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**Neurology Case Files > Wahba Notes > Flashcards

Wahba Notes Flashcards

1
Q

How much do I want to study?

A

-10000000%

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2
Q

Differential dx unilateral foot drop?

A

Common peroneal n neuropathy
L5 radiculopathy
Lumbosacral plexopathy
Sciatic n lateral trunk

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3
Q

Differential chronic bilateral foot drop?

A

Hereditary peripheral neuropathy AKA myotonia atrophica, CMT

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4
Q

CMT1 vs. CMT2

A

1: slowly progressive, high arches, absent DTRs, palpable nerves, demyelinating problem
2: onset later, preserved velocity, axonal problem

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5
Q

Ankle inversion
Intact toe and plantarflexion
Intact ankle jerk

A

Peroneal mononeuropathy

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6
Q

Is ankle jerk preserved in L5 radiculopathy?

A

Usually not

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7
Q

Sciatic nerve roots

A

L4-S3

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8
Q

Common peroneal nerve roots made up

A

L5-S3

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9
Q

Course of common peroneal nerve

A

W tibial division in thigh, where it innervates short head biceps femoris and does sensation lateral knee; separates in popliteal fossa and goes around fibular head, thru fibular tunnel (fibrous arch + aponeurosis of soleus), then divides into superficial and deep peroneal

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10
Q

Compression of common peroneal at fibular head

A

Loss of dorsiflexion and eversion = dominant inversion

Loss of sensation at anterolateral leg and dorsum of foot

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11
Q

What muscles does deep peroneal innervate?

A

PEET is DEEP! Peroneus tertius, Extensor digitorum longus/brevis, Extensor hallucis longus, Tibialis anterior

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12
Q

Where is the deep peroneal nerve usually entrapped?

A

@ anterior tarsal tunnel

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13
Q

Deep peroneal nerve entrapment presentation

A

Weak toe dorsiflexion
First web space sensory loss
Intact eversion!

AKA foot only no eversion/inversion

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14
Q

What does superficial peroneal innervate?

A

PB. Peroneus longus and brevis

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15
Q

What does superficial peroneal sensate?

A

Dorsolateral foot and leg

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16
Q

Where does superficial peroneal become entrapped?

A

At fascial exit on anterolateral leg

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17
Q

Superficial peroneal entrapment presentation

A

Weak eversion
Sensory loss anterolateral plus dorsum foot
Intact dorsiflexion

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18
Q

L5 root entrapment sensory loss?

A

BIG TOE

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19
Q

Review: sensory loss common peroneal

A

Lateral knee, leg, foot, btw digits 1-2

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20
Q

Review: superficial peroneal sensory loss

A

lateral leg and foot, NOT knee and NOT toes

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21
Q

Lumbosacral cord - roots?

A

L4 and L5

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22
Q

Where do herniated discs actually impinge on the root?

A

Intervertebral foramina

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23
Q

Weak muscle in sciatica

A

Extensor hallucis longus

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24
Q

What does the straight leg raise test do?

A

Passive traction of lumbosacral roots

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25
Q

S1 root impingement pres

A

Weak gastroc/soleus plus absent AJ

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26
Q

L5 entrapment pres

A 
Big toe sensory loss
Weak dorsiflexion
Weak inversion
Intact plantarflexion and AJ
Medial foot sensory loss
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27
Q

AJ root

A

S1! So L5 radic has ok AJ

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28
Q

The butt muscles are innervated by

A

L5-S1 (medius and maximus)

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29
Q

Tensor fascia lata innervated by root:

A

L5

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30
Q

Recent postpartum mom can’t move legs but no epidural?

A

Retroperitoneal hematoma of lumbosacral plexus

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31
Q

Tight casts can cause _ entrapment

A

Common peroneal

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32
Q

What 5 muscles are innervated by tibial nerve from L5 (NOT cmmon peroneal?)

A 
Paraspinals
gluteus medius
TFL
flexor digitorum longus
tibialis posterior
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33
Q

MRI can miss this on disc herniation

A

very lateral - need CT myelogram

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34
Q

Why get EMG if can dx foot drop w MRI?

A
  1. Asymptomatic discs
  2. Miss lateral
  3. Don’t fit in MRI
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35
Q

what does a slow SNAP across the fibular head indicate?

A

Common peroneal head entrapment

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36
Q

Normal SNAP =

A

ROOT only

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37
Q

SNAP gone lesion location =

A

PLEXUS or PERIPHERAL n.

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38
Q

CIDP LP

A

high protein normal cell count

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39
Q

CIDP nerve conduction study

A

demyelination

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40
Q

CIDP sensory loss pattern

A

stocking glove (vibration sense loss)

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41
Q

CIDP progression

A

Stepwise w/ plateaus

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42
Q

Essential CDIP muscle to be weak

A

Proximal hip flexor weakness

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43
Q

What is F wave delay?

A

Average of several responses taken as reliable nerve subpopulation to anterior horn cells and moves back down w/o synapsing….????

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44
Q

Underlying diagnosis w/ CIPD?

A

CTD, CMV, Hodgkin’s, hepatitis, HIV, IBS, Lyme, MS, raduloplexopathy

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45
Q

What is the first test to do after diagnosing CIPD?

A

Heme issues - M protein spike

46
Q

What do you look for on EMG for Lambert-Eaton?

A

CMAP - compound muscle action potential - low usually and is marker for disease severity

47
Q

Treatment of E-L syndrome

A

Guanidine hydrochloride - inhibits mito Ca uptake

48
Q

What roots does cauda equina affect?

A

Below T10

49
Q

S/S of cauda equina

A

ASYMMETRIC LMN signs and sensory loss inc absent AJ, urine probs, dec anal tone

50
Q

Myelopathy LP

A

Lymphocytes increased

51
Q

DDX myelopathy

A

Vascular, infection, tumor, abscess, autoimmune, structural

52
Q

S/S transverse myelitis

A

All sensory and motor lost below lesion - often from virus > bacteria

53
Q

Brown-Sequard syndrome pres

A

Ipsi UMN and loss of tactile/vibration; CL pain and temp loss; flaccid paralysis at level of lesion; +Horner’s if above T1

54
Q

These viruses cause exclusively LMN disease

A

WNV, enterovirus, poliovirus

55
Q

Common acute polio s/s

A

Bladder dysfunction, assymetric leg weakness

56
Q

What is Froin syndrome?

A

Spinal block from high (low?) protein and cord swelling

57
Q

Poliovirus CSF

A

Mild-mod lymphos plus high protein and normal/mild glucose

58
Q

CMV treatment

A

ganciclovir

59
Q

Timeline do mechanical embolectomy in stroke?

A

Up to 8 h anterior circulation or beyond 8 hrs for basilar artery stroke even

60
Q

After 8 hours stroke therapy

A

ASA only

61
Q

When to do IV vs. IA tPA?

A

> 4.5 hours = do arterial

62
Q

tPA inclusion criteria

A

> 18 y/o, stroke is dx, h/o TIA, CT done,

63
Q

Exclusion criteria tPA

A

Score 185/110, GI bleed last 3 weeks, heparin last 48h, INR 400, coma, suspected SAH, arterial puncture recently w bleed

64
Q

Always give tPA if:

A

Aphasia or hemianopia

65
Q

Avoid this drug in status epi

A

flumazenil

66
Q

Order of drug therapy in status epi

A

Ativan stat, then fosphenytoin, then more Ativan at 10 minutes, then phenobarbital or midazolam or propofol; simultaneous glucose + thiamine and Keppra or Depakote load

67
Q

Depakote CI when

A

bleed in brain

68
Q

S/S of epidural hematoma

A

Contralateral hemiparesis
Dilated ->nonresp pupil ipsi
CN3 compression

69
Q

Posterior fossa hematoma s/s

A

Cerebellar signs, nuchal rigidity, drowsiness

70
Q

Suspect posterior fossa hematoma next step

A

INTUBATE don’t wait for cerebral dehydration

71
Q

Subdural mechanism

A

Stretching of veins, usually lateral cerebral convexities

72
Q

Subdural common in these populations

A

Elderly/alcoholic/cerebral atrophy

73
Q

What is Tolosa-Hunt sydrome?

A

Granulomatous cavernous sinus infection that looks like thrombosis early - do steroids

74
Q

Compressive vs. noncompressive CN III

A

Noncompressive DM2: reactive pupil bc interior fascicles, vs. nonreactive in compressive which is noncompressive

75
Q

Multifocal motor neuropathy with conduction block?

A

Asymmetric predominantly motor neuropathy in middle age males usually very benign

76
Q

Most common locations of brain aneurysms?

A

PCOM and ACOM

77
Q

Studies to order if new-onset CIDP?

A

Nerve conduction, muscle, LP, MRI, paraneoplastic studies, serum IF and protein electrophoresis

78
Q

Best tx for hIv-induced CIDP?

A

IV Ig

79
Q

GBS/Miller Fischer suspected - workup

A

get MRA to r/o basilar artery thrombosis and always admit to ICU

80
Q

What are the 5 Parkinson-plus synucleinopathies?

A

Lewy body dementia, corticobasal degeneration, striatal nigral, MSA, PSP

81
Q

What are the classic symptoms of PSP?

A

Ocular + Cerebellar + EPS

82
Q

Alien hand syndrome common in:

A

Corticobasal degeneration

83
Q

Some drugs that cause status epi

A

Flumazenil, theophylline, INH, vigabatran

84
Q

Empiric tx of meningitis

A

ACV + rocephin + Vanc + Ampicillin

85
Q

Tx acute dystonia

A

Benadryl plus benztropine

86
Q

Anti-HAM s/s

A

WARP: wt gain, inc liver enzymes, rash, photosensitivity

87
Q

Tx of serotonin syndrome

A

Cyproheptadine (periactin)

88
Q

How is the pupil in MG?

A

SPARED!

89
Q

What are all the weird antibodies for MG?

A

MuSK, muscle protein titin, ryanodine in pts with thymoma

90
Q

EMG to do for MG?

A

Single-fiber EMG bc checks time btween transmission in synapse. Will show low variability

91
Q

Intubate MG crisis if FVC

A

1.2 L

92
Q

Treatment of intubated MG patient

A

Beta agonist to minimize bronchospasm, Atropine to minimize secretions

93
Q

Findings in optic neuritis

A

Pain around one eye, loss of color vision, blurry vision; exam shows swollen disc

94
Q

High ICP vs. bilateral ON

A

No field defect in papilledema

95
Q

Ddx APD

A

MS, NMO, Lyme, CTD, B12, sarcoid, syphilis

96
Q

Acute MS tx

A

IV steroids, NOT oral

97
Q

Cavernous sinus thrombosis affects these nerves

A

3, 4, 5i and 5ii, 6

98
Q

Two etiologies of noncompressive CN3

A

Diurnal variation MG and diabetes

99
Q

Where is giant cell arteritis

A

Branches of external carotid, esp the STA

100
Q

Thyroid stuff

A

Hyperthyroidism is a definite risk factor for stroke

Think of hyperthyroidism with a fib in young person with embolic stroke

101
Q

Hyperthyroidism is a/w these neuro things

A

MG

Pseudotumor cerebrii

102
Q

Signs of superior sagittal sinus thrombosis

A

Seizure, papilledema, suspect w postpartum and severe HA

103
Q

Who is hypercoagulable and gets superior sagittal sinus thrombosis

A

Pregnancy, cancer and cancer meds, sickle cell

104
Q

Lateral sinus thrombosis, usually from?

A

Infection in mastoid-inner ear or clot

105
Q

CPA tumors affect these nerves

A

5 7 8

106
Q

Weber lateralizes to:

A

the healthy ear

107
Q

EEG in HSV encephalitis

A

triphasic waves (slowing)

108
Q

Work-up of HSV encephalitis

A

ABCs, then CT w/o to r/o stroke, start antibiotics, do MRI look for temporal activity, then get EEG, do not use steroids

109
Q

Triad of Miller-Fischer

A

Ataxia, ophthalmoplegia, areflexia

110
Q

Antibodies in miller fisher

A

antiganglioside (GQ1b)

111
Q

Tumor often in 4th ventricle in young people

A

ependymoma

**Neurology Case Files (2 decks)

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