Neurology V Flashcards
What movement disorder is associated with Creutzfeldt-Jakob disease?
Myoclonus (“startle myoclonus”)
What movement disorders (2) are associated with Huntington disease?
[…] and […]
Chorea and Athetosis
What MRI finding is associated with multiple sclerosis?
Periventricular plaques
areas of oligodendrocyte loss and reactive gliosis with preservation of axons; also may involve juxtacortical, infratentorial, and spinal cord regions
What nerve is responsible for corneal sensation?
Ophthalmic branch of the trigeminal nerve (V1)
damage to this nerve results in corneal anesthesia
What nerve(s) are found medially within the cavernous sinus?
CN VI
What nerve(s) are found on the lateral walls of the cavernous sinus?
CN III, IV, V1, V2
What neurological pathology classically causes bilateral internuclear ophthalmoplegia?
Multiple sclerosis
What neurological pathology manifests as Parkinsonism with orthostatic hypotension, impotence, incontinence, or other autonomic dysfunction?
Multiple system atrophy (Shy-Drager syndrome)
anti-Parkinsonism drugs are generally ineffective; treatment is aimed at intravascular volume expansion (e.g. fludrocortisone, salt supplements)
What neurological pathology typically presents with nerve damage in two or more nerves in separate parts of the body in a patient with vasculitis?
Mononeuritis multiplex
typically manifests as asymmetric peripheral nerve findings, such as wrist and foot drop
What neurological side effect is associated with vincristine use?
Peripheral neuropathy
other common causative agents of peripheral neuropathy include platinum-based medications (e.g. cisplatin) and taxanes (e.g. paclitaxel)
What pathogen is the most common cause of spinal epidural abscess?
Staphylococcus aureus (65%)
classically presents with a triad of fever, focal/severe back pain, and neurologic findings
What retinal pathology is associated with a “blood and thunder” appearance on funduscopy?
Central retinal vein occlusion
due to dilated and tortuous veins and scattered, diffuse hemorrhages
What retinal pathology is associated with AV nicking, copper/silver wiring, and/or flame hemorrhages on funduscopy?
Hypertensive retinopathy
What sensory deficits does ALS present with?
None
important distinguishing feature from syringomyelia and ASA occlusion
What symptom is characteristic of early Alzheimer’s disease?
Short-term memory loss
later symptoms include impaired long-term memory and cognitive abilities, which interrupt activities of daily living
What syndrome is associated with lesion of the following areas: […]
- Spinothalamic tract
- Spinal trigeminal nucleus
- Sympathetic fibers
- Nucleus ambiguus (CN IX, X)
- Vestibular nucleus (CN VIII)
- Inferior cerebellar peduncle
What syndrome is associated with lesion of the following areas: lateral medullary (Wallenberg) syndrome
- Spinothalamic tract
- Spinal trigeminal nucleus
- Sympathetic fibers
- Nucleus ambiguus (CN IX, X)
- Vestibular nucleus (CN VIII)
- Inferior cerebellar peduncle
the lateral “S” tracts and CN X involvement suggest lateral medulla;
note: the vestibular portion of CN VIII is more commonly associated with lateral medullary lesions
What test is most likely to reveal the underlying etiology of amaurosis fugax?
Duplex ultrasound of the neck
most commonly due to atherosclerotic emboli from the ipsilateral carotid artery
What test is needed to definitely rule out subarachnoid hemorrhage in patients with a normal CT scan?
Lumbar puncture
What time of day is typically associated with worsening of delirium?
Nighttime (“sundowning”)
thus management of delirium should include minimizing disturbances at night
What type of hydrocephalus may be seen with Huntington disease?
Hydrocephalus ex vacuo
dilation of the ventricles secondary to caudate and putamen atrophy
What underlying neurological pathology should be suspected in a patient with bilateral trigeminal neuralgia?
Multiple sclerosis
demyelination of the trigeminal nerve nucleus or nerve root causes improper signaling of the nerve and paroxysms of severe pain
When facial nerve palsy is idiopathic it is called […] palsy.
When facial nerve palsy is idiopathic it is called Bell’s palsy.
causes of facial nerve palsy include Lyme disease, herpes simplex, herpses zoster (Ramsay Hunt syndrome), sarcoidosis, tumors, and diabetes mellitus
Which “language center” is located in the inferior frontal gyrus of the frontal lobe?
Broca’s area
Which “language center” is located in the superior temporal gyrus of the temporal lobe?
Wernicke’s area
Which “language center” is the center for language comprehension?
Wernicke’s area
Which “language center” is the center for motor speech?
Broca’s area
Which anti-epileptic medications (2) may be used for migraine prophylaxis?
topiramate and valproic acid
Which antiplatelet agent is recommended for all patients within 24 hours of ischemic stroke presentation?
Aspirin
if recurrent strokes occur with aspirin therapy, dipyridamole should be added to the treatment regimen or the patient should be switched to clopidogrel (aspirin + clopidogrel is associated with increased bleeding risk)
Which area of the brain is likely affected in a stroke resulting in hemispatial neglect syndrome?
Non-dominant parietal cortex
characterized by neglect of the contralateral half of the body
Which areas of the spinal cord are spared in a complete occlusion of the anterior spinal artery?
[…] and Lissaeur’s tract
Dorsal column and Lissaeur’s tract
Which areas of the spinal cord are spared in a complete occlusion of the anterior spinal artery?
Dorsal column and […]
Dorsal column and Lissaeur’s tract
Which artery is likely affected in a stroke resulting in motor/sensory deficits in the lower limb and urinary incontinence?
Anterior cerebral artery
urinary incontinence due to involvement of the frontal micturition center; ACA strokes may also present with primitive reflexes and behavioral symptoms
Which cerebral artery supplies the language centers (Broca’s area, Wernicke’s area)?
Middle cerebral artery
Which class of antibiotics is associated with ototoxicity and/or vestibulopathy with an abnormal head thrust test?
Aminoglycosides
may manifest as a sensation of objects moving around in the visual field when looking in any direction (oscillopsia)
Which class of antidepressant medication may be used for migraine prophylaxis?
Tricyclic antidepressants (e.g. amitriptyline)
Which class of autonomic drugs may be used for migraine prophylaxis?
β-blockers (e.g. propanolol)
Which CN III fibers (motor or parasympathetic) are affected first by compression?
Parasympathetics
e.g. posterior communicating artery aneurysm, uncal herniation
Which CN III fibers (motor or parasympathetic) are affected first by vascular disease?
Motor
decreased diffusion of oxygen and nutients to interior fibers from compromised vasculature that resides on outside of nerve; e.g. diabetes mellitus
Which CNS tumor compresses the optic chiasm, causing bitemporal hemianopsia, in children?
Craniopharyngioma
may be confused with pituitary adenoma (more common in adults)
Which CNS tumor is characterized by cholesterol crystals found in “motor-oil”-like fluid within the tumor?
Craniopharyngioma
Which cranial nerve lesion presents with diploplia that is worse while reading or walking downstairs?
CN IV (trochlear)
Which intracranial hemorrhage is seen in the image below?
Subarachnoid hemorrhage
Which intracranial hemorrhage presents as the “worst headache of my life”?
Subarachnoid hemorrhage
Which lobes are most commonly involved in a spontaneous lobar hemorrhage secondary to cerebral amyloid angiopathy?
parietal and occipital
occurs due to beta-amyloid deposition in the walls of small- to medium-size cerebral arteries
Which microorganism is the most frequent precipitant of Guillain-Barre syndrome?
Campylobacter jejuni
Which microorganisms (2) are the most common cause of brain abscess?
Viridans streptococci and Staphylococcus aureus
Which movement disorder presents as “flapping” motion upon extension of the wrists?
Asterixis
Which movement disorder presents as a high-frequency tremor with sustained posture (e.g. outstetched arms), often with a family history of tremor?
Essential tremor
tremor at rest and with movement
Which movement disorder presents as a slow, writhing movements, especially in the fingers?
Athetosis
“writhing, snake-like movement”; seen with Huntington disease
Which movement disorder presents as a slow, zigzag motion when pointing/extending toward a target?
Intention (cerebellar) tremor
Which movement disorder presents as a sudden, involuntary muscle jerking that is often rhythmic and/or repetitive?
Myoclonus
jerks; hiccups; may be seen with Creutzfeldt-Jakob disease and renal/liver failure
Which movement disorder presents as an uncontrolled movement of distal appendages at rest that is alleviated by intentional movement?
Resting tremor
most noticable in hands; e.g. “pill-rolling” tremor of Parkinson disease
Which movement disorder presents as brief, irregular, unintentional muscle contractions?
Chorea
seen with Huntington disease; tends to be non-repetitive and non-rhythmic versus myoclonus
Which movement disorder presents as restlessness and an intense urge to move?
Akathisia
can be seen with neuroleptic use or in Parkinson disease
Which movement disorder presents as sudden, wild flailing of 1 arm +/- the leg on the same side?
Hemiballismus
disruption in the indirect basal ganglia overstimulates the direct basal ganglia, producing excess muscle movement; contralateral lesion
Which movement disorder presents as sustained, involuntary muscle contractions?
Dystonia
e.g. Writer’s cramp, blepharospasm, torticollis
Which neuromuscular junction pathology, MG or LEMS, is characterized by diminished or absent deep tendon reflexes?
Lambert-Eaton myasthenic syndrome
helps differentiate LEMS from myasthenia gravis (preserved reflexes); other symptoms of LEMS include symmetric proximal muscle weakness and autonomic dysfunction
Which stroke subtype is characterized by abrupt neurological symptoms that are typically maximal at the start?
Embolic ischemic stroke
Which stroke subtype is characterized by early focal neurologic symptoms that worsen over minutes to hours with possible features of increased ICP (e.g. vomiting, headache, reduced alertness)?
Intracerebral hemorrhagic stroke
typically seen in patients with a history of uncontrolled hypertension; symptoms progress over minutes to hours
Which subtype of dementia is characterized by a step-wise decline in executive function with only mild memory loss early in the disease course?
Vascular dementia
early loss of executive function is classic; versus Alzheimer’s disease, which has a more gradual decline and begins with short-term memory, language, and visuospatial deficits
Which type of syncope is often preceded by nausea, bradycardia, and/or a feeling of warmth throughout the body?
Neurocardiogenic (vasovagal) syncope
secondary to excessive vagal tone; triggers include prolonged standing, emotional distress, and painful stimuli
Wilson disease is also known as […].
Wilson disease is also known as hepatolenticular degeneration.
Wilson disease is caused by an autosomal recessive defect in ATP-mediated hepatocyte […] transport.
Wilson disease is caused by an autosomal recessive defect in ATP-mediated hepatocyte copper transport.
