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Residency > Neurology > Flashcards

Neurology Flashcards

1
Q

Acute Disseminated Encephalomyelitis

A

Post-viral AI demyelinating perivenular inflammatory myelinopathy which can present as hemiparesis, sensory compromise, ataxia, optic neuritis, transverse myelitis, seizure, myoclonus

  • NOT ASSOCIATED W/ CN ISSUES
  • Difficult to differentiate from initial MS attack

Tx: Acyclovir should be started for HSV prophylaxis, however, steroids are mainstay of treatment

  • Can try IVIG after
  • Supportive tx as well
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2
Q

Adie pupil

A

Tonic pupil that has poor reaction to light but will accommodate on near gaze; slow to dilate after constriction

-Due to damage at the parasympathetic ciliary ganglion or short ciliary nerves

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3
Q

Parasympathetic nerves in CN III

A

Sit on outside of nerve just underneath epineureum therefore they are more susceptible to compression

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4
Q

Anisocoria

A

Unequal pupil size

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5
Q

PCA aneurysm causes what CN sign?

A

CN III Palsy

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6
Q

New CN III palsy; what should you do?

A

CTA or MRA

Any new CN III palsy is a neurologic emergency

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7
Q

chronic inflammatory Demyelinating polyneuropathy

A

Patients present with progressive symmetrical polyneuropathy over the course of at least two months; symptoms consist of weakness, impaired reflexes/balance

Biopsy: Segmental demyelination of nerve axons

Testing: Cytoalbuminologic dissociation

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8
Q

️Nucleus affected in internuclear ophthalmoplegia

A

Medial longitudinal fasciculus

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9
Q

Lahermitte sign

A

sensation of electricity running down the spine and extending to the limbs

Can be elicited by Flexion of the neck

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10
Q

MRI imaging in MS

A

Lesions are bright on T2 and located at the Periventricular, juxtacortical, and Infratentorial regions

“Dawson’s fingers”

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11
Q

Antibodies to check in MG pt who is negative for anti-Ach

A

Anti-MuSK or anti-Lrp4

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12
Q

Ways to test severity of MG

A

FVC and Negative inspiratory pressure

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13
Q

Oculomotor ophthalmoplegia

A

Drooped eyelid

Down and out eye

Dilation of the eye

-Warrants immediate workup

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14
Q

If you see a damaged lateral rectus muscle, what must you check?

A

ICP

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15
Q

What percent of people w/ TIAs go on to have stroke?

A

80% in 3 yrs; but many are in the following days/weeks

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16
Q

Akinetic mutism

A

Decreased thought, movement, and speech; associated sometimes w/ stroke

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17
Q

PCA stroke symptoms

A

Contralateral homonymous hemianopsia w/ macular sparing (1) and memory deficits (2)

Due to 1. dual supply by the MCA and 2. damage to the hippocampus

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18
Q

Stroke showing only motor deficits and no aphasia, vision loss, decreased consciousness

A

Suspect stroke of the lenticulostriate arteries supplying the internal capsule

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19
Q

Patient who is suddenly unable to feel pain

A

Thalamic stroke

-Could involve the posterior communicating artery, anterior choroidal artery, or PCA

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20
Q

Weber’s Syndrome

A

Stoke of the penetrating arteries of the PCA supplying the crus cerebri and CN III

-Presents w/ contralateral paralysis and ipsilateral oculomotor ophthalmoplegia

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21
Q

Claude’s Syndrome

A

Stroke involving the small branches of the PCA or basilar artery supplying the midbrain tegmentum

Presents w/ contralateral tremor (due to red nucleus involvement) and ipsilateral oculomotor ophthalmoplegia

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22
Q

Locked-In Syndrome

A

Bilateral syndrome of the basal pons that occurs following basilar artery stroke

Patient is paralyzed entirely except for eye movement

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23
Q

Wallenburg’s Syndrome

A

Occurs due to stroke of the PICA which supplies the dorsolateral area of the medulla

Patients have contralateral loss of pain/temp sensation and ipsilateral loss of pain/temp in the FACE, vertigo, nystagmus, N/V, ataxia, (vestibular nuclei involvement) dysphagia, dysphonia, weak gag reflex (IX and nucelus ambiguus) and Horner’s syndrome (loss of sympathetic tract)

24
Q

Medial medullary Syndrome

A

Causes Contralateral loss of fine touch, vibration, and proprioception, spastic paralysis, and deviation of tongue to side of lesion

25
Q

Cushing Response

A

HTN

Bradycardia

Irregular respirations

26
Q

Nonmotor symptoms of Parkinson’s

A

REM sleep behavioral disorder

Hyposmia

Autonomic dysfnxn (constipation, urinary frequency, orthostatic hypotension)

Depression

27
Q

Corticobasal degeneration

A

Unilateral neurogenerative disorder assoc. w/ Parkinsonism and apraxia

***Most notably, these pts have “alien limb syndrome” where their limb behaves with a mind of its own

28
Q

PSP

A

Progressive Supranuclear Palsy

Neurodegenerative condition w/ parkinsonism and impaired voluntary vertical gaze (supranuclear ophthalmoplegia)

-Sentinel symptom is often fall as these patients have limited downward gaze

29
Q

Is Parkinson’s a familial disorder?

A

RARELY; 90% of cases are actually sporadic

30
Q

COMT inhibitors

A

Entacpone, tolcapone

-Inhibit peripheral breakdown of dopamine

31
Q

MAOB inhibitors

A

Selegiline, rasagiline

  • Improves symptoms of patients already on LDOPA and can be useful in mild Parkinson’s
  • Caution of SS w/ use of SSRIs
32
Q

Use of amantadine in Parkinson’s

A

Can alleviate LDOPA induced dyskinesia

33
Q

Diagnostic Features of Lewy Body Dementia

A
  1. Central feature: Progressive cognitive decline that interferes w/ normal social or occupational fnxn
  2. Core features (two): Fluctuating cognition, recurrent visual hallucination, features of parkinsonism
  3. Suggestive features (one + core feature): REM sleep behavior disorder, severe neuroleptic sensitivity, low dopamine transporter uptake in BG as demonstrated by SPECT or PET
  4. Supportive features: Repeated falls, syncope, autonomic dysfnxn, delusions, depression, preservation of temporal lobe structures on imaging, slow wave activity on EEG w/ temporal lobe transient sharp waves
34
Q

Most sensitive test for MG

A

Single-fiber EMG; tests the recording of individual muscle fiber potentials within one motor neuron unit

35
Q

Velphoro

A

Sucroferric oxyhydride

Primarily fnxns as a phosphate binder

36
Q

Vitamin D intoxication symptoms

A

Confusion, polyuria, polydipsia, anorexia, vomiting, muscle weakness

Chronic =» nephrocalcinosis, bone demineralization, pain

-Similar to hypercalcemia

37
Q

Pseudotumor cerebri

A

Condition of increased ICP in overweight women of childbearing age; has 25% chance of permanent vision loss

CFs: Headache, papilledema, vision loss, (sometimes) CN VI palsy

*Can we worsened/caused by tetracyclines; OSA can also worsen

MRI findings: Tortuous optic nerve, empty sella, intraocular protrusion of optic nerve, enhancement of optic nerve
-These are not always seen but suggestive

Tx: Weight loss; acetazolamide, lasix
Visual symptoms: Optic nerve fenestration and/or CSF shunt

-Can try topiramate if acetazolamide intolerant

38
Q

When does rash occur w/ dermatomyositis?

A

Precedes the weakness; typically occurs w/ age >40

-Can also see dysphagia

39
Q

Other complications w/ dermato/polymyositis

A

Interstitial pneumonitis (10%)

CHF, LBBB/RBBB

Increased risk of malignancy

40
Q

Shawl sign

A

Erythematous rash in “V” distribution on the chest and across the shoulders consistent w/ dermatomyositis

41
Q

Inclusion Body Myositis

A

Gradual onset of weakness dating back for several years and weakness also affects distal muscle groups

-Often see atrophy of deltoids and quadriceps

CK often only mildly elevated

***Can have peripheral neuropathy w/ loss of deep tendon reflexes

42
Q

Initial therapy for inflammatory myopathies

A

Initial: Prednisone for 4-6 weeks w/ 9 month taper

-Start MTX or azathioprine at the same time

43
Q

Most common muscle acquired disease in pts >50 years old

A

Inclusion-Body Myositis

44
Q

Marker for CJD

A

14-3-3 proteins in pt CSF

45
Q

Only cortical dementia that effects the occipital lobe

A

Lewy Body Dementia

46
Q

Meds to avoid w/ Alzheimer’s patients

A

ANTICHOLINERGICS

47
Q

Nonconvulsive status epilepticus

A

Persistent AMS following seizure; can manifest w/ nystagmus, mild twitching, presence of UMN signs

48
Q

Miller-Fisher variant

A

Most common subtype of Guillan-Barre which has the triad of…

  1. Areflexia
  2. Ataxia (out of proportion to sensory deficits)
  3. Ophthalmoplegia
    - Also see predominantly CN weakness > Extremity weakness

**(+) anti-GQ1b (ganglioside) abs

49
Q

Acute Motor-sensory axonal neuropathy

A

GB subtype seen in adults w/ significant muscle atrophy and poor prognosis for recovery

50
Q

Indication for intubation w/ Guillan-Barre

A

FVC <15ml/kg or NIF

51
Q

Spinal Cerebellar Ataxia

A

Caused by a trinucleotide expansion of CTG

Typically presents at age 20-30 years and may present with other signs such as dysarthria, pyramidal signs, peripheral neuropathy, impaired reflexes, cognitive impairment, myoclonus, spasticity, and oculomotor abnormalities

MRI will reveal cerebellar atrophy

-Should always test other family members once repeat is identified

52
Q

Machado-Joseph Disease (MJD)

A

Most common SCA subtype (SCA-3) but has a variable presentation

CFs: Cerebellar ataxia, parkinsonism, spastic paraplegia, neuropathy, and restless legs

-May also see (but no specific) impaired temperature discrimination, pseudoexophthalmos, faciolingual myokymia, and dystonia

Tx: Supportive

53
Q

Limbic encephalitis

A

Inflammatory process involving the limbic cortex (mesial temporal lobes, hippocampus, amygdala) classically caused by an AI or paraneoplastic process

54
Q

Anti-NMDA encephalitis

A

Paraneoplastic or AI encephalitis caused by antibodies against the NMDA-type glutamate receptors that begins w/ psychosis and progresses to depressed consciousness, seizures, and coma

MRI can show hyperintensity in limbic cortex and other deep structures but is normal 70% of the time

EEG reveals generalized slowing

Tx: Corticosteroids + IVIG

May need to consider rituximab or cyclophosphamide if refractory

55
Q

Options for foot drop treatment

A

AFO, provides doesiflexion during foot upswing

Functional electrical simulation device, sensor pad detects change in stance and triggers an intact peroneal nerve to stimulate tibialis anterior and peroneous longus

Prognosis: Peripheral compressive ➡️ 3 months

Complete axon loss ➡️ variable because regeneration is at 1mm day

Nerve root compression ➡️ POOR IF >6 months, negative straight leg raise test, and old age

Residency (5 decks)

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