Neuro Conditions

MS

100

Diagnosis of MS requires dissemination in ...

Dissemination in time and space  for Relapsing Remitting MS

2 relapses  

and

2 lesions or  1 lesion and a clear cut previous attack involving a lesion in a distinct location

or 

→dissemination in time on MRI or + oligoclonal bands may substitute for the second relapse 

→dissemination in space by MRI may substitute for the second lesion  

200

List 5 symptoms of MS

-Balance/Gait

-Bowel/Bladder

-Heat intolerance

-Pain

-Sensory issues

-Weakness

- Visual disturbance

-Sleep/Fatigue

-Cognition

-Mood

-Dysarthria/dysphagia

300

Which medication has shown some promise in helping improving gait in persons with MS?

Fampyra

400

What is the MRI finding? 

Dawson's fingers - Periventricular white matter lesions

500

What are the Canadian exercise guidelines for persons w/ MS? 

To achieve important fitness benefits, adults (aged 18-64 years) with multiple sclerosis who have mild to moderate disability need at least:

• 30 minutes of moderate intensity aerobic activity 2 times per week
• Strength training exercises for major muscle groups 2 times per week
• Meeting these Guidelines may also reduce fatigue, improve mobility and enhance elements of health-related quality of life.

-Canadian Society of Exercise Physiology 

Epilepsy

100

Define epilepsy.

At least two unprovoked (or reflex) seizures occurring >24 h apart

200

List 3 causes of provoked seizures.

• aka "provoked seizures", seizures that occur in close temporal relation to an acute CNS insult

• 
  

  • metabolic, toxic 

  • structural

  • infectious

  • inflammatory

300

List 5 things on your differential for a transient neurologic event.

• Seizure

• Syncope

• Cerebrovascular (TIA, stroke, amyloid spells, etc)

• Migraine

• Parasomnia

• Encephalopathy (toxic, metabolic, etc)

• Psychogenic

400

List 4 red flags for psychogenic non epileptic events

• PNES are episodes of altered movement, emotion, sensation, or experience, resembling epileptic seizures, but which arise from emotional/psychological causes

• PNES Red Flags:

• 
  

  • Very high event frequency (multiple times a day)

  • Abrupt onset of seizures

  • Resistance to anti-epileptic drugs

  • Variable event semiology

  • Variable duration, very long events, often with a waxing/waning course

  • Specific triggers (stress, emotional upset, pain)

  • Comorbidities such as fibromyalgia, chronic pain, or somatization

  • History of prior psychological trauma (reported in up to 3/4 of PNES patients)

500

List one symptom/sign for each lobe of the brain that would make you think someone was having a focal seizure in that area.

Dementia

100

What percentage of mild cognitive impairment patients will transition to dementia within 2 years? (Give a 10% range)

• 10—20% may transition to dementia by two years

(3X risk of age matched controls)

200

Mild Cognitive impairment is defined as:

Cognitive decline not interfering or minimally

interfering with instrumental activities of daily

living. What are the two subtypes of MCI?

amnestic and non-amnestic

300

List 3 potential MRI findings in a person with dementia.

-leukokariosis (white matter changes)

-microbleeds on SWI (suggestive of amyloid angiopathy)

-stroke

-cortical atrophy

400

List 5 frontal behaviours that may be seen in a person with dementia?

• Apathy

• Aspontaneity

• Indifference/Emotional flatness

• Inflexibility

• Disorganization

• Inattention

• Personal neglect

• Loss of insight

• Logopenia

• Aphasia/verbal apraxia

• Comprehension deficit

• Alien hand/apraxia

• Perseveration/Obsessions

• Hoarding

• Inappropriatness

• Excessive Jocularity

• Restlessness/Roaming

• Irritability

• Aggression

• Hyperorality/food fads

• Hypersexuality

• Utililization behavior

• Incontinence

500

List 3 predictors of progression of mild cognitive impairment to dementia.

Predictors of Progression in MCI

• CSF p-tau and tau/amyloid-beta ratio

• Medial temporal atrophy (HC, ERC)

• Apolipoprotein E4

• White matter hyper intensity volume

• Depression

• Diabetes and hypertension

• Age and females

– from Li JQ et al. JNNP 2015

Headache

100

Define thunderclap headache

Severe onset of headache that peaks within 60 seconds

200

Which facet joint most commonly causes cervicogenic headache?

C2/C3

300

For medication overuse headache, according to ICHD criteria, what is the minimum days per month they have to take simple analgesics versus triptan/opiates to be considered overuse?

Simple analgesics >15 days/mo and for triptans/opiates >10 days/mo, for at least 3 months

400

List 5 red flags for thunderclap headache

500

List 3 risk factors for a medication overuse headache.

Risks for MOH

 Female gender

 Migraine as primary headache disorder

 Obesity

 Obese patients RR = 5 (Scher et al, 2003)

 Low socioeconomic status

 First generation immigrant

 First generation Turkish immigrants in Germany

MOH=21%

 Second generation Turkish immigrants in Germany

MOH=3.6%

Kavuk et al, 2006

Movement Disorders

100

List 5 things on the differential for atypical Parkinsons Disease

Atypical PD

• Multiple System Atrophy

• Dementia Lewy Bodies

• Progressive Supranuclear Palsy

• Corticobasal Degeneration (CBD)

• Vascular parkinsonism

• Medication induced parkinsonism

• Lesion producing parkinsonism

200

List 2 causes of myoclonus

-Physiologic (sleep, anxiety)

• Epileptic

• Secondary:

• Infectious: HIV, SSPE, CJD

• Degenerative: basal ganglia disorders, dementias

• Metabolic: all metabolic derangement-hypoxic, lytes, liver,

kidney...

• Inflammatory

• Drugs: narcotics, SSRIs, AED, benzo/propofol withdraw

300

List 3 hypokinetic and 3 hyperkinetic movement disorders.

Hypokinetic

• Bradykinesia

• Freezing (of gait)

• Apraxia

• Cataplexy

• Catatonia

• Stiff person syndrome

Hyperkinetic

• Tremor- rhythmic alternating contractions of

agonist/antagonist muscles

• Myoclonus-brief shocklike jerks

• Chorea-brief, irregular, semi-directed movements, flow

from one muscle to the next

• Dystonia-sustained muscle contraction

• Tics-sudden, repetitive, nonrhythmic motor movement.

simple or complex, premonition/ suppressibility

400

List 4 red flags for Atypical Parkinson's Disease

• Rapid disease progression

• Poor response to levodopa

• Prominent, early speech or swallowing difficulties

• Pyramidal, cerebellar, autonomic signs

• Early gait disorder and falls

• Early cognitive difficulties

• Symmetrical PS S/S

500

Where does ballism localize to in the central nervous system?

Ballism- flinging movement, usually hemiballism, due to vascular lesion at STN