Neurology Shelf Review – Flashcards
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What is a lacunar stroke?
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Small non cortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery. -Branches arise at acute angles from the large arteries of the circle of willis and stem from the MCA or the basilar artery.
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What are the common locations of lacunar strokes?
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Internal capsule Pons Thalamus
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What type of lacunar syndrome presents with unilateral motor deficit (face, arm and to a lesser extent, leg); mild dysarthria; No sensory, visual or higher cortical function dysfunction?
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Pure Motor hemiparesis
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What is the underlying pathology of pure motor hemiparesis?
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Lacunar infarct in the posterior limb of the internal capsule (carries descending corticospinal and corticobulbar tracts or basis pontis)
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What type of lacunar syndrome presents with unilateral numbness, parathesias and hemisensory deficit involving the face, arm, trunk and leg?
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Pure sensory stroke
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What is the underlying pathology of a pure sensory stroke?
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Stroke in the ventroposteriolateral nucleus of the thalamus. (infarct usually in the contralateral thalamus)
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What type of lacunar syndrome presents with weakness that is more prominent in the LE, along with ipsilateral arm and leg incoordination?
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Ataxic hemiparesis
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What is the underlying pathology of ataxic hemiparesis?
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Lacunar infarction in the anterior limb of the internal capsule (contains fibers running form the thalamus to the frontal lobe, fibers connecting the lentiform and caudate nuclei, fibers connecting the cortex with the corpus striatum and fibers passing from the frontal lobe through the medial fifth of the base of the cerebral peduncle to the nuclei pontis) .
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What lacunar syndrome presents with Hand weakness, mild dysarthria and NO sensory abnormalities?
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Dysarthria-clumsy hand syndrome
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What is the underlying pathology in dysarthria-clumsy hand syndrome?
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Lacunar stroke at the basis pontis.
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What are some body positions and actions that someone can do to increase their ICP?
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Leaning forward valsalva cough
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What are some sxs of elevated ICP?
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HA (worse at night) n/v mental status changes (decreased level of consciousness, cognitive dysfunction)
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What does the Cushing reflex suggest?
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Brainstem compression
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What are the 3 hallmarks of Cushing reflex?
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Hypertension Bradycardia Respiratory depression
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What can cause momentary vision loss that varies according to changes in head position?
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Papilledema-can cause visual blind spot at the head of the optic nerve because it enlarges.
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What is amaurosis fugax?
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Painless, transient monocular blindness that lasts a few seconds. It is usually vascular (ie. embolus to opthalmic artery) in origin.
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What condition should be considered as a diagnosis in a pt with parkinsonism who experiences orthostatic hypotension, impotence, incontinence or other autonomic symptoms?
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Multiple system atrophy (Shy-Drager syndrome)
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What are the three components of multiple system atrophy?
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1. Parkinsonism 2. Autonomic dysfunction 3. Widespread neurologic signs.
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What disease is AR seen in predominantly children of Ashkenazi Jewish ancestry. Characterized by gross dysfunction of the ANS with severe orthostatic hypotension.
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Familial dysautonomia (Riley-Day syndrome)
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What are the sxs of hypothyroidism?
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weight gain, fatigue, constipation, hoarseness, and memory changes.
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Pt presents with progressive ascending paralysis over hours-days. the paralysis is more pronounced in the legs although there is some paralysis in the arms. Sensation is normal, there is no autonomic dysfunction and CSF exam is normal. What is this pt suffering from?
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Tick borne paralysis
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Pt has a peripheral neuropathy characterized by weakness affecting the LEs first, progressing superiorly to the arms and facial muscles; any sensory loss presents as loss of proprioception and areflexia. What is this pt suffering from?
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GBS
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What is a tremor?
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Uncontrolled uncoordinated unwanted movement of the limbs, extremities or trunk.
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What is the cause of Parkinson's disease?
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Loss of the DA nerves in the substantial nigra
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What is the fundamental problem is parkinson's disease?
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bradykinesia
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Pt with parkinson's disease have what symptoms?
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Pill rolling tremor Cogwheel rigidity Mask-like facies unsteady gait shuffling steps
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How is parkinson's disease diagnosed?
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CLinical -can do an autopsy
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If a parkinson's disease pt is functional, how do you treat if <60?
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Use dopamine agonists like Bromocriptine
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If a parkinson's disease pt is functional, how do you treat if >60?
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Use anti-cholinergic SEs of Amantadine
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If a parkinson's disease pt has non-functional status, how do you treat ?
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Add levodopa-carbidopa
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If a parkinson's disease pt is non-functional, and the levodopa and carbidopa stop working, how do you treat?
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Use the "capones", Selegiline and other DA-agonists
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What is essential tremor?
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A familial disease -pt has no tremor at rest that worsens with movement -typically <30 -(+) FHx -EtOH makes this tremor improve
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Pt is <30 yo M with a family history of tremor and notices that when he picks up the remote to watch tv, his hand seems to shake. What type of tremor is this?
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Essential tremor
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What is essential tremor diagnosed?
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clinical
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How do you treat essential tremor?
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Beta-blockers, particularly propranolol.
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What is cerebellar dysfunction tremor?
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-Another tremor that is absent at rest and worsens with movement -Occurs in anyone with a cerebellar lesion (Wernickes encephalopathy or cerebellar ischemia)
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what is distinct about cerebellar dysfunction tremor?
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As pt gets closer to the object that they intend to touch, the tremor will get worse and will not be so bad if they are far away. -Additionally these pts are usually old >40 (in comparison to essential tremor) -EtOH makes this tremor worse.
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How can you diagnose cerebellar dysfunction tremor?
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clinical -can do an MRI to see loss of brain cerebellar tissue
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How can you treat cerebellar dysfunction tremor?
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There is no treatment
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What is delirium tremens?
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Withdrawal from EtOH or benzos
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Pt comes into the ED and reports a negative history of chronic alcohol abuse. After 48-72 hrs pt begins to get anxious, have a tremor and start seeing things. What is this pt suffering from?
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DT -signs that they are about to have a seizure.
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What are the sxs of DT?
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Tremor at rest anxiety elevated HR and elevated BP -if pt is actively hallucinating-->seizure!!!
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How is DT diagnosed?
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Clinically
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How do you treat DT?
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Before pt starts to seize, give them a long acting benzo such as chlordiazepoxide or lorazepam
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What is huntington's disease?
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Genetic Caused by a trinucleotide repeat (CAG) and exhibits anticipation.
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What are the sxs of huntington's disease?
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Chorea and dementia
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How do you diagnose?
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Clinically but can do a DNA scan
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How can you treat Huntington's dz?
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There is no treatment.
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What type of tremor is the following: -resting tremor (4-6hz) that decrease with voluntary movement -usually involves legs and hands -Facial involvement is less common
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Parkinson's disease tremor
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What type of tremor is the following: -bilateral action tremor of the hands, usually without leg involvement -possible isolated head tremor without dystonia -usually no other neurologic signs -relieved with alcohol in many cases
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Essential tremor
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What type of tremor is the following: -Usually associated with ataxia, dysmetria or gait disturbance -tremor increases steadily as the hand reaches its target
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Cerebellar tremor
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What type of tremor is the following: -Low amplitude (10-12 hz) not visible under normal conditions -acute onset with increased sympathetic activity (ie. drugs, hyperthyroidism, anxiety, caffeine) -usually worse with movement & can involve the face and extremities.
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Physiologic tremor
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What are some sxs of cerebellar dysfunction?
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-Chronic alcoholism -progressive gait disorder-->frequent falls -truncal ataxia -nystagmus -intention tremor -dysmetria (limb-kinetic tremor when attempting to touch a target) -impaired rapid alternating movements (dysdiadochkkinesia) -muscle hypotonia -->pendular knee reflex (more than 4 swings is abnormal)
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Where is the brain lesion that presents as: -unilateral motor impairment -no sensory or cortical deficits -no visual field abnormalities
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Posterior limb go the internal capsule (lacunar infarct)
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Where is the brain lesion that presents as: -Contralateral somatosensory & motor deficit (face, arm & leg) -Conjugate eye deviation toward side of infarct -Homonymous hemianopia -Aphasia (dominent hemisphere) -Hemineglect (nondominant hemisphere)
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MCA occlusion
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Where is the brain lesion that presents as: -Contralateral somatosensory & motor deficit, predominately in lower extremity -Abulia (lack of will or initiative) -Dyspraxia, emotional disturbances, urinary incontinence
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ACA occlusion
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Where is the brain lesion that presents as: -Alternate syndromes with contralateral hemiplegia & ipsilateral cranial nerve involvement -possible ataxia
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Vertebrobasilar system lesion (supplying the brain stem)
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Pt presents with HA, low grade fever, and periorbital edema days later. Pt further reports vomiting and papilledema is present on PE. What is this pt likely suffering from?
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Cavernous sinus thrombosis
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How is cavernous sinus thrombosis diagnosed?
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MRI with MRV
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How is cavernous sinus thrombosis treated?
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broad spectrum IV antibiotics and prevention or reveal of cerebral herniation.
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What is a diagnosis for the following: -In a child: liver disease with asymptomatic ALT elevation leading to fulminant hepatic failure -In young adult: Neuropsychiatric disease ranging from tremor & rigidity to depression, paranoia and catatonia.
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Wilson's disease
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How is Wilson's disease diagnosed?
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Confirmed by presence of low serum ceruloplasmin (particularly <20mg/dL) in conjunction with increased urinary copper excretion of Kayser-Fleischer rings
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What is included in the primary HA category?
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Brain parenchyma itself or vasculature which leads to pain: -Migraines -Cluster -Analgesic rebound -Tension HA
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What is included in the secondary HA category?
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Dangerous & require emergent evaluation. Come from outside brain parenchyma and lead to irritation: -SAH -meningitis -abscess -tumor -temporal arteritis
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What is the cause of analgesic rebound HA?
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Withdrawal of medications such as NSAIDs and Tylenol
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How do you treat analgesic rebound HAs?
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Discontinue the medications
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What type of HA is characterized by muscular pain: -Bilateral vice-like pain that radiates to the neck
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Tension HA
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How do you diagnose tension HAs?
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clinically
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How do you treat tension HAs?
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OTC meds -NSAIDs -acetaminophen
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What is the cause of cluster HAs?
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Primarily vascular in nature
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Pt reports that they have been asymptomatic for months and then they had multiple attacks -(30-60) clusters in 1-3 days. -attacks usually occur at night -lasts ~2 hours -(+) ipsilateral Horner's syndrome -lacrimation -conjuctival injection -scleral injection -(+) red, hot painful eye (periorbital or retro-orbital) . What are they suffering from?
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Cluster HA
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How do you treat cluster HAs?
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O2 (acute attack) +subcutaneous sumatriptan -because it is vascular you can treat it similar to migraines. ie. treat with ergots or prophylax with CCBs. -can be prevented with verapamil, lithium
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How often do cluster HAs occur?
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Last 20-30 minutes long and so can happen 8-20 times per day.
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If you find someone with cluster HAs, what further testing should you perform?
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Brain imagining.
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What is the underlying pathology in migraine HAs?
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Vascular in nature (vasodilation)
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Pt presents with HA & photophobia, phono phobia. Usually there is a trigger. -may present with an aura -HA may last for multiple days -if pt falls asleep, HA will abort and they will wake up hungover. What are they suffering from?
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Migraine
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How do you treat migraine if caught early?
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NSAIDs
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If pt has mild-moderate migraines, how do you treat?
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Ergots Triptans (watch out for coronary artery disease) -Prochlorperazine (an antiemetic-effective acute treatment and can be giving in IV form which is often necessary due to pts tendency towards vomiting)
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How can you prophylax migraines?
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CCBs and beta-blockers
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What can you prescribe a pt with a migraine who complains on nausea?
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Prochlorperazine (an anti-emetic
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What further study should you order if pt has migraines?
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Brain imaging
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What is the underlying pathology of Idiopathic Intracranial HTN (pseudo tumor cerebri)?
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Elevated ICP (Can be due to hypervitaminosis A, etc.)
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Pt presents with intense HA, may have some neurologic deficit, typically young women 20-30s with normal CT scan. LP revealed elevated opening pressure and relief of HA and deficits with LP. What is pt suffering from?
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Idiopathic intracranial HTN (pseudotumor cerebri)
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How do you treat Idiopathic intracranial HTN (pseudotumor cerebri) ?
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Stop OCPs if on them repeated LPs VP-shunt acetazolimide
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Pt presents with lightening shocks down the side of the face. What are they suffering from?
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Tic douloureux (trigeminal neuralgia)
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How do you treat tic douloureux?
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Carbamazepine
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Pt presents with HA that lasts 2-10 minutes, and so happen 50-100 times per day. What are they suffering from?
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Paroxysmal hemicrania
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How do you treat Paroxysmal hemicrania?
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They are aborted with indomethicine and prevented with verapamil
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Pt presents with HAs that last seconds and so happen 1000s of times per day. What are they suffering from?
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SUNCT/SUNA
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How do you treat SUNCT/SUNA HAs?
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They are so short that they dont get aborted (but people wouldn't mind ending their life since there isn't anything they can do about 1000 shocks of daily pain). They are prevented with Lamotrigine
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What are the red flags associated with secondary HAs?
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-Fever + HA -Focal neurologic deficit +HA -Progressive HA + n/v in morning (developing tumor) -New onset at age >50yo (risk for tumor) -Sudden onset (thunderclap HA)
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Pt reports fever, HA and a stiff neck. What is the likely diagnosis?
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Meningitis
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What are the known causes of meningitis?
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-Commonly bacterial (TB, RMSF, Lyme, Cryptococcus,) -Viral
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Pt reports fever, HA, and focal neurological deficit. What is the likely diagnosis?
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Brain abscess or cancer
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Pt reports fever, HA and some altered mental status. What is the likely diagnosis?
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Encephalitis (because it causes encephalopathy)
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What are the common caused of encephalitis?
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West Nile virus St. Louis virus Equine virus ... -->Tx is supportive for those above **Only one that matters in herpes (because you can treat it)
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What is the criteria that demonstrates an LP is contraindicated?
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"FAILS" Focial Neurologic Deficit Altered Mental Status Immunosuppressed Lesion over site of needle placement Seizures -->if increased ICP -->brain herniation
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If pt satisfies any of the FAILS criteria what test would you perform?
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Give empiric antibiotics + CT scan -if CT is negative get an LP
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LP shows 1000s PMNs. What is the likely diagnosis?
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Bacterial meningitis
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What antibiotics do you start to treat empirical bacterial meningitis?
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Ceftriaxone Vancomycin Steriods (if immunosuppressed, add on ampicillin)
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LP does not show many PMNs at all. What is the likely diagnosis?
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Not bacterial
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Pt presents with fever, rash that moves from the arms to the trunk and has a history of recent camping. What is their likely diagnosis and what would you see on CSF?
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RMSF -see antibodies on CSF
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How do you treat RMSF?
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Ceftriaxone
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Pt presents from recent travel to CT. They have a targeted rash with arthralgias, and an arrthymia. What is their likely diagnosis?
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Lyme Disease (invasive) -See lyme antibody
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How do you treat Lyme disease?
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Ceftriaxone
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Pt with a history of AIDs presents with fever and HA. Their LP revealed >20cmH2O opening pressure. What is the likely diagnosis?
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Cryptococcal meningitis -cryptococcal antigen is positive
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How do you treat cryptococcal meningitis?
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amphotericin B
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Pt presents with night sweats, weight loss, hemoptysis and symptoms of meningitis. They report that they are homeless. What is the likely diagnosis?
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TB meningitis -others at risk are homeless, in prison and from endemic areas
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How do you treat TB meningitis?
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RIPE therapy -Rifampin -Isoniazid -Pyrazinamide -ethambutol
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Pt with a history of primary chancre, secondary erythema multiforme and now presented with neurologic sxs. What is the likely diagnosis?
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Neuro syphilis -get CSF RPR or CSF antibodies
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Pt presented with fever, HA and altered mental status. LP revealed lymphocytes. What is the likely diagnosis and treatment?
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encephalitis -supportive therapy or if it is HSV, treat with acyclovir.
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Pt's LP revealed temporal lobe bleeding or hemorrhagic tap. What should you be thinking?
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HSV
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How do you diagnose HSV encephalitis?
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HSV PCR
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What are the alarm symptoms of back pain?
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h/o cancer fever urinary symptoms (retention or incontinence) -sexual dysfunction (priapism or inability to achieve erection) sensory deficit LE weakness
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If a pt presents with an alarm symptom of back pain, what is the likely diagnosis?
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Cord compression
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If you suspect cord compression in a pt, what should you immediately treat them with?
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Dexamethasone -the earlier the pt gets steroids, the more likely they will recover with normal neurologic function
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What imaging should be obtained if you suspect a pt has cord compression?
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X-ray then MRI for confirm
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If pt complains of back pain without any alarm sxs and a relatively negative PE, what should you recommend?
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Non-urgent back pain -NSAIDS -Exercise -tell them to return in 4-6 weeks
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If pt with non-urgen back pain improves in 4-6 weeks on conservative therapy, what was the likely cause?
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MSK
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If pt with non-urgen back pain does not improve in 4-6weeks on conservative therapy and although they still do not have any alarm symptoms but have a positive PE, what is the next step?
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Urgent back pain -X-ray followed by MRI -Dx and tx with surgery likely.
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What is the underlying pathology of msk back pain?
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Muscular strain
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Pt presents with a history of heavy lifting, <40 yr old. they describe their pain as a belt-like pain without any point of tenderness, no step-off on palpation and no neurologic sxs. What is the likely next step?
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MSK back pain -Tx with NSAIDs and exercise DO NOT get x-ray or MRI
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What is the underlying pathology of disc herniation?
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Nucleus pulposus pops out and pinches a nerve.
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Young person with history heavy lifting currently complains of sciatic (lightening pain) down back of leg, particularly when he coughs or has hip flexion (+) straight leg raise What other tests should be done?
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-Ankle plantar flexion to check the nerve root S1 & S2 -Ankle dorsiflexion to check the nerve root L4 & L5 -Check these regions for disc herniation.
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What is the work up for a pt that is suspected to have disc herniation?
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1st: X-ray 2nd: MRI to visualize the bulging disc
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How do you treat disc herniation?
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-at 6 mo. neurosurgery is better than conservative treatment -after 6mo, neurosurgery and conservative treatment have the same efficacy.
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What is the underlying pathology of osteophytes?
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Bone spur that grows into the exit of the nerve and pinches it.
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How does a pt with osteophytes present?
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Pt is typically older (>40) -all symptoms of sciatica -NO history of heavy lifting
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How do you diagnose pt with osteophytes?
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X-ray (1st) MRI (best)
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How do you treat a pt with osteophytes?
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Surgery
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What is the underlying pathology of a compression fracture?
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Osteoporosis
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Pt with a history of osteoporosis recently fell on her butt and not complains on pinpoint tenderness and on exam has vertebral step-offs and neurologic sxs. What is the likely diagnosis?
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Compression fracture
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How do you diagnose a compression fracture?
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X-ray (1st) MRI (Best)
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How do you treat a compression fracture?
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Surgery Tx osteoporosis
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What is the underlying pathology of spinal stenosis?
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When a bone grows into the vertebral canal and compresses the cord.
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Pt can exercise and walk upright normally but complains of an intense burning pain in hips, buttocks and thighs. However, if they lean forward, it relieves sxs. What is the likely diagnosis?
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SPinal stenosis
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How do you diagnose spinal stenosis?
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X-ray (1st) MRI (best)
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How do you treat spinal stenosis?
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Surgery (laminectomy)
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What is the result of damage to the lateral spinothalamic tracts?
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Brown-Sequard syndrome -causes contralateral loss of pain and temperature sensation beginning two levels below the level of the lesion. (Involves ipsilateral hemiplegia with contralateral pain and temp deficits due to the decussating fibers of the spinothalamic tract)
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What drug has been proven to decrease the frequency of relapse and reduce disability in pt with the relapsing-remitting form of MS?
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Interferon-beta
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If a parent presents with myasthenia gravis, what scan would likely be abnormal?
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CT scan of the chest--because 15% of pt have a coexisting thymoma.
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What type of intracranial hemorrhage presents with occipital HA, vomiting, gaze palsy or nystagmus, neck stiffness and gait ataxia?
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Cerebellar hemorrhage
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What type of intracranial hemorrhage presents with deep coma & total paralysis within minutes as well as pinpoint reactive pupils?
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Pons hemorrhage
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What is thought to be the underlying pathology is lacunar strokes?
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A combination of microatheroma and lipohyalinosis.
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Pt >40 complains of rapid onset severe eye pain and reports seeing halos around lights. The eye looks injected and the pupil is dilated and poor responsive to light. The pt further complains of tearing and HA with some n/v. What is this pt suffering from?
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Acute angle closure glaucoma. -typically affects the Asian and Inuit populations and individuals with farsightedness.
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What type of medication is trihexyphenidyl?
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an anticholinergic agent that can be used to treat early stage Parkinson's tremor in younger patients where tremor is the predominant symptom.
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65yo pt presents with weakness that is more pronouced in the bilateral UEs than in the LEs. What is he suffering from?
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Central Cord syndrome -pt typically complain of burning pain and paralysis un UEs with relative sparing of LEs.
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What is central cord syndrome?
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Typically occurs with hyperextension injury in elderly pts with preexisting degenerative changes in the cervical spine. -Causes selective damage to the central portion of the anterior spinal cord, specifically the central portions of the corticospinal tracts and the decussating fibers of the lateral spinothalamic tract.
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Pt presents with contralateral hemiparesis & hemisensory loss, homonymous hemianopsia and gaze palsy. Where is the likely location of their intracerebral hemorrhage?
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Basal ganglia
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How can you treat exertional heat stroke?
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1. rapid cooling: ice water immersion preferred; can consider high flow cool water dousing, ice/wet towel rotation, evaporative cooling 2. Fluid resusicitation 3. Electrolyte correction 4. Management of end organ complications 5. No role for antipyretic therapy
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Pt presents with ipsilateral ataxia, tends to sway to one side when standing with legs together, and exhibits titubation. Other findings are nystagmus, intention tremor, ipsilateral muscular hypotonia and marked difficulty in coordination and performing rapid alternating movements. What is this pt suffering from?
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Cerebellar tumor -Obstruction of CSF flow may occur leading to increased ICP leading to presentation of HA, n/v and papilledema. Titubation: forward and backward movement of the trunk
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What are some early side effects of treatment with levodopa +carbidopa?
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Somnolence, confusion, agitation, hallucinations and nausea
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What are some "late" side effects of treatment with levodopa +carbidopa?
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Involuntary movements (dyskinesia & dystonia) typically occur after 5-10 years of therapy in nearly 50% of pts.
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Pt presents with subcutaneous neurofibromas, hyper pigmented cafe-au-lair spots, deafness due to acoustic neuromas. What is the diagnosis?
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NF2 -AD -caused by a mutation in the tumor suppressor gene located on Chr22. The severe variant, Wishart, is caused by a frameshift or nonsense mutation and misreading of the nucleotide code downstream or early termination of the translation process occurs.
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What MMSE score is suggestive of dementia?
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24/30
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Pt presents with total loss of motor function below the level of a burst fracture of the vertebra and loss of pain and temperature on both sides below the lesion. What is this pt suffering from?
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Anterior Cord syndrome
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What is the most common site of hypertensive hemorrhage?
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30% occur in the putamen -the internal capsule that lies adjacent to the putamen is almost always involved, leading to contralateral dense hemiparesis.
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Pt presents with flushing, anhidrosis/dry mouth, hyperthermia, mydriasis/vision changes, delirium/confusion and urinary retention/constipation. They additionally complain of HA, dizziness and tachycardia. What are they experiencing?
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Anticholinergic excess.
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What are the sxs of hypokalemia?
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weakness fatigue muscle cramps -when severe can lead to paralysis and arrhythmia -EKG: U waves, flat and broad T waves and premature ventricular beats.
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How do you treat narcolepsy?
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Modafinil and armodafinil address excessive, uncontrollable daytime sleepiness. Amphetamine stimulants have been used for treatment. Sodium oxybate reduces cataplexy.
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What are the typical neuroimaging findings in autism?
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Increased total brain volume
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What are the neuroimaging findings in OCD?
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Abnormalities in orbitofrontal cortex & striatum
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What are the neuroimaging findings in panic disorder?
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Decreased volume of amygdala
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What are the neuroimaging findings in PTSD?
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Decreased hippocampal volume
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What are the neuroimaging findings in schizophrenia?
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Enlargement of cerebral ventricles.
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What is transient global amnesia?
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A clinical syndrome of reversible anterograde amnesia accompanied by repetitive questioning that occurs in middle aged and elderly individuals. -etiology is obscure & prognosis is benign
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What other conditions is transient global amnesia associated with?
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Migraines
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What do you treat transient global amnesia?
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There is no specific therapy indicated
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What are the three cardinal findings in brain death?
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unresponsiveness absence of brainstem reflexes apnea
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What tests can be used to assist in diagnosis of brain death?
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Cerebral angiogram EEG MRI transcranial Doppler
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What labs findings are associated with MS?
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mild CSF pleocytosis (rarely containing PMNs) normal CSF glucose CSF protein is mildly elevated CSF IgG CSF oligoclonal bands
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What are the benefits of using lamotrigine to treat a generalized seizure in a female of reproductive age?
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It appears to have a lower incidence of inducing birth defects than other anticonvulsants. -Frequency of cognitive side effects is low
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What nerve is expected to be pinched with a C5-C6 disc prolapse?
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C5 nerve lies above C6 vertebra and a C5-C6 disc prolapse will compress the 6th cervical nerve.
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What are the side effects of common migraine medications: Topiramate Propranolol Valproic acid Verapamil Amitriptyline
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Topiramate: can cause renal stones Propranolol: can exacerbate asthma Valproic acid: is potentially hepatotoxic Verapamil: 2nd line for migraine Amitriptyline: can cause drowsiness
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What are general causes of paroxysmal focal symptoms?
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TIA: aburpt onset & cause loss of function w/ no residual deficit Seizures: usually last 2-3mins migraine auras: cause positive phenomenon that progress over 15-30mins (commonly visual but tingling also possible)
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What portion of the brain is responsible for visuospatial functioning?
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Largely the nondominent parietal lobe
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What lobe of the brain is responsible for semantics?
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Lateral temporal cortex of the dominant hemisphere
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What region of the brain is necessary for facial recognition?
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the inferior occipitotemporal cortex (fusiform gyrus) -bilateral dysfunction of this region produces prosopagnosia (inability to recognize familiar faces)
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What muscles does the musculocutaneous nerve supply?
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The biceps brachial, brachialis, and coracobrachialis
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Where does the musculocutaneous nerve receive sensory information from?
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The lateral cutaneous nerve of the forearm.
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Which tract travels from the cerebellar cortex and projects to the ipsilateral deep grey nuclei of the cerebellum which in turn project via the superior cerebellar peduncle to the contralateral red nucleus and gives rise to this tract that crosses and travels ipsilaterally to the cerebellar cortex?
answer
Rubrospinal tract.
question
What is TRAP for PD stand for?
answer
resting tremor rigidity akinesia postural instability
