Questions Flashcards
Bilateral MLF lesions are usually seen in?
MS
Internuclear opthalmoplegia is a disorder of conjugate horizontal gaze that results from damage to the:
MLF
The affected eye, ipsilateral to the lesion, is unable to adduct and the contralateral eye abducts with nystagmus
Unilateral MLF lesions can occur with?
Lacunar stroke in the pontine artery distribution
The femoral nerve innervates the:
Muscles of the anterior compartment of the thigh (Quad, sartorius, pectineus);
responsible for knee extension and hip flexion;
Sensation to inner thigh and medial leg via the saphenous branch
The superficial peroneal nerve does what action?
foot eversion
Imaging in Alzheimer’s disease will show:
Diffuse cortical and subcortical atrophy, more prominent in the temporal and parietal lobes sometimes, ie hippocampi
Social disinhibition and personality changes are features of:
frontotemporal dementia
What are the symptoms of meningeal irritation?
Nausea, vomiting, photophobia
SAH most common cause
Ruptured arterial saccular aneurysm
Severe headache at onset;
Meningeal irritation;
Focal deficits not common;
Dx?
SAH
Complications of SAH
Rebleeding within 24 hours; Vasospasm after 3 days; hydrocephalus/increased intracranial pressure; Seizures; hyponatremia from SIADH
When is xanthochromia seen in LP in SAH?
About 6 hours after onset
How do you identify the source of a bleed in SAH?
Cerebral angiography;
can use procedure to stabilize aneurysm by coiling or stenting
What treatment should be considered in MS patients who are experiencing a flare, who are refractory to corticosteroid therapy?
Plasmapheresis
interferon-beta or glatiramer acetate should be considered in patients who have?
RR or Progressive MS
Progressive proximal muscle weakness and atrophy without pain or tenderness;
Lower extremity muscles are more involved;
Dx?
Glucocorticoid-induced myopathy;
ESR and CK normal;
Tx with cessation of steroids, can take weeks of months
Muscle pain and stifness in the shoulder and pelvic girdle;
Tenderness with decreased range of motion at shoulder, neck and hip;
Responds rapidly to glucocorticoids;
Dx?
Polymyalgia rheumatica;
ESR up;
CK normal
Muscle pain, tenderness and proximal muscle weakness;
Skin rash and inflammatory arthritis may be present;
Dx?
Inflammatory myopathies;
ESR and CK up
Prominent muscle pain/tenderness with or without weakness;
Rare rhabdomyolysis;
Dx?
Statin-induced myopathy;
ESR normal;
CK up
Muscle pain, cramps and weakness involving the proximal muscles; Delayed tendon reflexes and myoedema; Occasional rhabdomyolysis; Features of hypothyroidism present; Dx?
Hypothyroid myopathy;
ESR normal;
CK up
How does herpes encephalitis present initially?
Altered mentation; FNDs; Ataxia; Hyperreflexia; Focal seizures; Kluver-Bucy; Amnesia
What does an LP look like in herpes encephalitis?
Lymphocytic pleocytosis with increased number of erythrocytes (hemorrhagic destruction of temporal lobes), elevated protein levels
How is herpes encephalitis diagnosed?
PCR analysis of HSV DNA in CSF
What therapy is used in SAH to reduce vasospasm?
Nimodipine and hyperdynamic therapy
In SAH, noncontrast CT usually reveals bleeding where?
Around the brainstem and basal cisterns
What is the mgmt of a patient with stroke bu no prior antiplatelet therapy?
Aspirin
What is the mgmt of a patient with stroke who is already on aspirin therapy?
Aspirin + clopidogrel or dipyridamole
What is the cutoff BP for tPA?
> 185/110
Where is a medulloblastoma seen?
Cerebellum vermis, extending to the fourth ventricle
What is the management of a patient who has developed an intracranial bleed from anticoagulation in the treatment of PE?
IVC Filter
What is the hallmark symptom of a vertebrobasilar TIA?
Vertigo
Enlargement of the pons on MRI; Long list of minor complaints; Children; Neck stiffness or discomfort proceeding to torticollis; Dx?
Brain stem glioma
Cranial nerve deficits; Dysphasia; Nasal speech; Apnea; Dx?
Medullary tumor
Tumor in the Supraseller region; Calcification above Sella in MRI; Panhypolituitarism; Growth failure in children; DI; Bitemporal hemianopsia if optic chiasm is involved? Dx?
Craniopharyngioma
Most common type of neonatal seizure
hypoxic-ischemic encephalopathy;
low cord pH, low Apgar scores
What is the acute management of a suspected Brown-Sequard syndrome?
IV dexamethasone - most effective within the first 8 hours of injury
Two common etiologies of Brown-Sequard syndrome are:
trauma, progressive ie tumor ie mets to the spine
Ipsilateral spastic paralysis;
Ipsilateral Babinski;
Ipsilateral loss of pain and vibration sense;
Contralateral loss of pain and temperature below the lesion;
Dx?
Brown-Sequard syndrome
What is the most accurate test to determine CSF leakage?
Beta-2 transferrin
use in patients who present with head trauma
Nihilistic delusion disorder in which patiens complain about having lost their possessions, status, strength, inner organs;
Can be seen in schizophrenic or depressive episodes;
Dx?
Cotard’s syndrome
Decreased attention, slowed information processing, increased distractability, problems with memory, personality changes, depression, impulsivity;
Following blunt head trauma;
Dx?
Dementia pugilistica
Generalized weakness and pins and needles sensation; Loss of vibratory sensation; Increased deep tendon reflexes; Extensor plantar responses; Ataxic gait Chronic, seen in strict vegetarians
B12 deficiency –> pernicious anemia –> subacute combined degeneration of the spinal cord;
Tx with B12 replacement
Main diagnostic clue in Guillain-Barre syndrome
Absent deep tendon reflexes with ascending demyelinating neuropathy
Proximal muscle weakness;
Diplopia;
Ptosis;
Deep tendon reflexes are depressed or absent;
Repetitive nerve stimulation causes increased responses;
Dx?
Lambert-Eaton syndrome;
seen with small cell carcinoma of the lung
Are deep tendon reflexes preserved in MG?
Yes
Progressive proximal muscle weakness;
Difficulty climbing stairs and combing hair;
CK elevated;
Dx?
Polymyositis;
confirm with muscle biopsy and EMG
Multiple lesions seen in the white matter of both the brain and spine;
Signs and symptoms may include encephalopathy, acute hemiparesis, cerebellar ataxia, cranial neuropathies, spinal cord dysfunction, weakness to paralysis, bowel and bladder dysfunction;
Dx?
Acute diffuse encephalomyelitis (ADEM) - rapidly progressing central demyelination follows a viral illness or atypical infection;
Develops over days to weeks;
May resolve over several months;
Autoimmune;
Must differentiate from first episode of MS if recovery is rapid
In what patient population if progressive multifocal leukoencephalothy (PML) seen?
AIDS, the severely immunocomprimised, CD4 < 100
Inflammatory process of the gray and white matter of the spinal cord;
Axonal demyelination;
Weakness and sensory disturbances at the level of the lesion;
Dx?
Transverse myelitis
What is the treatment for trigeminal neuralgia (tic douloureux)?
Carbamazepine;
Baclofen can be adjunct
What are the treatment options for trigeminal neuralgia is medical therapy fails?
Surgical decompression of the ganglion;
Percutaneous radiofrequency;
Glycerol trigeminal rhizotomy
Acetylcholine is known to modulate what functions in the basal forebrain projections to the cortex and limbic structures?
Decreased in Alzheimer’s;
Attention, novelty-seeking, memory
Occurs with hyperextension injuries in elderly patients with pre-existing degeneration;
Weakness that is more pronounced in the upper extremities than the lower;
Dx?
Central cord syndrome
Loss of movement, pain and temperature below the level of the injury (aka bilateral spastic motor paresis distal to the lesion);
Dx?
Anterior (ventral_ cord syndrome;
Usually due to occlusion of the anterior spinal artery
Ipsilateral weankess, spasticity, loss of vibration sense and proprioception;
Contralateral loss of pain and temperaure;
Dx?
Brown-Sequard syndrome;
hemisection of the cord, can be due to penetrating injury
Bilateral loss of vibratory and proprioceptive sensation, often with weakness, parasthesias and urinary incontence or retention;
Dx?
Posterior cord syndrome;
can be due to many causes, ie MS and vascular disruption ie vertebra artery dissection
What are the precipitating factors for a myasthenic crisis?
Infection or surgery;
Pregnancy or childbirth;
Tapering immunosuppressive drugs;
Medications ie beta blockers, aminoglycosides, fluoroquinolones
What are the symptoms of a myasthenic crisis?
Increased generalized and oropharyngeal weakness (trouble swallowing);
Respiratory insufficiency/dyspnea;
What is the treatment for a myasthenic crisis?
Intubation for deteriorating respiratory status;
plasmapheresis or IVIG and corticosteroids
The posterior inferior frontal gyrus is aka
Broca’s area
A stroke to Broca’s area would result in:
Inability to verbalize and write properly (expressive aphasia)
In Broca aphasia syndrome, speech is:
sparse and nonfluent
In conduction aphasia, speech is
fluent with phonemic errors
In what aphasia is comprehension preserved?
Broca;
Conduction
In what aphasia is comprehension diminished?
Wernicke
In what aphasia is repetition impaired?
Broca;
Wernicke
In what aphasia is a right superior visual field defect often seen?
Wernicke
In what aphasia is right hemiparesis (face and upper limb) seen?
Broca
Meyer’s loop is in what lobe of the brain?
Temporal lobe
What is apraxia?
Inability to perform purposeful actions
Rapid impairment of vision in one eye; Pain on eye movement; Marked color changes in perception; Afferent pupillary defect and field loss occur, usually with central scotoma; Dx?
Optic neuritis;
common in MS;
Fundoscopy reveals swollen disc
Painful and red eye with blurring of vision;
Eye usually has a perilimbal injection;
Dx?
Anterior uveitis;
examiniation reveals keratic precipitates;
corneal stromal edema may be present
Gradual loss of peripheral vision resulting in tunel vision;
On exam, pathologic cupping of the optic disc is seen;
dx?
Open angle glaucoma
Holocranial headache; Transient vision loss; Pulsatile tinnitus; Diplopia; Dx?
Idiopathic intracranial HTN (Pseudotumor cerebri
How is idiopathic intracranial HTN diagnosed?
MRI +/- MRV;
Lumbar puncture CSF pressure >250 w/ normal analysis
What associations are there to idiopathic intracranial HTN?
Overweight;
female;
hypervitaminosis A, tetracyclines
What is the treatment for idiopathic intracranial HTN?
Stop the offendint medication;
weight loss;
acetazolamide
What kind of drug is sumatriptan?
5-hydroxytryptamine-1 agonist
Timolol eyedrops are used in the treatment of:
glaucoma
An embolic stroke usually means symptoms are:
Abrupt onset and maximal at the start
Forced gaze preference suggests damage where?
Frontal eye fields
Homonymous hemianopsia suggests damage where?
Lower optic radiations in the lateral temporal and parietal lobes
How does a subcortical lacunar stroke present?
Pure sensory, sensorimotor, pure motor, ataxic hemiparesis, dysarthria with clumsy hand;
due to an occluded single penetrating branch of a large cerebral artery (ie MCA, basilar)
Patients with atrial fibrillation PLUS existing structural heart disease have an increased risk of:
cardioembolic stroke
What is the treatment for the motor and psychiatric manifestations in Lewy body dementia?
Rivastigmine - Acetylcholinesterase inhibitor
What is the criterion for status epilepticus?
Any seizure >5 min at risk for excitatory cytotoxicity –>cortical laminar necrosis
What is amaurosis fugax?
Transient “curtain falling down” usually monocular retinal embolus from the ipsilateral carotid artery (atherosclerosis)
Light flashes;
Floaters;
Curtain coming across visual field;
dx?
Detached retina
What are common neurological complications of infective endocarditis?
Embolic stroke;
Cerebral hemorrhage;
Brain abscess;
Acute encephalopathy or meningoencephalitis
Subdural hematoma is what shape?
Crescent shape
Primary solitary brain mets are commonly:
Breast
Colon
Renal cell carcinoma
Multiple brain mets are commonly:
Lung
Malignant melanoma
Vertigo, falling to the side of the lesion;
Difficulty sitting upright without support;
Diplopia and nystagmus (horizontal and vertical);
Ipsilateral limb ataxia;
These are all vestibulocerebellar signs of:
Wallenberg syndrome - lateral medulla infarction - intracranial vertebal artery, or PICA
What autonomic dysfunction can be seen in Wallenberg syndrome?
Ipsilateral Horner’s syndrome;
Intractable hiccups;
Lack of automatic respiration is during sleep
What sensory symptoms are seen in Wallenberg syndrome?
Abnormal facial sensation or pain;
Loss of pain and temperature in ipsilateral face and contralateral trunk and limbs
What bulbar symptoms are seen in Wallenberg syndrome?
Dysphagia and aspiration;
Dysarthria, dysphonia and hoarseness
In medial medullary syndrome, contralateral hemiparesis results from infarct in what structure?
Medullar pyramid
In medial medullary syndrome, contralateral loss of tactile, vibratory and position sense indicates an infarct in what structure?
Medial lemniscus
In medial medullary syndrome, ipsilateral tongue paralysis with deviation to the side of the lesion results from infarct to what structure?
Hypoglossal nucleus and fibers
Medial medullary syndrome is typically due to an occlusion where?
Vertebral or anterior spinal artery
Contralateral ataxia;
hemiparesis of the face, trunk, limbs;
variable loss of contralateral tactile and position sense;
Dx?
Medial mid-pontine infarction
Phenytoin and carbamazepine use can result in what newborn deformities? (Fetal hydantoin syndrome)
Microcephaly; Hypoplasia; Cleft lip and palate; Digital hypoplasia; Hirsuitism; Developmental delay
Diplopia, bitempoeral hemianopsia, vision loss;
Hormonal deficiencies ie low libido;
Can be found on brain imaging incidentally;
Dx?
Craniopharyngioma
Defect: Monoculur scotoma;
Lesion:
Partial lesion in the retina, optic disc, optic nerve;
Causes include: Macular degeneration, optic neuritis
Defect: Right anopia (right side totally out);
Lesion:
Right optic nerve;
Causes include: Retinal artery of central retinal vein occlusion
Defect: Bitemporal hemianopsia;
Lesion:
Optic chiasm;
Causes include: Pressure exerted by a pituitary tumor, craniopharyngioma, aneurysm of the ACA
Defect: Right nasal hemianopsia;
Lesion:
Right peri-chiasmal lesion
Causes include: Calcification or aneurysm of the internal carotid artery impinging on uncrossed, lateral retinal fibers
Defect: Left homonymous hemianopsia (Left side both eyes totally out);
Lesion:
Right optic tract or radiation;
Causes include:
optic tract = occlusion of ACA
optic radiaton = occlusion of MCA branch or lesion involving posterior limb of the internal capsule
Defect: Left homonymous superior quadrantanopia (pie in the sky);
Lesion:
Right Meyer’s loop (temporal lobe)
Causes include: lesion or stroke involving temporal lobe
Defect: Left homonymous inferior quadrantanopia (pie on the floor);
Lesion:
Right parietal lobe (Dorsal optic radiation
Causes include: lesion or stroke involving parietal lobe
Defect: Left homonymous hemianopia with macular sparing;
Lesion:
Right primary visual cortex (occipital lobe);
Causes incluse: occlusion of PCA. Macula is spared due to collateral blood from MCA
Craniopharyngioma - benign?
Yes;
suprasellar;
50% >20 age
What cranial nerves pass through the cavernous sinus?
III, IV, V and VI
Because the facial/ophthalmic venous system is valveless, uncontrolled infection of the skin can result in:
Cavernous sinus thrombosis;
red flag symptoms include severe HA, bilateral periorbital edema, cranial nerve deficits of III-VI
What is the main SAH complication within 24 hours?
Rebleeding
What is the main SAH complication within 3 days?
Vasospasm
How do you reduce the risk of vasospasm following SAH?
Nimodipine and hyperdynamic therapy
Motor and sensory loss below the level of the lesion with bladder and bowel dysfunction;
Dx?
Transverse myelitis;
Patients initially have flaccid paralysis, followed by spastic paralysis with hyperreflexia
Altered mental status; Gait instability; Nystagmus; Conjugate gaze palsy; Diminished reflexes; Dx?
Wernicke encephalopathy (B1 thiamine deficiency)
Think of what bacteria in association with Guillain-Barre syndrome?
Campylobacter jejuni
Flaccid paralysis in infancy, most likely diagnosis?
Spinal muscular atrophy;
Anterior horn cells
After GBS is suspected, what is the next most important step in management?
Serial spirometry to assess breathing status (FVC)
Every case of leukocoria (white reflex on ophthalamic exam) is considered what until proven otherwise?
Retinoblastoma
Pronator drift is a physical exam finding that is relatively sensitive and specific for:
Pyramidal/corticospinal tract disease
Sudden loss of vision;
Onset of floaters;
Association with diabetic retinopathy;
Dx?
Vitreous hemorrhage
What is used as prophylaxis for cluster headaches?
Verapamil
Painless, rapid, transient monocular vision loss;
“Curtain descending over the eye”;
Dx?
Amaurosis fugax
Evaluate with carotid duplex
What are the common microbes responsible for brain abscess?
Viridans strep;
Staph aureus;
Gram negative organisms
Histopathologic examination of brain tissue in Alzheimer’s patients indicates:
A selective loss of cholinergic neurons
What is the first-line treatment for Alzheimer’s patients?
Cholinesterase inhibitors ie donepezil, galantamine, rivastigmine
What NMDA receptor agonist is approved for moderate to severe dementia?
Memantine
Painful, red eye (injection);
Ulceration of the cornea;
Dx?
Contact-lens associated keratitis;
usually due to gram negative organisms like pseudomonas;
medical emergency
Painful, red eye;
blurred vision;
sometimes corneal opacification;
Dx?
Acute angle closure glaucoma
Painful, red eye;
Conjunctival inflammation that spares the corrnea
Anterior uveitis
Well-demarcated patch of extravastated blood beneath the conjuctiva;
Dx?
Subconjuctival hemorrhage
What is the pathogenesis of tabes dorsalis?
Secondary degeneration of the dorsal columns;
Spirochetes directly damage the dorsal sensory roots
Sensory ataxia; Lancinating pains; Neurogenic urinary incontinence; Argyll Robertson pupil; Dx?
Tabes dorsalis
In tabes dorsalis or B12 deficiency,
damage to the dorsal column produces:
Lossof position and vibration
In tabes dorsalis, loss of the dorsal root produces:
Lancinating pain;
Hypo/areflexia
In B12 deficiency, loss of the lateral corticospinal tract produces:
Spastic paresis
In B12 deficiency, loss of the spinocerebellar tractproduces:
Ataxia
What medications are associated with pseudotumor cerebri?
tetracyclines;
hypervitaminosis A
Otitis media and Mastoiditis can cause brain abscess in which regions?
Temporal lobe, cerebellum
Frontal and ethmoid sinuses, and dental infection can cause brain abscess in which region?
Frontal lobe
Bacteremia from other infection sites and cyanotic heart disease can cause brain abscess by:
hematogenous spread;
site is multiple abscesses along the middle cerebral artery
HA, nauseam eye pain and a nonreactive mid-dilated pupil;
Dx?
Acute angle closure glaucoma;
acute rise in intraocular pressure
Common causes if acute angle closure glaucoma include:
decongestants (anticholinergics)
What is tonometry?
Measures IOP
How do you best differentiate between SAH and ICH?
In Intracerebral hemorrhage (ICH), symptoms worsen over minutes to hours
Usually bilateral, severe radicular pain;
Saddle hypo or anesthesia;
Assymmetric motor weakness;
Hyporeflexia/areflexia;
Late onset bowel and bladder dysfunction;
Dx?
Cauda equina syndrome (just LMN signs)
Sudden onset severe back pain; Perianal hypo/anesthesia; Symmetric motor weakness; Hyperreflexia; Early onset bowel and bladder dysfunction; Dx?
Conus medullaris syndrome
What is the mgmt of cauda equina syndrome?
Emergency MRI;
IV glucocorticoids;
Neurosurgery eval
What is the mgmt of conus medullaris syndrome?
Emergency MRI;
IV glucocorticoids;
Neurosurgery eval
Dysarthria/clumsy hand; Ataxic hemiparesis; Pure sensory stroke; Pure motor hemiparesis; Dx?
Lacunar stroke;
Absence of cortical signs ie aphasia, agnosia, neglect, apraxia, mental status change, seizure and hemianopsia
What are the risk factors for lacunar stroke?
HTN;
increased LDL;
smoking, diabetes, age
What are the affected areas of a lacunar stroke?
Basal ganglia;
Pons;
Subcortical white matter ie internal capsule, corona radiata
What comorbidities can be seen with absence seizures?
Anxiety;
ADHD
What is seen in EEG in absence seizures?
3Hz spike-wave distribution
Orofacial clefts, microcephaly, dysmorphic facial features, cardiac defects, nail/digit hypoplasia;
Dx?
Fetal hydrantoin syndrome;
from phenytoin exposure
What is athetosis?
Involuntary writhing movements
A stroke to the deep branches of the PCS involves what part of the brain?
Thalamus
A stoke to the PCA involves what part of the brain?
Occipital lobe or temporal lobe
A stroke to the Anterior choroidal artery involves what part of the brain?
Posterior limb of the internal capsule
A stroke to the deep branches of the MCA involves what part of the brain?
Lentiform nucleus - putamen and globus pallidus
A stroke to the deep branches of the ACA involves what part of the brain?
Head of the caudate nucleus AND anterior limb of the internal capsule
What is Dejerine-Roussy syndrome?
Post stroke, severe paroxysmal burning pain over the affected area, classically exacerbated by light touch (allodynia)
Ipsilateral oculomotor nerve palsy, ataxia, contralateral hemiparesis;
Stroke where?
Midbrain
Contralateral hemiparesis, sensory loss, conjugate gaze palsy toward the side of the lesion;
Stroke where?
Putamen with internal capsule involvement - common site of hyperintensive intraparenchymal brain hemorrhage
Contralateral sensory loss involving all sensory modalities;
Stroke where?
Lacunar stroke of posterior thalamus
What is the primary risk factor for neonatal intraventricular hemorrhage?
Low birth weight
Infant with pallor, cyanosis, focal neurologic signs, bulging or tense fontanel, apnea and bradycardia;
Dx?
IVH
What medication is used in Parkinson’s patients where tremor is the predominant symptom?
Trihexyphenidyl
What will EEG show in a patient with CJD?
Periodic sharp wave complexes
Deep come and total paralysis within minutes;
Pinpoint reactive pupils;
Area of hemorrhage?
Pons
Contralateral hemiparesis and hemisensory loss; Nonreactive miotic pupils; upgaze palsy; eyes deviate toward hemiparesis; Area of hemorrhage?
Thalamus
Usually no hemiparesis; Facial weakness; Ataxia and nystagmus; Occipital headache and neck stiffness; Area of hemorrhage?
cerebellum
Contralateral hemiparesis and hemisensory loss;
homonymous hemianopsia;
gaze palsy;
Area of hemorrhage?
Basal ganglia
Eyes deviate away from hemiparesis;
Area of hemorrhage?
Cerebral lobe
Early executive dysfunction;
Cerebral infarction and/or deep white matter changes on neuroimaging?
Vascular dementia
Visual hallucinations;
Fluctuating cognition?
Lewy body dementia;
Spontaneous parkinsonism
What is physiologic tremor?
Low amplitude (10-12Hz);
acute onset with increased symptheticactivity ie caffeine, anxiety;
Usually worse with movement and can involve the face and extremities
What is pseudodementia?
Dementia like symptoms in an elderly person with major depressive disorder
Patients >50;
Progressive and bilateral loss of central vision;
Dx?
Macular degeneration;
degenertaion and atrophy of the outer retina etc.
Why does putaminal hemorrhage often produce contralateral hemiparesis and contralateral sensory loss?
Injury to adjacent internal capsule
What is the triad of Wernicke encephalopathy?
- Encephalopathy
- Gait ataxia
- Ocular dysfunction
Common causes of cerebellar (ataxic, wide-based gait) include:
cerebellar degeneration;
stroke;
drug/alcohol intoxication;
vitamin B12 deficiency
Associated symptoms with ataxic gait include:
dysdiadokinesia;
dysmetria;
nystagmus;
Romberg sign
Gait apraxia, aka freezing start and turn hesitation gait, have what common causes?
Frontal lobe degeneration;
Normal pressure hydrocephalus
Common causes of steppage gait include:
L5 radiculopathy;
Neuropathy of the common peroneal nerve
What are the characteristics of a cluster headache?
Starts suddenly; Usually lasts about 2 hours; Intense, unilateral, retroorbital pain; Pain peaks rapidly, usually at night; May be accompanied by redness of the ipsilateral eye, tearing, stuffy or runny nose, Horner's syndrome
What prophylaxis is recommended for cluster headaches?
Verapamil;
Lithium;
Ergotamine
Use 100% O2 and Subq sumatriptan for attacks
Progressive bilaterally symmetric hearing loss with subjective tinnitus;
Dx?
Presbycusis - sensorineural
Descending flaccid paralysis in infant;
Poor suck/gag reflexes;
Sluggish pupils bilateral ptosis;
Dx?
Botulism spore ingestion
