Neurology

Question 1

What is aphasia?

Answer 1

inability to comprehend or formulate language because of damage to specific brain regions

Question 2

What are the characteristics of aphasia?

Answer 2

This damage is typically caused by postoperative cerebral vascular accident (stroke), or head trauma; however, these are not the only possible causes

• postoperative cerebral vascular accident (stroke) - trouble speaking, along with having a numb or drooping face and feeling weak in one arm, is one of the three major signs of stroke
• multiple sclerosis - lesions in areas of the brain responsible for speech can have speech issues that range from mild to severe
• Intracerebral hemorrhage
• migraine headache may cause transient aphasia
• carotid disease
• recurrent laryngeal nerve injury 0.77% of thyroidectomies resulting in hoarseness and aphonia
• apraxia of speech (AOS) is a neurogenic communication disorder affecting the motor programming system for speech production

Question 3

What is dysarthria?

Answer 3

a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system

Question 4

What are the characteristics of dysarthria?

Answer 4

• causes include toxic, metabolic, degenerative diseases, traumatic brain injury, or thrombotic or embolic stroke
• degenerative disease include Parkinsonism, amyotrophic lateral sclerosis (ALS), multiple sclerosis, Huntington’s disease, Niemann-Pick disease, and Friedreich’s ataxia
• toxic and metabolic conditions include: Wilson’s disease, hypoxic encephalopathy such as in drowning, and central pontine myelinolysis
• brain tumor
• cerebral palsy
• Guillain-Barre syndrome
• hypothermia
• Lyme disease
• stroke
• Intracranial hypertension (formerly known as pseudo tumor cerebri)
• Tay-Sachs disease

Question 5

What is change in vision?

Answer 5

periopertive vision loss is very rare, occurring at a frequency of 0.002% after nonocular surgeries and 0.2% after cardiac and spine surgeries

Question 6

What are the characteristics of change in vision?

Answer 6

• increased prevalence after cardiac, spine, head and neck, and some orthopedic procedures
• the most common cause of postoperative ocular injury is corneal abrasion, which may or may not be associated with visual loss
• the most common cause of permanent POVL are central retinal artery occlusion, ischemic optic neuropathy, and cerebral vision loss

Question 7

What is an epidural hematoma?

Answer 7

traumatic head injury, conscious in ER followed by unconsciousness
-epidural hematoma are caused by damage to the middle meningeal artery as it passes through the foramen spinous of the sphenoid bone

Question 8

What is anterior cord syndrome?

Answer 8

loss of pain and temperature below the level with preserved joint position/vibration sense

Question 9

What is central cord syndrome?

Answer 9

loss of pain and temperature sensation at the level of the lesion, where the spinothalamic fibers cross the cord, with other modalities preserved (dissociated sensory loss)

Question 10

What is complete cord transection?

Answer 10

rostral zone of spared sensory levels (reduced sensation caudally, no sensation in levels below injury); urinary retention and bladder distention

Question 11

What is Brown-Sequard syndrome (hemisection of the cord)?

Answer 11

• loss of joint position sense and vibration sense on the same side as lesion and pain and temperature on the opposite side a few levels below the lesion
• lesion of half-ipsilateral cervical cord lesion
• contralateral sensory findings; pain and temperature loss

Question 12

What is distal sensory polyneuropathy?

Answer 12

stocking-glove sensory loss is a term used to describe sensory loss affecting the distal lower and upper extremities that is most commonly seen in length-dependent axonal neuropathies

Question 13

What are axonal neuropathies most frequently due to?

Answer 13

• diabetes mellitus
• alcohol
• vitamin B12 deficiency
• syphilis
• human immunodeficiency virus
• Lyme disease
• uremia
• chemotherapy
• vasculitis
• paraneoplastic neuropathy
• amyloidosis

Question 14

What are other causes of sensory neuropathy?

Answer 14

• Sjogren’s syndrome
• Guillain-Barre syndrome variant
• Chemotherpy-induced, especially platinum drugs
• Vitamin B6 toxicity

Question 15

What is subarachnoid hemorrhage?

Answer 15

“worst headache of my life”

-subarachnoid hemorrhage typically occurs due to ruptured berry aneurysms and presents with the “worst headache” of a person’s life

Question 16

What is a subdural hematoma?

Answer 16

an elderly patient with a history of multiple falls who is now presenting with neurological symptoms - indicative of chronic subdural hematoma

Question 17

What is vascular disorders (carotid disease)?

Answer 17

carotid stenosis <70% is best managed with anti platelet therapy (aspirin), whereas stenosis > 70% is best managed with carotid endarterectomy