Term
| What are the normal CSF values? |
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Definition
- Opening pressure 60-150 mmH2O
- Glucose = two-thirds of systemic glucose
- Portein = 40-50 mg/dL
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Term
| What are radiologic contraindications to LP? What are some complications of LP and treatment? |
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Definition
- Closure of fourth ventrical and quadrigeminal cistern.
- Low-pressure headache - treat by lying down and increasing intake of liquids + caffeine
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Term
| What CSF findings distinguish MS from ADEM? |
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Definition
MS = slightly high protein with few lymphocytes and oligoclonal bands.
ADEM = protein usually high, with lymphocytes or polymorphs and typically absent oligoclonal bands. |
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Term
| Which substances are brightest on T1? What is this sequence best used for? T2? FLAIR? DWI? |
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Definition
- T1
- Fat is the brightest
- Useful for contrast; gadolinium-enhanced objects (tumors, abscesses, areas of inflammation, new MS lesions) appear bright
- T2
- Water is brightest (including CSF)
- Good for evaluating spinal cord
- FLAIR
- T2-weighted, with signal from CSF inverted
- Good screening for most pathological processes (including chronic MS lesions)
- DWI demonstrates cellular toxicity, and is good for diagnosing stroke half an hour after symptoms
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Term
| CT is the modality of choice for what pathology? Where is it inadequate? |
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Definition
| Acute intracranial bleeding; posterior fossa and craniocervical junction (bone artifacts) |
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Term
| How can gait distinguish cerebellar ataxia from sensory ataxia? |
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Definition
| While both will have wide gait and poor tandem, sensory will generally present with "steppage gait" (lifting the foot high and slapping it down heavily) |
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Term
| Vertical nystagmus is associated with which disorder? |
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Definition
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Term
| A patient presents with vertigo, nausea, vomiting, dysphagia, hoarseness, and nystagmus. Additionly, they possess right-sided Horner syndrome, limb ataxia, and impairment of all sensory modalities over the face. Left side is notable for loss of of pinprick and temperature appreciation. What is this condition, and most likely cause? |
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Definition
- Right lateral medullary infarction (Wallenberg syndrome)
- Caused by occlusion of the proximal right vertebral artery (possibly PICA)
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Term
| How is the ataxia of Wenicke encephalopathy characterized? |
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Definition
| Typically, purely gait (superior cerebellar vermis is primarily affected) |
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Term
| A patient has distinct clumsiness in their right-sided hand (ataxia), with 7 mm, poorly reactive pupils in their right eye. On exam, this eye cannot look left ward. Where is the lesion and what is its supply? |
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Definition
- Midbrain (red nucleus and CN III nucleus)
- Paramedian artery
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Term
| A 64 year-old patient with poorly controlled chronic hypertension comes in complaining of sudden, severe headache and vertigo. They have difficulty walking, but no dysmetria is observed on exam. What is the most likely diagnosis? What are the symptoms are likely to be observed? |
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Definition
- Cerebellar hemorrhage
- Additional signs
- Ipsilateral gaze palsy (with gaze preference away from the side of hemorrhage)
- Ipsilateral peripheral facial palsy.
- The gaze preference cannot be overcome by caloric stimulation.
- Nystagmus and ipsilateral depression of the corneal reflex may occur.
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Term
| What is the genetic profile seen in Friedriech's ataxia? Clinical presentation? What nutritional deficiency does it mimic? |
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Definition
- Nucleotide repeats on chromosome 9
- Clinically presents...
- ... between 4 years of age and puberty
- ... with lower limb/gait ataxia and sensory loss (vibration and proprioception)
- ... with severe kyphoscoliosis, leading to respiratory problems
- ... with cardiomyopathy
- Similar to Vitamin E deficiency
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Term
| How does benign positional vertigo present? What is the proposed pathophysiology? What is the treatment? |
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Definition
- Vertigo in specific positions (no hearing disturbance)
- Build up of debris in the semicircular canal, causing stimulation (canalolithiasis)
- Repositioning maneuver, to allow reabsorption of debris
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Term
| A patient initially presenting with severe vertigo and tinnitus has begun noticed progressive hearing loss. They describe a sensation of fullness in their ear. Weber's transmits sound away from the affected ear. The patient also noticed remission of her vertiginous signs with the onset of the hearing loss. What is the most likely diagnosis? |
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Definition
| Meniere disease (believed to be caused by build up of endolymph) |
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Term
| What are the diagnostic criteria for MS? |
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Definition
- Objective abnormality on exam
- Lesions predominantly affecting long white matter tracts (pyramidal, cerebellar, MLF, optic tract, posterior columns)
- 4 lesions >3mm (3 if one is periventricular)
- Either...
- ... two or more separate episodes of worsening involving different sites of the CNS, each lasting at least 24 h and occurring at least 1 month apart
- ... gradual or stepwise progression over at least 6 months if accompanied by increased IgG synthesis or two or more oligoclonal bands.
- Cannot be attributed to other disease
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Term
| What are the functions of the dominant-sided hemisphere? Non-dominant? |
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Definition
Dominant
- Calculation
- Left-right distinction
- Language
- Apraxia
- Agnosia
- Perseveration (if lesion)
Non-dominant
- Visuospatial functioning (copy figure, dress appropriately)
- Directed attention (double simultaneous stimulation)
- Agnosia (prosopagnosia -- inability to place face)
- Aprosodia (inability to process emotional cues)
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Term
| What is the quality of dysarthria in UMN lesion? LMN lesion? Cerebellar? Parkinson's? |
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Definition
- Spastic (slow and effortful, harsh sounding)
- Palatal, lingual or labial, depending on lesion
- Scanning (short bursts, explosive, excessive stress on syllables)
- Hypophonic
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Term
| How does a cerebellar lesion manifest with respect to DTRs? |
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Definition
| Pendular (swings back and forth) |
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Term
| How can myopathies be distinguished from LMN lesions? |
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Definition
While both have atrophy, only LMN has fasciculations.
(Note: fasciculations = entire motor unit, fibrillations = single motor neuron) |
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