Divine Intervention: All Neurology

What brain tumor leads to Parinaud’s syndrome and causes vertical gaze loss?

Pinealoma

What is the pathophysiology of pinealoma causing Parinaud’s syndrome?

Compression of the superior colliculus, the vertical conjugate gaze center.

What condition is characterized by hypopigmented macules and seizures in a 13-month-old child?

Tuberous sclerosis.

What are the hypopigmented macules known as in tuberous sclerosis?

Ash leaf spots.

What seizure syndrome is associated with tuberous sclerosis?

West syndrome (infantile spasms).

What is the EEG finding associated with West syndrome?

Hypsarrhythmia.

What is the treatment for West syndrome?

ACTH or vigabatrin.

What is the most common primary brain tumor in children?

Pilocytic astrocytoma.

What histological feature is seen in pilocytic astrocytoma?

Rosenthal fibers.

What tumor marker is associated with glial cells?

GFAP (Glial Fibrillary Acidic Protein).

Where is medulloblastoma typically located?

Cerebellar vermis.

What histological feature is characteristic of medulloblastoma?

Homer-Wright rosettes.

Which brain tumor often presents with hydrocephalus in children?

Ependymoma.

What histological feature is seen in ependymomas?

Perivascular pseudorosettes or ependymal rosettes.

What brain tumor can cause visual problems in children?

Craniopharyngioma.

From which embryonic structure is craniopharyngioma derived?

Rathke’s pouch.

What imaging characteristic is associated with craniopharyngioma?

Calcified suprasellar mass.

What is a common complication of craniopharyngiomas?

Bitemporal hemianopsia due to optic chiasm compression.

What is the most common cause of brain tumors in adults?

Metastasis.

Where do metastatic brain tumors typically occur?

Gray-white junction.

What is the most common primary brain tumor in adults?

Glioblastoma multiforme (GBM).

What is a characteristic imaging feature of GBM?

Butterfly-shaped mass that crosses the corpus callosum with edema and central necrosis.

What histological marker is associated with GBM?

GFAP (Glial Fibrillary Acidic Protein).

What is the most common cause of bilateral acoustic neuromas?

Schwannoma of CN8.

What is the location of acoustic neuromas?

Cerebellopontine angle.

What is the most common tumor at the cerebellopontine angle?

Acoustic neuroma.

What is the second most common tumor at the cerebellopontine angle?

Meningioma.

What tumor marker is associated with acoustic neuromas?

S-100 protein.

What syndrome is associated with bilateral acoustic neuromas?

Neurofibromatosis type 2 (NF2).

What type of brain tumor presents as a parasagittal mass along the falx cerebri?

Meningioma.

What histological feature is seen in meningiomas?

Psammoma bodies (laminated calcifications).

What does a 2-year-old child with an abdominal mass crossing the midline likely have?

Neuroblastoma.

What alternative location can neuroblastomas present in?

Posterior mediastinum.

What genetic syndrome is associated with neuroblastomas?

Neurofibromatosis type 1 (NF1).

What syndrome is associated with Wilms tumor?

Beckwith-Wiedemann syndrome.

What are the signs of Beckwith-Wiedemann syndrome?

Hemihypertrophy, macroglossia, enlarged abdominal organs, abdominal wall defects.

What is the treatment for hypoglycemic seizure in newborns?

Hyperplasia of beta cells of pancreatic islets.

What does a 2-year-old child with an abdominal mass that does not cross the midline likely have?

Wilms tumor.

What type of tumor typically occurs in the frontal lobe?

Oligodendroglioma.

What is the histological appearance of oligodendroglioma?

Fried egg appearance.

What brain tumor can produce erythropoietin?

Hemangioblastoma.

What syndrome is associated with hemangioblastoma?

Von Hippel-Lindau (VHL) syndrome.

Why must hemangioblastoma be treated promptly?

Because they can cause life-threatening hemorrhage.

What presents with recent viral illness followed by vertigo and tinnitus?

Labyrinthitis.

How does benign paroxysmal positional vertigo (BPPV) present?

Feeling like the room is spinning with positional changes and nystagmus with provocative maneuvers.

What is the diagnostic maneuver for BPPV?

Dix-Hallpike maneuver.

What is the treatment for BPPV?

Epley or Semont maneuver.

What indicates obturator nerve injury?

Anesthesia over the medial thigh and weak thigh adduction.

What nerve roots are associated with the obturator nerve?

L2-L4.

What does anesthesia over the lateral thigh indicate?

Lateral femoral cutaneous nerve injury.

What symptoms present in a 7-year-old with ataxia and hypertrophic cardiomyopathy?

Friedreich’s ataxia.

What is the pathophysiology of Friedreich’s ataxia?

GAA repeats lead to loss of function mutation in frataxin gene.

What are the classic signs of Friedreich’s ataxia?

Ataxia, confusion, hyporeflexia.

What is the inheritance pattern of Friedreich’s ataxia?

Autosomal recessive.

What is the most common cause of death in Friedreich’s ataxia?

Congestive heart failure due to hypertrophic cardiomyopathy.

What is the presentation of idiopathic intracranial hypertension?

Obese female with visual difficulties and severe intermittent headaches.

What is the first step in managing idiopathic intracranial hypertension?

Fundoscopic exam.

What abnormalities would be seen on a head CT for idiopathic intracranial hypertension?

No abnormalities.

What shows elevated opening pressure in idiopathic intracranial hypertension?

Lumbar puncture (LP).

What is the treatment for idiopathic intracranial hypertension?

Weight loss and acetazolamide.

What is the time window for tPA administration in ischemic stroke?

3-4.5 hours; up to 6 hours if injected directly into the involved vessel.

What are contraindications to tPA administration?

Bleeding disorders, recent GI bleeding, recent brain surgery.

What is the blood pressure management strategy in ischemic strokes?

Permissive hypertension up to 220/120.

What is the classic presentation of amaurosis fugax?

Painless loss of vision in one eye, described as a curtain coming down.

What is the first diagnostic step in suspected amaurosis fugax?

Non-contrast head CT.

What is the main treatment for recurrent episodes of amaurosis fugax?

Aspirin or aspirin plus dipyridamole.

What is the most common cause of stroke in children and young adults?

Dural sinus thrombosis.

What are the common causes of bell's palsy?

Herpes simplex and Lyme disease.

What is the characteristic finding on a CSF analysis for bacterial meningitis?

Elevated WBCs (neutrophilic predominance), elevated protein, and low glucose.

What is the most common cause of bacterial meningitis in neonates?

Group B Streptococcus (Strep agalactiae).

What is the empirical treatment for neonatal meningitis?

Cefotaxime plus ampicillin.

What pathogen causes bacterial meningitis in young adults?

Neisseria meningitidis.

What is the vaccination to prevent Neisseria meningitidis?

Neisseria meningitidis vaccine.

What is the classic complication of Neisseria meningitidis meningitis?

Waterhouse-Friderichsen syndrome.

What is the most common complication of untreated Wernicke encephalopathy?

Korsakoff syndrome.

What is the pathophysiology of Wernicke encephalopathy?

Vitamin B1 deficiency leads to decreased transketolase activity.

What is the treatment for Wernicke encephalopathy?

IV thiamine.

What type of tremor is worsened by activity and relieved by alcohol?

Benign essential tremor.

What is the initial treatment for benign essential tremor?

Beta blockers (e.g., propranolol).

What is the pathophysiological mechanism of myasthenia gravis?

Antibodies against post-synaptic nicotinic ACh receptors.

What diagnostic test is used for myasthenia gravis?

Anti-AChR or anti-MUSK antibody testing.

What is the main treatment for myasthenia gravis?

Acetylcholinesterase inhibitors (e.g., pyridostigmine).

What associated malignancy is found with myasthenia gravis?

Thymoma.

What is the best initial imaging study for assessing ischemic stroke?

Non-contrast head CT.

What does the presence of oligoclonal bands in CSF indicate?

Multiple Sclerosis.

What is the classic presentation of multiple sclerosis?

Female in her 30s with disparate neurological deficits.

What is the treatment for acute exacerbations in multiple sclerosis?

High-dose corticosteroids.

What is the common cause of CNS demyelination in children after vaccination?

ADEM (acute disseminated encephalomyelitis).

What is the distinguishing feature of Alzheimer's disease?

Senile plaques and neurofibrillary tangles.

What is the most common cause of dementia in older adults?

Alzheimer's disease.

What is the increased risk allele associated with Alzheimer's disease?

ApoE4.

What is the pathophysiological cause of Huntington’s disease?

CAG repeat expansion leading to neurodegeneration.

What brain structure undergoes atrophy in Huntington’s disease?

Caudate nucleus.