosis on brain MRI
Brain abscess
(usually strep viridans or Staph aureus)
Multiple well-circumscribed lesions w/ vasogenic edema at the gray and white matter junction
Metastatic brain cancer
(Lung > Breast > Unknown > Melanoma > Colon)
Guillain-Barre Syndrome GI bug
Campylobacter jejuni
Result of uncontrolled infection of the skin, sinuses, and orbit in setting of valveless facial/ophthalmic venous system
Excessive accumulation of endolymph in the membranous labyrinth of the ear
Meniere disease
(recurrent vertigo + UL aural fullness, tinnitus, sensorineural HL)
Ascending paralysis
- Within hours + hiking: Tick-borne Paralysis
- Over days-weeks: GBS (Guillain-Barré Syndrome) or Spinal cord tumor
Tumor of Schwann cells covering vestibular branch of CN VIII
Acoustic neuroma
(Sx: vertigo, tinnitus, sensorineural HL)
Presbycusis
Age-related sensorineural hearing loss
Intracerebral hemorrhage on warfarin Tx
IV Vitamin K + Prothrombin Complex Concentrate (PCC; II/VII/IX/X)
Rapidly progressive ascending paralysis + no fever or sensory abnormalities
Tick-borne paralysis
- Tx: Tick removal
Intermittent UL foot drop + dorsal foot numbness
Common fibular neuropathy
(peripheral nerve compression 2/2 leg immobilization or leg crossing)
AMS + Ataxia + Ophthalmoplegia
Wernicke Encephalopathy
- +confabulation, personality ∆, memory loss: Wernicke-Korsakoff Syndrome
- Tx: Thiamine
HA, confusion, amnesia, difficulty concentrating, sleep disturbance, anxiety - days to weeks following head trauma
Postconcussive Syndrome
(following mild TBI)
W/u of first-time seizure in adult
- Electrolytes
- Glucose
- Calcium
- Magnesium
- CBC
- Renal tests
- LFTs
- Toxicology Screen
Parkinsonism + orthostatic hypotension, impotence, incontinence, or other autonomic Sx
Multiple System Atrophy
(Shy-Drager Syndrome)
Recent diagnosis of MG
Chest imaging to look for thymoma
Heat Stroke first line Tx
Rapid cooling
ce water immersion), IVF
Waddling gait
Muscular Dystrophy
(2/2 weakness of gluteal muscles)
Parkinsonism is called by overactivity of ____ neurons, under activity of ____ neurons in the _____
Cholinergic; Dopaminergic; Substantia Nigra
4 Tenets of Parkinson Disease
BPRT:
- Bradykinesia
- Postural instability (Shuffling Gait)
- Rigidity
- Tremor (Resting)
Hyperextension injury in elderly w/ pre-existing cervical degenerative changes
Central Cord Syndrome
(as seen in MVC whiplash)
- Lateral spinothalamic tract (UE > LE)
- Loss of pain/temp in UE
BL spastic motor paresis distal to spinal lesion
Anterior Cord Syndrome
(2/2 occlusion of ASA)
Ipsi weakness, spasticity, loss of vibration/proprioception, Contra loss of pain/temp
Brown-Sequard Syndrome
Severe back pain + saddle anesthesia + hyporeflexia + asymmetric motor weakness
Cauda equina syndrome
Severe back pain + perianal anesthesia + hyperreflexia + BL motor weakness (mild)
Conus medullaris syndrome
Alteplase if presenting w/ ischemic stroke within ___ hours of symptom onset and no contraindications
3.5-4 hours