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Neuro 15- Dementia and Headache

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Identify the neuronal pigment/inclusion that matches the following statement:
-intranuclear inclusions seen in herpes simplex encephalitis
Cowdry type A inclusions
Identify the neuronal pigment/inclusion that matches the following statement:
-Cytoplasmic inclusions pathognomonic of rabies
Negri bodies
Identify the neuronal pigment/inclusion that matches the following statement:
-Neuronal inclusions characteristic of Parkinson disease
Lewy bodies
Identify the neuronal pigment/inclusion that matches the following statement
-Cytoplasmic inclusion bodies associated with aging
Lipofuscin granules
Identify the neuronal pigment/inclusion that matches the following statement:
-Dark cytoplasmic pigment in neurons of the substantia nigra and locus coeruleus, not seen in patients with parkinson
melanin
Identify the neuronal pigment/inclusion that matches the following statement:
-Eosinophilic, rod-like inclusions in hippocampus of Alzheimer patients
Hirano bodies
Identify the neuronal pigment/inclusion that matches the following statement
-Diagnostic of Alzheimer disease
Neurofibrillary tangles and plaques
Identify the neuronal pigment/inclusion that matches the following statement
-Filamentous inclusions that stain with silver, do not survive neuronal death
Pick bodies
Identify the neuronal pigment/inclusion that matches the following statement
-Filamentous inclusions that stain with PAS and ubiquitin
lewy bodies
What are the usual components of a "dementia work-up"?
• Syphilis screen
• HIV screen
• TSH (to rule out hypothyroidism)
• Vit B12
• Head CT or MRI (to rule out multiple infarct, stroke or normal pressure hydrocephalus)
•MMSE
Which neurodegenerative disease matches the following statement?
-Lou Gehris disease
ALS
Which neurodegenerative disease matches the following statement?
-Senile plaques, neurofibrillary tangles
Alzheimer disease
Which neurodegenerative disease matches the following statement?
-Presents at birth as "floppy baby"
Werdnig-Hoffman disease
Which neurodegenerative disease matches the following statement?
-Lewy bodies
•Parkinson disease
• Alzheimer disease (lewy body type)
• Lewy body dementia
Which neurodegenerative disease matches the following statement?
-Dementia often associated with frequent falls and/or syncope
Lewy body dementia
Which neurodegenerative disease matches the following statement?
-Atrophy of caudate nucleus → chorea
Huntington disease
Which neurodegenerative disease matches the following statement?
-Depigmentation of substantia nigra
Parkinson disease
Which neurodegenerative disease matches the following statement?
-Both upper and lower motor neuron signs (spasticity and weakness)
ALS
Which neurodegenerative disease matches the following statement?
-Dementia + visual hallucinations
Lewy body dementia
Which neurodegenerative disease matches the following statement?
-Dementia + personality changes and/or aphasia
Pick disease
What allele is associated with Alzheimer disease?
Why is Alzheimer disease so common in patients with Down syndrome?
• APP gene on chromosome 21
• APOE4 allele
• Down syndrome: have 3 copies of APP gene on chromosome 21
What is the mechanism of action of the drugs used in the treatment of Alzheimer disease?
Increase acetylcholine
What is the most likely cause of headache based on the following description?
-Made worse by foods containing tyramine
migrain headaches
What is the most likely cause of headache based on the following description?
-Obese female with papilledema
pseudotumor cerebri
What is the most likely cause of headache based on the following description?
-Jaw muscle pain when chewing
temporal arteritis
What is the most likely cause of headache based on the following description?
-periorbital pain with ptosis and myosis
cluster headache
What is the most likely cause of headache based on the following description?
-photophobia and/or phonophobia
migraine headache
What is the most likely cause of headache based on the following description?
-bilateral frontal/occipital pressure
tension headache
What is the most likely cause of headache based on the following description?
-lacrimation and/or rhinorrhea
cluster headache
What is the most likely cause of headache based on the following description?
-elevated ESR
temporal arteritis
What is the most likely cause of headache based on the following description?
-"worst headache of my life"
subarachnoid hemorrhage
What is the most likely cause of headache based on the following description?
-headache + extraocular muscle palsies
cavernous sinus thrombosis
What is the most likely cause of headache based on the following description?
-scintillating scotomata prior to headache
migraine with aura
What is the most likely cause of headache based on the following description?
-headache occurring either before or after orgasm
postcoital cephalgia
What is the most likely cause of headache based on the following description?
-responsive to 100% oxygen supplementation
cluster headache
What is the most likely cause of headache based on the following description?
-trauma to the head → headache begins days after the event, persists for over a week and does not go away
subdural hematoma
What features allow you to distinguish a migraine headache from a cluster headache or a tension headache?
Migraine
• Might have an aura
• N/V photophobia, phonophobia
• Time frame: 24-48 hrs

Cluster
• Might have tearing & rhinorrhea
• Occur on a daily basis in a certain cluster of time (e.g. e.g. every day for 3 months)
• Time frame: 30 mins to 3 hrs

Tension
• Frontal or occipital pain
• Timeframe: long period of time
What is the mechanism of action of sumtriptan?
Serotonin 5-HT1B/1D receptor agonist
What are the contraindications to sumatriptan use?
• CAD
• Prinzmental's angina
• Pregnancy
What is the usual treatment for migraine headaches in pregnancy?
opioids
What would you suspect as a cause of headache in a patient using topical retinoic acid for acne?
Benign intracranial HTN (pseudotumor cerebri)
(due to vit A toxicity)
A 20-year-old woman that has migraine headaches each proceeded by an aura should never be prescribed what medication?
Oral contraceptive pills (because it increases risk of thromboembolic stroke)
What makes Lewy body dementia unique?
• Visual hallucinations
• Repeated falls
• Syncopal episodes