ABPN Neurology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Lateral corticospinal decussation

The lateral corticospinal tract crosses in the medullary pyramids, so a lesion above the pyramids produces contralateral weakness; the anterior corticospinal tract crosses segmentally and affects axial muscles.

Spinothalamic tract lesion

Pain and temperature fibers cross one to two segments above entry in the anterior white commissure, so a spinal cord lesion causes contralateral loss beginning a couple of levels below the lesion.

Wallenberg syndrome

Lateral medullary infarction from PICA or vertebral artery occlusion causes ipsilateral facial pain and temperature loss, Horner syndrome, ataxia, dysphagia, and contralateral body pain and temperature loss.

Lewy body dementia features

Dementia with Lewy bodies shows fluctuating cognition, recurrent formed visual hallucinations, parkinsonism, REM sleep behavior disorder, and neuroleptic sensitivity, with occipital hypometabolism on imaging.

Normal pressure hydrocephalus triad

The classic triad is gait apraxia, urinary incontinence, and dementia; MRI shows ventriculomegaly out of proportion to atrophy, and a large-volume lumbar puncture tap test predicts shunt response.

Gerstmann syndrome

A dominant inferior parietal lesion causes acalculia, agraphia, finger agnosia, and left-right disorientation; it is distinct from aphasia and often accompanies constructional apraxia.

Thrombolysis blood pressure limits

For intravenous alteplase, blood pressure must be below 185/110 mm Hg before treatment and kept below 180/105 mm Hg for 24 hours afterward to reduce hemorrhagic risk.

Lacunar syndrome localizations

Pure motor stroke localizes to the posterior limb of the internal capsule; pure sensory stroke to the thalamus; ataxic hemiparesis to the pons or internal capsule; dysarthria-clumsy hand to the pons or genu.

Subarachnoid hemorrhage management

Thunderclap headache with CT or xanthochromia confirms subarachnoid hemorrhage; give nimodipine to reduce delayed ischemia, secure the aneurysm early, and monitor for hydrocephalus and hyponatremia.

Absence seizure EEG

Childhood absence epilepsy shows a 3 Hz generalized spike-and-wave discharge on EEG, is provoked by hyperventilation, causes brief staring without postictal confusion, and responds first line to ethosuximide.

Status epilepticus sequence

Give a benzodiazepine first, then a second-line agent such as fosphenytoin, valproate, or levetiracetam; if seizures persist, proceed to anesthetic-dose midazolam, propofol, or pentobarbital with EEG monitoring.

Juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy begins in adolescence with morning myoclonic jerks, generalized tonic-clonic seizures, and 4-6 Hz polyspike-wave discharges; valproate is effective but teratogenic.

Cluster headache treatment

Acute cluster headache responds to high-flow 100% oxygen and subcutaneous or nasal sumatriptan; verapamil is first-line prophylaxis, and patients are restless rather than still.

Giant cell arteritis red flags

Age over 50, new headache, jaw claudication, scalp tenderness, elevated ESR or CRP, and transient visual loss mandate immediate corticosteroids before temporal artery biopsy to prevent blindness.

Myasthenia gravis testing

Myasthenia gravis causes fatigable ptosis and diplopia; acetylcholine receptor antibodies are most sensitive, repetitive nerve stimulation shows decrement, and single-fiber EMG shows increased jitter.

Guillain-Barré syndrome

Guillain-Barré syndrome causes ascending areflexic weakness with albuminocytologic dissociation, reaches nadir within two to four weeks, and is treated with IVIG or plasma exchange, not steroids.

Amyotrophic lateral sclerosis

ALS combines upper and lower motor neuron signs without sensory loss; bulbar and respiratory involvement worsen prognosis, and riluzole or edaravone offer modest benefit.

Progressive supranuclear palsy

PSP causes vertical supranuclear gaze palsy, early falls, axial rigidity, and frontal executive dysfunction; MRI may show midbrain atrophy with the hummingbird sign.

Huntington disease genetics

Huntington disease is autosomal dominant with CAG repeat expansion in HTT; chorea, psychiatric symptoms, and dementia appear, with caudate atrophy and anticipation, especially with paternal transmission.

Wilson disease findings

Wilson disease causes liver disease, psychiatric symptoms, tremor, and dystonia; low ceruloplasmin, elevated urinary copper, and Kayser-Fleischer rings support diagnosis, and chelation is essential.

Neuromyelitis optica spectrum

AQP4-IgG neuromyelitis optica causes severe optic neuritis, longitudinally extensive transverse myelitis, and area postrema syndrome; eculizumab or inebilizumab prevent relapses.

HSV encephalitis

Herpes simplex encephalitis causes fever, seizures, confusion, and temporal lobe changes; CSF PCR confirms, and intravenous acyclovir should be started empirically before results return.

Anti-NMDA receptor encephalitis

Anti-NMDA receptor encephalitis affects young women, often with ovarian teratoma, causing psychiatric symptoms, seizures, dyskinesias, and hypoventilation; treat with steroids, IVIG, plasma exchange, and tumor removal.

Glioblastoma imaging

Glioblastoma is an IDH-wildtype, ring-enhancing intra-axial tumor with central necrosis and surrounding edema, often crossing the corpus callosum; treatment combines resection, radiation, and temozolomide.

Optic neuritis features

Optic neuritis causes painful monocular vision loss, reduced color vision, a relative afferent pupillary defect, and Uhthoff phenomenon; MRI brain white matter lesions predict multiple sclerosis risk.

Vestibular schwannoma

A vestibular schwannoma causes unilateral sensorineural hearing loss, tinnitus, and imbalance; gadolinium MRI shows an enhancing mass in the internal auditory canal, and small tumors may be observed.

Febrile seizure criteria

Simple febrile seizures occur between 6 months and 5 years, last under 15 minutes, are generalized, and do not recur within 24 hours; they do not require daily antiepileptic therapy.

Tuberous sclerosis

Tuberous sclerosis from TSC1 or TSC2 mutations causes ash-leaf spots, facial angiofibromas, cortical tubers, subependymal giant cell astrocytomas, and infantile spasms; mTOR inhibitors treat tumors.

Epidural hematoma

Epidural hematoma usually results from middle meningeal artery injury with a temporal bone fracture, appears biconvex on CT, and may show a lucid interval before deterioration.

Cerebral perfusion pressure

Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure; after severe traumatic brain injury, it is typically targeted to 60-70 mm Hg while avoiding hypotension.

Wernicke encephalopathy

Wernicke encephalopathy causes ophthalmoplegia, ataxia, and confusion from thiamine deficiency; give intravenous thiamine before glucose to prevent progression to Korsakoff syndrome.

Subacute combined degeneration

Vitamin B12 deficiency damages dorsal columns and corticospinal tracts, causing paresthesias, loss of vibration and position sense, spastic weakness, and macrocytic anemia; replace B12 promptly.