IIH
Idiopathic intracranial hypertension (pseudotumor cerebri) causes a palsy of which cranial nerve?
CN VI
What eye muscle moves the eye inward and up
Inferior Oblique
Where do you insert the needle for a lumbar puncture?
Between L3-L4 or L4-L5
What is the treatment for idiopathic intracranial hypertension (pseudotumor cerebri)?
Nitroprusside
Carbamezapine
Acetazolamide
Hydralazine
Acetazolamide
What muscle moves the eye Lateral
Lateral rectus
How is the patient positioned for a Lumbar puncture?
lateral recumbent
What is Acetazolamide MOA?
reducing bicarbonate ion formation--> decreases sodium transport-->reducing osmotic gradient that drives water into the CSF --> lowering CSF production and intracranial pressure
A 17-year-old girl presents with one month of worsening headache that she describes as a bifrontal band-like pressure that is accompanied by transient vision loss and occasional tinnitus. The headache does not worsen with bright light or loud noises. She sometimes feels nauseated and vomits when the pain is severe. She often wakes in the morning with headache and vomiting. Her family history is unremarkable, except for migraines in her grandmother.
On examination, she has a BMI of 32 and a blood pressure of 115/70 mm Hg. She has bilateral papilledema and is unable to abduct her left eye, although her other extraocular movements are intact. The rest of her neurologic examination is normal. Emergency MRI reveals an empty sella.
Which one of the following diagnoses is most likely in this case?
Migraine
Tension Headache
Pituitary Adenoma
IIH
IIH
What is the difference between IIH and Hydrocephalus?
In Hydrocephalus the ventricles become enlarged due to an accumulation of cerebrospinal fluid (CSF), causing increased pressure within the brain
What Cranial nerve controls most eye muscles including the medial rectus (adduction), inferior rectus (downward gaze), and superior rectus (upward gaze).
CN III
A 31-year-old woman comes to the office because of headaches and nausea for 2 weeks. The headaches are worse on awakening and she describes them as 7 out of 10 in intensity. During this period, she has noticed brief episodes of visual loss in both eyes lasting several seconds, especially when she suddenly stands up or bends over. BMI is 36 kg/m2. Fundoscopic examination shows bilateral optic disc swelling. An MRI of the brain shows no abnormalities. A lumbar puncture is performed; opening pressure is 310 mm H2O. Which of the following is the most appropriate next step in management?
Prednisone Therapy
Serial lumbar punctures
Ventricular Shunting
Acetazolamide therapy
Acetazolamide Therapy
Which of the following is not a complication following subarachnoid hemorrhage?
Rebleeding
Vasospasm
Focal Nuerological Deficits
TIA
TIA
What layers does the needle go through?
Skin --> Fascia-->Supra-spinal Ligament-->Interspinous Ligament-->Ligamentum Flavum -->Epidural Space -->Dura Mater-->Arachnoid Mater-->Subarachnoid Space
A 22-year-old woman comes to the emergency department because of frontal throbbing headaches for 3 weeks. Yesterday, the patient had blurry vision in both eyes and a brief episode of double vision. She has been taking ibuprofen with only mild improvement of her symptoms. She has not had any trauma, weakness, or changes in sensation. Medical history is remarkable for polycystic ovarian syndrome, type 2 diabetes mellitus, and facial acne. Her current medications include metformin and vitamin A. She is 158 cm (5 ft 2 in) tall and weighs 89 kg (196 lb); BMI is 36 kg/m2. Vital signs are within normal limits. Examination shows decreased peripheral vision. Fundoscopic examination of both eyes is shown. An MRI of the brain with contrast shows an empty sella but no other abnormalities. Which of the following is the most appropriate next step in management?
Emergency Craniotomy
Acetazolamide Therapy
Cerebral Shunt
Lumbar Puncture
Lumbar Puncture
What would a patient with normal pressure hydrocephalus classically present with?
dementia, Urinary Incontinence, ataxia
What would happen if you have a CN IV palsy?
Bonus: Name an activity you might have difficulty doing with CN IV palsy
Diplopia; particularly when looking downwards, and often compensate by tilting your head to the side opposite the affected eye to minimize the double vision
Bonus: Difficulty going down stairs)
A 28-year-old man is admitted to the hospital for the evaluation of symmetric, ascending weakness that started in his feet and has become progressively worse over the past 5 days. A lumbar puncture is performed to confirm the diagnosis. As the needle is advanced during the procedure, there is resistance just before entering the epidural space. This resistance is most likely due to which of the following structures?
Ligamentum Flavum
Topiramate MOA?
Na+ and Ca+ antagonist and Cl- agonist to allow increased GABA activity
Also weak carbonic anhydrase inhibitor