Vertigo

BPPV
Menieres Disease
Labyrinthitis
Acoustic Neuroma
Post-traumatic
Multiple Sclerosis
Cerebrovascular
Disease
Sensory
Disturbances
Mononeuropathy
Mononeuropathy
Multiplex
Radiculopathy
Polyneuropathy
Myelopathy
Syringomyelia
SCDC
Thalamic lesions
Parietal lobe lesion

Seconds to minutes, free-floating otoconia, Eplys to treat; improve with motionless;

Hallpike positive; latency, extinction, & adaptation
Hours, tinnitus, sense of fullness & pressure, SNHL; progressively worsens; treat with
diuretic or low salt diet
Days, follows a viral URI; hearing disturbance
Constant; false positive Hallpike; SNHL; mass at CP angle, Schwannoma; no latency, no
fatigue, no adaptation; facial sensorimotor symptoms, ipsilateral ataxia
Battles sign (basilar skull fracture); skull fracture of temporal bone near labyrinth
Demyelination of fibers from vestibular nucleus to the hemispheres
Vascular risk factors, sudden onset; Labyrinth ischemia, internal labyrinth artery (no
neighborhood signs); Vestibular nucleus (neighborhood signs)
Single peripheral nerve; compression, vascular, or repetitive use
More than one peripheral nerve in a short period of time; underlying condition (SLE, RA,
DM2); autoimmune inflammatory condition increase the risk of entrapment neuropathy
LMN weakness in a single myotome; ischemia or compression at root; sensory change in a
single dermatome; n/t in a single nerve distribution
Gradual onset of numbness and tingling, DM2 common; stocking-and-glove; LMN
weakness; autonomic symptoms possible (OH); distal to proximal, symmetric; ataxia
Involvement of myelinated sensory tracts of spinal cord; UMN weakness; sphincter
dysfunction; spinal cord disturbance; B12, SCA
Decreased pain and temperature in UEs; enlargement of central canal; compression of
internal arcuate fibers; LMN weakness if long-standing
Gait disturbance; decreased vibration and position sense in feet; UMN weakness in legs;
B12 deficiency; high MMA and/or homocysteine = low B12; demyelinated DCML; no DTR
Contralateral pain, numbness and tingling; only stroke that causes pain, but not until a few
hours later
Contralateral sensory disturbance; language (dominant)/spatial (non-dominant); two-point
discrimination disturbance; extinction with bilateral stim; astereognosis

Trauma
Concussion
Subdural Hematoma
Epidural Hematoma
Intracerebral
Hemorrhage
Traumatic
Myelopathy
Cauda Equina
Periventricular
Leukomalacia
Cerebrovascular
Disease
Asymptomatic
Carotid Bruit

Transient decreased LOC, amnesia; normal neuro exam, negative imaging; disruption of
neuronal membranes; RAS suffers brunt of traumatic force waves
Severe trauma, headache; crescent moon hyperdensity; shearing of bridging veins; altered
mental status
Trauma to temporal area, lucid interval; biconvex hematoma; middle meningeal artery
Spontaneous due to hypertension; tearing of intraparenchymal vessels
UMN weakness; spinal shock temporary loss of spinal reflexes below injury,
bulbocavernosus reflex returns first; could be spinal epidural hematoma
Trauma to lumbosacral spine below L2, LMN weakness in legs; saddle anesthesia; requires
surgical decompression
Infarct in the supratentorial periventricular white matter; chalky yellow plaques; white
matter necrosis and calcifications
Internal, common, or external carotid artery; higher degree of stenosis = higher pitch; most
dangerous stenosis: very high-pitched and very faint; arterial bifurcations; atherosclerosis

Transient Ischemic
Attack
Global Cerebral
Ischemia
Watershed Infarct
Atherosclerotic
Ischemic Stroke
Cardioembolic
Ischemic Stroke
Lacunar Ischemic
Stroke
Intraparenchymal
Hemorrhagic Stroke
Lobar Hemorrhage
Subarachnoid
Hemorrhage
Arteriovenous
Malformations
Autonomic
Disorders
Non-neurogenic OH
OH with brain
disorder: MSA
OH with peripheral
nerve dysfunction
Horners Syndrome
Language
Disturbances
Brocas Aphasia
Wernickes Aphasia
Conduction Aphasia
Global Aphasia

Focal neurological deficit that is less than 24 hours and self corrects; consistent with known
arterial distribution
Diffuse ischemia/hypoxemia; pyramidal cells of the hippocampus (Sommer sector), purkinje
cells of the cerebellum, Betz motor neurons of the cerebral cortex
Region of brain most distal to arterial blood supply; border zone between ACA and MCA;
band necrosis over cerebral convexity; associated with hypotensive episodes
Acute, CT first to check if hemorrhagic, normal CT if ischemic and within 24h, ECG to rule
out Afib; vascular risk factors and history of TIAs
Afib, acute; more likely to undergo hemorrhagic transformation within 72h; cardiac
condition conductive to clot formation, previous MI
Acute, pure motor(IC or pons)/sensory(thalamus); 2/2 atherosclerosis of small penetrating
brain arteries; DM2 & HTN; lenticulostriate arteries; 15mm or less wide
Very abrupt/acute, severe/acute headache; HTN; early seizure; CT WOC; brain edema and
herniation follow; Charcot-Bouchard microaneurysms
Due to amyloid cerebral angiopathy; amyloidogenic peptides are deposited in the walls of
medium and small caliber meningeal and cortical blood vessels microbleeds
WHOML, nuchal rigidity, no fever; ruptured aneurysm; blood irritates tunica externa and
causes vasospasm; vasospasm causes infarction and leads to death; CSF is red
Asymptomatic until rupture; younger than the average stroke patient; common cause of
epilepsy in adults requires treatment; Foix-Alajouanine: lumbosacral malformation in SC
Drug-induced, hypovolemia; drop >20 systolic & >10 diastolic with >15BPM increase;
normal pulse increase shows normal autonomic function
Older adults with Parkinson symptoms, cerebellar dysfunction; several other autonomic
dysfunctions; no compensatory increase in HR 2/2 failure of autonomic baroreceptor
Riley-Day dysautonomia; stocking/glove sensory disturbance; disruption of post-ganglionic
autonomic fibers; 2/2 DM polyneuropathy, loss of autonomics
Ptosis, miosis, anhydrosis; lesion could be at any location in the sympathetic path;
Pancoasts tumor, carotid artery dissection, lateral medulla (PICA) stroke
Comprehension intact, follows verbal and written commands, cannot repeat, non-fluent,
motor, expressive aphasia; inferior left frontal lobe; superior MCA
Comprehension impaired, does not follow commands, fluent gibberish, does not repeat,
cannot read, no motor weakness due to superior temporal gyrus lesion; inferior MCA
Comprehension impaired, fluency impaired less than Broca, gibberish less than Wernicke,
cannot repeat, follows written command but cannot read aloud; superior arcuate fasciculus
Comprehension severely impaired, non-fluent, cannot repeat, cannot read aloud or follow
written instruction; right hemiparesis & hemianopsia; entire left MCA territory

CNS Infections
Aseptic Meningitis
Bacterial Meningitis

Viral encephalitis or
meningoencephalitis
HSV encephalitis

History of URI; PCR to check HSV; CSF: protein; acyclovir if HSV

Fever, photophobia, altered mental status; WBC w/ left shift; follow CT protocol; CSF:
pressure, WBC, protein, glucose; vancomycin + 3G cephalosporin to all, add ampicillin to
>50yo or anything besides Neisseria meningitidis and Streptococcus pneumoniae
Profound mental status changes, seizures, FNS; CSF: protein; WNV if summer of history
of mosquito bites
RBCs, high fever, glucose (Cowdry); empiric acyclovir; loss of TLR3 function;
perivascular cuffs of lymphocytes; inferior/medial temporal lobes; 10% have PMHx of HSV

Cytomegalovirus
encephalitis
HIV
PML
Rabies
Subacute Meningitis
(fungal or TB)
Brain Abscess
Spinal Cord Abscess
Creutzfeldt-Jakob
Variant CJD
Subdural Empyema
Neurosyphilis
Toxoplasmosis
Movement
Disorders
Postural Tremor
Resting Tremor
Intention Tremor
Cerebellar Ataxia
Spinocerebellar
Ataxia
Ataxia
Telangiectasia
Freidreichs Ataxia
Sensory Ataxia
Huntingtons
Disease
Progressive
Supranuclear Palsy
Dystonia/Dyskinesia

Fetal: periventricular necrosis microcephaly and calcification; immunocompromised:

severe hemorrhagic necrotizing ventriculoencephalitis and choroid plexitis
Microglial nodules; first symptom of HIV can be meningitis isolated from CSF;
relentlessly progressive dementia;
Encephalitis caused by JC polyomavirus infecting oligodendrocytes; immunocompromised
patients
Ascends along peripheral nerves, incubation time depends on distance from infection site to
brain; significant CNS excitability; death from respiratory failure; paresthesia around wound
Low fever, chronic headache, immunocompromised, pulmonary symptoms; CSF: glucose,
pressure, protein, lymphocytic pleocytosis; acid fast or India ink; Crypt soap bubble
Gradual onset, HA, focal neurological signs, seizures, previous bacterial sinus infection;
mass effect from abscess; CSF: protein, WBC
Hematogenous spread, follows injury or surgery, spine pain, progressive neurological
symptoms below the lesion; radicular if below SC, myelopathy if on SC, no fever
Rapidly progressive dementia, 7th decade, PRNP; startle myoclonus; fatal w/7m average;
spongiform transformation
Kuru plaques; prominent early behavioral changes; BSE exposure; halo of spongiform
change; affects young adults
Infection of skull bones or air sinuses; arachnoid and subarachnoid spaces are spared; mass
effect thrombophlebitis or bridging veins occlusion and infarction
Meningovascular: base of brain, cerebral gummas; Paretic: severe dementia, brain invasion
by Treponema, iron deposits, rod cells; Tabes: lightning pains, DCML loss, Charcot joints
Multiple ring-enhancing lesions at gray-white junction; tachyzoites and bradyzoites;
TORCH; immunocompromised
Worsens with movement, outstretched limb, or delicate movement; does not get worse near
endpoint; overactive -sympathetics; pre vs post treatment spiral; familial
Usually associated with PD; must r/o drug-induced tremor; disappears with movement
Occurs with attempt at purposeful movement; worsens as the target is reached; often
accompanied by cerebellar dysfunction
Limb ataxia, dysmetria, dysarthria, nystagmus, hypotonia, dysdiadochokinesia, past
pointing, gait ataxia, intention tremor
Often a FHx; CAG repeats; Polyglutamine: Machado-Joseph (1,2,3), Visual (6,7), DRPLA
(17)
ATM 11q22, dsDNA repair; death in 2nd decade; T cell leukemia; loss of Purkinje and
granule cells in cerebellum; recurrent sinopulmonary infections
1st decade of life; cardiomyopathy death; GAA expansion of frataxin (9q13), iron-sulfur
crystal assembly; mito ox phos, free Fe2+; Clarke, CN 8,10,12, dentate, Purkinje, Betz;
scoliosis, areflexia, except Achilles; pes cavus
Numbness and tingling in feet with sensory deficits; positive Romberg, absent DTRs;
impaired proprioception; underlying condition
CAG repeats > 35 at 4p16, AD, HTT gene, Huntingtin; loss of medium spiny striatal
neurons; chorea; intranuclear inclusions; dysregulation of basal ganglia motor output,
deficit of GABA; dementia; death in 15 years; caudate atrophy
6th decade and beyond; preserved intellect; unstable gait; vertical gaze loss; dysarthria,
dysphagia; unrelenting, death in 10 years; hyperextension
Focal, asynchronous muscle movement; abnormal movements that arent chorea; possible
2/2 anti-dopaminergic; oro-facial-lingual muscles; consider Wilsons & test for copper

Demyelinating
Disorders
Multiple Sclerosis
Neuromyelitis
Optica
Acute Disseminated
Encephalitis
Acute Necrotizing
Hemorrhagic
Encephalomyelitis
Central Pontine
Myelinolysis
Neurodegenerative
Disorders
Alzheimers Disease

Exacerbations >24h, average weeks to months, resolve spontaneously; multiple separate

attacks over time and space within CNS; T cells target oligodendrocytes; UMN weakness
Synchronous bilateral optic neuritis; no MS plaques on MRI; poor recovery after 1st episode;
antibodies against aquaporin-4; hallmark cell is neutrophils; acute transverse myelitis
A week or two after a viral illness; diffuse, monophasic; 20% die, the rest fully recover
Fulminant CNS demyelination following an upper respiratory infection; mostly fatal, or
severely debilitating; destruction of small blood vessels, fibrin deposition
2-6 days after rapid hyponatremia correction; rapid increase in osmolality damages
oligodendrocytes; rapid quadriplegia; Locked-in syndrome; demyelination at basis pontis

Impairment of higher cognitive function; A plaques in neuropil & tau tangles; APP
cleavage by -secretase A amyloid; loss of ACh neurons at nucleus basalis of Meynert
Parkinsons Disease Bradykinesia, rigidity, resting tremor, and disequilibrium; loss of pigmented neurons in zona
compacta; depression is common before other symptoms; -synuclein 4q21; Lewy body
FTLD
Alterations in personality, behavior, and language precede memory loss; tau Pick; TDP43
inclusions; Pick bodies are inclusions of tau protein
Multiple System
-synuclein in oligodendrocytes more sensitive to oxidative stress; may be atrophy of
Atrophy
cerebellum and pons
Amyotrophic Lateral SOD1 on 21 toxic accumulation; FTLD TDP/c9orf72; UMN and LMN loss; Bunina bodies;
Sclerosis
Depleted: anterior horn cells, cortical motor neurons, corticospinal myelinated fibers,
anterior nerve roots
Metabolic Diseases
Wernicke
Encephalopathy
Korsakoff syndrome
Subacute Combined
Cord Degeneration
Ethanol
Developmental
Defects
Spina Bifida

Thiamine (B1); psychotic symptoms and ophthalmoplegia; hemorrhage and necrosis of

mammillary bodies; reversible when treated with thiamine
Untreated Wernickes; irreversible; chronic alcoholism; lesions of dorsomedial nucleus of
thalamus; memory disturbances and confabulations
B12 deficiency; defect in myelin formation; degeneration of ascending and descending
tracts; bilateral LE symmetrical numbness, tingling, and slight ataxia; high MMA
Loss of granule cells in the anterior vermis; proliferation of astrocytes between granular and
molecular layers Bergmann gliosis

Holoprosencephaly

Occulta: only bony defect, tuft of hair; Meningocele: meningeal extrusion;

Myelomeningocele: extension of CNS tissue
-fetoprotein in mothers serum and amniotic fluid; disrupted forebrain development at 28
days; malformation of anterior end of the neural tube
Simplification in gyral folding
Reduced number of gyri; Type 1: smooth surface; Type 2: rough surface; mutation of
glycosylation enzymes
Cyclopia, CN1 absence; trisomy 21 or Shh pathway mutations

Dandy-Walker

Enlarged posterior fossa; absent cerebellar vermis with midline cyst; spina bifida

Arnold-Chiari

Small posterior fossa; misshapen midline cerebellum with herniation of tonsils and vermis;
type 2 worse than 1; lumbosacral meningomyelocele

Anencephaly
Microcephaly
Lissencephaly