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Neurology Flashcards

1
Q

Acute Disseminated Encephalomyelitis

A

Post-viral AI demyelinating perivenular inflammatory myelinopathy which can present as hemiparesis, sensory compromise, ataxia, optic neuritis, transverse myelitis, seizure, myoclonus

  • NOT ASSOCIATED W/ CN ISSUES
  • Difficult to differentiate from initial MS attack

Tx: Acyclovir should be started for HSV prophylaxis, however, steroids are mainstay of treatment

  • Can try IVIG after
  • Supportive tx as well
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2
Q

Adie pupil

A

Tonic pupil that has poor reaction to light but will accommodate on near gaze; slow to dilate after constriction

-Due to damage at the parasympathetic ciliary ganglion or short ciliary nerves

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3
Q

Parasympathetic nerves in CN III

A

Sit on outside of nerve just underneath epineureum therefore they are more susceptible to compression

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4
Q

Anisocoria

A

Unequal pupil size

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5
Q

PCA aneurysm causes what CN sign?

A

CN III Palsy

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6
Q

New CN III palsy; what should you do?

A

CTA or MRA

Any new CN III palsy is a neurologic emergency

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7
Q

chronic inflammatory Demyelinating polyneuropathy

A

Patients present with progressive symmetrical polyneuropathy over the course of at least two months; symptoms consist of weakness, impaired reflexes/balance

Biopsy: Segmental demyelination of nerve axons

Testing: Cytoalbuminologic dissociation

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8
Q

️Nucleus affected in internuclear ophthalmoplegia

A

Medial longitudinal fasciculus

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9
Q

Lahermitte sign

A

sensation of electricity running down the spine and extending to the limbs

Can be elicited by Flexion of the neck

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10
Q

MRI imaging in MS

A

Lesions are bright on T2 and located at the Periventricular, juxtacortical, and Infratentorial regions

“Dawson’s fingers”

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11
Q

Antibodies to check in MG pt who is negative for anti-Ach

A

Anti-MuSK or anti-Lrp4

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12
Q

Ways to test severity of MG

A

FVC and Negative inspiratory pressure

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13
Q

Oculomotor ophthalmoplegia

A

Drooped eyelid

Down and out eye

Dilation of the eye

-Warrants immediate workup

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14
Q

If you see a damaged lateral rectus muscle, what must you check?

A

ICP

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15
Q

What percent of people w/ TIAs go on to have stroke?

A

80% in 3 yrs; but many are in the following days/weeks

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16
Q

Akinetic mutism

A

Decreased thought, movement, and speech; associated sometimes w/ stroke

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17
Q

PCA stroke symptoms

A

Contralateral homonymous hemianopsia w/ macular sparing (1) and memory deficits (2)

Due to 1. dual supply by the MCA and 2. damage to the hippocampus

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18
Q

Stroke showing only motor deficits and no aphasia, vision loss, decreased consciousness

A

Suspect stroke of the lenticulostriate arteries supplying the internal capsule

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19
Q

Patient who is suddenly unable to feel pain

A

Thalamic stroke

-Could involve the posterior communicating artery, anterior choroidal artery, or PCA

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20
Q

Weber’s Syndrome

A

Stoke of the penetrating arteries of the PCA supplying the crus cerebri and CN III

-Presents w/ contralateral paralysis and ipsilateral oculomotor ophthalmoplegia

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21
Q

Claude’s Syndrome

A

Stroke involving the small branches of the PCA or basilar artery supplying the midbrain tegmentum

Presents w/ contralateral tremor (due to red nucleus involvement) and ipsilateral oculomotor ophthalmoplegia

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22
Q

Locked-In Syndrome

A

Bilateral syndrome of the basal pons that occurs following basilar artery stroke

Patient is paralyzed entirely except for eye movement

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23
Q

Wallenburg’s Syndrome

A

Occurs due to stroke of the PICA which supplies the dorsolateral area of the medulla

Patients have contralateral loss of pain/temp sensation and ipsilateral loss of pain/temp in the FACE, vertigo, nystagmus, N/V, ataxia, (vestibular nuclei involvement) dysphagia, dysphonia, weak gag reflex (IX and nucelus ambiguus) and Horner’s syndrome (loss of sympathetic tract)

24
Q

Medial medullary Syndrome

A

Causes Contralateral loss of fine touch, vibration, and proprioception, spastic paralysis, and deviation of tongue to side of lesion

25
Cushing Response
HTN Bradycardia Irregular respirations
26
Nonmotor symptoms of Parkinson's
REM sleep behavioral disorder Hyposmia Autonomic dysfnxn (constipation, urinary frequency, orthostatic hypotension) Depression
27
Corticobasal degeneration
Unilateral neurogenerative disorder assoc. w/ Parkinsonism and apraxia ***Most notably, these pts have "alien limb syndrome" where their limb behaves with a mind of its own
28
PSP
Progressive Supranuclear Palsy Neurodegenerative condition w/ parkinsonism and impaired voluntary vertical gaze (supranuclear ophthalmoplegia) -Sentinel symptom is often fall as these patients have limited downward gaze
29
Is Parkinson's a familial disorder?
RARELY; 90% of cases are actually sporadic
30
COMT inhibitors
Entacpone, tolcapone -Inhibit peripheral breakdown of dopamine
31
MAOB inhibitors
Selegiline, rasagiline - Improves symptoms of patients already on LDOPA and can be useful in mild Parkinson's - Caution of SS w/ use of SSRIs
32
Use of amantadine in Parkinson's
Can alleviate LDOPA induced dyskinesia
33
Diagnostic Features of Lewy Body Dementia
1. Central feature: Progressive cognitive decline that interferes w/ normal social or occupational fnxn 2. Core features (two): Fluctuating cognition, recurrent visual hallucination, features of parkinsonism 3. Suggestive features (one + core feature): REM sleep behavior disorder, severe neuroleptic sensitivity, low dopamine transporter uptake in BG as demonstrated by SPECT or PET 4. Supportive features: Repeated falls, syncope, autonomic dysfnxn, delusions, depression, preservation of temporal lobe structures on imaging, slow wave activity on EEG w/ temporal lobe transient sharp waves
34
Most sensitive test for MG
Single-fiber EMG; tests the recording of individual muscle fiber potentials within one motor neuron unit
35
Velphoro
Sucroferric oxyhydride Primarily fnxns as a phosphate binder
36
Vitamin D intoxication symptoms
Confusion, polyuria, polydipsia, anorexia, vomiting, muscle weakness Chronic =>> nephrocalcinosis, bone demineralization, pain -Similar to hypercalcemia
37
Pseudotumor cerebri
Condition of increased ICP in overweight women of childbearing age; has 25% chance of permanent vision loss CFs: Headache, papilledema, vision loss, (sometimes) CN VI palsy *Can we worsened/caused by tetracyclines; OSA can also worsen MRI findings: Tortuous optic nerve, empty sella, intraocular protrusion of optic nerve, enhancement of optic nerve -These are not always seen but suggestive Tx: Weight loss; acetazolamide, lasix Visual symptoms: Optic nerve fenestration and/or CSF shunt -Can try topiramate if acetazolamide intolerant
38
When does rash occur w/ dermatomyositis?
Precedes the weakness; typically occurs w/ age >40 -Can also see dysphagia
39
Other complications w/ dermato/polymyositis
Interstitial pneumonitis (10%) CHF, LBBB/RBBB Increased risk of malignancy
40
Shawl sign
Erythematous rash in "V" distribution on the chest and across the shoulders consistent w/ dermatomyositis
41
Inclusion Body Myositis
Gradual onset of weakness dating back for several years and weakness also affects distal muscle groups -Often see atrophy of deltoids and quadriceps CK often only mildly elevated ***Can have peripheral neuropathy w/ loss of deep tendon reflexes
42
Initial therapy for inflammatory myopathies
Initial: Prednisone for 4-6 weeks w/ 9 month taper -Start MTX or azathioprine at the same time
43
Most common muscle acquired disease in pts >50 years old
Inclusion-Body Myositis
44
Marker for CJD
14-3-3 proteins in pt CSF
45
Only cortical dementia that effects the occipital lobe
Lewy Body Dementia
46
Meds to avoid w/ Alzheimer's patients
ANTICHOLINERGICS
47
Nonconvulsive status epilepticus
Persistent AMS following seizure; can manifest w/ nystagmus, mild twitching, presence of UMN signs
48
Miller-Fisher variant
Most common subtype of Guillan-Barre which has the triad of... 1. Areflexia 2. Ataxia (out of proportion to sensory deficits) 3. Ophthalmoplegia - Also see predominantly CN weakness > Extremity weakness ****(+) anti-GQ1b (ganglioside) abs
49
Acute Motor-sensory axonal neuropathy
GB subtype seen in adults w/ significant muscle atrophy and poor prognosis for recovery
50
Indication for intubation w/ Guillan-Barre
FVC <15ml/kg or NIF
51
Spinal Cerebellar Ataxia
Caused by a trinucleotide expansion of CTG Typically presents at age 20-30 years and may present with other signs such as dysarthria, pyramidal signs, peripheral neuropathy, impaired reflexes, cognitive impairment, myoclonus, spasticity, and oculomotor abnormalities MRI will reveal cerebellar atrophy -Should always test other family members once repeat is identified
52
Machado-Joseph Disease (MJD)
Most common SCA subtype (SCA-3) but has a variable presentation CFs: Cerebellar ataxia, parkinsonism, spastic paraplegia, neuropathy, and restless legs -May also see (but no specific) impaired temperature discrimination, pseudoexophthalmos, faciolingual myokymia, and dystonia Tx: Supportive
53
Limbic encephalitis
Inflammatory process involving the limbic cortex (mesial temporal lobes, hippocampus, amygdala) classically caused by an AI or paraneoplastic process
54
Anti-NMDA encephalitis
Paraneoplastic or AI encephalitis caused by antibodies against the NMDA-type glutamate receptors that begins w/ psychosis and progresses to depressed consciousness, seizures, and coma MRI can show hyperintensity in limbic cortex and other deep structures but is normal 70% of the time EEG reveals generalized slowing Tx: Corticosteroids + IVIG May need to consider rituximab or cyclophosphamide if refractory
55
Options for foot drop treatment
AFO, provides doesiflexion during foot upswing Functional electrical simulation device, sensor pad detects change in stance and triggers an intact peroneal nerve to stimulate tibialis anterior and peroneous longus Prognosis: Peripheral compressive ➡️ 3 months Complete axon loss ➡️ variable because regeneration is at 1mm day Nerve root compression ➡️ POOR IF >6 months, negative straight leg raise test, and old age

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