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Neurology Flashcards

1
Q

The ratio between carotid area and vertebrobasilar stroke

A

4:1

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2
Q

Cerebral blood flow in the penumbra

A

10–20 ml/min/100 g brain tissue

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3
Q

Which mechanism plays an important role in the ischemic cascade?

A

calcium influx

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4
Q

Symptoms of vertebrobasilar insufficiency

A

Symptoms include:

  1. Vertigo (the most common symptom)
  2. Dizziness/syncope
  3. “Drop attacks:” Patient feels suddenly weak in the knees and fall.
  4. Diplopia/Loss of vision.
  5. Paresthesia.
  6. Confusion.
  7. Dysphagia/dysarthria.
  8. Headache.
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5
Q

Apraxia

A

Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex) in which the individual has difficulty with the motor planning to perform tasks or movements when asked, provided that the request or command is understood and the individual is willing to perform the task.

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6
Q

Typical symptoms of transient global amnesia

A

A) loss of anterograde memory
B) the patient is alert
C) shorter than 24 hours

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7
Q

gnostic disturbance

A

Gnostic dysfunction appear in lesions next to the primary sensory centers, supplied by the branches of the middle cerebral artery.

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8
Q

Thalamus-syndrome & thalamus-hand

A

This occurs as a consequence of the occlusion of the branches of the thalamogeniculate artery (branches of the posterior cerebral artery), when the ventral posteromedial and posterolateral thalamic nuclei are damaged.

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9
Q

Symptoms of anterior cerebral artery circulation disturbance

A

apathy, liberation reflexes, disturbance of attention, perseveration and echolalia

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10
Q

Weber-syndrome

A
  1. ipsilateral CN III palsy–> diplopia, ptosis, afferent pupillary defect
  2. contralateral hemiplegia or hemiparesis–> involvement of the corticospinal and/or corticobulbar tracts
  3. contralateral parkinsonian rigidity (only if substantia nigra involved) 5
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11
Q

Cause of pseudobulbar palsy

A

bilateral lesion of the corticobulbar fibers

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12
Q

Lateral superior pontine syndrome

A
  1. corticospinal tract: contralateral hemiplegia/hemiparesis
  2. spinothalamic tracts: contralateral loss of pain and temperature sensation
  3. cerebellar tracts: ipsilateral limb ataxia
    facial nerve (CN VII) nucleus: ipsilateral facial paralysis
  4. vestibulocochlear nerve (CN VIII) nuclei: ipsilateral hearing loss, vertigo and nystagmus
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13
Q

Hunt and Hess Scale

A

The Hunt and Hess scale describes the severity of subarachnoid hemorrhage resulting from the rupture of an intracerebral aneurysm and is used as a predictor of survival.

  1. grade 1–> asymptomatic or minimal headache and slight neck stiffness
    70% survival
  2. grade 2–> moderate to severe headache; neck stiffness; no neurologic deficit except cranial nerve palsy
    60% survival
  3. grade 3–>drowsy; minimal neurologic deficit
    50% survival
  4. grade 4–> stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances
    20% survival
  5. grade 5–> deep coma; decerebrate rigidity; moribund
    10% survival
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14
Q

Which artery’s aneurysm may cause unilateral oculomotor nerve palsy?

A

posterior communicating artery

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15
Q

postictal state

A

The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms.

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16
Q

Ticlopidine side effects

A

Symptoms of acute toxicity were GI hemorrhage, convulsions, hypothermia, dyspnea, loss of equilibrium and abnormal gait.
Longterm side effects: neutropenia, aplastic anemia, thrombotic thrombocytopenia purpura, and agranulocytosis.

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17
Q

When is the lower of the BP in acute ischemic stroke recommended?

A

If systolic blood pressure exceeds 190-200 mmHg and diastolic blood pressure exceeds 120 mmHg,

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18
Q

How can the functional status in patient with cerebrovascular disease be evaluated?

A

Barthel index

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19
Q

Mechanisms involved in regulation of cerebral blood circulation

A

1) neurogenic regulation
2) metabolic regulation
3) cerebral autoregulation

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20
Q

Non-modifiable risk factors for stroke

A

TIA, left ventricular hypertrophy, previous myocardial infarction, peripheral vascular disease, age, gender

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21
Q

Modifiable stroke risk factors

A

drug use, alcohol consumption, smoking, obesity

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22
Q

Mechanisms that play a role in coagulation

A

1) adhesion
2) aggregation
3) release reaction
4) platelet activation

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23
Q

Diaschisis

A

a sudden change of function in a portion of the brain connected to a distant, but damaged, brain area.
This may occur in the contralateral brain hemisphere and in the contralateral cerebellar hemisphere

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24
Q

Heubner arteritis

A

This is meningovascular syphilis is endarteritis with perivascular inflammation

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25
medial medullary lesion
This is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, I or C facial palsy, ataxia, vertigo, nystagmus, dysphagia. Due to occlusion of the anterior spinal artery
26
Millard–Gubler syndrome
This is one of the classical brainstem-crossed syndromes caused due to a unilateral lesion in ventral pons, manifesting as ipsilateral palsy of CN VI and VII with contralateral hemiplegia
27
Symptoms of Gerstmann syndrome
1) left-right confusion 2) finger agnosia 3) acalculia
28
Causes of cerebral venous (sinus) thrombosis
1) use of oral contraceptive pills 2) purulent otitis or sinusitis (purulent middle ear infection, or purulent infection of paranasal sinuses) 3) postpartum septic state
29
typical for intracranial hemorrhage
1) appears mostly daytime, during physical activity | 2) sudden onset, rapid, progressive disturbance of consciousness
30
Fogging phenomenon
This is explained by macrophage invasion, proliferation of capillaries, and sometimes extravasation of blood cells through damaged vessel walls
31
Indication of cerebral angiography
1) in urgent cases, when angiography helps in clinical decisions and treatments (e.g. subarachnoideal hemorrhage, local thrombolysis in acute large vessel occlusion) 2) to plan intra-arterial intervention like intraluminal angioplasty
32
Complications after stroke
1) depression--> seen in 20-50% of the cases 2) dementia --> Cognitive decline often appears in cerebrovascular diseases. The memory and the abstraction are mostly affected.
33
Neurological consequences after heart surgery
The most frequent complications are: amnesia, para-, hemi-, tetraparesis, cortical blindness, epileptic seizures, extrapyramidal symptoms, visual agnosia. The frequency of myelon lesion is not rare, hypotonic paraparesis, sensory abnormality, urinary retention are characteristic
34
Which plaque type(s) is (are) considered as source of embolisation on B-mode ultrasound image?
1) exulcerated 2) haemorrhagic 3) heterogeneous
35
Therapy in secondary stroke prevention
1) 100-325 mg acetylsalicylic acid 2) 75 mg clopidogrel 3) 2x25 mg acetylsalicylic acid + 2x200 mg dipyridamole
36
Binswanger
Binswanger disease is a progressive neurological disorder caused by arteriosclerosis and thromboembolism affecting the blood vessels that supply the white-matter and deep structures of the brain
37
Does occlusion of the external carotid artery cause neurological symptoms?
NOPE
38
endocarditis lenta
Subacute bacterial endocarditis
39
The average duration of migrain attacks
4-72 hours
40
What is the prevalence of migraine in adults?
8–12%
41
Which accompanying sign is not a diagnostic feature of migraine?
A) nausea, vomiting B) phonophobia C) photophobia
42
Osmophobia
hypersensitivity to odors
43
Which primary headache is more prevalent in males ?
Cluster headaches
44
Symptoms of Cluster headaches ?
1. Excruciating periorbital pain 2 .Lacrimation & Rhinorrhea 3. Horner Syndrome--> ptosis, mitosis & anhydroisis
45
menstrual migraine
Menstrual migraine is associated with falling levels of oestrogen. The migraine is most likely to occur in the two days leading up to a period and the first three days of a period. It affects fewer than 10% of women
46
What is the characteristic nerve conduction velocity of unmyelinitaed pain-transmitting C fibers?
0.2–2 m/s
47
Lateral cordotomy
a surgical procedure that injures the spinothalamic lateral tract in the spinal cord
48
Abdominal lancinating pain
Lancinating pain is a symptom of lues when granulomatous inflammation infiltrate posterior roots of thoracic spine and ganglion coeliacum and cause pain with sharp quality and very short duration. It is a symptoms of tabes dorsalis.
49
What is the difference between neuralgic and radicular pain?
1. Radicular pains have longer duration and are constant | 2. Neuralgic pains lasts for seconds, is sharp, can be triggered, and is restricted to one nerve supply.
50
Which one is effective in prophylaxis of cluster headache?
calcium channel blockers
51
What can be effective in the treatment of tension type headache?
Tricyclic antidepressants
52
Typical signs of alcoholic polyneuropathy
numbness and burning pain in the leg, foot and sole, hypaesthesia in all of the sensory functions with a distal predominance, and diminished or absent deep tendon reflexes
53
Dissociated sensory loss
Dissociated sensory loss is a pattern of neurological damage caused by a lesion to a single tract in the spinal cord which involves preservation of fine touch and proprioception with selective loss of pain and temperature.
54
Trigeminal-neuralgia is the least common in the following division of the trigeminal nerve
V1
55
Herpes zoster most often affects.....
the thoracic region
56
In which localization can disc herniation cause pain radiating into the thumb?
CV–CVI
57
Which headache is often associated with depression?
Tension Headache
58
Does Trigeminal neuralgia disturb sleep?
NOPE
59
What is the prevalence of headache that is a primary or associated symptom in brain tumors
60-70%
60
Cervicogenic headache
A cervicogenic headache is a pain that develops in the neck, though a person feels the pain in their head. Cervicogenic headaches are secondary headaches. Secondary headaches are those caused by an underlying condition, such as neck injuries, infections, or severe high blood pressure
61
Pseudotumor cerebri
Pseudotumor cerebri is a disorder related to high pressure in the brain that causes signs and symptoms of a brain tumor—hence the term “pseudo” or false tumor.
62
Symptoms of Pseudotumor cerebri
1. Changes in vision (like double vision) 2. Vision loss 3. Feeling dizzy or nauseated 4. Vomiting 5. Neck stiffness 6. Difficulty walking 7. Frequent headaches, often along with nausea or vomiting 8. Persistent ringing in the ears (tinnitus) 9. Forgetfulness 10. Depression
63
Meralgia paraesthetica
This is a common clinical condition caused by damage to the lateral cutaneous nerve of the thigh, resulting in pain, numbness and tingling in the front and outer side of the thigh
64
Scintillating scotoma
Scintillating scotoma is a common visual aura. It may precede a migraine headache, but can also occur acephalgically (without headache).
65
Tentorial meningioma
These are rare tumors located along the surface of the tentorium cerebella in the brain
66
Which of the following headaches can predict/anticipate rupture of cerebral aneurysm
1) migraine with aura | 2) short-lasting, extremely intense „predictive, anticipating” headache episodes (sentinel headache)
67
Convexity meningioma
Convexity meningiomas are tumors that grow on the surface of the brain (called the convexity). These tumors are about 20 percent of all meningioma cases.
68
Causalgia
Severe burning pain in a limb caused by injury to a peripheral nerve
69
Causes of radicular pain
1) extramedullary tumor 2) herpes Zoster 3) disc herniation
70
Froment’s sign
Froment's sign is a physical examination of the hand to test for palsy of the ulnar nerve which results in reduced functionality and muscle weakness of the pinch grip
71
Neuromyelitis optica
Neuromyelitis optica (NMO) is a central nervous system disorder that primarily affects the eye nerves (optic neuritis) and the spinal cord (myelitis).
72
Side effects of interferon treatment
1) fever and influenza-like symptoms at the beginning of treatment 2) may increase symptoms of depression 3) local reaction on the site of injection
73
Melkersson-Rosenthal syndrome
a rare neurological disorder characterized by recurring facial paralysis, swelling of the face and lips and the development of folds and furrows in the tongue
74
Progression in neuromyelitis optica
* 50% chance that patients will develop blindness within five years or become wheelchair-bound * 30% of them die due to respiratory paralysis due to myelencephalon involvement
75
Oral and manual automatisms are characteristics for
complex partial seizures
76
Can ACTH be used in the treatment of epilepsy?
Yes, in some cases it can cause a seizure free state
77
Characteristics of convulsive syncope
``` A) open eyes B) jerking C) sweating D) pallor E) biting the tip of the tongue ```
78
The most frequently type of epilepsy surgery
temporal lobectomy
79
Prevalence of epilepsy in industrialized countries
0.5-1%
80
jamais vu
meaning "never seen", is the phenomenon of experiencing a situation that one recognizes in some fashion, but that nonetheless seems novel and unfamiliar
81
diphenylhydantoin
Also known as phenytoin
82
Hepatic enzyme inducers
* diphenylhydantoin/ phenytoin | * carbamazepine
83
Mechanism of action of antiepileptic drugs
* GABA-receptor-agonism | * NMDA-receptor-antagonism
84
Juvenile myoclonic epilepsy
one of the most frequent epilepsy syndromes in adulthood: its prevalence is ca. 0.1%. It is characterized by grand mal seizures and myoclonic jerks (usually on awakening).
85
blepharospasm
involuntary tight closure of the eyelids.
86
Hoehn–Yahr staging
Shows the 5 stages of Parkinson's disease
87
The prevalence of the Parkinson’s disease is approximately:
100–200 patients per 100 000 people
88
What do proteins do to Levodopa absorption?
The large neutral proteins inhibit the absorption of levodopa through competitive antagonism.
89
Essential tremor
1) frequently familial 2) usually occurs in old age 3) characterised by action tremo
90
Which antipsychotics cause Parkinson like symptoms?
1) haloperidol 2) chlorpromazin 3) levomepromazin
91
Aphasia
disturbance of higher integral process of the brain due to the damage of certain cortical areas and connecting pathways
92
Autoimmune disease may be associated with polyneuropathy
1) Systemic Lupus Erythematosus 2) rheumatoid arthritis 3) Wegener's-granulomatosis 4) Sjögren-syndrome
93
Common symptom of ALS and acute Guillain-Barré syndrome
muscle weakness
94
Therapy for acute Guillain-Barré syndrome
* vitamins (B1 vitamin) | * plasma exchange therapy
95
funicular myelosis
AKA--> subacute combined degeneration
96
Mortality of Guillain-Barré syndrome
about 3%
97
Typical cerebrospinal fluid finding in Guillain-Barré-syndrome
cell-protein dissociation--> Albuminocytologic dissociation, characterized by elevated protein levels and normal cell counts in cerebrospinal fluid (CSF), is a hallmark finding of GBS.
98
vegetative disturbances
Vegetative symptoms are disturbances of a person's functions necessary to maintain life

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