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Tarascon Flashcards

1
Q

Anton syndrome

A

Bilateral occipital lobe strokes

Bilateral PCA or top of the basilar syndrome

Visual deficit without recognition of blindness (visual agnosia)

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2
Q

Balint syndrome

A

Bilateral PCA (parietal-occipital)

Loss of voluntary but not reflexive eye movements

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3
Q

Claude’s syndrome

A

Dorsal midbrain syndrome

Ipsilateral CNIII palsy with contralateral ataxia

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4
Q

Dejerine syndrome

A

Medial medullary syndrome

Basilar artery, vertebral artery, anterior spinal artery

CL spastic weakness that spares face (pyramidal tracts), loss of vibration/position sense (medial lemniscus), ipsilateral tongue weakness (CN XII nucleus)

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5
Q

Dejerine-Roussy syndrome

A

PCA thalamic perforators

Hemisensory loss

Hemibody pain

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6
Q

Foville’s syndrome

A

Inferior medial pontine syndrome

Basilar artery perforators

CL weakness (corticospinal), facial weakness (CN VII nucleus), lateral gaze deficit (CV VI nucleus), decreased sensation/vibration sense (medial lemniscus)

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7
Q

Gerstmann syndrome

A

Dominant parietal lobe (MCA)

Agraphia
Acalculia
L-R confusion
Finger agnosia
Ideomotor apraxia
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8
Q

Locked in syndrome

A

Basilar artery

Paralysis of all movement except vertical gaze and eyelid opening (supranuclear ocular motor pathway preserved)

Sensation and consciousness preserved (reticular formation spared)

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9
Q

Marie-Foix syndrome

A

Lateral inferior pontine syndrome

AICA occlusion

Ipsilateral ataxia (cerebellar tract), nausea, vertigo, decreased hearing (vestibular nucleus), CL hemiparesis (corticospinal tract), ipsilateral facial weakness (facial nucleus), ipsilateral loss of facial sensation (spinal trigeminal nucleus), CL hemihypesthesias (spinothalamic tract)

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10
Q

Millard-Gubler syndrome

A

Ventral pontine syndrome

Basilar artery perforators

Base of pons syndrome

CL weakness (corticospinal tract), diplopia, strabismus, loss of extroversion (CN VI), ipsilateral facial weakness ( CN VII)

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11
Q

Raymond syndrome

A

Ventral pontine syndrome

Perforators of basilar artery

Lateral gaze deficits (CN VI), weakness (pyramidal tract)

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12
Q

Top of the basilar syndrome

A

Sudden onset of AMS, ophthalmoplegia, papillary, and visual field deficit (homonymous hemianopsia)

Generally embolic or post-angio stent complications

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13
Q

Function of angular gyrus

A

Involved in visual function and in the dominant hemisphere (usually the left), functions in language, specifically comprehension of writing

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14
Q

Signs/symptoms of conductive aphasia

A

Difficulties with repetition

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15
Q

Lesion producing semantic aphasia

A

Atrophy of the anterior temporal lobe

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16
Q

Signs and symptoms of semantic aphasia

A

No knowledge of word meaning, semantic paraphasias, no memory deficits, prosopagnosia, alexia, later may develop behavioral changes

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17
Q

Definition of prosopagnosia

A

Inability to recognize familar faces

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18
Q

Definition of anomia

A

Inability to name an object when presented

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19
Q

Definition of alexia

A

Inability to read

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20
Q

Definition of agnosia

A

Inability to recognize and identify objects or persons

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21
Q

Definition of agraphia

A

Inability to compose written language

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22
Q

Foster Kennedy syndrome signs/symptoms

A

Ipsilateral anosmia, ipsilateral scotoma with optic atrophy, contralateral papilledema

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23
Q

Location and function of super nuclear gaze center

A

Located in the frontal lobe and initiates saccadic eye movement to the contralateral side

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24
Q

Lesion of the super nuclear gaze center produces…

A

Deviation to the affected side

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25
Q

Function of the pontine gaze center

A

Directs eye movement to the ipsilateral side

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26
Q

Lesion of pontine gaze center produces…

A

Eye deviation to the contralateral side

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27
Q

Lesion of the MLF produces..

A

Loss of adduction of the ipsilateral eye, and nystagmus of the contralateral eye on abduction

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28
Q

Gradenigo syndrome

A

Otalgia (ophthalmic branch of trigeminal nerve), ipsilateral paralysis of abducens nerve, otitis media/mastoiditis (involving apex of petrous temporal bone)

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29
Q

Tolosa-Hunt syndrome

A

Granuloma of superior orbital fissure required for dx

Painful, unilateral ophthalmoplegia, pupil sparring

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30
Q

Foix syndrome

A

Syndrome of superior orbital fissure

Ophthalmoplegia, corneal anesthesia, proptosis, pupillary dilation

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31
Q

Tonic (Adie’s pupil)

A

Postganglionic parasympathetic interruption (ciliary ganglion)

Loss of direct or consensual light reflex, light-near dissociation

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32
Q

Marcus-Gunn pupil

A

Afferent pupillary defect

Consensual reflex stronger than direct

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33
Q

Auditory agnosia: lesion and definition

A

Right temporal lobe lesion

Inability to interpret sounds

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34
Q

Amusia: lesion and definition

A

Right temporal lobe lesion

Inability to interpret music

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35
Q

Significance of lipid/lactate in MR spec

A

Inflammation, necrosis, anaerobic glycolysis

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36
Q

Significance of NAA in MR spec

A

Neuronal viability

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37
Q

Significance of creatine in MR spec

A

Energy metabolism, useful reference peak as generally stable

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38
Q

Significance of glutamine/glumatate in MR spec

A

Neuronal damage (astrocytes), neurotransmitters

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39
Q

Significance of choline in MR spec

A

Membrane turnover (phospholipid synthesis)

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40
Q

Neurogenic shock

A

Hypotension secondary to interruption of sympathetics (loss of vascular tone), bradycardia from unopposed parasympathetics, relative hypovolemia due to venous pooling from decreased muscle tone, and hypothermia

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41
Q

Treatment of hypotension in neurogenic shock

A

Dopamine ggt (epi can exacerbate bradycardia)

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42
Q

Spinal shock

A

Transient flaccid paralysis and areflexia after acute spinal cord injury, which transitions into spasticity in 1-2 weeks

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43
Q

Watershed area of the spine

A

Mid-thoracic

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44
Q

Anterior spinal artery syndrome

A

Flaccid transitioning to spastic paralysis, hyperreflexia, loss of pain and temperature, intact vibratory and proprioception (posterior column function preserved)

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45
Q

Atlanto-dental interval (ADI)

A

Distance on lateral XR between back of C1 anterior tubercle (atlas) to the anterior aspect of the odontoid

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46
Q

Normal ADI

A

Adult is up to 3 mm, in children is up to 5 mm

47
Q

Chamberlain’s line

A

Posterior aspect of hard palate to posterior edge of foramen magnum (opisthion)

If the dens > 6 mm above this line, consistent with vertical translocation

48
Q

McGregor’s line

A

Dorsal edge of the hard palate to the caudal occiput

If dens > 4.5 mm, consistent with invagination

49
Q

McRae’s line

A

Opening of the foramen magnum

Tip of dens should not be above this line

50
Q

Power’s ratio

A

Ratio of BC (distance from the basion to the midcervical portion of the posterior laminar line of the atlas) over OA (opisthion to midcervical portion of posterior surface of anterior ring of atlas)

Anterior subluxation present if ratio > 1

51
Q

Rule of Spence

A

On odontoid view XR, if sum of C1 lateral mass overhang on C2 is 7 mm, then this suggests transverse ligament instability

52
Q

Facet orientation in cervical spine

A

Posteromedial

53
Q

Facet orientation in upper thoracic spine

A

Coronal (resistance to anterior translation but not rotation)

54
Q

Facet orientation in lower thoracic spine

A

Sagittal (less resistance to anterior translation)

55
Q

Definition of teardrop fracture

A

Flexion-compression injury

Vertebral body with > 50% original height

Injury to PLL

Unstable

56
Q

Definition of wedge fracture

A

Fracture of the anterior column

Stable if

57
Q

Definition of clay-shovelers fracture

A

C7 spinous process fracture

58
Q

Definition of burst fracture

A

Fracture of the anterior and middle columns from axial compression injury

59
Q

Definition of Chance fracture

A

A flexion-distraction fracture through all 3 columns (including disruption of PLL, shearing of pedicle/vertebral body)

60
Q

Definition of Schmorl’s nodes

A

Herniation of the nucleus pulposus into the end plate

Associated with endplate fracture

61
Q

Definition of AA impaction (basilar invagination)

A

Subluxation of the dens through the foramen magnum leading to brainstem compression

62
Q

Symptoms of basilar invagination

A

Myelopathy, HA, nystagmus, cranial neuropathies

63
Q

Definition of lateral recess syndrome

A

Compression of nerve root in lateral recess between hypertrophied superior articular facet, pedicle, and inferior vertebral body

64
Q

Extradural spinal tumors that are metastatic and destructive

A

Lymphoma, lung, breast, prostate

65
Q

Extradural spinal tumors that are metastatic and osteoblastic

A

Prostate, breast

66
Q

Characteristics of eosinophilic granulomas

A

Lytic lesion without surrounding sclerosis

Classic cause of single collapsed vertebral body in pediatric patients, if no evidence of trauma

Hyperintense on T2, enhances with contrast

67
Q

Type 1 spinal AVM

A

Dural AV fistula

Extramedullary, no nidus, low flow, simple dorsal venous drainage, lower thoracic/conus

Presents with progressive neurologic deficits, secondary to venous congestion

68
Q

Type 2 spinal AVM

A

Glomus

Intramedullary, may present with hemorrhage, high flow, cervicothoracic junction

69
Q

Type 3 spinal AVM

A

Juvenile

Intra- and extradural but with intramedullary nidus, high flow, cervical/upper thoracic

Marked propensity to bleed, multiple feeders over multiple segments, present with progressive neurological deficit

70
Q

Type 4 spinal AVM

A

Perimedullary dural AV fistula with extramedullary nidus

71
Q

Foix-Alajouanine syndrome

A

Thrombosis of spinal cord AVM

Necrosis of gray>white matter

Presents with subacute myelopathy

72
Q

Definition of transverse myelitis

A

Sudden onset of autoimmune demyelination or inflammation across one spinal cord segment

73
Q

Etiology of transverse myelitis

A

Lupus, postinfectious viral or bacterial, vaccinations, Bechet’s syndrome, MS

74
Q

Presentation of transverse myelitis

A

Sensory level, weakness, pain, paralysis, urinary incontinence

75
Q

Treatment of transverse myelitis

76
Q

Klippel-Feil syndrome

A

Congenital fusion of two or more cervical vertebrae (usually involves C2-3)

77
Q

Common location for mycotic aneurysms

A

MCA distribution

78
Q

More common location for fusiform aneurysms

A

Vertebrobasilar system

79
Q

Possible localizing signs for ACOM aneurysms

A

BLE weakness, numbness

80
Q

Possible localizing signs for MCA bifurcation aneurysms

A

Contralateral weakness, aphasia (left), or hemi-neglect (right)

81
Q

Possible localizing sings for basilar tip aneurysms

A

Vertical ophthalmoplegia

82
Q

Possible localizing signs for vertebral-PICA junction aneurysms

A

Wallenberg’s, vertigo, Horner’s, sensory deficits

83
Q

Possible localizing signs for ICA-PCOM junction aneurysms

A

Ipsilateral CN III palsy (pupil involving)

84
Q

Signs/symptoms of venous sinus thrombosis

A

HA, nausea, vomiting, seizures, hemiparesis, CN dysfunction, papilledema, blurred vision, AMS

85
Q

Diagnosis of venous sinus thrombosis

A

CT (“delta sign” looking at sagittal sinus)

86
Q

Treatment of venous sinus thrombosis

A

Heparin anticoagulation, +- thrombolytics, AVOID steroids, control BP, monitor ICP

87
Q

Cavernous hemangioma (AKA cavernous malformation, cavernoma)

A

Low flow, low pressure vascular malformations

88
Q

Presentation of cavernomas

A

Seizures (60%), progressive neuro deficit (50%), and hemorrhage (20%), or hydrocephalus

89
Q

Location of cavernomas

A

Mostly supratentorial

90
Q

Radiographic characteristics of cavernomas

A 
Flow voids on MRI
GRE is most sensitive for hemorrhage
Well circumscribed
Enhances with contrast
T2 may have a dark rim from hemosiderin deposition
91
Q

Pathology of cavernomas

A

Irregular vasculature with no intervening brain

“popcorn or mulberry” apperance

92
Q

Pathophysiology of moyamoya

A

Progressive occlusion of one or both supraclinoid ICAs, M1s, A1s, (and rarely P1 PCAs) resulting in a “puff of smoke” appearance of dilated capillary lenticulostriate collateral vessels

93
Q

Presentation of amyloid angiopathy

A

Presents as lobar intraparenchymal hemorrhage

94
Q

Common location for intraparenchymal hemorrhages in amyloid angiopathy

A

Frontoparietal, corticomedullary junction

95
Q

Pathology of amyloid angiopathy

A

Deposition of beta amyloid in the media and adventitia of small and mid-sized arteries

96
Q

Osler-Weber-Rendu disease

A

AVMs of lung, liver, brain, and spine

97
Q

Symptoms/signs of Osler-Weber-Rendu disease

A

In addition to AVMs, patients develop telangiectasias of skin, mucosa (epistaxis)

98
Q

Wyburn-Mason syndrome

A

Multiple intracranial AVMs along the visual pathways (including optic tract, midbrain), AVMs (including retina), and facial cutaneous vascular nevi

99
Q

Signs/symptoms of Wyburn-Mason syndrome

A

Optic nerve atrophy, seizures, strokes, SAH

100
Q

Blue rubber bleb nevus syndrome

A

Vascular malformations of skin, GI tract, CNS (hemangiomas, venous angiomas, sinus pericrani)

101
Q

Signs/symptoms of blue rubber bleb nevus syndrome

A

Anemia from GI bleeds, nevi on arms/trunk, palms, fractures (from bone hemangiomas)

102
Q

Definition of Wallerian degeneration

A

Process of axonal degeneration distal to the site of injury or transection; occurs in both the CNS and PNS

103
Q

Findings of Sunderland nerve injury grade 1 (neuropraxia)

A

Localized myelin damage (compression)

104
Q

Findings of Sunderland nerve injury grade 2 (axonotmesis)

A

Loss of axonal continuity; endo-, peri-, and epineurium intact

105
Q

Findings of Sunderland nerve injury grade 3

A

Axonal and endoneurial continuity lost

106
Q

Findings of Sunderland nerve injury grade 4

A

Axonal, endoneurial, perineurial continuity lost

107
Q

Findings of Sunderland nerve injury grade 5 (neurotmesis)

A

Complete nerve lesion

108
Q

Symptoms of occipital neuralgia

A

HA involving the posterior occiput in the greater or lesser occipital nerve distribution

109
Q

Contents of carpal tunnel

A

Flexor digitorum superficialis and profundus tendons, flexor pollicis longus tendon, and the median nerve

110
Q

Location of ligament of Struthers and what nerve does it compress?

A

Located between the distal humerus and medial epicondyle

Entrapment of the median nerve here leads to distal median nerve symptoms plus decreased pronation, wrist/digit flexion, thumb flexion, abduction, and opposition

111
Q

Wartenburg’s sign seen in ulnar nerve entrapment

A

5th finger has position of abduction secondary to unopposed ulnar insertion of extensor digiti quinti

112
Q

Duchenne’s sign seen in ulnar nerve entrapment

A

Clawing of medial 2 digits

113
Q

Froment’s sign seen in ulnar nerve entrapment

A

On attempt to adduct the joint, will flex the finger

114
Q

Classic triad of symptoms in Parkinson’s disease

A

Resting tremor (4-8 Hz/second), cogwheel rigitidy, and bradykinesia

NS (25 decks)

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