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1

26 yo female patient presents with altered mentation, focal cranial nerve deficits, hemiparesis, seizures, aphasia, ataxia, and fever

HSV-1 encephalitis

2

What are some symptoms of herpes encephalitis?

- altered mentation
- focal cranial nerve
- hemiparesis
- dysphasia
- aphasia
- ataxia
- focal seizures
- FEVER
- seizures

3

What lobe does herpes encephalitis attack?

temporal

4

treatment of choice for herpes encephalitis?

IV acyclovir

5

CSF characteristics of herpes encephalitis

- lymphocytosis
- increased erythrocytes
- elevated protein levels
- low CSF glucose levels

6

What does imaging show in herpes encephalitis?

temporal lobe lesions- use MRI

7

what is the gold standard for diagnosis of herpes encephalitis?

PCR analysis of HSV DNA in the CSF

8

What is the hallmark sign of myasthenia gravis?

resolution of muscular weakness with rest

9

What is acute steroid myopathy and how soon does it occur?

- occurs w/in 1 week of drug initiation and
- diffuse muscle weakness and rhabdpmyolysis
- pts present w proximal mm weakness, difficulty rising from chair, combing hair, climbing stairs

10

Symptoms ofpolymyalgia rheumatica?

- seen in 50% of patients with temporal arteritis
- present with aching and morning stiffness, pain in shoulders, hip girdle, and neck
- increased ESR
- sx improve w steroids

11

What are some typical causes of vestibulopathy?

- Meniere's disease
- perilymphatic fistulas
- benign positional vertigo
- labrynthitis
- acoustic neuromas

12

what is anisocoria?

unequal size of the eys oupils

13

what nerve lesion results in impaired corneal sensation?

Trigeminal Nerve- V1 specifically

14

What might you find on CT scans of pts w alzheimers dementia?

- cortical and subcortical arophy, specifically in the parietal and temporal lobes (hippocampi)

15

What are the clinical signs of cerebellar hemorrhage? What else would you see in a large hemorrhage?

1. Acute onset
2. Occipital headache
3. repeated vomiting
4. Gait ataxia
Large:
- 6th nerve palsy
- conjugate deviation
- blepharospasm

16

What are the clinical signs of cerebellar hemorrhage? What else would you see in a large hemorrhage?

1. Acute onset
2. Occipital headache
3. repeated vomiting
4. Gait ataxia
Large:
- 6th nerve palsy
- conjugate deviation
- blepharospasm

17

What medication can slow the long-term progression of relapsing-remitting MS? what about progressive MS?

RR: IFN-beta
Progressive: immunosuppressive agents (cyclosporine, methrotrexate, mitoxantrone)

18

Areflexic weakness in the upper extremities + anesthesia (loss of pain and temp) with preserved position and vibration in a cape like distribution

syringomyelia

19

what is the pathology behind syringomyelia?

cavitary expansion of the spinal cord destroying gray and white matter adjacent to the central canal

20

What does neuroimaging show in Arnold-Chiari malformation?

caudal displacement of the fourth ventrical due to displacement of the cerebellar tonsils through the foramen magnum

21

what are some risk factors for pseudotumor cerebri? aka idiopathic intracranial HTN

1. Meds: corticosteroids, OCPs
2. Trauma
3. Obesity

22

What are some initial symptoms of pseudotumor cerebri? (aka IIH)

- pulsatile HA that usually awakens pt from sleep and is assoc with pulsatile tinnitus (whooshing sound in ears)

23

MRI reveals an empty sella tursica and slit like ventricles

pseudotumor cerebri

24

What is Dejerine Roussy syndrome?

- stroke involving the VPL nucleus of the thalamus which transmits sensory information from the contralateral side o the body

25

What is Dejerine Roussy syndrome?

- stroke involving the VPL nucleus of the thalamus

26

what is the clinical presentation of a VPL thalamic stroke?

- hemianesthesia accompanied by transient hemiparesis, athetosis or ballistic movements
- thalamic pain phenomenon: dysesthesia of the area affected by the sensory loss

27

what is the most significant complication of IIH?

blindness!

28

What are some characteristics of an MCA stroke?

- contralateral motor and/or sensory deficits that are more pronounced in the upper limb than the lower
- dominant lobe= aphasia, nondominant lobe= neglect and/or anosognosia

29

What are some characteristics of an MCA stroke?

- contralateral motor and/or sensory deficits that are more pronounced in the upper limb than the lower
- dominant lobe= aphasia, nondominant lobe= neglect and/or anosognosia

30

What is anosognosia?

deficit of self-awareness, don't acknowledge that theres a neurologic problem