Week 3 Neuro

Question 1

Infantile spasms Sxs

Answer 1

Sudden flexion and adduction of arms, few seconds many times daily

Question 2

Absence seizures Sxs

Answer 2

Typical: Ages 4-12 yrs, no falling or convulsions, many times daily with eyelid fluttering, neuro and cognitive exams normal
Atypical: under 4 yrs, assoc w Lennox Gastaut, LOC complete, hx of damage to nervous sys, seizures into adulthood

Question 3

Tonic clonic seizures

Answer 3

Outcry->LOC/falling–> tonic contraction with clonic motions, tongue biting, frothing, 1-2 min

Question 4

Atonic seizures

Answer 4

Children (assoc w Lennox-Gastaut), LOC, fall to ground

Question 5

Myoclonic seizures

Answer 5

Brief, lightening like jerks of a limb, bilateral or unilateral

Question 6

Partial seizures

Answer 6

Excess neuronal discharge from one cerebral cortex, usu from structural abnormalities
Simple or complex

Question 7

Simple partial seizure

Answer 7

Motor and sensory seizures= structural brain disease… Work up!!
Motor: contralateral face, trunk, limbs with clonic movement and Jacksonian March
Sensory: parasthesias or tingling in extremity/face assoc with distortion of body image

Question 8

Complex partial seizure

Answer 8

Originate in temporal lobe, aura prodrome

Question 9

Postictal state

Answer 9

After a generalized seizure: deep sleep, headache, confusion, muscle soreness

Question 10

History questions for seizure dx

Answer 10

Sxs, prior head trauma or CNS infection, drug use or withdrawal, family hx

Question 11

Brain abscess

Answer 11

Due to sinusitis, mastoiditis, head wound, sepsis

Sxs: headache, nausea, vomiting, lethargy, fever, seizures

Question 12

Encephalitis

Answer 12

Inflammation of brain parenchyma, due to virus (rarely helminthic)
Sxs: fever, headache, seizures, neuro deficits
Dx: MRI and CSF testing

(Eg rabies: hydrophobia with ascending paralysis)

Question 13

Subdural empyema

Answer 13

Due to sinusitis, ear infection, cranial trauma, bacteremia (rare)
Sxs: fever, lethargy, focal neuro deficit, seizure

Question 14

Creutzfeldt-Jakob Dz

Answer 14

Prion dz, variant from meat with bovine spongiform encephalopathy (Mad Cow)
Suspect in elderly pts with rapidly progressing dementia esp with ataxia or myoclonus

Question 15

Bacterial meningitis

Answer 15

Rapidly progressing, N. Meningitidis or Strep pneumoniae

Sxs: severe! Malaise, fever, irritability, vomiting, fever, headache, seizures in 40% children

Question 16

Viral meningitis

Answer 16

Due to enterovirus or HSV

Sxs: fever, myalgia, GI or resp sxs, headache, fever, nuchal rigidity

Question 17

Essential tremor

Answer 17

FHx in 50%, with voluntary movement, bilateral, alcohol alleviates

Question 18

Tremor red flags

Answer 18

Abrupt onset, under 50yrs with no family hx, neuro deficits, tachycardia and agitation

Question 19

Generalized seizures

Answer 19

Electrical discharge involves cortex of both hemispheres, often due to metabolic disturbances
Infantile spasms, absent seizures (petit Mal), tonic-clonic (grand Mal), atonic, myoclonic

Question 20

Huntington Dz

Answer 20

Neuronal loss in basal ganglia –> dementia then chorea, tics, myoclonal disturbances, facial grimacing

Question 21

Parkinson Dz

Answer 21

Bradykinesia, resting tremor, cogwheel rigidity, postural reflex impairment, coarse tremor

Due to Lewy bodies

Question 22

Multiple Sclerosis

Answer 22

20-40 yrs, paresthesias in 1+ extremities, weakness or clumsiness of leg or hand, stiffness, gait disturbances

PE: Opthalmoplegia, central scotoma, wide gait, hyper reflexive DTRs

Question 23

Myasthenia Gravis

Answer 23

Age 20-40yrs (F), Episodic muscle weakness, fatigabilify, ptosis, diplopia

Dx: serum anti-AchR Abs and EMG

Question 24

Guillain Barre syndrome

Answer 24

Sxs: paresthesias of feet then hands, rapid severe muscle weakness (symmetric), respiratory paralysis
PE: sinus tachycardia, urinary retention, no DTRs

Question 25

Amyotrophic Lateral Sclerosis

Answer 25

Lou Gehrig’s Dz.
Sxs: random, asymmetric cramps, weakness, muscle atrophy. Fasiculations, hoarseness, dysphagia
PE: hyper reactive DTRs, + Babinski
Dx: clinically

Question 26

Gliomas

Answer 26

Primary tumors in brain parenchyma