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Weakness
Multiple Sclerosis (MS) Etiology Idiopathic Exclusive to CNS white matter Women Cold climates 3-23% familial Presentation First presentation Focal sensory symptoms Gait problem Balance problem Most common presentation Optic neuritis Blurry vision Visual disturbance Painful eye movement Characteristic Internuclear ophthalmoplegia Inability to adduct one eye + nystagmus in the...
Read moreTourette Disorder
Etiology Idiopathic Presentation Vocal + motor tic Vocal tics Grunts Coprolalia Motor tics Sniffing Blinking Frowning OCD Diagnosis Clinical Complications later in life ADHD OCD Treatment Habit reversal therapy Antipsychotic Risperidone Aripiprazole Fluphenazine Pimozide Haloperidol Alpha-2 agonist Clonidine Tetrabenazine
Read moreHuntington Disease
Etiology Hereditary → Anticipation Autosomal dominant CAG repeat on Ch 4 Caudate atrophy Start at age 30-50y Presentation Movement Starts with → Fidgetiness (restlessness) Choreaform movements (dyskinesia) Dystonic posturing Rigidity Akinesia Memory Dementia Mood Behavioral changes Irritability Moodiness Antisocial Suicide Diagnosis Mainly clinical Specific genetic test → CAG repeat CT/MRI...
Read moreRestless Leg Syndrome
Presentation Uncomfortable sensation in legs Creepy and crawly At night Worsened by caffeine Relieved by moving legs Can happen during sleep Kicks partner! Treatment Dopamine agonist → Pramipexol
Read moreParkinsonism
Parkinson’s Disease Etiology Loss of cells in substantia nigra ⇒ ↓ Dopamine Idiopathic (most common) Repeated head trauma Encephalitis Drugs Antipsychotics (thorazine) Reserpine Metochlopromide Presentation 50-60y Tremor → Pill-rolling (4-6 Hz) Rigidity Bradykinesia Shuffling (hypokinetic) gate, unsteady, tendency to fall, No arm swing Cogwheel rigidity Hypomimia (Masked facies) Micrographia...
Read moreTremor
Essential Tremor Presentation Familial Men 40-60y No tremor at rest Tremor with movement Greatest in hands Can be in head Better with Alcohol Worse with Caffeine Treatment Propranolol Intention Tremor Etiology Cerebellar Dysfunction Presentation No tremor at rest Tremor at movement that worsens close to target Diagnosis Clinical No...
Read moreNeurocutaneous Diseases
Tuberous Sclerosis Autosomal dominant Presentation Skin Adenoma sebaceum (red facial nodules) → Butterfly distribution Shagreen patches (leathery plaques on trunk) Ash leaf spots (hypopigmented) Angiofibromas Neuro Infantile spasm (West Syndrome) Bilateral symmetrical limb jerking NOT generalized, NO fever Treatment ACTH Vigabatrin Seizure Psychomotor retardation Mental abnormality Eye Retinal lesions Heart...
Read moreBrain Abscess
Etiology Sinusitis Otitis media Pneumonia Endocarditis Bacteremia Presentation Headache N/V Fever Seizure Focal neurologic signs All signs even fever can be seen with cancer Diagnosis Best initial → Head CT/MRI → Ring, contrast enhancing, edema, mass effect Cancer and abscess are indistinguishable with imaging Most accurate → Brain biopsy...
Read moreSpine
Anterior Spinal Artery Infarction Presentation Early Loss of Motor (flaccid paralysis) + Pain/Temp below level of infarction Posterior column spared → Pos/Vib OK ⊖ DTR at level of infarction Late Spastic paraplegia after several weeks Babinski Treatment No specific treatment Subacute Combined Degeneration of the Cord Etiology B12 deficiency...
Read moreHemorrhagic Stroke
Subarachnoid Hemorrhage (SAH) Etiology Aneurysm rupture Anterior circle of Willis 2% of population Risk Factors PCKD Tobacco Hypertension Hyperlipidemia Alcohol Presentation Sudden severe headache Differentiate from meningitis History of a sentinel headache (1/3 of patients) Meningeal irritation Stiff neck Photophobia Fever Blood irritates meninges LOC (50%) Sudden ↑ICP Distinguishes...
Read moreSeizure
Etiology Generalized Tonic-Clonic Seizure Metabolic ↓Na ↑Na ↓O2 ↓Glucose ↓Ca ↑Cr (Uremia) Hepatic failure ↓Mg (rare) CNS Infection Encephalitis Meningitis Abscess Anatomic Trauma Stroke Tumor Substance related Withdrawal Alcohol Barbiturate Benzodiazepine Overdose Cocaine Presentation Partial seizure Focal to one part of body Simple → Intact consciousness Complex → Altered...
Read morePostherpetic Neuralgia
Etiology After shingles in 15% Presentation Pain over the area Treatment TCA Amitriptyline Imipramine Nortriptyline Gabapentin Pregabalin Carbamazepine Phenytoin Topical Capsaicin Prevention Treat shingles with antiherpetics → ↓ Incidence of postherpetic neuralgia Acyclovir Famciclovir Valganciclovir Treating shingles with steroids will NOT ↓ Incidence of postherpetic neuralgia Zoster vaccine Prevents shingles...
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