NeuroSAE Flashcards
Cardinal features of Parkinson Disease
- Resting Tremor
- Bradykinesia
- Rigidity
- Postural instability
Need 2/4 of these criteria.
Trigeminal neuralgia can be empirically treated with what?
Carbamazepine
CSF findings of MS
Mild CSF pleocystosis rarely containing significant PMNs. Glucose is normal and protein is normal to mildly elevated.
ie. WBC 20; PMN 5%; glucose 75; protein 80
Head to head collision with a “jolt” and “dazed” but without LOC. What to do?
Remove from play for the day and assess him before the next game
A patient has trouble drawing distinctly different animals (they all look the same with a head, 4 legs and a tail) but he can draw intersecting pentagons accurately. What part of the brain is at fault?
Dominant lateral temporal lobe.
Semantic problem in understanding what features make animals unique. Drawing the pentagons correctly indicates that the visuospatial (nondominant parietal lobe) is ok.
Best AED for a young, reproductive age female with generalized sz? (17 y/o)
Lamotrigine - has the least cognitive side effects
Proximal > Distal weakness, and normal reflexes = disease localized to where?
Muscle
Meniere disease symptoms
Progressive hearing loss, episodes of vertigo, tinnitus
Due to excessive pressure in the endolymphatic system
Tx with salt restriction and diuretics
Complications of surgery in a myasthenic patient
Respiratory failure
Treatment for temporal lobe epilepsy?
Lamotrigine
Headache worse with laying down, tetracycline use, and 15 lb weight gain. What is found on physical exam?
Papilledema
Horner syndrome (ipsilateral ptosis and miosis) in a young female. Most common cause of this kind of stroke?
Carotid dissection due to trauma
Double vision, difficulty swallowing, nasal speech and weakness in arms and legs. Symptoms improve when getting out of bed, but get worse with routine physical activity. Confirm diagnosis with what test?
Tensilon (Edrophonium) Test. For Myasthenia gravis.
Left superior quadrantanopia in both eyes. Where is the lesion?
Right temporal
Diabetic polyneuropathy (symmetric distal lower limb sensory polyneuropathy) comes with what other systemic complication?
Nephropathy or retinopathy
No pupillary response, no corneal response, no OCR, no gag reflex, no oculovestibular response. What test confirms brain death?
Apnea test. The EEG, angiogram, MRI, and TCD are not necessary.
Symptoms of carpal tunnel and + Phalen - what’s appropriate next step?
Wrist splinting.
Mild to moderate bilateral foot drop and weakness with eversion of feet. Where is compression occurring?
peroneal nerve at the head of the fibula
TIA Symptoms and Risk factors
Transient dysarthria with at least one episode of facial drooping. Risk factors: vascular such as Afib, HTN, vascular stenosis and diabetes
Chronic inflammatory demyelinating polyneuropathy
Stocking-glove distribution with proximal and distal weakness. Reduction in conduction velocities suggest a demyelinating process both at the roots and distally. The acute form is Guillain Barre.
Inheritance pattern of DMD and BMD
X-linked recessive.
Most women carriers will not manifest the disease. BMD slower than DMD. Corticosteroids are beneficial in DMD.
What is most likely to be seen in small fiber peripheral neuropathy?
C and A delta fibers that carry pain and temperature sensation. Complain of burning pain and paresthesias. Joint position and vibration spared.
Weakness and atrophy are not seen in pure small fiber neuropathies.
Criteria for migraine without aura
- nausea
- lasting >4 hrs <72 hrs
- phonophobia/Photopohobia
Portion of the brain responsible for facial recognition
Bilateral inferior occipitotemporal cortex
lesion produces prosopagnosia
Poor comprehension, paraphasic errors, neologisms with agnosia – Wernicke’s aphasia + homonymous hemianopsia = what kind of lesion?
Intracerebral hemorrhage focused in the left temporal and parietal lobes
Tremor not present at rest, and improved with alcohol but worsened with stress. What kind of tremor?
Essential tremor - most common of all movement disorders
Autosomal dominant inheritance.
Abnormal behavior at night while asleep - immediately awakening and reporting vivid dreams. Occur 90 minutes after sleep onset and are more frequent in the second half of the night. What is he likely to have as he ages?
Parkinson disease - because of REM sleep behavior disorder. Can be other lewy body diseases too.
Expressive aphasia, intact comprehension, awareness of deficit. Dysnomia and impaired repetition. Mild corticospinal weakness. Most likely what area of brain?
High grade primary brain tumor in left posterior frontal and parietal lobes
Benign paroxysmal positional vertigo
Misplaced otoconia in the inner ear - brief but intense episodes of vertigo provoked by head turning. Episodes last <1 min and are assoc with nausea. Do Dix-Hallpike and Epley.
Which Alzheimer’s drug causes bradycardia?
Donepezil - cholinesterase inhibitor.
Memantine can do this too but not as prominent as donepezil.
Acute onset progressive unilateral visual loss, orbital pain, worse with eye movement and central scotoma. Marcus gunn pupil and issue with color perception. What is it and what medication speeds recovery?
Optic neuritis and use methylprednisolone.
Global developmental delay, narrow elongated face, prominent ears, low muscle tone = what syndrome?
Fragile X
What treatment is recommended for diabetic sensorimotor polyneuropathy?
Pregabalin
OR (duloxetine, amitryptyline, valproate, opioids, and capsaicin)
Which test should be ordered in addition to a MMSE score for evaluation of a patient with Alzheimer’s?
Neuroimaging to look for atrophy in the medial temporal lobes
Note: 14-3-3 protein is in Creutzfeldt-Jakob disease.
Blood pressure cutoff for tPA?
1185/110
Can an EEG clear you to drive?
No, only cleared by a physician and state law.
Suspect dissection from trauma - what study do you get?
MRA of the neck
Gradually progressive course of proximal lower extremity weakness, clonus, and bilateral hoffman signs - what is it and which lab helps confirm?
Subacute combined degeneration from B12 deficiency. Causes a macrocytic anemia (low hematocrit with elevated mean corpuscular volume)
Clumsiness of a limb + left pontine lesion - treat how?
Intravenous methylprednisolone for early MS.
More irritable patient with MS. Girlfriend moved out. What should neurologist ask about next?
Thoughts of self-injury due to depression.
Should you do bedrest or glucocorticoids in acute back pain?
No. They should start with NSAIDs.
Profound muscle weakness after exercise and large meals. Caused by what?
Hypo or hyperkalemic periodic paralysis.
Autosomal dominant.
Most common cause of sporadic encephalitis (involvement of the limbic system)
HSV-1 , do PCR on CSF.
Lewy body disease vs. Alzheimer’s
Lewy body dementia - visual hallucinations and parkinsonism
Prostate cancer met in spinal canal. What do you do in addition to IV dexamethasone?
Surgical decompression
Bell’s Palsy
Drooling, facial droop, noises louder in ear, forehead weakness + facial weakness. Sensation feels heavy but normal pinprick
Fluctuating weakness worsened by infection (myasthenia gravis) where is the disorder occurring?
Neuromuscular junction
Primary treatment for Parkinsons
Levodopa
Worsening headache with blurred vision and peripheral vision loss. Menstrual irregularity and galactorrhea. Where is the tumor located?
Optic chiasm - prolactin secreting pituitary tumor.
Loss of vision is for the entire visual field in the ipsilateral eye.
Pupil-sparing 3rd nerve palsy. What does it look like, and what is it caused by?
Double vision and pain in the forehead behind the eye. Ptosis and lateral and inferior deviation of the left eye. Normal accomodation and reaction to light. Caused by diabetes and microvascular cranial nerve infarction
Essential tremor best treated with what?
Propanalol.
Urinary incontinence, slowed gait - what do you ask about next?
Cognitive dysfunction - NPH
WET WOBBLY WACKY!
When you think someone suffers from toxic and metabolic encephalopathy (delirium) with asterixis, what do you order as a next test?
CMP to check for metabolic derangement.
Also consider ABG, CT, EEG, LP
B12 deficiency
Unsteady gait and “numbness and stiffness”. Stocking decrease in sensation and ataxic heel-knee-shin. Memory problems indicate cortical involvement. Beefy red tongue
Wernicke encephalopathy
Mental status changes, ophthalmoplegia, ataxia, and nystagmus. Treat with thiamine
Musculocutaneous neuropathy
biceps brachii, brachialis, coracobrachialis, sensory info on lateral cutaneous nerve of forearm.
Weakness in elbow flexion, forearm supination and numbness over lateral aspect of forearm.
Myelin of the optic nerve and CNS is maintained by what cell?
Oligodendroglia
3 causes of paroxysmal focal symptoms;
- TIAs
- Seizures (2-3 min)
- Migraine auras (positive symptoms 15-30 min)
Anti-aquaporin-4
Neuromyelitis optica is associated with Ab to this channel.
pseudodementia
severe form of depression which mimics dementia
Parsonage-Turner syndrome
Acute and severe pain around the shoulder followed by weakness and atrophy of proximal muscles of the arm. Unilateral and can have sensory loss. Viral infection or vaccination causes it, otherwise idiopathic.
Dysarthria-clumsy hand sydnrome
Lacunar stroke in the contralateral pons or internal capsule.
Other lacunar syndromes: ataxic hemiparesis, pure motor hemiparesis, pure sensory stroke
Vascular dementia
Risk factors: age and HTN
- multiple impairments with periventricular and subcortical white matter hypointensities.
Isolated weakness in dorsiflexion and eversion with sensory loss to pinprick
Caused by crossing legs at the knee
IIH - how to diagnose?
Get MRI then LP
Pain in index finger and thumb comes from which nerve root?
C6
Syncope with opisthotonic movements - diagnostic intervention most helpful?
Orthostatic blood pressure measurement
Weakness and burning with absent reflexes of progressive distal extremities
Chronic inflammatory demyelinating polyneuropathy
Seizure with stiff neck and fever. Eevated white count and left shift. What study do you get if CT is normal?
LP
Transient monocular blindness (amaurosis fugax) . Which blood vessel affected?
The ipsilateral internal carotid artery
When are symptoms worst with hypokalemic periodic paralysis
- on awakening
- after a carbohydrate-rich meal
- alcohol consumption
- exposure to cold
Weakness of thumb flexion and abduction with decreased pinprick sensation in first 3 and a half fingers. Where is the lesion?
Median nerve in the forearm
Hemorrhage in subthalamic nucleus
Hemiballism - abnormal movement with large amplitude (flailing movements). Usually contralateral.
Side effects of migraine prophylaxis
- Topiramate = renal stones
- propanalol = asthma
- valproic acid = hepatotoxic
Amitryptiline is good if person has hep C, nephrolithiasis, asthma.
Carpal tunnel affects which nerve?
Median
Rubrospinal tract
Crosses after red nucleus, so travels ipsilaterally to the cerebellar cortex from which the information originally rose. Gives ipsilateral dysmetria
After two doses of lorazepam, which med do you give to stop a seizure?
fosphenytoin
nausea med for parkinson disease
ondansetron
weakness of brachioradialis muscle and inability to extend the wrist and fingers. Where is the lesion?
Right radial nerve at the humerus
Sluggish pupils, dysphagia, dysarthria, dry mouth, constipation, urinary retention and canned food
Botulism.
Symptoms of toxic-metabolic encephalopathy. What is an appropriate screen in initial evaluation?
Urinalysis and urine culture
MRI with predominant mesial temporal atrophy
Alzheimer disease
Clumsiness in dominant hand with decreased blink rate, bradykinesia, rigidity and resting tremor. localized to where?
Basal ganglia
Most important test for possible acute or subacute spinal compression process
MRI
> 50 age, HTN, worst headache of my life, difficulty walking which is the first diagnosis to consider?
cerebellar hemorrhage
Transient global amnesia
Reassurance - associated with migraines and will show bilateral hippocampal abnormalities
smoking + thoracic myelopathy
epidural neoplastic metastasis
positive kernig sign and normal ct - what next?
LP
Altitude trauma vs acoustic trauma
Altitude = conductive loss
Acoustic trauma = sensorineural (like from gun firing)
Idiopathic transverse myelitis - what tells you the most about localization?
Extensor plantar responses
Cerebral anoxia
produces myoclonus. poor prognosis
Parinaud syndrome
Loss of vertical gaze, loss of pupillary light reflex, lid retraction, and convergence retraction nystagmus - due to pineal gland tumor
Migraine -unilateral or bilateral?
unilateral, throbbing
Ipsilateral pain and temp fibers from face, and contralateral pain and temp from the body + horner syndrome = lesion where?
Lateral medullary syndrome (Wallenberg)
Young healthy guy with first seizure after a few beers - what else do you get before he leaves the ER if he had a normal exam?
Urine drug screen
Subacute combined degeneration - what vitamin deficiency?
B12
Lower extremity weakness, saddle anesthesia, diminished reflexes = cauda equina syndrome . Most urgent treatment?
Surgical decompression
best choice for secondary stroke prevention in a high cardioembolic risk patient?
Warfarin
Left hemiparesis, hemineglect and arm > leg infolvement
Right middle cerebral artery territory (anterior branch)
BP 160/80 - need antihypertensive for TPA?
nope, keep it there or lower if it goes down
