BRAIN, CRANIAL NERVES, SPINE

YOU'RE GETTING ON MY NERVES

100

PATIENT PRESENTING WITH AN UNREMARKABLE EXAM OF THE HEAD AND NECK WITH NO NEURO DEFICITS COMPLAINING OF UNILATERAL FACIAL PAIN WITH NONPAINFUL TRIGGERS IS LIKELY TO HAVE THIS CONDITION

TRIGEMINAL NEURALGIA

LANCINATING PAROXYSMS OF PAIN IN THE LIPS, TEETH, GUMS OR CHIN

TREATED WITH CARBAMAZEPINE OR OXYCARBAZEPINE (SODIUM CHANNEL BLOCKERS)

GET EKG BEFORES STARTING THESE MEDS; CONTRAINDICATED IN PATIENTS WITH AV BLOCK

200

PATIENT PRESENTING WITH INABILITY TO MOVE THE EYE DOWNWARD AND LATERALLY LIKELY HAS DYSFUNCTION OF THIS NERVE

CRANIAL NERVE IV, TROCHLEAR NERVE

WHICH MUSCLE DOES THIS NERVE INNERVATE?

300

THIS NERVE IS PRONE TO INJURY DUE TO ITS LENGTH AND POSITION

CRANIAL NERVE VI, ABDUCENS NERVE

THIS NERVE CONTROLS WHAT EYE MUSCLE?

400

BELL'S PALSY CAUSES AN UPPER OR LOWER MOTOR NEURON LESION?

LOWER MOTOR NEURON

500

RAMSAY HUNT SYNDROME

600

THESE 2 DISEASES ARE ASSOCIATED WITH BILATERAL FACIAN NERVE PALSY

LYME, INFECTIOUS MONONUCLEOSIS

700

WHAT CONDITION CAN BE SEEN IN AN IMMUNOCOMPROMISED PATIENT PRESENTING WITH EAR PAIN AND FACIAL PARALYSIS ON THE SAME SIDE?

MALIGNANT OTITIS EXTERNA

PSEUDOMONAL INFECTION TYPICALLY 

800

CONSIDER THIS IN A PATIENT WITH RECURRENT IPSILATERAL FACIAL PARALYSIS, SIGNIFICANT PAIN, PROLONGED SYMPTOMS OR ANY OTHER CONCOMITANT FACIAL NERVE ABNORMALITY

NEOPLASM

900

HOW DO YOU GRADE NEUROMUSCULAR WEAKNESS?

0 - NO FIRING OF MUSCLE

1 - MUSCLE FIRES, BUT CAN'T MOVE INTENDED PART

2 - MUSCLE ABLE TO MOVE INTENDED PART WITH GRAVITY ELIMINATED

3 - MUSCLE ABLE TO MOVE INTENDED PART AGAINST GRAVITY

4 - MUSCLE ABLE TO MOVE INTENDED PART BUT NOT AT FULL STRENGTH

5 - FULL STRENGTH

1000

LACK OF THIS FINDING ON PHYSICAL EXAM DISTINGUISHES DISCITIS FROM OTHER ACUTE SPINAL PATHOLOGY LIKE SPINAL EPIDURAL ABSCESS OR SPINAL EPIDURAL HEMATOMA

LACK OF NEURO DEFICITS

CHILDREN MORE LIKELY TO HAVE THIS DUE TO PERSISTENT VASCULAR SUPPLY OF VERTEBRAL DISCS

WILL HAVE SEVERE PAIN LOCALIZED TO LEVEL OF INVOLVEMENT WITH ANY SPINAL MOVEMENT

1100

A PATIENT IS HAVING DULL, CONSTANT ACHING BACK PAIN THAT IS WORSE WITH RECUMBENCY, AND WORSE AT NIGHT. WHAT WOULD THIS BE CONCERNING FOR?

SPINAL NEOPLASM

1200

THIS CONDITION IS DEFINED AS THE LOSS OF COORDINATION BETWEEN HEART RATE AND VASCULAR TONE IN RESPONSE TO INCREASED DEMAND

AUTONOMIC DYSREFLEXIA

SPINAL CORD INJURIES THAT DISRUPT THE SPLANCHNIC INNERVATION IN LESIONS AT OR ABOVE T6

PARASYMPATHETIC COMPENSATORY ACTIVITY IS INHIBITED

DEFINED AS SYSTOLIC PRESSURE >20MMHG OVER BASELINE, OR A SYSTOLIC READING >150MMHG WITH SYMPTOMS (HEADACHE, DIAPHORESIS, CONGESTION, BLURRED VISION, ANXIETY, NAUSEA) IN THE ABSENCE OF A KNOWN BASELINE

ASSESS FOR BLADDER DISTENTION, FECAL IMPACTION, SKIN WOUNDS, TIGHT CLOTHING, INFECTION - ANY NOXIOUS STIMULUS

NOW YOU'RE REALLY ANNOYING ME

100

ASYMMETRICAL SENSORINEURAL HEARING LOSS IS THE HALLMARK OF THIS 

VESTIBULAR SCHWANNOMA

MAY HAVE UNILATERAL TINNITUS, IMBALANCE, HEADACHE, FULLNESS IN THE EAR, OTALGIA, FACIAL NERVE WEAKNESS

200

WHAT TEST CAN YOU DO TO DISCERN BETWEEN CONDUCTIVE AND SENSORINEURAL HEARING LOSS?

300

DIABETIC MONONEUROPATHY WILL SPARE THE SYMPATHETIC OR PARASYMPATHETIC INNERVATION OF THE OCULOMOTOR NERVE (CN III)

PARASYMPATHETIC

PARASYMPATHETIC FIBERS ARE ON THE BORDER OF THE NERVE

CAUSED BY OCCLUSION OF ARTERIES SUPPLYING DEEPER PORTION OF THE NERVE

400

CONSIDER THIS IN A PATIENT PRESENTING WITH UNEXPLAINED HEADACHE WITH A FOCAL NEURO DEFICIT, PAPILLEDEMA OR SEIZURE

CENTRAL VENOUS THROMBOSIS

MORE PRONE TO HEMORRHAGIC INFARCTS AND LOCAL NEURO DEFICIT COMPARED TO SINUS THROMBOSIS (SYMPTOMS TYPICALLY THAT OF INTRACRANIAL HTN)

WHAT WOULD BE THE IMAGING STUDY OF CHOICE FOR THIS?

500

UNILATERAL EYE PAIN WITH ASSOCIATED CENTRAL VISUAL FIELD LOSS IS CONCERNING FOR THIS CONDITION

OPTIC NEURITIS

600

OPTIC NEURITIS IS THE MOST COMMON CRANIAL NERVE ABNORMALITY ASSOCIATED WITH THIS CONDITION

MULTIPLE SCLEROSIS

BROAD RANGE OF SYMPTOMS INCLUDING: COGNITIVE DIFFICULTY, CRANIAL NERVE DYSFUNCTION, SPASTICITY, EXAGGERATED DTRs, CLONUS, PARESTHESIAS, BOWEL/BLADDER DYSFUNCTION, SEXUAL DYSFUNCTION

700

THIS PHENOMENON OCCURS IN MS PATIENTS DUE TO SMALL INCREASES IN BODY TEMP

UHTHOFF'S PHENOMENON 

800

PATIENTS WITH MS FLARE ARE ADMITTED FOR TREATMENT WITH THIS CLASS OF MEDICATION

STEROIDS

HIGH DOSE METHYLPREDNISOLONE

900

THIS CONDITION TYPICALLY PRESENTS WITH STROKE LIKE SYMPTOMS IN OTHERWISE YOUNG, HEALTHY ADULTS, AND ACCOUNTS FOR ONLY 0.5% TO 1% OF STROKES.

CENTRAL VENOUS THROMBOSIS

MEAN AGE OF PRESENTATION IS 40 YEARS

WOMEN 3 TIMES MORE COMMONLY AFFECTED

RISK FACTORS INCLUDE THROMBOPHILIAS, PREGNANCY, POST-PARTUM PERIOD, ORAL CONTRACEPTIVES, HEAD AND NECK INFECTIONS, CANCER, CHRONIC INFLAMMATORY CONDITIONS, HEAD TRAUMA, LP AND NEUROSURGICAL PROCEDURES

1000

WHAT ARE 2 OF THE 4 "SYNDROMES" DESCRIBED FOR CENTRAL VENOUS THROMBOSIS?

INTRACRANIAL HTN - HEADACHE, DECREASED VISUAL ACUITY, PAPILLEDEMA

FOCAL NEURO DEFICITS - MOTOR WEAKNESS, APHASIA

SEIZURES - FOCAL, GENERALIZED, STATUS

ENCEPHALOPATHY - AMS, COMA

1100

THIS CONDITION WILL CAUSE, SUDDEN, SEVERE BACK PAIN. THEY MAY COMPLAIN OF HEADACHE OR HAVE CERVICAL RIGIDITY.

SPINAL SUBARACHNOID HEMORRHAGE

STUDY OF CHOICE IS MRI WITHOUT CONTRAST, BETTER AT ID'ING BLOOD

1200

THIS CONDITION CAUSES SUDDEN, SEVERE, BACK PAIN THAT IS CONSTANT. IT IS FREQUENTLY RADICULAR AND MAY OCCUR AFTER AN EPISODE OF STRAINING. PATIENTS OFTEN SEEK CARE PRIOR TO DEVELOPMENT OF NEUROLOGIC SIGNS.

SPINAL EPIDURAL HEMATOMA

CONSIDER THIS IN PATIENTS WITH A STROKE SYNDROME AND ACUTE NECK OR BACK PAIN

MRI WITH AND WITHOUT CONTRAST

1300

THESE 2 LAB TESTS ARE NOT HIGHLY SPECIFIC FOR SPINAL EPIDURAL ABSCESS, BUT ARE VIRTUALLY ALWAYS BE ELEVATED AND HAVE BEEN STUDIED AS A SCREENING TEST FOR "AT RISK" POPULATIONS

CRP AND SED RATE

1400

WHAT AREA OF THE SPINE IS THE MOST FREQUENT SITE OF INFECTION IN SPINAL EPIDURAL ABSCESS?

THORACOLUMBAR - EPIDURAL SPACE IS LARGER AND THERE IS MORE ADIPOSE TISSUE HERE

THAT'S IT, I'M GOING TO STAB YOU IN THE SPINE

100

A LESION HERE CAUSES WHAT SYMPTOMS

IPSILATERAL POSITION AND VIBRATION SENSE LOSS, CONTRALATERAL PAIN AND TEMP SENSATION LOSS, IPSILATERAL MOTOR LOSS

WHAT IS THIS SYNDROME CALLED?

200

UPPER EXTREMITY WEAKNESS THAT IS MORE PRONOUNCED DISTALLY THAN PROXIMALLY AFTER A FALL CAUSING A HYPEREXTENSION INJURY IS CONCERNING FOR THIS

CENTRAL CORD SYNDROME

PATIENTS MAY COMPLAIN OF BURNING SENSATION IN THE UPPER EXTREMITIES

M-U-D MNEMONIC - MOTOR GREATER THAN SENSORY, UPPER GREATER THAN LOWER, DISTAL GREATER THAN PROXIMAL

300

ANTERIOR CORD SYNDROME WILL CAUSE WHAT TYPE OF SENSORY AND MOTOR LOSS?

LOSS OF PINPRICK AND TOUCH SENSATION WITH VIBRATION AND POSITION PRESERVED

MOTOR LOSS OR WEAKNESS BELOW CORD LEVEL

MORE OFTEN ASSOCIATED WTH FLEXION INJURIES

400

A 28 YO MALE PRESENTING AFTER BEING EJECTED IS UNABLE TO FEEL OR MOVE HIS LOWER EXTREMITIES. HE IS ALSO HYPOTENSIVE AND HAS A PRIAPISM. THIS IS CONCERNING FOR WHAT SPINAL CORD INJURY

COMPLETE CORD SYNDROME

500

THIS FINDING HAS A SENSITIVITY OF 90% IN REGARDS TO CAUDA EQUINA SYNDROME

URINARY RETENTION

POST-VOID RESIDUAL OF MORE THAN 100-200 ML SHOULD PROMPT EVAL FOR NEUROLOGIC CAUSE OF BLADDER DYSFUNCTION

600

THIS IMAGING STUDY CAN BE DONE IF THERE IS CONCERN FOR CORD COMPRESSION IN SOMEONE UNABLE TO UNDERGO MRI

CT MYELOGRAPHY

700

THIS IS THE MOST FREQUENT MANIFESTATION OF MS INVOLVEMENT OF THE SPINAL CORD

MOTOR SYSTEM DYSFUNCTION

WILL CAUSE UMN FINDINGS

800

THIS DISEASE WILL CAUSE PARAPLEGIA, TRANSVERSE LEVEL OF SENSORY IMPAIRMENT, SPHINCTER DISTURBANCE

TRANSVERSE MYELITIS

THORACIC CORD MORE COMMONLY INVOLVED

FOLLOWED BY VIRAL INFECTION IN 30% OF CASES

COMMONLY COMPLAIN OF BACK PAIN AND FEVER

900

THIS NONINFECTIOUS CONDITION TYPICALLY CAUSES DEFICITS THAT INCLUDE EXTREMITY NUMBNESS, WEAKNESS, SPHINCTER DYSFUNCTION AND SOMETIMES MENINGEAL SIGNS

SPINAL SUBARACHNOID HEMORRHAGE

USUALLY DUE TO AV MALFORMATION

1000

A PATIENT WHO IS CURRENLY BEING TREATED FOR A DVT WITH XARELTO PRESENTS WITH ATRAUMATIC BACK PAIN OF SUDDEN ONSET WITH RADIATION INTO THE LEFT LEG. WHAT SHOULD YOU BE CONSIDERING?

SPINAL EPIDURAL HEMATOMA

PAIN OFTEN CAUSES PATIENT TO SEEK CARE BEFORE NEUROLOGIC SYMPTOMS DEVELOP, POSSIBLY LEADING TO DELAYED DIAGNOSIS

PAIN WILL BE SIGNIFICANT

1100

A PATIENT COMES IN FOR 5 DAYS OF BACK PAIN. THEY STATE THAT INITIALLY IT WAS ONLY A MILD ACHE, BUT HAS NOW LOCALIZED TO THE MIDLINE OF THE LOW BACK. THEY ARE AFEBRILE BUT REPORT NIGHT SWEATS AND RIGORS. THEY DENY IV DRUG USE, BUT DRINK HEAVILY. WHAT SHOULD BE HIGH ON YOUR DIFFERENTIAL?

SPINAL EPIDURAL ABSCESS

CLASSIC TRIAD OF BACK PAIN, FEVER, AND PROGRESSIVE NEURO DEFICITS IS NOT COMMON, LEADING TO DELAYED DIAGNOSIS

MAJOR RISK FACTORS INCUDE: DM, IVDA, CRF, ETOH, IMMUNOSUPPRESSION

1200

A PATIENT PRESENTS WITH SEVERE BACK PAIN AT ROUGHLY THE LEVEL OF L4. THEY DENY TRAUMA. THERE ARE NO NEURO DEFICITS, BUT THEY HAVE RADICULAR SYMPTOMS BILATERALLY. PAIN IS WORSE WITH ANY MOVEMENT OF THE SPINE. THEY HAVE A FEVER ON ARRIVAL. WHAT ARE YOU WORRIED ABOUT?

DISKITIS

INFECTION OF NUCLEUS PULPOSUS

MOST HAVE RADICULAR SYMPTOMS, BUT ARE NEUROLOGICALLY INTACT

L SPINE MOST COMMON SITE

FEVER NOTED IN MAJORITY OF PATIENTS

1300

THIS CONDITION WILL USUALLY PRESENT AS CONSTANT BACK PAIN THAT IS WORSE WHEN LYING DOWN, CAUSING MORE PAIN AT NIGHT

SPINAL NEOPLASM

CONSTITUTES A TRUE EMERGENCY IF ANY SYMPTOMS OF CORD COMPRESSION ARE PRESENT

1400

THIS CONDITION IS CAUSED BY A MIDLINE RUPTURE OF AN INTERVERTEBRAL DISK.

CAUDA EQUINA SYNDROME

FECAL/URINARY INCONTINENCE/RETENTION, IMPOTENCE, DECREASED RECTAL TONE, DISTAL MOTOR WEAKNESS, SADDLE ANESTHESIA, DTR'S MAY BE REDUCED

MAY NOT ALWAYS COMPLAIN OF BACK PAIN