Untitled Quiz

Credit 1 Neurology

• Smell pseudohalucinations: Present in patients with:

  • Uncus gyri parahipokampi lesion
  • Psychiatric disorders
  • Damage of nasal mucosa
  • Parkinson disease

• Parkinsonism clinical features:

  • Postural instability
  • Rigidity
  • Bradykinesia
  • Ataxia

• Ischemic stroke in anterior cerebral artery (ACA) territory:

  • Homonymous hemianopia contralaterally (rarely)
  • Homonymous hemianopia ipsilaterally
  • Changes of behaviour – prefrontal syndrome
  • Contralateral hemiparesis – more prominent on upper limb

• Evoked potentials (BAEP) pathological findings:

  • Absence or prolonged latency of P100 wave
  • Absence or prolonged latency of wave I, III, or V
  • Absence or prolonged latency of wave IV
  • Absence or prolonged latency of N20 wave

Hypoglossal nerve palsy and hemiparesis

• Left hypoglossal nerve palsy with right-side spastic hemiparesis:

  • Internal capsule syndrome on left side and
  • Hemiplegia/hemiparesis alternans inferior
  • Hemiplegia/hemiparesis alternans superior
  • Hemiplegia/hemiparesis alternans media

• Right hypoglossal nerve palsy with left-side spastic hemiparesis:

  • Lesion in Pons
  • Lesion in Medulla oblongata
  • Internal capsule syndrome

Intracranial brain vessels

• Anterior cerebral artery: Not a terminal branch of internal carotid artery

• Middle cerebral artery: Supplies mostly medial part of frontal and parietal lobe

• Anterior communicating artery: Connects both anterior cerebral arteries

• Posterior communicating arteries: Terminal branches of basilar artery

Neurological Examination of the brain

• Dysdiadochokinesia: Inability to perform rapid alternating movements
• Tandem gait: Walking heel-to-toe
• Positron Emission Tomography (PET): Functional examination of the brain
• Standard brain MRI: Functional examination of the brain
• Brain CT: Functional examination of the brain
• Brain angiography: Functional examination of the brain
• Photophobia: Clinical feature of meningeal syndrome
• Romberg sign: Clinical feature of meningeal syndrome
• Neck opposition/stiffness: Clinical feature of meningeal syndrome
• Kernig sign: Clinical feature of meningeal syndrome
• Glasgow coma scale: Scales severity of subarachnoid hemorrhage
• Hunt-Hess scale: Scales severity of subarachnoid hemorrhage
• EDSS scale: Scales severity of subarachnoid hemorrhage
• Cerebellar lesion signs: Diadochokinesia, ataxia, and anisocoria.
• Tabic dissociation of sensation: Loss of deep, tactile, temperature or pain sensation.

Cerebellar Lesions

• Anisocoria: Unequal pupil size
• Sign of cerebellar lesion: Diadochokinesia, ataxia, and anisocoria

Functional Examination of the Brain

• Standard brain MRI: Functional examination of the brain
• Positron emission tomography (PET): Functional examination of the brain
• Brain CT: Functional examination of the brain
• Brain angiography: Functional examination of the brain

Meningeal Syndrome

• Clinical Features: Photophobia, Romberg sign, neck stiffness, Kernig sign

Subarachnoid Hemorrhage

• Severity Scaling: Glasgow Coma Scale, NHSS scale, Hunt-Hess scale, EDSS scale.

Neurological Issues

• Spinal column lesion (Th4): Chipaults rule: lesion in the level of Th2, Th4, Th8 or Th6.
• Evoked potential (EP) test: Based on registration of nerve impulse propagation along the nerve pathway.
• NREM sleep features: K-complexes, vertex sharp waves, Delta frequency band, sleep spindels.
• Plegia: Complete muscle loss, or Lower motor neuron lesion, or Upper motor neuron lesion, or Partial muscle loss,

Other Neurological Conditions

• Neocerebellum: Structures: flocculonodular lobe, cerebellar hemispheres
• Extracranial vessels sonography: Diagnostic tool for atherosclerotic plaque and nature of a plaque, used as a non-invasive method. -Not used for acute ischemic stroke.
• Protein cytological dissociation/association: Increased protein, without increased cell count (dissociation) or Increased protein, without increased cell count (association) in cerebrospinal fluid.
• Bacterial meningitis: Decreased level of proteins in cerebrospinal fluid (CFS) and Increased level of polymorphonuclear cells (PMNs)
• Viral meningitis: No typical finding in CFS (cerebrospinal fluid)

Neurovascular Conditions

• Acute ischemic stroke: CT scans can't always detect ischemia immediately and is more sensitive than CT.
• Brachial plexus tumor: Symptoms are typically bilateral damage of the hemispheres, or cranial nerves IX – XII (ncc.), or localized in the bulbar brain stem or white matter of the hemispheres.
• Transverse myelitis: Not a feature of occipital brain herniation (occipital conus), characterized by loss of sensory, and motor functions below the lesion level.

Other important topics

• Cerebrovascular diseases— Diagnostic use of ultrasound examination.
• Postural and kinetic tremors: Associated with Parkinson's disease.
• Genetic disorders/tremor: Creutzfeldt-Jacob disease, Parkinson's disease, Huntington's disease, and Wilson's disease.
• Rigidity: Worsens with co-activation of contralateral limbs; can be a symptom of Parkinson's disease, and atypical Parkinsonian syndromes.
• Meningeal syndrome: Clinical features of meningeal syndrome include photophobia, positive Kernig sign, neck opposition, and positive Hanzal sign.
• Intracranial hypertension syndrome: Clinical features include increased intracranial pressure, headache, nausea, and vomiting. Possible causes include: brain tumors, encephalitis, hemorrhagic stroke, and optic neuritis.
• Complete transversal spinal cord lesion: Manifestation with spastic paraparesis or flaccid paraparesis, or Cauda equine syndrome.
• Motor fluctuations in Parkinson's disease: Occur and worsen over the course of the disease.

Other Neurological Topics

• Hypoglossal nerve palsy: One side only.
• Neurinoma/schwannoma: Benign tumor, most often in the vestibular part of cranial nerve VIII.
• Vascular supplies of the brain; anterior cerebral, middle cerebral, posterior communicating, basilar artery
• Cerebral arteries: Diagnosable by duplex ultrasound exam: visualize atherosclerotic plaques (etc.).

Cranial Nerves

• VII facial nerve lesion (peripheral): Inability to open eye, decreased nasolabial wrinkle (one side), mouth angle drop (opposite side), impaired taste or or sensation.
• III oculomotor nerve: Control of eye muscles and pupil responses.
• Facial nerve (VII): Sensory/motor - affected by certain conditions.

Neurological Examination Methods

• Brain CT: Not the primary method for detecting acute ischemic stroke

• Duplex ultrasound: Can visualize atherosclerotic plaques and blood vessels (etc.).

• CT Angiography: Non-invasive method to visualize blood vessels/plaques

• Electromyography (EMG): Used in case a suspected peripheral nerve lesion or myopathy (etc.)

• Electroencephalography (EEG): Can't be used to differentiate loss of consciousness (in hepatic coma), epilepsy, headache, or cognitive decline (in Creutzfeldt-Jacob disease).

• EEG(evoked potentials): BAEP, and other evoked potentials - may have reduced amplitude or prolonged latency and are utilized to assess auditory, visual pathways, and nerve conduction studies.

• Evoked potentials(EP): Assessment of nerve response to stimuli (such as nerve impulse propagation); also called a evoked potentials such as BAEP which refers to Brainstem auditory evoked potential recordings - BAEPs are helpful in assessing the integrity of the auditory pathways in the brainstem.

Neurological Symptoms

• Myoclonus: Brief, involuntary muscle jerks (also called simple, or complex).
• Spasticity: Increased muscle tone, exaggerated reflexes, and stiff muscles.
• Sensory disturbance: Including pain and temperature sensation disturbances within the body.
• Cerebellar syndromes: Include various cerebellar dysfunction symptoms (etc.).

Disease/disorder lists

• Multiple sclerosis (MS): A chronic autoimmune demyelinating neurological disease.
• Cerebrovascular disfunction: A disruption in blood flow to part of the brain affecting blood vessel, that leads to multiple symptoms. -Ischemic stroke (lack of blood flow) -Hemorrhagic stroke (bleeding in the brain) -Epidural hematoma (collection of blood outside the brain)
• Neuroborelliosis: Symptoms in case of infection or inflammation typically in lesions localized within white matter of the brain or within the brain stem.
• Neuroimaging; use of tools (imaging and others) to view the brain

Other Conditions

• Upper alternating hemiplegia/stroke: Symptoms including abnormal vertical ocular sacades, autonomic dysfunctions like orthostatic hypotension, dementia, paralysis on one side or both.

• Parkinson's disease: Neurodegenerative disorder affecting motor.

• Meningeal syndrome: Headache, nausea, stiff neck or inability to flex, Kernig sign, Brudzinski sign.

• Epidural bleeding: Hypodense semicircular shape lesion, or hyperdense biconvex lens.

• Strokes and cerebral lesions: Can affect specific neuro functions and may result in certain side effects, such as hemiparesis (etc.).

• Spastic paraparesis: Loss of motor control/movement below the level of the spinal injury; this may include weakness or paralysis.

• Cerebellar ataxia: Abnormal coordination and balance.

• Vestibular ataxia: An unsteady gait and difficulty with balance while standing with eyes closed, or difficulty with balance when walking.

• Spinal cord lesion (C2-3); can result in flaccid quadriparesis.

• Atypical parkinsonian syndromes: Parkinson-like symptoms that don't fit the typical Parkinson's disease pattern.

• Dysmetria: Difficulty with the accuracy of movements (etc.)

• Tremor: Involuntary rhythmic movement of body part(s).

• Multiple system atrophy; Symptoms may include autonomic nervous system dysfunction, and impaired mobility (etc.).

• Weber's syndrome: Associated with unilateral impairment of eye movement (etc.).

• Cranial nerve syndromes: Associated with specific pathways and dysfunction, such as ocular motility, sensory, or motor loss, (etc.).

• Neurodegenerative/neuroinlfammatory disorders; Characterized by changes in nerve structures affecting cognitive and motor processes (etc...).

• Meningeal infection: Inflammation of the membranes surrounding the brain and spinal cord.

• CSF or cerebrospinal fluid: Important fluid surrounding and inside the brain and spinal cord.

• Peripheral neuropathies: Disease affecting peripheral nerves resulting in diminished or no nerve conduction.

• Ptosis; Drooping eyelids.