Practice RITE Flashcards
parasympathetic nervous system governs
pupil constriction, bronchoconstriction, detrusor contraction and sphincter relaxation, and penile erections.
orbitofrontal syndrome consists of
socially inappropriate behaviors as well as poor impulse control with disinhibition
lateral convexity syndrome is associated with
dysexecutive symptoms
mesial frontal syndrome is associated with
amotivation.
combination of optic nerve dysfunction and ocular motility deficits localizes to the
orbital apex.
Cortical areas critical for gait include the
medial frontal region, the paracentral lobule, and the supplementary motor cortex.
Fifty patients with elevations of serum cardiac troponin levels had strokes involving the
right posterior, superior medial insula, and the right inferior parietal lobule
biceps are innervated by the _______ nerve, which arises from the ______ cord of the brachial plexus
musculocutaneous, lateral
pronator teres is innervated by the _____ nerve from axons that travelled in the _____ cord of the brachial plexus
median, lateral
deltoid is innervated by the _____ axillary nerve, which arises from the _____ cord of the brachial plexus
axillary, posterior
brachioradialis is innervated by the _____ nerve, which arises from the _____ cord of the brachial plexus.
radial, posterior
rhomboid receives supply directly from the _____
C5 root
supraspinatus is innervated by the ______ nerve, which arises from the _____ trunk of the brachial plexus.
suprascapular, upper
This serve as the primary input nuclei for the basal ganglia
caudate and the putamen
The ________, which projects to the ventral anterior nucleus of the thalamus, is the primary output nucleus.
globus pallidus
_______, located in the midbrain, sends dopaminergic fibers to the putamen.
substantia nigra pars compacta
_______ receives inhibitory input from the external part of the globus pallidus and sends excitatory input to the globus pallidus pars interna.
subthalamic nucleus
In ischemic third nerve palsies, the pupil is typically spared, as is the periphery of the nerve, where the _________ fibers course.
pupillomotor
_______ aneurysms typically cause third nerve palsies involving the pupil, as they compress the nerve, and therefore the peripheral pupillomotor fibers
posterior communicating artery
“one-and-a-half” syndrome in which the
ipsilateral eye has no horizontal movements and the contralateral eye is only able to abduct.
“one-and-a-half” syndrome
combination of a left intranuclear ophthalmoplegia (which prevents the left eye from adducting on rightward gaze with end-gaze nystagmus of the abducting right eye) and a left abducens nuclear palsy (which produces an ipsilateral gaze palsy preventing the patient from looking left).
“one-and-a-half” syndrome lesion
This lesion must involve the left medial longitudinal fasciculus and left abducens nucleus.
When the eye is abducted, the primary depressor is the
inferior rectus
eye is adducted, the
superior oblique and inferior rectus depress the eye.
When the patient looks down and to the left, she is primarily using the
right superior oblique and left inferior rectus.
Cheiro-Oral Syndrome is a lacunar syndrome characterized by contralateral sensory deficits of the mouth and hand.
It typically localizes to the VPM and VPL in the thalamus.
ipsilateral side of a spinal cord hemisection there would be an upper motor neuron syndrome, greatly impaired discriminatory tactile sense, and reduced muscle tone below the level of the lesion.
Contralateral to the lesion there would be loss of pain and temperature due to interruption of the ascending spinothalamic tracts (which cross soon after entry)
short head of the biceps femoris is the only muscle proximal to the knee innervated by the peroneal division of the sciatic nerve.
Needle EMG abnormalities of this muscle would indicate that a lesion of the peroneal nerve would have to be proximal to the fibular head.
Auditory fibers from the superior olivary nucleus ascend in the lateral lemniscus to reach the inferior colliculus.
The electrical activation of the lateral lemniscus is reflected in wave 4 of a brainstem auditory evoked potential.
fibers in the trapezoid body arise from the
ventral cochlear or the superior olivary nucleus and decussate to the contralateral side.
Palatal myoclonus or palatal tremor is characterized by rhythmic jerking movements of the palate and pharyngeal structures that persist during sleep.
It is associated with lesions that interrupt the dentato-rubro-olivary pathway, also known as the Guillain-Mollaret triangle.
Guillain-Mollaret triangle.
triangle begins in the inferior olive, which projects via the inferior cerebellar peduncle to the contralateral dentate nucleus.
dentate nucleus projects via the
superior cerebellar peduncle to the ipsilateral red nucleus.
ipsilateral red nucleus completes the triangle by projecting to the ipsilateral inferior olive via the central segmental tract.
This patient’s dysarthria is likely caused by involvement of the nucleus ambiguous which provides axons to both the glossopharyngeal and vagus nerves
Fibers carrying information from the superior temporal visual field briefly bend up into the
contralateral optic nerve (Willebrand’s Knee).
lesion of the optic nerve as it joins the optic chiasm therefore interrupts all the fibers from the ipsilateral eye as well as the crossing fibers from the contralateral superior temporal visual field.
This would cause the complete vision loss on the right and the left temporal hemianopsia.
superior gluteal nerve innervates tensor fascia latae, as well as gluteus medius and minimus.
The superior gluteal nerve arises from the lumbosacral plexus.
tensor fascia latae is primarily an L5-innervated muscle and thus clinical weakness or denervation on EMG of the tensor fascia latae can be used to exclude a
lesion distal to the lumbosacral plexus, such as a sciatic neuropathy.
lateral inferior or caudal pontine syndrome due to occlusion of the anterior inferior cerebellar artery (AICA syndrome) involves lesions in the fascicles of cranial nerve VII, the spinal tract, and nucleus of cranial nerve V, the lateral spinal thalamic tract, descending sympathetic fibers (lateral reticular nucleus), the middle cerebellar peduncle, the inferior surface of the cerebellum, and in addition, the inner ear and cochlear nerve due to occlusion of the labyrinthine artery, a common branch of the AICA.
Clinical findings include ipsilateral ataxia, loss of pain and temperature sensation of the face, Horner syndrome, deafness, and contralateral pain and temperature loss of the limbs.
ciliospinal (pupillary-skin) reflex refers to
pupillary dilation in response to painful stimulation
Three embryonic communications between the vertebrobasilar and carotid systems are the trigeminal, otic and hypoglossal arteries.
Persistence of the trigeminal artery is the most common.
motor and parasympathetic portions of CN VII pass through the _______ ganglion without synapsing
geniculate
superior salivatory nucleus gives rise to
preganglionic autonomic fibers.
sphenopalatine ganglion contains the cell bodies of the
postganglionic fibers for lacrimation.
Sensory fibers originating from the external auditory canal and tympanic membrane as well as fibers conveying taste have cell bodies that reside in the
geniculate ganglion.
bilateral upper extremity weakness, affecting distal muscles more than proximal ones, with decreased pinprick sensation and retained fine touch, (i.e. a dissociated sensory level in a “cape-like” distribution) is most suggestive of a
central cord syndrome.
central cord lesion affecting the anterior commissure will affect the crossing spinothalamic tracts,
resulting in sensory deficits only at the level of the lesion. It will not cause more caudal sensory deficits and will spare vibration and light touch, since the dorsal columns are spared.
Venous blood of the torcula exit the skull via the
transverse sinus, then the sigmoid sinus, and then the jugular vein
grip a card or paper between the thumb and index finger indicates weakness of
thumb adduction and index finger abduction. Both of these muscles are innervated by the ulnar nerve. This is often called Froment sign or Froment prehensile thumb sign.
accommodating the Froment sign
by flexing the distal thumb and index finger making an OK sign. These muscles are innervated by the anterior interosseous nerve.
median nerve has motor branches to
lumbricals 1 and 2, the abductor pollicis brevis, the opponens pollicis brevis, and the flexor pollicis brevis, distal to the carpal tunnel.
third order neurons of the oculosympathetic pathway arise from the superior cervical ganglion on the common carotid artery.
A dissection of the internal carotid artery may result in an ipsilateral Horner syndrome with ptosis, and a miotic pupil that poorly dilates. The fibers destined for the facial sweat glands are carried on the external carotid artery and therefore would be spared.
third cranial nerve emerges from the midbrain at the level of the superior colliculus in the
interpeduncular fossa
structure is the substantia nigra, which projects to and receives fibers predominantly from the caudate and putamen.
Degeneration of this structure is seen in idiopathic Parkinson’s disease.
anterior commissure of the spinal cord, which is where the
fibers of the anterolateral system, carrying pain and temperature, decussate.
lateral geniculate nucleus, which receives
visual input from the optic tract.
Neural crest derivatives include cells of the dorsal root ganglia (involved in transmission of pain) and sympathetic ganglia.
These derivatives require nerve growth factor (NGF) for survival. Other neural crest derivatives are Schwann cells and melanocytes.
arcuate fasciculus is a connection between Wernicke’s area in the superior temporal gyrus and Broca’s area in the inferior frontal gyrus.
The inferior frontal gyrus can be subdivided into three parts: pars opercularis, pars triangularis, and pars orbitalis with the first two being the anatomical substrate for Broca’s area.
global brain ischemia, damage may be seen most conspicuously in parts of the cerebral cortex, hippocampus and the cerebellar Purkinje cells.
In the neocortex, layer 3 is the most vulnerable to global ischemic injury, with layers 2 and 4 the most resistant. The reason for this selective vulnerability is unknown.
Innervation of the dura within the cranial vault is provided by
ophthalmic branch of the trigeminal nerve.
The greater occipital nerve innervates the scalp on the
back of the head.
greater petrosal nerve innervates the
lacrimal gland
maxillary and mandibular divisions of the trigeminal nerve innervate the
skin of the face below the eyes.
Sympathetic fibers descending in the lateral dorsal medulla, lie in close approximation to the
inferior cerebellar peduncle, nucleus ambiguous, fibers from the dorsal motor nucleus of X, vestibular nuclei, spinothalamic tract, and spinal trigeminal nucleus. These structures are supplied by the posterior inferior cerebellar artery and are involved in a Wallenberg syndrome.
infundibulum carries compounds from the hypothalamus to the
neurohypophysis and adenohypophysis modulating the activities of these structures
hypothalamic derived compound that tonically inhibits pituitary gland synthesis and release of prolactin is
dopamine (also known as prolactin inhibitory factor)
Interruption of the infundibulum leads to loss of tonic inhibition of prolactin secretion by
dopamine and elevation of prolactin
dopamine receptor antagonists will elevate prolactin and
dopamine receptor agonists can suppress
prolactin secretion and have been used in the medical management of prolactin secretion pituitary adenomas.
Fetal posterior cerebral artery is a common vascular anomaly, where the distal PCA is supplied by the
internal carotid artery, with an absent P1 segment. PCA territory is supplied by the anterior circulation; thus, internal carotid artery lesions can be responsible for PCA strokes.
Decerebrate posturing is due to dysfunction of the red nucleus and the rubrospinal tract with preserved function of the lateral vestibular nucleus and the lateral vestibular spinal tracts
rubrospinal tract facilitates motor neurons in the cervical cord subserving flexor muscles of the upper extremities. The lateral vestibulospinal tract facilitates motor neurons in the lumbosacral cord subserving extensor muscles of the lower extremities.
Entrapment of the suprascapular nerve may cause
shoulder pain, weakness of shoulder abduction, and sparing of sensation about the shoulder.
axillary nerve supplies sensation to the skin
overlying the lateral deltoid.
pulvinar receives fibers from the superior colliculus and projects to
areas 17, 18 and 19.
inferior and lateral pulvinar have
reciprocal connections with the occipital cortex.
medial geniculate receives input from the ______ while the ventral anterior nucleus receives input from the ______ - particularly the non-motor information stream.
inferior colliculus, globus pallidus pars interna
The ventral posteromedial and posterolateral nuclei receive _________
somatosensory input.
lateral dorsal nucleus has connections similar to those of the anterior nucleus to which it is adjacent though it may also have _________
posterior parietal connections as well.
Wisconsin Card Sort Test (WCST), which challenges a patient to change cognitive sets without warning, is particularly sensitive to ______ damage.
frontal
Face recognition and visual perception abnormalities such as hemi-inattention syndromes are most often associated with damage to the _______ rather than the frontal lobes.
parietal, temporal, or occipital lobes,
Patients who chronically inhale toluene vapors develop dementia (clinically consistent with ____________ and in some cases cranial nerve palsies.
subcortical dementia), cerebellar ataxia and long tract findings, not uncommon for these patients to also manifest a paranoid psychosis.
MRI findings of toluene toxicity
diffuse leukoencephalopathy, cerebral atrophy, and T2 hypointense lesions of the thalamus and/or the basal ganglia
posterior cortical atrophy present with progressive deficits that affect the dorsal and ventral streams of vision.
They tend to have preserved insight and lack the characteristic memory deficits which are pathognomonic for Alzheimer disease
angular gyrus syndrome results from an infarct or mass lesion affecting the angular gyrus on the dominant side.
The syndrome consists of difficulty with naming, reading, writing, memory and contains the elements of a Gerstmann syndrome
Semantic dementia is a subtype of
frontotemporal lobar degeneration, Patients early on have fluent spontaneous speech but have simplified content and anomic substitutions with general words. They also fail to correctly read or spell irregular words.
corticobasal degeneration and primary progressive aphasia usually present with a ________
nonfluent aphasia.
Posterior cortical atrophy usually presents with _________
visuospatial and visuoperceptual abnormalities.
Alzheimer dementia’s language issues are usually word-finding difficulties as well as ________
memory and language retrieval abnormalities.
multiple system atrophy (MSA)
This condition can manifest with parkinsonism, cerebellar dysfunction, or pyramidal tract signs. Patients with MSA frequently have alpha-synuclein inclusions distributed throughout the cortex.
Contusion of the orbitofrontal cortex is associated with ________
social disinhibition.
Apathy, depression and loss of task set is more commonly seen in ____________
dorsolateral prefrontal lesions.
Akinetic mutism is more commonly associated with ________
medial frontal lesions
Anton syndrome, (the denial of blindness), despite objective evidence of visual loss, is typically associated with _____________
bilateral posterior cerebral artery territory infarction producing cortical blindness plus memory impairment.
Haloperidol, perphenazine, and trifluoperazine are antipsychotics with a mechanism of action of antagonism of dopamine receptors in the _________. They block postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain.
mesolimbic and mesofrontal systems.
JC papovavirus that affects immunocompromised patients. It has a predilection for the __________
white matter in the bilateral occipito-parietal regions.
Right-left confusion occurs with dominant parietal lobe lesions, and can be associated with ____________
finger agnosia, agraphia and acalculia, as well as alexia (Gerstmann syndrome).
Neglect or denial of the contralateral (usually left) half of the body and space generally results from damage to the ___________
non-dominant parietal lobe.
Dressing apraxia appears to be a related phenomenon and has been seen in patients with lesions in the ________
dominant parietal region
Impaired ability to perceive emotions (alexithymia) is a personality dysfunction seen in some psychiatric conditions including ____________
affective disorders and autism, with unclear specific localization.
Prosopagnosia results from ___________
occipital or occipitotemporal lesions, generally bilateral.
rapid switch from overvaluing her doctor to devaluing him
dichotomous thinking
Phonemic errors are more typical of _______ loosening of associations may mimic the rambling jargon of Wernicke aphasia, but can be distinguished by intact comprehension.
Broca’s aphasia,
NSE, like 14-3-3, is elevated in any condition in which there is _______ including CJD and hypoxic injury.
rapid neuronal death
Tau is increased in _____ disease
Alzheimer
Spelling “WORLD” backward or alternatively doing serial 7s is the assessment for _______
attention and concentration
Three variants of PPA have been described;
semantic dementia, nonfluent/agrammatic aphasia and logopenic aphasia.
Patients with ___________ have significant atrophy in the left posterior parasylvian or parietal region,
logopenic aphasia
patients with ________ have atrophy in the left anterior temporal regions
semantic dementia
patients with _________ have atrophy involving the left frontoinsular region.
nonfluent/agrammatic aphasia
Atrophy of the ______ is associated with Alzheimer’s disease
left medial temporal region
Atrophy in the orbitofrontal region is associated with _________
behavior variant frontotemporal dementia.
Balint syndrome, identified by Rezs (Rudolf) Bàlint in 1909, is characterized by
optic ataxia (the inability to accurately reach for objects), optic apraxia (the inability to voluntarily guide eye movements/ change to a new location of visual fixation), and simultanagnosia (the inability to perceive more than one object at a time, even when in the same place).
Balint syndrome has been found in patients with bilateral damage to the
posterior parietal cortex (and rarely, the frontal lobe; perhaps due to parietal frontal eye-field disconnection).
Serotonin syndrome is characterized by
mental status changes, autonomic instability and neuromuscular hyperactivity.
Neuroleptic malignant syndrome is caused by
dopamine receptor blockade usually secondary to an adverse reaction to antipsychotic medications. It is characterized by muscle rigidity followed by hyperthermia and altered mental status.
Malignant hyperthermia is a rare condition linked to mutations in the
ryanodine receptor gene and exposure to anesthetic agents such as succinylcholine. It is characterized by muscle rigidity and hypermetabolic state.
Toxic shock syndrome is a life-threatening illness generally caused by infection with
Staphylococcus aureus. It is characterized by rash, hypotension, high fever and multiorgan failure.
toddler with classic Rett syndrome appears normal to her parents for most of the first year of life
except for possible mild motor delays.
Natural hx of Rett syndrome
Purposeful hand use is replaced by stereotypic hand movements. The lost developmental skills are never recovered; and she moves through life at a level of profound intellectual disability often accompanied by seizures.
______ gene mutation is the cause of Rett syndrome
MeCP2
_______ deficiency is the cause of Canavan disease which typically appears in early infancy and progresses rapidly from that stage with abnormal muscle tone, poor head control, and megalocephaly.
Aspartoacylase
_______ injury is the cause of cerebral palsy, a permanent movement disorder with or without mental dysfunction
Neonatal hypoxic ischemic
_______ gene mutation is the cause of Lafora body disease with symptoms of seizures, drop attacks, myoclonus, and ataxia manifesting in children from 10 to 17 years old.
EpM2A
Copper accumulation is the cause of _____ disease, with symptoms typically beginning between 5 and 35 years old and manifesting with behavioral changes, tremors, hallucinations, and liver dysfunction from copper overload.
Wilson’s
_______ identified by antithyroid antibodies, can cause cognitive dysfunction including confusion, memory loss, aphasia and word finding problems and seizures.
Hashimoto’s Thyroiditis, Hints include the high dose of thyroid medication with the thyroid-stimulating hormone still elevated. Evidence of nonspecific inflammatory markers such as polyclonal gammopathy may be present.
Vitamin B12 deficiency may be associated with _____ but does not typically cause seizures.
anemia
Vasculitis and seizures due to lupus are often accompanied by ________
new infarcts.
Patients with _____ lack the usual limb paralysis that normally accompanies REM sleep.
REM behavior disorder
Non-REM sleep disorders such as _______ do not usually involve violent behaviors, although they can in rare cases
somnambulism
______ lobe seizures rarely lead to complex violent behavior.
Frontal
Classic findings of prion disorders include
hyperekplexia (exaggerated startle), insomnia, encephalopathy, and ataxia.
asymmetric rigid parkinsonism manifested by focal dystonia and apraxia are classic early features seen in most patients with _______. The presence of an alien limb while almost diagnostic is not universally present.
corticobasal syndrome
locked-in syndrome is characterized by
being mute, quadriplegic, with preserved consciousness demonstrated by blinking or voluntary vertical eye movements with inability to voluntarily move eyes horizontally
The locked-in syndrome is not coma;
it results from lesions below the mid pons that preserves the brainstem reticular activating system for arousal and the brain for consciousness. Locked-in syndrome usually has preserved pupil reactivity and hearing as well.
right parietal lobe tumor could interfere with the optic radiations and cause a
left inferior quadrantanopsia (spares Meyer loop). Tumor could cause impaired graphesthesia in the left hand only, not both
Gerstmann syndrome may occur if the
left (dominant) parietal lobe was affected.
Receptive aprosody may occur in
right temporoparietal lesions
Neglect is a common finding in
right parietal lesions.
HIV infection can result in minor cognitive and motor disorder, HIV-associated mild neurocognitive disorder, and HIV-associated dementia.
The earliest symptoms revolve around mental slowing and processing speed
Dextromethorphan (combined with quinidine which serves to increase the bioavailability of dextromethorphan) is a dual action glutamate inhibitor, via sigma-1 agonist activity and also via NMDA receptor antagonism
these actions are believed to help regulate excitatory neurotransmission to diminish the unpredictable emotional episodes of pseudobulbar affect
Sigma-1 receptors are expressed in specific regions of the brain such as layers of the cortex, hippocampus, hypothalamic nuclei, substantia nigra and Purkinje cells in the cerebellum.
Although the exact molecular action of sigma-1 receptors is still unclear, a number of studies have demonstrated that they play a role as a modulator of ion channels (K+ channels; N-methyl-D-aspartate receptors [NMDA]; inositol 1,3,5 trisphosphate receptors).
Sigma-1 agonists, while having no effects by themselves, cause the amplification of signal transductions incurred upon the stimulation of the glutamatergic, dopaminergic, IP3-related metabotropic, or nerve growth factor-related systems.
hypothesized that sigma-1 receptors, at least in part, are intracellular amplifiers creating a super sensitized state for signal transduction in the biological system.
dorsomedial nucleus (commonly seen in Korsakoff syndrome) result in ____________
encoding deficits and therefore memory loss.
Lesions of the paramedian region of the thalamus generally result in __________
apathy, disinterest and lack of drive.
Lesions of the ventral posterior region generally result in
sensory loss.
Lesions of the intralaminar and reticular nuclei affect
normal alertness
clinical criteria for frontotemporal dementia (FTD) include
gradual onset with progressive decline, changes in personal hygiene, loss of social decorum, lack of insight, emotional blunting, and loss of empathy
FTD has been linked to motor neuron disease, as well as _______, both in the patients with FTD as well as in family members.
parkinsonism
TAR DNA-binding protein 43 (TDP-43) is a major protein component of the ubiquitin-immunoreactive inclusions characteristic of
sporadic and familial frontotemporal lobar degeneration with ubiquitin-positive, tau-negative inclusions (FTLD-U), with and without motor neuron disease, as well as in sporadic amyotrophic lateral sclerosis (ALS)
These conditions with TDP-43 do not have
tau, beta-amyloid, or alpha-synuclein inclusions.
Alpha-synuclein inclusions are seen in dementia with
Lewy bodies and Parkinson disease.
Tau inclusions are seen in some other types of ________.
frontotemporal dementias and Alzheimer disease. Beta-amyloid inclusions are classically seen in Alzheimer disease.
Pick bodies are aggregations of tau protein in neurons associated with Pick disease, a subtype of _______
frontotemporal lobar degeneration.
Midodrine is a prodrug that is metabolized in the liver to ______, a potent alpha-1 adrenergic agonist that produces arterial and venous vasoconstriction.
desglymidodrine. Unlike other sympathomimetics, midodrine has a predictable absorption and plasma half-life. It is currently the drug of second choice after fludrocortisone for management of neurogenic orthostatic hypotension
midodrine dose is 10-40 mg/day. It should not be administered in the evening given the risk of supine hypertension.
Scalp pruritus is a common side effect.
Epilepsy related visual hallucinations are characteristically ________
very brief and simple. They tend to occur in a hemifield and are associated with a description of motion.
Migraine aura may be confounded with occipital seizures but is typically much
longer lasting and classically consist of geometric patterns such as black and white zigzag lines which are often scintillating in character.
Acute ischemic stroke in the distribution of the _________ is the leading cause of acute audiovestibular loss.
anterior inferior cerebellar artery (AICA)
Isolated hearing loss without other neurologic symptoms is associated with a ___________
labyrinthine artery infarction
In the absence of an EEG, ________
pupillary dilatation and hypertension can be signs of persistent electrographic seizure activity.
Inclusion body myositis is an inflammatory condition in older individuals (male predominant) which is slowly progressive.
Clinical features of early weakness and atrophy of select muscles is found: quadriceps, flexors of the forearms and ankle dorsiflexors.
polymyositis is generally more
fulminant, painful and symmetric;
central core disease is
congenital with fairly mild progression over life
both types of myotonic dystrophy are autosomal dominant, typically present
earlier in life and have many systemic manifestations
recurrent, self-limiting, aseptic meningitis – which has also been called Mollaret meningitis.
This syndrome is caused by the herpes simplex virus 2 and may benefit from treatment with acyclovir.
Huntington disease is an autosomal dominant movement disorder characterized by
chorea, dementia and behavioral disturbances.
Cervical spinal stenosis could also produce
painless four-limb weakness with upper motor neuron signs in the legs
Fasciculations and wasting in the lower extremities are not symptoms of cervical stenosis as they imply a disorder of the lower motor neuron at the ________-
lumbosacral level
In addition to symptoms of headache, transient visual obscurations, diplopia, and visual loss, many patients with IIH also experience _________
pulsatile tinnitus.
patient’s signs and symptoms of sensory loss to pinprick with preservation of vibratory sense and reflexes, is most consistent with a ______
small fiber neuropathy
His symptoms are compatible with leprosy, which occurs due to Mycobacterium leprae, a neurotropic bacterium.
This diagnosis is supported by the distribution of this patient’s sensory loss, which includes his ears and nose, and the fact that he has emigrated from a country endemic for leprosy.
Propofol has been reported to cause ______
dystonic reactions
large _______ with neurologic deterioration over the last couple of hours. While medical therapy can be attempted as a temporizing measure, this patient will likely need a suboccipital craniectomy given the size of the stroke and the rapid deterioration over hours.
left cerebellar stroke
trigeminal autonomic cephalgias are a group of primary headache disorders characterized by .
short-lasting episodes of severe unilateral headaches that are associated with ipsilateral cranial autonomic symptoms
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
(SUNCT) syndrome,
The attacks of SUNCT syndrome
resemble those of cluster headaches but are primarily differentiated by the
much briefer attack duration and greater frequency in SUNCT than cluster headache.
SUNCT can also resemble V1 trigeminal neuralgia but the latter should not have the
prominent autonomic features of SUNCT.
Triptans are contraindicated in the presence of known coronary artery disease due to the risk of
precipitating vasospasm and coronary ischemia.
isolated trochlear nerve palsy
microvascular ischemia in the setting of high blood pressure and diabetes is the most common cause of this condition
Verapamil, a calcium channel blocker, is currently the preferred agent for prophylaxis of ______
cluster headaches during a cluster.
Verapamil can be titrated off once the patient has been headache free for more than 2 weeks as there is __________
no known prophylactic benefit between clusters.
fingolimod, is a sphingosine 1-phosphate receptor inhibitor.
It’s putative mechanism of action in MS is sequestration of lymphocytes in lymph nodes.
Pseudotumor cerebri is characterized by
headaches, visual obscurations and papilledema
Several medications including _________ are associated with the development of pseudotumor.
isotretinoin and other vitamin A-containing compounds
In patients within the 6-hour window with a head CT demonstrating an ASPECTS > 6, no additional imaging is needed beyond a
CT angiogram demonstrating a large vessel occlusion
“HINTS to diagnose stroke in the acute vestibular syndrome” include the presence of skew eye deviation (vertical ocular misalignment), nystagmus which changes direction on eccentric gaze, and the absence of vestibulo-ocular reflex tested by the bedside horizontal impulse test. A brainstem lesion is highly likely when the acute vestibular syndrome is associated with any of these findings.
Skew eye deviation is the most sensitive, being even more sensitive than brain MRI for the diagnosis of acute brainstem stroke in the first 48 hours of symptom onset.
diagnosis of probable multiple system atrophy can be made in a patient with symptoms of __________
autonomic failure (typically beginning with bladder and erectile dysfunction, with prominent orthostasis on examination) and no response to levodopa.
Fingolimod has been associated with ______ in approximately 1% of treated patients.
macular edema
Weakness of ankle dorsiflexion could localize to the
deep peroneal (fibular) nerve, common peroneal (fibular nerve), sciatic nerve, lumbosacral plexus, or L5 nerve root.
The involvement of ankle eversion eliminates the
deep peroneal (fibular) nerve ankle eversion is innervated by the superficial peroneal (fibular) nerve
The involvement of ankle inversion eliminates the common peroneal (fibular) nerve since ankle inversion is innervated by the
tibial nerve
The sparing of ankle plantarflexion argues against either the
Lumbosacral plexus or the sciatic nerve. In this context, L5 is the most likely localization.
Most cases of trigeminal neuralgia are thought to be due to compression of the trigeminal nerve by a
vascular loop. Imaging is indicated to exclude other, though less common, structural causes such as a meningioma, cerebellopontine angle neoplasm, and aneurysm.
(known as the recurrent artery of Heubner) is a branch of the anterior cerebral artery that supplies part of the
caudate head.
The caudate head is also supplied by branches of the _______
middle cerebral artery.
pericallosal arteries are branches of the anterior cerebral artery that supply ________
medial aspects of both hemispheres
anterior choroidal artery supplies the
posterior limb of the internal capsule, the medial globus pallidus, and the lateral geniculate body.
posterior choroidal artery supplies the
lateral geniculate body, pulvinar, posterior thalamus, hippocampus, and parahippocampal gyrus
artery of Percheron is a variant that supplies
both thalami.
According to the SAMMPRIS Study, best medical management with
high dose statin, blood pressure control, and dual antiplatelet therapy with aspirin and clopidogrel for 3 months is the optimal treatment for patients with stroke from severe intracranial atherosclerosis and was shown to be more efficacious than mechanical interventions.
WASID study showed that antiplatelets had overall better outcomes than
anticoagulation for patients with severe intracranial atherosclerosis.
Cerebral vasospasm is a serious complication of subarachnoid hemorrhage typically occurring between the _______. It often presents with focal neurologic deficits and drowsiness.
4th and 14th day after hemorrhage
Diabetic lumbosacral radiculoplexus neuropathy presents with ______, followed by muscle weakness and atrophy
acute and severe proximal lower limb pain. It is the most commonly observed in patients with well-controlled type 2 diabetes mellitus.
patient developed hypertension, a seizure, and cortical blindness that is consistent with a reversible posterior leukoencephalopathy while on
bevacizumab.
_______ is also associated with an increased incidence of stroke, intracranial hemorrhage, and optic neuropathy.
Bevacizumab
history is consistent with Mal de debarquement syndrome, described by patients usually as a feeling of
motion, rocking or swaying when there is no physical motion. Notable for typically lacking nausea, vomiting, vertigo or other common vestibular symptoms as well as an absence of hearing symptoms.
Patients usually feel some relief by being in motion themselves, either by driving or going back out on the ocean, and they feel most symptomatic when they are ________
sitting still.
patient’s symptoms and EEG findings are most consistent with ________
juvenile myoclonic epilepsy (JME).
JME is a generalized epilepsy that typically presents during
adolescence or early adulthood.
patients with sickle cell disease and stroke, blood transfusions to reduce the hemoglobin S level to under ___ is recommended.
30%
post-transplant lymphoproliferative disease (PTLD) resulting from _________. EBV causes monoclonal transformation of B-lymphocytes and in turn can result in primary CNS lymphoma.
chronic immunosuppression and activation of Epstein-Barr virus (EBV) infection.
