Miscellaneous Neurology Topics
What are the mechanisms of central pontine myelinolysis (CPM)?
A demyelinating disease of the central nervous system, also known as “osmotic demyelination syndrome.”
Hyponatremia and its inappropriate correction are traditionally considered to be associated with CPM. However, the etiology is usually multifactorial.
Chronic alcoholism is the most common underlying disorder.
How does CPM present in imaging studies?
Computed tomography (CT): Hypodense areas within the central pons.
Magnetic resonance imaging (MRI): Hypointense on T1 and hyperintense on T2.
Of what disease is involuntary gait acceleration a characteristic feature?
Parkinson disease.
What are characteristic cerebrospinal fluid (CSF) findings in multiple sclerosis?
Oligoclonal bands of immunoglobulin G and myelin basic protein on protein electrophoresis.
What are clinical features of giant cell arteritis?
Usually elderly patients.
Severe headache associated with periods of monocular visual loss.
Aches and probable stiffness in various joints, usually in the morning.
Jaw pain is typical.
What are the clinical findings in hypertensive encephalopathy?
Systemic: A sudden increase in blood pressure may result in encephalopathy and headache in hours to days.
Gastrointestinal: Vomiting (central).
Visual disturbances, retinal arteriolar spasm, papilledema, retinal hemorrhages, and exudates.
Neurologic: Focal deficits, focal or generalized seizures.
What are common symptoms of water intoxication?
Tremor, ataxia, restlessness, diarrhea, vomiting, polyuria, and eventual stupor.
About 20% of patients with chronic schizophrenia drink water excessively, and 4% suffer from chronic hyponatremia and episodic water intoxication.
SIADH (syndrome of inappropriate secretion of antidiuretic hormone) may present with similar symptoms.
What are diagnostic tests and first-line treatment for giant cell arteritis?
Increased erythrocyte sedimentation rate.
Temporal artery biopsy.
High-dose steroids.
What are the major pathologic features of idiopathic parkinsonism?
Loss of pigmentation and cells in the substantia nigra.
Cell loss in the globus pallidus and putamen.
Presence of eosinophilic intraneural inclusion granules (Lewy bodies) in the basal ganglia, brainstem, spinal cord, and sympathetic ganglia.
Lewy bodies may appear in many forms of parkinsonism, but not in postencephalitic parkinsonism.
A patient reports involuntary jerking of the legs while falling asleep that is not associated with discomfort, and ceases during sleep. What is the likely diagnosis?
A normal phenomenon with no pathologic significance.
What are the principles of treatment for CPM?
Prevention and early diagnosis.
Correction of electrolytes at the proper rate.
Multispecialty involvement, particularly neurology.
Possible advances in use of thyroid-releasing hormone, plasmapheresis, corticosteroids, and intravenous immunoglobulins.
What are the characteristics and treatment of pseudotumor cerebri, also known as benign intracranial hypertension?
Symptoms: Headache, papilledema, and diminished visual acuity.
Evaluation: MRI or CT shows both normal and typical small, slitlike
ventricles, and increased intracranial pressure.
ventricles, and increased intracranial pressure.
Pseudotumor cerebri is more common in women than in men, and reaches peak frequency in the third decade.
Treatment: Acetazolamide, a carbonic anhydrase inhibitor.
What are the characteristics of cluster headache?
Quality of pain: Brief, severe, excruciating, sharp stabbing, nonthrobbing, unilateral headache, recurs on the same side, retroorbitally, and/or in the nostril.
Time: Nighttime occurrence, awakening the patient from sleep, and may recur in the day. Duration from 10 minutes to 2 hours.
Other symptoms: Ipsilateral lacrimation, conjunctival injection, nasal stuffiness, and Horner syndrome.
Frequently occurs in men. Mean age at onset is 25 years.
What are the common findings in normal pressure hydrocephalus?
The triad of ataxia, urinary incontinence, and dementia.
Enlarged ventricles can be seen by CT or MRI.
What are the electroencephalographic (EEG) patterns of a normal sleep cycle?
Fully awake: Random fast waves;
Drowsiness: Alpha waves;
Nonrapid eye movement (NREM) stage I: Theta waves;
NREM stage II: Theta waves with sleep spindles and K complexes;
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