Last Week Prep

Question 1

Triad of normal pressure hydrocephalus

Answer 1

1. Subcortical dementia (attentional deficit, apathy)
2. Gait dysfunction
3. Urinary incontinence

Question 2

First-line for migraine prophylaxis during pregnancy

Answer 2

Propranolol or metoprolol

Beta blockers have a great safety profile for pregnancy

Question 3

Characteristics of PML on imaging

Answer 3

Ultimately, PML is a demyelinating disease

On MRI, this will appear hyperintense.

On CT, this will appear hypodense and non-enhancing.

Question 4

Features of catatonia

Answer 4

• Triad of:
  
  • Immobility
  • Mutism (with or without echolalia)
  • Negativism (proportional resistance to passive movement)
• Occurs in the context of:
  
  • Mood disorder
  • Psychotic disorder
  • Autism

Question 5

Treatment of catatonia

Answer 5

1st line: Benzodiazepines (IV lorazepam)

Refractory: Electroconvulsive therapy

Question 6

Cavernous sinus thrombosis symptoms

Answer 6

• Unilateral:
  
  • Headache
  • Ocular palsy
  • Periorbital edema
  • V1/V2 distribution sensory changes (hypo- or hyper-esthesia)

Question 7

Infection resulting in cavernous sinus thrombosis

Answer 7

Since the facial/ophthalmologic venous system is valveless, skin infection of the face can secondarily result in CST

This will look like some initial infection which then acutely worsens with headache, CN3-6 abnormalities, V1/V2 sensory abnormalities, and papilledema on exam

Question 8

Diagnosis of normal pressure hydrocephalus

Answer 8

• Suspected with CT showing enlarged ventricles in the appropriate clinical context
• Normal pressure on large-volume LP and post-LP improvement in symptoms is diagnostic – if elevated, something else should be suspected
• Definitve therapy is with shunt placement

Question 9

Treatment of a myasthenic crisis

Answer 9

• Cirtocisteroids + (Plasma exchange or IVIG)
• Intubation

Question 10

Spindylolithesis

Answer 10

• Form of back pain that presents in adolescents
• Due to increased lumbar lordosis during growth spurts
  
  • Playing a sport w/ repetitive back flexion/extension is a risk factor
• May have neurologic signs/symptoms beneath lesion
• Palpable step-off on exam
• Pain exacerbated by lumbar extension
• Dx: Lumbar radiograph
• Tx: Limit activity, physical therapy, analgesia. If this fails or there are disabling neurologic deficits, surgery.

Question 11

What are we trying to rule out by doing MRI prior to LP in suspected IIH?

Answer 11

• Non-communicating hydrocephalus
• Tumors
• Venous sinus thrombosis

Question 12

Subependymal nodules

Answer 12

• Visualized on CT as small bilateral calcifications along the ventricles
• Often present in tuberous sclerosis patients who present with seizure

Question 13

What should you consider when it looks like a small child had a stroke?

Answer 13

Sickle cell anemia

Treat w/ plasma exchange transfusion

Question 14

How to think of CIDP

Answer 14

Chronic Gullian Barre

Question 15

Spinocerebellar tracts

Answer 15

• First-order neurons deliver information from Golgi tendons to the posterior horn of the spinal cord
• From there, this information is relayed to second-order neurons divided between two tracks:
  
  • The dorsal spinocerebellar tract carries information ipsilaterally to the cerebellum through the inferior cerebellar peduncles
  • The ventral spinocerebellar tract carries carries information ipsilaterally and contralaterally to the cerebellum through the superior cerebellar peduncles

Question 16

Flow of information through the red nucleus

Answer 16

Question 17

Rubrospinal tract

Answer 17

Question 18

Lateral brain slice showing deep gray structures

Answer 18

Question 19

Glabellar sign

Answer 19

Failure of blinking reflex to extinguish

Form of frontal release sign

Sign of Parkinson’s

Question 20

Hockey stick sign

Answer 20

Question 21

Two cases where syringomyelia is usually seen

Answer 21

• Arnold-Chiari type I malformation
• Cervical spinal injury

Question 22

Von Hippel Lindau

Answer 22

Additionally, patients with VHL may have elevated blood pressure at baseline due to catecholamine overproduction

Question 23

Associated tuberous sclerosis tumors

Answer 23

• Hamartomas
• Subependymal nodules
• Cardiac rhabdomyomas

Question 24

Risk reduction of Alzheimer’s disease

Answer 24

Managing chronic medical conditions well can delay onset of Alzheimer’s

Question 25

Basic picture of Friedrich ataxia

Answer 25

* **Subacute combined degeneration picture** (dorsal column and UMN signs) * Scoliosis * Cardiomyopathy * Diabetes mellitus

Question 26

Oculogyric crisis

Answer 26

A form of dystonic reaction that may be observed in patients on neuroleptics Forced upward gaze deviation Treat with anticholinergics (ex. trihexyphenidyl, benztropine)

Question 27

Choroid plexus papilloma

Answer 27

* Basically an intraventricular papilloma that secretes CSF and raises the ICP * Occurs most commonly in infants * Associated signs * "Vomits after waking up from a nap" * Hydrocephalus

Question 28

Thalamic pain syndrome

Answer 28

Occurs following a **thalamic lacunar stroke** The affected sensory distribution regains some sensation, but has **hyperesthesia with allodynia**

Question 29

Restless leg syndrome in pregnancy

Answer 29

Common and progresses throughout the pregnancy Due to increased iron needs Can treat with supplemental iron. Resolves after delivery.

Question 30

Stroke in a young adult patient without risk factors

Answer 30

Think cocaine or amphetamines Check the vitals and the pupils

Question 31

Inheritance patterns of muscular dystrophies

Answer 31

Duschene's: X-linked Becker's: X-linked Myotonia: Autosomal dominant

Question 32

How test makers trick you into thinking that a patient has ADPKD when they have VHL

Answer 32

VHL can have multiple clear cell carcinomas, which can appear "polycystric" on ultrasound. So, if a patient has **hemangioblastomas** and a VHL-like presentation, don't be tricked by "polycystic kidneys" into thinking that they have ADPKD.

Question 33

\_\_\_ may be a non-epileptic sequela of bacterial meningitis that can mimic absence epilepsy

Answer 33

**Hearing loss** may be a non-epileptic sequela of bacterial meningitis that can mimic absence epilepsy In fact, all patients (particularly children) with bacterial meningitis should undergo **audiologic testing** after completing therapy.

Question 34

Malignant hemispheric infarction

Answer 34

When a large stroke causes **cerebral edema and/or hemorrhagic transformation** Usually occurs in first 48 hours, but may occur up to 1 week post large infarct. Dx: Emergent non-contrast CT Tx: Emergent decompressive craniotomy

Question 35

How cortical vs peripheral blindness are described

Answer 35

In peripheral blindness, it is like there is a "curtain over your vision". The radiations also fall into this category. If cortical blindness, it is like the that part of your field of vision just *isn't there*

Question 36

Serotonin syndrome symptoms

Answer 36

May present mildly as someone who appears anxious and jittery when taking a new serotonergic medication

Question 37

Two things to know about pediatric astrocyoma

Answer 37

1. It s the most common pediatric CNS tumor 2. It can appear anywhere in the cortex, most commonly frontal/parietal

Question 38

Autonomic dysreflexia in spinal cord injury

Answer 38

* May happen in any **spinal cord injury**. Occurs in the context of a **noctious stimulus (distended bladder, pain, etc).** * Due to dissociation between primary sympathetic and modulating parasympathetic responses. * **Above** the lesion, the **parasympathetic** response predominates, causing bradycardia and facial flushing. * **Below** the lesion, the **sympathetic** response predominates, causing severe hypertension.

Question 39

Most likely auerysms to compress CN3?

Answer 39

Most commonly **PICA aneurysm,** sometimes internal carotid aneurysm. In contrast, **CN6 is rarely ever compressed by an aneurysm**. Instead, it is a false localizing sign in elevated ICP. Both CN3 and CN6 may be affected in **cavernous sinus syndrome.**