Multiple Sclerosis
Seizure Disorders
GBS + ALS
Myasthenia Gravis and CRPS
Brain Imaging
Spine and Spinal Cord Imaging
Images
100
What is the "anaconda sign" referring to in MS? What causes it?
Sensation of tightness around the chest; caused by spinal lesion
100
When should you initiate therapy for seizures?
two unprovoked seizures at least 24 hours apart
one unprovoked seizure with high probability of further seizure occurring
100
Describe the pathophysiology of ALS. What is the most common cause of death?
necrosis of upper motor neurons and lower motor neurons
Death usually from progressive respiratory failure
100
Which types of muscles are most likely to be affected by myasthenia gravis? (4) Why?
Ocular, bulbar, limb, respiratory
Most used, so most fatigued
100
Fluid in mastoid air cells is concerning for what type of fracture?
Basilar skull fracture
100
What is a Jefferson fracture?
Disruption of C1 ring, typically in 2-4 parts
100
What pathology is this image consistent with?
DDD
200
What would be seen on a lumbar puncture in MS?
oligoclonal bands
200
What does tonic describe? Clonic?
Tonic- tenseness, the body is stiff and rigid
Clonic- convulsions, rhythmic jerking and shaking
200
Describe the hallmark presentation of Guillan-Barre Syndrome
symmetric weakness, worse in LEs than UEs; ascending weakness with areflexia
200
What is the difference between Type I and Type II CRPS? Which is more common?
Type I- no evidence of peripheral nerve injury
Type II- evidence of peripheral nerve injury
Type I is more common
200
How is the shape of an epidural hematoma described? What are these commonly associated with and what artery is typically injured?
lenticular; skull fracture/trauma; middle meningeal artery
200
In what condition do you see a scotty dog deformity?
Spondylolysis
200
Is this T1 or T2 weighted?
T2
300
What is the Uhthoff phenomenon?
Patients with MS experience worsened symptoms with small increases in body temperature, potentially due to quicker demyelination of nerves
300
Define status epilepticus
seizure lasting longer than 5 minutes or recurrent seizures without return to baseline in between
300
What are the two first line treatments for GBS? What medication class is contraindicated?
IVIG, plasmapheresis (PLEX)
Glucocorticoids
300
How is CRPS diagnosed? What is the purpose of ancillary testing?
Clinical diagnosis; ancillary testing is to rule out other causes
300
What is a CT perfusion scan measuring and what does it help differentiate?
measures mean transit time of blood
differentiates penumbra from infarct core
300
What are the four areas of nerve compression in the spine? Which is most common?
Disc level, lateral recess, frame, extraforaminal
disc level is most common
300
What type of pathology is this? What is most likely damaged?
Epidural hematoma; middle meningeal artery
400
What might be some findings on a brain MRI of patients with multiple sclerosis?
hyperintense lesions on T2, ring enhancing ovoid plaques, black hole lesions, Dawson's fingers (projections from ventricles)
400
Describe a typical absence seizure. What is seen on EEG?
staring into space or rapid eye blinking, lasting anywhere from several seconds to one minute. A "characteristic 3 second electrical spike" is seen on EEG
400
Describe the expected spread of ALS starting in the right arm
R arm -> L arm -> R leg -> L leg -> bulbar muscles
400
What tests should be performed for diagnosis of myasthenia gravis?
Acetylcholine receptor antibody test- if negative, perform MuSK and LRP4 antibody test
CT/MRI brain and thorax to rule out thymoma
400
What type of glioma has the worst prognosis? What may cause mass effect?
glioblastoma multiforme; vasogenic edema
400
In herniated discs, what is the difference between a focal herniation and a broad-based herniation?
focal <90 degrees
Broad-based >90 degrees
400
Identify A, B, C, D
A- falx cerebri
B- sulcus
C- gyrus
D- superior sagittal sinus
500
What is Brown-Sequard syndrome?
On the ipsilateral side of the lesion on the spinal cord the patient has weakness/paralysis, on the contralateral side there is loss of pain and temperature sensation
500
What are the six types of generalized seizures?
absence, atonic, myoclonic, tonic-clonic, tonic, clonic
500
What would you expect to see on LP in GBS? What is this called?
increased protein, normal glucose, normal WBC
this is called albuminocytological dissociation
500
Describe the 3 stages of CRPS
1. limb burning, throbbing, sensitivity, edema
2. soft tissue edema, muscle wasting, skin thickening
3. limitation of movement, contractures, bone demineralization
500
If emergent CT is unclear and there is high suspicion for subarachnoid hemorrhage, what should be obtained? What are you looking for?
Lumbar puncture; looking for increased opening pressure and presence of blood
500
A "chance" fracture is most often seen at what vertebral levels? What are associated soft tissue injuries and what must be ordered to evaluate
T11-L2
pancreatic and duodenal injuries; must order CTAP
500
Identify A, C, D
A- falx cerebri
C- anterior horn of lateral ventricle
D- third ventricle
600
What these:
Marcus-Gunn pupil
Internuclear ophthalmoplegia
Pendular nystagmus
Marcus-Gunn pupil- light in affected eye causes pupil to dilate
Internuclear ophthalmoplegia- impaired adduction in one eye with horizontal nystagmus of abducting eye
Pendular nystagmus- sinusoidal oscillation of the eyes
600
What labs should be included in a seizure workup?
CBC, CMP, magnesium, urinalysis, LDH, pregnancy test, toxicology screen
Consider EKG and lumbar puncture
600
What will be seen on the following diagnostic studies in ALS?
MRI
EMG
Electrodiagnostics
MRI- normal
EMG- fibrillations and positive sharp waves
Electrodiagnostics- decreased motor conduction velocity
600
What three medication types are most likely to cause myasthenic crisis? What is the treatment?
antibiotics (especially fluoroquinolone + aminoglycosides), beta blockers, anti-arrhythmics
Treatment: IVIG or plasma exchange
600
Describe the three different types of LeFort fractures
I- floating palate
II- floating palate and nose
III- entire face floating
600
What will DDD look like on XR? MRI?
XR- decreased height of intervertebral space
MRI- darker discs due to decreased H2O
600
Identify: A-G
A- frontal lobe
B- frontal bone
C- dorsum sellae
D- basilar artery
E- temporal lobe
F- mastoid
G- cerebellum