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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
Q

Symptom of bil PCA infarction?

A

memory problems

26
Q

Occlusion of PCA causes…

A
  • 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
Q

Vision changes in dominant only vs bil PCA occlusion?

A
  • dominant: inability to read w/o other signs of aphasia

- bil: complete cortical blindness or tunnel vision

28
Q

Proximal occlusion of PCA:

thalamic infarction causes…

A

severe contralateral sensory loss

29
Q

What is Webber syndrome?

A

midbrain infarction, which causes contralateral hemiparesis and ipsalateral CN3 palsy

30
Q

Basilar and vertebral arteries supply…

A

posterior fossa (brainstem and cerebellum)

31
Q

Basilar and vertebral artery ischemia causes…

A
  1. diplopia
  2. vertigo
  3. hearing loss
  4. circumoral numbness
  5. dysphagia
  6. hiccups
  7. NV
  8. altered consciouness
    (bilateral symptoms)
32
Q

Basilar and vertebral artery ischemia exam abn:

A
  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
Q

Infarct of superior cerebellar artery causes:

A
  • prominent dysarthria
  • ipsilateral limb & truncal ataxia
  • nystagmus (fast phase toward lesion)
34
Q

Infarct of ant inferior cerebellar artery affects:

A

lateral pons + anterolateral cerebellum

35
Q

Infarct of post inferior cerebellar artery causes:

A
  • truncal ataxia
  • ipsilateral limb ataxia
  • acute vertigo & nystagmus
  • life threatening edema and hydrocephalus (4th ventr compression)
  • brainstem compr and herniation
36
Q

Basilar artery strokes are usually…

A

embolic

37
Q

MC infarct of cerebellum?

A

PICA

38
Q

“Top of the basilar” syndrome affects…

A
  • midbrain
  • thalamus
  • occipital lobe
  • medial temporal lobes
39
Q

Symptoms of basilar artery infarct?

A

impaired consciousness

PCA symptoms

40
Q

Parinaud Syndrome:

A
  • Pupil: midsized and unreactive
  • Eye: abn of vertical gaze with convergence nystagmus (CN 6 spared)

*basilar artery

41
Q

Prox basilar artery infarct:

A

locked in syndrome = infarction of pons with sparing of midbrain

42
Q

What labs should you order if cerebellar infarct?

A

CBC, PT, PTT, BMP, Cardiac enzymes, CT, MRI, Diagnostic ultrasound

43
Q

Central Midbrain infarct:
artery?
CN?

A

PCA

CN3

44
Q

Lateral mid-Pins infarct:
artery?
CN?

A

sup cerebellar

CN 5

45
Q

Central lower pons:
artery?
CN?

A

paravertebral

CN6

46
Q

lateral lower pons:
artery?
CN?

A

AICA

CN7

47
Q

central upper medulla:
artery?
CN?

A

spinal

CN 12

48
Q

lateral upper medulla:
artery?
CN?

A 
PICA
nucleus ambiguus (CN 9/10)

Neuro (7 decks)

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