neuroscience Flashcards

Question

normal pressure hydrocephalus

Answer 1

- ATAXIA early in disease - urinary INCONTINENCE - DILATED VENTRICLES on neuroimaging

Answer 2

- behavioral changes - RAPIDLY PROGRESSIVE - MYOCLONUS and/or seizures

Answer 3

- considered an intermediate stage between normal aging and dementia (from any etiology) and is associated w/ an increased risk for developing dementia - it should NOT interfere w/ social or occupational function

Answer 4

-associated w/ a gradual decline in mental processing capacity and can result in occasional forgetfulness but should not interfere w/ activities of daily living

Answer 5

- presents as a sudden or stepwise decline in executive function after stroke, which interferes w/ activities of daily living - pts typically have abnormal neurologic findings on exam

Answer 6

- migraines are the most common cause of acute and recurrent headaches in the pediatric population (occur before age 20 in 50% of cases) - typically present w/ unilateral or bifrontal pain, photophobia, phonophobia, nausea, vomiting, and a visual, auditory, or linguistic aura - first line tx in children includes acetaminophen, NSAIDs, and supportive care; Triptans may be tried if these measure are not effective - although migraines in kids may be bifrontal, occipital headaches are extremely rare, and if present should raise concern for a structural lesion

Answer 7

-hx of coordination difficulties, numbness, tingling, focal neurologic signs, hx of headache that causes awakening from sleep, hx of increasing headache frequency

Answer 8

lumbar puncture

Answer 9

-ulceration, pus, drop in visual acuity, lack of healing within 3-4 days

Answer 10

-tumor, trauma, prior herpes zoster infection

Answer 11

- trauma, foreign body lodging under the lid, and contact lens use leading to corneal epithelial defect - abrasion can also occur w/o obvious corneal trauma - pts typically develop severe eye pain, photophobia w/ reluctance to open the eye, and a sensation of a foreign body in the eye - absence of eye pain suggests trigeminal nerve dysfunction as the ophthalmic branch (V1) of the trigeminal nerve (cranial nerve V) controls corneal sensation

Answer 12

- facial movement, taste in the anterior 2/3 of the tongue, lacrimation (via the greater petrosal/vidian nerves), salivation (via chorda tympani), and eyelid closure - also carries sensory fibers supplying sensation to parts of the external ear and the nasopharynx

Answer 13

- majority of eye movement (adduction via the medial rectus, elevation via the superior rectus and inferior oblique, and depression via the inferior rectus), eyelid opening, and pupillary constriction - its a pure motor nerve carrying general somatic efferent and general visceral efferent fibers

Answer 14

- carries visual info to the brain as well as mediates the afferent limb of the pupillary light reflex pathway - damage to this nerve can cause monocular blindness and an afferent pupillary defect; however, corneal sensation would be spared

Answer 15

- responsible for swallowing, palate elevation, phonation, and parasympathetic outflow to the thoracoabdominal viscera, including monitoring of the aortic arch baro- and chemoreceptors - the vagus nerve is also responsible for taste in the epiglottis and sensation from parts of the external ear; also mediates the afferent limb of the cough reflex and the efferent limb of the gag reflex

Answer 16

- degenerative disease characterized by the following: - parkinsonism - autonomic dysfunction (postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis, etc.) - widespread neurological signs (cerebellar, pyramidal or lower motor neuron) - the accompanying bulbar dysfunction and laryngeal stridor may be fatal - anti-parkinsonism drugs are generally ineffective, and tx is aimed at intravascular volume expansion w/ fludrocortisone, salt supplementation, alpha-adrenergic agonists, and application of constrictive garments to the lower body

Answer 17

-Multiple system atrophy (Shy-Drager syndrome)

Answer 18

-seen secondary to the degeneration of postganglionic sympathetic neurons; pathology is confined to the autonomic nervous system

Answer 19

-regional dysautonomia characterized by ANHIDROSIS, MIOSIS, and PTOSIS

Answer 20

- autosomal recessive disease seen predominantly in children of Ashkenazi Jewish ancentry - characterized by gross dysfunction of the autonomic nervous system w/ severe orthostatic hypotension

Answer 21

- characterized by sudden cessation of mental activity - an episode is very short, but may occur repeatedly throughout the day - there are NO associated complex automatisms or tonic-clonic activity - the diagnosis is best confirmed by EEG studies (activation procedures such as hyperventilation, photic stimulation, sleep helps further in diagnosis) - NO postictal somnolence or confusion

Answer 22

- used to diagnose PERIPHERAL nerve disorders - EMG is used to analyze the neuromuscular system, differentiate disease of neuromuscular system from primary neuropathies

Answer 23

-increased aggression, acne, baldness, gynecomastia, hepatic dysfunction, altered lipid profiles, virilization, testicular failure, and mood and behavior changes

Answer 24

- characterized by a sudden cessation of mental activity - an episode is very short, but may ocur repeatedly throughout the day - there are no associated complex automatisms or tonic-clonic activity - diagnosis is best confirmed by EEG studies

Answer 25

-associated w/ damage to the lateral spinothalamic tracts, causing contralateral loss of pain and temperature sensation beginning TWO LEVELS BELOW THE LEVEL OF THE LESION

Answer 26

- sudden onset of severe headache - lethargy, coma, or vomiting - non-contrast CT is diagnostic study of choice, and shows blood in the sulci and cisternae - in 10% of pts, the CT scan is normal, and lumbar puncture is required to confirm the diagnosis

Answer 27

-HYPODENSE parenchymal areas on CT

Answer 28

-usually present with pure motor stroke, pure sensory stroke, or clumsy-hand dysarthria

Answer 29

- may include inability to walk, occipital headache, neck stiffness, gaze palsy, and facial weakness - CT scan would reveal HYPERDENSE area

Answer 30

Stage 1: nonblanchable redness w/ intact skin Stage 2: shallow open ulcer w/ a partial thickness loss of dermis Stage 3: possible visualization of subcutaneous fat w/ a full thickness tissue loss Stage 4: exposed bone, tendon or muscle w/ possible slough or eschar

Answer 31

- result from chronic unnoticed trauma due to advanced peripheral neuropathy and poor wound healing from microvascular insufficiency - its believed that peripheral neuropathy plays a bigger role in pathogenesis - these wounds occur most commonly on the soles of the feet over the metatarsal heads and the top of the toes w/ Charcot deformity

Answer 32

- occur in the setting of chronic lower extremity edema and occur on the pretibial area of the lower leg or above the medial malleolus in the ankle - they often begin insidiously on a background of stasis dermatitis

Answer 33

- due to arterial occlusive disease that blocks blood supply and causes tissue necrosis - they usually occur in the most distal parts of the body where blood supply is lowest such as tip of the toes

Answer 34

- REBLEEDING is the major cause of death within the FIRST 24 HOURS or presentations, especially within the first 6 hours of untreated SAH - VASOSPASM can occur in up to 30% of SAH pts from DAYS 3-10 after presentation and is the major cause of delayed morbidity and death - CT ANGIOGRAPHY is preferred for detecting vasospasm, which can best be prevented w/ initiation of NIMODIPINE

Answer 35

- rare familial disorder that presents w/ migraine headache associated w/ unilateral motor deficits - the neurological deficits usually occur at the time of the headache instead of days later

Answer 36

-usually occurs after a focal motor seizure

Answer 37

- can present w/ headaches - pts tend to develop progressive mental decline and multiple neurologic deficits due to compression of the cranial nerves, brainstem, and/or cerebral cortex

Answer 38

NIMODIPINE

Answer 39

- an anticonvulsant agent that converts to phenylethylmalonamide and phenobarbital, which can be used to treat benign essential tremors (along w/ beta-blockers) - its administration can precipitate acute intermittent porphyria, which can be diagnosed by checking for urine porphobilinogen

Answer 40

beta-blockers (not recommended if patient is bradycardic or has severe COPD)

Answer 41

-characterized by the presence of both upper (spasticity, bulbar symptoms, hyperreflexia) and lower (fasciculations) motor neuron lesions

Answer 42

- Pts w/ dementia have impaired functioning due to their poor memory - impairment of daily functioning is essential in distinguishing between dementia and normal changes of aging. - pts w/ dementia have functional impairments

Answer 43

- should be suspected in pts w/ a unilateral headache w/ a pulsatile quality, particularly if it is accompanied by vomiting and photophobia - IV antiemetics (chlorpromazine, prochlorperazine, or metoclopramide) can be used as monotherapy for acute migraine attacks, particularly in pts w/ accompanying nausea and vomiting - amitriptyline and propranolol are effective PROPHYLACTIC medications, but not helpful in acute setting

Answer 44

- in a young patient w/ acoustic neuroma and multiple cafe-au-lait spots - MRI w/ gadolinium enhancement is the best method to diagnose acoustic neuromas

Answer 45

- usually presents w/ acute, severe retroorbital pain that wakes the patient from sleep, peaks rapidly, and lasts for approx. 2 hours - more common in men - may be accompanied by redness of the ipsilateral eye, tearing, stuffed or runny nose, and ipsilateral Horner's syndrome - attacks occur in clusters, daily, for 6-8 wks, followed by remission lasting up to a year - prophylaxis is key!! (verapamil, lithium, and ergotamine) - for ACUTE ATTACKS: inhalation of 100% oxygen and subcutaneous sumatriptan

Answer 46

- autoimmune inflammatory demyelinating disease of the CNS affecting primarily women of child-bearing age - acute exacerbations should be tx w/ high dose IV glucocorticoids - Plasma exchange is reserved for pts who do not respond to high dose steroids - optic neuritis, Lhermitte's sign, internuclear ophthalmoplegia, fatigue, Uhthoff's phenomenon (heat sensitivity), sensory symptoms (paresthesia, numbness), motor symptoms (paraparesis, spasticity), bowel/bladder dysfunction - diagnoses by clinical or imaging findings disseminated in time and space (periventricular, juxtacortical, infratentorial, or spinal cord) - Oligoclonal IgG bands on CSF analysis - relapsing-remitting (majority), primary progressive, secondary progressive, progressive relapsing

Answer 47

- results from rupture of bridging veins - EPIDURAL hematoma results from rupture of middle meningeal artery - semi-lenticular hematoma on CT - more common in elderly and alcoholics due to brain atrophy and possible use of anticoagulation therapy

Answer 48

- rupture of middle meningeal artery from trauma to temporal bone - biconvex hematoma on CT

Answer 49

- results from hypertensive hemorrhage usually | - most common sites are the PUTAMEN and THALAMUS

Answer 50

-rupture of an aneurysm and sometimes head trauma

Answer 51

meningoma | -usually seen over the convex surfaces of the brain

Answer 52

- direct thrombin inhibitor that reversibly binds to the active thrombin site of free and clot-associated thrombin - used mainly for prophylaxis or treatment of thrombosis in pts w/ heparin-induced thrombocytopenia

Answer 53

antiplatelet agents (aspirin, clopidogrel) and statins

Answer 54

- paresthesias and ataxia associated with loss of vibration and position sense - severe weakness, spasticity, clonus, and paraplegia, memory loss or cognitive impairment

Answer 55

- characterized by rapidly progressive ascending paralysis (which may be asymmetrical), absence of fever and sensory abnormalities, and normal CSF exam - Ticks must feed for 4-7 days before they release the neurotoxin, and are typically found on pts after meticulous searching - removal of the tick results in spontaneous improvement in most pts - NO autonomic dysfunction (unlike that seen in majority of pts w/ Guillain-Barre syndrome)

Answer 56

- presents w/ an ascending symmetrical paralysis over days to weeks, but not usually hours - sensation is usually normal to mildly abnormal - autonomic dysfunction (eg. tachycardia, urinary retention, and arrhythmias) occurs in 70% of pts - the CSF exam typically is abnormal and may show ALBUMINOCYTOLOGIC dissociation (high protein with few cells). This finding may not be present early in the course, but is present in 80-90% of pts at 1 week - Tx: IVIG or plasmapharesis - Can be difficult to differentiate from tick-borne paralysis in some cases; however, meticulous search for a tick is very easy to perform

Answer 57

- DESCENDING paralysis and early CRANIAL NERVE involvement | - Pupillary abnormalities are common

Answer 58

- may present w/ ascending paralysis over days to weeks - sensation is either mildly or grossly abnormal - MRI confirms; tx is IV steroids (methylprednisone)

Answer 59

- must order immediate non-contrast head CT - this is a critical branchpoint in management; pts w/ ischemic stroke are candidates for thrombolytic therapy possibly, while those w/ hemorrhagic stroke are not - CT can immediately visualize hemorrhagic strokes, but ischemic strokes might not be visible untile >24 hours after the event

Answer 60

-focal neurologic deficit following a seizure

Answer 61

nerve conduction studies

Answer 62

Lumbar puncture (xanthochromia on exam)

Answer 63

- 25% of ischemic strokes - due to microatheroma and LIPOHYALINOSIS in small penetrating arteries of the brain - they often affect the INTERNAL CAPSULE (especially the posterior limb) and result in pure motor dysfunction - HTN, HLD, smoking, and DM are major risk factors - usually of THROMBOTIC origin - pts have symptoms affecting the CONTRALATERAL face, arm, and leg EQUALLY - other common lacunar stroke syndromes are ataxic hemiparesis, clumsy-hand dysarthria, pure sensory stroke, and mixed sensory-motor stroke

Answer 64

-headache, vision changes, nausea, vomiting, papilledema

Answer 65

-UNILATERAL, throbbing pain, nausea, phonphobia, photophobia

Answer 66

- progressive proximal muscle WEAKNESS and atrophy WITHOUT PAIN or tenderness - lower-extremity muscles are more involved - ESR and CK are NORMAL

Answer 67

- muscle PAIN AND STIFFNESS in the shoulder and pelvic girdle - tenderness w/ decreased ROM at shoulder, neck and hip - RESPONDS rapidly to GLUCOCORTICOIDS - ESR is INCREASED; CK is normal

Answer 68

- muscle pain, tenderness, and proximal muscle weakness - SKIN RASH and INFLAMMATORY ARTHRITIS may be present - ESR and CK are INCREASED

Answer 69

- prominent muscle pain/tenderness with or without weakness - rare rhabdomyolysis - ESR is normal; CK is INCREASED

Answer 70

- muscle pain, cramps and weakness involving the proximal muscles - delayed tendon reflexes and myoedema - occasional rhabdomyolysis - features or hypothyroidism are present - ESR is normal; CK is INCREASED

Answer 71

- complication of chronic corticosteroid use - characterized by painless proximal muscle weakness, which is more prominent in the lower extremities - there is no muscle inflammation or tenderness, and creatine kinase level and ESR are normal - it slowly improves once the offending med is d/c

Answer 72

- usually seen in vasculitis and is caused by nerve damage in 2 or more nerves in separate parts of the body - pts typically develop asymmetric peripheral nerve findings such as wrist or foot drop

Answer 73

- eg myasthenia gravis - may cause proximal muscle weakness - upper more than lower extremity disease and usually have ocular symptoms - fluctuating; more muscle weakness is observed later in the day and following exercise

Answer 74

- can be seen in up to 50% of pts w/ temporal arteritis!!!! - pts typically complain of aching and morning stiffness, w/ pain and decreased ROM in the shoulders, neck, and hip girdle - pts have objectively NORMAL MUSCLE STRENGTH - the ESR is usually elevated > 40 mm/hr - SYMPTOMS IMPROVE RAPIDLY (IN DAYS) W/ GLUCOCORTICOIDS, and ESR usually returns to normal in a few weeks - CK is normal

Answer 75

INTERFERON-BETA -several well-designed clinical trials have proven that IF-beta decreases the frequency of relapse, and reduces disability in pts w/ the relapsing-remitting form of MS

Answer 76

- exertional and non-exertional - exertional heat STROKE occurs in otherwise healthy individuals undergoing conditioning in extreme heat and humidity due to thermoregulation failure - heat EXHAUSTION is due to inadequate fluid and salt replacement - CNS dysfunction (altered mental status) is NOT present in heat EXHAUSTION - know the difference between heat stroke and heat exhaustion! - heat stroke: temp > 40C (105F), altered mental status, hypotension, tachycardia, tachypnea; may have moist or dry skin and often are NOT volume-depleted; rhabdomyolysis and organ damage can occur above 105F.

Answer 77

- cytokine activation during inflammation | - temp are usually

Answer 78

- uncontrolled efflux of calcium from the sarcoplasmic reticulum - rare autosomal dominant disorder - occurs in genetically susceptible pts after administration of the anesthetic drugs halothane and succinylcholine and may be associated w/ severe hyperthermia (up to 113F)!

Answer 79

- different than heat stroke! - due to inadequate sodium and water replacement during physical activity; due to body's inability to maintain adequate cardiac output - core body temp is usually

Answer 80

- results in cardiac outlet obstruction - like exertional heat stroke, it often occurs in young, physically active individuals - symptoms: dyspnea, palpitations, syncope, and sudden cardiac death

Answer 81

- life-threatening condition characterized by diplopia, ptosis, weakness of the proximal muscles, and weakness of the bulbar muscles and diaphragm leading to respiratory distress - pts w/ declining respiratory status (declining oxygen sat, vital capacity, max inspiratory force) should be intubated for airway protection (AChE inhibitors are usually stopped to reduce secretions) - Tx: corticosteroids PLUS IVIG or plasmapheresis - infection is the most common underlying precipitant and should be treated appropriately - differentiated myasthenic crisis from MG cholinergic crisis by the Edrophonium test (short acting AChE; pts get better if myasthenic crisis and worse if MG cholinergic crisis)

Answer 82

-anticholinergic agent that may be used to prevent the muscarinic side effects of AChE therapy in pts w/ myasthenia gravis

Answer 83

- urge to move the legs and is accompanied by dysesthesias that are worsened by inactivity and improved w/ movement - symptoms are worse in the evening/night - Tx: iron supplementation for iron deficiency, conservative measures (leg massage, heating pad, exercise, avoiding sleep deprivation), and pharmacotherapy w/ dopamine agonists (pramipexole, ropinirole) or alpha-2-delta calcium channel ligands (eg. gabapentin) - can be idiopathic or secondary to iron deficiency anemia, pregnancy, uremia, diabetes mellitus, Parkinson disease, MS, or meds (antidepressants, metoclopramide)

Answer 84

-principal neurotransmitter in the PNS; also involved in CNS and autonomic systems

Answer 85

-bind to GABA receptors and enhance the inhibitory effect of GABA (increases frequency of opening of receptors)

Answer 86

- neurotransmitter involved in CNS and gastrointestinal signaling processes - decreased in depression and anxiety

Answer 87

- fluid-filled cavity located within the cervical and thoracic spinal cord that is most commonly associated w/ Arnold Chiari malformation type 1 - pts typically present w/ areflexia weakness in the upper extremities and dissociated sensory loss following a "cape" distribution - dilation of central canal or a separate cavity within the spinal parenchyma - loss of pain/temp sensation in the dermatomes corresponding to site of spinal involvement, but vibration/proprioception is preserved

Answer 88

- can cause degeneration of the dorsal and lateral spinal tracts (subacute combined degeneration) - typically presents w/ impaired vibration/proprioception and spastic muscle weakness

Answer 89

- presents w/ sudden flaccid paralysis (spinal shock) and loss of pain/temperature sensation below the level of spinal injury - autonomic dysfunction may also occur due to interruption of descending autonomic tracts - risk factors: aortic surgery or dissection

Answer 90

- segmental demyelination/inflammation of the spinal cord - may occur w/ MS - subacute onset of flaccid paralysis (spinal shock) and loss of all types of sensation below the level of spinal injury

Answer 91

-may present in older adults w/ progressive neck pain, and various symptoms/sign of radiculopathy and myelopathy

Answer 92

-heterogenous and serpiginous contrast enhancement

Answer 93

-butterfly appearance w/ central necrosis

Answer 94

- high fever, acute onset, evidence of systemic infectious process - uniform contrast enhancement

Answer 95

- usually have a duration of symptoms of less than 2 months - site of metastasis is the gray-white junction or watershed zones - usually multifocal and spherical in shape

Answer 96

- seizures, longer duration of symptoms | - contrast enhancement is less likely

Answer 97

-at the ELBOW where the ulnar nerve lies at the medial epicondylar groove

Answer 98

- can result from chronic malabsorption (Crohn disease, ileal resection, chronic atrophic gastritis, gastrectomy) and manifest clinically as macrocytic anemia and subacute combined degeneration. Peripheral blood smear: Macro-ovalocytes and hypersegmented neutrophils - numbness/paresthesias, imparied proprioception/vibration sense, gait ataxia, UMN signs such as spastic weakness and hyperreflexia, peripheral neuropathy, memory loss, dementia - serum methylmalonic acid (MMA) levels should be obtained in pts w/ borderline B12 levels as elevations in MMA are more sensitive in detecting vitamin B12 deficiency than serum vitamin levels alone

Answer 99

- rare condition that can occur in pts w/ short-bowel syndrome - unabsorbed carbs are metabolized by intestinal bacteria that produce D-lactic acid, which becomes systemically absorbed - usually asymptomatic but can develop episodes of confusion, ataxia, and dysarthria during carb loading

Answer 100

-monoclonal gammopathy and multiple myeloma can cause this -presents w/ polyneuropathy and anemia -

Answer 101

- can cause macrocytic anemia and polyneuropathy | - neuro exam shows reduction in deep-tendon reflexes and a delayed relaxation phase

Answer 102

Primary CNS lymphoma

Answer 103

- MRI usually shows multiple, ring-enhancing, spherical lesions in the basal ganglia - a positive toxoplasma serology is quite common in normal subjects in the US and is therefore NOT specific for toxoplasmosis (the disease)

Answer 104

-imaging reveal cortical and subcortical atrophy and secondary ventricular enlargement

Answer 105

- pain in the distribution of CN V - clinical diagnosis based on pain, which is severe, intense, burning or electric shock-like - paroxysmal that last a few seconds to minutes each, but occurs many times a day - Carbamazepine is the drug of choice

Answer 106

- rare cause of facial pain, caused by a virus and the individual has reddened mucosa and significant pain - condition is aggravated by dryness - tx is supportive care

Answer 107

- sudden onset of sustained muscle contractions resulting in twisting and abnormal postures (eg torticollis) - tx: benztropine or diphenhydramine

Answer 108

- subjective, restlessness, inability to sit still | - tx: benzodiazepine (lorazepam)

Answer 109

- gradual onset after > 1-6 months of therapy - dyskinesia of the mouth, face, extremities - no effective tx

Answer 110

- action tremor that worsens w/ fine motor activity | - typically the only abnormal neuro finding

Answer 111

-older adults w/ fluctuating cognition, parkinsonism, and visual hallucinations

Answer 112

- common form of focal dystonia involving the sternocleidomastoid muscle - can occur idiopathically, but is very often medication-related (typical antipsychotics, metoclopramide, and prochlorperazine) - discontinuation of causative agent may improve symptoms

Answer 113

-resting tremors, bradykinesia, rigidity, postural instability

Answer 114

- form of intention tremor affecting the upper extremities, head, voice, and other body parts - resolves during sleep and often improves w/ alcohol consumption - propranolol and primidone are first-line tx

Answer 115

- brief, irregular, unintentional muscle contractions | - movements tend to flow from one to another but are not repetitive or rhythmic

Answer 116

slow, writhing movements that typically affect the hands and feet - characteristic of Huntington's disease - chorea and athetosis often occur together

Answer 117

-sensation of restlessness that causes the patient to move frequently

Answer 118

- involuntary, stereotyped, repetitive movements and vocalizations called tics - common tics: shoulder shrugging, blinking, grimacing, and coprolalia (swearing)

Answer 119

-unilateral, violent arm flinging caused by damage to the contralateral subthalamic nucleus

Answer 120

- involuntary jerking of a muscle or muscle group | - can be rhythmic or patterned and is usually initiated by contraction or relaxation

Answer 121

- suspect in an HIV-infected patient w/ focal neuro signs and multiple non-enhancing lesions w/ no mass effect on the CT scan - PML is an opportunistic infection caused by the JC virus, a human polyomavirus - predominantly involves the cortical white matter, but the brainstem and cerebellum may also be involved - hemiparesis and disturbances in speech, vision and gait

Answer 122

- most common ring-enhancing mass lesion in HIV-infected pts - MRI shows multiple, spherical masses in basal ganglia - this is unlikely to occur if the patient is receiving trimethoprim-sulfamethoxazole! - a positive Toxoplasma serology is quite common in normal subjects in the US, and is NOT specific for this condition

Answer 123

- second most common cause of mass lesions in HIV infected pts (behind toxoplasmosis) - also presents as a ring-enhancing lesion on MRI, but is usually solitary, weakly enhancing and periventricular - the presence of EBV DNA in CSF is quite specific for the diagnosis

Answer 124

- occurs many years after an antecedent measles infection | - CT scan shows scarring and atrophy

Answer 125

- typically presents in young, obese women w/ headache, vision changes (blurry vision and diplopia), and pulsatile tinnitus - diagnosis involves ocular exam, neuroimaging (MRI, MRV) and LP - Papilledema is NOT a contraindication to LP in the absence of obstructive/noncommunicating hydrocephalus or mass lesion - CSF analysis is normal in IIH w/ the exception of elevated opening pressure (> 250 mm H2O)

Answer 126

-5-hydroxytryptamine-1 agonist used in the acute tx of migraine headache

Answer 127

- used for tx of glaucoma - pts present w/ peripheral visual field defects that may appear insidiously or acutely (acute angle-closure glaucoma) - pts usually do NOT have positional holocranial headache and abducens nerve palsy (psuedotumor cerebri)

Answer 128

- early, insidious short-term memory loss - language deficits and spatial disorientation - later personality changes

Answer 129

- STEPWISE decline - early executive dysfunction - CEREBRAL INFARCATION and/or deep white matter changes on neuroimaging

Answer 130

- early personality changes - apathy, disinhibition and compulsive behavior - frontotemporal atrophy on imaging

Answer 131

- VISUAL HALLUCINATIONS - spontaneous PARKINSONISM - fluctuating cognition

Answer 132

- ATAXIA early in disease - urinary incontinence - dilated ventricles on imaging

Answer 133

- behavioral changes - RAPIDLY PROGRESSIVE (eg over a few months) - MYOCLONUS and/or seizures - mortality within 1-2 years

Answer 134

- typically presents as a sudden or stepwise decline in executive function w/ mild memory loss early in the disease - pts can have focal neurologic deficits on exam, and neuroimaging classically demonstrates cerebral infarction and/or deep white matter changes from chronic ischemia

Answer 135

- peripheral neuropathy of CN VII (lesion below the pons) - sudden onset of unilateral facial paralysis - common findings of the affected side include inability to raise the eyebrow or close the eye, drooping of the mouth corner (with the mouth drawn to the unaffected side), and disappearance of the nasolabial fold - pts may also have decreased tearing, hyperacusis, and/or loss of taste sensation over the anterior 2/3 of the tongue - lesions in the CNS occurring ABOVE the facial nucleus will typically cause a CONTRALATERAL LOWER facial weakness that SPARES THE FOREHEAD!!!!!!!!!! - lesions in the PNS cause weakness of the entire face - acute onset of symptoms (

Answer 136

- occurs due to occlusion of the posterior inferior cerebellar or vertebral artery - pts develop loss of pain and temp over the ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vestibulocerebellar impairment (eg vertigo, nystagmus), and Horner's syndrome - motor function of the face and body is typically spared - acute treatment usually involves IV thrombolytics (eg tPA)

Answer 137

-present w/ minimal dizziness and ipsilateral ataxia

Answer 138

-affect the motor and principal sensory nuclei of the ipsilateral trigeminal nerve, causing weakness of the muscles of mastication, diminished jaw jerk reflex, and impaired tactile and position sensation over the face

Answer 139

- typically due to branch occlusion of the vertebral or anterior spinal artery - pts develop contralateral paralysis of the arm and leg and tongue deviation toward the lesion - contralateral loss of tactile and position sense can also occur w/ infarcts that extend dorsally

Answer 140

- presents w/ contralateral ataxia and hemiparesis of the face, trunk, and limbs (ie ataxic hemiparesis) - there is also variable loss of contralateral tactile and position sense

Answer 141

vestibulocerebellar symptoms: -vertigo, falling to the side of the lesion -difficulty sitting upright w/o support -diplopia and nystagmus (horizontal & vertical) -ipsilateral limb ataxia sensory symptoms: -abnormal facial sensation or pain (early sx) -loss of pain & temp in ipsilateral face and contralateral trunk & limbs ipsilateral bulbar muscle weakness: -dysphagia & aspiration -dysarthria, dysphonia & hoarseness (ipsilateral vocal cord paralysis) autonomic dysfunction: -ipsilateral Horner's syndrome (miosis, ptosis & anhidrosis) -intractable hiccups -lack of automatic respiration (esp during sleep)

Answer 142

PUTAMEN (30%) -the internal capsule that lies adjacent to the putamen is almost always involved, leading to contralateral dense hemiparesis

Answer 143

- contralateral hemiparesis and hemisensory loss - homonymous hemianopsia - gaze palsy

Answer 144

- usually NO hemiparesis - facial weakness - ataxia and nystagmus - occipital headache and neck stiffness

Answer 145

- contralateral hemiparesis and hemisensory loss - nonreactive miotic pupils - upgaze palsy - eyes deviate Toward hemiparesis

Answer 146

- contralateral hemiparesis (frontal lobe) - contralateral hemisensory loss (parietal lobe) - homonymous hemianopsia (occipital lobe) - eyes deviate away from hemiparesis - high incidence of seizures

Answer 147

- deep coma and total paralysis within minutes | - Pinpoint reactive pupils

Answer 148

- cafe-au-lait spots - macrocephaly - feeding problems - short stature - learning disabilities - pts may later develop fibromas, neurofibromas or different tumors

Answer 149

- bilateral acoustic neuromas | - cataracts

Answer 150

- should be suspected in children w/ impaired social communication/interactions and restricted repetitive interests or behaviors - comprehensive evaluation includes structured assessments of social, language, and intellectual development in addition to hearing, vision, and genetic testing

Answer 151

- a MMSE score of less than 24 points is suggestive of dementia - initially presents w/ memory symptoms, w/ sx that progress over a period of yrs - neuroimaging may demonstrate atrophy which is more prominent in the temporal and parietal lobes, although imaging should primarily be used to exclude alternative causes for dementia as opposed to making a diagnosis of Alzheimer's

Answer 152

frontotemporal dementia

Answer 153

- associated w/ focal neurologic signs and evolves in a stepwise fashion - multiple hypodense infarcts may be seen on CT

Answer 154

- tried of dementia, gait disturbance and bladder incontinence - ventricles are frequently prominent in older pts from volume loss, however the absence of sulcal enlargement can be helpful in differentiating NPH from atrophy

Answer 155

- often associated w/ a lucid interval followed by rapid neurological deterioration - they appear as a BICONVEX mass on CT scan of the head, and pts w/ features suggestive of deteriorating neurological status or increased ICP require an emergent craniotomy - indications for emergent craniotomy: GCS

Answer 156

a follow-up CT in 24 hours

Answer 157

Multiple sclerosis

Answer 158

- usually presents during the third or fourth decade w/ recurrent focal neurologic dysfunction - that attacks are non-predictable and erratic in presentation - sx may last a few weeks w/ variable recovery - one of the few conditions that may present w/ bilateral trigeminal neuralgia

Answer 159

- progressive dementia, which may occur during the third or fourth decade of life - autosomal dominant - depression, choreiform movements and subcortical dementia - CAUDATE atrophy is usually found on CT scan

Answer 160

- usually occurs in the summer months, and is caused by an ECHOVIRUS - may present w/ flu-like illness, malaise, vomiting, photophobia, stupor and fever - CSF may show elevated WBC - diagnosis is made by serology - Tx is supportive care

Answer 161

- can present in varied ways affecting the motor, sensory, or ocular system - most TIAs are transient and occur due to emboli from the carotid arteries

Answer 162

can present with loss of motor and sensory function, loss of rectal tone, and urinary retention - management includes emergent surgical consulation, neuroimaging, and possibly IV glucocorticoids - descending corticospinal tracts (lower-extremity weakness and loss of rectal tone) - ascending sensory spinothalamic tracts (the sensory level is often 2 spinal cord segments below the level of lesion) - descending autonomics in the reticulospinal tract (urinary retention/bladder flaccidity/bladder shock)

Answer 163

- usually unilateral, severe RADICULAR PAIN - saddle hypo/anesthesia - ASYMMETRIC motor weakness - HYPOREFLEXIA/AREFLEXIA - late onset bowel and bladder dysfunction

Answer 164

- sudden onset severe back pain - perianal hypo/anesthesia - SYMMETRIC motor weakness - HYPERREFLEXIA - early onset bowel and bladder dysfunction

Answer 165

- AChE inhibitors (pyridostigmine, neostigmine; this is the INITIAL TREATMENT CHOICE - immunosuppressive agents (prednisone, azathioprine, cyclosporine; steroids are used in pts who show a poor response to AChE inhibitors) - thymectomy

Answer 166

-short acting AChE inhibitor, used for diagnostic purposes only

Answer 167

-anticholinergic agent that can be used to prevent muscarinic side effects (bradycardia, hypotension, bronchospasm (and hypoxia), increased respiratory secretions,possibly nausea and vomiting) of anticholinesterase therapy in pts w/ myasthenia gravis

Answer 168

- removes ACh receptor antibodies from circulation - used in seriously ill pts when other tx are not effective or contraindicated - its effect is transient and cannot be used on a long-term basis - other indications: stabilization of the patient before thymectomy, myasthenia crisis

Answer 169

-can be due to central or peripheral nervous system disease involving the motor cortex, spinal cord, peripheral nerve, or muscle itself depending on the distribution of findings

Answer 170

- can cause extra-ocular muscle weakness (eg diplopia and ptosis) w/ symmetrical proximal weakness of the extremities (upper more than lower), neck (flexors and/or extensors), and bulbar muscles (eg dysarthria or dysphagia) - pts usually have normal reflexes, muscle bulk/tone, and autonomic function. This makes sense because it is NOT a UMN or LMN problem, but rather a NMJ problem in which auto-antibodies attack the ACh Receptor in the post-synaptic membrane

Answer 171

- neurodegenerative disease that is primarily sporadic and more frequently affects men age 40-60 - pts typically develop upper AND lower motor neuron degeneration leading to asymmetric muscle atrophy, bulbar signs, muscle weakness (distal more than proximal), hyperreflexia, spasticity, and fasciculations - sensory abnormalities and ocular deficits are usually absent

Answer 172

- pain disorder characterized by multiple well-defined and localizable tender muscle points - pts can present w/ proximal pain-limited weakness but do not usually have ptosis, diplopia, or dysphagia

Answer 173

-pathology of a single peripheral nerve (eg median neuropathy at wrist, ulnar neuropathy at elbow) that typically presents w/ sensory and/or motor symptoms in the distribution of the affected nerve

Answer 174

- peripheral nerve damage (axon and/or myelin) due to conditions such as diabetes mellitus, vitamin B12 deficiency, Guillain-Barre syndrome, or chronic inflammatory demyelinating polyneuropathy (CIDP). - pts usually present w/ reduced or absent reflexes, paresthesias, and motor (nonfatigable) and/or sensory symptoms that can involve the upper and/or lower extremities - however, bulbar muscles are less commonly affected (except in GBS and CIDP)

Answer 175

- can present w/ proximal muscle weakness and myalgias - pts typically do NOT have fatigable weakness, involvement of the eyelids, ocular dysmotility, or swallowing difficulties

Answer 176

- can present w/ proximal muscle weakness and diplopia (restrictive ophthalmopathy) - thyroid-related eye disease (eg Graves' disease) can lead to proptosis, lid retraction, and diplopia (usually not fatigable) - they typically do NOT cause dysphagia or bilateral ptosis

Answer 177

- rapidly progressive dementia, myoclonus and sharp, triphasic, synchronous discharges on EEG - this spongiform encephalopathy is caused by a prion - most pts die within one year of symptom onset

Answer 178

- defect in an autosomal dominant gene ON CHROMOSOME 4 - striatal neuro-degeneration - early onset dementia (35-50 yrs old), progressive choreiform movement of all limbs, grimacing, and ataxic gait

Answer 179

- progressive loss of nigrostriatal dopaminergic neurons | - bradykinesia, resting pill rolling tremor, cogwheel rigidity, shuffling gait and masked facies

Answer 180

- amyloid plaques - neurofibrillary tangles - selective loss of CHOLINERGIC neurons

Answer 181

- neurodegenerative disease of frontal and temporal lobes - resembles Alzheimer's dementia clinically, but is more commonly seen in FEMALES - onset of symptoms is around 50 years of age - personality and language changes are often more prominent than cognitive symptoms

Answer 182

- commonly occurs as a response to pupillary dilation from medications (eg anticholinergics, sympathomimetics) or another stimulus (eg dim light). - pts typically develop unilateral orbitofrontal headache associated w/ nausea/vomiting, unilateral eye pain w/ conjunctival injection, and a dilated pupil w/ poor light response - untreated pts can develop permanent vision loss within 2-5 hours of symptoms onset!! - more common in women (esp age > 40), asian and inuit population, and those w/ farsightedness

Answer 183

- more common in men | - last

Answer 184

-generally presents less acutely and may be accompanied by a unilateral rash in the trigeminal distribution

Answer 185

-insidious onset of headache over weeks to months, occasionally w/ focal neurologic changes

Answer 186

ESR > 50 mm/h

Answer 187

- acute vision loss, pain, afferent pupillary defect | - most commonly occurs in women

Answer 188

risk factors: strenuous activity during hot and humid weather, dehydration, poor acclimatization, lack of physical fitness, obesity, anticholinergics, antihistamines, phenothiazines, tricyclics clinical manifestations: core temp > 40C (104F) immediately after COLLAPSE AND: -CNS dysfunction (AMS, confusion, irritability, seizure) -Additional organ or tissue damage (renal/hepatic failure, DIC, ARDS) Management: rapid cooling preferably with ICE WATER IMMERSION (can consider high flow cool water dousing, ice/wet towel rotation, evaporative cooling), fluid resuscitation, electrolyte correction, management of end-organ complications, NO ROLE FOR ANTIPYRETIC THERAPY

Answer 189

-both have a body temp > 104F, but heat stroke also has CNS dysfunction (confusion, irritability, seizure, etc.)

Answer 190

-evaporative cooling is preferred in NONEXERTIONAL or CLASSIC heat stroke (seen in elderly pts w/ underlying comorbidities that limit their ability to cope w/ excessive heat) as ice water immersion is associated w/ higher morbidity and mortality in these pts

Answer 191

- headache, focal neurologic deficity, and ring-enhancing intracranial lesion(s) on contrast CT of brain in an immunocompetent patient w/ an adjacent bacterial infection - fever is present in only 50% of cases - Viridans streptococci and other head-and-neck anaerobes are the most common pathogens when brain abscess results from sinusitis - 25% of cases result from hematogenous spread from distant infections, usually lung infections or endocarditis; in these cases gram-negatives and Staph aureus are most common - in rare cases of direct inoculation from trauma or surgery, Staphylococcus predominates - Tx: PROLONGED (4-8 week minimum) antibiotic therapy and ASPIRATION/DRAINAGE

Answer 192

- cause of MUCORMYCOSIS and can cause cerebral infection due to direct extension of rhino-sinusitis - causes infection in IMMUNOCOMPROMISED pts and those w/ poorly controlled diabetes

Answer 193

ring-enhancing lesions in pts w/ AIDS | -usually multiple lesions and tend to occur in the basal ganglia and at the cortical grey-white matter interface

Answer 194

Levodopa/carbidopa - the most common early side effects are hallucinations, dizziness, headache, and agitation - after several years of therapy, involuntary movements are more likely to occur

Answer 195

Choreiform dyskinesia

Answer 196

Livedo reticularis

Answer 197

urinary retention | -they improve tremor and rigidity but do NOT have much effect on bradykinesia

Answer 198

- characterized by signs and symptoms of UMN dysfunction distal to the site of compression - these include weakness, hyperreflexia, and an extensor plantar response - cord compression is a medical emergency requiring prompt diagnosis by spinal MRI

Answer 199

- typically presents as erythema migrans, headache, arthralgias, and myalgias - late disseminated disease that occurs months to years after infection can manifest as subacute encephalopathy (meningitis/encephalitis) and axonal polyneuropathy

Answer 200

- ascending weakness, bulbar symptoms (eg dysarthria, dysphagia) and respiratory compromise after antecedent illness such as respiratory or GI infection (esp Campylobacter jejuni) - CSF analysis shows ALBUMINOCYTOLOGIC DISSOCIATION - Tx: IVIG or Plasmapheresis - Monitor autonomic (eg arrhythmias, orthostatic hypotension, urinary retention, ileus, lack of sweating) and respiratory functions

Answer 201

- ocular symptoms (eg ptosis, diplopia) and fluctuating muscle weakness that is worse late in the day - deep tendon reflexes are normal - cyclosporine and pyridostigmine for treatment

Answer 202

IV acyclovir

Answer 203

studies have shown they are NOT beneficial, and so they are no longer recommended

Answer 204

- acute exacerbation: high dose IV corticosteroids - long term: beta-interferon, glatiramer acetate, plasmapheresis, cyclophosphamide, IVIG - beta-interferon or glatiramer acetate is used to decrease the frequency of exacerbations in pts w/ relapsing-remitting or secondary progressive form of MS

Answer 205

- risk factors: IV drug use, immunocompromised state (eg diabetes, HIV, alcoholism), infectious spread from contiguous/distant source, spinal trauma or surgery - clinical features: classic triad (fever, severe FOCAL back pain and neurologic deficits), progressive symptoms (radiculopathy, motor & sensory deficits, bowel or bladder dysfunction & eventual paralysis) - management: CBC, ESR/CRP, Blood cultures, MRI OF SPINE W/ GADOLINIUM CONTRAST, CT-guided aspiration/biopsy, Empiric antibiotics, surgical decompression - Antibiotics along w/ emergency surgical decompression and drainage of the abscess are recommended for most patients - Staph aureus accounts for about 60% of infections caused by pyogenic bacteria

Answer 206

- mainly affects the temporal lobe of the brain | - may present acutely (

Answer 207

- often seen in immunocompromised patients (eg HIV) and is uncommon in immunocompetent patients - CSF: elevated opening pressure, low leukocytes (mononuclear predominance), slightly elevated proteins, and low glucose - organisms can be detected by INDIA INK PREPARATION

Answer 208

- benign suprasellar tumors that arise from Rathke's pouch - usually present w/ signs of hypopituitarism, headaches, and bitemporal blindness - bimodal age distribution: children and 55-65 age group - in children, retarded growth is most prominent feature; in adults, sexual dysfunction is most prominent; women may have amenorrhea - Tx: surgery and/or radiotherapy

Answer 209

- may be monocular or binocular depending on the cause | - usually associated w/ loss of central vision (scotomas) and an afferent pupillary defect

Answer 210

- differentiated from other dementing illnesses by early personality changes and compulsive behaviors, earlier age of onset, and a strong hereditary component - aka Pick's disease

Answer 211

- progressive dementia that typically begins w/ memory loss, language difficulties, and apraxia, followed by impaired judgement and personality changes in the late stages - risk factros: advanced age, female gender, family hx, head trauma, and Down syndrome - Tx: psychosocial intervention and pharmacotherapy w/ AChE inhibitors (eg donepezil, galantamine, rivastigmine) and/or the NMDA antagonist MEMANTINE

Answer 212

- early presentation of VISUAL HALLUCINATIONS accompanied by fluctuating cognition w/ variations in attention and alertness (often leading to misdiagnosis as delirium) - complex, highly detailed visual hallucinations may occur - Parkinsonism may also occur, but it responds poorly to dopaminergic agonist therapy

Answer 213

-appears in 15-20% of late syphilis cases and can present w/ forgetfulness, personality change, dysarthria, and intention tremor

Answer 214

-accounts for 15-20% of dementia cases | -

Answer 215

1. anterior vasculature is comprised of the internal carotid artery and its branches, especially the paired anterior and middle cerebral arteries 2. posterior circulation is comprised of the paired vertebral arteries, which unite to form the basilar artery that then further divides into the paired posterior cerebral arteries

Answer 216

- contralateral motor or sensory deficits, which are more pronounced in the lower limb than the upper limb - urinary incontinence can also be seen, gait dyspraxia, primitive reflexes (grasp, suck), abulia, and emotional disturbances.

Answer 217

- small vessel infarcts typically affecting the deep subcortical structures - caused by occlusion of a single, deep-penetrating branch of a large cerebral artery - well-recognized syndromes: pure motor hemiparesis, pure sensory stroke, sensorimotor, dysarthria-clumsy hand, and ataxic hemiparesis - the face, arm, and leg are all equally affected w/ sensorimotor lacunar stroke, and there are no associated cortical symptoms (ie, no urinary incontinence)

Answer 218

- contralateral motor and/or somatosensory deficits (more pronounced in the face or upper limb than lower limb), and homonymous hemianopia or quadrantanopia - if the dominant lobe (left) is involved, a patient may have APHASIA; if the nondominant lobe (right) is involved, a patient may have HEMINEGLECT or ANOSOGNOSIA (lack of awareness regarding one's illness)

Answer 219

- supplies the anterior circulation, generally results in extensive neurologic deficits as both the MCA and ACA territories are affected - sx include dense, contralateral hemiplegia (face, arm, and leg equally affected) w/ contralateral sensory, visual, language, or spatial impairments

Answer 220

-homonymous hemianopia, alexia w/o agraphia (dominant hemisphere), visual hallucinations (calcarine cortex), sensory sx (thalamus), third nerve palsy w/ paresis of vertical and horizontal eye movements, and contralateral motor deficits (cerebral peduncle, midrain)

Answer 221

- unilateral MOTOR impairment - NO sensory or cortical deficits - NO visual field abnormalities

Answer 222

- CONTRALATERAL somatosensory AND MOTOR DEFICIT (face, arm, and leg - conjugate eye deviation TOWARD SIDE OF INFARCT - homonymous hemianopia - aphasia (dominant hemisphere) - hemineglect (nondominant hemisphere)

Answer 223

- contralateral somatosensory and motor deficit, predominantly in lower extremity - abulia (lack of will or initiative) - dyspraxia, emotional disturbances, urinary incontinence

Answer 224

- alternate syndromes w/ contralateral hemiplegia and IPSILATERAL cranial nerve involvement - possible ataxia

Answer 225

- can cause Wernicke's encephalopathy (encephalopathy, oculomotor dysfunction (nystagmus, conjugate gaze palsy), and gait ataxia) - this condition may be induced iatrogenically in susceptible pts by administration of glucose without thiamine! - chronic thiamine (B1) deficiency can also cause Korsakoff's syndrome, characterized by irreversible amnesia, confabulation, and apathy - pathogenesis involves dietary deficiency, impaired utilization, and poor GI absorption

Answer 226

- medial vermis causes severe vertigo and nystagmus | - lateral hemispheres cause dizziness, ataxia, and weakness

Answer 227

- contralateral hemiparesis and hemisensory loss - homonymous hemianopsia - gaze palsy

Answer 228

- usually NO hemiparesis - facial weakness - ataxia and nystagmus - occipital headache and neck stiffness

Answer 229

- contralateral hemiparesis and hemisensory loss - nonreactive miotic pupils - upgaze palsy - eyes deviated Towards hemiparesis

Answer 230

- contralateral hemiparesis (frontal lobe) - contralateral hemisensory loss (parietal lobe) - homonymous hemianopsia (occipital lobe) - eyes deviate AWAY from hemiparesis - high incidence of seizures

Answer 231

- deep coma and total paralysis within minutes | - Pinpoint reactive pupils

Answer 232

- thought to result from DECREASED CSF ABSORPTION or transient increases in intracranial pressure that cause permanent ventricular enlargement w/o chronically increasing ICP. - characterized by dementia, gait disturbances, and incontinence

Answer 233

- classically present w/ the "5 P's": Pain, Pallor, Pulselessness, Paresthesia, and Paralysis - immediate anticoagulation w/ heparin and referral for emergency vascular surgery evaluation should be performed in those w/ suspected limb ischemia

Answer 234

- Wernicke's encephalopathy (confusion, ataxia, ophthalmoplegia) - give thiamine! - if history is limited, the goal should be to treat potentially reversible causes of confusion: thiamine, dextrose, supplemental oxygen, naloxone

Answer 235

Flumazenil

Answer 236

nitroprusside | labetalol

Answer 237

Myasthenia gravis | -approx. 15% of MG also have a coexisting THYMOMA, thus, screening CT of the chest is recommended

Answer 238

- common among chronic alcohol abusers | - symptoms: gait instability, truncal ataxia, difficulty w/ rapid alternating movements, hypotonia, and intention tremor

Answer 239

- "red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, and full as a flask" - flushing, anhidrosis/dry mouth, hyperthermia, mydriasis/vision changes, delirium/confusion, urinary retention/constipation, headache, dizziness, tachycardia - can precipitate acute glaucoma

Answer 240

- med used for Parkinson's disease - nausea and vomiting are seen in 80% of pts if carbidopa is not also given - ANXIETY AND AGITATION are central effects of dopamine that occur regardless of whether carbidopa is added or not

Answer 241

- MAO-B inhibitor used in tx of Parkinson's - co-administration w/ SSRIs and/or TCA's can precipitate serotonin syndrome, which is characterized by agitation, confusion, tachycardia, muscle rigidity, and sometimes seizures

Answer 242

- dopamine agonist used in tx of Parkinson's | - side effects: hypotension, nausea, constipation, headaches, dizziness

Answer 243

- NON-selective beta blocker used most often to treat benign essential tremor and portal hypertension - NOT indicated for use in Parkinson's didase - side effects: bradycardia, hypotension, somnolence, and impotence

Answer 244

- used to treat hypothyroidism | - side effects: tremor, anxiety, tachycardia, weight loss, and diarrhea

Answer 245

- atherosclerotic risk factors (uncontrolled HTN, diabetes), +/- hx of TIA - local in-situ obstruction of an artery - sx often fluctuate- stuttering progression w/ periods of improvement

Answer 246

- hx of cardiac disease (a. fib, endocarditis) or carotid atherosclerosis (bruit) - onset of symptoms is ABRUPT and USUALLY MAXIMAL AT THE START - multiple infarcts within different vascular territories

Answer 247

- hx of uncontrolled HTN, coagulopathy, illicit drug use (amphetamines, cocaine) - sx progress over minutes to hours - focal neuro sypmtoms appear early, followed by features of increased ICP (vomiting and headache, bradycardia, reduced alertness)

Answer 248

- rupture of an arterial saccular ("berry") aneurysm or from an AV malformation - severe headache at onset of neurologic symptoms - meningeal irritation - focal deficits UNCOMMON

Answer 249

- most commonly in the basal ganglia (PUTAMEN!!), thalamus, pons, and cerebellum - pts tend to present intitially w/ focal symptoms but can rapidly progress to signs of elevated ICP

Answer 250

- usually presents w/ >2 distinctive episodes of CNS dysfunction w/ at least some resolution - T2 weighted MRI shows multifocal ovoid subcortical white matter lesions located in periventricular, juxtacortical, infratentorial, or spinal cord areas - CSF shows normal pressure and the presence of oligoclonal IgG bands in >95% of pts

Answer 251

myelin oligodendrocyte glycoprotein and myelin basic protein | -however, these are NOT specific for MS

Answer 252

- glutamate inhibitor that is currently approved for use in pts w/ amyotrophic lateral sclerosis (ALS) - note, it may prolong survival and the time to tracheostomy - side effects: dizziness, nausea, weight loss, elevated liver enzymes, skeletal weakness

Answer 253

MS: corticosteroids GBS: IVIG and plasmapharesis

Answer 254

- symmetric, distal, SENSORY neuropathy that spreads in a stocking-glove pattern - common causative agents: platinum-based meds (cisplatin), taxanes (paclitaxel), and Vinca alkaloids (vincristine)

Answer 255

- manifestation of late neurosyphilis that involves the posterior spinal columns and dorsal roots - usually presents w/ sensory ataxia, brief stabbing pains, and is associated w/ pupillary irregularities (eg Argyll-Robertson pupil)

Answer 256

- an important cause of reversible changes in memory and mentation. - it will be accompanied by systemic changes such as weight gain, fatigue, and constipation

Answer 257

- early problems in visuospatial abilities (eg getting lost in their neighborhood) and anterograde memory formation - old memories tend to be preserved - personality and behavioral changes (hypersexuality, agitation) may occur as the disease progresses - hallucinations and changes in alertness are late findings

Answer 258

- presents w/ alterations in alertness, visual hallucinations, and extrapyramidal symptoms - memory deficits occur later in the course of disease

Answer 259

- step wise deterioration as damage from multiple strokes slowly adds up - risk factors for vascular disease, hx of cerebrovascular disease, and imaging evidence of strokes - psychiatric disturbances such as depression and agitation are common

Answer 260

- autosomal dominant - neurodegenerative disease affecting the caudate and putamen - mean age of onset is 35-44 years of age - sx: choreathetoid movements, behavioral disturbances, and dementia

Answer 261

- more common in elderly and alcoholics due to decreased brain volume and propensity for falls - present insidiously w/ decreased consciousness, headache, cognitive and memory deficits, balance problems, aphasia, or motor deficits

Answer 262

- presentation of major depression in the elderly | - depressed pts may have memory changes and other symptoms concerning for dementia

Answer 263

- dementia, abnormal gait, and urinary incontinence | - gait is broad-based and shuffling and pts tend to be bradykinetic

Answer 264

- dementia w/ megaloblastic anemia and posterior spinal column deficits - the most common cause is pernicious anemia

Answer 265

- can lead to Wernicke-Korsakoff syndrome - presents as ataxia, ophthalmoplegia, and confusion (Wernicke's) in addition to confabulation and amnesia (Korsakoff's) - particularly common in alcoholics

Answer 266

- characterized by a "steppage" gait: exaggerated hip and knee flexion while walking - common causes include L5 radiculopathy and compression peroneal neuropathy - L5 radiculopathy may also have weak foot inversion and plantar flexion, while these will be normal in peroneal neuropathy

Answer 267

-slow shuffling gait (Parkinson's)

Answer 268

- can result from lesions of the vermis (truncal ataxia) or the cerebellar hemispheres (limb ataxia) - features include staggering and swaying from side to side, impaired tandem gait and titubation (truncal tremor)

Answer 269

- spastic ataxia - gait appears stiff or rigid w/ circumduction (the spastic leg is abducted and advanced while in extension and internal rotation) and plantar flexion of the affected limb

Answer 270

- gait apraxia (Bruns ataxia) - strength, coordination, and sensory function are intact, but there is difficulty in initiation of forward movement of the feet when they are in contact w/ the ground ("magnetic gait")

Answer 271

- unsteady, falling to one side - normal sensation, reflexes and motor strength; nausea and vertigo are usually present - causes: acute labyrinthitis, Meniere disease

Answer 272

- IgG oligoclonal bands are present in 85-90% of cases of multiple sclerosis - CSF pressure, protein and cell count are grossly normal - note that elevated Ig levels may be found in other diseases, and so the presence of oligoclonal bands is NOT considered diagnostic for MS

Answer 273

albumino-cytologic (elevated protein and normal cell count) dissociation

Answer 274

- alterations in alertness (fluctuating), visual hallucinations, and extrapyramidal symptoms - "Lewy bodies" are eosinophilic intracytoplasmic inclusions representing accumulations of ALPHA-SYNUCLEIN PROTEIN, and may be seen in the neurons of the substantia nigra, locus ceruleus, dorsal raphe, and substantia innominata - tx: AChE inhibitor like rivastigmine; for hallucination refractory to AChE inhibitors, atypical antipsychotics may be of benefit

Answer 275

Lewy bodies are found in both. -the key distinction is the early appearance of dementia in Lewy body disease and of motor symptoms in Parkinson's disease

Answer 276

-Neurofibrillary tangles and senile plaques

Answer 277

-impaired CSF absorption

Answer 278

- appears to involve both hemispheres of brain - can have loss of consciousness - bilateral motor findings - can be convulsive or nonconvulsive (absence)

Answer 279

- limited to part of 1 hemisphere of brain - simple partial seizures: no loss of consciousness, feeling of familiarity (deja-vu), can have aura, patient may remember event well - partial seizures w/ generalization: loss of consciousness, tonic-clonic activity - complex partial seizures: loss of consciousness, can have aura, more automatisms (eg chewing, swallowing, sucking), sometimes have bilateral motor findings

Answer 280

- generally present as multiple short episodes of staring and behavioral arrest that can sometimes mimic a complex partial seizure - generally associated w/ minimal to NO postictal state and are much shorter in duration that complex partial seizures - they rarely evolve into generalized tonic-clonic seizures

Answer 281

-can present w/ a variety of different seizure types, but pts are usually age

Answer 282

- unilateral motor weakness of the face, arm, and leg WITHOUT any higher cortical dysfunction or visual field abnormalities - lesions in the vertebrobasilar system that supply the BRAINSTEM are characterized by "ALTERNATE" SYNDROMES, with contralateral hemiplegia and ipsilateral cranial nerve involvement!

Answer 283

- pure motor hemiparesis, pure sensory syndrome, ataxic hemiparesis, sensorimotor syndrome, and dysarthria-clumsy hand syndrome - pute motor strokes can occur in the subcortical white matter or brainstem - pure sensory strokes typically occur in the thalamus - ataxia-hemiparesis generally occurs with strokes in the pons

Answer 284

- supplies the medial aspect of the cerebral hemisphere - causes contralateral somatosensory and motor weakness that predominantly affects the lower extremity - associated findings: dyspraxia, abulia, emotional disturbances, and urinary incontinence

Answer 285

- characterized by "alternate" syndromes, w/ contralateral hemiplegia and ipsilateral cranial nerve involvement - in mid-brain stroke, there will be ipsilateral oculomotor paralysis w/ contralateral ataxia or hemiplegia

Answer 286

-contralateral somatosensory and motor weakness (face, arm, and leg), conjugate eye deviation toward the side of the infarct, Broca's expressive aphasia (if dominant side is affected), homonymous hemianopia, and hemineglect (nondominant side lesion)