Neuro Shelf II

eesohbel's version from 2015-09-20 23:47

CSF analysis

Question Answer
Protein in bacterial meningitisgreater than 250
WBC count in bacterial meningitisgreater than 1000
protein in TB meningitisgreater than 250
glucose in TB menigitisless than 10
protein in Guillain barre45-1000


Question Answer
gait apraxiamagnetic gait (start and turn heistation)
Parksonian giatshort steps. referred to as hypokinetic
vestibularunsteady fallowing to one side
causes of gait apraxiaNPH, frontal lobe degeneration
steppagemotor neuropathy
cerebellar vermal lesionsprominent truncal and gait ataxia
cerebellar hemispheric lesionsipsilateral limb ataxia
alcoholic cerebellar degenerationaffects the vermis and manifests with gait and truncal ataxia
slapping gaitlarge fiber sensory or dorsal column function

Spinal Cord Injury

Question Answer
anterior cord syndrometotal loss of motor function below the level of lesion with loss of pain and temperature on both sides of the lesion
central cord syndromecharacterized by burning pain and paralysis in upper extremitis with relative sparking of lower extremities
Brown Sequardacute hemisection of cord. ipsilateral motor and propioception loss and contralateral pain below the lesion
acute disk prolapsesevere radicular pain with positive straight leg raising test
cauda equinaparaplegia, variable sensory loss, urinary and fecal incontinence
conus medularis
posterior cord syndromebilateral vibratory and propiceptive sensation loss
peripheral nerve lesionloss in affected area
rootvariable loss of all sensory modalities in a dermatomal distribution
plexussensory loss in the distribution of two ro more peripheral nerves
brainstemipsilateral facial numbness and contralaleral body numbness
thalamushemibody motor weakness

Spinal nerves and tracts

Question Answer
# of spinal nerves31 - 8cerv, 12 thoracic, 5 lumbar, 1 coccygeal
Vertebral disc herniationnucleus pulposus (soft central disc) herniates through anulus fibrosus (outer ring)
usually posterolaterally at L4-L5 or L5-S1
Spinal cord extends to where?L1-L2
Subarachnoid space extends to where?Lower border of S2
Lumbar tap levelsL3-L5
Conus medullaris syndromelesions at L2 leads to flaccid paralysis
Cauda Equinadamage to S2 to S4 leads to loss of contraction of anal sphincter.
Orientation of lateral coricospinal tractlegs are lateral
Orientation of dorsal columnsArms are lateral (fasciculus cuneatus)
Legs are medial (fasciculus gracilis)
Fn of dorsal column (ML pathway)ascending pressure, vibration, fine touch, proprioception
Decussation dorsal columnmedulla → ascends contralaterally in medial lemniscus
Fn of lateral spinothalamic tractpain/temp
Fn of anterior spinothalamic tractcrude touch, pressure
Decussation spinothalamic tractanterior white commissure at cervical level → ascends contralaterally
Fn of lateral corticospinal tractDescending voluntary movement of contralateral limbs
Decussation of lateral corticospinal tractat caudal medulla descends contralaterally
UMN lesioneverything up (tone, DTRs, toes)
spastic paralysis
LMN lesioneverything down (muscle mass, muscle tone, reflexes, toes)
Flaccid paralysis
If corticospinal lesion above pyramidal decussation (caudal medulla)contralateral UMN less
If corticospinal lesion below pyramidal decussation (caudal medulla)ipsilaterlal UMN signs]
LMNventral horn

Vitamin Deficiencies

Question Answer
B12dorsal column, lateral corticospinal and sometimes lateral spinothalamic dysfunction. initial symptoms are parasthesias in hand and feet
Vitamin Espinocerebellar ataxia
B6disorder of early infancy with seizures featuring prominently in the presentaiton

Conus Medularis versus Cauda Equina

Question Answer
presentation of conus medullarissudden and bilateral
reflexes of conus medularrisknee jerks present but ankle jerks affected
sensory symptoms conusnumbness localized to perinanal area. symmetric and bilateral
motor strength conustypically symmetric, hyperreflexic, fasiculations may be present
impotence conusfrequent
sphincter dysfunction of conusurinary retention and atonic anal sphincter cause overflow urinary incontinence. tends to present early in course
presentation of caudagradual and unilateral
reflexes of caudaankle and knee jerks affected
radicular pain of caudamore severe
urinary symptoms caudalate in course of disease
LMN or UMN caudaLMN
conus LMN or UMNLMN and UMN


Question Answer
detrusor hypeereflexia istype of urge incontinence can be referred to as spastic bladder
neurologic causes of spastic bladderstroke, frontal lobe dysfunction, suprasacral spinal cord lesions and MS
UMN or LMN spastic bladderUMN
UMN or LMN overflow incontinenceLMN. atonic bladder.
intraabdominal pressure exceeds urethral sphincter pressurestress
loss of urethral supportstress
leaking with sneezing, coughing, laughing, liftingstress
detrusor overactivityurge
overwhelming frequent need to empty bladderurge
impaired detrusor contractilityoverflow
bladder outlet obstructionoverflow
constant involuntary dribbling of urineoverflow
incomplete emptyingoverflow
treatment for urge incontinenceantimuscarinic (M3 receptor) meds --> decrease IP3 --> decrease Ca release --> relaxation
urge continencegive tolterodine or oxybutinin (muscaranic anatongist)
stress incontinencealpha adrenergic agonists (Ex. pseudoephedrine and midodrine)
overflow incontinenceValsalva; self-catheterization; bethanechol
someone who cannot pee after surgery or atonic bladder (urinary retention)bethanechol (muscarinic agonist)
stress incontinencegive alpha agonist

Male Sexual Response

Question Answer
Erectionparasympathetic fibers via the pelvic nerve
Emissionsympathetic fibers via the hypogastric nerve
Ejaculationmediated by visceral and somatic nerve (ie pudenal)
Point and ShootErection (PNS) and Emission (Sympathetic)
ordererection, emission, ejaculation
bicylist what willl be damaged in erectal dysfunctionpudenal
spinal cord injuryusually parasympathetic aka pelvic nerve


Question Answer
posterior limb of internal capsuleunilateral motor impairment
MCAcontralateral somatosensory and motor. homonymous hemianospia aphasia (dominant hemisphere). hemineglect (nondominant)
ACAcontrallateral somatosensory and motor. abulia (lack of will or initiative)
vertebrobasilarcontralateral hemiplegia and ipsilateral cranial nerve.

Parkinsonian symptoms

Question Answer
progressive supranuclear palsysupranuclear opthalmoplegia with limitation of vertical more than horizontal gaze
corticobasal ganglionic degnerationapraxia, cortical sensory impairment and alien-limb phenomenon
vascular parkinsonism"lower-half" parkinsonism with rigidity in the legs and marked gait impairment
multiple system atrophyearly and prominent features of autonomic dysfunction; evidence of corticospinal tract dysfunction; cerbellar signs
when a patient with parkinsonism experiences autonomic symptoms considermultiple system atrophy (shy-drager syndrome)

Head trauma

Question Answer
athletes with no loss of consciousness and concussion lasting less than 15 minutesreturn to play but second even that day requires a week of rest
no loss of consciousness and concussion lasting more than 15may return to play in a week
loss of consciousnessif loss brief can return to play in a week if longer two weeks. if second event at least a month of rest.
treatment of early posttraumatic seizuresdoes not alter long term chance of developing epilepsy
early sign of uncal herniationdilated pupil ipsilateral to the side of a mass lesion
Kernohan notchipsilateral hemiplegia compression of contralateral cerebral peduncle with resulting hemiplegia ipsilateral to herniating uncus.
GCS score 13 to 15mild head injury
GCS score 8 to 12moderate
GCS score 3 to 7severe

Neurologic Manifestations of Systemic Diseases

Question Answer
PANmononeuropathy multiplex, seizures, stroke
Churg-Straussmononeuropathy multiplex, encephalopathy, stroke, chorea
Giant cell arteritisheadache, blindness, polyneuropathy, stroke
GPAmononeuropathy multiplex, cranial neuropathy, basal meningitis
Sjogrensensory polyneuropathy
Behcetaseptic meningoencephalitis
cryoglobulinemiaTIA, storke, peripheral neuropathy
TTPencehalopathy, seizures, stroke
Whippledementia, seizures, myoclonus, ataxia
most common manifestations of neurosarcoidcranial neuropathy and basal meningitis

Effects of Alcohol on the Nervous System

Question Answer
peripheral neuropathydistal sensorimotor axonal neuropathy; recovery with abstinence is slow and incomplete
cerebellar degenerationgait ataxia greater than limb ataxia, dysarthria, typically no nystagmus
tobacco-alcohol amblyopiainsidious and painless loss of vision; centrocecal scotoma
marchiafava-bignamifrontal-type dementia, seizures and pyramidal signs
acute alcohol intoxicationimpaired cognition, ataxia dysarthria, nystagmus, diplopia
acute withdrawalagitation, insomnia, tremulousness, hallucinations, seizures
wernicke'sconfusion, ataxia, opthalmoplegia
korsakoffisolated memory disturbance with confabulation

Vitamin Deficiency syndromes

Question Answer
confusion and encephalopathythiamine, niacin
dementiaB12, folate, niacin
seizurespyroxidine, niacin
ataxiavitamin E, niacin
myelopathyb12 and E, niacin
peripheral neuropathythiamine, pyridoxine, B12 and E, niacin

Entrapment Neuropathies

Question Answer
weakness and atrophy of the thenar musclesmedian nerve
descreased sensation in the volar aspect of the first three and a half digitsmedian nerve
difficulty spreading the fingersunlar nerve
wrist drop and sensory loss on the dorsal aspects of hte handradial nerve
area of sensory changes over the lateral aspect of the thighentrapment of the lateral femoral cutaneous nerve. meralgia paresthetica
sensory loss of the anterior thigh and medial legfemoral neuropathy
sensory loss over the dorsal part of the footperoneal
knee extension and hip flexionfemoral nerve
abduction of the thighobturator nerve

Disorders of the NMJ and Skeletal muscle

Question Answer
fatigable proximal muscle weakness, prominent ocular and bulbar involvementmyasthenia gravis
molecular defect of MGantibodies against the nicotinic acetylcholine receptor
childhood onset of proximal muscle weaknessDMD and BMD
myotonic dystrophydistal muscle weakness and stiffness, myotonia, systemic features (ptosis, balding etc)
episodes of generalized weakness lasting hours to dayshypokalemic periodic paralysis
episodes of generalized weakness lasting minutes to hourshyperkalemic periodic paralysis
fever, depressed level of arousal, muscle rigidity, and autonomic dysfunctionNMS
if a patient has MG with negative acetylcholine receptor anitbodies but positive MUSK are there thymomasno

Peds Neuro

Question Answer
long face, enlarged ears and macro-orchidismfragile X
mental retardation, decreased muscle tone, short stature, emotional lability and insatiable appetitePrader-Willi
happy puppetAngelman's
normal development until 6 to 18 months the hypotonia and autustic like behavior. sterotyped hand movements. usually girlsRett syndrome
torches infections that cause cerebral calcificationsCMV and toxo

Neurocutaneous syndrome

Question Answer
cafe au lait spots, neurofibromasNF-1
NF-1 neuro findingoptic nerve gliomas
NF-2 neuro findingbilateral acoustic neuromas
ash-leaf spots, angiomyolipomas of kidney, cardiac rhabdomyomaTuberous Sclerosis
Neuro findings tuberous sclerosisastrocyotmas
VHL neuro findingscerebellar hemangioblastomas, ataxia
port-wine stain in the distribution of the opthalamic nerveStruge Wber
neuro finding of sturge webervenous angioma of the pia mater, seizures, hemiparesis

Lysosomal storage diseases Fabry, Gaucher, Hurler, Hunter, Nieman Pick, Tay Sachs

DiseaseInheritanceEnzymeMetaboliteClinical Presentation
Fabry DiseaseX-Linked Recessivealpha galactosidaseceramide trihexosideangiokeratomas, cardiac and renal involvement, and painful neuropathy, corneal opacities
Gaucher Diseaseautosomal recessiveB-glucocerebrosidesglucocerebrosideGaucher cells (macrophages that look like crumpled tissue paper), hepatosplenomegaly, pancytopenia, severe bone and joint pain
Hurler syndromeautosomal recessivealpha-L-iduronidasedermatan and herparan sulfategargoylism, corneal clouding, hepatosplenomegaly, developmental delay
Niemann-Pick diseaseautosomal recessivesphinomyelinasesphinomyelinhepatosplenomegaly, cherry-red spot in macula, foam cells, progressive neurodegeneration
Tay Sachs diseaseautosomal recessiveB-hexosaminidase AGM2 gangliosidecherry-red spot in macula, progressive neurodegeneration,NO hepatosplenomegaly
Krabbe diseaseautosomal recessivegalacto-cerebrosidasegalactosyl-sphingosine and galactocerebrosideprogressive neurodegeneration and optic atrophy
metachromatic leuokdystrophyautosomal recessivearylsulfatase Acerebroside sulfatecherry red spot, muscle wasting, dementia, ataxia
Hunter syndromeautosomal recessiveiduronate sulfateheparan sulfate, dermatan sulfatemild Hurler plus aggressive behavior, no corneal clouding

Lysosomal Storage Diseases

Question Answer
what is the disease angiokeratomas, cardiac and renal involvement and painful neuropathy, corneal opacitiesFabry
what is enzyme in Fabryalpha galactosidase
what is the disease macrophages that look like crumpled tissue paper, hepatosplenomegaly, pancytopenia, severe bone and joint painGaucher disease
what is the disease hepatosplenomegaly, cherry red spot in maculaNiemann Pick
what enzyme is messed up in Niemann Picksphingomyelinase
what is the disease cherry red spot in macula, no hepatosplenomegalyTay Sachs
what enzyme is messed up in Tay Sachsb-hexosaminidase
what metabolite goes up in Tay SachsGM2 ganglioside
What enzyme is messed up in Gaucherb-glucocerebroside
what is the metabolic defect in adrenoleukodystrophyvery long chain fatty acid oxidation
white matter hyperdensityadrenoleukodystrophy


Question Answer
contralateral hemiparesis and hemisensory lossbasal ganglia
homonymous hemianopsiabasal ganglia
no hemiparesiscerebellar
contralateral hemiparesis and hemisensory lossthalamus
contralateral hemiparesisinternal capsule
homonymous hemianopsiaoccipital lobe
pinpoint reactive pupilONS
contralateral hemisensory lossparietal lobe
contralateral hemiparesisfrontal lobe