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Neurology > 17 Jan 24 > Flashcards

17 Jan 24 Flashcards

1
Q

Emergence from anesthesia

A

Normal ;
Fully awake within 15min of extubation

Delayed emergence ;
Hypoactive state , smnolence persisting >30-60min

Emergence delirium :
Hyperactive state , manifests in OR

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2
Q

Cause and ttt of delayed emergence/emergence delirium

A

Residual effects of anesthetic /adjuvant meds.

Inhaled anesthetics
NM blockers
Benzodiazepines

Ttt: Reassure and reorient
Evalute for hypercapnia , stroke
CT
ABGs

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3
Q

Tremor worsened by sertraline.

A

Enhanced physiologic tremor.

Medication enhanced tremor;

⛱Temporal relationship to initiation of medication
⛱Dose response relationship
⛱Lack of tremor progression
⛱Symmetry of affected limbs

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4
Q

Causes of enhanced physiologic tremors

A

Medicines.

     Beta agonists 
     SSRI
     TCA
     Nicotine 
     Caffeine  Steroids.

Physiologic. :

           Stress 
           Anxiety

Medical conditions:

           Hypoglycemia 
          Alcohol 
          Opioid withdrawal 
          Thyrotoxicosis 
          Liver dx
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5
Q

Ttt of enhanced physiologic tremor

A

Dose reduction
Stop medication

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6
Q

Dystonic tremors

A

Irregular tremors
Exacerbated by stress
Sustained muscle contraction in the same area as tremor
Wrist spasm
Torticollis

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7
Q

Pt with rigidity , upward gaze deviation restricted EOM after haloperidol.

A

Acute dystonia
(EP symptom of first gen antipsychotic)

Mech;
Dopamine antagonists cause imbalance between dopamine and acetylcholine in BG.

Ttt:
Anticholinergics
Benztropine trihexyphenidyl

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8
Q

Acute dystonic reaction SS

A

Sudden sustained contraction of neck , mouth , tongue , eye muscle

Oculogyric crisis(forced upward gaze)
Torticollis
Blepharospasm
Trismus

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9
Q

Akathisia ttt

A

(Subjective restlessness inability to sit still)

Ttt;
BB
BZ
Benztropine

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10
Q

Parkinson EPS

A

Tremor rigidity bradykinesia

Ttt :
Benztropine
Amantadine

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11
Q

Tardive dyskinesia def and ttt

A

Dyskinesia of mouth, face , trunk, extremities.

Gradual onset after prolongeddd therapy >6mo

Ttt: Valbenazine
Deutetrabenazine

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12
Q

Pt taking metoclopromide has bradykinesia rigidity tremor

A

Drug induced parkinsons
Due to dopamine receptor blockade

Common agents :

First gen antipsychotics
Metoclopromide
Prochlorperazine

Tttt: discontinue drug

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13
Q

If patient with H/o cancer seizes
Management?

A

Do MRI to see mets

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14
Q

Trigger for seizures

A

Lack of sleep
Flashing light
Emotional stress
Alcohol withdrawal
Idiopathic

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15
Q

Signs that suggest seizure over syncope

A

Seizure :

     Preceding aura ( olfactory hallucinations) 
     Can occur with sleeping/sitting
     Tonic/clonic movements
     Rapid, strong pulses 
     Tongue biting 
     Incontinence 
     Delayed return to baseline (postictal drowsiness or confusion)

Vasovagal syncope :

     Preceding lightheadedness       (presyncope)
     Never occur in sleep/sitting
     Uncommon to have clonic jerks 
     Weak slow pulses 
     Pallor , diaphoresis 
     Immediate return to baseline
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16
Q

Types of seizures

A

Focal ; One brain hemisphere but can spread to entire brain
Generalized ; Both hemispheres

17
Q

Cardiogenic syncope trigger and feature s

A

Trigger :
Exertion
Dehydration

CF:
Sudden LOC without prodrome

Post event:
Immediate return

18
Q

Cause of perioral cyanosis in generalised seizures.

A

Muscle stiffening during initial tonic phase of gen tonic clonic seizure causes patient to fall and have difficulty breathing (due to contraction of chest wall muscles) leading to perioral cyanosis.
Ass with tongue biting , urinary incontinence.
Can go unwitnessed and is brief

19
Q

Todds paralysis clues

A

Self limited focal weakness or paralysis that occurs in postictal period after focal onset seizure.
Transient hemiplegia after LOC with gradual return to baseline
Normal imaging studies

Resolves in 36hrs

20
Q

Clues to hemipegic migraine

A

Adolescence
Family history
H/o headache with aura
Self resolves

21
Q

Focal seizure CF

A

🍔 abnormal movements of one side
🍔 impaired awareness (staring episodes and lack if response to external stimuli) indicate spread to both hemispheres.
🍔 repititive semi purpose movements (chewing , picking) AUTOMATISMS
Seen in focal seizure with impaired awareness.
🍔 post ictal confusion and lethargy
🍔 EEG normal between episodes
During focal seizure EEG shows abnormal electrical activity

22
Q

Absence seizure CF

A

Generalised (both hemispheres)
Staring spells
With or without automatisms 10-20s
(Chewing picking)
Easily provoked by hyperventilation

No post ictal period.

23
Q

Fetal hydantoin syndrome

A

Microcephaly
Cleft lips and palate
Cardiac defects
Hypoplasia of nails and phalanges

24
Q

Status epilepticus complication…

A

Single seizure lasting > 5minutes or > 2 seizure without return to baseline.
Occurs in cortex as it is site of seizure origin.

Complication ;
Cortical laminar necrosis
Permanent injury (lasting neurologic deficits)

25
Q

Febrile seizure diagnostic criteria

A

Age 6mo to 5years
No prev Afebrile seizures
No signs of CNS infection
No acute metabolic cause(hypoglycemia)

26
Q

Ttt of febrile seizures

A

Supportive
Reassure
Counsel about inc risk of future feb seizures
No longterm sequel

27
Q

Febrile seizure definition

A

Gen tonic clonic movements lasting<15 mins
In the setting of fever > 100.4 in children age 6mo to 5 years.
Normal neurologic exam
Do not recur in 24hrs.

No diagnostic testing required.

28
Q

Phenytoin toxicity CF

A

Cerebellar dysfunction ;

   Horizontal Nystagmus 
   Ataxia 
   Dysmetria 
   Slurred speech 
   NV 
   Hyperreflexia

AMS (lethargy, confusion)
Coma
Seizures.
Death

29
Q

Mechanism of phenytoin toxicity

A

PHenytoin is hepatically metabolised by cytP450. CYP450 inhibitors TMPSMX , fluconazole , displace phenytoin from Plasma proteins and inc the risk of drug toxicity.

Ttt: gastric lavage , dialysis

30
Q

Myoclonic status epilepticus cause

A

Severe neurologic injury (prolonged hypoxia) eg cardiac arrest

31
Q

Myoclonus status epilepticus CF

A

🧇Comatose patients
🧇Appears within 72hrs injury
🧇Involuntary muscle contraction in a joint or limb
🧇Gen symmetric
🧇 marker of poor prognosis

Ttt; Antiepileptics

Dx. : EEG helps diff between myoclonus and seizures

32
Q

How to evaluate an adult e first time seizure ?

A

Labs :
CBC, glucose , electrolytes , renal function, liver function, urine drug screen

Neuroimaging;
CT scan without constrast acutely
MRI in elective cases

LP :
To rule out meningitis

EEG

33
Q

Indications to start antiepileptic in adults

A

Abnormal EEG or neuroimaging
Nocturnal seizure
Focal neurologic exam

34
Q

Intoxicated pt fell downstairs and seized labs sent … next step?

A

CT without contrast
(To rule out intracranial bleed)

Neurology (19 decks)

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