Yellow Pages Flashcards
Unilateral hearing loss and ataxia
Acoustic schwannoma
Cerebellopontine angle meningioma
If large enough, can cause hearing loss and V and VII dysfunction
Welling up sensation of doom or fearfulness can be due to what neurological condition
Complex partial seizures
What can cause transient tingling in hands and feet
Hyperventilation
Meniere’s dz
Peripheral Vertigo. Tinnitus, Nausea
>1 episode vertigo. Eventually low freq. hearing loss.
Meniere’s tx
Labyrinthine ablation with gentamicin
What processes can occur subacutely?
Infectious/inflammatory, demyelinating, and autoimmune.
Anti-Yo antibody is
Anti-Purkinje cell.
Associated with small cell lung cancer, gynecologic, and nonHodgkin’s lymphoma.
Where is the Foramen of Monro
Between Lateral and 3rd ventricle
Where is the Cerebral aqueduct (aqueduct of Sylvius)
Between 3rd and 4th ventricle
In the midbrain
Where is the third ventricle
It is sandwiched between both thalami. Above is the Foramen of Monro, below is the cerebral aqueduct
Where is the fourth ventricle
It is ventral to the cerebellum and dorsal to the pons.
Where does the CSF go from the fourth ventricle
It goes into the Subarachnoid space through the Lateral apertures (Luschka) and midline foramen of Magendie.
How to treat NPH?
Shunt
What can meningitis due to Ventricular/CSF system
Scars arachnoid granulations
What is the region of the leg motor fibers in the brain..
The parasagittal region: meningiomas can affect this
GBS CSF
CSF formula is albuminocytologic dissociation
Increased ICP may affect which nerve
Sixth nerve dysfunction (the “nonlocalizing” abducens deficit)
Brainstem astrocytomas, more common in adults or children?
Children
Pediatric tumors are supra or infratentorial
Usually infratentorial, reverse for adults
Transient global aphasia is recurrent and has lasting effects, true or false?
False, it resolves and rarely comes back
Paraneoplastic disorders are reversible?
Nope, generally irreversible damage
Testicular cancer has what paraneopastic disorder?
Anti-Ma
Pump head is what
Hypoxic-ischemic encephalopathy
How to diagnose Creutzfeldt-Jakob
Charactersitic abnormalities in posterior hemispheres on diffusion weighted MRI and presence of 14-3-3 protein in CSF. Disease unlikely if both negative.
Early Alzheimer’s presents with
Paranoia, hoarding behavior, and visuospatial deficits
Treatment of early Alzheimer’s
Can include Quetiapine
Difference between Mild Cognitive Impairment and Dementia
Dementia impairs occupational and social functioning. Both can be amnestic.
MCI prognosis
Can progress to Dementia, stabilize, or get better
Preventing MCI
Challenging the brain like board games or musical instruments
Disease modifying drugs for early AD
Galantamine, donepezil, and rivastigmine
potent enzyme inducer drug
phenytoin and oxcarbazepine
What chemotherapy drugs cause peripheral neuropathies
Docetaxel, paclitaxel, vincristine, platinum
Chemotherapy and cerebellar ataxias
Cytosine arabinoside or 5-FU
Some causes of PRES
preeclampsia, chemotherapy drugs, cyclosporine, and tacrolimus
PRES syndrome findings
HTN, confusion, seizures, and visual changes
Pregnant hypertensive differential
PRES, eclampsia, cerebral venous thrombosis
Treatment for dystonia
Diphenhydramine, why not benztropine?
Erythromycin drug-drug interactions
Can elevate Carbamazepine
AED toxicity
Ataxia, nystagmus, diplopia
Oxcarbazepine bad side effect
AED most associated with hyponatremia
Anticholinergic toxicity sxs
Tachycardia, blurred vision, fever, mental status changes
What does RPLS stand for?
Reversible Posterior Leukoencephalopathy Syndrome
Diabetic sixth nerve palsy cause
Infarct
Pituitary apoplexy is also called
Sheehan’s syndrome
When does Sheehan’s happen
Peripartum
Eyes and chronic steroids
Cataracts
Cluster HA more in men or women
Young men
Cause of INO in old person
Paramedian pontine perforating vessel stroke
Cause of INO in young person
Demyelination
Signs of optic neuritis
Pain on eye movement; central scotoma, normal fundus, poor vision
Papilledema causes what visual field issues
Enlarged blindspot and a centrocecal scotoma
Giant cell arteritis eye complication
Central retinal artery occlusion
Basilar migraine in a child would be what in an adult
Vertebrobasilar TIAs
Posterior Communicating Artery aneurysm leads to
Painful, pupil involving third nerve palsy
What to do for P.comm aneurysm
- CT, 2. LP, 3. Angiography
What happens if an aneurysm is clipped/coiled and deteriorates 3 days later?
Vasospasm. tx with nimodipine
Review herniation syndromes
Uncal Cerebellar Tonsillar Subfalcine Central Upward Locked in
Medical cause of acute angle closure glaucoma
Topiramate
Tunnel vision that doesn’t reveal more as the testing screen is moved further away
Functional, malingering or conversion
Neurofibromatosis type I and eye problem
Optic Nerve glioma
When do you see optic atrophy in optic neuritis
4-6 weeks after the acute event, until then the fundus is likely normal
Most common cause of of Acute Optic neuropathy in patients older than 50
Ischemic Optic Neuropathies
Anterior Ischemic Optic Neuropathy
Can be due to temporal arteritis
Presents with painless vision loss developing over hours to days
Blurred vision and frequently altitudinal field defect.
Generally remains stable.
Risk factors for ION
Congenitally small optic cup, HTN, diabetes
Posterior Ischemic Optic Neuropathy causes
Spinal surgery: irreversible vision loss
Drug causes of ION
Amiodarone, interferon alpha, nasal decongestants, viagra
Cause of a left homonymous hemianopia…
PCA stroke
Why is there Macular sparing if you get a PCA stroke
MCA also supplies macula
How to treat tic douloureux
Carbamazepine
Signs of Temporal Arteritis
ESR elevated; anemia; jaw claudication; diagnose with temporal artery biopsy
Parasagittal lesion that is hyperdense, enhances uniformly is…
Meningioma (extra-axial)
How does a GBM enhance
Heterogeneously and it is intra-axial
What is used for prophylaxis of migraines?
Antihypertensives: Beta blockers, CCBs, ACE inhibitors/Angiotensin Receptor Blocker
Anticonvulsants: Valproate, Topiramate, Gabapentin
Contraindications for triptans
uncontrolled HTN and CAD
How do venous sinus thromboses present
Cavernous sinus
Straight sinus
Sagittal sinus
Know the CSF formulas, draw up an excel sheet
….
Most common opportunistic infection in CD4 range of around 120
Cryptococcus.
Crypto findings in the brain
Very elevated ICP. Which leads to nonlocalizing sixths.
Treatment for Crypto
Amphotericin B and flucytosine
TB meningitis signs
Basilar meningitis with multiple cranial neuropathies, raised ICP and hydrocephalus, and low sugar.
Guilllain Barre CSF
Albuminocytologic dissociation
Albuminocytologic dissociation
increase in the level of albumin in cerebrospinal fluid without an accompanying increase in the number of cells.
What is CIDP
Chronic inflammatory demyelinating polyneuropathy: Chronic GBS
Ramsay-Hunt Syndrome
Reactivation of Zoster in facial nerve geniculate ganglion, leads to loss of facial movements with erythematous rash, ageusia, ear pain, dry eyes and mouth
How to treat Ramsay-Hunt syndrome
IV acyclovir
Periventricular masses in HIV+ that still grow with toxo tx
CNS lymphoma from EBV
Bilateral facial weakness infection (bilateral peripheral VII nerve palsies)
Neuroborreliosis
When to think of Crypto
Immunosuppressed, high opening pressure
Calcified lesions in someone from the DR
Cysticercosis (T. solium)
Prophylaxis for N. meningitides
Rifampin to reduce NP colonization, can also use ciprofloxacin
Congenital CMV
Hearing loss, spasticity, hyperintensities along the ventricular margins on MRI
Cerebral palsy signs
Generalized hyperreflexia, bilateral Babinski signs, heel cord contractures, writing movements of the upper limbs.
Charcot-Marie-Tooth disease
High arched feet and tripping.
Slowly progressive weakness in distal limbs with loss of proprioception and vibration sense.
Legs before arms.
Onset <30 years.
Myotonic dystrophy signs
DMII, frontal balding, ptosis, slow relaxation of grip is the myotonia
NF2 and acoustic neuromas
Bilateral
NF1 vs. NF2
NF1 is 10x more common
Which type of tuberous sclerosis is better
Type I is less severe with normal intellect
What is tuberous sclerosis
Neurocutaneous disorder with widespread hamartomas in CNS, skin, and viscera.
Ash Leaf spots on skin.
A common Acute intermittent porphyria sx
Abdominal pain
Acute intermittent porphyria treatment
IV hematin
Acute intermittent porphyria precipitants
Sulfonamides, hormones, barbiturates
McArdle’s disease
Look for symptoms after exercise: muscle cramping, weakness, dark urine
CMV tx
Gangcyclovir
Congenital CMV
Retardation, microcephaly, seizures, hearing defects. Hyperdensities along margins of the lateral ventricles.
Friedreich’s ataxia
Most frequently inherited ataxia in Whites. Kyphoscoliosis and pes cavus and gait difficulty. Can also have retinitis pigmentosa. Spinocerebellar signs: limb ataxia, dysarthria, absent reflexes.
Friedreich’s ataxia pathology
Posterior columns, dorsal and ventral spinocerebellar tracts and lateral corticospinal tracts.
Friedreich’s ataxia tx
Idebenone, coenzyme Q10 analogues that is a free radical scavenger
Isoniazid tx and vitamin deficiency
Pyridoxine (B6) depletion leading to peripheral neuropathy
How to treat organophosphate poisoning
OPs are ACEIs so they cause a massive parasympathetic response, block with Atropine (anti-muscarinic) and pralidoxime (anti-nicotinic)
Pseudotumor MRI findings
Normal or small, slit-like ventricles
Carbon monoxide damages what
Globus pallidus necrosis few weeks out
Vitamin E deficiency
Spinocerebellar syndrome. Ataxia, hyporeflexia, and loss of proprioceptive and vibratory sensation. A skeletal myopathy and pigmented retinopathy also may be present
Lead poisoning
Predominance of extensor muscle weakness (wrist and foot drop) and autonomic symptoms, microcytic anemia (sideroblasts)
Subacute Combined Degeneration
B12 deficiency Dorsal columns
Causes of excess manganese
TPN or cirrhosis
Excess manganese on MRI
Basal ganglia increased signal on T1
Excess manganese signs
Cogwheeling, tremulous (Basal ganglia affected)
Most common electrolyte abnormality in any CNS process
Hyponatremia
Arsenic poisoning signs
N/V, tinnitus, total body rash, oval patches on neck and increased pigmentation around the axillae.
Causes of elevated MCV
B12 deficiency, Alcoholism, folate deficiency
Causes of decreased MCV
Iron-deficiency, thalassemia, chronic disease, sideroblastic anemia (lead poisoning)
Ethylene glycol poisoning signs
Profound peripheral nerve and CN dysfunction (almost locked in)
How does straight leg raising work…
Nerves have slack when lower body is not flexed, but it tightens up with flexion (straight leg raising)
Ankle reflex nerve root
S1
Sciatica signs
…….
Syringomyelia associated with
Arnold-Chiari Malformation
Chiari malformation types
Type I: cerebellar tonsils squeeze lower brainstem
Type 2: Associated with meningomyelocele
Myasthenia diagnosis
Edrophonium (Tensilon) test: Reversible AChEI
Myasthenia tx
AChEI like pyridostigmine
Myasthenic symptoms, what else to consider
Thyroid disease and thymoma
Eaton-Lambert syndrome
Paraneoplastic, antibodies to calcium channels presynaptic, improves with exertion
Deep peroneal nerve Sensory
Region of the first interosseous space
Patellar reflex
L4
L5 radiculopathy
Lateral thigh and anterolateral leg, sensory loss in the dorsal aspect of the foot. L5 radiculopathy, inversion is affected as well.
Acute tx for suspected spinal cord compression
High dose methylprednisolone
How do steroids reduce ICP?
It has been suggested that corticosteroids produce their anti-edema effect by reducing the permeability of tumor capillaries.
Polymyositis signs
Proximal distribution of weakness, elevated CK, and EMG signs
Steroid myopathy
Proximal, painless myopathy
Hypothyroidism associated findings
Weight gain, cold intolerance, cognitive slowing, myopathy
Brown-Sequard
Typically ipsilateral, but if it is caused by compression from a mass then it could affect the contralateral spinothalamic/corticospinal tracts
Trigeminal neuralgia tx
Carbamazepine
Tx for neuropathic pain
Gabapentin, pregabalin, duloxetine, nortriptyline, amitriptyline.
Why gabapentin instead of TCAs
They will cause urinary retention in older patients from teh anticholinergic effect
EMG of myopathy will show…
- No insertional fibrillations (usually)
- Low amplitude small motor units
- Early recruitment of motor units but normal interference pattern
EMG of neuropathic disease
- Fibrillation potential on needle insertion
- Large motor units
- Reduced interference pattern when patient asked to contract muscle more strongly
Visual field of papilledema
Enlarged blindspot with some peripheral field constriction
Toxo tx
Pyrimethamine/sulfadiazine
CNS lymphoma diagnosis
EBV by pcr in CSF or brain biopsy
Hemiballismus and what brain structure
Subthalamic nucleus
Parinaud’s or dorsal midbrains yndrome
Pineal region…
Supraoptic nucleus and eating
…..
Eaton-Lambert syndrome is associated with what disease
Small Cell Lung cancer
Charcot joint
Diabetic neuropathy leading to fucked up ankle b/c you can’t feel it
Lateral Medullary Syndrome
Lower CN dysfunction and crossed sensory signs.
Caused by vertebral artery occlusion or PICA occlusion.
Tx with warfarin.
When to use warfarin
Valvular a. fib, mechanical valves, cerebral venous sinus thrombosis, decreased ejection fraction, mural thrombus and DVTs. NOT intracranial vascular stenosis.
When to use heparin
Extracranial arterial dissections, stuttering TIA, acute 100% large vessel occlusion, basilar artery thrombosis, DVTs.
How do you get crossed signs with lateral medullary syndrome?
Spinothalamic tracts from contralateral side and trigeminal ganglion from ipsilateral side.
Wedge shaped infarcts
Start out on the surface and go inwards
When can you do an endarterectomy
Stenosis >70%
Time frame for TIA to stroke
<48 hrs, admit TIAs
Tx for essential tremor
Topiramate, beta blockers
Drug class of topiramate
Anticonvulsant
Biggest risk factor for stroke
HTN
Suddenly comatose?
Brainstem disease: pontine hemorrhage or basilar occlusion: pinpoint pupils, quadriparesis, impaired eye movements. OR bilateral supratentorial disease (unlikely)
Persistent Vegetative State
Takes 6 weeks for formal criteria. Patient awake but not alert.
Minimally conscious state
More apparent interaction with the environment
REM Behavior disease leads to what
Parkinsons
MUPS
Medically Unexplained Physical Symptoms (patients want care, not cure)
MS bladder
Small capacity, detrusor hyperreflexia.
How to treat detrusor hyperreflexia
Oxybutynin or Tolterodine (anticholinergics)
Lambert-Eaton and eye problems
It does NOT involve ocular muscles
Know the side effects of major AEDs, steroids, neuroleptics, chemotherapeutic agents. Also know ingestions, drug-drug interactions.
….
Third nerve palsy involving pupil
P.Comm aneurysm
Papilledema visual field
Enlarged blind spot
Optic neuritis/Ischemnic optic neuropathy visual field
Central scotoma
Headache prophylaxis
Propranolol, topiramate
Pseudotumor MRI
NORMAL MRI or slit-like ventricles, diagnose by LP
Ratio for a blood tap?
….
Necrotizing encephalitis
Think HSV
Huntington’s in 3 phrases
Triplet repeats, caudate atrophy, choreiform movements
Nerve roots vs. Peripheral Nerve
Lesions to roots cause more localized or incomplete weakness
Earliest imaging for infarction
Diffusion Weighted Imaging
Trigeminal Autonomic Cephalgias
Cluster HA, Paroxysmal Hemicrania
Lateral Medullary Syndrome (Wallenberg syndrome)
Loss of pain and temperature sensation on the contralateral side of the body and ipsilateral side of the face. This crossed finding is diagnostic for the syndrome.
Swallowing difficulty, or dysphagia, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner syndrome, diplopia, and possibly palatal myoclonus.
