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Step Up To Medicine > Diseases Of Central And Peripheral Nervous System > Flashcards

Diseases Of Central And Peripheral Nervous System Flashcards

1
Q

What is ischemic stroke?

A

A sudden focal neurological deficit due to part of the brain loosing its blood supply.

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2
Q

What are the different classes of ischemic stroke?

A
  1. TIA: a neurological deficit that lasts from a few minutes to no more than 24 hours
  2. Evolving stroke: a stroke that is worsening
  3. Completed stroke: maximal deficit has occurred
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3
Q

What are the important risk factors for ischemic stroke?

A

Age and HTN

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4
Q

What are the causes of ischemic stroke?

A
  1. Emboli (common cause): Heart being most important source, embolization of mural thrombus in patients with AFib.
  2. Thrombotic stroke
  3. Lacunar stroke (small vessel thrombotic stroke)
  4. Nonvascular causes such as low cardiac output and anoxia
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5
Q

How does a patient with thrombotic stroke present?

A

Patient awakens from sleep with a neurological deficit.

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6
Q

When does emboli stroke symptoms appear?

A

Onset of symptoms is very rapid and deficits are maximal initially.

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7
Q

What is the most commonly involved artery in ischemic stroke?

A

Middle cerebral artery

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8
Q

What is the treatment of ischemic stroke in acute setting?

A
  1. Supportive treatment (airway protection, oxygen, IV fluids)
  2. Thrombolytic therapy (t-PA): given within 4.5 hours
  3. Aspirin given ASAP, but avoided for 24 hours if t-PA is given
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9
Q

How to prevent stroke recurrence?

A
  1. Lifestyle and pharmacotherapy
  2. Long-term antiplatelet therapy
  3. High intensity statin
  4. Anticoagulation for cardioembolic strokes
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10
Q

What is hemorrhagic stroke?

A

Bleeding from brain blood vessels resulting in a hematoma that compresses and damages surrounding brain tissue

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11
Q

What are the clinical features of ICH?

A
  1. Abrupt onset of a focal neurological deficit that worsens steadily over 30 to 90 minutes.
  2. Altered level of consciousness, stupor, coma
  3. Headache, vomiting
  4. Signs of ICP
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12
Q

What are the diagnostic tests of ICH?

A
  1. CT scan of the head
  2. Coagulation panel and platelets
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13
Q

What is the treatment of ICH?

A
  1. Admission to ICU
  2. ABC’s
  3. BP reduction if systolic BP is >180
  4. Management of elevated ICP: elevate head of bed to 30 degree, appropriate sedation, pain control, mannitol
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14
Q

What is the characteristic feature of SAH?

A

Worst headache of my life

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15
Q

What are the diagnostic tests of SAH?

A
  1. Noncontrast CT scan
  2. Perform lumbar puncture if CT scan is unrevealing:
    • Blood in the CSF is the hallmark of SAH
    • Xanthochromia
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16
Q

What is the treatment of SAH?

A
  1. Surgically clip the aneurysm
  2. Medical therapy:
    • Bed rest in quiet, dark room
    • Stool softeners to avoid straining
    • Analgesia for headache
    • IV fluid for hydration
    • Control of HTN (gradual)
    • CCB for vasospasm
17
Q

What is multiple sclerosis?

A

Selective demyelination of CNS (autoimmune), multi focal zones of demyelination are scattered throughout the white matter.

18
Q

What are the clinical features of multiple sclerosis?

A
  1. Transient sensory deficit
  2. Fatigue
  3. Motor symptoms mainly weakness or spasticity
  4. Visual disturbances (optic neuritis, inter nuclear ophthalmoplegia)
  5. Cerebellar involvement
  6. Loss f bladder control
  7. Autonomic involvement
  8. Cerebral involvement
  9. Neuropathic pain
19
Q

How is MS diagnosed?

A
  1. It is diagnosed clinically based on multiple CNS lesions separate by time and space.
  2. MRI is the most sensitive test which shows periventricular whit matter plaques
  3. LP and CSF analysis: oligoclonal bands of immunoglobulin G
20
Q

How is MS treated?

A
  1. Acute attacks are treated with high-dose IV corticosteroids
  2. Disease-modifying therapy
  3. Symptomatic therapy
21
Q

What is Guillian-Barré Syndrome?

A

Inflammatory demyelinating polyneuropathy that primarily affects motor nerves (autoimmune)

22
Q

How does GBS present?

A
  • It usually is preceded by a viral or mycoplasma infection of upper respiratory or GI tract.
  • Rapid ascending weakness/paralysis of all four extremities, frequently progresses to involve respiratory, facial, and bulbar muscles
23
Q

How is GBS diagnosed?

A

Based on:
1. Clinical findings
2. CSF analysis findings showing elevated protein and normal cells
3. Decreased motor nerve conduction velocity

24
Q

What is the management plan for GBS?

A
  1. Careful monitoring of pulmonary function
  2. Administering IV immunoglobulin if patient has significant weakness
25
Q

What is Myasthenia Gravis?

A

Autoantibodies are directed against the nicotinic acetylcholine receptors of NMJ, which leads to a reduced postsynaptic response to acetylcholine and results in significant muscle fatigue.

26
Q

What are the clinical features of Myasthenia Gravis?

A
  1. Skeletal muscle weakness that worsen toward the end of the day
  2. Ptosis, diplopia, and blurred vision
  3. Generalized weakness, dysarthria, and dysphagia
27
Q

How is Myasthenia Gravis diagnosed?

A
  1. Acetylcholine receptor antibody test is the test of choice
  2. EMG shows a decremental response to repetitive stimulation of motor nerves
28
Q

What is Myasthenic crisis?

A

Diaphragm and intercostal fatigue resulting in respiratory failure, often requiring mechanical ventilation.

29
Q

What is the management plan for Myasthenia Gravis?

A
  1. AchE inhibitors such as pyridostigmine
  2. Plasmapheresis
  3. IV immunoglobulin
30
Q

What are seizures?

A

A sudden abnormal discharge of electrical activity in the brain. The diagnosis of epilepsy is reserved for a syndrome of recurrent, idiopathic seizures (2 or more separated by at least 24 hours).

31
Q

What are the causes of seizures?

A
  1. Metabolic and electrolyte disturbances
  2. Mass lesions
  3. Missing drugs (noncompliance with anticonvulsant)
  4. Miscellaneous
  5. Intoxications
  6. Infections
  7. Ischemia (stroke, TIA)
  8. Increased ICP
32
Q

How are seizures managed?

A
  1. ABCs: secure airway and roll patient onto his side prevent aspiration
  2. Known case of epilepsy:
    • Give a loading dose of the anticonvulsant medication
    • If the seizure persists increase the dosage of the anticonvulsant and add a second drug if uncontrolled
    • If controlled continue the medication for at least 2 years
  3. If first seizure episode no treatment is given
  4. DOC for generalized tonic-clonic seizures and partial seizures are phenytoin and carbamazepine
  5. DOC for absence seizure is ethosuximide and valproic acid
33
Q

Are anticonvulsants safe during pregnancy?

A

No, so pregnancy test should be done before prescribing. Levetiracetam, lamotrigine, carbamazepine can be given during pregnancy.

34
Q

What is status epilepticus?

A

Refers to prolonged (>5 min) continuous seizure activity or repetitive seizures without recovery of consciousness for >30 minutes. It is considered a medical emergency, treated by ABC, IV diazepam, IV phenytoin, and 50 mg dextrose.

35
Q

What is Amyotrophic Lateral Sclerosis?

A

A disorder affecting the anterior horn cells and corticospinal tracts at many levels. Th presence of upper and lower motor neuron signs is a hallmark. Bowel control, bladder control, sensation, cognitive function, Extraocular muscles and sexual function are normal and unaffected.

36
Q

What are the types of aphasia?

A
  1. Wernicke aphasia (fluent): impaired comprehension of written or spoken language, speech is fluent but doesn’t make much sense
  2. Broca aphasia (non fluent): failure of word formation
  3. Conduction aphasia: disturbance in repetition
  4. Global aphasia: disturbance in all areas of language function
37
Q

What causes UMNL?

A

Primary lateral sclerosis
Heridetary spastic paraplegia

38
Q

What causes combined UMNL and LMNL?

A

Amyotrophic lateral sclerosis

39
Q

What causes LMNL?

A

Spinal muscular atrophy
Hereditary bulbar palsy
Post poli
Post irradiation

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