neuro

treatment of choice for alzheimers dz and secondary add on?

donepezil (cholinesterase inhib) memantine

good first line for parkinson that works on the 20% dopamine receptors left over

dopamine agonist pramipexole, rapinirole try to save sinemet

A 61-year-old male presents with left-sided hand weakness and trouble with walking. On physical exam, tongue fasciculations are appreciated. He has slow speech. The left upper extremity shows forearm atrophy and depressed reflexes. The right lower extremity is hypertonic, with 3+ reflexes, and positive Babinski sign

ALS (UMN AND LMN SIGNS)

what allele if used with clinical criteria improves specificity of dx of alzheimer

APOE4

4 basic features of parkinson how many for definite dx

BRIT: bradykinesia, idigity, tremor, impaired postural reflexes, need 3 for definite dx.

Guillain barre dx and tx

CSF with high protein 2-3 wks later Tx: plasmapheresis and IVIG

for encephalitis, first test via __ and __ but what is the gold standard for dx

CT , LP, but viral cultures/brain biopsy gold standard

pt has syncope, postural hypotension, abnormal HR regulation, tx

dysautonomia avoid abrupt postural change, sleep in semierect, salt intake, FLUDROCORTISONE

absence seizure first and 2nd line tx

ethosuximide, valproic

pt has bilateral constant urge to move legs worse at night. suspect what 3 possible conditions

fe deficiency, pregnancy, peripheral neuropathy

seizure of this lobe has prominent motor manisfestations (bicycle, head turning) often nocturnal arising from sleep and brief

frontal lobe focal seizure

gait that is magnetic, in NPH

gait apraxia

generalized seizures typically arise in___ while partial seizures typically arise in ___

general- childhoood or teen partial focal- older

what type of astrocytoma has necrosis and is the MC malignant, high grade. what age

glioblastoma multiforme. 70 yo.

tumor located at cerebellum, cystic with a mural nodule

hemangioblastoma

Most effective for parkinson motor sx (rigidity and bradykinesia)

sinemet levodopa

type of stroke with punched out hypodense areas on CT

small lacunar

MC overall organism of meningitis and 2nd

step pneumoniae n. meningiditis

gait that results from foot drop (injury to peripheral nerve)

steppage gait

occipital lobe seizure has

sudden visual changes, may spread to other lobes

Most congenital ateriovenous malformations are ___ lying at the ___ and what imaging is needed

supratentorial near MCA CT determines if hemorrhage Arteriography to exclude aneurysm or AV malformation even if findings on CT suggest it

MC focal seizure with olfactory or gustatory involvement, automatisms (chewing, lip smacking, mumbling, fumbling) , DEJA VU feeling

temporal lobe focal seizure

pt has a band like headache, not worse with movement and NO photophobia, phonophobia or assoc. sx besides mild NAUSEA

tension headache, MC primary headache

mysathenia gravis can have associated ____ and is tx with___

thymoma, Mestinon

pt has ictal cry, contraction of muscles and loss of postural control followed by rhythmic relaxation

tonic clonic seizure

child has sudden behavioral arrest, staring, unresponsiveness, 10-20 secs with sudden return to activity (no confusion) with generalized 3-4 Hz spike and slow wave complexes on EEG

absence seizure

Generalized 3-4 hz spike and slow wave complex on EEG is characteristic of

absence seizures

MC tumor in cerebello pontine angle, benign,

acoustic neuroma

treatment for cluster headache? acute attack and prophylaxis

acute- oxygen at 12-15 L and sumatriptan injection Prophylaxis- verapamil is first line preventative

plaques with beta amyloid peptide and neurofibrillary tangles containing tau protein is what dz

alzheimer

young pt present with foot deformity, gait disturbance

charcot marie tooth tx: nsaids

3 main sx of huntington

chorea, dementia, behavioral change

small vessel lacunar infarcts are MC with what underlying condition

chronic htn or dm

first line tx for tourettes/TICs

clonidine, haldol

pt has headaches many times in couple weeks/ months then has an extended pain free interval of 9-11 months with a seasonal pattern

cluster headache

an occluded bilateral vertebral or basilar a. will result in

coma with pinpoint pupils, flaccid quadriplegia, sensory loss

what is the most common seizure overall

complex focal/partial seizure

what is the diffference between a simple partial/focal seizure vs a complex? similarity?

complex- consciousness is impaired both have AURA

Gold standard for epilepsy dx

concurrent EEG and video monitoring

status epilepticus defined as

30 min of continuous seizure activity or 2 seizures occurring within a 30 min period without recovery of consciousness inbetween

huntington gene is identified on chromosome _ with unstable ___ trinucleotide repeat in huntingtin gene

4, CAG

A 46-year-old male is brought to the emergency department by his wife due to a seizure event. She reports that prior to the event, he complained of headache, fever, and nausea. She also reports her husband appeared confused. On exam, the patient cannot clearly answer questions. A CT of the head shows no evidence of a hemorrhage, or a space-occupying lesion. MRI of the brain is shown. A lumbar puncture is performed, and cerebral spinal fluid analysis shows a normal opening pressure, a lymphocytic pleocytosis, normal glucose, and elevated protein. PCR is positive for herpes simplex virus-1 what test to order

CT to rule out space occupying lesion then LP for etiology ENCEPHALITIS

obstruction of the cerebellar arteries result in

IPSILATERAL limb ataxia and CONTRALAERAL spinothalamic sensory loss in limbs

A 35-year-old banker presents to the ED after hitting his head when he tripped while climbing the subway stairs. He has noted his legs feeling heavy over the last 5 days and reported trouble pushing himself up after the fall. nausea, vomiting, and diarrhea 3 days ago (admits to eating discount sushi). Exam is remarkable for symetric 3/5 lower and upper extremity weakness, absent ankle and patellar reflexes and 1+ biceps reflex. He is only able to count to 10 in one breath. Routine labs, chest x-ray, and head CT are unrevealing.

Guillain barre

pt presents with dementia, urinary incontinence, gait ataxia (magnetic)

NPH

pseudotumor cerebri dx and tx

LP confirms intracranial HTN but CSF is normal ACETAZAMIDE (reduce formation of CSF)

pt has contralateral hemiplegia, hemisensory loss homonymous hemianopia, GLOBAL aphasia, (face) what artery is occluded

MCA

Gold standard dx of MS what does it show

MRI with gadolinium 4+ white matter lesions 3mm or larger 3 white matter lesion with at last 1 periventricular lesion

pt presents with optic neuritis, unilateral vision loss, color desaturation, leg paresthesias, cerebellar ataxia

MS

A 20-year-old woman is brought to the ER 30 minutes after acute onset of double vision in the left eye. Two months ago, she had an acute episode of pain with movement of the left eye along with loss of both central vision and pupillary light reflex. These symptoms subsided spontaneously. Examination shows a delay in the adduction of the left eye with nystagmus of the right eye on lateral gaze

MS (2 EPISODES - dissemination in time)

how to tx the medical emergency of status epilepticus acute and long term

Maintain airway. IV lorazepam Fosphenytoin or phenytoin for IV long term control

thalamic syndrome with contralateral hemisensory disturbance and spontaneous pain, what is occluded

PCA posterior cerebral artery

pt has horner syndrome what is occluded

PICA posterior inferior cerebellar artery

n obese 31-year-old female presents to the neurologists office complaining of severe headaches, visual obscurations, ringing in the ears and "papilledema". She has been taking large amounts of vitamin A because a friend told her that it would give her more energy. Examination of the patient shows limited ABduction of both eyes.

PSEUDOTUMOR CEREBRI abducens nerve CN VI dysfunction.

most sig. complication of intracranial aneurysm and how to dx/eval

SAH, angiography

where is cluster headache pain localized

Short, severe unilateral headaches in clusters Pain is deep, usually periorbital, often excruciating in intensity, nonfluctuating, and explosive in quality.

large vessel cva often affect what

cortex resulting in aphasia, visual field deficits or transient monocular blindness

NPH dx and tx

ct/mri LP will be relieving Ventricular shunt by neurosurgeon

edema due to NA/K pump failure BBB intact, na and water enter cells mcc?

cytotoxic edema caused by hypoxia ischemia

type of dementia with quicker onset, rigidity, fluctuation in alertness and cognition, visual hallucinations, paranoid delusions

diffuse lewy body

what gives rise to meningiomas

arachnoid capsules (meningothelial cells)

this seizure often in children with lennox- gastaut syndrome (type of epilepsy with multiple different types of seizures.)

atypical absence seizure

pt has headache fever and focal neurologic deficit, what management is needed

before abscess capsule has formed entirely (during cerebritis stage) abx essential. Surgical interventions NEEDLE ASPIRATION is preferred.

pt has 3 or more migraines a month with impaired function. start them on..

beta blockers, CCBs, seizure meds,

tx for relapsing MS

beta interferons, natalizumab (PML risk), ocrelizumab

facial paralysis that does not spare forehead. how to tx.

can resolve completely without tx, steroids 2 week taper. lyme titer.

CT/MRI of huntington dz will show

cerebral and caudate nucleus atrophy

development of granulation tissue in the first 7-14 days before formation brain abscess is called

cerebritis

MC type of hemorrhagic stroke

intracerebral hemorrhage bleeding directly into brain parenchyma

how to tx acute exacerbations of MS

iv corticosteroids

what is the MC type of CVA and mcc of it

large vessel (ischemic) caused by atherosclerotic plaques at arterial bifurcation

aphasia, apraxia incontinence in what phase of dementia

late

diffuse astrocytoma is __ grade and tx is to ___

low grade, remove what you can since total removal not possible

loss of orientation and psychotic sx in what phase of dementia

middle to late

aura results from cortical spreading depression in this type of headache

migraine

Pt has lateralized headache, throbbing w n/v, photophobia and phonophobia

migraine headache

difference between migraine and cluster headaches in terms of movement

migraine- like to be motionless cluster- move about during attacks, pacing, rocking, or rubbing their head for relief; some may even become aggressive during attacks

A 62-year-old man presents to his primary care physician for "seeing double." He reports that he has been experiencing these symptoms for a few months. His diplopia is worse after reading a book or watching television. He says that at times he notices his left eyelid "droops" at the end of the day and improves after waking up from sleep. He notes episodes of fluctuating weakness when chewing harder foods. On physical examination, there is left-sided ptosis. Pupillary reflex is intact. A plastic glove with ice is applied on the ptosis for approximately 2 minutes and the ptosis markedly improves. Serology is positive for anti-acetylcholine receptor antibodies and preparations are made for a computerized tomography scan of the chest.

myasthenia gravis

jerky movements either diffusely or locally

myoclonic seizure

drug for prophylaxis of arterial vasospasm in SAH

nimodipine

Guillain-Bare Syndrome ___ WBC, ___Protein ___ glucose

normal wbc high protein normal glucose

tx of trigeminal neuralgia

oxcarbazepine or caramazepine

Loss of dopamine in the substantia nigra in the indirect system leading to EPS Imbalance between dopamine and ACh

parkinson

pt with meningitis has fever stiff neck headache. what is a very bad sign.

petechial skin rash.

young child with MRI of midline tumor. only FOCAL one out of the astrocytomas

pilocytic astrocytoma (most benign) tx with surgery

MC cause of chiasmal syndrome

pituitary adenoma

in what tumor can a bitemporal superior quadrant progresss to a bitemporal hemianopia

pituitary adenoma

germinoma, teratomas, endodermal sinus tumor, embryonal CA, choriocarcinoma are all what king of tumors. which one is benign

primary germ cell tumors teratoma benign

tumor that presents with amenorrhea, loss of libido and infertility

prolactin secreting lactotroph adenoma

treatment of choice for benign essential tremor

propanolol

classic sx of myasthenia gravis

ptosis, diplopia, dysphagia, dysarthria, muscle weakness

most common variant of MS, resolution of sx after active demyelination period

relapsing remitting MS (RRMS) months or years after initial episode, sx recur or new ones appear

MC sx of parkinson

resting hand tremor

only tx to slow down ALS progression

riluzole

A 54-year-old female presents with severe, stabbing pain on her left mandible. The pain lasts a few seconds and is triggered by brushing her teeth or chewing food. The pain episodes lasts a few seconds and occur 20 times per day. She denies any recent trauma or dental procedures. Over the counter simple analgesics do not improve the pain. On physical exam, touching the mandibular region reproduces the pain. Neurological exam is otherwise normal.

trigeminal neuralgia

standard of care for abortive therapy of migraine headaches

triptans, best one is injectable sumatriptan

MS should not be dx until there is evidence that

two or more different regions of the central white matter (dissemination in space) have been affected at different times (dissemination in time)

first seizure in an adult is commonly due to _

underlying tumor

edema due to BBB failure (endothelial cell) as protein rich plasma swells up brain tissue

vasogenic edema

benign essential tremor is worse with __ and may improve with ___

worse with stress, cold, improve with alcohol