Rest of neuro Flashcards
presentation of early parkinsons vs late
Early PD presents as TRAP –
pill-rolling Tremor, cogwheel
Rigidity, Akinesia, Postural
instability
late PD presents as Alzheimer-like dementia
pathophys of parkinsons + treatment
loss of DA neurons in substantia nigra
early PD → Tx Sinemet (carbidopa + levodopa)
late PD → Tx subthalamic nucleus deep brain stimulation
pathology seen in brain with PD
PD brain: neuronal death in substantia nigra, senile plaques, Lewy bodies
PD + autonomic insufficiency
Shy-Drager syndrome
PD w/o ophthalmoplegia or tremors
Progressive supranuclear palsy (PSP)
genetics of huntingtons
AD CAG trinucleotide repeats on
chromosome 4
presentation and pathophys of huntingtons + Tx
↓GABA → chorea, apathy, depression,
dementia w/ onset at 35-50 y/o
no tx available
AD tremor w/ intentional activity but not at rest,
improved w/ EtOH use
Tx?
essential tremor
Bblockers
gait instability, loss of balance,
impaired limb coordination
ataxia
ataxia w/ staggering gait, nystagmus, pes
cavus and hammer toes
fridreich ataxia
Friedreich ataxia (ataxia w/ staggering gait, nystagmus, pes cavus and hammer toes) + telangiectasias
Ataxia-telangiectasia
Etiologies of aquired ataxia?
EtOH, B12/thiamine deficiency, cerebellar dz, demyelinating dz, or 3° syphilis
most severe tic disorder w/
multiple daily motor/vocal tics,
onset before 18 y/o; associated
w/ OCD and ADHD
tx?
tourettes
rx with clonidine or pimozide (haldol if severe)
*Coprolalia: involuntary swearing, pathognomonic but rare in Tourette syndrome
selective CNS demyelination → optic neuritis, intranuclear ophthalmoplegia (crazy eyes), transient sensory deficits, etc.
how to dx? treat?
MS
Dx MRI (multiple white plaques), LP w/ CSF analysis (oligoclonal bands)
Tx IFN-β (prevent relapses), high-dose steroids (for acute attacks)
rapid PNS demyelination → ascending weakness/paralysis, possible respiratory arrest
how to Dx? tx?
guillian-Barre syndrome
Dx CSF (↑protein), EMG (↓nerve conduction)
Tx IVIG vs. plasmapheresis
differential dx for ring enchaning lesions
MALT mets abcess lymphoma toxo
general brain cancer smx/ mass effect smx?
HA, seizures, focal neuro smx
MC brain cancers?
Mets»_space;> astrocytoma (adults) > infratentorial (kids)
can cross corpus callosu, pseudopalisading
necrosis, GFAP+
GBM
Rosenthal fibers, GFAP+
astrocytoma
“fried egg” cells, chicken-wire
capillary pattern
oligiodendroglioma
Psamomma bodies, attached to
dura
meningioma
S-100+, CN VIII
acoustin neuroma
multiple ring-enhancing lesions + AIDS/immunosuppresion
primary CNS lymphoma
MC souces of brain mets
lung > breast > skin > kidney > colon
Bilateral schwannoma, think:
NF type 2
cancer that metastasizes to meninges via bloodstream → focal neuro sx, meningitis,
hydrocephalus
Dx with? tx?
Meningeal carcinomatosis
Dx with LP and CSF analysis showing malignant cells
tx intrathecal chemotherapy
gradually progressive muscle weakness
(initial sx is ptosis, diplopia, blurry vision) that get worse w/ repetitive muscle use
pathophys? how to dx/work up? tx?
Myasthena gravis
Dx ↑anti-nAChR (best),
edrophonium test, EMG (decreased response w/ repetitive stimulation), chest CT to look for thymoma
Tx pyridostigmine, plasmapheresis (if severe), thymectomy (if thymoma)
treatment for myathenic crisis
emergent ventilation
gradually progressive muscle weakness
that get better w/ repetitive muscle use
pathophys? how to dx?
SCLC → anti-VGCC
dx with elevated anti-VGCC
ascending weakness w/ Gowers maneuver, calf
pseudohypertrophy, death by 15 y/o
pathophys, how to dx?
Duchenne MD
XR ∆dystrophin → muscle cells
die off
Dx ↑CPK, DNA testing, bx with fatty/fibrotic replacement of muscle cells
café-au-lait spots, Lisch nodules (iris hamartomas), CNS tumors, pheos
pathyophys, how to dx?
NF 1 (von Recklinghausen disease) AD ∆NF1
Dx pheo in pt with NF w/ HTN → Dx urinary metanephrines
bilateral acoustic neuromas, juvenile cataracts
NF 2
AD ∆NF2
CNS/retinal hamartomas, sebaceous
adenomas, hypopigmented “ash leaf spots”, Shagreen patches, renal angiomyolipoma, cardiac rhabdomyoma
Tuberous sclerosis
AD ∆TSC1/2
facial “port-wine stain” w/ ipsilateral brain AVM
Struge-weber
hemangioblastomas, bilateral RCC, pheochromocytomas
VHL
Corticospinal tract carries what kind of info and where does it cross?
Motor
crosses in medulla
what tract carries touch and proprioception and where does it cross
dorsal columns
crosses in medulla
what tract carries pain and temp and where does it cross?
spinothalamic (anteriolateral system)
crosses in spinal cord
central cavitation of cervical cord → bilateral “cape-like”
what tracts are affected? ow to dx? tx?
syrinomyelia
loss of spinothalamic and corticospinal
Dx with MRI
Tx with syringosubarachnoid shunt
stab wound → spinal cord
hemisection
what tracts are affected and what is presentation
Brown-Sequard syndrome
ipsilateral loss of DC and CS, contralateral
loss of ST
paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion
viral infx → loss of function of entire spinal cord at a single level → bilateral loss of CS/DCML/ALS below level of lesion + sphincter dysfunction
Dx? Tx?
Transverse myelitis
Dx with MRI na Tx with high dose steroids
polio infx (fecal-oral) → bilateral lower motor neuron loss of function → asymmetric muscle weakness w/ normal sensation
poliomyelitis
What are the 5 types of vertigo?
(BLAME) – Benign paroxysmal positional vertigo Labyrinthitis Acoustic neuroma Meniere disease, EtOH/drug-induced
treatment of vertigo
Tx underlying cause + meclizine for nausea
how to dx and treat vasovagal syncope
Dx tilt-table study,
Tx β-blockers + disopyramide
transient unilateral movements w/o LOC
work up? tx?
simple partial sz
first time → Dx labs (renal panel, glucose) + EEG + MRI (r/o mass lesions)
if, epileptic → check anticonvulsant levels
Tx: phenytoin or CBZ
transient automatisms w/ LOC → postictal confusion
work up? tx?
complex partial sz
first time → Dx labs (renal panel, glucose) + EEG + MRI (r/o mass lesions)
if, epileptic → check anticonvulsant levels
Tx: phenytoin or CBZ
sudden LOC → rigidity (tonic phase) →
musculature jerking (clonic
phase) → postictal confusion
grandmal sz
“staring into space” for a few seconds
tx?
absence sz
ethosuximide
etiologies of seizures
4 Is + 4 Ms – Infx, Ischemia (stroke/TIA), ↑ICP, Intoxication,
Metabolic and electrolytes,
Mass lesions,
Missing drugs (anticonvulsants, sedatives/EtOH)
Misc
looks like sz but no EEG changes
pseudo seizure
partial sz → generalized sz
secondary generalized sz
brain is stuck in a state of persistent seizure
status epilepticus
upper and lower motor neuron lesions → progressive muscle weakness → death in 5-10 yrs
how to dx? tx?
ALS
Dx EMG (fasciculations, fibrillations), nerve conduction studies (↓conduction velocity)
Tx supportive care + riluzole (glutamate-antagonist that delays death by 3-5 months)
Wernike’s: where is the lesion? how does it present?
superior temporal gyrus lesion → fluent
w/ impaired comprehension
Broca’s: where is the lesion? how does it present?
inferior frontal gyrus lesion → nonfluent w/
intact comprehension
Conduction aphasia : where is the lesion? how does it present?
both gyri lesion → nonfluent w/ impaired
comprehension
Global aphasia : where is the lesion? how does it present?
arcuate fasciculus lesion → can’t repeat
“no ifs, ands, or buts”
etiology of aphasias
Etiology: stroke (#1), trauma, tumors, Alzheimer dz
b/l bells palsy, think
Lyme disease or Guillain-Barre syndrome
treatment for bells palsy
Tx : depends on etiology
steroids if ≥10 days,
ACV if shingles,
doxycycline if Lyme disease
treatment for trigeminal neuralgia
CBZ
