Random Flashcards
How do you diagnose creutzfeld-jakob disease?
EEG shows 1 Hz discharges
CSF shows 14-3-3 protein
Triad of Normal pressure hydrocephalus?
- Apraxic gait
- dementia
- urinary incontinence
Triad of wernicke’s encephalopathy
- confusion
- ataxia
- oculomotor involvement (nystagmus, gaze palsy)
How do you treat wernicke’s encephalopathy?
IV thiamine BEFORE glucose
How do you diagnose brain death?
- unresponsiveness (coma)
- brainstem death as evidenced by absent BST reflexes and absent spontaneous breathing (apnea test)
- must ensure all variables are accounted for (temperature, electrolytes, oxygenation)
What is the difference between coma and persistent vegetative state?
persistent vegetative state has sleep-wake cycles and coma does not
Where do the eyes deviate in cold and warm caloric testing?
COWS
Cold = opposite
Warm = same
nystagmus
what is the treatment for ET?
beta-blockers
primidone
what structure will be highlighted in PET scan of ET?
thalamus
When does the tremor come out in ET compared to parkinson?
Et = 1-2 seconds PD = 9 seconds
how many repeats needed for huntington disease to be clinical?
> 40 usually
what chromosome is huntington on?
CAG 4
Treatment for huntington disease
haloperidol and sometimes tetrabenazine
SSRIs for depression
PEG tube for swallowing and aspiration
Choreaform movements in child
Huntington disease wetphal variant that presents like parkinsonism
what is the most effective treatment for generalized dystonia?
high frequency stimulation of globus pallidus pars interna by DBS
whats a good treatment for DYT-1?
trihexyphenidyl
Clinical features of DYT-1
abnormal movements in association with action early in course of disease
how can you prevent peripheral breakdown of L-dopa?
Carbidopa (dichlorosioprenaline) COMT inhibitors (entacapone and tolcapone)
what are the dopamine agonist drugs and what receptor do they work on?
pramipexole, ropinirole, bromocriptine
D2 type receptors
What are the MAO-B inhibitors used in PD?
selegiline and rasagiline
What is amantadine?
NMDA receptor antagonist
helps alleviate tremor and dystonia especially levodopa–induced dyskinesia
What 3 classes of drugs are most likely to induce parkinsonism and what are some examples?
- DA receptor blocking agents (prochlorperazine, metoclopramide)
- dopamine depleting agents (reserpine, tetrabenazine)
- atypical antipsychotic agents
what is the tetrad of parkinsonism?
resting tremor, rigidity, bradykinesia, postural instability
what is seen on MRI of SCA patients?
high T2 signal in cerebellar cortex
what is seen on MRI of MSA?
high signal lateral to striatum
high signal “hot cross bun” sign in the brainstem
what are the risk factors for developing tardive dyskinesia?
advanced age, female gender, coexistent brain damage
what are the key characteristics of tardive dyskinesia?
arching of the back and neck
what is the treatment for tardive dyskinesia?
benzodiazepines
baclofen
vitamin E
which dopamine depleting agents have been shown to cause tardive dyskinesia?
reserpine or tetrabnazine
Where are the inclusions in Parkinsons disease?
Intracytoplasmic
What location are the lesions in parkinson disease
substantia nigra
locus coeruleus
substantia innominata
what drug can be used to help reverse drug induced parkinsonism?
trihyxyphenidyl (anti-cholinergic)
what is Meige syndrome?
focal dystonia with: blepharospasm forceful jaw opening lip retraction neck contractions tongue thrusting
injury to which structure causes hoarseness and dysphagia?
nucleus ambiguous
occlusion of which artery causes lateral medullary syndrome?
vertebral artery
what is the most common cause of lobar hemorrhage in elderly patients without hypertension?
cerebral amyloid antipathy (congophilic angiopathy)
what is another name for post-ictal paralysis?
todd paralysis
what would be found on CT scan of a person with Sturge weber/ encephalofacial angiomatosis?
leptomeningeal angiomas
aneurysm of which arteries can compress the oculomotor nerve?
Posterior communicating artery
Superior cerebellar artery
what is anomic aphasia?
isolated word finding deficit
what is transcortical sensory aphasia?
similar to wernicke aphasia with exception that patient is able to repeat phrases in transcortical sensory aphasia
What is transcortical motor aphasia?
similar to broca aphasia with exception that patient is able to repeat phrases in transcortical motor aphasia
what is shown on EEG for primary generalized epilepsy of childhood?
3 Hz spike and wave pattern
when is the greatest risk for alcohol withdrawal seizures?
first day of drinking cessation
when is the greatest risk for delerium tremens?
days 2-4
when do all signs of withdrawal usually resolve?
7-14 days
What are the features of Lennox-Gastaut syndrome?
mental dysfunction, multiple seizure types, 1-2 hz generalized spike-wave discharges on EEG
what are the features of Lendau-Kleffner syndrome?
loss of language function
abnormal EEG during sleep
where do gustatory auras originate?
hippocampus or perihippocampal gyrus
what is west syndrome? Treatment?
generalized seizure disorder of infants characterized by spasms, EEG of hypsarrhythmia, and retardation
Tx with ACTH
what drugs worsen generalized seizures?
phenytoin
carbamazepine
(both sodium channel blockers)
what is the treatment for seizures in ecclempsia?
magnesium sulfate
what drug should be given to patients with spine injury within 8 hours?
high dose methylprednisolone
What are the hallmarks of delirium?
cognitive impairment
impaired attention
fluctuating course
what drugs are used to treat delirium?
lorazepam
halloo
risperidone
what structure is responsible for wakefulness?
ascending reticular-activating system (ARAS)
what is aphasia?
impariemtn of ability to use or comprehend words
what is agnosia?
loss of ability to recognize objects, persons, sounds, shapes or smells
what is apraxia
loss of ability to execute or carry out learned purposeful movements
what do cortical symptoms in a stroke suggest territory?
carotid
what do brainstem or cerebellar findings in stroke territory suggest?
vertebrobasilar territory stroke
best way to prevent vasospasm after SAH?
Triple H therapy
- hypertensive hypervolemic hemodilution
and nimodipine
what type of dissection is associated with horner syndrome?
carotid artery dissection
Treatment for partial seizures
carbamazepine valproate gabapentin lamotrigine topiramate phenytoin levetiracetam gabapentin pregabalin oxcarbazepine zonisamide lacosamid
treatment for primary generalized
valproate topiramate lamotrigine zonisamide levetiracetam
Treatment for absence seizure
valproate lamotrigine ethosuximide zonisamide topiramate
treatment for myoclonic seizures
valproate conazepam levetiracetam topiramate zonisamide
treatment for tonic seizures
valproate felbamate clonazepame topiramate zonisamide
where do schistosome mansoni eggs deposit?
the spinal cord on veins that drain the intestines and the lumbosacral spinal cord
how do you treat JC virus PML?
HAART
what is the most common form of acute encephalitis?
herpes encephalitis
what types of lesions are seen with patients with HIV and CMV?
Microglial nodules
what EEG findings would be seen in herpes encephalitis?
bilateral periodic epileptiform spikes
where do most brain abscesses come from?
hematogenous spread
where do abscess mostly form in the brain?
gray-white matter junction
what is important about subacute sclerosing pan encephalitis (SSPE)
associated with measles virus, –> demyelination. Occurs before 18, die 1-3 years after onset
what is the most common primary adult brain tumor?
astrocytoma
the most common source of primary adult brain tumors?
glial cells
what are the most common brain tumors in children?
astrocytomas and medulloblastomas
where do mets to the brain usually form?
the gray-white matter junction
cancer mets with the worst prognosis. why?
malignant melanoma or choriocarcinoma
because they like to hemorrhage
precocious puberty, uncontrollable laughter followed by seizure
hypothalamic hamartoma
what is parinaud syndrome
loss of vertical gaze
loss of pupillary light reflex
lid retraction
convergence-retraction nystagmus (eyes jerk up into the orbit on upward gaze)
what causes parinaud syndrome?
pineocytoma
what is paraneoplastic cerebellar degeneration?
subacute and relentlessly progressive ataxia, dysarthria, and nystagmus
what are the most commonly associated tumors with paraneoplastic cerebellar degeneration?
lung
ovarian
lymphoma
(in that order of prevalence)
accumulation of glucosylceramide
gauche disease or B-glucosidase deficiency
Changes in what cells of the brain are seen in chronic alcoholics?
alzheimer type II astrocytes
what is seen in the CSF of hypertensive encephalopathy?
increased protein but below 100
what neurological symptom do patients with chronic renal failure exhibit?
peripheral neuropathy
Treatment for restless leg syndrome
clonazepam gabapentin L-dopa dopamine agonists (pramipexole, ropinirole) opiates
What drugs make restless leg syndrome worse?
neuroleptics
CCBs
caffeine
what is the most common visual defect in vitamin B12 deficiency?
centrocecal scotoma
ocular disturbances from tobacco smoking and alcohol use term
deficiency amblyopia
pickwikian syndrome?
weight gain, smoking leading to sleeping episodes during the day
Hypersomnia
what kind of language problems do alzheimers patients develop?
transcortical sensory aphasia
What are the features of Rett syndrome?
loss of language skills once learned, loss of eye contact and wringing movement of hands, or patting, tapping, or hand-mouth movements
no treatment, unknown etiology
what is general paresis associated with?
neurosyphilis
what is alien hand syndrome associated with?
JC virus infection in immunocompromised leading to progressive multifocal leukoencephalopathy
what are the features of Canavan disease?
macrocephaly
defect in N-acetylaspartic acid metabolism
developmental regression at 6 months of age, spongiform like degeneration
What is leber optic atrophy?
when a centrocecal scotoma forms (loss of central vision)
mutation in mitochondrial DNA
Pelizaeus-Merzbacher disease
symptomatic first months of life, myelin islands around blood vessels
what are the most common agents of bacterial meningitis in children under the age of 6 months?
H influenza
S pneumonias
N meningitides
What is most common agent of bacterial meningitis in children under 3 months?
Listeria monocytogene
E coli
GBS
how do you treat trigeminal neuralgia?
carbamazepine
baclofen
phenytoin
hartnup disease has a decrease in what?
nicotinamide
what is seen on CT of sturge-weber?
railroad track pattern on cerebral gyri
