Secrets - Neuro Chapter Flashcards
Locate site of brain injury responsible for memory impairment, hyperaggression, hypersexuality, hyperorality.
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.
Locate site of brain injury responsible for inability to read, write, name, or do math.
Dominent parietal lobes
Locate site of brain injury responsible for ignoring one side of the body, trouble with dressing.
Non-dominent parietal lobes
Locate site of brain injury that would affect CN 3 and 4.
Midbrain
Locate site of brain injury that would affect CN 5, 6, 7, 8.
Pons
Locate site of brain injury that would affect CN 9, 10, 11, 12
Medulla
What is pseudodementia?
Depression in older adults that causes some clinical sxs and signs of dementia BUT is reversible with tx
Brudzinski sign?
Severe neck stiffness seen in Meningitis causes patient’s hip and knees to flex when neck is flexed.
Kernig sign?
Severe stiffness of the hamstrings seen in Meningitis causes an inability to straighten the leg when the hip is flexed to 90 degrees.
Defects along Meyer’s loop (along temporal lobe) cause what visual field deficit?
“Pie in the sky” or upper quadrant anopsia 2/2 optic radiation injury in temporal lobe
Lesions along optic radiations in the parietal lobe cause what visual field deficit?
Lower quadrant anopsia
What disease should be considered in setting of bilateral trigeminal neuralgia?
Multiple sclerosis in a young woman
Other than facial droop what other problems affect patients with a CN 7 lesion?
Can’t close their eyes, also Hyperacusis (quiet noises sound extremely loud) 2/2 stapedius paralysis in Bell palsy.
What disease in children causes injury to CN 8?
Meningitis
What is the most common cause of injury to CN 8 in adults?
Toxin or medication (e.g. aspirin, amino glycosides, loop diuretics, cisplatin), infection (labyrinthitis), tumor or stroke
Neurological signs associated with Vitamin E deficiency?
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!
Neurological signs associated with Vitamin A toxicity?
Papilledema, Pseudotumor cerebri
Neurological signs associated with Vitamin A deficiency?
Alopecia, dry skin, Night time blindness
Classic CT finding for Huntington disease?
Atrophy of caudate nuclei
Signs and symptoms of Huntington disease?
Choreiform movements (irregular, spasmodic, involuntary movements of limbs or facial muscles), progressive intellectual deterioration, dementia or psychiatric disturbances.
Tx for Anti-psychotic induced Parkinsonian symptoms?
Anticholinergics (Benztropine, Trihexyphenidyl) or Antihistamines (Diphenhydramine)
Athetosis?
“Snake-like movement” or slow writhing movements seen in fingers.
Brain lesion location associated with athetosis?
Basal ganglia
Brain lesion location associated with chorea?
Basal ganglia, specifically atrophy of caudate nuclei
Brain lesion location associated with resting tremor?
Basal ganglia
Brain lesion location associated with intention tremor?
Cerebellar dysfunction
Brain lesion location associated with hemiballismus?
Contralateral subthalamic nucleus
Common features of Friedreich ataxia.
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
Common features of Ataxia-Telangiectasia.
Progressive cerebellar atrophy [p/w: ataxia], spider angiomas [p/w: oculo-cutaneous telangiectasias], immune deficiency of IgA [p/w: frequent sino-respiratory infections]
Two causes of “floppy (flaccid) baby.”
Werdnig-Hoffman disease (WHD) and Infant botulism
Werdnig-Hoffman disease (WHD)?
AR degeneration of anterior motor horns in spinal cord and brainstem (LMN disease), where babies are hypotonic at birth with tongue fasciculations.
Classic sxs of Lead intoxication.
Blue gingival lines, erythrocyte basophilic stippling, abdominal colic, HA, memory loss, WRIST/FOOT DROPS 2/2 to peripheral neuropathy.
Tensilon test.
Used to diagnose Myasthenia gravis. Tensilon is edrophonium, a short-acting anticholinesterase inhibitor.
What major muscle group is spared in Eaton-Lambert syndrome vs. Myasthenia gravis?
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.”
Features of organophosphate poisoning.
Miosis, Excessive bronchial secretions, urinary urgency, diarrhea, Dry. Tx w/ atropine and pralidoxime.
Most common type of muscular dystrophy and how it is inherited.
Duchenne muscular dystrophy, X-R, characterized by muscle weakness around age 3-7, elevated creatine phosphokinase, pseudohypertrophy of calves, Gower sign, low IQ
How to manage increased intracranial pressure?
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.
Meningocele.
Protrusion of meninges outside the spinal canal.
Myelomeningocele
Protrusion of meninges + CNS tissue outside the spinal canal.
CSF of Multiple Sclerosis pt contains..
Oligoclonal/IgG bands + myelin basic protein
CSF of TB and Fungal meningitis..
Low glucose (100)
Phenytoin tx in Pregnant patient
Phenytoin is teratogenic, taper pt off of drug
Trihexylphenidyl
Anticholinergic tx for Parkinsonism
Myotonic dystrophy, features…
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
