Pretest Questions Flashcards
Where do mycotic aneurysms occur?
Over cerebral convexities
What causes mycotic aneurysms?
Usually bacterial infections from drug use or HIV.
Do hematomas enhance with contrast?
No
Why is levatiracetam better to use than lamotrigine in acute management of seizures?
The dose of lamotrigine must be increased very slowly to prevent steven johnsons syndrome. Over weeks to months.
Amaurosis fugax and cause?
Transient monocular vision loss usually from extracranial carotid artery disease.
Why can’t phenytoin be infused rapidly IV? What to use instead?
Phenytoin infused IV above 50mg/min can cause cardiac arrhythmias or hypotension. Use fosphenytoin instead (can also be given IM).
Course of action if a patient has a first seizure?
Get a brain MRI to rule out a structural lesion.
Lenox Gastaut Syndrome
Mental retardation with multiple seizure types (usually 1-2 Hz spike and wave). Often with a history of infantile spasms.
What drug should be given to patients with a traumatic head injury?
Phenytoin to decrease the incidence of post traumatic seizures
Diffuse axonal injury
Shearing of axonal bundles at the grey white junction due to intense acceleration/deceleration injury.
Mesial temporal sclerosis and treatment?
Most common cause of complex partial seizures in adults. Can be seen on MRI. Can be treated with surgical resection of right anterior temporal lobe.
Jacksonian March
Focal motor seizure that spreads and can secondarily generalize causing LOC and tonic-clonic seizures. Face can be involved early due to proximity of face and thumb on the motor strip.
Myoclonic seizures
Usually happen upon awakening, with light, and with loud sounds. Seen in Benign Juvenile Myoclonic Epilepsy.
Epilepsia Partialis Continua
Focal motor seizure activity that persists (focal motor status epilepticus)
West Syndrome. Associated disease?
Generalized seizure disorder in infants with recurrent spasms. Can be associated with tuberous sclerosis (ash-leaf spots, cardiac rhabdomyomas, angiofibromas).
Triptans side effect
Vasospasm so don’t give to patients with CAD
Migraine abortive medications
Triptans, ergots, etc
Migrane preventative medications
Beta blockers, amytriptyline, nifedapine, topamax, valproate.
How to abort cluster headaches
100% O2, triptans, ergots
Trigeminal neuralgia can caused by? Associated disease?
Aneurysm of superior cerebellar artery can press on V. Can be associated with MS
Pseudotumor cerebri, cause?
Increased intracranial pressure causes headaches, optic disk atrophy (pallor), tinnitus. Vit A overdose, idiopathic in obese women
How to treat pseudotumor cerebri? Diagnose?
Acetazolamide, VP shunts. Opening pressure >250 mm H2O.
Classic vs common migraine?
Classic has aura
Basilar Migraine
Women>Men, visual changes for 10-30 mins, then headache. Can cause coma, psychosis, transient quadriplegia.
Essentially just a migraine with super intense consequences.
Atypical facial pain
Constant throbbing unilateral pain that can be treated with antidepressants.
Intracranial Hypotension
Headaches that occur on standing after a lumbar punction. Negative pressure pulls meninges down. Also occurs if CSF is leaking through nose after trauma.
Which lobe of the brain is most likely injured in a traumatic brain injury?
The temporal and inferior frontal lobes (coup injury). Can cause uncal herniation.
Countrecoup injury is when the occipital lobe rebounds and gets injured.
Cushing reaction
Hypertension, bradycardia, respiratory depression from increased ICP due to mass or other.
Von Economo Encephalitis (encephalitis lethargica)
Occurred with the influenza virus from 1918 to 1928. Cause parkinsonism, oculogyric crises, dystonia, autonomic symptoms
Neurological injury associated with sarcoidosis?
Facial nerve palsy. Facial paresis with no sensory loss.
PML
Nonenhancing white matter lesions that cause hypertonia, LAD, involuntary movement, ataxia, dementia , and seizures. Rapidly progressive, caused by the JC virus.
Neurologic Symptoms of Schistosoma
Lay eggs in the veins of batson, can migrate and deposit in cord causing compression. Causes granulomatous inflammation in cord leading to focal weakness and paralysis.
Echinococcus brain cysts?
Large cyst filled with daughter cysts.
Creutzfeld Jacob Disease EEG findings?
Rapidly progressive dementia, EEG shows general slowing and triphasic sharp waves but LP is normal.
Creutzfeld Jacob disease symptoms and LP findings
Ataxia, gradual cognitive decline, myoclonus, seizures, involuntary movements. LP largely normal but sometimes can show 14-3-3 protein.
Creutzfeld Jacob disease imaging
DWI shows cortical and subcortical abnormalities.
CNS lymphoma caused by
EBV in HIV
When is it safe to LP somebody?
When there is no mass effect.
Most common form of acute encephalitis?
HSV-1
Microglial nodules associated with
HIV and CMV
EEG of herpes encephalitis
Bilateral periodic epileptiform discharges
Where do abscesses form?
At grey-white junction
Most common fungal abscess?
Aspergillus
What is more common in AIDS? Toxo or crypto?
Toxoplasmosis is more common. Can cause brain abscesses
Symptom of brain abscesses?
Headache is most common.
Most common bacterial cause of brain abscess?
Strep
How are staph brain abscesses acquired?
Which is more likely? Staph or enteric bacteria abscesses?
Penetrating wound or neurosurgery.
Enteric bacterial abscesses
Elderly person meningitis?
Listeria, treat with ampicillin and gentamicin.
One interesting way CJD can be spread?
Through GH prep from cadaveric pituitary glands
SSPE
Increase in gamma globulin in CSF. Causes emotional lability, seizures, chorioretinitis, ataxia, UMN destruction years after measles.
Bartonella Henselae Encephalitis
From cats, can cause status epilepticus and affects the pulvinar of the thalamus on MRI.
Most common brain tumor
astrocytoma
Hyperostosis
Less common in 1 brain tumors than hypo-ostosis. Meningiomas can cause hyperostosis
Pineal region tumors special characteristic
Can be from all germ layers, so can behave similarly to choriocarcinoma or germinomas which can cause precocious puberty.
Which cancer is most likely met to brain without a primary tumor?
Lung
Shortest lifespan after a met?
Melanoma due to a propensity for bleeding
Tumors that met to brain and bleed?
Thyroid, choriocarcinoma, melanoma, renal cell carcinoma
Hypothalamic hamartomas
Nonneoplastic malformations of neurons and glia that can cause neurendocrine symptoms (like puberty or acromegaly) and paroxysms of laughter known as gelastic seizures. Cure surgically
Gelastic seizure
A paroxysm of laughter generally seen in patients with hypothalamic hamartomas.
Paraneoplastic cerebellar degeneration
Anti-yo antibodies against cerebellar purkinje cells produced in SCLC gyn and breast maligancies. Relentlessly progressive. Often develops before primary cancer is apparent.
Multiple myeloma neurological side effect?
Peripheral neuropathy. Can be solely sensory or sensorimotor, can put a patient in a wheelchair. Can also be seen with MGUS.
Liver failure effect on the brain?
Changes astrocytes.
CSF change with hypertensive encephalopathy?
Slight increase in protein (100 mg/dl)
Common neurological consequence of chronic renal failure?
Peripheral neuropathy (mixed sensorimotor). Improves with dialysis.
How to treat RLS?
Dopamine agonists
B12 deficiency field cut?
Causes a scotoma that widens the macular blind spot.
Deficiency ambliopia
Seen with B12 deficiency or alcoholism/tobacco use due to decreased thiamine.
Which deficiency causes peripheral neuropathy?
B6.
EEG finding of alzheimers
General slowing of the posterior dominant rhythm. It’s usually 8-12 Hz, but with AD it slows.
Most common cause of dementia?
At least 50% is caused by AD.
Common complication of VP shunts for NPH?
Subdural hematoma – due to quickly lowering pressure. presents with confusion.
What type of aphasia is common in alzheimer’s?
Transcortical sensory. Repetition intact, but ability to understand complex sentences is decreased.
Transient global aphasia
Antero and retrograde memory loss
General paresis
Manifestations of neurosyphilis. Memory loss, inappropriate behavior, myoclonus, delusions.
Symptoms of hypothyroidism
myoedema, inattention, poor concentration, delusions
Nonenhancing white matter lesions
PML
Bladder dysfunction in MS?
Spastic bladder = premature emptying
Neuromyelitis Optica
Recurrent episodes of optic neuritis followed by transverse myelitis. Associated with anti-aquaporin4 antibody.
Paraparesis, bladder+bowel dysfunction, sensory deficit.
Pelizaus-Merzbacher Disease
Demyelinating sudanophilic leukodystrophy, symptomatic as a toddler, may extend to 3rd decade.
Causes optic atrophy and athetosis
How to treat hemangioblastoma from VHL?
Surgery
Symptoms of VHL
Erythrocytosis, hemagioblastomas, cerebellar signs, hematuria, and HSM
Cause of congenital hydrocephalus?
Viral infection like mumps, rubella, during first trimester.
Tuberous sclerosis eye findings
Retinal phakomas– gliomatous tumors that require no treatment
What are calcifications on Xray in tuberous sclerosis?
Subependymal glial nodules
What does a downs syndrome brain look like?
Smaller and more simplified
How does alcohol cause fetal alcohol syndrome?
It impairs fetal neuronal migration
Myotonic dystrophy
CGG repeat disease with frontal balding, cataracts, repetitive EMG discharges with minor stimulation and impaired relaxation.
Poorest prognostic indicator for ALS?
Tongue fasciculations, indicates spread to brainstem
How does lead poisoning cause brain herniation in very young kids?
Massive brain edema
Manganese poisoning symptoms?
Mimics Wilson disease
Retinitis pigmentosa
Common hereditary disease involving retinal receptors. Causes optic disk pallor and usually abetalipoproteinemia
Sturge-Weber opthalmic finding?
Glaucoma
Papilledema vs papillitis
Papillitis has vision loss
Gradenigo Syndrome
Osteomyelitis of petrous bone that can cause gaze palsy of abducens nerve in young kids.
Eye muscle at risk during trauma
Superior oblique innervated by the trochlear.
Ocular motor nerve likely to be involved with varicella zoster opthalmicus?
Trochlear
If no optokinetic nystagmus, where is the lesion?
In the parietal lobe
Vision loss with cherry red fovea and narrow arterioles?e
Occlusion of the central retinal artery
Orbital cellulitis vs cavernous sinus thrombosis
Orbital cellulitis is characterized by periorbital pain, double vision, proptosis. Cavernous sinus thrombosis has these things PLUS vision loss.
PRES
Posterior reversible encephalopathy syndrome, seen in cyclosporine and tacrolimus. Headache, visual dysfunction, confusion, seizures.
Most common cause of acute monocular blindness?
Ischemic optic neuropathy
Which is more likely to infarct? Anterior spinal artery or posterior spinal artery?
Anterior. So dorsal columns (vibration) usually spared.
Early phases of meniere’s hearing loss?
Loss of low frequency sounds
What causes toxic labyrithitis and tinnitus?
Aspirin
How long does spinal shock last? What are the symptoms?
Lasts 3 days - 3 weeks. Causes lower motor neuron signs (hyporeflexia, decreased tone) even though the spinal cord is damaged
What causes abdominal aortic aneurysm?
Atherosclerosis
Level of the artery of adamkiewicz?
T10-L1
Lyme radiculopathy
Lyme disease can cause a radiculopathy that is not cured by sertoids
Most common cause of mononeuritis multiplex?
Diabetes mellitus
Common sequellae of Friedrich’s ataxia?
Diabetes mellitus
What is responsible for friedrich Ataxia peripheral findings?
Degeneration of the DRG
Why is LP necessary in baby between 0 and 1 with fever and seizures?
Because meningitis can present this way in the absence of other symptoms.
What do raccoon eyes signify?
Basilar skull fracture
How to improve the outcome of a severe TBI?
Hypothermia
How to treat optic neuritis
IV methylprednisolone
% of women who develop MS after optic neuritis?
75%
How to treat MS bladder spasticity?
Oxybutynin, imipramine, or anything else with anticholinergic properties
How to treat GBM
Surgery then radiotherapy. Poorly responsive to chemotherapy.
