Week 4 Flashcards
if you lesion the right MLF what way can you not adduct
your right eye will not be able to ADDuct when looking to the left. INO= Ipsilateral adduction failure Nystagmus Opposite
what cancer is most associated with paraneoplastic cerebellar degeneration
breast cancer
if a patient has loss of pain and temp in their arms where is the lesion
central spinal cord like a syringomyelia bc it compresses the anterior commissure first
etiologies of central cord syndrome
syringomyelia, hyperextension of the neck (like from a fall), tumors
what does wrong way eyes mean
this means that the eyes are down and out towards the opposite way of the lesion. Meaning they are towards the same side as the weakness.
where is the hemorrage if there is wrong way eyes
thalamus always!
what test can you do to dx central retinal vein occlusion
fluorecein angiography
what is the drug of choice for delerium in patients
haloperidol
what is the drug of choice for delerium tremens
benzos
what is associated with ankylosing spondyloarthritis
sacroilitis, achilles tendon insertion site pain, morning stiffness that improves with activity, reduced spinal mobility, dactylitis, etc.
what is the first line treatment for tension headaches prevention
amitriptyline
what is first line treatment of migrains prophylaxis
topiramate or propanolol –> amitriptyline –> verapamil
what is the first line treatment for cluster headache prophylaxis
verapamil
what is the differences in clinical presentation of menieres vs. acoustic neuroma
hearing loss, vertigo, tinnitus, all are similar. However menieres has stronger more severe vertigo attacks and ear fullness whereas
what are some neurological manifestations of hypothyroidism
poor concentration, muscle weakness (proximal > distal), hyporeflexia, truncal and gait ataxia, obstructive and central apnea etc
what can get damaged when correct Na imbalance
low to high your pons will die, high to low your brains will blow
what is subacute combined degeneration
this is just B12 deficiency!
what clinical signs are involved in subacute combined degeneration
paresthesias especially of lower extremities (due to demyelination of the dorsal columns), spastic paresis of lower limbs bc of demyelination of LCST
what is the antibody for cerebellar degeration
anti-yo
what cancer is associated with anti NMDA antibodies
ovarian teratoma
what should be suspected as the possible etiology of a younger patient with a stroke
antiphospholipid syndrome; especially if they do not have any clear risk factors
what antibodiesa are associated with antiphospholipid syndrome
anti-cardiolipin, lupus anticoagulant, anti-beta2-glycoprotein
what is a neurological effect of sarcoid
myopathy, mono- or poly- neuropathies, radiculopathies, myelopathy, neuroendocrine dysfunction
what skin condition is a sign of sarcoid
erythema nodosum
what is TME
toxic metabolic encephlaopathy and this is when there is global cerebral dysfunciton in absence of structural cause
what can cause TME
metobolic disturbances, infection (systemic), drugs, commonly seen in the ICU
how do diagnose TME
EEG, will show global dysfunction via a slow background rhythm, and triphasic waves
enxyme missing in neiman pick and notable features
sphingomyelinase, YES HSM, cherry red spot
enzyme missing in gaucher and notable features
glucocerebrocidase, cherry red spot, gaucher cells in bm
enzyme missing in Krabbe and notable features
galactosylceramide P-galactosidase, globoid cells with PAS+granules
enzyme missing in hurler and notable features
a-L-iduronidase, clouding of the cornea, characteristic facies and dwarfism
enzyme missing in hunter and notable features
iduronidase sulfatase, Xlinked, no clouding
metachromatic leukodystrophy enzyme and features
arylsulfatase, cherry red spot, demyelinating disorder, schizophrenia in adults
adrenoleukodystrophy enzyme and features
VLCFA oxidation, x linked
what brain tumor is associated with von hippel-lindau syndrome
hemangioblastoma
glioblastoma pathology
central necrosis, round and highly pleomorphic cells, palisading
what is a good mutation for glioblastomas to have
MGMT methyl transferase
common treatment for glioblastoma
surgical resection and then temozolomide (cytotoxic alkylating agent)
presentation of oligodendroglioma
mostly seizures
good mutation for prognosis of oligodendroglioma
IDH mutant
pathology of oligodendroglioma
derived from oligodendrocytes, chicken wire capillaries, fried egg appearance
ependymoma epidemiology
mostly children
ependymoma pathology
pseudorosettes
meningioma presentation
often nothing, but if in falx cerebri can have leg paresis
meningioma pathology
whirled pattern, progesterone receptors
medulloblastoma location
mostly in the 4th ventricle
medulloblastoma pathology
anaplastic small blue cells and homer-wright rosettes
medulloblastoma metastasis relation
can drop mets to the spinal cord
Schwannoma associated features clinically
hearing loss, vestibular symptoms, facial symptoms (CNVII is right there)
how do you get Primary CNS lymphoma
has to be from EBV and is associated with immunodeficiency
what are clinical signs of craniopharyngioma
hypopituitarism, headache, bitemporal hemianopia, vomiting, hyperprolactinemia
what are the clinical signs of pituitary adenoma
most of them are prolactinomas so galactorrhea, amenorrhea, reduced bone density, headache, bitemporal hemianopia, impotence
what is the first line treatment for postherpetic neuralgia
first is a tricyclic antidepressant but this is contraindicated in patients with heart conditions, then gabapentin
what does a hypodense area on CT scan mean in terms of stroke
it means something happened about 24 hours ago
how can you tell if someone is volume depleted
elevated BUN:Creat ratio indicating a pre-renal azotemia from lack of perfusion
what are signs of heatstroke
rhabdomyolysis, temps super high, acute kidney injury, DIC
what is complex regional pain syndrome
this is when you have severe pain along with cool limbs but still have normal pulses and everything. pain is more severe than should be. motor dysfunctions
what is propagnosia
inability to recognize faces but can identify parts of the face like nose mouth teeth etc
what area is lesioned if the patient has propagnosia
the right posterior superior temporal cortex
neurological signs of polycythemia vera
strokes! bc you have way too many RBCs they can clump together and cause a clot
treatment of polycythemia vera
frequent phlebotomy
what is an adverse drug effect of levodopa
orthostatic hypotension
what does adding carbidopa help do
this inhibits the peripheral conversion of levodopa to dopamine via dopamine decarboxylase which decreases orthostatic hypothension
what is the treatment for vascular dementia
cognitive training
in patients with afib, what drug should they be on to prevent stroke/TIA
an anticoag drug like rivaroxaban
what are the signs that you should not do a lumbar puncture (pneumonic)
FAILS: focal neurological signs, altered mental status, immunocomprimised/ICP elevated, lesions in skin near brain or LP site, seizures
do patients with NPH have increased ICP
often no, so they wont have papilledem
how do we get tetanus toxin
from trauma/rusty nails
what does tetanus toxin inhibit
this inhbits GABA/glycine release so there is excess glutamate which causes spasticity
what are the signs of botulism toxin
descending paralysis, especially starting with swallowing, weakness in the arms etc
what structure is compressed in a pancoast tumor that causes horners
the stellate ganglion
what is the mode of inheritance for neurofibromatosis
autosomal dominant
does a CT scan have to show evidence of SAH for it to be a SAH
NO, a small bleed wont show, can do an LP
what are signs of vertebrobasialar disfunction
often vestibulocerebellar signs (dizziness, vertigo, blurry vision), ipsilateral cranial nerve palsies, contralateral paresis
signs of tethered cord syndrome
back pain, gait abnormalities, dimple/tuft of hair at sacrum, diminished reflexes
best way to manage cauda equina syndrome
lubosacral laminectomy
how soon do you see demylination in GBS vs. CIDP
GBS is ascending within days vs. CIDP is more chronic over weeks
what is the pathophys of idiopathic intracranial HTN aka pseudotumor cerebri
this is due to lack of CSF absorption
what type of bleed does a ruptured berry aneurysm lead to
SAH
what type of bleed can hypertension lead to
intracerebral hematoma
signs of krabbe disease
hypotonia, babinski sign, fevers, optic nerve pallor vision loss, spasticity
pathophys/enzyme missing in Krabbe
degeneration of white matter, galactocerebrecidase
how are acute relapses of MS treated
corticosteroids–> IV methylpredisolone
what are soem DMARDS for MS
interferon beta 1a and 1b, Glatiramer, Natalizumab
what is the target of natalizumab
mab against alpha-4-integrin
what is a side effect of natalizumab
PML from JC virus
what is ADEM
acute disseminated encephalomyelitis –> where you have multiple white matter lesions like MS but they are more spread out
what is brudzinskis sign and kernigs sign
this is when you are moving the leg or flexing the neck and it elicits pain
if there are multiple brain abcesses what is the route of transmission
hematoginously
what is the most common virus that causes meningitis
enterovirus (cosackievirus)
what are clinical signs of HSV encephalitis
complex partial seizures of the temporal lobe origin, olfactory hallucinations, memory distubances
HSV encephalitis CSF findings
elevated RBC count and leukocytosis
what is the endemic area of coccidiodies
southwest US and mexico
where is blastomycoses
mississippi river valley
histoplasma loci
ohio river valley
what fungus can cause meningitis
cryptococcus especially in the immunocomprimised
what gives us neurocysticercosis
taenia solium from central and south america seen in immigrant populations
