Neuro review 2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Head trauma, disoriented => lucid => coma | Epidural Hematoma
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| Lens shaped hemorrhage | Epidural Hematoma
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| Concave shped hemorrhage | Subdural Hematoma
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| Unilateral facial weakness w/ inability to close eye | Bell palsy (self-limiting)
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| Adolescent female w/ HA. +FHx. Severe HA, N/V, photphobia. +/- auras (usu contra to HA) | Migraine HA
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| Male, recurrent relapsing HA. Worsened w/ EtOH, Lacrimation, salivation, rhinorrhea | Cluster HA
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| Sudden onset thunderclap HA, "worse HA of my life" | Subarachnoid hemorrhage
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| >50 yo female w/ HA. Temporal artery tenderness or blindness | Temporal arteritis (Giant cell arteritis). Elevated ESR, get temporal artery biopsy
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| Recurrent episodes of vision change, diplopia, weakness & tingling in extremities that resolve | MS
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| HA worse in AM w/ focal neuro deficits | Brain Tumor (MC is glioma)
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| s/p Fall w/ bilateral LE weakness, urinary and rectal incontinence, decreased rectal tone | Cauda equine syndrome = neurosurgical consult
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| Ascending paralysis | GBS
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| Paralysis after Campylobacter enteritis | GBS
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| Young kid with difficulty standing from seated position. Calf muscle wasting | Muscular dystrophy (weakness begins at pelvic girdle)
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| Pediatric with fever or Hx URI with encephalopathy, emesis, hyperactive reflexes, hepatomegaly, elevated liver enzymes | Reye's syndrome from URI/post-flu or aspirin use
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| "Ash leaf" hypopigmentation of trunk & Ext, shagreen patch, sebaceous adenomas, seizures, mental retardation; assoc w/ PCK, renal hemartomas | Tuberous sclerosis (auto dominant)
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| Ortho BP defn | drop of 20 (SBP) or 10 (DBP) within 3 min of standing
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| fluctuating weakness/fatigability of voluntary mx (diplopia, blurry vision, ptosis, difficulty swallowing); resp difficulty, limb weakness (worsened w/activity); bulbar sxs (dysarthria, dysphagia, fatigable chewing) | Myasthenia gravis
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| Light touch: Side of Neck: | C2-3
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| Light touch: Tip of Shoulder: | C4
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| Light touch: Lateral Deltoid: | C5
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| Light touch: Thumb: | C6
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| Light touch: Middle Finger: | C7
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| Light touch: Pinky Finger: | C8
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| Light touch: Medial Forearm at elbow: | T1
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| Light touch: 1st Dorsal web: | Radial nerve
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| Light touch: Palmar middle pad: | Median
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| Light touch: Palmar small pad: | Ulna
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| Light touch: Groin: | L1
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| Light touch: Upper thigh: | L2
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| Light touch: Outer thigh at knee: | L3
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| Light touch: Medial ankle: | L4
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| Light touch: Dorsal 1st web space: | L5
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| Light touch: Lateral ankle: | S1
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| Light touch: Buttock: | L2-3
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| Light touch: Perianal: | L4
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| DTR: Biceps: | C5
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| DTR: Brachioradialis: | C6
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| DTR: Triceps: | C7
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| DTR: Knee: | L 3,4
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| DTR: Ankle: | S1
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| DTR: 0: | absent
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| DTR: 1: | diminished
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| DTR: 2: | average
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| DTR: 3: | exaggerated
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| DTR: 4: | clonus
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| Ischemic stroke pathophys | atheroembolic (50%); cardioembolic (30%); OR 2/3 thrombotic & 1/3 embolic
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| Stroke pathophys | 80% ischemic, 20% hemorrhagic
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| Hemorrhagic stroke pathophys | parenchymal ICH (10-15%); subarachnoid (5-10%)
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| Most common parenchymal ICH: | Hpertensive intracerebral hemorrhage
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| Primary ICH presentation | HA, N/V; progressive hemiparesis & hemisensory def; HTN (on hx and on PE)
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| Primary hypertensive ICH: typical locations | Thalamus; Basal Ganglia; Pons; Cerebellum
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| ICH presentation: Thalamus/ Basal Ganglia | Contralateral Motor/ Sensory Deficit; Aphasia, Neglect; Depressed LOC with mass effect, IVC extension
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| ICH presentation: Cerebellum | Ipsilateral Ataxia; Depressed LOC
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| ICH presentation: Pons | Vertigo, Diplopia; Crossed signs; Depressed LOC
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| Anterior circulation consists of: | Ant choroidal, ant cerebral, MCA
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| Anterior circulation supplies: | Cortex, subcortical white matter, basal ganglia, internal capsule
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| Anterior circulation stroke | Hemispheric s/s: aphasia, apraxia, hemiparesis, hemisensory loss, visual field defects
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| Posterior circulation consists of: | Verterbral & basilar arteries
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| Posterior circulation supplies: | Brain stem, cerebellum, thalamus, parts of temporal & occipital lobes
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| Posterior circulation stroke | Sxs of brainstem dysfn: coma, drop attacks, vertigo, N/V, ataxia
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| Thrombotic vs embolic stroke sx progression | Thrombotic: stepwise progression, often preceded by TIA; Embolic: abrupt & without warning
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| Amyloid angiopathy stroke: patho | Blood vessel degeneration; Dementia; Lobar hemorrhage
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| Amyloid angiopathy: presentation | Dementia; Episodic worsening; No h/ o HTN; poss acute limb weakness; BP less severe than in ICH; stroke d/t cerebral microhemorrhages
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| Venous infarction presentation | h/o OCP/SMK; HA; aphasia, weakness
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| Most common cause of subarachnoid bleed | aneurysm
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| Subarachnoid bleed: RF | HTN; SMK; heavy EtOH; genetics (polycystic kidney dz; Ehlers-Danlos; 1st-degree relative)
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| SAH stroke presentation | Abrupt severe HA; meningismus; depressed LOC; nonfocal neuro exam; BP rises precipitously; poss temp to 39C
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| Atheroembolic stroke characterized by: | Single vascular territory; Warning signs; Stepwise progression
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| Atheroembolic stroke presentation | Hx HTN, CAD; transient language disturbance; transient weakness
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| Ant cerebral art infarct: likely fx: | contralateral leg (motor > sensory)
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| MCA infarct: likely fx: | face/arm more than leg/vision; poss aphasia
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| Vertebrobasilar art infarct: fx: | Midbrain: 3d nerve nuclei; ipsilateral ptosis; eye deviated outward (bc CN VI is fine, but III is affected); crossed signs: pt has CNIII probs on one side and sensory probs on opp side of body
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| Subcortical infarct effects by body area: | face = arms = legs
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| Cortical infarct fx by body area: | gradation btw face, arms, & legs
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| Lacunar syndromes | Pure Motor Stroke; Pure Sensory Stroke; Ataxic Hemiparesis; Clumsy Hand Dysarthria
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| Cardioembolic stroke presentation | h/o A fib; aphasia; hemiparesis/hemisensory deficit affecting face and arm
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| Cardioembolic: dx | Maximal deficit at onset; Multiple vascular territories; Cardioembolic source; Hemorrhagic infarction (Wedge shaped infarct towards cortical surface)
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| Cardioembolic: possible etiology | A fib; Cardiomyopathy; Acute MI; Valvular heart dz
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| TIA S/S | Acute focal neuro def; S/S resolve within 24 hr; No rad evidence of infarction; Ischemic etiology, usu carotid or vertebral vascular distn
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| TIA: risk of subsequent stroke: | 11% risk of stroke within 3 mo; 1/3 of TIAs have stroke within 5 yrs; 63% of strokes occur within the first wk, 85% within first month
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| Modifiable RF for first stroke | *HTN*; A fib; carotid stenosis; DM; hyperlipidemia; prior stroke/TIA
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| Prevention of A fib RF: | Low risk (0-1) ASA; mod (2) ASA or warfarin (but AE/bleed risks); high risk (>2) warfarin
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| Stroke prevention DM pts | glucose ctrl: no fx on stroke/macrovascular comp; tight BP ctrl (<130/80) effective; statins
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| TIA carotid: S/S | contralat hand-arm weak & sensory def; ipsilateral visual sx & aphasia or amaurosis fugax; poss carotid bruit (absent in high grade stenosis)
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| TIA vertebrobasilar S/S | diplopia, ataxia, vertigo, dysarthria, CN palsies, LE weak, blurred vision, perioral numbness, poss drop attacks
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| TIA DDx | Sz, migraine, syncope, hypoglycemia, mass lesion
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| SAH etio: aneurysm | nontraumatic: 75% saccular (berry) aneurysm, 50% mort; 5th-6th decade, M=F
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| aneurysm RFs | SMK, HTN, high chol; PKD, coarct
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| complex partial sz | may have aura, then impaired consciousness
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| simple partial sz has no: | impairment of consciousness
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| Most common cause of tonic-clonic in pts (onset < 30 yo): | idiopathic epilepsy
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| Clonic seizures: | usu in childhood; impaired consciousness, followed by asymmetric bilateral jerking
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| Most common seizure type: | complex partial
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| complex partial sz: | 10-30 yo; common post-head trauma; 50% abnml CT/MRI; 50% mesial temporal sclerosis; 20% hamartoma
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| complex partial sz: etio by age | 30-60 yo: poss brain tumor; >60 yo: more likely stroke
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| Status epilepticus dx does not apply to: | continuous simple partial seizures
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| EtOH withdrawal seizure: | onset 6-48 hr after last drink; often primary generalized, often have Todd paralysis
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| Sz remission: | usu within 3 yrs of first seizure; prolonged remission in 60% of such pts
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| Factors against sz remission | FH; psych comorbid; febrile seizure hx; more seizures; age
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| Todd paralysis = | post-ictal focal weakness in part of body, confined to L or R, usu arms/legs
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| Most common agent of meningitis in adults | S. pneumo
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| Meningitis general S/S | HA, fever, neck / back stiffness, neuro impairment
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| Meningitis presentation | acute (hrs - days), usu w/ fever, HA, stiff neck, lethargy; usu without focal sx
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| Typical purulent meningitis orgs | N. meningitidis, S. pneumoniae, or H. influenzae
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| Chronic meningitis: orgs | TB; fungal
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| Encephalitis presentation | diffuse infxn; confusion, lethargy, often seizures; CSF may be normal
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| N. meningitidis | petechial rash; GN diplococci; often assoc w/DIC
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| H flu meningitis: commonly found: | less common in adults; in setting of otitis or sinusitis
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| Tuberculous meningitis S/S | usu gradual onset; listlessness & irritability; CN palsies;
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| Abscess: common orgs | streptococcus, staphylococcus or anaerobes
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| Rabies S/S | (> 10 days) delirium, painful swallowing, rage alternating with calm
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| Rabies incubation period | >10 days (usu 3-7 wks) (infected animal dies within 5-7 days)
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| Herpes encephalitis: commonly found: | more common in elderly; often medial temporal lobes
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| CJD S/S | usu later in life; rapidly progressive dementia, myoclonus, ataxia & somnolence; epileptiform pattern on EEG
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| MS S/S | Optic neuritis; Transverse myelitis; Paresthesias; focal neuralgia; Ataxia; Weakness/ incoordination; Spasticity; Cognitive impairment
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| Lhermitte's sign = | electrical sensation down body w/ neck flexion; seen in MS
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| MS pathophys | immuno d/o assoc w/CNS Ig prodn & T-lymph alteration; poss viral etio
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| MS pattern of sxs | affect multiple areas over time (if they don't, prob not MS)
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| Anti Epileptic Drugs: titration | Start low & gradually increase; initiate with 1/3-1/4 of anticipated maintenance dose & increase over 3-4 weeks
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| when Anti Epileptic Drugs may be dc'd: | If onset btw age 2-35 & normal EEG; seizure-free period 2-4 yrs; complete ctrl within 1 yr; very gradual taper over 6 mos; relapse usu within first few mos after withdrawal; f/u in 5 yrs if no probs
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| Majority of malignant gliomas are: | grade IV tumors (GBM or gliosarcomas)
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| Gliomas include: | Astro (Grade 1); oligo (2); ependymoma; glial cells
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| Grade 3 Glioma = | Anaplastic Astrocytomas, Anaplastic Oligodendrogliomas
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| Grade 4 Glioma = | GBM; Gliosarcoma
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| Diffuse astrocytomas include: | Low-grade infiltrative Astro (WHO II); anaplastic astro (WHO III); Glioblastoma (WHO IV)
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| Circumscribed astrocytomas include: | Pilocytic Astro (WHO grade I); Pleomorphic xanthoastrocytoma (PXA); Subependymal giant cell Astro (SEGA)
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| Well-differentiated Astro: | 10-15% of Astros; 35 yo; 5-10 yr surviv; cerebral hemi / cortex; slow growing; often undergo malig progression to AA or GBM
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| characteristic of high-grade gliomas (III/IV): | Invasion via white matter tracts, cross via corpus callosum
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| Primary characteristic of a grade IV glioma = | necrosis with vascular proliferation
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| Anaplastic astro | High-Grade; 1/3 of Astros; 45 yo; 3 yr surviv; usu in cerebral white matter; relatively fast-growing; Frequent progression to GBM
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| GBM | usu in cerebral hemi white matter; spreads rapidly & diffusely; Ring of tissue around necrotic core; Highly vascular
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| Oligodendroglioma | Usu presents at low-grade (II) stage; young / middle-aged; grade II >10 yr surviv; Fried-egg cells
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| Most common primary brain neoplasm = | GBM
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| Untreated GBMs: growth | double in size in 14 days
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| Brain tumor: genl clin presentation | HA; seizures; Cognitive dysfn; Focal neuro deficits; N/V; Sx endocrine dysfn; Visual sx; Sx from plateau waves (ICP changes)
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| Headache in brain tumor | 20% of pts present w/HA (more w/ post fossa tumor); usu d/t inc ICP; Progressive increase in HA freq & severity; Classic HA on waking or HA that wakens one from sleep
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| Seizure in brain tumor | 35% of pts present with this; often the sx that precedes dx; focal or secondarily generalized
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| Probably most common problem in pts w/brain tumors = | cognitive dysfn (Frontal personality; Memory problem; Depression)
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| Cognitive dysfn: Left hemispheric tumors: | language dysfunction
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| Cognitive dysfn: Right hemispheric tumors: | problems with visual perception & scanning
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| Brain tumor: Focal neurologic deficits | Hemiplegia; Hemiparesis; Ataxia; Nystagmus; Can mimic stroke
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| Brain tumor: N/V more common in: | posterior fossa tumors
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| Endocrine sxs in brain tumor: | hypothyroid; dec libido
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| Visual symptoms in brain tumor include: | Contralateral flashing lights; Visual field loss; Diplopia
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| Low grade glioma: Tx | Bx (confirm dx & r/o high grade); seizures only: defer tx til progresses; if progressive sx: resect +/- CTx (+ RTx only if refractory)
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| Second leading COD in brain tumor pts: | thromboembolic complications
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| Meningioma | slow growing, benign; attached to dura mater; 13-26% of primary IC tumors; RF: prior radiation; often Asx; visual complications; DDx: neurofibromatosis; Firstline tx: Surgery
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| Ependymoma: worse prognosis: | <3 yo
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| Ependymomas within brain: locations | Infratentorial > supratentorial (2:1)
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| Ependymoma | Usu slow growing; kids & YA; young adults; 4% all BT; from walls of ventricles or spinal canal (obstructive hydrocephalus); 90% are in brain, 10% in spinal cord (often adults)
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| Characteristics of Medulloblastoma | Malig, invasive embryonal cerebellar tumor; kids & YA; 70-80% 5-yr survival; Most arise in vermis (4th ventricle involvement)
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| Medulloblastoma: metastases | Metastasize via CSF pathways (Drop Mets); Rare mets to bone, lymph nodes, other extracranial sites
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| Characteristics of Primary CNS lymphomas | Usu present deep in brain parenchyma; usu multifocal (diffuse lg cell B-cell lymphoma); Survival w/o tx <1 yr; Steroid tx & Methotrexate CTx
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| most common spinal tumor: | ependymomas; 10% of spinal tumors are intramedullary
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| Brain tumor: frontal lobe: S/S: | cog decline; contralat grasp reflex; expressive aphasia
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| Brain tumor: temporal lobe: S/S: | sz, olfactory hallucination, depersonalization, vis field def, auditory illusions
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| Brain tumor: parietal lobe: S/S: | contralat sensory def; cortical sens loss (stereognosis); inattention
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| Brain tumor: occipital lobe: S/S: | crossed homonymous hemianopia / partial field defect; visual agnosia
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| Brain tumor: brain stem/cerebellar: S/S: | CN palsies, ataxia, incoordination, nystagmus, pyramidal & sensory def
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| Lucid interval seen in what trauma? | epidural hematoma
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| subdural hematoma: blood source | usu venous (bridging veins in space)
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| subdural hematoma: etiology | Acceleration/ Deceleration injury; Veins transversing subdural space
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| Orbital blowout fx | comminuted floor fx: herniated orbital contents; inf rectus mx entrap or vert diplopia d/t edema; blood in max sinus when orbital trauma
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| 2/3 of all cerebral infarcts are: | MCA stroke
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| Lacunar stroke | 15-20% of strokes; small vessel ischemia; HTN; usually pure sensory OR motor
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| Astrocytoma | Glial tumors: 40-50% of CNS Neoplasms
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| Astrocytoma: Grade IV | GBM (45-55 yo); necrosis/ hemorrhage, edema, ring enhancement
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| Meningioma | 50-60 yo; may increase in PG; various grades (90% benign)
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| Brain neoplasm: mets | 1/3 of all intracranial neoplasms; lung, breast, melanoma, colon, lymphoma, prostate
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| Brain neoplasm: most common site for kids (unlike adults) | posterior fossa (medulloblastoma)
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| Argyll Robertson pupil = | pupil reacts to light but does not accommodate (seen in tertiary syphilia/tabes dorsalis)
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| NPH (chronic hydrocephalus) S/S: | Incontinence, gait abnormalities, dementia
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| Ulnar neuropathy | stretch / compress ulnar n.; cubital tunnel or Guyon canal; d/t pressure, bone spurs, cysts; sensory precede motor sx
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| Ulnar neuropathy: provoking factors | Elbow Flexion (Cubital), Wrist Extension (Guyon); Nighttime
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| Radial neuropathy: etiology | axilla (crutches); Saturday night palsy; handcuffs; humerus fx
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| Radial neuropathy: S/S | Motor>sensory; weakness in extension & arm ext rotation; forearm atrophy; xray shoulder/humerus
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| Meralgia paresthetica: S/S | pain, paresthesia, numb; outer thigh; usu unilateral (relieved by sitting); no motor sx
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| Fem neuropathy: RF | lithotomy posn (inguinal lig); DM; retroperitoneal neoplasm/hematoma; pelvic fx; fem art cath (n. trauma)
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| Fem neuropathy: S/S | Quads atrophy/weakness; sensory impairment anteromedian thigh; decreased patellar DTR; EMG/NCS; CT/MRI
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| Sciatic n. palsy: S/S | weakness w/ leg flexion, dorsiflexion & foot eversion (drop foot); hamstring & ankle DTR dec/absent; sensory loss posterior thigh/leg/foot; tingling/burning/lanceting pain (worse w/standing, cough)
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| Peroneal n. palsy: S/S | weak dorsiflexion (foot drop) & eversion; sensory loss/ paresthesia: anterolateral calf & foot dorsum
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| CN VII palsy (Bell): etiology | idio; HIV, sarcoid, Lyme, tumor; HSV infxn? RF = PG, DM
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| CN VII palsy: S/S | abrupt; facial paralysis (some upper sparing); drooping corner of mouth; ptosis/ forehead smooths out; ear pain; dysgeusia; hyperacusis
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| CN VII palsy: to distinguish btw peripheral & central lesion: | peripheral: complete paralysis forehead mx; central: partial sparing forehead mx
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| CN VII palsy: prognosis | 60% spont resolve; 10% perm disfigurement/dysfn; best indicator of severity = progress first 2-3 days; worst: complete palsy at onset, advanced age, hyperacusis, severe initial pain
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| Charcot-Marie-Tooth: genetics | usually auto dom
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| Charcot-Marie-Tooth: patho | Type I: demyelinating; II: axonal; Motor>Sensory; Lower > Upper; childhood/young; slow progression
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| Charcot-Marie-Tooth: CMT I vs CMT II: S/S | CMT II: less mx wasting/ secondary weakness; less common postural tremor/arm involvement; NO peripheral n. hypertrophy
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| Dejerine-Sottas Dz (CMT III): pathophys | phytanic acid disturbance; prog demyelinating neuropathy; infancy/kids
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| Dejerine-Sottas Dz: S/S | weakness, ataxia; sensory loss; DTR: global hyporeflexia
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| Refsum dz: patho | Progressive demyelinating neuropathy; early childhood
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| Refsum dz: S/S | weakness, ataxia; sensory loss; DTR: global hyporeflexia; retinitis pigmentosa; Tx supportive
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| Systemic-metabolic neuropathies include: | DM; uremia; alcoholic & nutrition def; paraproteinemias; CTD, amyloidosis
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| DM neuropathy | sensory precedes motor; lower ext precedes upper; Hx: autonomic sx?; NCS nml / mildly slow
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| Charcot arthropathy | 2/2 Joint Subluxation, Periarticular fx; rocker bottom foot; pain, swelling, ulceration
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| Uremia: S/S | Symmetric sensory-motor; lower ext > upper; distal > proximal; severity correlates with degree of renal insufficiency
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| Neuropathy: EtOH/ Nutritional deficiency | cobalamin (B12) def; axonal > myelin; slow progression
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| EtOH/Nutritional deficiency: S/S | Distal symmetric Polyneuropathy; sensory precedes motor; Lower ext precedes upper; cramps, painful paresthesias, tenderness; CNS Sx often precede PNS; mental status change; myelopathy; optic neuropathy
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| AIDP (GBS): patho | Progressive Demyelinating; prob immune-mediated; Axonal Subtypes (AMAN; AMSAN)
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| AIDP (GBS): Motor S/S | Ascending weakness; Symmetric; Proximal > Distal mx; Lower ext before Upper; Advanced: Resp mx Compromise, CN Involvement
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|
||||
| AIDP (GBS): Sensory S/S | Pain/paresthesias; Loss of Sensation; Distal before Proximal; DTR: Global hyporeflexia or areflexia; autonomic dysfn: tachycardia, cardiac irreg; BP changes, pulmonary dysfn, loss of rectal tone
🗑
|
||||
| Leprosy: 2 Types: | tuberculoid (multifocal) & lepromatous (symmetrical)
🗑
|
||||
| MG pathophys | Abs vs acetylcholine receptors
🗑
|
||||
| LEMS pathophys: | defective release of Ach in response to nerve impulse; may be assoc with small cell ca
🗑
|
||||
| MG vs LEMS: S/S | LEMS: power increases w/sustained contraction; MG: fatigability
🗑
|
||||
| Ataxic (intention) tremor | Absent at rest/start of movement; dysmetria; Dz of cerebellum / connections (MS; tumors; infarct; ethanol-induced cerebellar degeneration)
🗑
|
||||
| Athetosis = | slow writhing purposeless movements usu involving hands, tongue & face; usu in kids w/ cerebral palsy or result of kernicterus or hypoxia
🗑
|
||||
| Chorea: Sx | Involuntary, irregular jerky movements; can cause continuous movements.
🗑
|
||||
| Chorea: may be due to: | untreated strep infxn (Sydenham chorea), PG (chorea gravidarum) or Huntington dz
🗑
|
||||
| Tics | onset 2-13 yo; tx Haldol/pimozide
🗑
|
||||
| Hemiballismus | Violent flinging movements; Unilateral hemiballismus usu d/t infarct in contralateral subthalamic nucleus of Luys
🗑
|
||||
| Dystonia: | Maintenance of a persistent extreme posture in one or more joints.
🗑
|
||||
| Focal dystonias: | torticollis, writer's cramp, blepharospasm; tx Botox / surg
🗑
|
||||
| Parkinson dz: Sx | Rest tremor/3-6 hz; pill rolling; cogwheeling; rigidity; bradykinesia; difficulty initiating movement; masked facies; stooped posture, shuffling; disturbance of postural reflexes; diminished eye blinking rate
🗑
|
||||
| Parkinson dz: Patho | Degen nigrostriatal pathway, raphe nuclei, locus ceruleus & motor nucleus of vagus; dramatic loss of DA-containing neurons
🗑
|
||||
| Huntington Dz presentation | AD, varying age of onset; Sx often begin w/ psych disorder (immaturity, impulsivity, depression); later apathy & dementia; Chorea, Athetosis; butterfly ventricles (caudate atrophy)
🗑
|
||||
| Huntington chorea due to: | DA excess state
🗑
|
||||
| Wilson dz | Auto rec; onset 2nd-3rd decades; first sx: hepatic dysfn/cirrhosis; tremor/ bradykinesia, dysarthria, dysphagia; limbs rigid, facial mx fixed empty smile; arms: wing-beating tremor; Kayser-Fleischer (deep cornea)
🗑
|
||||
| Wilson: patho | CNS changes: brownish discoloration of some basal ganglia; proliferation of protoplasmic astrocytes (Alzheimer Type II cells)
🗑
|
||||
| Tardive dyskinesia: Sx | Abnormal BLM (tongue thrusting & chewing); head movements (turning & bobbing); poss also abnormal limb movements; Sx can fluctuate & may take mos-yrs to resolve (sometimes permanent)
🗑
|
||||
| Tardive dyskinesia: most successful tx: | achieved with DA-depleting agents (tetrabenazine); also Vitamin E?
🗑
|
||||
| Action of acetylcholine & DA: | Act in opposite directions; adding DA is equivalent to blocking acetylcholine
🗑
|
||||
| Huntington dz genetics | Huntingtin gene is on short arm of chromosome 4; >35 CAG trinucleotide repeats = penetrance/affected/dz
🗑
|
||||
| RLS can be primary, or secondary to: | periph neuropathy, uremia, PG, Fe def
🗑
|
||||
| Migraine dx criteria | ≥2 of: (Unilateral; Pulsating; Mod/ severe intensity; fx: avoidance of routine physical activity); 1 of: (N/V; Photophobia & phonophobia)
🗑
|
||||
| Severe episodic HA with cerebellar sx = | basilar migraine
🗑
|
||||
| Chronic migraine: dx | chronic daily HA ≥3 months; >8 d/mo x 3 mos
🗑
|
||||
| Sinus HA vs migraine | sinus usu continuous (not intermittent); TTP over sinuses; tx w/ Abx
🗑
|
||||
| chronic daily HA | ≥ 15 d/mo; primary or secondary (usu considered primary); ≥1 migraine/wk = RF for dev chronic daily HA
🗑
|
||||
| SUNCT = | Short-lasting; Unilateral; Neuralgiform HA, with Conjunctival injection & Tearing; rare; M>F (>50 yo)
🗑
|
||||
| SUNCT sx | burning, stabbing, throbbing; seconds to 4 min; 5-6 per hr; SBP may rise
🗑
|
||||
| Cluster HA = | M>F (older than migraine); severe, unilateral, nasal congestion, injected conjunctiva, ipsilateral sweating; at night (wakes pt)
🗑
|
||||
| HA red flags (SNOOP) | Systemic sx; secondary RF; neuro sx; onset sudden; older pt; Progression/prior HA hx; Pattern changes
🗑
|
||||
| Sumatriptan: indications | migraine (abortive tx); acute tx cluster HA; Fast onset, short duration; repeat dose in 1 hr if nec; Never give IV or IM
🗑
|
||||
| Ergotamine MOA | direct sm mx vasoconstrictor
🗑
|
||||
| Beta blockers: MOA: | central/serotonergic, beta-1 mediated
🗑
|
||||
| Migraine: prophylaxis | Beta (50-60% efficacy); TCA; SSRIs; bupropion; Valpro; verapamil; NSAIDs (ST for predictable)
🗑
|
||||
| Prophylactic tx: adequate trial of tx: | 6-8 weeks
🗑
|
||||
| Menstrual migraine: Tx | NSAIDs: begin 2-7 days prior to menses, continue through last day of flow; Hormonal therapy (OCP)
🗑
|
||||
| TCA MOA | antagonism of vascular or brainstem 5-HT2
🗑
|
||||
| concomitant dysphasia, hemianopia, or focal epilepsy is a __ lesion | supratentorial
🗑
|
||||
| brain tumors seldom__ | metastasize outside the CNS
🗑
|
||||
| __ spread the soonest with metastatic brain tumors | lung and renal cancer cells
🗑
|
||||
| mets to the brain in men generally come from __ | lung, colon, and renal cancers
🗑
|
||||
| mets to the brain in women generally come from __ | breast, lung, and melanoma
🗑
|
||||
| epilepsy that has failed two medications is | medically intractable epilepsy
🗑
|
||||
| to reduce risk of damaging language and memory, patients can undergo a __ test before neurosurgery | WADA
🗑
|
||||
| Subarachnoid hemorrhage may block __ causing hydrocephalus | arachnoid villi
🗑
|
||||
| T or F: diplopia, syncope, dizziness, vertigo, and paresthesia are symptoms of carotid disease | false
🗑
|
||||
| Cause of Amurosis Fugax | embolization of retinal arteries
🗑
|
||||
| a tumor in the supratentorial region may result in which pathologic disorder | epilepsy
🗑
|
||||
| which cancers metastasize to the brain the fastest? | lung and renal
🗑
|
||||
| in which area of the brain do most mets tumors arise? | cerebrum 80%
🗑
|
||||
| tethered cord | abnormally low conus medullaris
🗑
|
||||
| Acute subdural hematoma: timeframe | Acute: 0-1 week
🗑
|
||||
| Chronic subdural hematoma: timeframe | >2 weeks
🗑
|
||||
| Most common cause of SAH | Trauma
🗑
|
||||
| Loss of consciousness requires: | Both cerebral hemispheres damaged OR brainstem lesion
🗑
|
||||
| Coma: causes | Cerebral infarction 10%; Cerebral hemorrhage 20%; Metabolic causes 50% (Drug ingestion >50%; Hypoglycemia 5-10%); Psych 2%
🗑
|
||||
| Hollenhorst plaque | cholesterol emboli from carotid
🗑
|
||||
| Decorticate posturing: | hemispheric or diencephalic dysfn d/t destructive lesions or metabolic abnormality; hands come up (response to stimuli) but do not localize
🗑
|
||||
| Decerebrate posturing: | midbrain or upper pons dysfunction on a structural or metabolic basis; wrists flex (response to stimuli), not localizing
🗑
|
||||
| Cheynes-Stokes: | Bilateral hemispheric lesions; most commonly seen in non-neurologic disorders (CHF); crescendo-decrescendo
🗑
|
||||
| Central neurogenic hyperventilation is 2/2: | Commonly metabolic cause (Sepsis; DKA)
🗑
|
||||
| Apneustic = | Rare, but usually associated with pontine infarction; pt breathes in, holds breath 15-20 sec, breathes out
🗑
|
||||
| Ataxic breathing (Biot's respiration) | Damage to the medullary respiratory centers; breathing slows; long breathless pause; then inhales; this is often premorbid
🗑
|
||||
| Most common reason for noting unreactive pupils: | an inadequate light source
🗑
|
||||
| Reactive pupils = | midbrain is intact
🗑
|
||||
| Intact pupillary responses in unresponsive pt w/ absent EOM & corneal responses: | metabolic (e.g., hypoglycemia) or drug ingestion (e.g., barbiturate)
🗑
|
||||
| Midposition (3-5mm) nonreactive pupils = | midbrain damage
🗑
|
||||
| Blown pupil = | unilaterally dilated, nonreactive pupil: sx of CN III (oculomotor nerve) compression (Aneurysm, Mass Lesion); dilated nonreactive pupil may also be 2/2 DM or drugs (atropine, scopolamine)
🗑
|
||||
| Small, reactive pupils: seen in: | pontine damage (infarct or hemorrhage) or with some drug use (opiates, pilocarpine).
🗑
|
||||
| Bilateral midposition unreactive pupils: | hypothermia
🗑
|
||||
| Eye deviation occurs in what direction? | toward a unilateral hemispheric lesion and away from a unilateral brainstem lesion
🗑
|
||||
| Functional testing of eye movements is done by: | oculo-cephalic reflex (Doll's head) or oculo-vestibular reflex (ice water calorics)
🗑
|
||||
| Oculo-cephalic reflex (Doll's head): CI if: | if there is a question of cervical spine injury
🗑
|
||||
| Oculo-cephalic reflex: Abnormal response = | absent or asymmetric eye movement: destructive lesion at midbrain or pontine level; poss also deep barbiturate poisoning
🗑
|
||||
| Oculo-vestibular reflex: Normal response (conscious pt): | Tonic (sustained) deviation of eyes toward stimulated side, w/ quick phase of nystagmus toward the opposite side
🗑
|
||||
| Oculo-vestibular reflex: Response in comatose pt w/ intact brainstem: | Tonic deviation of eyes, but no nystagmus
🗑
|
||||
| Oculo-vestibular reflex: Response in comatose pt w/ brainstem dysfn: | Loss of tonic deviation w/ stimulation of one, or both ears; if there is no tonic deviation there can be no fast response
🗑
|
||||
| Oculo-vestibular response does not distinguish between: | metabolic and structural causes of coma
🗑
|
||||
| Corneal sensation: | carried by CN V (Trigeminal); test with cotton swab pressed gently onto cornea; abnormal reponse suggests a pontine lesion
🗑
|
||||
| GCS: 3 tests | Eye, verbal, motor; range: 3-15; <8 means coma
🗑
|
||||
| ALS: Dx criteria | UMN & LMN sx in 3 regions; UMN: clinical; LMN: EMG; CK nml or high
🗑
|
||||
| Primary lateral sclerosis: path | degeneration of lateral corticospinal tract
🗑
|
||||
| Primary lateral sclerosis clin findings | usu legs before arms; leg weak/stiff; spasticity; ave duration >8 yrs; many pts develop LMN sx & transition to ALS
🗑
|
||||
| progressive muscular atrophy | pure LMN dz; slower progress than ALS; often spares bulbar mx; CK very high
🗑
|
||||
| Kennedy dz genetics | X-linked rec, TNR; mutation in androgen receptor
🗑
|
||||
| Kennedy dz S/S | facial fasciculations, weakness mouth/tongue; dysphagia, limb weakness; gynecomastia, DM, oligospermia
🗑
|
||||
| Disorders of neuromx transmission (NMJ): | MG, LEMS, botulism
🗑
|
||||
| MG: pathophys | Acquired autoimmune: Ach receptor insufficiency
🗑
|
||||
| MG S/S | fluctuating mx weakness (worse w/reps); asymmetric ptosis; tired face, difficulty chewing/swallowing; SOB
🗑
|
||||
| LEMS S/S | usu paraneoplastic (autoimm rare); proximal weakness / autonomic sx (dry mouth); hypo/absent reflexes; voltage gated Ca channel Abs; facilitation w/ RNS
🗑
|
||||
| Botulism MOA | irreversible blockade of Ach release
🗑
|
||||
| Duchenne MD | onset at 3-5 yrs; calf pseudohypertrophy; loss of ambulation by teens; cardiomyopathy; death in 20s
🗑
|
||||
| Emery Dreifuss | Humeroperoneal / scapuloperoneal weakness w/ early contractures (ankle neck elbow); teen onset (very thin); scap winging/deltoid sparing; x linked or auto dom; cardiac conduction block/arrhythmia (need pacemaker)
🗑
|
||||
| Most common MD's | Duchenne/Becker; myotonic; Facioscapulohumeral dystrophy
🗑
|
||||
| Myotonic dystrophy | auto dom; any age; TNR
🗑
|
||||
| Myotonic dystrophy S/S | tenting upper lip; distal weakness; frontal bald; cataracts; conduction block; DM, infertile; cognitive impairment; percussion myotonia
🗑
|
||||
| Autosomal dominant disorders | Huntington, NF1/NF2, spinocerebellar ataxias, familial Alz, CMT
🗑
|
||||
| NF1: manifestations: | hydrocephalus, seizures, learning disabilities, short, lack of GH, precocious puberty, renal artery stenosis
🗑
|
||||
| Auto recessive disorders | PKU, Tay-Sachs, MSUD, Friedreich's, Wilson, homocystinuria, sickle cell
🗑
|
||||
| Wilson manifestations: | hepatolenticular degen (impaired ceruloplasmin synth); presents in teen years (hepatitis); tremor, dysarthria, slow, hoarse, chorea
🗑
|
||||
| X-linked recessive pattern | F-toM trans; M=affected, F=carrier
🗑
|
||||
| X-linked rec dz | Duchenne/Becker MD; Kennedy; adrenoleukodystrophy; Menkes (kinky hair); Lesch-Nyhan; Fragile X
🗑
|
||||
| X-linked dom dz | F-to-F transmission (lethal to males); Rett; Aicardi; Lissencephaly 2
🗑
|
||||
| Rett dz | Onset 6-18 mos; live to 40s; autism; cardiac & scoliosis
🗑
|
||||
| Mitochondrial dz | multi generations; trans by F only; 1:1 M:F affected; MERRF, MELAS, LHAN, Kearns-Sayre
🗑
|
||||
| MELAS manifestations | 2/2 pt mutation of transfer DNA from leucine; <40 yo; lactic acidosis; HA, stroke, seizure, short; progressive dementia; no tx
🗑
|
||||
| TNR: mode of inheritance | can be multiple modes of inheritance
🗑
|
||||
| TNR dz | Huntington, Fragile X, myotonic dys; Kennedy; spinocerebellar ataxia; Friedreich
🗑
|
||||
| Alz: APOE gene | E2: protective vs Alz; E4: inc risk of dev Alz
🗑
|
||||
| Parkinson dz S/S | usu unilateral onset; resting tremor, slow, cogwheel rigidity, festinating gait, masked facies, postural instability
🗑
|
||||
| Parkinson: TRAP = | Tremor, Rigidity, Akinesia, Postural instability
🗑
|
||||
| Most common genetic form of Parkinson: | PARK8
🗑
|
||||
| Central cord syndrome S/S | motor deficit in UE > LE; Varying degrees of sensory loss (pain/temp); most common of the incomplete spinal cord lesions (better prognosis)
🗑
|
||||
| Ligamentum flavum buckles into spinal cord => contusion to central regions of spinal cord = | Central cord syndrome
🗑
|
||||
| Anterior cord syndrome S/S | Paraplegia and dissociated sensory loss with loss of pain and temperature sensation; 2/2 infarction of the cord in the region supplied by the anterior spinal artery
🗑
|
||||
| Anterior cord syndrome: what fn is preserved: | Posterior column (position, vibration, deep pressure) preserved
🗑
|
||||
| Brown-Sequard syndrome: cause | Hemisection of the cord; From penetrating injuries; Rare
🗑
|
||||
| Brown-Sequard syndrome S/S | Ipsilateral motor loss w/loss of vibration, pressure, proprioception; contralateral loss of pinprick, pain, temperature sensations
🗑
|
||||
| Progressive demyelinating; brain, sp cord, optic n.; viral; F>M, peak 20-40yo | MS
🗑
|
||||
| Bell palsy sx | Abrupt onset upper & lower (ipsilateral) facial paresis/ paralysis, mastoid pain, hyperacusis, dry eyes, altered taste; ipsilat ear pain may precede
🗑
|
||||
| LP w/ decreased glucose, increased protein | Bacterial meningitis
🗑
|
||||
| LP w/ decreased protein, very few neutrophils | syphilitic meningitis
🗑
|
||||
| 3 mHz spike-and-wave on EEG | Absence (petit-mal) seizures
🗑
|
||||
| Emergent eval of stroke | CBC/plt; PT/ PTT; Lytes, glu, renal; ECG/ markers of cardiac ischemia; Brain CT or MRI
🗑
|
||||
| Atheroembolic stroke dx studies | Normal head CT; Doppler US: high grade stenosis (e.g., L ICA)
🗑
|
||||
| Atheroembolic stroke: dx studies | Neuroimaging; Carotid US; MRA; CTA; Catheter angiography
🗑
|
||||
| Cardioembolic stroke imaging | Carotid US normal (no brain lg vessel prob)
🗑
|
||||
| Cardioembolic stroke: dx studies | pulse; EKG; 24-48 hr EKG; TTE (microcavitation); TEE
🗑
|
||||
| Asymptomatic carotid stenosis: dx studies | Carotid bruit; Doppler US; MRA, CTA
🗑
|
||||
| best modality to distinguish ischemic from hemorrhagic stroke: | CT
🗑
|
||||
| TIA definitive study: | arteriography; MRA more common (less invasive)
🗑
|
||||
| TIA dx studies | CT or MRI to r/o cerebral hemo; cardiac w/u; cbc, esr, coags, antiphospholipids; Poss echo, ecg, carotid doppler
🗑
|
||||
| SAH dx studies | CT (90%); CSF: hi opening P & bloody fluid; cerebral angiography, EEG
🗑
|
||||
| EEG: focal rhythmic discharge at onset, poss no ictal activity seen: | simple partial seizure
🗑
|
||||
| EEG: interictal spikes assoc w/slow waves in temporal/frontotemp | complex partial seizure
🗑
|
||||
| Seizure: labs | Glucose; lytes; AED levels; LP if poss meningitis; EtOH/tox if susp; ABG if susp hypoxia; poss CXR, CT, MRI
🗑
|
||||
| MS: MRI findings | multiple characteristic white matter lesions or plaques: periventricular or subcortical U-fibers, corpus callosum lesions
🗑
|
||||
| MS: CSF findings | oligoclonal bands, increased IgG index, myelin prodn/fragments
🗑
|
||||
| MS: types of dx criteria | Schumacher; Poser: Macdonald
🗑
|
||||
| When do LP? | suspect meningitis; not if suspect abscess
🗑
|
||||
| Glucose depressed: usually: | bac mening, or TB or fungal
🗑
|
||||
| Increased WBC in CSF indicates: | inflammation (not necessarily infection)
🗑
|
||||
| Tuberculous meningitis dx studies | active TB elsewhere in body; CSF inc WBC (100-150), mostly lymphs; abnormal CXR; acid-fast normal
🗑
|
||||
| Ring enhancing lesion is usually: | abscess or tumor
🗑
|
||||
| Symptoms from plateau waves | Transitory episodes of altered consciousness & visual disturbances
🗑
|
||||
| Brain tumor: eval & dx | H&P; CT +/- MRI; EEG; LP; PET
🗑
|
||||
| Brain tumor: VEGF | higher the VEGF, worse the prognosis; anti-VEGF Ab's effective in xenografts
🗑
|
||||
| MRI: T1/T2 | T1: fat bright (water dark); T2: water bright
🗑
|
||||
| quadrigeminal cistern: | should smile
🗑
|
||||
| suprasellar cistern: | (if healthy): resembles a star
🗑
|
||||
| Trauma/Bleeds: imaging of choice | noncontrast CT
🗑
|
||||
| epidural hematoma: appearance on CT | lenticular (biconvex)
🗑
|
||||
| subdural hematoma: appearance on CT | Cross suture lines and extends over larger area; Crescent shaped
🗑
|
||||
| SAH: appearance on CT | Linear, within cisterns and sulci; bleed follows outlines of the gyri
🗑
|
||||
| Normal vertebral disk on MRI: | low T1 signal, High T2 (nuc pulposus is mostly water); normal disks do not extend past margin of vert
🗑
|
||||
| Degenerative disk on MRI: | dehydrates: decreased T2; loses height
🗑
|
||||
| Spinal cord lesion types: | Demyelination; Cysts; Infarction; Tumor
🗑
|
||||
| Demyelination on MRI | patchy T2 signal; may be d/t: MS; Post infectious Myelitis; Compressive Myelopathy; Post Radiation
🗑
|
||||
| Spinal cord infarction on MRI | Gray Matter Affected Preferentially: H-pattern high T2 signal
🗑
|
||||
| Edema on MRI | T1: dark; T2: bright
🗑
|
||||
| Purpose of CT in CVA | Not dx; only to r/o other conditions that would CI some tx (tumor, bleed)
🗑
|
||||
| CVA on CT | Hyperdense artery sign; loss of grey; CT normal up to 12 hours post; insula ribbon sign: blurring of gray-white junction
🗑
|
||||
| Brain neoplasm: imaging of choice | MRI
🗑
|
||||
| Brain neoplasm: imaging | Gray-white matter junction; marked edema; can be multiple, bilateral
🗑
|
||||
| AIDS-related CNS infxn: imaging of choice | MRI; 2/3 develop CNS infxn
🗑
|
||||
| MS imaging | MR sensitive, but not diagnostic; Periventricular T2 bright signal: inflammation
🗑
|
||||
| NPH on CT | Ventriculomegaly out of proportion to sulcal prominence
🗑
|
||||
| Imaging findings assoc w/ 4 stages of brain abscess evolution | early cerebritis (swollen/edema; high T2); late cerebritis (inc central necrosis; vasogenic edema at edges); early capsule; late capsule (well define ring)
🗑
|
||||
| Meningioma: imaging | Often along brain surface; hyperdense, homogeneous enhancement
🗑
|
||||
| Ulnar neuropathy: Dx | Hx; EMG/NCS can help find site of lesion
🗑
|
||||
| Sciatic n. palsy: Dx tests | EMG/NCS (distinguish from peroneal neuropathy); xray
🗑
|
||||
| Charcot-Marie-Tooth Dx: | H&P; DNA testing; Nerve/mx bx (confirmatory); EMG/NCS
🗑
|
||||
| CMT: EMG/NCS | CMT I: segmental demyelination; reduced motor & sensory conduction velocity; CMT II: axonal loss; normal/sl dec motor conduction, dec SNAPs; chronic partial denervation in affected mx
🗑
|
||||
| Dejerine-Sottas Dz: Dx | high CSF pro; EMG/NCS: dec motor velocity, sensory conduction
🗑
|
||||
| Refsum dz: Dx findings | CSF protein normal; nerve bx; EMG/NCS: dec motor velocity, sensory conduction
🗑
|
||||
| Guillain-Barre dx studies | NCS: slow S/M nerve conduction velocities; poss denervation/axonal loss; CSF high pro
🗑
|
||||
| CNS neoplasm CSF | xanthochromic; inc pro, normal cell count & glucose
🗑
|
||||
| MG dx studies | NCS: decrementing mx response; CXR to r/o thymoma; serum acetylcholine Ab
🗑
|
||||
| Wilson: labs | Serum ceruloplasmin (Cu carrying pro) very low; urine Cu high
🗑
|
||||
| Huntington dz on CT | atrophy of cerebrum & caudate nucleus
🗑
|
||||
| Huntington dz on MRI/PET | decreased glucose metab
🗑
|
||||
| Neuroimaging not needed when: | No focal neuro findings; Pt has stable pattern of recurrent HA; No h/o seizures
🗑
|
||||
| HA: Consider neuroimaging when: | Neuro exam abnormal; progressively worsening HA; new persistent HA; new, rapid onset HA (thunderclap headache); HA does not respond to standard tx
🗑
|
||||
| Use LP only after: | normal CT obtained & platelet count is normal
🗑
|
||||
| LP should be performed if: | Neuroimaging is normal or suggests dz that must be dx by measuring cerebrospinal fluid (CSF) pressure, cell count, and chem
🗑
|
||||
| lemon sign on US | Myelomeningocele: 2 frontal bones appear convex inward
🗑
|
||||
| banana sign on US | Myelomeningocele: elongated and curved posterior fossa 2/2 Chiari malformation
🗑
|
||||
| 5 steps to dx & tx pt w/suspected brain tumor | MRI is TOC to confirm; Pan CT of chest/abd/pelvis to detect other tumors; Bx of distant tumor or Br tumor resection to confirm patho; xrt/CTx for malig; F/U MRI, PET
🗑
|
||||
| Fisher grade is used to: | classify appearance of SAH on scan
🗑
|
||||
| Hunt Hess scale is used to: | classify severity of symptoms in SAH
🗑
|
||||
| Coma: labs | GLUCOSE, lytes, renal, Ca, PO4, ABG, CBC, tox screen; CXR, imaging (after stabilization)
🗑
|
||||
| Diagnostic LP: indications | CNS infxn (meningitis, encephalitis); HA (SAH); Pseudotumor cerebri (idiopathic ICH); MS; Support dx of NPH & predict response to surgical shunting
🗑
|
||||
| LP: CI | Suspected brain / epidural abscess; elevated ICP, esp if papilledema; suspect mass lesion; Ventricular obstn;
🗑
|
||||
| LP: insert needle into: | L3-L4 space (elderly: may need to do cisternal procedure)
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| LP in kids: | spinal cord extends more caudally, do low LP
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| CSF collection: amount: | 1-2 mL CSF per tube
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| Routine CSF analysis includes: | Opening pressure; Appearance/color; Consistency; Tendency to clot; Diff cell count; Protein; Glucose
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| CSF cloudy = | Inc WBC or protein
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| CSF: Xanthochromia (yellow tinge) = | hyperbilirubinemia, hypercarotenemia, melanoma
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| CSF: Red tinge = | Blood from bleeding into SA space or traumatic tap
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| CSF: Cells | Normal 0-5 small lymphs/ml; PMNs, lg monos & RBCs are never normal
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| CSF: RBCs & WBCs: | only present via ruptured blood vessels or by meningeal response to inflammation or irritation
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| WBC in CSF | Inc WBCs = inflam (>100, prob infxn); PMNs: bac infxn; Lymphs = viral or other (TB, fungal, ca); Eosinophils: shunt, parasitic infection & allergic rxn
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| CSF pressure | Normal 60-200 mm H2O (mean = 120); usu drops 5-10 mm for each ml CSF removed
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| CSF pressure: Marked elevation: | poss purulent meningitis or intracranial tumors
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| CSF pressure: Moderate elevation: | mild inflammation, encephalitis, neurosyphilis
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| CSF pressure: Elevated pressure with normal CSF: | confirms pseudotumor cerebri (benign ICH): one instance where LP is done despite presence of papilledema
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| CSF protein: increased in: | inc permeability of blood-CSF barrier (tumor, trauma, inflam), or increased intrathecal synthesis of Igs
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| CSF protein: decreased in: | CSF protein leak, hyperthyroidism, water intoxication
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| CSF glucose | Normal CSF glu 60-70% of plasma glu; Low levels assoc w/ bacterial or TB infection
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| CSF lactate: | usu parallels blood levels; if markedly different from blood level = biochem abnormality in CSF
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| Increased CSF lactate associated with: | CVA, IC bleed, bacterial meningitis; Not altered in viral meningitis; lactate may differentiate btw viral & bacterial
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|
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| Organism conc required for detection on CSF smear: | 10,000/ /ml (Gram & AFB stains may be neg despite org presence in CSF; cx on several media; consider empiric tx)
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| CSF antigen serology: | More rapid, but less specific, than cx; cryptococcal Ag test very specific/accurate
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| Primary lateral sclerosis: dx studies | EMG, MRI (br & spcord), LP, evoked potls; B12, Lyme, RPR, long chain fatty acids
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| Myasthenia gravis Dx studies | Tensilon test; Ach receptor & MuSK Abs; Repetitive nerve stim; Single fiber EMG; CT Chest to exclude thymoma
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| MD: labs/studies | ultrastructural protein abnormalities; mx bx: mx fiber necrosis
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| Duchenne/Becker: Dx studies | Mx bx; genetic testing (need complete sequencing); CK sometimes >10,000; FH
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|
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| Wilson: dx | high ceruloplasmin & copper; low copper on liver bx; Kayser Fleischer rings
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|
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| Duchenne/Becker Dx | genetic testing, elevated CK, EMG
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|
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| Alz dx | dx of exclusion (neuropsych eval); MRI/CT: hippocampal atrophy; amyloid on PET (Pittsburgh B); LP: inc tau, dec amyloid-beta 42
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|
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| Pathological hallmark of Parkinson: | Lewy body (alpha-synuclein is main component)
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|
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| MELAS dx studies | Mitochondrial inheritance, labs: high pyruvate / lactate; stroke lesions (don't conform to normal vasc distn)
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|
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| Pseudoseizure | Clinically resembles seizure; does not have EEG evidence of seizure, or respond to epilepsy meds
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|
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| NCS | uses electrodes; record response to shock (amp & timing)
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|
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| EMG | uses needle; electrical activity observed during rest & activitation
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|
||||
| NCS / EMG utility: | suspicion of peripheral nerve or mx injury; detect CTS; investigate polyneuropathy /poss etiology or radiculopathy
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|
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| Evoked potential studies | to study conduction of CNS pathways; electrodes on scalp; brain potentials recorded in response to stim
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|
||||
| Evoked potential studies: 3 kinds: | Visual; Brainstem (auditory); Somatosensory
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|
||||
| Evoked potential studies: useful to dx: | MS (VEP, SSEP), spinal cord diseases
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|
||||
| Visual evoked potential: optic neuritis: | After optic neuritis, the VEP will often remain abnormal indefinitely even after recovery of vision
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|
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| SSEP | record potentials from stimulus at wrist or ankle
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|
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| Blood EtOH usu measured on: | whole blood (serum levels 12% higher than whole blood)
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|
||||
| Chronic alcohol use: labs | macrocytosis; anemia (later); high AST, ALT, GGT, CDT
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|
||||
| Urine drug test methods | Immunoassay; GC-MS (HPLC)
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|
||||
| Drug test: Immunoassay | fast; large-scale screening; false pos & req confirm by HPLC
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|
||||
| Drug test: HPLC | accurate; time consuming; expensive
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|
||||
| Opiates | Natl: heroin & hydrocodone; synthetic: meperidine & methadone (less detectable)
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|
||||
| Drug with longest detection time: | Benzo or THC
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|
||||
| Drugs with lowest/highest detection thresholds: | Lowest: THC; highest: amphetamine
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|
||||
| oligoclonal bands in CSF = | MS
🗑
|
||||
| Acoustic neuroma (vestibular schwannoma): dx with: | CT or MRI; surgical tx
🗑
|
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