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English 2 > Neurology > Flashcards

Neurology Flashcards

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1
Q

Poliomyelitis and spinal muscular atrophy (spinal cord lesion)

A

LMN les*

Anterior horn

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2
Q

Multiple sclerosis (spinal cord lesion)

A

Demyelination
Random and asymmetric les*
Esp white matter

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3
Q

Amyotrophic lateral sclerosis (spinal cord lesion)

A

UMN + LMN deficits
No sensory, No oculomotor
Fatal
ttt: riluzole (↑survival)

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4
Q

Anterior spinal artery occlusion (spinal cord lesion)

A

All spinal cord but spares dorsal columns

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5
Q

Tabes dorsalis (spinal cord lesion)

A

Demyelination of dorsal columns + roots
Progr sensory ataxia
Poor coordination
Absence of DTRs and ⊕Romberg

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6
Q

Syringomyelia (spinal cord lesion)

A

Anterior white commissure of spinothalamic tract

From trauma/tumor/Chiari (in 35%)

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7
Q

Vitamin B12 deficiency (spinal cord lesion)

A

Subacute combined degeneration

Demyelination of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts

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8
Q

Facial nerve lesions (UMN vs LMN)

A

-UMN: les* of motor cortex (contralateral paralysis of lower face)

-LMN: ipsilat facial paralysis + inabil to close ipsil eye
Is complic of: AIDS, Lyme, Sarcoidosis, Tumors, Diabetes
Gradual recovery

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9
Q

Stroke (RF)

A 
#5 mortality in US
Disrup bld flow → neurons death → acute focal neuro def
Ischemic (80%) or hgic (20%)

Modif RF: CAD, obes, AF, carot steno, hyperchol, smok, HTN, DM, illicit drugs
Nonmodif RF: fam Hx MI/strok, >60yo. male, blac/hisp/asian

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10
Q

Stroke (etiologies)

A
  • Atheroscl: int/comm carot, basilar, verteb art
  • Chron HTN, hyperchol, DM: deep Vx → lacunar infarcts
  • Card or Ao emboli
  • Others: hypercoag, craniocerv dissect, venous sinus thromb, SCD, vasculitis
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11
Q

Stroke in MCA (PE)

A

Contral paresis + sensory loss: Face + arm
Gaze to side of les*

  • Nondom hemisph: neglect
  • Domin hemisph: aphasia
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12
Q

Stroke in ACA (PE)

A

Contral paresis + sensory loss: Leg

Cognit or personal changes

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13
Q

Stroke in PCA (PE)

A

Vertigo
Homonymous hemianopsia

4D’s of post stroke: Diplopia; Dizziness; Dysphagia; Dysarthria

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14
Q

Lacunar stroke (PE)

A

1 of these:

  • Pure motor
  • Pure sensory
  • Ataxic hemiparesis
  • Dysarthria
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15
Q

TIA (PE)

A

Sympt dep on location
Neuro def <24h
No findings on MRI

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16
Q

Stroke (dg)

A

Emerg head CT w/o contrast (isch <6h not visible)
MRI (early isch)
Immed labs: CBC, PT/PTT, card enz, trop, BUN/creat

Determ underl cause: cardioembol (ECG, echo); thromb (carot US/Doppler, MRA, CTA, angiogr); others

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17
Q

Acute ischemic stroke (ttt)

A

-Thrombolytics (tPA) if <3h + No bleed + No CI
SBP<185 and DBP<110 for tPA
-ASA if >3h; switch to Clopidog if already tak ASA

ttt fever + hyperglyc (worse pg)
!monitor for brain swell, ↑ICP, herniation → mannitol + hyperventil

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18
Q

Contraindications to tPA therapy

A 
Stroke or head trauma ≤ 3mo
Anticoag w/ INR >1.7 or ↑PTT
MI in ≤ 3mo
Prior intracran hge
↓plts <100K
SBP >185 or DBP >110
Major surgery ≤ 14d
TIA ≤ 6mo
GI or urin bleed ≤ 21d
Glycemia >400 or <50
Seizures at onset of stroke
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19
Q

Preventive and long-term treatment for stroke

A

Prevent complic: aspir pneumo, UTI, DVT
Manage HTN, hyperchol, DM
ASA or clopidogrel
Anticoag: in new AF or hypercoag state, INR 2-3
In prosthetic valve, INR 2.5-3.5
Carotid endarterectomy: if stenosis >60% w/ sympt or >70% w/o sympt; Never if 100%

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20
Q

Subarachnoid hemorrhage (etiologies, PE)

A

Rupt saccul aneurysm (berry), AVM, trauma of Willis

Aneur: abrupt intense pain, then mening irritat* (neck stiff; photoph; N/V; Kernig/Brudzinski)
1/3 have Hx of sentinel bleed (d-wks prior)

If no interv, rapid obstruc hydroceph or seiz → coma/death

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21
Q

Subarachnoid hemorrhage (dg, ttt)

A

Dg: immed head CT w/o contrast; if CT⊖ then LP (RBCs, xanthoch, ↑prot, ↑ICP); angiogr when SAH confirmed (see source)

ttt: neurosurg (defin) w/ coiling +/or stenting
Prev rebleed (in 24h): SBP<150
Prev vasospasm + isch stroke (in 4-10d): CCB (nimodip)
↓ICP: immed raise head + hyperventil
ttt hydroceph: lumb drain, serial LPs, VPshunt

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22
Q

Conditions ass w/ berry aneurysms

A 
Marfan sd
Aortic coarctation
Kidney ds (ADPCKD)
Ehlers-Danlos sd
SCD
Tobacco
Atherosclerosis
Fam Hx
HTN
Hyperlipidemia
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23
Q

Intracerebral hemorrhage (RF, PE)

A

Bleed in parenchyma; esp deep regions (basal gg, thalamus, pons, cerebellum)
RF: HTN (#1), tumor, illicit drugs

  • Early: focal motor or sensory def, worse as hematoma expands
  • Late: ↑ICP (vom, headac, bradycard, ↓alert)
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24
Q

Intracerebral hemorrhage (dg, ttt)

A

Dg: immed head CT w/o contrast (hyperdense area, mass eff, edema, herniation)

ttt: neurosurg (defin) w/ coiling +/or stenting
Prev rebleed (in 24h): SBP<150
Prev vasospasm + isch stroke (in 4-10d): CCB (nimodip)
↓ICP: immed raise head + hyperventil
Monitor herniation (Cushing triad, fixed pupils, loss consci); medical emerg; evacuate bld/CSF + give CS or mannitol
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25
Q

Subdural hematoma

A

Trauma → bridging veins
Bld betw/ dura and arachnoid membr
Elder, alcoholic
Subacute or chronic: headac, mental stat chang, contral hemiparesis, focal neuro def

CT: crescent-shap, concave hyperdensity (acute), isodens (subacute), hypodens (chron)
ttt: neurosurg evacuat* if sympt; may regress spont

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26
Q

Epidural hematoma

A

Severe trauma → lat skull fx → middle meningeal artery
Bld betw/ skull + dura mater
Immed loss of consc then lucid interval

CT: lens-shaped, biconvex hyperdensity
ttt: emerg neurosurg evacuat*
Complic: herniat*, death

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27
Q

Cavernous sinus thrombosis (etiology, PE)

A

By uncontrol inf (central fac skin, orbit, nas sinus)
S.aureus (#1)

Early: headac, edema, vis disturb (nerv involv), fev
Late: ment sta chang, sepsis, coma

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28
Q

Cavernous sinus thrombosis (dg, ttt)

A

Dg: MRI w/ Gado; MR venogr; CT angiogr/venogr
Bld Cx

ttt: aggress + empir broad AB in IV x3-4wks
Penicillinas-resist peni + C3G or C4G
Metronid (anaerob); Vanco (MRSA); +/- antifungal
If no resp in 24h, surg drain

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29
Q

Migraine headache (RF)

A

W>M; familial; start early 20s
Chang in vasc tone + neurotransm (serot, dopam)

Trigg: food, fasting, stress, menses, OCPs, bright light, abNl sleep pattern

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30
Q

Migraine headache (PE, dg)

A

Throbb unilat, pulsat for 4-72h
Ass w/ N/V, photoph, phonoph, aura (visual/scotoma/light)
↑activ, ↓sleep/dark

Dg: Hx + ⊖workup

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31
Q

Migraine headache (ttt)

A

Avoid known triggers
Abortive ttt: NSAIDs but when failure, triptans +/- naproxen
ttt nausea
Prophyl (fqt/sev): anticonv (gabapentin, topiramate), TCAs (amitriptyline), B⊖ (propranolol), CCBs

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32
Q

Cluster headache (PE)

A

M>W; 25yo
Brief excruciat unilat periorbit headac; 0.5-3h
Attacks in clusters (same part of head, same time of day (sleep), same season of year)
Ass w/ ipsil lacrimat, conjunc inject, Horner sd, nas congest

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33
Q

Cluster headache (dg, ttt)

A

Dg: Hx; No imaging if suspect
If 1st episode, do workup (MRI, carot US) + r/o brain les*, carot dissect, cav sin inf

ttt: acute (high-flow O2 or sumatriptan inject*)
Prophyl: verapamil (#1), lithium, valpr ac, topiram

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34
Q

Tension-type headache

A

Tight bandlike pain, ↑fatig/stress; at end of day
Dg: ≥2 of these: bilat, pressing qlty, mild-mod, not ↑by activ
R/o giant cell arteritis in >50yo w/ new headac by ESR, even if no other sympt/sign

ttt: relax, massage, hot bath, avoid exacerb fact
NSAIDs or acetamino (#1); triptans

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35
Q

Secondary headaches (red flags)

A
  • Fever, rash (meningitis, other inf)
  • Jaw claudic (tempor arteritis)
  • ↓weight (neopl, inflamm, inf)
  • Photoph, N/V, neck stiff (aneurys SAH, meningitis)
  • Neuro sequelae (ment stat chang, dizzy, atax, visu dist, papilled, pupil abNl, focal def)
  • Sudden severe headac; nocturnal headac; morning vomit; >50yo; Hx of head trauma
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36
Q

Secondary headaches (dg, ttt)

A

Dg: when ⊕ red flags
If SAH suspect, head CT w/o contrast
CBC (r/o inf); if tempor arteritis suspect (ESR)

ttt: underl cause; analgesics

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37
Q

Pseudotumor cerebri (RF)

A

Idiopathic intracranial HTN
Sympt suggest brain tumor + CSF pressure but Nl imag

RF: obes, tetracycl, GH, excess vitA

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38
Q

Seizure disorders (etiologies by age)

A
  • Infants: perinat injur; inf; metab; congen
  • 2-10yo: idiop; inf; traum; fev
  • Ado: idiop; traum; drug withdraw; AVM
  • 18-35yo: traum; alcoh; brain tumor
  • > 35yo: traum; stroke; metab; alcoh; brain tumor
39
Q

Seizure disorders (etiologies)

A

-Idiop: recurr, unprovoked; genet/environm/…

  • Acquir:
  • Struct brain les* (tumor, stroke, AVM hge): focal seiz

*Non-neuro cause (hypoGlyc/Na/Ca, hepatic enceph, hyperOsm/urem/therm, drug overdose/withdrawal, eclamps, HTN encephalop, trauma, cereb hypoperf)

40
Q

Partial seizure disorders

A 
≥1 discrete regions
Motor/sensory/autonom/psychic
Ass w/ aura; postict focal neuro def (<24h)
-Simple
-Complex (esp tempor lobe; unconsc)
41
Q

Generalized seizure disorders

A

Both cerebr hemispheres; unconsc
-Tonic-clonic: idiop, transfo of simple/complex partial seiz
Incontin, tongue bit, cyanotic, postictal confu/drowsy

-Childhood absence: brief (5-10sec) hundreds/day
Trigg: hyperventilat*
No postictal; stops before adult

42
Q

Seizure disorders (dg)

A

EEG (partial=focal; absence=3/sec spike; tonic-clonic=10Hz+slow waves)
R/o systemic causes (CBC, e-, glu, LFTs, renal, ESR, toxicol)
If focal, CT/MRI w/ contrast (r/o brain les*)

43
Q

Seizure disorders (ttt)

A

Secure airway
If 2*, ttt underl cause
-Partial or tonic-clonic: levetiracetam, pheytoin, carbamazepine, valproic acid, phenobarbital (#1 child)
If 1 ineff, try another. If ineff, try multiple
-Absence: ethosuximide (#1), valproic acid (#2)
-Intractable tempor: ant tempor lobectomy
!!! if >5min

44
Q

Status epilepticus (etiologies)

A

!!!Emerg; seiz >5min or ≥2 seiz w/o return to baseline

Anticonvuls withdraw/noncomply
Anoxic brain injury
Alcoh/sedative withdraw
Drug intoxic
Metab disturb
Head trauma
Infection
45
Q

Status epilepticus (dg)

A

ttt+dg started together!!! Morta 10-20%

Hx, PE, CBC, e-, glu, ABG, LFTs, BUN/creat, ESR
Antiepilep level, toxicol screen
Continuous EEG
Stat CT if intracran pathol suspect then +/- LP

46
Q

Status epilepticus (ttt)

A

!!! Airway, Breathing, Circulation
ttt cause
Thiamine then glucose + naloxone
-IV benzo (loraz/diaz) in 0-5min
-2nd dose benzo at 5-10min
-If seiz still at 20min: fosphenytoin, valproate Na, phenobarb, levetirac, continuous midazolam
-If refract, continuous antiepilep w/ bolus + intubation

47
Q

Benign paroxysmal positional vertigo

A

Recurr periph vertigo; otolith
Transient, episodic vertigo (< 1min) + nystagm (to affected side) trigg by chang head posit*

Dg: Dix-Hallpike maneuver
If >1min, gait disturb, vomit: think central les*
ttt: Epley maneuver; resol in wks-mos; !recurr
!!! CI antivertigo meds

48
Q

Acute peripheral vestibulopathy (labyrinthitis or vestibular neuritis)

A

Acute vertigo, haed mot* intoler, gait unsteadiness
+ N/V, nystagm

  • Labyr: auditory or aural sympt (tinnit, ear fullness, hear loss); #dg lateral pontine/cerebellar stroke (AICA)
  • Vestib neuritis: No auditory or aural sympt; #dg lateral medullary/cerebellar stroke (PICA)
49
Q

Acute peripheral vestibulopathy (dg, ttt)

A 
Dg: of exclusion (r/o cerebell stroke)
AbNl vestibulo-ocular reflex
Horizont nystagm (1 direct*, opposite to les*)
No vertic eye misalignment
If high risk/atypical → MRI w/ diffus*

ttt: acute CS (in <72h) + antivertigo (meclizine); resolv in wks-mos

50
Q

Meniere disease (PE, dg)

A

Recurr sev vertigo + auditory sympt (hear loss, tinnit, ear fulln) for hours-days; N/V
Progr losing low-fqcy hearing in years on affected side

Dg: clinic; 2 episodes of ≥20min w/ remission betw/ + hearing loss (documented) + tinnit/fullness
All 3 criteria needed after r/o other causes

51
Q

Meniere ds (ttt)

A

Acute: meclizine or benzo; antiemetics
Chronic: limit salt intake, diuretics

Sev unilat: intratympanic inject* of gentamicin (↓fqcy and severity)

52
Q

Syncope (definition)

A

Loss of cs 2/2 sudden drop in cerebral perfus*
Cardiac or noncardiac

Presyncope (ass w/ noncard): imminent loss of cs w/o fainting

Trigg: orthostat, long stand, see bld, Valsalva

53
Q

Syncope (etiologies)

A 
-Noncardiac: prodrom sympt (N, diaphor) then loss of cs + M. tone; < 30sec; recover in secs
Orthost hypoTN (dehydr, autonom neuropathy)
Vasovagal (↑vagal tone; by prolong stand, emot*, pain)

-Cardiac: No prodrom/postdrom sympt; Hx of arrhyth, valv ds, struct heart ds
LVOTO (Ao sten, hypertroph obstruc CM): sync w/ exert*
Arrhythmia (CAD, MI, CM, WPW sd, low EF)
Tors de pointes (by K+/Mg+ abNl, any medic that ↑QT)

54
Q

Syncope (dg, ttt)

A

Dg: unless clear vasovag in young ptt w/o card Hx/RF; all ptts should have Holter monito + ECG + card enz
+/- echocardio, tilt-test, neuroimag
!seizure (EEG) if jerk, prolong confus*, tongue bite

ttt: underl cause + avoid trigg

55
Q

Myasthenia gravis (PE)

A

Ab anti-postsynapt ACh recept
Young W; ass w/ thymoma, thyrotoxicosis, other AI ds

Ptosis/double vis*; dysarth/dysphag; prox muscle weakn
Sympt worse by end of day
Myasth crisis: lethal complic (resp)

56
Q

Myasthenia gravis (dg, ttt)

A

Dg: ACh recept Ab; Edrophonium (Tensilon; anticholinesterase); confirm w/ EMG or ↓response to repetitive nerv stimul; Chest CT (thymoma)

ttt: anticholinesterase (pyridostigmine); prednisone/immsuppressants; plasmapher; IVIG
Resect* of thymoma; avoid aminoglyc/fluoroq/B⊖

57
Q

Lambert-Eaton myasthenic syndrome (PE)

A

Paraneopl AI ds (small cell lung carcin)
Ab anti-presynap Ca channels Ab

Prox muscl weakn; ↓DTR
!!! Extraocular, resp, bulbar muscl spared
Weakn improve w/ activ

58
Q

Lambert-Eaton myasthenic syndrome (dg, ttt)

A

Dg: repetit nerv stimulat* w/ incremental resp
Presynap Ca chann autoAb

ttt: lung cancer ttt; 3-4diaminopyridine or guanidine; pyridostigmine; CS or azathioprine

59
Q

Multiple sclerosis (PE)

A

T-cell mediated AI ds; esp W; 20-40yo
Relaps-remitt; 1* progress; 2* progress; progress relapse

Multi neuro sympt (separate time/space; not single les*)
Worse w/ hot shower
Charcot’s triad: scanning speech, INO, nystagmus
Attacks ~/1.5y + last 2-8wks

60
Q

Multiple sclerosis (dg, ttt)

A

Dg: clinic; MRI (multip, asymm, periventric white matter les* esp corpus callosum); LP (↑IgG)

ttt: acute (high-dose IV CS; if refract, plasma exchange)
Immunomodulat (↓relaps); Interferon-B1a + Int-B1b + copolymer-1
Sympt ttt: baclofen (spastic), cholinerg (ur retent*), antichol (ur incont), carbamaz/amitript (painful paresth), antidepr

61
Q

Guillain-Barre syndrome (PE)

A

Acute, rapid progress demyelin AI ds; periph nerves
Ass w/ campylob jejuni, viral inf, influ vacc
Almost complete recovery ≤1y

Progr symm ascend paralysis, areflexia
Sev: paralys trunk, diaphr, cranial N
Autonom or sensory N may be affect (paresth, autonom dysregul)

62
Q

Guillain-Barre syndrome (dg, ttt)

A

Dg: N conduct* study (diffuse demyel; ↓cond velocity)
CSF: prot >55mg/dL, albuminocytologic dissociat*

ttt: fqt respir monito (ICU?); plasmapher + IVIG (#1); No CS
Aggress phys rehab

63
Q

Amyotrophic lateral sclerosis (PE)

A

Chron progress degenerative ds
Loss of upp + low motor neurons
In 5y, almost always resp failure + death
M>W; 40-80yo

Asymm, slow progr weakn (mo to ys); arm/leg/diaph/low cranial N; ↓weight
Spare: sensat*, eye mvts, sphinct tone

64
Q

Amyotrophic lateral sclerosis (dg, ttt)

A

Dg: clinic; EMG/nerv conduct* (widespr denerv + spontan AP); exclude other demyelin motor neurop
CT/MRI cervical (exclud struct les*)
Bulbar involv: tongue (CN XII) or orophar M. (CN IX/X) suggest path above foramen magnum (# cervic spondylosis)

ttt: support ttt + ptt educat*; Riluzole may delay progr (↓glutamate)

65
Q

Alzheimer disease (RF, PE)

A

RF: age; W; fam Hx; Down sd; low educat*
Neurofibrill tangles, neuritic plaques, amyloid

Amnesia (new info) → visuospatial def, language def, cognit↓; + depress* + agitat*
MMSE <24 (# Nl aging MMSE >24)
Mild cognit impairm: 10y before

66
Q

Alzheimer disease (dg, ttt)

A

Dg: of exclus* (clinic + progr cogn↓ w/o motor impairm; autopsy (defin dg); MRI/CT (atrophy esp tempor/pariet + r/o other dementias); Nl CSF; neuropsy test (r/o depress)
R/o hypothyr, vitB12 def, neurosyph

ttt: prevent progr (cholinest inh; donepezil) in mild-mod, (NMDA recep antag; memantine) in mod-sev
Support (ptt + fam); ttt depress/agit/sleep dso/halluc/delus

67
Q

Vascular dementia

A

Stepwise ↓ in cogn fct*
Ass w/ other sympt of stroke (senso/motor def)
RF: age, HTN, DM, embol, Hx of stroke

Dg: dementia + ≥2 of these (focal neuro sign; abrupt sympt; imaging not indic unless other susp)
ttt + prevent: same as stroke

68
Q

Frontotemporal dementia (Pick disease)

A

Rare, progress
Disinhib + signif chang in behav/personal (early)
Speech disturb, inattent, compulsiv, extrapyr signs

Dg: clinic + MRI/CT (atrophy of frontal + tempor)
ttt: symptom

69
Q

Normal pressure hydrocephalus

A

Impair reabs of CSF; potentially tttable
Triad: dementia, gait apraxia, urin incont
No signs of ↑ICP (papilled, headac)

Dg: clinic; CT/MRI (ventric enlarg+++); LP (Nl CSF press)
ttt: LP or continuous lumbar drainag xd; VP shunt

70
Q

Creutzfeldt-Jakob disease (PE)

A

1 of the transmiss spongiform encephalop
Neur degen, astrocytic prolif
AbNl protease-resist prion prot accum

Subacute dementia + ataxia, myoclonic jerks + rapid progr (wks-mos)

71
Q

Creutzfeldt-Jakob disease (dg, #dg, ttt)

A 
Dg: clinic; ↑CSF 14-3-3 and tau prot; brain biopsy/autopsy (defin); MRI or EEG help
#dg: limbic encephalitis, Hashimoto encephalop, toxic encephalop

No ttt; death ≤1y
!!! transmission

72
Q

Lewy body dementia

A

Progr cognit chang, visual-spatial prob, execut dysfct*
Parkinson-like mvt abNl (bradykin, rigid, tremor, shuffl gait)
Psychiatric: halluc, delus*, depress, anxiety

Dg: clinic; imaging + neuropsy eval (r/o other)
Brain biopsy/autopsy (defin; alpha-synuclein prot accum = Lewy bodies)
ttt: sympt

73
Q

Huntington disease

A

AD; CAG triplet repeats; anticipation
30-50yo; chorea; alter behav; dementia; ↓weight; depres

Dg: clinic; confirm w/ genetics; CT/MRI (cerebr atroph, caudate/putamen)
ttt: No cure; reserpine/tetrabenazine (↓mvt); atyp antipsych (↓psychosis w/o extrapy side eff); genet counsel (kids)

74
Q

Parkinson disease (PE)

A

Idiop; >50yo; dopamin deplet* in subst nigra
-Parkinsonism: by antipsych; muti subcortic infarcts; toxins; trauma

Tetrad: rest tremor (4-6Hz; ↓w/ mvt); rigidity (cogwheel); bradykin + gait abNl (w/o arm swing); postural instab
Other: masked facies; ↓memory; micrographia

75
Q

Parkinson disease (ttt)

A
  • Amantadine: early ttt; short-term (akines; rigid; tremor)
  • Levodopa/carbidopa: Levo cross BBB; Carbi block periph conv of Levo
  • Dopamine agon: ropinirole/pramipexole/bromocriptine (early)
  • Selegiline (MAO-B inh): neuroprotect; ↓need for levodopa
  • COMT inh: entecapone/tolcapone w/ levodopa
  • Anticholin: trihexyphenidyl/benztropine; early for tremor
  • If all insuff: surg pallidotomy or deep brain stimulators
76
Q

Intracranial neoplasms

A
  • 1* (30%)
  • Meta (70%): lung/brst/kidn/GI/skin; at gray-white junct*; rapid, invasiv, necrosis

Mass eff, cereb edema, ↑ICP, seiz, focal progr def
Dg: CT/MRI; biopsy (histo)
ttt: surg, RT, chemoT; manag ICP; antiepilep

77
Q

Common 1* neoplasms in adults

A
  • Glioblastoma (Gr. IV astrocytoma): malignant; poor pg
  • Meningioma: benign
  • Vestibular schwannoma: benign
78
Q

Common 1* neoplasms in children

A
  • Pilocytic astrocytoma: benign; GFAP⊕
  • Medulloblastoma: highly malign; neuroectodermal
  • Craniopharyngioma: benign; calcificat*
79
Q

Neurofibromatosis (NF1 vs NF2)

A

-NF1: ≥2 of these: 6 café au lait spots, 2 neurofibromas, freckling in axill/inguin, optic glioma, 2 lisch nodules, bone abNl, 1st* relative w/ NF1

-NF2: bilat vestib schwannomas OR
Unilat vest schw or 2 of (neurofibromas, meningiomas, gliomas, schwannoma) AND 1st* relative w/ NF2
+/- seiz, skin nodules, café au lait spots

80
Q

Neurofibromatosis (dg, ttt)

A

Dg: MRI w/ Gado (brain, brainstem, spine); dermato + ophthalmo exams; fam Hx; auditory test

ttt: sympt, No cure
Surg (vestib schw, optic gliom, meningioma)

81
Q

Tuberous sclerosis (PE, dg)

A 
Infantile spasm/seiz, ash-leaf hypopigm, mental disab
Sebaceous adenomas (nose/cheeks), shagreen patch (lumbosacral), cardiac rhabdomyom, renal cysts, angiolipom, carcinomas

Dg: clinic; MRI brain (tumors), Echocardio, MRI abdo (tumors), EEG (seiz)

82
Q

Tuberous sclerosis (ttt)

A

Symptomatic, cosmetic
ttt seiz
ttt spasms (ACTH or vigabatrin)
Surg if ↑ICP, seiz, develop delay

83
Q

Broca aphasia

A

Ds of spoken and/or written language
Intact comprehension
Left post infer frontal cortex; left sup MCA stroke

W/ impaired repetit, awarness/frustrat, arm/face hemiparesis, hemisens loss, apraxia (oral muscl)

84
Q

Wernicke aphasia

A

Ds of language comprehens*
Intact yet nonsensical product*
Left post sup tempor lobe; left inf/post MCA stroke

W/ impaired repetit, neologism, word substitut, lack of awarness

85
Q

Coma (etiologies)

A

Unconsciousness + ↓/no response to stimuli
Dysfct* both cereb hemisph or brainstem

Diffuse hypox/isch encephalop; diffuse axonal injury; brain herniat; widesprd inf; massive brainstem hge/infarct; central pontine myelinolysis; e- disturb; exogen toxins; general seiz; endocrin/metabol dysfct

86
Q

Coma (dg)

A

Dg: comlete Hx (+meds); neuro/ophth/motor/sens/autonom
exams; labs; toxicology screen; Cx (bld/CSF)
CT w/o contr to r/o hge/structure les* + before LP
MRI to r/o ischem/structure les*
R/o catatonia, convers* unresp, locke-in sd, vegetat state

87
Q

Coma (ttt)

A

Stabilize ptt (ABC)
Reverse the reversible (Dextrose, Oxygen, Naloxone, Thiamine)
Underlying cause + complic
Prevent further damage

D/c artific life support if 2 Drs declare brain death

88
Q

Locked-in syndrome

A

Wakeful, alert, retained cognit*
Causes: central pontine myelinolysis, brainstem stroke, advanced ALS

Voluntary motor: eyes, eyelids
Respiratory drive ⊕

89
Q

Persistent vegetative state

A

Wakeful w/o awareness
Eyes open/close; sleep/wake cycles
Causes: diffuse cortical injury; hypoxic ischemic injury

No voluntary mvt
Respiratory drive ⊕

90
Q

Coma vs Brain death

A

Both: unconscious, eyes closed, No sleep-wake cycles, No voluntary mvt
Same causes: diffuse hypoxic encephalop, widesprd inf, e- disturbances, toxins

Respiratory drive ⊕ in coma but ⊖ in brain death

91
Q

Wernicke encephalopathy vs Korsakoff dementia

A

WE: triad of encephalop, ophthalmopl, ataxia
By alcoh; hyperemes; starvat*; dialysis; AIDS; ↑by high glucose admin
ttt: revers w/ vitB1 admin

KD: triad + anterog/retrograde amnesia, horiz nystagm, confabulat*
Same causes + if WE ttt too late or inadeq
ttt: irreversible

92
Q

Vitamin B12 deficiency

A

Periph subacute combined neuropathy
Progress, symm paresth, spasticity, paraplegia, bowel/bladder dysfct; dementia
↑methylmalonic acid; ↑homocysteine

Ptts w/ pernicious An; vegetarians; gastric/ileal resect/ds; malnutrit
ttt: vitB12

93
Q

Vitamin B9 deficiency

A

Irritab; personality chang w/o neuro sympt
In alcoholics
Reversible if early ttt (folate admin)

English 2 (16 decks)

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