1. The specific pathology of multiple sclerosis (MS) is demyelination with axonal sparing, and the mean age of onset for MS is 32 years.

2. MS is the most common demyelinating illness in the central nervous system (CNS).

3. The disease course for MS usually manifests itself as relapsing and remitting.

4. MS is primarily diagnosed clinically in conjunction with magnetic resonance imaging (MRI) findings typical of the disease (periventricular white matter changes).

5. Ménière’s disease consists of vertigo, hearing loss, and a feeling of fullness or blockage in the ear(s).

6. Intractable cases of Ménière’s disease may be treated via surgical shunting.

7. The tetrad of narcolepsy consists of excessive daytime sleepiness, cataplexy, hypnagogic or hypnapompic hallucinations, and sleep paralysis.

8. Horner’s syndrome consists of ptosis, miosis, and anhidrosis.

9. Subdural hematomas are caused by tearing of the bridging emissary veins.

10. Radiologic manifestation of subdural hematomas are concave or crescentic in shape typically seen on computed tomography (CT) scan.

11. Epidural hematomas are usually caused by skull fractures and result from tearing of the middle meningeal artery.

12. Epidural hematomas are lens shaped on CT scan.

13. Temporal arteritis is a granulomatous arteritis affecting large and medium-sized arteries. Histologic studies demonstrate intimal thickening and lymphocytic infiltration of the media and adventitia.

14. The most common pathogens for bacterial meningitis are Streptococcus pneumoniae (most common in adults), Haemophilus influenzae, and Neisseria meningitides.

15. Typical cerebrospinal fluid (CSF) findings in septic meningitis are neutrophils, high protein, and low glucose versus aseptic meningitis which has lymphocytes, normal glucose, and high protein.

16. Tuberculosis meningitis is rare, however, it should be thought of in patients with the right clinical symptoms and with a history of immunosuppression, alcoholics, intravenous drug abusers, immigrants from endemic areas, or prisoners.

17. Herpes simplex virus (HSV) encephalitis is typically caused by HSV type 1. The CSF findings are lymphocytes, normal glucose, elevated protein, and many high red blood cell counts.

18. A long-term complication of HSV encephalitis is often amnesia.

19. Untreated cases of HSV encephalitis have a mortality rate of 70%.

20. Tabes dorsalis is caused by untreated primary infection with syphilis (treponema pallidum) and usually occurs 10 to 20 years after the initial infection.

21. Progressive multifocal leukodystrophy (PML) is due to reactivation of the John Cunningham (JC) virus. It causes widespread demyelination due to infecting the oligodendrocytes in immunocompromised patients.

22. PML is a subacute course resulting in subcortical dementia, and death usually occurs within 6 months of diagnosis.

23. Lacunar strokes account for approximately one fifth of all strokes.

24. Amaurosis fugax is due to retinal artery occlusion/ischemia and is primarily caused by internal carotid artery stenosis.

25. Carotid endarterectomy for symptomatic artery stenosis (70% to 99%) is the standard of care for stroke prevention.

26. The most common cause for subarachnoid hemorrhage (spontaneous) is rupture of a berry aneurysm.

27. Nimodipine (calcium channel blocker) is thought to be neuroprotective in the case of vasospasm.

28. Treatment of vasospasm includes triple H therapy (hypertension, hypervolemia, and hemodilution).

29. The highest risk for rebleeding after Subarachnoid Hemorrhage (SAH) is within the first 48 hours.

30. The most common sites for hypertensive hemorrhagic stroke are the basal ganglia, thalamus, cerebellum, and pons.

31. Approximately two thirds of hemorrhagic strokes are due to hypertension.

32. Broca’s aphasia is a nonfluent (motor) aphasia that results in an inability to speak (broken speech) but comprehension of speech is intact.

33. Wernicke’s aphasia is a fluent (sensory/receptive) aphasia in which patients make incomprehensible speech and are usually unaware of their deficit. Comprehension is impaired.

34. Brown-Séquard syndrome is caused by unilateral hemisection of the cord and results in ipsilateral weakness, loss of vibration and proprioception with hyperreflexia, and loss of pain and temperature contralaterally below the lesion.

35. Vitamin B12 deficiency can result in neuropathy, weakness, depression, and dementia.

36. Pernicious anemia is a common cause of vitamin B12 deficiency.

37. Carpal tunnel syndrome is caused by compression of the median nerve at the wrist under the flexor retinaculum.

38. Tinel’s sign is numbness or tingling that occurs while tapping or percussing the wrist over the median nerve.

39. Guillain-Barré syndrome (GBS) is a progressive ascending flaccid paralysis (areflexia) that peaks within 4 weeks of onset.

40. Treatment of choice for GBS is plasmapheresis or intravenous immunoglobulin (IVIG).

41. GBS is classically preceded by gastroenteritis or upper respiratory infection.

42. Amyotrophic lateral sclerosis (ALS) affects the anterior horn cells and the corticospinal tract.

43. SOD1 mutation occurs in familial ALS (rare form).

44. Complicated migraine is a migraine headache with severe or persistent sensorimotor deficits (suggestive of a cerebral infarction).

45. Cluster headache is excruciating, unilateral head pain associated with ipsilateral tearing, conjunctival injection, and nasal congestion.

46. The triad of headache, papilledema, and increased intracranial pressure (ICP) is known as benign intracranial hypertension (pseudotumor cerebri).

47. One third of patients with benign intracranial hypertension have resolution after their first lumbar puncture.

48. Optic nerve sheath fenestration is an option for medically refractive patients with pseudotumor cerebri.

49. The main complication of temporal arteritis is visual loss (ischemic optic neuropathy).

50. Myasthenia gravis can be established with Tensilon test, repetitive nerve stimulation, single-fiber electromyography, and acetylcholine receptor antibodies.

51. About 5% of patients with acute stroke will have early seizure.

52. Alcohol-related seizures usually occur about 24 hours after the last drink but can occur at any time in chronic alcoholics.

53. Antiepileptic drugs are not indicated in pure alcohol-related seizures.

54. Approximately 3% to 6% of patients undergoing supratentorial craniotomy will develop seizures perioperatively.

55. Approximately 5% of patients who have sustained concussion will have an intracranial hemorrhage.

56. Parkinson’s disease is a clinical diagnosis with the cardinal features of tremor, rigidity, bradykinesia, and loss of postural reflexes.

57. Toxoplasmosis is the most common opportunistic infection affecting the CNS in patients with AIDS.

58. Wilson’s disease diagnosis is supported by Kayser-Fleischer rings, low serum ceruloplasmin level, abnormal liver function tests, or hepatitis.

59. The gene for Wilson’s disease is located on chromosome 13.

60. A common gene for idiopathic torsion dystonias, the DYT1 gene, is located on chromosome 9 and is inherited in an autosomal dominant manner with a penetrance as low as 30%.

61. Fifteen percent of strokes are caused by artery-to-artery embolism.

62. Six classic lacunar syndromes are clumsy-hand dysarthria, pure-motor hemiparesis, ataxic hemiparesis, sensorimotor syndrome, and pure hemisensory loss. More than 70 lacunar syndromes have been described.

63. Up to 40% of strokes are cryptogenic.

64. Fifty percent of patients that have a transient ischemic attack (TIA) go on to develop a stroke within the next 5 years. Ten percent of the strokes occur in the first 90 days (if untreated).

65. If no carotid stenosis or cardioembolic source is identified, acetylsalicylic acid is the drug of choice.

66. The posterior communicating artery is the most common site of aneurysms.

67. Cigarette smoking is an increased risk factor for aneurysmal bleeding.

68. Surgical resection followed by whole brain radiation therapy is the gold standard for the treatment of solitary brain metastases.

69. Leptomeningeal metastasis is most common from the breast, lung, non-Hodgkin’s lymphoma, and malignant melanoma.

70. The prognosis of patients with leptomeningeal metastasis is about 3 to 6 months.

71. Approximately 40% of patients have a solitary metastasis to the brain (usually gastrointestinal and gynecologic).

72. Brain metastasis usually presents with headache, motor weakness, and mental status change.

73. Most highly vascular metastatic cancers are melanoma and renal cell carcinoma.

74. Acoustic neuromas account for approximately 8% to 9% of all primary brain tumors, arise from the eighth cranial nerve, and usually grow at the cerebellopontine angle.

75. Meningiomas account for 20% of all intracranial tumors. They are usually benign tumors that arise from arachnoid cap cells.

76. Patients with olfactory groove meningiomas present with dementia, ipsilateral optic atrophy, or contralateral papilledema (Foster-Kennedy syndrome).

77. Ependymomas account for 60% of spinal cord gliomas. On histopathology, rosettes and pseudorosettes are seen perivascular space.

78. The pathology of oligodendrogliomas contains cells that have a characteristic “fried egg” appearance.