Neurology Flashcards
1
Q
What is the VAN score?
A
Weakness and one of Visual disturbance, Aphasia, and Neglect
People w h this should be considered for endovaculat thrombectomy.
2
Q
What is the BP threshold for post TPA?
A
SBP 180
3
Q
What patients get DAPT after CVA?
A
Two populations:
- low risk stroke (by NHSS score)
- high-risk TIA (by ABCD2)
4
Q
Review the differentiation between central and peripheral vertigo.
A
Central:
- Multidirectional nystagmus
- Postural instability
- FND
- Immediate nystagmus that persists > 1 min
Peripheral:
- Horizontal, unidirectional nystagmus
- Mild postural instability
- No FNDs
- Visual fixation helps
- Delayed nystagmus
5
Q
What questions do you need to ask about headache?
A
- Onset: Sudden or gradual? Associated with trauma or manipulation?
- Similarity to prior?
- Age and comorbidities?
- Associated symptoms: fever, AMS, neck pain, FNDs, vomiting
6
Q
What physical exam things should you assess for in a patient with HA?
A
- Full neuro exam
- Kernig’s (passive leg flexion causing back/HA pain
- Brudzinski’s (bowing the head while supine leads to involuntary flexion of the hips
- Neck tenderness/stiffness
- Rash
7
Q
Review the HPI for HA.
A
Emergent diagnoses:
— SAH: sudden-onset maximum pain, AMS, blood thinner use, FNDs, meningismus, different from prior HAs, older patients, trauma, alcoholic
— Clot: OCPs, PMH of cancer, pregnant or recently pregnant
— PRES: HTN, AMS
— Meningoencephalitis: fever, neck pain, meningismus, AMS, local infection, immunocompromised status, different from past HAs
— Dissection of vertebral artery: recent neck trauma (including chiropractic manipulation)
— Cancer: age > 50, PMH of cancer, behind on screenings
— Space-occupying lesion: vomiting in AM, B symptoms, progressively worsening HA
— Pregnancy
— CO poisoning: family all has HA now, winter months
— GCA: vision changes, jaw claudication, neck pain
— Glaucoma: vision changes, eye pain
Non-emergent diagnoses:
— Migraine: photophobia, phonophobia, nausea, aura, association with menses, improves with rest, hallucinations, more often unilateral and throbbing
— Tension: more often bilateral and non-throbbing, typically featureless otherwise
— Cluster: eye symptoms (tearing, conjunctivitis, pain), clustered time-wise, improves with O2
— Sinus: sinus symptoms
— Referred tooth/ear pain: oral/otalgic disorders
— Rebound HA: frequent NSAID use, HA happens after NSAID wears off
8
Q
Why is a thorough HPI and exam important for patients presenting with headache?
A
The vast majority of headaches are idiopathic headaches that go away on their own. You should only do a workup with labs and imagining if they have concerning features.
9
Q
In treating a HA patient, always remember to ________ after any intervention.
A
reassess, reassess, reassess
The more you know about how they’re doing, the sooner you can make a plan for next steps.
10
Q
What is sphenopalatine nerve block?
A
Putting anesthetic in the nose – helpful for frontal headache
- Atomizer
- 3 mL syringe
- 1% lidocaine w/o epinephrine
- 2 10 cm applicator
Soak applicator in lidocaine. Spray 1 mL in each nare. Place applicator in nose for 5-15 minutes.
11
Q
Review the technique for greater occipital nerve block.
A
- Draw 5 mL 1% lidocaine w/o epinephrine
- Inject halfway between mastoid and occipital protuberance
12
Q
Noncontrast head CT is only definitively negative for SAH if it is done within _________ of symptom onset.
A
6 hours
If it’s after 6 hours and the head CT is negative, then consider an LP or CTA.
13
Q
LPs will diagnose how many SAHs missed on noncontrast CTs done for SAH r/o?
A
1 in 90
14
Q
What disorder that causes a cauda equina-like syndrome can be seen in those with autoimmune disease?
A
Transverse myelitis
15
Q
What are common triggers for migraines?
A
Think Valentine’s Day:
- Wine
- Chocolate
- Aged cheese
Also not in the mnemonic, menses.
16
Q
The corticospinal tract is in which part of the spine?
A
Lateral and anterior
17
Q
The corticospinal tract controls _______________.
A
ipsilateral motor function
18
Q
The spinothalamic tract transmits _______________.
A
contralateral pain and temperature sensation
19
Q
The spinothalamic tract is in which part of the spinal cord?
A
Anterolateral
20
Q
True or false: the dorsal columns transmit proprioception from the ipsilateral side.
A
True (they cross in the brainstem
21
Q
Which dermatomes are innervated by the thoracic spine?
A
From above the nipples (including the medial arms) to the infraumbilical area
22
Q
The sacral dermatomes primarily innervate the __________ aspect of the body.
A
dorsal
23
Q
Review the motor exam by gross nerve root.
A
C5: shoulder shrug
C6: biceps flexion
C7: triceps extension
C8: wrist extension
T1: finger abduction
L2: hip flexion
L3: knee extension
L4: knee flexion
L5: plantarflexion
S1: dorsiflexion
24
Q
Embolectomy for LVOs can be up to _______________.
A
24 hours
25
Thrombolytics in stroke can be given up to ________ hours.
4.5 (per the ECASS 3 trial)
26
What is the adult dose of Ativan for seizure?
4 mg IV
Though because this is a higher dose a lot of people do 2 mg followed by another 2 mg immediately if no abatement in seizure.
27
Do not give thrombolytics if the BP is > _________.
180/110
If it is this elevated, then give labetalol and reassess.
28
True or false: thrombectomy in LVOs will not require tPA.
False
Thrombolytics are also given to those undergoing thrombectomy.
29
Opening pressure should be done with the patient in what position?
Lateral recumbent
30
What factors indicate a pre-LP CT?
FND
Papilledema
New-onset seizure
History of CNS mass
Immunocompromised status (risk factor for abscess)
31
Broca's aphasia is typically the __________ division of the ___________ artery.
superior; L middle cerebral
32
The __________ maneuver leads to resolution of BPPV symptoms.
Epley
33
The Epley maneuver helps dislodge __________ otoliths.
posterior (the most common site where they get stuck)
34
How do you do the Dix-Halpike?
Have the patient sit upright and turn their head 45º to the affected side. Then have them bend back and dangle their head off the side of the bed.
Repeat on the other side.
35
What is it called when the eyes are deviated in an extrapyramidal reaction?
Oculogyric crisis
36
Pain out of proportion to exam, skin changes such as mottling, temperature fluctuations, and pain to minor touch such as with sheets (a phenomenon called allodynia) are features of what diagnosis?
Complex regional pain syndrome
CRPS is thought to occur when an injury leads to changes in neuropeptides that produces dysautonomia and hyperalgesia.
In severe cases, transient osteoporosis can develop.
37
People who do frequent squatting in their work can get impingement of the ___________ nerve which leads to numbness on the outer aspect of the thigh.
lateral femoral cutaneous
The syndrome is called meralgia paresthetica. Treat this with weight loss and avoidance of tight garments around the waist.
38
Which CN controls the tongue?
Hypoglossal nerve (XII)
39
Review the neuromuscular pathway and note the disorders at each step that can cause weakness.
Upper motor neurons: stroke, B12 deficiency, and CNS mass
Anterior horn cells: ALS, polio, and SMA
Peripheral nerves: diabetic neuropathy, lead poisoning, amyloidopthy, Guillain-Barre
Neuromuscular junction: myasthenia gravis, Lambert-Eaton, organophosphate poisoning, botulism
Muscle fibers: myositis, myopathy (HIV, statins, steroid)
40
Review the presentation of dural venous sinus thrombosis.
- Headache feels different than past headaches the person has had
- Is persistent and gradually worsening
- Worse in the morning and with maneuvers that increase intracranial pressure (Valsalva, coughing, vomiting)
- Risk factors of increased clot risk (OCPs, pregnancy, thrombophilic disorder, h/o intracranial infection or masses)
- Exam findings of papilledema and FNDs
41
The first-line treatment for preventing cluster headaches is _____________.
verapamil 240 mg daily
42
Propranolol is a preventive medicine for which class of headaches?
Migraine
43
First-line treatment for acute cluster headache is ____________.
100% oxygen by facemask
44
An elderly person with dementia who has "severe sensitivity to antipsychotics", such as developing extrapyramidal symptoms from low doses, may have ______________.
Lewy body dementia
45
The oculomotor nerve emerges between what two cerebral vessels?
Posterior cerebral artery (superior to the vessel) and superior cerebellar artery (inferior to the vessel)
46
What cranial nerves exit between the pons and medulla?
Abducens, facial, vestibulocochlear
The olfactory nerve exits from the inferior cerebrum.
The optic nerve exits from the midbrain.
The oculomotor nerve exits just between the superior pons and the cerebral crus.
The trochlear nerve exits from the lateral junction of the superior pons and cerebral crus.
The trigeminal nerve exits from the lateral pons.
The abducens, facial, and vestibulocochlear nerves exit from the area between the inferior pons and the superior medulla.
The glossopharyngeal, vagus, and accessory nerves exit from the lateral medulla.
The hypoglossal nerve exits from the medial medulla.
47
The ____________ arteries come together to form the pontine artery.
vertebral
48
The abducens nerve exits between which two vessels?
Labyrinthine and anterior inferior cerebellar artery
49
The posterior inferior cerebellar artery is inferior to which cranial nerve?
Accessory nerve
50
Ptosis and anisocoria are often seen with ___________ aneurysms.
posterior communicating artery
51
True or false: acute transverse myelitis presents with hyperreflexia.
False
That is a chronic finding. Acute transverse myelitis presents with flaccidity and hyporeflexia.
52
What is the one test you need to order in evaluating someone with restless leg syndrome?
Ferritin
Supplemental iron is indicated for those who have RLS and a ferritin level less than 75 ug/L.
53
Review the risk factors for pseudotumor cerebri.
- Obesity
- Female sex
- Medications: isotretinoin, ATRA, tetracyclines, steroids, Macrobid
- Endocrine disorders: hypothyroidism, hypoparathyroidism, Cushing syndrome
54
True or false: Parkinsonism is usually bilateral in onset.
False
Parkinsonism is and usually remains asymmetric.
55
The triad of Parkinsonism is _____________.
bradykinesia, rigidity, and a resting tremor
56
True or false: entacapone is one of the best treatments for early symptomatic Parkinsonism.
False
Entacapone is a catechol-O-methyl-transferase (COMT) inhibitor that helps prolong levedopa. It has no effect by itself.
57
When should you consider pramipexole instead of SInemet?
Sinemet works well but is thought to ultimately hasten the progression of Parkinson disease due to increased degradation of the substantial nigra. As such, Sinemet is reserved for the elderly (older than 65) or those with severe symptoms. Pramipexole doesn't work as well but is not thought to hasten the progression of the disease, so it is usually the first-line medicine for those with mild symptoms or age younger than 65.
58
Walking with one foot directly in front of and in line with the other is referred to as _________ walking.
tandem
59
The pineal gland is where?
On the posterior aspect of the brainstem, superior to the superior collicuii which are on the posterior aspect of the cerebral cruri.
60
Pineal gland tumors present with what signs and symptoms?
Parinaud's syndrome:
- Ataxia
- Headache (from obstructive hydrocephalus)
- Vertical gaze paralysis
- Loss of pupillary reaction
61
Don't forget that Sydenham chorea presents with jerky movements and _____________.
emotional lability
62
Explain the "get up and go" test.
This is a common test used to screen for need of physical therapy or other assistive needs in the elderly. To perform it, you have a person stand from an armless chair, walk around the room, and return to the chair. If they have difficulty with any part of it, refer for physical therapy or a home screen.
63
Describe the presentation of frontotemporal dementia.
FTD typically presents at a younger age than most other forms of dementia (classically in the patient's 50s) with disinhibition (usually described as inappropriate social behavior), apathy (usually described as a lack of motivation), executive dysfunction, and mild motor symptoms that are both upper and lower. It is rapidly progressive.
64
Review the HINTS exam (indications, tests, meaning).
The HINTS exam is used to differentiate central and peripheral causes of persistent vertigo. It should only be used in people who are having active vertigo.
The exam involves three parts:
- Head impulse: have the patient sit upright and look at you. Using your hands, make them look to each side quickly. If they have saccadic movement (instead of moving slowly and smoothly), then that is positive and reassuring. Negative (meaning they can move slowly and smoothly like a normal person) is indicative of CNS.
- Nystagmus: vertical, rotary, or bidirectional nystagmus is positive and indicative of CNS causes
- Test skew: cover one eye with them looking straight ahead then quickly remove it. If they have vertical skew of their eyes it is positive and indicative of CNS causes.
65
Why should you get an MRI/MRA to rule out posterior CVA in a vertiginous patient?
CT is insensitive -- only 10% of strokes show up on CT
MRAs are needed to rule out stenosis of the vertebral vessels that can cause positional occlusion and dizziness.
66
What is the fastest acting IM seizure med?
Diazepam 5 mg
67
When someone with a history of seizures who is on meds has a seizure, always check _____________.
levels if possible
68
Review the treatments of myasthenia gravis.
- Corticosteroids
- Thymectomy
- Physostigmine
- IVIG
69
Those with myasthenia gravis typically need __________ doses of nonpolarizing paralytics for intubation.
lower
They need higher doses of polarizing paralytics.
70
The V1 distribution of the trigeminal nerve covers what area?
Frontoparietal region to nose (medially) and inferior eyelids (laterally)
71
Trigeminal (and other) neuralgias are classically described as "___________" pain.
lancinating
72
The ________ nerve exits the posterior midbrain.
trochlear
73
What two nerves control the corneal reflex?
Afferent (V) and efferent (VIi)
74
__________ can help treat the vertigo caused by viral labyrinthitis.
Prednisolone
75
Vestibular neuritis + _____________ = labyrinthitis.
unilateral hearing loss
Remember that vestibular neuritis is characterized by vertigo, gait instability, and nausea.
76
Review status epilepticus meds.
1st line: any benzodiazepine
- Ativan (lorazepam) IV 0.1 mg/kg up to max of 4 mg; can repeat dose one additional time
- Versed (midazolam) IM/IN 0.2 mg/kg up to max of 10 mg or buccal 0.3 mg/kg up to max of 10 mg
- Valium (diazepam) IV 0.2 mg/kg up to max of 10 mg or PR 0.2 mg/kg up to max of 20 mg
2nd line: any of the following
- Keppra (levetiracetam) IV 60 mg/kg up to max 4.5 g
- Fosphenytoin IV 20-30 mg/kg (avoid in suspected Na channel toxicity such as TCA overdose)
- Valproate 20-40 mg/kg IV w/ max dose of 3000 mg ** not in pregnancy **
3rd line: intubate and then any of the following
- Propofol IV 2-5 mg/kg then gtt at 2-10 mcg/kg/hr
- Phenobarbital IV 15-20 mg/kg then gtt at 0.5-4.0 mg/kg/hr
77
What are the criteria for simple febrile seizure?
- Age 6 mths to 6 yrs
- One seizure lasting less than 15 minutes
- Full return to neurologic baseline
- No history of trauma or suspected NAT
- No focal seizure
78
Seizure is a relative contraindication to _____________ (stroke therapy).
tPA
* Seizure at the time of the stroke
79
What spirometry values determine respiratory failure in someone with GBS?
NIF less than 30
FVC less than 20 mL/kg
80
GBS presents with what CSF pattern?
Albuminocytologic dissociation
81
What is the upper limit of normal of CSF pressure?
25 cm of H2O
82
What will you find in an abducens palsy on physical exam?
Inability to abduct the eye on the ipsilateral side
83
Review the DDx for chorea.
- Stroke in the basal ganglia (most common adult cause)
- Non-ketotic hyperglycemia (second-most common adult cause)
- Infections (HIV, Sydenham chorea)
- Huntington's
84
What are the causes of normal pressure hydrocephalus?
NPH stems from impaired CSF absorption, which can results from any of the following:
- Idiopathic (often the case in the elderly)
- Prior TBI
- SAH
- Meningitis
85
True or false: patients with NPH typically report headaches.
False
86
What is the classic triad of Wernicke's encephalopathy?
- Ataxic gait
- Oculomotor dysfunction
- AMS
87
Neuroprognostication in the post-ROSC setting usually does not begin until how many hours?
72
88
What disorder presents with the delta sign on CTV?
Dural venous sinus thrombosis
The contrast in the superior sagittal sinus goes around the clot and makes a shape like that of the Greek letter delta.
89
The first two symptoms of Parkinsons are usually what? Hint, both are premotor.
Constipation and reduced olfaction
90
Why should you have a person draw a clock in evaluating for Parkinsons?
Micrographia
91
True or false: multi-lobe infarcts or wide areas of hypodensities are contraindications to tPA in stroke.
True
Also, stroke in the past 3 months.
92
The center of the cerebellum controls what anatomical region?
The trunk
People with midline cerebellar lesions will have difficulty with tandem gait and truncal ataxia.
93
What nerve controls the muscles of mastication?
V3
This is the only part of the fifth cranial nerve that carries motor fibers.
94
True or false: Guillain-Barre syndrome always presents with numbness.
False
There may be slight sensory findings such as paresthesias or mildly diminished sensation, but generally there should be no sensory involvement in GBS.
95
How is Miller-Fischer syndrome different from GBS?
MFS causes bulbar symptoms (e.g., ophthalmoplegia and swallowing difficulty) followed by ataxia and descending paralysis.
96
Why does a stroke lead to lower facial droop and Bell's palsy lead to upper and lower facial droop?
The upper part of the face is controlled by both cerebral hemispheres whereas the lower face is controlled by the contralateral hemisphere only. Thus, in a stroke, you have secondary control of the upper face but not the lower face. When the peripheral nerve is inflamed, however, both the upper and the lower face are affected.
97
The triad of Bell's palsy is unilateral whole face paralysis, _________, and __________.
hyperacusis; diminished taste
All on the same side. Usually in the setting of a viral prodrome.
98
Cavernous sinus thrombosis is most often triggered by what?
Infection: bacterial rhinosinusitis and orbiital cellulitis
99
What physical exam feature suggests cavernous sinus thrombosis?
Ophthalmoplegia
100
Warfarin is contraindication to tPA only if the INR is _______.
1.7 or greater
101
Tardive dyskinesia is caused by prolonged use of dopamine _______.
antagonists
102
A NIF less than ______ suggests potential need of intubation in those with GBS.
30 cm
103
What two common medicines can trigger myasthenic crises?
Steroids
Macrolides
104
Review the ice pack test for myasthenia.
Ice improves ptosis
105
What is respiratory dyskinesia?
Dopamine antagonists can cause short, gasping muscle spasms
106
Diabetes can cause what isolated cranial nerve palsy?
Abducens ("a diabetic 6th")
107
When testing motor strength, always test the _______ muscles.
weakest
The weaker muscles are more sensitive -- hence testing the pronator drift.
108
What is the "Babinski's of the upper extremities"?
Hoffman's
Flicking the middle finger and watching for clonus of the thumb.
109
For a truly positive Dix-Halpike, you need what two features?
Latency and fatigability
110
When doing head impulse, always make the fast component in the direction of ___________.
returning
111
Someone presents with recurrent thunderclap headaches. They use albuterol and cocaiine. What is the likely diagnosis and what imaging study is needed?
Reversible Cerebral Vasoconstriction Syndrome (RCVS)
This is vasospasm of the cerebral vasculature that can be seen on CTA or MRA.
112
Review the symptoms that cerebral venous sinus thrombosis can cause by vein location.
- Superior and inferior sagittal sinus: motor deficits and seizures
- Straight sinus: motor symptoms and mental status changes
- Transverse sinus: CN palsy, aphasia, ICH
- Cavernous sinus: CN palsy, orbital pain, chemosis
- Internal jugular: CN palsy, neck pain, tinnitus
* Note, CVST can cause bilateral stroke symptoms.
113
Carbapenems can precipitously lower what AED?
Valproic acid
114
Phenytoin is bound to __________________ in the blood.
albumin
Diseases that decrease albumin may require decreasing doses of phenytoin.
115
Review the pathophysiology of pupil-sparing CN III palsy.
CN III has motor function on the inside and PNS fibers on the outside. Pupillary function is primarily affected by external compression (like herniation). Motor function is primarily affected by microvascular ischemia from diabetes.
116
True or false: known intracranial aneurysm is a contraindication to tPA.
True
117
Xanthochromia takes approximately _____ hours to develop from SAH.
12
118
What neural pathway (a "complex") controls breathing?
The pre-Bötzinger complex
119
Review the presentations of Menieres, labyrinthitis, and vestibular neuritis.
Labyrinthitis: constant vertigo + hearing changes
VN: constant vertigo
Menieres: relapsing/remitting vertigo with chronic hearing changes
120
What are the two parts of the cerebellum?
The body and the flocculonodular lobe
121
What score is used to determine if TIA patients should get DAPT?
ABCD2 > 3
122
What type of weakness is triggered by high carbohydrate meals, exercise, and fasting?
Hypokalemic periodic paralysis
123
Review the three categories of vertigo that EMRAP delineates.
AVS (acute vestibular syndrome):
- Vestibular neuritis, labyrinthitis, CVA
s-EVS (spontaneous episodic vestibular syndrome):
- Meniere's, TIA, vestibular migraine
t-EVS (triggered episodic vestibular syndrome):
- BPPV, CPPV, orthostasis
124
What are the doses of the first and second line status epilepticus drugs?
First:
- Lorazepam (Ativan) 2-4 mg IV
- Diazepam (Valium) 5-10 mg IV
- Midazolam (Versed) 2-4 mg IV or 5-10 mg IM
Second:
- Phenytoin (Dilantin), levetiracetam (Keppra), or valproic acid (Depakote) 20 mg/kg IV
125
What is the feared side effect of infusing phenytoin too rapidly?
Hypotension (from propylene glycol, the diluent)
Fosphenytoin can be infused much faster.
126
True or false: a normal MRI does not rule out transverse myelitis.
True
It can show inflammation but is not necessarily so.
127
Review the dermatomes of the leg.
L3: mid thigh to over knee
L4: lateral lower leg
L5: top of the foot lateral half
S1: top of the foot medial half and bottom of the leg up the back of the leg lateral side
S2: medial posterior leg top to bottom
128
Withdrawal from which medication can cause neuroleptic malignant syndrome?
Levodopa
129
Platelets less than _________ are a contraindication to tPA.
100
130
What is the pathophysiology of meralgia paresthetica?
Compression of the lateral cutaneous nerve by the inguinal ligament
131
Patients with optic neuritis are more likely to have vision loss in what pattern (central or peripheral)?
Central
132
What CN abnormality can those with cluster headaches get?
Ptosis
133
The triad of Miller-Fisher?
Areflexia, ataxia, and ophthalmoplegia
134
What nerves pass through the cavernous sinus?
CN III (hence ptosis)
CN IV (hence lateral gaze palsy)
CN V branches 1-2 (hence numbness to forehead, cheeks, and nose)
135
Review the three types of tremors.
Resting:
- Happens at rest but improves with movement
- Parkinson's and Parkinsonian disorders
Intention:
- Not present at rest but occurs and worsens with movement. Improves with alcohol.
- Essential tremors, Wilson's disease
Postural:
- Happens with prolonged holding of a posture
- Cerebellar disease, MS, and alcoholism
136
True or false: after giving tPA to a patient going to thrombectomy you need to wait 2 hours to observe for bleeding events.
False
Patients can go to thrombectomy immediately.
137
What two features signify worse prognosis in GBS?
Elderly age
Rapid onset
138
How has the treatment of seizures changed since 2004?
Prior to 2004, neurologists advised waiting until 30 minutes until starting treatment. Now longer duration of seizure is thought to lead to increased likelihood of refractory status. After 2004, advice changed to 5 minutes.
139
Why should you maximize anti-epileptic therapy early?
If a seizure doesn't break with a first-line medication, there is only a 7% chance (according to one study) of breaking with the second agent.
140
You should have a high index of suspicion of non-epiletic status in which patient population?
Post-ROSC
141
Why do EMS crews not have Ativan?
It has to be refrigerated.
142
What is the second-line agent for status epilepticus in pediatric patients?
Fosfenytoin 20 mg/kg IV
143
What cranial nerve pattern is classic for carotid artery dissection?
Partial CN III palsy (ptosis w/ miosis)
144
Describe the scoring system used to predict benefit of EVT in acute MCA stroke.
The scoring system is the Alberta Stroke Program Early CT Score (ASPECTS). You use the noncontrast CT scan. Start with a score of 10 for a totally normal CT. Subtract 1 point for evidence of infarction in 10 areas. The lower the score, the greater the area of brain that is nonsalvageable.
145
What hearing abnormality is associated with Bell's palsy?
Hyperacusis
146
True or false: any history of ICH is an absolute contraindication to tPA.
True
147
What are the indications for steroid therapy in PSGN?
Trick question: steroids are not indicated in PSGN.
148
What are differences between GBS and tick paralysis?
GBS usually causes urinary retention, whereas tick paralysis does not.
149
What is the mnemonic for caloric testing of the 8th cranial nerve?
COWS
Cold Opposite, Warm Same
The fast beat of the nystagmus goes as above when patient has no brainstem reflexes.
150
True or false: thrombolytics are indicated for CVA from septic emboli.
False
151
True or false: stroke can never cause upper and lower face paralysis.
False
A brainstem stroke can cause a Bell's-like palsy. In a brainstem stroke, however, EOM will be lost. Always check EOM in suspected Bells!
152
When are steroids indicated in GBS?
Never
They can make GBS worse.
153
How can you differentiate myasthenia from botulism?
In MG, the reflexes are preserved and it does not affect the pupils. In botulism, there with be hyporeflexia and mydriasis.
154
Review the CN that control EOM.
The easiest way to remember it is that CN III (oculomotor) does everything except lateral gaze (CN VI, abducens nerve) and inferior oblique (CN IV, trochlear). Because of this, if CN III gets knocked out the eye will be abducted (CN VI) and looking down with the top rotated down toward the nose (CN IV).
155
Explain the oculocephalic reflex.
In a comatose person with intact brainstem function, the eyes should appear to stay fixed on a point in space. In a person with no brainstem function, they move with the head.
