Secrets - Neuro Chapter

Question 1

Locate site of brain injury responsible for memory impairment, hyperaggression, hypersexuality, hyperorality.

Answer 1

Temporal Lobes (more specifically the amygdala bilaterally, found in the temporal lobe where a lesion can present with Kluver-Bucy Syndrome of hyperphagia, hypersexuality, hyperorality). HSV-1 LOVES the temporal lobe.

Question 2

Locate site of brain injury responsible for inability to read, write, name, or do math.

Answer 2

Dominent parietal lobes

Question 3

Locate site of brain injury responsible for ignoring one side of the body, trouble with dressing.

Answer 3

Non-dominent parietal lobes

Question 4

Locate site of brain injury that would affect CN 3 and 4.

Answer 4

Midbrain

Question 5

Locate site of brain injury that would affect CN 5, 6, 7, 8.

Answer 5

Pons

Question 6

Locate site of brain injury that would affect CN 9, 10, 11, 12

Answer 6

Medulla

Question 7

What is pseudodementia?

Answer 7

Depression in older adults that causes some clinical sxs and signs of dementia BUT is reversible with tx

Question 8

Brudzinski sign?

Answer 8

Severe neck stiffness seen in Meningitis causes patient’s hip and knees to flex when neck is flexed.

Question 9

Kernig sign?

Answer 9

Severe stiffness of the hamstrings seen in Meningitis causes an inability to straighten the leg when the hip is flexed to 90 degrees.

Question 10

Defects along Meyer’s loop (along temporal lobe) cause what visual field deficit?

Answer 10

“Pie in the sky” or upper quadrant anopsia 2/2 optic radiation injury in temporal lobe

Question 11

Lesions along optic radiations in the parietal lobe cause what visual field deficit?

Answer 11

Lower quadrant anopsia

Question 12

What disease should be considered in setting of bilateral trigeminal neuralgia?

Answer 12

Multiple sclerosis in a young woman

Question 13

Other than facial droop what other problems affect patients with a CN 7 lesion?

Answer 13

Can’t close their eyes, also Hyperacusis (quiet noises sound extremely loud) 2/2 stapedius paralysis in Bell palsy.

Question 14

What disease in children causes injury to CN 8?

Answer 14

Meningitis

Question 15

What is the most common cause of injury to CN 8 in adults?

Answer 15

Toxin or medication (e.g. aspirin, amino glycosides, loop diuretics, cisplatin), infection (labyrinthitis), tumor or stroke

Question 16

Neurological signs associated with Vitamin E deficiency?

Answer 16

SIMILAR to Vit B12 deficiency BUT w/o macrocytic anemia; instead, HEMOLYTIC anemia, acanthocytosis, muscle weakness [p/w: areflexia], Posterior column demyelination [p/w: loss of proprioception/vibratory sensation] and spinocerebellar tract demyelination [p/w: ataxia, gaze palsy]. THINK patient with Cystic Fibrosis, FADE deficiency!

Question 17

Neurological signs associated with Vitamin A toxicity?

Answer 17

Papilledema, Pseudotumor cerebri

Question 18

Neurological signs associated with Vitamin A deficiency?

Answer 18

Alopecia, dry skin, Night time blindness

Question 19

Classic CT finding for Huntington disease?

Answer 19

Atrophy of caudate nuclei

Question 20

Signs and symptoms of Huntington disease?

Answer 20

Choreiform movements (irregular, spasmodic, involuntary movements of limbs or facial muscles), progressive intellectual deterioration, dementia or psychiatric disturbances.

Question 21

Tx for Anti-psychotic induced Parkinsonian symptoms?

Answer 21

Anticholinergics (Benztropine, Trihexyphenidyl) or Antihistamines (Diphenhydramine)

Question 22

Athetosis?

Answer 22

“Snake-like movement” or slow writhing movements seen in fingers.

Question 23

Brain lesion location associated with athetosis?

Answer 23

Basal ganglia

Question 24

Brain lesion location associated with chorea?

Answer 24

Basal ganglia, specifically atrophy of caudate nuclei

Question 25

Brain lesion location associated with resting tremor?

Answer 25

Basal ganglia

Question 26

Brain lesion location associated with intention tremor?

Answer 26

Cerebellar dysfunction

Question 27

Brain lesion location associated with hemiballismus?

Answer 27

Contralateral subthalamic nucleus

Question 28

Common features of Friedreich ataxia.

Answer 28

VERY SIMILAR TO SCD [Chronic VitB12 def] but Starts young, AR, peripheral neuropathy [p/w: muscle weakness, loss of DTRs], posterior column degeneration [p/w: loss of vibration/position sense], spinocerebellar tract degeneration [p/w: staggering gait, falls, nystagmus, dysarthria], cardiomyopathy, pes cavus, hammer toes

Question 29

Common features of Ataxia-Telangiectasia.

Answer 29

Progressive cerebellar atrophy [p/w: ataxia], spider angiomas [p/w: oculo-cutaneous telangiectasias], immune deficiency of IgA [p/w: frequent sino-respiratory infections]

Question 30

Two causes of “floppy (flaccid) baby.”

Answer 30

Werdnig-Hoffman disease (WHD) and Infant botulism

Question 31

Werdnig-Hoffman disease (WHD)?

Answer 31

AR degeneration of anterior motor horns in spinal cord and brainstem (LMN disease), where babies are hypotonic at birth with tongue fasciculations.

Question 32

Classic sxs of Lead intoxication.

Answer 32

Blue gingival lines, erythrocyte basophilic stippling, abdominal colic, HA, memory loss, WRIST/FOOT DROPS 2/2 to peripheral neuropathy.

Question 33

Tensilon test.

Answer 33

Used to diagnose Myasthenia gravis. Tensilon is edrophonium, a short-acting anticholinesterase inhibitor.

Question 34

What major muscle group is spared in Eaton-Lambert syndrome vs. Myasthenia gravis?

Answer 34

Extraocular muscles are spared in Eaton-Lambert syndrome. It attacks proximal muscles t/f pt present with inability to: “get things from high shelfs or comb their hair or get out of the chair.”

Question 35

Features of organophosphate poisoning.

Answer 35

Miosis, Excessive bronchial secretions, urinary urgency, diarrhea, Dry. Tx w/ atropine and pralidoxime.

Question 36

Most common type of muscular dystrophy and how it is inherited.

Answer 36

Duchenne muscular dystrophy, X-R, characterized by muscle weakness around age 3-7, elevated creatine phosphokinase, pseudohypertrophy of calves, Gower sign, low IQ

Question 37

How to manage increased intracranial pressure?

Answer 37

1) intubate in reverse Trendelenberg position
2) hyperventilate (decrease CO2 [potent cerebral vasodilator] t/f increase cerebral vasoconstriction to decrease intracranial blood volume to decrease pressure)
3) Mannitol for longterm tx, decreases cerebral edema
4) DO NOT initially tx HTN in pt w/ elevated ICP b/c (CPP = BP - ICP) decreasing BP decreases CPP so HTN in this situation is actually the body’s way of trying to increase cerebral perfusion.

Question 38

Meningocele.

Answer 38

Protrusion of meninges outside the spinal canal.

Question 39

Myelomeningocele

Answer 39

Protrusion of meninges + CNS tissue outside the spinal canal.

Question 40

CSF of Multiple Sclerosis pt contains..

Answer 40

Oligoclonal/IgG bands + myelin basic protein

Question 41

CSF of TB and Fungal meningitis..

Answer 41

Low glucose (100)

Question 42

Phenytoin tx in Pregnant patient

Answer 42

Phenytoin is teratogenic, taper pt off of drug

Question 43

Trihexylphenidyl

Answer 43

Anticholinergic tx for Parkinsonism

Question 44

Myotonic dystrophy, features…

Answer 44

AD 2/2 CTG trinucleotide repeat expansion, presents at ages 20-30 with: Myotonia (inability to relax muscles), MR, Frontal baldness, Testicular/ovarian atrophy, Arrhythmia