USMLE Step 2 (Fach) / Neurology (Lektion)
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Step 2 CK
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- Mnemonic: MCA stroke can cause CHANGes Contralateral paresis and sensory loss in the face and arm Hemiparesis Aphasia (dominant) Neglect (nondominant) Gaze preference toward the side of lesion
- Stroke Symptoms - ACA - Contralateral paresis and sensory loss in the leg - Cognitive or personality changes - Abulia: flat affect and lack of motivation→ E.g., inability to complete goal-directed tests
- Stroke Symptoms - PCA - Vertigo - homonymous hemianopsia
- Stroke Symptoms - Lacunar - pure motor - pure sensory - ataxic hemiparesis - dysarthria
- Stroke Symptoms - TIA - depend on location of vascular lesion - neurologic deficit lasts <24 hours (most last <1h) - often without findings on MRI
- Subarachnoid hemorrhage Epidemiology:- Traumatic: head trauma is the most common cause of SAH- Peak incidence: around the age of 50- ♀ > ♂ (3:2) Etiology:- Traumatic- Ruptured aneurysm usually in the circle of Willis→ ...
- Conditions associated with berry aneurysms that can ... - Marfan syndrom- Aortic coarctation- Kidney disease (autosomal dominant, polycystic)- Ehlers-Dahnlos syndrom- Sickle-cell anemia, smoking tobacco- Atherosclerosis- Hypertension, hyperlipidemia
- Cavernous sinus syndrome Etiology:- Cavernous sinus thrombosis (e.g., due to sinusitis)- Carotid-cavernous fistula- Cavernous sinus tumors- Carotid artery aneurysms- Tolosa-Hunt syndrome (idiopathic granulomatous inflammation ...
- Cluster headache Epidemiology: - Sex: ♂ > ♀ (3:1)- Peak incidence: 20-40 years Etiology:- Risk factor: tobacco use- Possible triggers: alcohol, histamine, seasonal fluctuations Clinical features:- Agonizing pain- ...
- Epidural hematoma Epidemiology: - Sex: ♂ > ♀ (4:1)- Peak incidence: 20-30 years Pathophysiology: Head trauma (usually severe) → skull fracture (often temporal bone) → rupture of a middle meningeal artery → ↑ ...
- Subdural hematoma Etiology:- Blunt head trauma (most common)→ Shaken baby syndrome→ Frequent falls (e.g., due to old age, alcohol abuse, epilepsy, hyponatremia)- Nontraumatic intracranial hemorrhage→ Anticoagulation ...
- Seizure disorders Etiology:- Metabolic and electrolyte disturbances: hypoglycemia and hyperglycemia, hyponatremia and hypernatremia, hypocalcemia, uremia, thyroid storm, hyperthermia- Mass: brain tumors and metastases, ...
- Status epilepticus Criteria:- ≥ 5 min of continuous seizures- OR ≥ 2 seizures with consciousness not being fully regained in the interictal period Etiology:- Withdrawal from antiepileptic drugs- Metabolic disturbances ...
- Benign paroxysmal positional vertigo A disease of the inner ear caused by small particles (otoliths) dislodging and migrating within the endolymph fluid into one of the semicircular canals. Epidemiology:- Most common type of peripheral vestibular ...
- Ménière disease Etiology: Endolymph hydrops (accumulation of fluid in the endolymphatic sac) Clinical features:- Acute, unilateral symptoms that last from minutes to hours- The frequency of these episodes decreases ...
- Myasthenia gravis Epidemiology:- Women: 2-3rd decade- Men: 6-8th decade Clinical features:- Fluctuating & fatigable proximal muscle weakness that is worse later in the day- Ocular: Diplopia, ptosis- Bulbar: Dysphagia, ...
- Multiple sclerosis Chronic, degenerative disease of the CNS that is caused by an immune-mediated inflammatory process.- Sex: F > M (2:1)- Age of onset: 20-40 years of age- Ethnicity: ↑ prevalence among the white population- ...
- Amyotrophic lateral sclerosis Chronic, progressive degenerative disease, that is characterized by loss of upper and lower motor neurons.- ♂ > ♀- Mutations of superoxide dismutase 1 Clinical features:- Asymmetric limb weakness, ...
- Normal pressure hydrocephalus Etiology:- Idiopathic (most common in adults > 60 years)- Possible secondary causes:→ Inflammatory diseases of the CNS (e.g., meningitis)→ Intraventricular hemorrhage→ Subarachnoidal hemorrhage ...
- Creutzfeldt-Jakob Disease Etiology:- Sporadic (∼ 85%): no identifiable cause- Familial (∼ 10-15%): various mutations in the PRNP gene- Iatrogenic CJD (< 1%): transmission during medical procedures (e.g., via organ transplantation, ...
- Huntington disease Etiology:- Increased number of CAG repeats in the huntingtin gene on chromosome 4- Autosomal dominant- Anticipation Clinical features:- Chorea: involuntary, irregular, nonrepetitive, arrhythmic movements ...
- Parkinson disease Etiology:- Idiopathic- Secondary parkinsonism (pseudoparkinsonism)→ Medication with anti-dopaminergic effects: typical antipsychotics (e.g., haloperidol), some antiemetics (e.g., metoclopramide), some ...
- Neurofibromatosis Most common neurocutaneous disorder. Autosomal dominant. Neurofibromatosis type 1 (von Recklinghausen disease):- Café-au-lait spots- Neurofibromas (benign peripheral nerve sheath tumors), seizures when ...
- Tuberous sclerosis Autosomal dominant disorder that affects many organ systems (CNS, skin, heart, retina, kidneys) Clinical features:- Infantile spasms or seizures- ≥ 3 "Ash-leaf" hypopigmented lesions on the trunk and ...
- Ischemic stroke Etiology:- Large artery atherosclerosis: secondary to hypertension (∼ 20% of cases) E.g., carotid artery stenosis- Embolic stroke (∼ 20% of cases)→ Cardiac emboli: Atrial fibrillation, myocardial ...
- Intracerebral hemorrhage Etiology:- Hypertension (most common cause)- Cerebral amyloid angiopathy (most common cause of spontaneous ICH in the elderly)- Ruptured arteriovenous malformations - Coagulation disorders (e.g., anticoagulant ...
- Resting tremor - Age of onset: ∼ 60 years Etiology: - Parkinson's disease- Drug induced parkinsonism (neuroleptics, metoclopramide)- Progressive supranuclear palsy Clinical features:- Typically, asymmetric resting ...
- Essential tremor Epidemiology:- Most common form of tremor- Bimodal distribution: teens and 6th decade of life (common in elderly patients) Etiology: - Positive family history (50-70%; autosomal dominant inheritance) ...
- Intention tremor Etiology:- Cerebellar stroke, tumor, or trauma- Multiple sclerosis- Drug-induced: alcohol, lithium- Wilson's disease Clinical features:- Coarse hand tremor with a frequency of < 5 Hz- Worse with goal-directed ...
- Dementia Etiology:- Neurodegenerative brain diseases: Alzheimer disease (> 50% of dementia cases), Parkinson disease, frontotemporal dementia, dementia with Lewy bodies, progressive supranuclear palsy, Huntington ...
- Alzheimer disease Alzheimer disease is a chronic neurodegenerative disease and the leading cause of dementia. ApoE-2: ↓ risk of sporadic formApoE-4: ↑ risk of sporadic formAPP, presenilin-1, presenilin-2: familial forms ...
- Frontotemporal dementia Etiology:- Associated with pathological intracellular inclusion bodies (Pick bodies) that are caused by mutations in tau or progranulin proteins- Also associated with ubiquitin inclusion bodies hypothesized ...
- Lewy body dementia Second most common form of neurodegenerative dementia (10-20% of dementia cases). Clinical features:- Dementia- Fluctuating cognition/attention- Extrapyramidal motor symptoms- Visual hallucinations and ...
- Vascular dementia Etiology:- VD may occur as a result of a prolonged and severe cerebral ischemia of any etiology; primarily → Large artery occlusion (usually cortical ischemia)→ Lacunar stroke (small vessel occlusion ...
- Persistent vegetative state Persistent vegetative state (PVS) is a clinical condition in which function of the cortex is impaired while function of the brainstem is preserved for a period of more than one month. Etiology:- Traumatic ...
- Guillain-Barré syndrome Etiology:- About ⅔ of GBS patients experience symptoms of an upper respiratory or gastrointestinal tract infection 1-4 weeks prior to onset of GBS.- Pathogens associated with GBS: Campylobacter jejuni, ...
- Idiopathic intracranial hypertension (Pseudotumor ... Epidemiology: - Predominantly affects obese women aged 15-45 years Risk factors:- Obesity- Growth hormone- Tetracyclines- Excessive vitamin A or derivatives Clinical features: - Diffuse headaches- Transient ...
- Infantile spasms (West syndrome) Epidemiology:- Age of onset: 3-7 months- Sex: ♂ > ♀ Etiology:- Perinatal infections- Hypoxic-ischemic injury- PKU- Tuberous sclerosis complex- Idiopathic Clinical features:- Sudden symmetric, synchronous ...
- Metastatic brain cancer Incidence:- Order of increased metastatic brain frequency: Lung > Breast > Melanoma > Colon Primary solitary brain metastases:- Breast- Colon- Renal cell carcinoma Multiple brain metastases:- Lung cancer- ...
- Tethered cord syndrome Abnormal stretching of the spinal cord caused by adhesions or obstructions that tether the cord to the base of the spinal canal Etiology:- Meningeal adhesions- Terminal filament adhesions or thickening- ...
- Spinal cord compression Etiology:- Spinal injury (eg, motor vehicle crash)- Malignancy (eg, lung, breast, prostate cancers; myeloma)- Infection (eg, epidural abscess) Clinical features:- Gradually worsening, severe local back ...
- Central cord syndrome Injury to the central region of the spinal cord (central corticospinal tracts and decussating fibers of the lateral spinothalamic tract). Epidemiology:- Most common type of incomplete cord syndrome- Common ...
- Spinal stenosis Etiology: Progressive narrowing of the central spinal canal, intervertebral neural foramen and/or lateral recess (cervical C2 or lumbar spine L1) caused by:- Degenerative joint disease (most common): Spondylolisthesis ...
- Pronator drift Physical examination finding that is relatively sensitive and specific for upper motor neuron or pyramidal/corticospinal tract disease. Upper motor neuron lesions cause more weakness in the supinator ...
- Sleepwalking disorder Non-REM sleep arousal disorder (no memory of dream) Epidemiology:- Discrete episodes are common (up to 7% of adults and 30% of children), but the disorder is rare.- Associated with sleep deprivation, irregular ...
- Sleep terror disorder Non-REM sleep arousal disorder (no memory of dream) Epidemiology: Discrete episodes of sleep terrors are relatively common (up to 2% of adults and 20% of children), but the disorder is rare. Etiology: ...
- Restless legs syndrome Relatively common, neurological sleep disorder characterized by unpleasant sensations in the legs and a strong urge to move them. Etiology: - Idiopathic, but is familial in 25-75% of cases - Chronic ...
- Postconcussive syndrome Can occur a few hours or days after a traumatic brain injury. Clinical features:- Headache- Confusion- Amnesia- Difficulty concentrating or with multitasking- Vertigo- Mood alteration- Sleep disturbance- ...
- Brain death Irreversible, complete loss of function of the entire brain (including the brainstem), even if cardiopulmonary functions can be upheld by artificial life support. Requirements for the diagnosis of brain ...
- REM sleep disorder Epidemiology:- Prevalence ~ 0.5%- Usually in older men (> 50 years) Risk factors: narcolepsy, psychiatric medications, neurodegenerative disorders Clinical features:- Physically acting out dreams during ...