Glossary of Neurology Rotation
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- What are the three signs of an UMN lesion?
- hyper reflexia
- What are the signs of a LMN lesion?
- What is clonus?
- maintained reflex
- What would a lesion of the arcuate fasciculus cause?
- normal language, but cannot repeat
- Where is a lesion if language is involved?
- what part of the brain involves cranial nerves 9 and 10?
- what is wallenbergs?
- alternation pain and temp
- What artery might have an infart if wallenberg is the result? And what would be the cause?
- What is brown-sequard?
- hemi-sected spinal cord
- Go bottom up in localization
- What should you test on the general examination?
- Pulse, bruit, heart rhythm and blood pressure in case of stroke
orthostatic blood pressure measurements with syncope
temporal artery palpataion
palpation of muscles to look for tenderness in myopathy
- Breakdown the mini mental state test of higher intellectual function
- What is asomatognsia
- inability to recognize body parts
- what is anasognosnia
- unaware of weakness or defecit
- what is the word for inability to feel an object being drawn?
- what is prospognosia?
- inability to recognize faces
- what is asteriognosis
- inability to recognize objects placed in the hand
- What do you test for in language?
- when can you see multiple cranial nerves deficites?
- basilar meningitis- TB, fungal, carcinomatous
- What divides LMN VII vs. UMN VII?
- UMN VII- motor cortex to mid-pons
LMN VII- lower pons prior to decussation
- Where in the brainstem does the facial nerve originate?
- where in the brainstem does the hypoglossal originate
- What are the two possible sites of lesion if both pain and strength are impaired?
- periphery or cortex
- What is the site of a lesion that has one side w/ pain temp loss and the opposite side w/ vibration/position sensation loss?
- spinal cord on the side of the vibration/sensation loss.
- if there is pain/temp loss on one side of the face and the other side of the body, where is the lesion?
- between the pons and C2
ipsilateral facial numbness
- What is the difference in ptosis presentation for third nerve palsy and Horner's?
- both cause ptosis and pupillary asymmetry
third nerve-> ptosis on the large pupil side
horner's on the small pupil side.
- Where is the lesion when Diplopia is present?
- brainstem or periphery, no tthe cortex
- where is the lesion in a gaze palsy?
- cortex or brainstem, not the periphery
- Where is a lesion that causes dysarthria?
- subcortical, brainstem, or cerebellar lesion.
- What three signs in headache necessitate an MRI?
focal neurologic defecit
or positional headaches
- what medications treat partial seizures?
- what medications treat absence seizures?
- what is the risk of using valproic acid and lamotrigine?
- lamotrigine must be started at a very low dose. it can lead to a severe skin reaction.
- loss of initiative, willpower or drive
- inability to calculate
- inablitity to recognize one or meor classes of environmental stimuli, even though the necessary intellectual and
- Right-Left confusion
angular gyrus in dominant hemisphere
- what are the centers of alertness?
- both cerebral hemishperes
reticular activating system.
- Where is the lesion in someone who demonstrates impersistance, perseveration
- bilateral prefrontal cortex
- What is the first branch of the ICA?
- ophthalmic artery.
- slow, sinuous writing of the distal parts of limbs
- violent, large-amplitude, involuntary flinging movementes of the proximal parts of limbs
- involuntary tendency for steps to accelerate and decrease in amplitude
- what part of the brain is most involved in tremor?
- basal ganglia
(striatum, globus pallidus, substantia nigra, subthalamic nucleus
- Hyperkinetic movement disorders
- involuntary movements
- what are the hallmark signs of parkinsonism?
- How is dystonia classified?
- focal- specific localized muscle groups
segmental- two or more contiguous areas of the body
multifocal- two or more not contiguous areas of the body
hemidystonia- one side of the body
generalized- entire body
- involuntary , sustained muscle contractions with preferred direction
- what causes postural and kinetic tremors?
- abnl cerebellar outflow to the thalamus
- what is alpha-synuclein
- principal component of LB
maintains the integrity of neurotransmitter vesicles.
mutation of this gene-> parkinsons.
- Progressive supranuclear palsy
- parkinsons tremor
then an upgaze palsy
then difficulty with voluntary horizontal gaze.
oculocephalic reflexes are intact
neck dystonia and rigidity occur.
- What is the treatment for progressive supranuclear palsy?
- Corticobasal degeneration
- after 50
presents with clumsiness, stiffness, or jerking of one arm
spreads to involve the ipsilateral limb
dystonic posturing, apraxia
can cause alien limb
rigidity and bradykinesia
- Multiple System Atrophy
- combo parkinsons, cerebellar dysfunction, autnomic impairment
spasticity, CN abnlties, ant horn cell dysfunction. Peripheral polyneuropathy in any combination. 2/3rds have REM sleep behavior disorder.
- what is the difference between MSA-C and MSA-P?
- C- cerebellar predominant
P- Parkinsons predomninant
- What is shy-drager syndrome?
- parkinsons and autonomic symps in MSA-P
- What are teh pathologic changes in MSA?
- neuronal loss in striatum, brainstem, cerebellum, and spinal cord nuclei w/ selective nitration of alpha-synuclein in glial cytoplasmic inclusions.
- Friedreichs ataxia
- AR ataxia
early in adolescence with progressive gait difficulty
loss of position and vibration sense in the lower extremities
no tendon reflexes in the lower extremities.
ataxic gait, speech.
- what is the underlying genetic cause of friedrichs?
- unstable expansion of GAA
- Ataxia telangiectasia
- first decade of life.
develops an ataxic gait, followed by upper extremity ataxia and ataxic speech.
difficulty initiating gaze
- what is the mutation in ataxia telangiectasias?
- poinositol 3 kinase
- spinocerebellar ataxia
- dominant inheritance
differentiation requires genetic testing.
mutation is an expanded CAG sequence
- patients head turned to one side, flexed, extended, tilted, or any combo
- blilateral eye closure- exacerbated by bright light
- writer's cramp
- hand assumes an infoluntary twisted posture when writing.
- generalized dystonia
- seen in kids, DYT1 gene is AD w/ low penetrance.
- what is the treatment for focal dystonia?
- botulinum toxin
- What are the neurologic symps of Wilson's disease?
- copper toxicity- tremor, dystonia, dysarthria, dysphagia, congitive detriorationa nd psychiatric symps.
- What will a slit-lamp show in Wilson's disease?
- Keyser-Fleishcer rings in most of those with neuro symps.
- What are some instances to use CT over MRI?
- skull fracture
intracranial bleeds- acute bleeds are white on CT w/in 20 min.
Trauma- CT is faster and safer.
Hydrocephalus- ventricles are easily seen, faster and cheaper
- What is white in T2 MRIs?
- edema and water accumulation.
(and CSF, but the other stuff is pathologic)
DWI- Ischemia appears white.
- What are the CSF results in Bacterial meningitis?
- Increased PMNs
increased opening pressure
- CSF in viral meningitis
- Increased monos
maybee increased protein and opening pressure
- CSF in SAH
- increased blood, RBCs and WBCs, increased protein
- GBS CSF
- increased protein
- MS CSF
- increased gammaglobulin
- CSF pseudotumor
- increased opening pressure
- Cheyne-Stokes respirations
- crescendo-decrescendo from bilateral hemisphere dysfunction
- Central neurognic hyperventilation
- rapid deep breathing due to midbrain damage
- Apneustic breating
- prolonged inspirations with apnea from pontine dysfunction
- Ataxic breating
- irregular breating from medullary dysfunction.
- What are the causes of delirium?
- MOVE STUPID
- What are the differences between delirium and dementia?
- Delirium- Fluctuating orientation, stupor or agitated, rapid onset, reversible
Dementia- memory loss, normal arousal, slow development, irreversible.
- what are the five As of Dementia?
- What are the causes of dementia other than alzheimers?
Degenerative disease- Park, Pick, Hunting, LBD
Endocrine- Thyroid, Parathyroid, pit-adrenal axis
Metabolic- alcohol, fluid e-lytes, b12, gcose, hepatic/renal
Exogenous- heavy metals, CO, drugs
Trauma- subdeural hematoma
Infection- Meningitis, encephalitis, abscess, endocarditis, HIV, syphilis, prions, Lyme disease
Affective disorders- Pseudodemitia 2ry to depression
Stroke/Structure- Multi-infarct, ischemia, vasculitis, normal pressure hydrocephalus
- what are some drugs used in alzheimers?
- Anticholinesterase inhibitors
Anti-oxidants- Vit E- Alpha tocopherol selegiline
- AChE inhibitor
- AChE inhibitor
- AChE inhibitor
- vit E
- Meniere's disease
- intermittent vertigo from dilation and periodic rupture of the endolymphatic compartment of the inner ear.
- What is the DDx for peripheral vestibular disorders?
- What is the DDx for acute central ataxias?
- What is the DDX for chronic central ataxias?
Posterior fossa mass
- what agents can be used prophylactically in migraine?
- B-blockers- propranolol
Ca-channel blockers- verapamil
- What is abortive therapy for cluster headaches?
- 100% O2, sumatriptan, erogts, intranasal lidocaine, corticosteroids
- What is the prophylactic treatment for migraines?
- Ca-channel blockers
- Headache and increased ICP
Unilateral paralysis in CN V-VII and X
Slow, protracted course
Resection or rads
- GBM- Grade IV astrocytoma
- most common 1ry brain tumor
presents w/ headache and ICP
Rx- Surgery, Rads
- Originates from the dura mater or arachnoid
increased incidence w/ age
Surgical resection; radiation for unresectable tumors
- Acoustic neuroma
- Ipsilateral hearing loss, tinnitus, vertigo, and cerebellar dysfunction
4th ventricle-> increased ICP
Malignant, may spread to subarachnoid space
Surgery, rads, chemo
- Common in kids
arise from ependyma of a ventricle or spinal cord
- increases dopa tone
good for parkinsons
- increases dopa tone
good for parkinsons
- What is the Rx for huntingtons?
- Reserpine- decreases unwanted movements
Haloperidol- for the psychosis
Benzos- for anxiety
Genetic counseling for offspring
- Lhermitte's sign
- electrical sensation running down the spine and into the lower extremities w/ neck flexion
- Uthoff's phenomenon
- exacerbation of weakness w/ heat.
- What is the Rx for MS?
Avonex- IFN B 1a
Betaseron- IFN B 1b
Copaxone- copolymer 1
Steroids for acute exacerbations
- PT and symptomatic treatment.
- Juvenile epilepsy, 1.5-2 Hz, loss of body tone
- west syndrome:
what is it, what is it's treatment?
- infantile spasms
- What drug is used in complex partial seizures
- Carbamezapine, phenytoin
- Absence seizures
- what is the Rx for seizure in preeclampsia
- what is the treatment for trigeminal neuralgia?
Not Effective: indomethacin, valproic acid
- What neurologic disease is associated with trigeminal neuralgia?
- what is similar between facial pain and trigeminal neuralgia?
facial pain is constant, trigeminal is paroxysmal
- what are some prophylactic medications for migraine
- what are abortive againts
- what is the manifestation of encephalitis lethargica?
- movement disorders
- What nerve is damaged in sarcoid?
- How do you treat Toxo?
- Sulfadiazine and Pyrimethamine
- what is the Rx for JC on top of HIV?
- What CN does Lyme disease affect?
- what eeg is seen with HSV?
- bilateral epileptiform discharges
- how do you treat lyme disease?
- what is the Rx for Rabies
- Supportive therapy
- What is the Rx for CMV?
- what is a gumma?
- largely avascular granuloma
seen in syphylis
- what causess osteomyelitis in HIV?
- what is the most common cause of brain abcess in HIV?
- What virus causes SSPE?
- What is the hallmark of bartonella encephalitis?
- what cells change in chronic liver failure?
- in what dementia is myclonus common?
- what is the triad of normal-pressure hydrocephalus?
- gait disturbance, dementia, and incontinence.
- What is the treatment for alzheimers?
- what aphasia is common in alzheimers?
- Transcortical sensory aphasia
- what is the drug used when a long-term neuroleptic causes parkinsonism?
- what is the drug of choice for turet's
- what is Meigs' syndrome?
- forceful blinking and grimacing movements, tongue protrusion
- locked-in syndrome
- paralysis with perserved conciousness.
infarction of the pons.
- what is the role of baclofen in MS?
- Neuromyelitis optica
- bilateral optic neuritis with transverse myelitis.
- adrenal dysfunction with progressive degnerative disease.
brain damage, atp binding transporter.
- Pelizaeus-Merzbacher disease
- demylenation- sudanophilic leukodystrophies.
most are male.
- rapid hyponatremia correction in alcoholic casues what?
- central pontine myelinolysis.
- what part of the CNS does alcohol effect?
- superior vermis
- TOCP causes what?
- severe motor polyneuropathy
- how does lead kill kids?
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