Traumatic Brain Injuries
Which group of people are susceptible to depression, anxiety and social role dysfunction just as much as patient with a TBi?
Families [slide 29]
Name the hypothalamic nucleus that regulates the circadian rhythm in response to light from the retina.
Suprachiasmatic Nucleus (SCN) [slide 6]
What is temporary regional loss of function or weakness in whatever region was just involved in a seizure?
Todd's paralysis [slide 30]
Which class of drugs is the preferred choice for short term therapy of generalized anxiety disorder?
A 28-year-old woman presents with intermittent blurry vision in her right eye and difficulty walking that began a few months ago. She also notes increased fatigue and worsening of symptoms after hot showers. Neurological exam reveals nystagmus, intention tremor, and scanning speech. MRI of the brain shows periventricular white matter plaques.
Which of the following is the most likely diagnosis?
A. Neuromyelitis optica
B. Multiple sclerosis
C. Amyotrophic lateral sclerosis
D. Guillain-Barré syndrome
E. Chronic inflammatory demyelinating polyneuropathy (CIDP)
B
Which type of injury occurs at the point of impact and which type arises 180 degrees away?
Coup; contrecoup
What condition is described as an unpleasant aching of the calves and thighs or crawling feelings, coldness, heaviness and an uncontrollable urge to move?
Ekbom Syndrome [slide 43]
In the postictal state, the eyes [look away from/look towards] the lesion.
look towards
[slide 31]
A 27-year-old woman with a history of acute intermittent porphyria (AIP) is admitted for management of generalized seizures. The resident prescribes phenobarbital for seizure control. Twelve hours later, the patient develops severe abdominal pain, confusion, and dark-colored urine.
Which of the following best explains the patient's symptoms?
A. Hepatotoxicity due to phenobarbital
B. Hypersensitivity reaction to phenobarbital
C. Precipitation of porphyria attack due to phenobarbital
D. Electrolyte imbalance from seizure activity
E. Renal toxicity due to drug accumulation
Precipitation of porphyria attack due to phenobarbital
A 36-year-old woman presents with progressive muscle weakness, most noticeable by evening. She reports difficulty keeping her eyes open and trouble swallowing. Physical exam reveals ptosis and diplopia. Edrophonium (Tensilon) test temporarily improves her symptoms.
What is the most likely cause of her symptoms?
A. Autoantibodies against presynaptic calcium channels
B. Autoantibodies against postsynaptic acetylcholine receptors
C. Inhibition of voltage-gated sodium channels
D. Autoimmune demyelination of cranial nerves
E. Deficiency of dopamine in the motor cortex
B
Which condition is commonly observed after medial temporal lobe or diencephalic pathology?
Retrograde amnesia [slide 17]
What is the sudden loss of muscle tone while awake that makes you unable to move? What can trigger this?
Cataplexy; strong emotions such as laughter or anger [slide 29]
Name that seizure.
A 24-year-old woman is brought to the emergency department by her roommate who reports that the patient experienced sudden jerking of her right arm followed by lip-smacking and staring off into space. The episode lasted about 90 seconds, and she was confused for a few minutes afterward. She has no history of epilepsy. Vital signs are stable, and neurological exam is normal.
Focal seizure with impaired awareness
A 58-year-old woman presents with difficulty staying asleep. She falls asleep easily but frequently wakes up after 2–3 hours and cannot return to sleep. She has tried melatonin without success. Her medical history is unremarkable, and she is not on other sedatives. You prescribe a non-benzodiazepine hypnotic that is safe for long-term use and improves sleep maintenance.
Which of the following medications is most appropriate for this patient?
A. Zaleplon
B. Eszopiclone
C. Diphenhydramine
D. Temazepam
E. Ramelteon
B. Eszopiclone
A 64-year-old man presents with progressive weakness in his legs. He notes difficulty rising from chairs and climbing stairs, but says that strength improves with repeated activity. Physical exam reveals hyporeflexia, but reflexes improve after brief exercise. He has a 40-pack-year smoking history.
Which of the following is the underlying mechanism of this condition?
A. Antibodies against postsynaptic acetylcholine receptors
B. Autoimmune demyelination of motor neurons
C. T-cell-mediated destruction of anterior horn cells
D. Antibodies against presynaptic voltage-gated calcium channels
E. Inhibition of acetylcholinesterase at the neuromuscular junction
D
Which additional stressors should a pt be under when an EEG is performed?
sleep/food deprived
photic stimulation & hyperventilation
[slide 20]
Which type of apnea is caused by the collapsing of posterior pharyngeal muscles that compromise the airway?
A 9-year-old girl is brought to her pediatrician by her teacher, who noticed that she often "spaces out" for a few seconds during class. These episodes last about 10 seconds, occur multiple times per day, and the child resumes activity without confusion. An EEG shows 3-Hz spike-and-wave discharges.
What is the most appropriate first-line treatment for this patient’s condition?
Ethosuximide
A 65-year-old man with a history of insomnia reports difficulty falling asleep and frequent nighttime awakenings. He does not want benzodiazepines due to fear of addiction. You prescribe suvorexant. After a few days, he returns with complaints of vivid dreams, daytime sleepiness, and episodes of muscle weakness upon waking.
These side effects are most likely due to what mechanism of action of suvorexant?
A. Dopamine receptor antagonism
B. GABA-A receptor agonism
C. Melatonin receptor agonism
D. Orexin (hypocretin) receptor antagonism
E. Serotonin receptor antagonism
D.
A 12-year-old girl is brought in for sudden, involuntary jerky movements affecting her face and arms. She also has emotional lability and difficulty writing. Her mother reports a recent sore throat 1 month ago. Physical exam shows hypotonia and choreiform movements. ASO titer is elevated.
Which of the following is the most likely underlying pathophysiology?
A. Autoantibodies against basal ganglia after streptococcal infection
B. Genetic mutation of the HTT gene
C. Dopamine deficiency in the substantia nigra
D. Autoimmune destruction of cerebellar Purkinje cells
E. NMDA receptor antibody-mediated encephalitis
A
What is the name for the condition where symptoms of a TBI (headache, dizziness, insomnia, etc) persist more 6 months after injury?
Postconcussion Syndrome
During which stage of sleep does Pavor nocturnus occur?
Stage 3/4 [slide 35]
A 5-year-old boy with a history of developmental delay and frequent seizures is brought in by his mother. She reports episodes where the child suddenly collapses or drops his head without warning. These last only a few seconds, and he gets up right away. His EEG shows slow spike-and-wave discharges (<2.5 Hz).
Which of the following is the most likely seizure type?
Atonic Seizure
Which melatonin agonist is effective in treating non-24 hour sleep wake disorder?
Tasimelteon
A 32-year-old man presents with a 2-week history of right-sided weakness and difficulty concentrating. MRI reveals a lesion with concentric rings of alternating demyelinated and preserved myelin in the cerebral white matter. There is no enhancement of other white matter areas.
This condition is most closely related to which of the following?
A. Amyotrophic lateral sclerosis
B. Sarcoidosis
C. Balo's Concentric Sclerosis
D. Central pontine myelinolysis
E. Progressive multifocal leukoencephalopathy
C