Epilepsy
Stroke
Neuroanatomy
Headache
Encephalopathy, dementia
100
Define epilepsy.
Epilepsy is the condition of recurrent unprovoked seizures.
100
List three cardiac causes of stroke.
Atrial fibrillation
Cardiac valvular disease
Left ventricular failure
Myocardial infarction (mural thrombus)
Infective endocarditis
Marantic endocarditis (e.g., Libman-Sacks in lupus, malignancy)
Cardiac tumors (e.g., myxoma, metastasis, elastoma)
Patent foramen ovale
Cardiac arrest with hypoxic-ischemic injury
100
Which meningeal space contains cerebrospinal fluid?
Subarachnoid space.
100
Name three types of primary headache disorder.
Migraine; Tension; Trigeminal autonomic cephalalgias (including cluster); Exertion headaches (primary cough headache, primary exercise headache, primary headache associated with sexual activity, primary thunderclap headache); External stimuli headache (cold stimulus headache, external pressure headache); Epicranial headaches (Primary stabbing headache, nummular headache [coin-shaped]); Hypnic headache; New daily persistent headache
100
What proportion of comatose patients in intensive care units have evidence of non-convulsive status epilepticus on continuous EEG?
0-5%
10-20%
40-60%
200
List three side effects of sodium valproate.
Vomiting
Alopecia
Liver damage
Pancytopenia, Pancreatitis
Retention of fat (weight gain)
Oedema (British spelling...)
Anorexia
Tremor
Enzyme-inhibitor
200
What is the blood pressure goal for giving tPA?
The key BP target before starting tPA (alteplase) is < 185/110 mm Hg, and the maintenance BP after tPA (alteplase) administration is < 180/105 mm Hg.
200
What pattern of ophthalmoplegia is expected in internuclear ophthalmoplegia (INO)?
200
What medication class is most likely to cause medication overuse headaches?
In general, the following medicines can cause medication overuse headache, listed in highest to lowest incidence:
Opioids, butalbital-containing combination analgesics, and acetaminophen-aspirin-caffeine combinations
Triptans
NSAIDs
Calcitonin gene-related peptide antagonists
Medication overuse headache is thought to occur when patients are taking acute headache medication with the following frequencies: 15 days or more per month for simple analgesics (i.e., acetaminophen, NSAIDs); and ten days or more per month for ergotamine, triptans, opioids, or combination analgesics (i.e., butalbital/acetaminophen/caffeine).
200
What triad characterizes Wernicke's Encephalopathy?
Encephalopathy
Ataxia
Eye movement abnormalities (nystagmus, gaze palsy)
300
How can you differentiate stroke from seizure on MRI?
Both stroke and seizure can cause diffusion restriction, however seizure-related diffusion restriction is often limited to the cortex, spans multiple arterial territories, and the ipsilateral thalamus may also be involved (https://www.sciencedirect.com/science/article/pii/S0969996123001080).
300
Describe three early signs of ischemia on CT imaging.
- Dense middle cerebral artery (MCA) sign.
- Dot sign.
- Insular ribbon sign.
- Basal ganglia asymmetry.
- Loss of gray-white boundary.
- Low attenuation of the cortex.
300
What structures should you pass through when doing a lumbar puncture?
A palpable pop is felt through the ligamentum flavum
300
What is first line preventive treatment for paroxysmal hemicrania and hemicrania continua?
Indomethacin
Paroxysmal hemicrania and hemicrania continua are trigeminal autonomic cephalalgias characterized by sharp, stabbing, severe, unilateral headaches of the frequency of ~10 per day for <30 minutes (paroxysmal), continuous (continua).
300
Name two antibiotic classes associated with encephalopathy.
Cephalosporins (especially cefepime, ceftazidime)
Fluoroquinolones (ciprofloxacin, levofloxacin)
Macrolides (azithromycin, clarithromycin, erythromycin)
Metronidazole
Isoniazid
400
What is the difference between status epilepticus, refractory status epilepticus, and super-refractory status epilepticus?
Status epilepticus = 5 or more minutes of continuous seizures, or repeated seizures without return of consciousness between them.
Refractory status epilepticus = When seizures persist despite administration of one first-line medication (IV benzodiazepine) and one second-line medication (IV antiepileptic drug).
Super-refractory status epilepticus = Status epilepticus that persists despite 24-hour treatment with IV anesthetic and recurs when weaning the patient off the anesthetic.
Bonus:
New-onset refractory status epilepticus (NORSE) is defined as new-onset RSE where no discernible cause is identifiable in otherwise healthy individuals. If refractory status epilepticus is preceded by fever, it is called FIRES (febrile infection-related epilepsy syndrome).
400
Which clinical trials demonstrated superiority of dual antiplatelets over antiplatelet monotherapy for high-risk TIA or small ischemic stroke?
Use of aspirin and clopidogrel together is beneficial compared to aspirin alone when used for the first 21 days following high-risk TIA or small ischemic stroke (NIHSS <=3) in preventing stroke recurrence in the short-term (CHANCE trial, 2013; POINT trial, 2018. CHANCE: 300mg load and maintained clopidogrel after 21 days; POINT: 600mg clopidogrel and DAPT 90 days but with increased risk of hemorrhage). The combination of ticagrelor and aspirin for 30 days after mild-moderate stroke (NIHSS<=5) or TIA improves short-term outcomes compared to aspirin alone, but with higher bleeding risk (THALES trial, 2020).
Combined treatment with aspirin and clopidogrel is not more effective than either alone in long-term secondary prevention, and bleeding risk is increased compared to either alone (MATCH trial, 2004; CHARISMA trial, 2006; SPS3 trial, 2012).
400
Name this vein (specify)
400
What are the ingredients of a UCLA migraine cocktail?
Toradol 30mg IV (OR acetaminophen 1000mg IV) + metoclopramide [reglan] 15mg IV OR compazine [prochlorperazine] 10mg IV with benadryl 25mg IV + 1 liter of IV fluid + 2g magnesium.
400
How can you differentiate ventricle dilation from cerebral atrophy (ex vacuo) from ventriculomegaly caused hydrocephalus?
The Evans ratio - calculated by dividing the largest wingspan of the frontal horns of the lateral ventricles by the maximum horizontal width between the left and right inner table of the skull on the same axial slice.
A ratio > 0.3 demonstrates ventriculomegaly (non-specific).
Bonus point:
NPH is also associated with disproportionately enlarged subarachnoid space hydrocephalus (DESH)
500
What is the first choice treatment for West Syndrome?
West syndrome is a pediatric epilepsy syndrome with onset between age 0-1 associated with infantile spasms and hypsarrhythmia on EEG, plus developmental delay. Typical treatments include ACTH, steroids, or vigabatrin.
500
What did the INTERACT2 and ATACH-2 trials reveal about management of high blood pressure in acute intracerebral hemorrhage?
INTERACT2 (2013): Included systolic BP 150-220, randomized to SBP <140 within 1 hour for 7 days vs goal SBP >180. Primary outcome death or major disability; did not standardize BP medications; OR 0.87; ARR 3.6%; p = 0.06. High variability associated with worse outcomes; smooth, sustained is better.
ATACH-2 (2016): Included systolic BP 180-240, randomized to SBP 110-139 or 140-180. Standardized BP medications (nicardipine 1, labetalol 2); RR 1.02; ARI 1.0%, p = 0.84. Trial stoppped early due to futility. Post-hoc showed that starting nicardipine within 2 hours associated with significiantly less diisability (p = 0.004).
*2022 AHA/ASA guidelines recommend an SBP goal of 130-150 based on borderline perspective (culture here often 140-160)
*Earlier antihypertensive therapy is better
*Lower BP cautiously
500
Name two of the three tracts which carry input into the inferior cerebellar peduncles.
Vestibulocerebellar (vestibular information about where the head is in space)
Spinocerebellar (proprioceptive information about where the body is in space)
Olivocerebellar (motor learning)
500
What genetic mutations are associated with hemiplegic migraine?
SCN1A (sodium channel)
CACNA1A (calcium channel)
ATP1A2 (sodium-potassium pump)
500
Which part of the brain atrophies in nonfluent (agrammatic) variant primary progressive aphasia?
Nonfluent (agrammatic) variant = Broca's (inferior frontal gyrus) area/left insula
Semantic variant = Anterior temporal (left > right)
Logopenic = left temporoparietal lobe
