Week 1 Flashcards
What are the four key features of narcolepsy?
- excessive daytime sleepiness
- hypnagogic hallucinations
- sleep paralysis
- cataplexy
What is the first line therapy for narcolepsy?
sleep hygiene, scheduled naps, and modafinil
Describe the presentation, diagnosis, and treatment of Guillain-Barre syndrome.
- the illness is preceded by a GI or respiratory infection
- symptoms include neuropathic pain, a symmetric and ascending weakness with diminished DTRs, and autonomic dysfunction; there are no UMN signs
- it is a clinical diagnosis supported by an LP finding elevated protein and normal leukocytes or EMG/NCS
- management includes serial spirometry for FVC and negative inspiratory force with intubation for respiratory distress or autonomic instability
Diabetics are at increased risk for what sort of spinal cord lesion?
a spinal abscess
What is neuralgia paresthetica?
it is a mononeuropathy caused by compression of the lateral femoral cutaneous nerve (L2-3) at the inguinal ligament, typically due to tight belts or clothing and presenting with paresthesias or numbness in the lateral thigh
What are the symptoms of common peroneal nerve dysfunction?
foot drop, impaired foot eversion, and numbness of the posterolateral leg and dorsolateral foot
How can superficial peroneal and deep peroneal nerve injuries be distinguished from one another?
- the superficial nerve carries sensory fibers from the dorsum of the foot and supplies the muscles for foot eversion
- the deep nerve carries sensory fibers from the first web space of the toes and supplies the muscles for foot dorsiflexion and toe extension
What often leads to obturator nerve injury and what are the symptoms?
- often the result of anterior hip dislocation or damaged during pelvic surgery
- presents with weakness of the adductors and sensory loss over the medial thigh
A long history of alcohol abuse and slowly progressive postural gait dysfunction is suggestive of what disease process?
alcohol neurotoxicity affecting the Purkinje cells of the vermis, contributing to cerebellar degeneration
What are the developmental milestones expected of a two year old?
- walk up and down stairs with both feet on each step
- build a tower of 6 cubes and copy a line
- vocabulary of more than 50 words and using 2 word pharses
- follows 2 step commands, engages in parallel play, and begins toilet training
What is Todd paralysis?
a self-limited, focal weakness or paralysis that occurs in the postictal period following a focal or generalized seizure
What is athetosis?
a slow, writhing movement characteristic of Huntington’s disease
What causes hemiballismus?
a lesion to the contralateral sub thalamic nucleus
What are the symptoms of uncal herniation and what lesions explain them?
dilation of the ipsilateral pupil due to oculomotor nerve compression and ipsilateral hemiparesis due to compression of the contralateral crus cerebri
What is amaurosis fugax?
a transient, monocular blindness lasting only a few seconds, most often due to atherosclerotic emboli originating from the ipsilateral carotid
What are the features of optic neuritis? With what condition is it classically associated?
- associated with MS
- presents with unilateral eye pain, loss of vision, and an afferent pupillary defect
Describe the vision loss associated with papilledema.
it is transient, lasting only a few seconds, and corresponds to changes in head position
How can glucocorticoid-induced myopathy be differentiated from polymyalgia rheumatica?
- glucocorticoid-induced presents with weakness and atrophy but no pain and a normal ESR and CK
- PR presents with pain, stiffness, and diminished ROM as well as an elevated ESR and normal CK
Where are Broca’s and Wernicke’s areas?
Broca’s is in the posterior inferior frontal gyrus and Wernicke’s is in the superior temporal lobe
How can Marfan syndrome be differentiated from homocystinuria?
- Marfan is more likely to have normal intellect, aortic root dilation, and upward lens dislocation
- homocystinuria is more likely to have intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, and a fair complexion
Describe the presentation, diagnosis, and treatment of homocystinuria.
- presents with marfanoid habitus, intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, and a fair complexion
- the diagnosis is supported by finding elevated levels of homocysteine and methionine levels
- treat with vitamin B6, B12, and folate
What is the Cushing reflex?
a syndrome of hypertension, bradycardia, and respiratory depression produced by increases in ICP that contribute to brainstem compression
What is the most important risk factor for intracerebral hemorrhage?
hypertension
How is orthostatic hypotension diagnosed?
based on a drop in SBP greater than 20 mmHg or DBP greater than 10 mmHg
What is the Dix-Hallpike test?
a test used to diagnosed benign paroxysmal positional vertigo
What two ocular manifestations are common in those with MS?
- optic neuritis
- internuclear ophthalmoplegia
What are five risk factors for MS?
- HLA-DRB1 genotype
- low vitamin D levels
- living at higher longitude
- living in colder climate
- smoking
What are the three things used to diagnose MS?
- a history of episodic/progressive symptoms disseminated over time and space
- MRI finding demyelinating in the periventricular white mater
- finding oligoclonal IgG bands on CSF analysis
What are the acute and maintenance therapies for MS?
- acute: glucocorticoids; plasmapheresis if refractory
- maintenance: interferon beta and glatiramer acetate
What is the likely cause and etiology of a pure motor stroke?
it is likely the result of a lacunar stroke in the posterior limb of the internal capsule secondary to hypertension and the lipohyalinosis and arteriolar sclerosis that follows
What is the pathogenesis for lacunar strokes?
these are the result of chronic hypertension which leads to arteriolar sclerosis and lipohyalinosis and subsequently occlusion of small vessels
Which parkinson’s treatment has the highest risk for causing hallucinations?
direct dopamine agonists like pramipexole more so than levodopa or COMT and MAO inhibitors which have an indirect effect on dopamine levels
What are the criteria for diagnosing dementia with levy bodies?
dementia and two of the following four:
- visual hallucinations
- parkinsonism
- REM sleep behavior disorder
- fluctuating cognitive function
What are the criteria for diagnosing dementia with levy bodies?
dementia and two of the following four:
- visual hallucinations
- parkinsonism
- REM sleep behavior disorder
- fluctuating cognitive function
Describe the organization of CN III fibers within the fiber bundle.
parasympathetic fibers for pupillary constriction run on the outside of the bundle and are thus more affected by extrinsic compression while motor fibers for extra ocular movements run more interior and are more affected by ischemia
How does the management of pupil-sparing CN III palsies differ from that of pupil-involving CN III palsies?
- pupil-involving are more often due to compression secondary to intracranial aneurysm, thus the first step is MRA or CTA
- pupil-sparing are more often due to microvascular ischemia secondary to diabetes, hypertension, HLD, or age, thus observation, supportive care, and metabolic workup are indicated
What are the criteria for a simple febrile seizure and what is the management?
- they are defined as generalized seizures lasting less than 15 minutes and no recurring within 24 hours
- they can be managed with reassurance and do not require workup or treatment
Describe the risk factors, presentation, diagnosis, and treatment of orbital cellulitis.
- the most common risk factor is sinusitis but orbital trauma or local infection are also risk factors
- presents with ophthalmoplegia, vision change, eye pain, and proptosis
- diagnosis is clinical but CT is performed to identify any drainable fluid collections
- treat with IV antibiotics; drainage if there is an abscess
What is the difference between orbital cellulitis and preseptal cellulitis?
- orbital cellulitis is a deeper infection, one that extends behind the orbital septum
- because of this preseptal cellulitis does not involve vision change, proptosis, and ophthalmoplegia
Huntington’s disease is associated with what gross anatomical change?
atrophy of the putamen and caudate nucleus
What are the three key features of Huntington’s disease?
- motor disturbance, particularly chorea
- cognitive disturbance
- psychiatric symptoms (e.g. depression, psychosis, OCD)
Decreased dopamine has what effect in the following pathways:
- mesolimbic
- nigrostriatal
- tuberoinfundibular
- mesolimbic: antipsychotic effect
- nigrostriatal: EPS
- tuberoinfundibular: hyperprolactinemia
What is the most common cause of SAH and what syndrome suggests SAH over other kinds of stroke?
- usually due to Berry aneurysms
- have a syndrome of thunderclap headache and meningismus, typically without focal deficits
What is the most common cause of intraparenchymal hemorrhage and what syndrome suggests IPH over other kinds of stroke?
- usually secondary to uncontrolled hypertension
- focal deficits tend to present early followed by symptoms of increased ICP
What features suggest thrombotic stroke and what features are more suggestive of an embolic stroke?
- patients with thrombosis tend to have more atherosclerotic risk factors and a stuttering progression of symptoms
- patients with emboli tend to have more cardiac disease, multiple infarcts in different vascular territories, and symptoms that are maximal at the start
What features suggest thrombotic stroke and what features are more suggestive of an embolic stroke?
- patients with thrombosis tend to have more atherosclerotic risk factors and a stuttering progression of symptoms
- patients with emboli tend to have more cardiac disease, multiple infarcts in different vascular territories, and symptoms that are maximal at the start
What is the mechanism of action for tetanus toxin?
it undergoes retrograde transport within the lower motor neuron and is taken up by the presynaptic cell where it blocks the release of inhibitory neurotransmitters GABA and glycine
What is autonomic dysreflexia?
- a potential complication of spinal cord injury above T6 whereby noxious stimuli in the form of constipation, urinary retention, or pressure ulcers can precipitate an unregulated sympathetic response due to the loss of descending input
- the resulting vasoconstriction and hypertension is met by a compensatory parasympathetic response above the level of the lesion with flushing, diaphoresis, and bradycardia
Pronator drift can be localized to a lesion where in the nervous system?
to the pyramidal/corticospinal tract
The Romberg test is an evaluation of what?
proprioceptive functioning
What is transverse myelitis?
a combination of motor and sensory loss below the level of the lesion along with incontinence, often a symptom of MS
What is believed to be the pathogenesis for NPH?
decreased CSF reabsorption through the arachnoid granulations