Neurology Flashcards
Friedreich’s ataxia
- Spinocerebellar degeneration (gait ataxia, dysarthria, UMN signs, sensory neuropathy - but cognition intact)
- Skeletal abnormalities (scoliosis, high arch, hammer toe)
- Cardiac disease (concentric hypertrophic cardiomyopathy, CHF and arrhythmias)
(Diabetes is also commonly seen)
Most common cause of death in Friedreich’s ataxia
Cardiac disease (concentric hypertrophic cardiomyopathy, myocarditis, CHF, arrhythmias)
Pendular reflexes
Cerebellar disease (e.g. alcoholic cerebellar deeneration)
Region classically affected in Huntington’s chorea
Caudate nucleus
Rapidly progressive dementia with myoclonus. EKG sign? CSF finding?
Creuteld-Jakob disease.
EEG: Sharp triphasic synchronous discharges.
CSF: 14-3-3- protein
Dementia with subcortical effects early and memory loss later
HIV-associated dementia
Medications that can cause pseudotumor cerebri (IIH)
Tetracyclines, vitamin A and systemic retinoids
Treatment for pseudotumor cerebri (IIH)
Acetazolamide (+/- furosemide)
Signs of transtentorial uncal herniation
- Hemiparesis (often ipsilateral due to compression of contralateral cerebral peduncle, but can be the other way around)
- Blown pupil early, oculomotor palsy late (CN III compression)
- Contralateral homonymous hemianopsia (PCA compromise to occipital lobe)
- Depressed MS and coma (reticular formation compression)
Presentation of tick-borne paralysis
Ascending paralysis without autonomic involvement
What is suggested by pronator drift
UMN lesion
Monocular vision loss (washed-out colors, central scotoma, APD), +/- painful eye movements
Optic neuritis
CNs that travel through cavernous sinus
III, IV, V1, V2, and VI
Cause of intranuclear ophthalmoplegia
Lesion to medial longitudinal fasciculis (unilateral in stroke, can be bilateral in MS)
Parkinson’s med that can led to closed-angle glaucoma
Trihexyphenidyl (anticholinergic that dilates the pupil)
Primarily for tremor in early disease
Parkinson’s med that can lead to ankle edema and livedo reticularis
Amantidine
Peripheral neuropathy with GI symptoms and sideroblastic anemia
Lead poisoning
Peripheral neuropathy with skin thickening and pigment changes
Chronic arsenic poisoning
Acute poisoning: garlic breath, V/D, long QT, potentially pancytopenia and hepatitis
Treatment for arsenic poisoning
Dimercaprol (chelates arsenic as well as mercury, gold, and lead)
Treatment for myasthenic crisis
Steroids + plasmapheresis/IVIG, potentially intubation
Sudden onset of bilateral cranial neuropathies, symmetric descending weakness, and potentially respiratory failure
Foodborne botulinism (kinda like MG, but rapid and with no history)
How can you tell the different between carpal tunnel syndrome and more proximal median nerve injury (e.g. supracondylar humerus fracture?
Sensation to thenar eminence spared in carpal tunnel but not more proximal lesion
(Both have sensation to palmar first 3.5 fingers and thenar weakness/atrophy)
Cause of radial nerve injuries
Mid-shaft humeral fracture or improper crutches/saturday night palsy
Cause of ulnar nerve injury
Fracture of medial epicondyle (see claw hand)
Cause of axillary nerve injury
Anterior shoulder dislocation (wraps around humerus)
See weakness in shoulder abduction and sensation to lateral arm
How can you differentiate between foot drop due to peroneal nerve injury and L5 root injury?
Plantarflexion spared in peroneal nerve injury but weak in L5 injury
Cause of Trendelenberg gait
Injury to superior gluteal nerve (to gluteus medius and minimus muscles)
Most common superior fossa tumor in children
Low-grade astrocytomas (e.g. pilocytic astrocytoma)
2 most common posterior fossa tumors in children. Where are they classically located?
- Most common is cerebellar astrocytoma, in lateral cerebellar hemispheres (limb ataxia)
- 2nd most common is medulloblastoma, in cerebellar vermis (truncal ataxia)
Cause of loss of vertical gaze and pupillary light reflex with lid retraction and convergence-retraction nystagmus when look up
Parinaud syndrome due to pineocytoma (compresses superior colliculi and pretectum)
Most common cause of hemorrhagic stroke overall?
In patients over 60?
In children?
Overall: Hypertensive vasculopathy
Over 60: Cerebral amyloid angiopathy
Children: Vascular malformations (e.g. AVMs)
Common features and differences between hemorrhagic stroke of basal ganglia and thalamus
Both: contralateral hemiparesis and hemisensory loss (internal capsule involved in basal ganglia strokes)
Basal ganglia: conjugate gaze deviation (look towards BG stroke) (also see homonymous hemianopsia)
Thalamus: contralateral gaze deviation (look away from thalamic stroke (also see upgaze palsy and nonreactive constricted/miotic pupils)
Deep coma and reactive pupils
Pontine hemorrhagic stroke
Ipsilateral hemiataxia, facial weakness and nystagmus, and HA and nystagmus
Cerbellar hemorrhagic stroke (unlike thalamic and basal ganglia, no hemiparesis)
Stroke with sensorimotor deficits in legs
ACA stroke
Contralateral sensorimotor deficit with cojugate gaze deviation and homonymous hemianopsia, with aphasia or hemineglect
MCA stroke
(Note that basal ganglia hemorrhagic stroke can also lead to contralateral sensorimotor deficit with conjugate gaze deviation, but won’t see aphasia or hemineglect)
Most common lacunar infarct
Pure motor hemiparesis (e.g. due to internal capsule infarct)
(Others: pure sensory, ataxic hemiparesis, and dysarthria-clumsy hand)
Common features of lateral medullary and lateral mid-pontine syndrome? Differentiating features?
Common:
1. Ipsilateral pain/temp to face (trigeminal nucleus)
2. Contralateral loss of pain/temp to body (lateral spinothalamic tract) (DCML and motor spared)
3. Vertigo/nystagmus (vestibular nucleus)
4. Ataxia and ipsilateral dysmetria (cerbellar peduncles)
5. Ipsilateral Horner syndrome
Lateral pontine only (AICA stroke)
1. Ipsilateral LMN facial paralysis
2. Ipsilateral hearing loss (cochlear nucleius)
Lateral medullary only (Vertebral artery or PICA stroke):
1. Dysphagia/dysarthria/dysphonia (nucleus ambiguus, motor to glossopharyngeal and vagus)
2 complications of SAH. When do they occur, and how can they be prevented?
- Rebleed: early (24 hrs), prevent with clipping/coiling
- Vasospasm: delayed (3 days), prevent with nimodipine)
(Can also see hydrocephalus, elevated ICP, and SIADH)
