5 - Nervous, Neuromusc Flashcards
Transient ischemic attacks (TIAs)
- characteristics
- carotid vs vertebrobasilar
Always <24hrs
Most likely due to embolism (e.g. Hollenhorst plaque)
Carotid: IPSI AMAUROSIS FUGAX, contralateral hand/arm weakness
Vertebrobasilar: DIPLOPIA, ataxia, vertigo, dysarthria, uni/bilat vision loss
Stroke
- # 1 cause
- testing
HTN
CT scan
Macular-sparing homonymous hemianopsia
Macula-only homonymous hemianopsia
Mac-sparing: usually STROKE of EITHER MCA or PCA
Mac-only: usually TUMOR compressing BOTH MCA/PCA
Ischemic vs hemorrhagic stroke
I: 80% of all strokes, usually embolism of atherosclerosis
H: most common is subarachnoid hem
Subarachnoid hemorrhage
- signs/symp
- causes
Sudden severe HA
PUPIIL-INVOLVING CN 3 palsy
Nuchal rigidity (stiff neck)
1: head trauma
2: aneurysm rupture
CoW supply
-anterior cerebral
Frontal lobe
-logic, personality, voluntary movement
CoW supply
-middle cerebral
Frontal lobe
Lateral surfaces of Temporal and Parietal lobes
Occipital lobe
Primary motor and sensory of the face, throat, hand, and arm
Areas for speech and vision
CoW supply
-posterior cerebral
Temporal and Occipital lobes
Stroke: contralateral hemiplegia, hemianopsia, color blindness, verbal dyslexia, opposite VFDs
Seizures
- epilepsy vs status epilepticus
- treatment
S: symptom
E: condition
Status epi: >5min seizure
“Limit Debilitating Seizures”
Luminal
Dilantin
Topamax (myopic shift)
Syncope characteristics
Abrupt, transient loss of consciousness
Prompt recovery = no neuro defects
Cluster HAs
Men, 30-50 Smokers, drinkers Unilateral, above eye Red eye, nasal stuffiness IPSILATERAL HORNERS
Tension HAs
Females, all ages
Worse with stress or precede migraine
Band-like distribution
Migraine HAs
Women, 20-30: think hormones, triggers
-rare after menopause (50yo)
4-72 hours
Aggravated by physical activity
Aura
Temporal arteritis
- ocular assoc
- blood tests to run
- tx
AAION (SPCA occlusion) -> permanent vision loss
ESR, CRP, CBC
Biopsy
Immediate steroids
Brain tumor HAs
No relief, interrupt sleep, worse in AM
Usually more going on clinically than just HA
Meningitis
Viral
Triad: fever, HA, neck stiffness (meningismus)
Papilledema due to incr CSF
Most common primary malignant brain tumor
Most common benign brain tumor
Glioblastoma multiforme
Meningioma (arachnoid cells, mid-age women)
Pituitary adenoma
- most common type
- ocular signs/symp
- tx
Prolactin-secreting (leaky breasts)
Bitemporal hemiopsia or junctional scotoma
Bromocriptine (incr DA, Parkinsons drug)
Multiple sclerosis
- who
- what
- dx
Women 20-40yo, North latitudes, White
Genetic, autoimmune
Recurrent inflamm -> demyelination of CNS
Younger you get it = better prognosis
2+ lesions on 2+ MRIs
Multiple sclerosis
- most common presenting symptom
- ocular MS
Optic neuritis
Optic neuritis (25%) Pain on eye movement (90%) APD INO (MLF lesion: ipsil (-) adduct, contra nystagmus) Diplopia Uthoff’s (incr temp = decr VA)
Guillain-Barre syndrome
- what
- ocular
Peripheral demyelination
ADie’s
Diplopia (CN palsies)
Incr CSF protein -> papilledema
Myasthenia gravis (MG)
- who
- assoc tumor
- ocular
Young women, old men (“Hugh Heffner dz”)
Thymoma (thymic tumor)
Ptosis and diplopia worse at end of day
Parkinson’s
- what
- tx
Deficiency of DA TRAP: Tremor at rest Rigidity (cogwheel) Akinesia (difficulty start/stopping movements) Postural instability Flat affect
Levodopa, bromocriptine, carbidopa, sinemet
Head trauma
-blown pupil
May signal impending uncal herniation
Horner’s
- examples of pre-ganglionic causes
- examples of post-ganglionic causes
Pre: neck trauma, pancoast tumor
Post: carotid artery dissection, ICA aneurysm, cluster HA
Bell’s palsy
- what
- ocular
Idiopathic CN7 palsy
Ectropion, exposure K
