Neurology Flashcards
What are several ways to distinguish Duchenne’s muscular dystrophy from spinal muscular atrophy?
SMA often presents in infancy, has fasciculations which Duchenne’s does not, caused by a defect in the SMN1 gene, and is autosomal recessive.
Both can present in infancy and childhood with muscle weakness, difficulty walking, the Gower maneuver, reduced reflexes, and pseudohypertrophy of the calves (although SMA less frequently)
What disorder does the loss of the ATM gene cause?
Ataxia-telangiectasia (A-T): An autosomal recessive disorder. Symptoms include ataxia (typically begins before the age of 5 years), telangiectasias in the eyes and skin, oculomotor apraxia, myoclonus, frequent infections, and choreathetoid movements, and a weakened immune system with increased risk of chronic infections, leukemia, and lymphoma.
What is the empiric regimen for suspected bacterial meningitis?
Ceftriaxone and vancomycin (add ampicillin in very young or very old)
From which sinuses does orbital cellulitis most frequently develop?
Ethmoid and maxillary
What is first line therapy for postherpetic neuralgia?
Oral tricyclic antidepressants (can also use gabapentin in patients with cardiac problems/frail elderly)
How does diabetic retinopathy appear on fundoscopic exam?
Simple: Microaneurysms, hemorrhages, exudates, and retinal edema.
Pre-proliferative: cotton wool spots
Proliferative/malignant: newly formed vessels
What is the main treatment for Guillain-Barré syndrome?
IVIG or plasmaphoresis
What medication prophylaxis is recommended for cluster headaches?
Verapamil
At what time of day do patients with intracranial masses most often have headaches?
At night or any time with body positioning that increases ICP.
In pt with suspected subarachnoid hemorrhage and a negative head CT, what should be the next diagnostic step?
LP. LP findings would include elevated RBCs, high protein, xanthochromia, and possibly elevated opening pressure.
Where’s the lesion in a patient with pronator drift?
Relatively sensitive and specific for upper motor neuron or pyramidal/corticospinal tract disease
What metabolic disturbance can occur after a tonic-clonic seizure?
Lactic acidosis
What medications are associated with idiopathic intracranial hypertension?
Tetracyclines and isotretinoin
What are treatments for idiopathic intracranial hypertension?
Acetazolamide is first-line therapy (inhibits choroid plexus carbonic anhydrase thereby decreasing CSF production). Furosemide can be added if pts continue to have sx. For pts refractory to medical therapy or have more severe sx such as vision loss, surgical intervention with optic nerve sheath decompression or LP shunting is recommended.
What is medial medullar syndrome?
Alternating hypoglossal hemiplegia. Typically due to a branch occlusion of the vertebral or anterior spinal artery. Patients develop contralateral paralysis of the arm and leg and tongue deviation towards the lesion. Contralateral loss of tactile and position sense can also occur with infarcts that extend dorsally
How does medial mid-pontine infarction present?
Contralateral ataxia and hemiparesis of the face, trunk, and limbs (ie ataxic hemiparesis). There is also variable loss of contralateral tactile and position sense
How do lateral mid-pontine lesions present?
Affect the motor and principal sensory nuclei of the ipsilateral trigeminal nerve, causing weakness of the muscles of mastication, diminished jaw jerk reflex, and impaired tactile and position sensation over the face
What is the most significant complication of pseudotumor cerebri?
Blindness
What is the most common cause of CN III palsy in adults?
Ischemic neuropathy due to poorly controlled diabetes
Stroke of what cerebral artery can lead to urinary incontinence?
Anterior cerebral
What neoplasm is anti-NMDA receptor encephalitis associated with?
Ovarian teratoma - more than 50% of women with this condition will have a teratoma (teratomas can contain a large amount of neural tissue which introduces it to the immune system)
What are maneuvers that worsen intracranial hypertension?
Leaning forward, valsalva, cough
What area of the brain is Broca’s area in?
Frontal lobe (dominant hemisphere)
What is the pharmacologic treatment of choice for delirium in the elderly?
Low-dose haloperidol
What are the main features of multiple system atrophy (Shy-Drager syndrome)?
- Parkinsonism
- Autonomic dysfunction (postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis, etc)
- Widespread neurologic signs (e.g. cerebellar, pyramidal or lower motor neuron)
What area of the brain is affected in hemineglect?
The non-dominant (often right) parietal lobe
What are the CT findings for progressive multifocal leukoencephalopathy?
Nonenhancing, hypodense white matter lesions without surrounding edema
