**Neurology Case Files > Wahba Notes > Flashcards

Wahba Notes Flashcards

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1
Q

How much do I want to study?

A

-10000000%

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2
Q

Differential dx unilateral foot drop?

A

Common peroneal n neuropathy
L5 radiculopathy
Lumbosacral plexopathy
Sciatic n lateral trunk

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3
Q

Differential chronic bilateral foot drop?

A

Hereditary peripheral neuropathy AKA myotonia atrophica, CMT

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4
Q

CMT1 vs. CMT2

A

1: slowly progressive, high arches, absent DTRs, palpable nerves, demyelinating problem
2: onset later, preserved velocity, axonal problem

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5
Q

Ankle inversion
Intact toe and plantarflexion
Intact ankle jerk

A

Peroneal mononeuropathy

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6
Q

Is ankle jerk preserved in L5 radiculopathy?

A

Usually not

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7
Q

Sciatic nerve roots

A

L4-S3

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8
Q

Common peroneal nerve roots made up

A

L5-S3

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9
Q

Course of common peroneal nerve

A

W tibial division in thigh, where it innervates short head biceps femoris and does sensation lateral knee; separates in popliteal fossa and goes around fibular head, thru fibular tunnel (fibrous arch + aponeurosis of soleus), then divides into superficial and deep peroneal

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10
Q

Compression of common peroneal at fibular head

A

Loss of dorsiflexion and eversion = dominant inversion

Loss of sensation at anterolateral leg and dorsum of foot

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11
Q

What muscles does deep peroneal innervate?

A

PEET is DEEP! Peroneus tertius, Extensor digitorum longus/brevis, Extensor hallucis longus, Tibialis anterior

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12
Q

Where is the deep peroneal nerve usually entrapped?

A

@ anterior tarsal tunnel

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13
Q

Deep peroneal nerve entrapment presentation

A

Weak toe dorsiflexion
First web space sensory loss
Intact eversion!

AKA foot only no eversion/inversion

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14
Q

What does superficial peroneal innervate?

A

PB. Peroneus longus and brevis

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15
Q

What does superficial peroneal sensate?

A

Dorsolateral foot and leg

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16
Q

Where does superficial peroneal become entrapped?

A

At fascial exit on anterolateral leg

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17
Q

Superficial peroneal entrapment presentation

A

Weak eversion
Sensory loss anterolateral plus dorsum foot
Intact dorsiflexion

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18
Q

L5 root entrapment sensory loss?

A

BIG TOE

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19
Q

Review: sensory loss common peroneal

A

Lateral knee, leg, foot, btw digits 1-2

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20
Q

Review: superficial peroneal sensory loss

A

lateral leg and foot, NOT knee and NOT toes

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21
Q

Lumbosacral cord - roots?

A

L4 and L5

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22
Q

Where do herniated discs actually impinge on the root?

A

Intervertebral foramina

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23
Q

Weak muscle in sciatica

A

Extensor hallucis longus

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24
Q

What does the straight leg raise test do?

A

Passive traction of lumbosacral roots

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25
S1 root impingement pres
Weak gastroc/soleus plus absent AJ
26
L5 entrapment pres
``` Big toe sensory loss Weak dorsiflexion Weak inversion Intact plantarflexion and AJ Medial foot sensory loss ```
27
AJ root
S1! So L5 radic has ok AJ
28
The butt muscles are innervated by
L5-S1 (medius and maximus)
29
Tensor fascia lata innervated by root:
L5
30
Recent postpartum mom can't move legs but no epidural?
Retroperitoneal hematoma of lumbosacral plexus
31
Tight casts can cause _ entrapment
Common peroneal
32
What 5 muscles are innervated by tibial nerve from L5 (NOT cmmon peroneal?)
``` Paraspinals gluteus medius TFL flexor digitorum longus tibialis posterior ```
33
MRI can miss this on disc herniation
very lateral - need CT myelogram
34
Why get EMG if can dx foot drop w MRI?
1. Asymptomatic discs 2. Miss lateral 3. Don't fit in MRI
35
what does a slow SNAP across the fibular head indicate?
Common peroneal head entrapment
36
Normal SNAP =
ROOT only
37
SNAP gone lesion location =
PLEXUS or PERIPHERAL n.
38
CIDP LP
high protein normal cell count
39
CIDP nerve conduction study
demyelination
40
CIDP sensory loss pattern
stocking glove (vibration sense loss)
41
CIDP progression
Stepwise w/ plateaus
42
Essential CDIP muscle to be weak
Proximal hip flexor weakness
43
What is F wave delay?
Average of several responses taken as reliable nerve subpopulation to anterior horn cells and moves back down w/o synapsing....????
44
Underlying diagnosis w/ CIPD?
CTD, CMV, Hodgkin's, hepatitis, HIV, IBS, Lyme, MS, raduloplexopathy
45
What is the first test to do after diagnosing CIPD?
Heme issues - M protein spike
46
What do you look for on EMG for Lambert-Eaton?
CMAP - compound muscle action potential - low usually and is marker for disease severity
47
Treatment of E-L syndrome
Guanidine hydrochloride - inhibits mito Ca uptake
48
What roots does cauda equina affect?
Below T10
49
S/S of cauda equina
ASYMMETRIC LMN signs and sensory loss inc absent AJ, urine probs, dec anal tone
50
Myelopathy LP
Lymphocytes increased
51
DDX myelopathy
Vascular, infection, tumor, abscess, autoimmune, structural
52
S/S transverse myelitis
All sensory and motor lost below lesion - often from virus > bacteria
53
Brown-Sequard syndrome pres
Ipsi UMN and loss of tactile/vibration; CL pain and temp loss; flaccid paralysis at level of lesion; +Horner's if above T1
54
These viruses cause exclusively LMN disease
WNV, enterovirus, poliovirus
55
Common acute polio s/s
Bladder dysfunction, assymetric leg weakness
56
What is Froin syndrome?
Spinal block from high (low?) protein and cord swelling
57
Poliovirus CSF
Mild-mod lymphos plus high protein and normal/mild glucose
58
CMV treatment
ganciclovir
59
Timeline do mechanical embolectomy in stroke?
Up to 8 h anterior circulation or beyond 8 hrs for basilar artery stroke even
60
After 8 hours stroke therapy
ASA only
61
When to do IV vs. IA tPA?
>4.5 hours = do arterial
62
tPA inclusion criteria
>18 y/o, stroke is dx, h/o TIA, CT done,
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Exclusion criteria tPA
Score 185/110, GI bleed last 3 weeks, heparin last 48h, INR 400, coma, suspected SAH, arterial puncture recently w bleed
64
Always give tPA if:
Aphasia or hemianopia
65
Avoid this drug in status epi
flumazenil
66
Order of drug therapy in status epi
Ativan stat, then fosphenytoin, then more Ativan at 10 minutes, then phenobarbital or midazolam or propofol; simultaneous glucose + thiamine and Keppra or Depakote load
67
Depakote CI when
bleed in brain
68
S/S of epidural hematoma
Contralateral hemiparesis Dilated ->nonresp pupil ipsi CN3 compression
69
Posterior fossa hematoma s/s
Cerebellar signs, nuchal rigidity, drowsiness
70
Suspect posterior fossa hematoma next step
INTUBATE don't wait for cerebral dehydration
71
Subdural mechanism
Stretching of veins, usually lateral cerebral convexities
72
Subdural common in these populations
Elderly/alcoholic/cerebral atrophy
73
What is Tolosa-Hunt sydrome?
Granulomatous cavernous sinus infection that looks like thrombosis early - do steroids
74
Compressive vs. noncompressive CN III
Noncompressive DM2: reactive pupil bc interior fascicles, vs. nonreactive in compressive which is noncompressive
75
Multifocal motor neuropathy with conduction block?
Asymmetric predominantly motor neuropathy in middle age males usually very benign
76
Most common locations of brain aneurysms?
PCOM and ACOM
77
Studies to order if new-onset CIDP?
Nerve conduction, muscle, LP, MRI, paraneoplastic studies, serum IF and protein electrophoresis
78
Best tx for hIv-induced CIDP?
IV Ig
79
GBS/Miller Fischer suspected - workup
get MRA to r/o basilar artery thrombosis and always admit to ICU
80
What are the 5 Parkinson-plus synucleinopathies?
Lewy body dementia, corticobasal degeneration, striatal nigral, MSA, PSP
81
What are the classic symptoms of PSP?
Ocular + Cerebellar + EPS
82
Alien hand syndrome common in:
Corticobasal degeneration
83
Some drugs that cause status epi
Flumazenil, theophylline, INH, vigabatran
84
Empiric tx of meningitis
ACV + rocephin + Vanc + Ampicillin
85
Tx acute dystonia
Benadryl plus benztropine
86
Anti-HAM s/s
WARP: wt gain, inc liver enzymes, rash, photosensitivity
87
Tx of serotonin syndrome
Cyproheptadine (periactin)
88
How is the pupil in MG?
SPARED!
89
What are all the weird antibodies for MG?
MuSK, muscle protein titin, ryanodine in pts with thymoma
90
EMG to do for MG?
Single-fiber EMG bc checks time btween transmission in synapse. Will show low variability
91
Intubate MG crisis if FVC
1.2 L
92
Treatment of intubated MG patient
Beta agonist to minimize bronchospasm, Atropine to minimize secretions
93
Findings in optic neuritis
Pain around one eye, loss of color vision, blurry vision; exam shows swollen disc
94
High ICP vs. bilateral ON
No field defect in papilledema
95
Ddx APD
MS, NMO, Lyme, CTD, B12, sarcoid, syphilis
96
Acute MS tx
IV steroids, NOT oral
97
Cavernous sinus thrombosis affects these nerves
3, 4, 5i and 5ii, 6
98
Two etiologies of noncompressive CN3
Diurnal variation MG and diabetes
99
Where is giant cell arteritis
Branches of external carotid, esp the STA
100
Thyroid stuff
Hyperthyroidism is a definite risk factor for stroke | Think of hyperthyroidism with a fib in young person with embolic stroke
101
Hyperthyroidism is a/w these neuro things
MG | Pseudotumor cerebrii
102
Signs of superior sagittal sinus thrombosis
Seizure, papilledema, suspect w postpartum and severe HA
103
Who is hypercoagulable and gets superior sagittal sinus thrombosis
Pregnancy, cancer and cancer meds, sickle cell
104
Lateral sinus thrombosis, usually from?
Infection in mastoid-inner ear or clot
105
CPA tumors affect these nerves
5 7 8
106
Weber lateralizes to:
the healthy ear
107
EEG in HSV encephalitis
triphasic waves (slowing)
108
Work-up of HSV encephalitis
ABCs, then CT w/o to r/o stroke, start antibiotics, do MRI look for temporal activity, then get EEG, do not use steroids
109
Triad of Miller-Fischer
Ataxia, ophthalmoplegia, areflexia
110
Antibodies in miller fisher
antiganglioside (GQ1b)
111
Tumor often in 4th ventricle in young people
ependymoma
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