- Auto-Dom - Café-au-lait spots - optic glioma - neurofibroma - lisch nodules - freckles (axillary, inguinal)

- degenerative changes over the age of 40 - neck pain and stiffness are most common Sx - may develop spinal stenosis --> neurologic deficits

UWorld Flashcards by Mitch Rostad

Absence - post seizure finding

automatisms

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Marfan syndrome vs homocysturia

Both: joint+skin hyperlaxity, tall, pectus deformity
Marfan: aortic root dilitation
Homocysturia: intellectual disability, thrombosis

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TBI pts - most common morbidity

Diffuse axonal damage at gray-white junction

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Myotonic dystrophy vs Duchenne and Becker

MD - Autosomal dominant, testicular atrophy, balding

D/B - X-linked Recessive

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Aminoglycoside toxicity

hearing problems
VOR can elicit vestibular problems from gentamicin
pts can get oscillopsia (see objects moving around vision)

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lacunar stroke

provides blood to deep brain structures (ex: subcortical, lenticulostriae)

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Peripheral nerve compression can have intermittent symptoms

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Pronator drift vs Romberg

Palms up, if pronation occurs =
UMN sign in pyramidal/corticospinal tracts

Romberg: stand with eyes closed, this tests posterior tracks and proprioception

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Absence seizure comorbidities

ADHD, anxiety

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Status epilepticus/continuous brain seizing - Cx

cortical laminar necrosis - due to chronic excitatory toxicity, leads to chronic neurologic deficits and more seizures

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Traumatic carotid injuries (internal carotid)

sports, falls with toothbrush in mouth

- Sx: gradual oneste hemiplegia, aphasia, neck pain, “thunder-clap” headache

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“curtain descending over visual field”

amaurosis fugax - retinal ischemia from atherosclerotic emboli from ipsilateral carotid artery. Get a neck Doppler! (ICA)

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NF 1

Auto-Dom
Café-au-lait spots
optic glioma
neurofibroma
lisch nodules
freckles (axillary, inguinal)

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Multi-infarct dementia
vs
AD

Multi-infarct dementia = abrupt, step-wise deterioration in memory, strokes accumulate. *exec function worse than memory eary

AD = memory worse initially. poor speech = difficulty finding words. cognitive decline. Late findings: Neuropsych, lack of insight, non-cognitive neuro deficits: seizure, clonus

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Most common causes of syringomyelia:

old spinal cord injuries, Arnold Chiari malformations

- symptoms develops months-years after initial injury and onset is gradual (why see hand muscle wasting)

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cervical spondylosis

degenerative changes over the age of 40
neck pain and stiffness are most common Sx
may develop spinal stenosis –> neurologic deficits

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Posterior cord vs
Central cord vs
Anterior cord syndromes

Posterior cord - posterior columns/vibration/proprioception

Central anterior spinal cord - hyper extension injuries in elderly, or prior degeneration of cervical spine… results in corticospinal tracts for upper extremities, lateral spinothalamic tracts (legs would be fine)

Anterior cord - bilateral motor spastic paresis distal to the lesion (anterior spinal artery)

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Trihexyphenydil can cause acute angle-closure glaucoma

bc is an anti-cholinergic

Brain tumors and differentiations:
craniopharyngioma
ependymoma
glioblastoma
medulloblastoma
neuroblastoma
pilocytic astrocytoma

craniopharyngioma - bitemporal hemianopsia
ependymoma - 4th ventricle, supratentorial
glioblastoma - cerebral hemispheres, seizures
medulloblastoma - cerebellar vermis, infratentorial
neuroblastoma - symp ganglion cells, from abd mass
pilocytic astrocytoma - #1 child tumor

anterior vs posterior tumor locations

anterior - seizure, weakness, sensory changes

posterior - cerebellar dysfunction

AD vs Vascular Dementia

AD - early short term memory loss, late personality changes

Vascular Dementia - step wise decline. abrupt decline in exec function. objective neurologic deficits (left hemiparesis, Romberg sign, pronator drift –> may suggest ischemic stroke on top of vascular dementia)

Cerebral Palsy - Risk factors, Sx/Comorbidites

Prenatal brain insults before 32 weeks gestation (most important factor–many things cause insults)
spastic diplegia is commonly seen in toddlers (no leg use, use arms to crawl instead)
Intellectual disability, epilepsy, strabismus, scoliosis

Intraparenchymal hemorrhage -locations, desc order

basal ganglia (putamen)(contralat hemiparesis/sensory loss, gaze preference)
cerebellar nuclei (NO HEMIPARESIS!)
thalamus (contra hemiparesis, eyes deviate towards)
pons (Pinpoint* reactive pupils)
cerebral cortex (Sx depends on location)

-gradual onset Sx (min-hr)

Intraparenchymal hemorrhage vs embolic stroke

Intraparenchymal hemorrhage = will have focal findings that then progress to show increased ICP (vomiting)

Embolic stroke - abrupt and Sx are maximal from the start

neurogenic claudication vs cauda equine vs vascular claudication/PVD

- neurogenic claudication = spinal stensosis, secondary to DJD --> worse Sx by spinal extension, relived by flexion (going uphill) *still painful when standing still* - cauda equine syndrome = saddle anesthesia, ANS sx - vascular claudication/PVD = worsened by walking, relived by standing still

Greatest CVA risk factor

-having HTN (not sedentary lifestyle or Fhx)

DiGeorge Syndrome - mnuemonic + neuro risk

- thymic aplasia (T cell deficiency) - hypocalcemia (no parathyroid development) - tetralogy of Fallot (PROVe) - neuro risk: from recurrent sinusitis -> brain abscess (triad: fever, nocturnal/morning headaches, neurologic findings)

Pseudo dementia and MDD

Evaluation head trauma 2-18 yo

- no CT needed if only minor head trauma without other sx (vomiting) - otherwise, CT non-con

Single vs multiple brain abscesses

``` Single = direct spread (otitis, sinusitis, dental infection) multiple = hematogenous spread (endocarditis, osteomyelitis) ```

Most common single brain lesion species

- virdans streptococci, staph aureus - direct spread (otitis, sinusitis, dental infection) - focal brain lesion: enhancing with central necrosis

Subacute Combined Degeneration

- B12 deficiency Cx - starts with dorsal/posterior tracts --> dec vib/proprio, then gait - Dz progression: cortico-spinal tract degeneration UMNs, spastic paresis, hyperreflexia - Other Cx: peripheral neuropathy, memory loss, dementia

Example of how uncal herniation can occur

MVC -> Epidural hematoma -> uncal herniation -> CN 3 issues/hemiplegia and hemisensory loss

Cushin's Reflex:

1 - HTN 2 - Bradycardia 3 - Respiratory depression

vasovagal/neuro-mediated syncope vs | orthostatic hypotension

vasovagal syncope = prolonged standing, emotional stress, painful stimuli (prodromal Sx: warmth, nausea, diaphoresis) orthostatic syncope = postural changes

MS - CSF

- Nrm opening pressure - Nrm cell count (inc T-cell) - Nrm total protein (IgG elevated) *Albuminocytologic dissociation = in GBS*

Work up for distribution of weakness and numbness

- start with distribution - localize by muscle or reflex - localize further by dermatomal distribution

Viral meningitis CSF -odd finding

protein is <100

Tx for pseduotumor cerebri / IIH

Tx = Acetazolamide (inhibits CSF production via choroid plexus carbonic anhydrase) +/- furosemide (TX IS NOT MANNITOL!)(Mannitol is for severely obtunded pts/those with severe cerebral edema)

Cushing Reflex

HTN, bradycardia, respiratory depression --> concerning for brainstem compression

Intracranial HTN (pseudo tumor cerebri)

- Sx: can be HA, mental status changes, blurred vision - PEx: +/- papilledema - Tx: weight loss / acetazolamide

Wernicke Encephalopathy vs alcohol cerebellar degeneration

- due to Thiamine deficiency-neuronal loss - Sx: gait ataxia, oculomotor dysfunction (horizontal nystagmus), encephalopathy - alcohol cerebellar degeneration: purkinje damage to cerebellar vermis. - Sx: slowly progressive ambulation difficulties (ex: wide-based gait)

GTC pt no severe risk factors w/u algo:

1 - basic blood tests, check urine drug screen (rule out toxic/metabolic 1st) 2 - then, maybe get MRI for seizure