PINEAL GLAND TUMORS, can sometimes secrete what hormone causing what syndrome?
HCG, causing precocious puberty.
What are the most common causes of Vertebrobasilar insufficiency which is caused by decreased blood flow to base of brain…causing a wide variety of Labyrinth and Brain stem issues IE vertigo, dizziness, dysarthria, diplopia and numbness.
- DM ***
- Emboli
- Thrombi
- Arterial dissection
What are the three indications for Carotid Endarterectomy?
> 80% occlusion
OR
> 70% occlusion + symptoms
OR
Male with >59% + symptoms
What are the three nerves that can get damaged during Carotid Endarterectomy?
What symptoms do you see due to damage of these nerves?
- Hypoglossal Nerve (CN 12)
- -> tongue deviation toward lesion - Facial Nerve (CN 7)
- -> Asymmetric smile - Recurrent Laryngeal Nerve
- -> unilateral vocal cord paralysis
- -> change in voice.
Posterior communicating Artery aneurysm often presents with what symptoms?
CN 3 pathology (Occulomotor)
- Ptosis (laveter palpebra)
- Aniscoria (unequal pupils)
- diff with accommodation
- problem with eye movement, diplopia
Spina Bifida is the failure of neural tube closure during fetal development…what is the difference between
Meningocele and Myelomeningocele?
In patient with Myelomeningocele…even after surgery many can have what deficits?
Meningocele = herniation of meninges only Myelomeningocele = Herniation of meninges and spinal cord.
Neurogenic bladder, neurogenic bowel and motor/sensory deficits.
Amyotrophic Lateral Sclerosis is a CLINICAL dx with >2 regions of UMN disease and >1 region with LMN disease…
What are symptoms of UMN vs LMN disease?
What is PROGNOSIS?
UMN:
- Spastic paralysis
- Increased DTR
- babinski
LMN:
- Flaccid Paralysis
- Decreased DTR
- Fasciculations
- Muscle atrophy
DEATH IN 3-5 YEARS due to respiratory failure
What drug can help prolong survival in ALS?
What is the mechanism of action?
RILUZOLE
glutamate inhibition
Treatment of essential tremor?
Propranolol
What is the genetics of TUBEROUS SCLEROSIS?
What are the S/S you see in the following systems:
- SKIN
- CNS
- HEART
- RENAL
Autosomal dominant mutation of TSC 1 or TSC 2 gene. \
- SKIN:
- Ash leaf spots – hypo pigmented macules
- Shagreen patches – thick, pebbly skin - CNS
- Glioneuronal hamartomas
- Autism/Cognitive disability
- Epilepsy - HEART
- Rhabdomyoma - RENAL:
- Agiomyolipoma
Are individuals with Tuberous Sclerosis at an increased risk of malignancy, given their numerous growths?
NO, growths rarely undergo malignant transformation.
IF you suspect Tuberous Sclerosis, what five exams must you do in your initial work up?
- Thorough skin exam
- EEG
- MRI brain –> hamartomas
- Fundoscopy –> Hamartomas
- Abd imaging –> Renal mass
What is the leading cause of death for individuals with Tuberous Sclerosis?
Neurologic impairment (seizures, hydrocephalus, ext)
What is the first line TRX for a PROLACTINOMA?
DA RECEPTOR AGONIST
- Bromocriptine
- Cabergoline
(even large tumors can be managed medically)
What is First line TRX for Alzheimers?
What agent can you add if mod-severe (mmse < 17)
FIRST LINE = Acetylcholinesterase Inhibitors
- DONEPEZIL
- RIVASTIMINE
- GALANTAMIE
Add Memantine