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1
Q

CSF in meningitis =

  • yellow/viscous?
  • yellow/turbid?
  • clear?
  • very incr poly’s + ~incr/nml lymphocytes?
  • decr glu?
  • very incr protein?
A
  • yellow/viscous: TB vs fungal
  • yellow/turbid: bacterial
  • clear: viral
  • very incr poly’s + ~incr/nml lymphocytes: bacterial
  • decr glu: bacterial vs TB
  • very incr protein: bacterial
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2
Q

MILLER FISHER VARIANT:
symptoms?
dx?

A

o Ataxia + Ophthalmoplegia + Areflexia (AOA)

o Antiganglioside atb (GQ1b)

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3
Q

Froin syndrome =

A

“clotting” CSF from high protein

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4
Q

LP in Guillan-Barre?

EMG?

A

incr CSF protein w/ normal cell count (albuminocytological dissociation)

nerve conduction shows dymyelination

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5
Q

Pt w/ HA + blurred vision + projectile vomiting (morning) + papilledema +/- other signs?

A

Ependymoma

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6
Q

Posterior Fossa Tumors: age?

A

younger

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7
Q

CEREBELLAR HEMORRHAGE:

MC symptom?

A

sudden onset headache and inability to stand or walk independently

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8
Q

CEREBELLAR HEMORRHAGE:
presentation?
MC cause of bleeding?

A

vomiting
meningismus

HTN (may occur with AVM or tumor)

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9
Q

CEREBELLAR HEMORRHAGE:

exam?

A
  • Nystagmus
  • Dysarthria
  • Occasional ipsilateral facial and gaze palsy (compression of ipsilateral pons)
  • Ipsilateral appendicular incoordination
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10
Q

CEREBELLAR HEMORRHAGE:

Management?

A
  1. CT
  2. MRI (may show hemorrhage in foramen magnum)
  3. Cerebral angiogram if MRI is negative and still suspected
  4. Coagulation studies

*if >3cm = emergency srx

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11
Q

MCA stem:

1st part supplies…

A

internal capsule

basal ganglia

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12
Q

Occlusion of MCA stem =

A
  1. Contralateral hemiparesis & Sensory Loss
  2. Homonymous hemianopia (optic radiations)
    3, Conjugate gaze paresis (eyes deviate TOWARDS infarction)
    
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13
Q

MCA infarct on dominant side =

On nondominant side =

A

dominant = global aphasia

nondominant = impaired spatial perception and contralateral neglect

Pain and T are less affected than proprioceptive and discriminative

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14
Q

Superior division of MCA supplies..

A
  • lateral frontal lobe
  • anterior lateral parietal lobe
  • insula
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15
Q

Superior division of MCA infarct causes…

Dominant vs nondominant?

A
  • contralateral hemiparesis and sensory loss of face/arm > leg
  • Contralateral weakness and sensory loss are worse distally
  • Contralateral gaze paresis without homonymous hemianopsia (spares optic radiations)

Dominant: Broca aphasia
Nondominant: hemineglect + spatial disorders

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16
Q

Inferior division of MCA supplies..

A
  • posterior lateral parietal lobe

- lateral temporal lobe

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17
Q

Inferior division of MCA infarct causes…

Dominant vs nondominant?

A
  • Contralateral homonymous hemianopia or quadrantanopia
  • Little or NO weakness, sensory loss or gaze paresis
    
    Dominant: Wernicke aphasia
    Nondominant: same as above + possible behavioral changes
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18
Q

ACA supplies…

Symptoms of infarct? (5)

A

medial frontal lobe

behavioral abn:

  1. akinetic mutism
  2. motor inertia
  3. psychomotor retardation
  4. incontinence
  5. incr muscle tone
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19
Q

Unilateral ACA infarction causes…

Bilateral ACA infarction will occur when…

A

Unilateral =

  • Contralat leg weakness + sensory loss (distal > proximal)
  • Trouble initiating and spontaneous speech
  • Urinary incontinence

Bilateral: in the setting of an incomplete circle of Willis (congenital abn)

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20
Q

ICA infarct can cause…

A
  • varying degrees of contralateral weakness and sensory loss
  • homonymous hemianopia
  • aphasia or hemineglect

*MCA and ACA syndromes

21
Q

Embolization from ICA goes to…

A

central retinal branch of ophthalmic artery –> ipsalateral blindness

22
Q

Location of MAC-ACA border zone (watershed)?

A

upper portion of frontal parietal convexity

23
Q

S/s of MCA-ACA watershed infarction?

A

weakness on proximal arm/leg (face spared)

*stereotypes TIA prior to infarction

24
Q

PCA supplies… (prox branches)

A

midbrain and thalamus –> cross tentorium –>

occipital lobe and inferior medial temporal lobe

25
Symptom of bil PCA infarction?
memory problems
26
Occlusion of PCA causes...
- Contralateral homonymous hemianopia - Macular sparing my take place bc of collateral MCA to occipital pole P-Proximal fling movements O-Occipital lobe infarction (contralateral homonymous hemianopsia) S-Speech and Spelling maintained, but unable to read fluently T-Thalamic syndrome
27
Vision changes in dominant only vs bil PCA occlusion?
- dominant: inability to read w/o other signs of aphasia | - bil: complete cortical blindness or tunnel vision
28
Proximal occlusion of PCA: | thalamic infarction causes...
severe contralateral sensory loss
29
What is Webber syndrome?
midbrain infarction, which causes contralateral hemiparesis and ipsalateral CN3 palsy
30
Basilar and vertebral arteries supply...
posterior fossa (brainstem and cerebellum)
31
Basilar and vertebral artery ischemia causes...
1. diplopia 2. vertigo 3. hearing loss 4. circumoral numbness 5. dysphagia 6. hiccups 7. NV 8. altered consciouness (bilateral symptoms)
32
Basilar and vertebral artery ischemia exam abn:
1. dysconjugate gaze 2. horner syndrome 3. nystagmus 4. unilat pharyngeal weakness 5. ataxia 6. ipsalateral face weakness/sensory 7. contralateral body weakness/sensory
33
Infarct of superior cerebellar artery causes:
- prominent dysarthria - ipsilateral limb & truncal ataxia - nystagmus (fast phase toward lesion)
34
Infarct of ant inferior cerebellar artery affects:
lateral pons + anterolateral cerebellum
35
Infarct of post inferior cerebellar artery causes:
- truncal ataxia - ipsilateral limb ataxia - acute vertigo & nystagmus - life threatening edema and hydrocephalus (4th ventr compression) - brainstem compr and herniation
36
Basilar artery strokes are usually...
embolic
37
MC infarct of cerebellum?
PICA
38
"Top of the basilar" syndrome affects...
- midbrain - thalamus - occipital lobe - medial temporal lobes
39
Symptoms of basilar artery infarct?
impaired consciousness | PCA symptoms
40
Parinaud Syndrome:
- Pupil: midsized and unreactive - Eye: abn of vertical gaze with convergence nystagmus (CN 6 spared) *basilar artery
41
Prox basilar artery infarct:
locked in syndrome = infarction of pons with sparing of midbrain
42
What labs should you order if cerebellar infarct?
CBC, PT, PTT, BMP, Cardiac enzymes, CT, MRI, Diagnostic ultrasound
43
Central Midbrain infarct: artery? CN?
PCA | CN3
44
Lateral mid-Pins infarct: artery? CN?
sup cerebellar | CN 5
45
Central lower pons: artery? CN?
paravertebral | CN6
46
lateral lower pons: artery? CN?
AICA | CN7
47
central upper medulla: artery? CN?
spinal | CN 12
48
lateral upper medulla: artery? CN?
``` PICA nucleus ambiguus (CN 9/10) ```

Neuro (7 decks)

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