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Clin Med 2 > Exam 7 > Flashcards

Exam 7 Flashcards

1
Q

Migraines effect up to…

A

12% of the population, more women

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2
Q

Migraine pathophysiology

A

Genetically predisposed hyperexcitable neurovascular system

Cortical spreading, vasodilation and inflammation

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3
Q

Migraine prodrome

A

60% of migraine sufferers

24-48 hours before HA

Euphoria/ depression/ irritability
Food cravings
Constipation
Neck stiffness
Increased yawning
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4
Q

Migraine aura

A

25% of migraine sufferers

Visual (most common)
Sensory
Verbal
Motor

Less than one hour!! Completely reversible

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5
Q

Visual aura of migraine

A 
Field defects
Luminous visual hallucinations
Scintillating scotomas (field defects and luminous visual hallucinations)
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6
Q

Motor aura

A

Familial hemiplegic migraine- autosomal dominant, fully reversible motor weakness

Sporadic hemiplegic migraine- no relative has had an attack

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7
Q

Migraine HA characteristics

A

4-72 hours

At least 2:
Unilateral
Pulsating or throbbing
Moderate or severe
Aggravated by physical activity

NV, photophobia or photophobia

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8
Q

Migraine postdrome

A

Sudden head movement causes pain, exhaustion, mild elation or euphoria

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9
Q

Migrainous vertigo

A

Recurrent episodic vertigo in a patient with migraines

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10
Q

Basilar type migraine

A

Migraine with aura symptoms that come from the brainstem and/or both hemispheres simultaneously

NO MOTOR WEAKNESS

At least two of these fully reversible stroke like symptoms

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11
Q

Retinal/ocular migraine

A

Repeated attacks of monocular scotoma or blindness, less than 1 hour

Followed by HA

Irreversible visual loss is common here

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12
Q

Ophthalmoplegic migraine

A

Lateralized eye pain with NV, diplopia

HA for a week or more, latent period of around 4 days before ophthalmoplegia

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13
Q

Consider prophylaxis for migraines if…

A

2 or three migraines per month or significant disability with attacks

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14
Q

Tension headache epidemiology

A

86% prevalence, more women than men

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15
Q

TTH patho

A

Heightened sensitivity of pain pathways

Increased muscle tenderness

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16
Q

TTH presentation

A

Vise like, tight
Neck or back of head
Generalized and bilateral
Mild to moderate

No neuro symptoms!

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17
Q

Three main types of TTH

A

Infrequent episodic- less than 1 day a month

Frequent episodic- 1-14 days per month

Chronic- greater than 15 days per month

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18
Q

Duration and at least 2 of these for TTH

A

30 min -7 days for episodic

Pressing/tightening
Mild to moderate
Bilateral
Not aggrated by routine physical activity

*no NV, no photobia or phonophobia

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19
Q

Cluster headache presentation

A 
Severe pain
Orbital, temporal, supraorbital
Strictly unilateral
At night, awake the patient
Autonomic phenomena
Restless, pacing, rocking back and forth
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20
Q

Cluster headache timing

A

Up to 8 times a day

Short lived, 15 minutes to 3 hours

Cluster period can last 6-12 weeks

Remissions can last 12 months even

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21
Q

Autonomic symptoms in clusters

A

Ipsilateral to side of pain

Ptosis
Miosis
Lacrimation
Conjunctival injection
Rhinorrhea
Nasal congestion
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22
Q

Horner’s syndrome

A

Ptosis, miosis, anhidrosis

Common in cluster headaches

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23
Q

Types of cluster headaches

A

Episodic- most common, 2 cluster periods lasting 7 days to 1 year separated by pain free periods of 1 month or more

Chronic- more than 1 year without remission or with remissions less than 1 month

Probable- fulfilling all but one criteria

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24
Q

Workup of cluster

A

Unlike other headaches, have to get brain CT or MRI on these patients

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25
Q

Acute cluster traetment

A

SubQ sumatriptan and oxygen, upright position with 12 L/min 100%

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26
Q

Meds and surgical procedures to prevent cluster HA

A

Verapamil, Li, steroids and topiramate

Radio frequency, gamma knife, nerve sectioning, cocaine and alcohol

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27
Q

Headache red flags

A

Progressive HA

Disturbs sleep

Exertional HA

Associated neurologic symptoms, focal deficiency

Fever

Onset of new or different HA

Onset of HA after age of 50

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28
Q

Primary cough HA

A

HA provoked by coughing or straining in the absence of intracranial disorder

> 40 years old

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29
Q

Primary cough HA features

A

Sudden
Bilateral
Seconds to 30 minutes

Not associated with NV, photo/phonophobia

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30
Q

Primary cough HA workup

A

Must do imaging, could have low ICP, IC hypervolemia, carotid artery occlusion, posterior fossa lesion, chiari type 1 malformation, unruptured aneurysm

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31
Q

Imaging primary cough HA

A

CT or MRI repeated annually for several years

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32
Q

Giant cell arteritis

A

Chronic vasculitis effecting large and medium sized arteries

Blindness is the worst complication

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33
Q

GCA HA diagnosis

A

72 years old average, almost never younger than 50

If over 50 and new laterlized HA, abrupt visual disturbance, polymyalgia rheumatica, jaw claudication, fever or anemia, anorexia, weight loss

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34
Q

Diagnostic tests of GCA

A

Temporal artery biopsy

Halo sign on ultrasound

Elevated ESR

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35
Q

GCA treatment

A

Start prednisone right away!

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36
Q

HA from intracranial mass lesions

A

Posterior fossa- occipital HA
Supratentorial lesions- bifrontal HA

Symptoms MAY be nonspecific and variable, worsen with activity and postural change, or have associated NV

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37
Q

Medication overuse headache

A

Chronic daily headache from someone with a pre existing HA disorder

Addictive personalities, anxiety and fear of HA

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38
Q

MOH most commonly results from overuse of…

A

Opioids
Butabital containing combo analgesics
ASA/APAP/caffeine combos

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39
Q

MOH criteria

A

More than 15 days a month

Regular overuse for more than 3 months of:
Ergotamine, Tristan’s, opioids or combo for more than 10 days, or simple analgesics, opioids/ergotamine/triptan combinations greater than 15 days a month

Headache markedly worsened during medication overuse

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40
Q

MOH treatment

A

Weaning of analgesic overused

Preventive therapy

Avoid abrupt discontinuation

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41
Q

Neuralgia

A

Neuropathic pain that is paroxysmal, breif, shock like or lightning like

Follows peripheral or cranial nerve distribution

No neuro deficit

Nonpainful stimuli can provoke it

Refractory period following the attack

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42
Q

Trigeminal neuralgia

A

> 50 years old, women

Vascular compression of trigeminal nerve root

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43
Q

TN definition

A

Paroxysmal attacks of intense, sharp, superficial stabbing pain in the distribution of one or more branches of the trigeminal nerve, usually unilateral

Facial muscle spasms

One-several seconds and repetitive

Refractory or continuous dull pain

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44
Q

TN triggers

A 
Lightly touching trigger zone 
Chewing
Talking
Brushing teeth
Cold air
Smiling
Grimacing
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45
Q

TN diagnostics

A

CT, MRI, MRA

MRI if trigeminal sensory loss, bilateral, <40 years old

Electrophysiologic trigeminal reflex testing
Jaw jerk reflex

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46
Q

TN prognosis

A

6-12 months may remit

25-50% stop responding to drug therapy

90% pain free immediately or soon after surgery

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47
Q

Atypical facial pain

A

Depressed middle aged women

Constant, often burning pain

Restricted distribution, then spreads to face on affected side and sometimes to the opposite side, neck or back of the head

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48
Q

Glossopharyngeal neuralgia

A

Pain similar to TN

Throat, sometimes deep in ear and back of tongue

Accompanied by syncope sometimes

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49
Q

Glossopharyngeal neuralgia triggers

A

Swallowing

Chewing

Talking

Yawning

MS?

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50
Q

Postherpetic neuralgia

A

Pain beyond 4 months from initial onset of herpes zoster

15% of patients with hx of shingles develop this

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51
Q

PHN incidence increases with…

A

Advanced age
Greater acute pain
Greater rash severity
V1 trigeminal nerve involvement

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52
Q

Neurons vs. neuroglia

A

Neurons area typical cells within nervous system, info transmitters

Neuroglia are metabolic, immunologic and structural support

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53
Q

Microglia

A

Activated with immune system and brain injury, clean up cells

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54
Q

Oligodendrocytes and Schwann cells

A

Oligodendrocytes- myelinate in the CNS

Schwann cells- myelinate in the PNS

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55
Q

Astroctye

A

Act on blood vessels, are the blood brain barrier

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56
Q

Ependymal cells

A

Line the ventricles of the brain, produce CSF

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57
Q

Afferent nerve

A

Arrive in the CNS

Sensation, sensory nerves

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58
Q

Efferent nerves

A

Exit the CNS, motor nerves

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59
Q

Ascending versus descending tracts

A

Ascending deliver info to the brain, sensory

Descending deliver info to the periphery, they are motor

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60
Q

If the tract begins with spino…

A

It is sensory, starts in the spine and goes to the brain

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61
Q

If the tract ends in spinal…

A

Motor, starts in the brain and ends up in the spine

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62
Q

Posterior column tract is…

A

A sensory tract

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63
Q

Corticobulbar tract

A

Motor

Facial expressions, voluntary movement

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64
Q

Extrapyrimadal tracts and symptoms

A

Info from brainstem to involuntary parts of spine

Dystonia
Akathisia
Parkinsonism
Tardive dyskinesia

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65
Q

Upper motor neuron lesion

A

Problem with the pyramidal tracts

Loss of the upper motor inhibition allows for exaggerated motor stretch reflex of the lower motor unit

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66
Q

UMN lesion presentation

A 
Spastic paralysis
Hyperreflexia
Babinski
Clonus
Clasped knife reflex
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67
Q

LMN lesion presentation

A

Flaccid paralysis
Atrophy
Fasciculations/fibrillations
Hyporeflexia

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68
Q

LMN lesion examples

A 
Spinal cord injury/nerve root compression
Motor neuron disease
Peripheral neuropathy
Diabetic neuropathy
Poliomyelitis
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69
Q

UMN lesion example

A

Cerebrovascular accident (stroke)
Cervical or thoracic spine injury of the cord
Intracranial tumor

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70
Q

Spasticity

A

Velocity dependent increase in tonic stretch reflex

Results from abnormal input from dorsal/posterior horn causing the UMN lesion symptoms

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71
Q

Treatment of spasticity

A

Botox injection

Dorsal rhizotomy

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72
Q

ASIA impairment scale

A

5 grades from complete, sensory, motor, normal

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73
Q

Glad standard for spinal cord injury

A

MRI

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74
Q

Spine fx concerning for SCI

A

Posterior element disruption

Compression fx with posterior wall of vertebral body displaced into spinal canal

Dens fx

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75
Q

SCIWORA

A

Spinal cord injury without radiographic abnormality

Usually cervical spine

Rare, usually kids under the age of 8

30 min-4 day latent period

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76
Q

Syndromes

A

5 types, most common in central cord

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77
Q

Treatment of SCI

A

Stabilize spine and immobilize

High dose IV methylprednisone WITHIN 8 HOURS OF INJURY

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78
Q

Sympathetic autonomic dysreflexia

A

Sweating

Increased BP

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79
Q

Parasympathetic autonomic dysreflexia

A

Bradycardia

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80
Q

Autonomic dysreflexia

A

Occurs with spinal cord lesions above T6

After spinal shock has resolved, around 6 months

More common in quadriplegia

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81
Q

Syringomyelia

A

Cyst in the spinal cord, destroying a portion of the cord from the inside out

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82
Q

Chiari malformation

A

Congenital condition, anatomic defect in skull base

Varying degrees of cerebellum and brainstem herniation through foramen magnum

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83
Q

findings in chiari

A

Pain, numbness, gait ataxia, HA, weakness

Burns from loss of pain sensation, hyperhidrosis, glossy skin, pallor coolness

Charcot joints

Long tract signs

IMPAIRED PAIN AND TEMP WITH PRESERVATION OF LIGHT TOUGH

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84
Q

Delirium

A

Disorientation, bewilderment, difficulty following commands

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85
Q

Lethargy

A

Mild drowsiness, aroused by moderate stimuli then drift back to sleep

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86
Q

Obtunded

A

Moderate drowsiness, sleep more than normal, slow response to stimuli

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87
Q

Stupor

A

Severe drowsiness, only vigorous and repeated stimuli arouse the individual

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88
Q

Glasgow coma scale

A

15 is good
<8 intubated
3 is coma

Eyes, verbal, motor

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89
Q

Locked in syndrome

A

Patient unable to move or speak, but normal cognitive skills

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90
Q

A kinetic mutism

A

Move or speak very slowly, but are alert

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91
Q

Psychogenic unresponsiveness

A

Hold eyes closed and resist opening, normal eye responses

Faking a coma

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92
Q

Minimally conscious state

A

Intact awareness but poor response

Intact wakefulness

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93
Q

Vegetative state

A

No awareness of self or environment

Intact wakefulness

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94
Q

Brain death

A

Irreversible and unresponsive coma
Absence of brainstem reflexes
Apnea test- cannot sustain appropriate oxygen level

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95
Q

Traumatic brain injury

A

Structural or physiologic disruption of brain function

Any period of confusion, disorientation, change in consciousness
Neurologic dysfunction

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96
Q

Basal skull fracture

A

Hemotympanum
Panda eyes
CSF leakage from ear or nose
Battle sign (behind ear)

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97
Q

Systems effected by dysautonomia

A 
Cardiac
GI
GU
Sexual
skin
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98
Q

Postural tachycardia syndrome

A

Lightheadedness, palpitations, feeling faint

> 30 bpm increase upon standing, no fall in BP

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99
Q

Baroreflex failure

A

Stress induced systolic BP surges of more than 300, vagus nerve giving no input

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100
Q

Familial dysautonomia

A

Ashkenazi Jewish descent

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101
Q

Multi system atrophy

A

Progressive neurodegenerative disorder with autonomic, extrapyrimidal, cerebellar and pyramidal features

Fatal

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102
Q

Autonomic neuropathy

A

Autonomic dysfunction from postganglionic autonomic nerves

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103
Q

Neruocardiogenic syncope

A

Symptomatic, sudden drop in BP with simultaneous bradycardia @ 10 minutes

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104
Q

Dysautonomia for tilt table

A

Continuous drop in BP and no compensatory increase in HR

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105
Q

MS epidemiology

A

Autoimmune, 20-40 peak incidence

Most common demyelinating disease

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106
Q

Classically… MS

A

Lesions are separated by space and time

Areas of demyelinating arise, cause problems, and slowly resolve

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107
Q

MS mechanism of disease

A

Demyelination occur

Microglia activation increases tissue damage

Lesions re-myelinate with time

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108
Q

Examples of MS symptoms

A 
Weakness
Numbness
Tingling
Spasticity
Paresthesias
Imbalance
Optic neuritis
Diplopia
Urinary issues
Pain
109
Q

Lhermitte sign

A

MS

Sensation of electric shock radiating down spine or to the limbs with neck movement

110
Q

Uhthoff phenomenon

A

Worsening of MS symptoms with an increase in temperature

111
Q

Optic neuritis and MS

A

Acute, monocular vision loss

Painful, central

112
Q

Transverse myelitis

A

Inflammatory demyelination of 1-2 segments of the thoracic spinal cord

Weakness pain and sensory disturbance that is rapidly evolving

113
Q

MS diagnosis

A

Can be clincal

MRI to confirm/support

114
Q

CSF in MS

A

Increase gamma globulin synthesis, mostly IgG

Oligoclonal bands seen in 90% of patients even if IgG is normal

115
Q

Tabes dorsalis

A

Seen in neurosyphilis

Sensory ataxia, foot drop, wide based/ataxic gate

Lancinating/stabbing pains

Argyll Robertson pupils

116
Q

Basal ganglia function

A

Planning and executing movement (and inhibiting movement when it is not desired)

117
Q

Dopamine from…

A

The substantia nitro modulates the function of the striatum

118
Q

Parkinsonism is one or more of these signs:

A

Tremor
Rigidity
Bradykinesia
Postural instability

**PD is the most common cause

119
Q

Patho of Parkinson’s disease

A

Degernation of dopamine producing neurons in substantia nigra

60-80% of these neurons are lost before the onset of symptoms

Lewy bodies- eosinophilic inclusions created

120
Q

Parkinson’s tremor

A

At rest
Stops or decreases with purposeful movement

Pill rolling

121
Q

Parkinson’s bradykinesia

A

Gait changes, like shuffling or festination (quick short steps)

Micrographia

122
Q

Parkinson’s rigidity

A

Cogwheel from numerous hitches

Clasp knife contractions

123
Q

Other PD symptoms

A 
Depression
Sleep disturbance
Autonomic dysfunction
Dementia
Seborrheic dermatitis
Masked facies/lack of expression
124
Q

Huntington disease general

A

Autosomal dominant

Trinucleotide repeat on chromosome 4

30-50 year old onset

125
Q

Patho of Huntington

A

Atrophy of the striatum

9-20 years before onset of sx

126
Q

Huntington movement changes

A

Fidgety early

Then chorea, dystonia, rigidity

127
Q

Cognitive changes in Huntington

A

Irritable
Antisocial
Psychiatric issues
Dementia

128
Q

Huntington diagnosis

A

Genetic testing

129
Q

Benign essential tremor

A

Occurs at any age, worsened by stress, nicotine and caffeine

Rhythmic movements, only occurs with movement

130
Q

Benign essential tremor traetment

A

Not necessary, but deep brain stimulation showed promise

131
Q

Restless leg syndrome general

A

Increases with age

Irresistible urge to move limbs, intense sensory disturbances like itching burning or crawling

Occurs during sleep or inactivity

132
Q

Idiopathic torsion dystonia

A

Painful, prolonged muscle contractions

Often manifest in childhood

133
Q

Examples of idiopathic torsion dystonia

A

Torticollis

Facial grimacing

Forced opening and closing of the mouth

Posturing

Blepharospasm

134
Q

Myoclonus

A

Spontaneous muscle contractions

135
Q

Seizure definition

A

Sudden change in cortical electrical activity

136
Q

Epilepsy definition

A

Any disorder characterized by recurrent unprovoked seizures

137
Q

Primary generalized seizure definition

A

Widespread electrical activity involving both sides of the brain at once

138
Q

Simple partial seizure

A

Patient remains conscious, secondary to electrical discharge from one specific area of the brain

139
Q

Complex partial seizure

A

Electrical discharge from a specific area of the brain, patient loses responsiveness or consciousness

140
Q

Todd’s paralysis

A

Transient neurologic deficit that lasts for hours or rarely days after a seizure

141
Q

Aura in seizures

A

Can be sensory like sensation

Somatosensory like singling

Visual like hallucinations/flashing lights

Auditory like buzzing, drumming

Taste

142
Q

Affective aura

A

Fear, depression and anger

143
Q

Mnemonic aura

A

Memory phenomena like deja vu

144
Q

Absence seizure

A

Impairment of awareness and responsiveness

Abrupt onset, often begin in childhood

Generalized seizure

145
Q

Atomic seizure

A

Abrupt loss of muscle tone, loss of control of muscles

Most commonly fall forward

146
Q

Myoclonic seizure

A

Single or multiple myoclonic jerks lasting less than 1 second, clustered in a few minutes

147
Q

Tonic clonic seizures

A

Sudden loss of consciousness

Tonic phase- rigid and drop to ground, falling backward, sudden LOC

Clonic- jerking of musculature

Posictal- abnormal behavior, no memory of event, headache, confusion, fatigue

148
Q

Epilepsy diagnosis

A

At least 2 unprovoked seizures, occuring greater than 24 hours apart

May treat after 1 seizure if it is likely that they will have another

If they have had no seizures in 10 years and off meds for 5, no more diagnosis

149
Q

A normal EEG…

A

Does NOT rule out an epilepsy or seizure disorder

150
Q

Status epilepticus

A

Emergency!

Single seizure of >30 minutes

151
Q

TIA definition

A

Transient episode of neuro dysfunction

Ischemic without acute infarction

**warning sign for true ischemic stroke

152
Q

TIAs occur most often in the …

A

48 hours prior to the stroke

More likely to follow a carotid TIA

153
Q

Large artery low flow TIA

A

Stenotic atherosclerotic lesions

Often at internal carotid artery

154
Q

Lacunar or small penetrating vessel TIA

A

Middle cerebral artery stem, basilar or vertebral artery, circle of Willis

155
Q

Low flow TIA presentation

A

Short lived, minutes

Several times per year-day

Marked symptoms dependent on artery affected

156
Q

Embolic TIA presentation

A

Hours

Infrequent

Anterior or posterior cerebral circulation dependent

157
Q

Lacunar presentation TIA

A

Brief

Repetitive

Stepwise and progressive rather than abrupt

Pure motor or pure sensory symptoms

158
Q

TIA imaging

A

Within 24 hours of symptom onset!

Diffusion weighted brain MRI is preferred

159
Q

Neurovascular imaging for TIA

A

Carotid duplex US

CTA or MRA

Gold standard: cerebral arteriography

160
Q

When TIA is caused by embolism, get a…

A

EKG asap!

161
Q

ABCD score for high risk stroke post-TIA

A

> 60 1 point

> 140/90 1 point

Unilateral weakness 2 points
Isolated speech disturbance 1 point

More than 60 min 2 points
10-59 minutes 1 point

Diabetes 1 point

162
Q

Hospitalization for TIA

A

TIA AND have ABCD score of greater than 3, OR

0-2 score plus

Uncertainty that workup can be completed outpatient or focal ischemia

163
Q

Carotid circulation supplies…

A

The anterior and middle of the brain

164
Q

Vertebrobasilar circulation provides…

A

To the posterior part of the brain

165
Q

Anormalities of language

A

Anterior circulation/middle cerebral artery

166
Q

Vertigo, ataxia, bilateral deficits

A

Posterior circulation

167
Q

Pure motor or pure sensory deficits

A

Lacunar

168
Q

Ischemic stroke imaging

A

Noncontrast CT initially

MRI better for early

US of carotid

CTA or MRA

169
Q

Lacunar stroke

A

Small infarcts in the deeper parts of the brain and brainstem caused by the occlusion of a single penetrating branch of a large cerebral artery

1/4 of ischemic strokes

Less severe

170
Q

Lipohyalinosis

A

90-95% of lacunar strokes, small vessel disease from diabetes

171
Q

Lacunar infarct presenation

A

Lack cortical signs

Pure motor or pure sensory

Clumsy hand dysarthria syndrome

Internuclear ophthalmoplegia

Abrupt or gradual onset, progress

172
Q

CT and diffusion weighted MRI findings for lacunar infarct

A

Ct- small punched out hypodense areas

MRI- small, punched out CSF filled spaces

173
Q

MCA infarct

A

Largest proportion of the brain, severe stroke

Usually embolism

174
Q

MCA infarct findings

A

Contralateral hemiplegia/hemisensory loss

Contralateral homonymous hemianopsia

Eye deviation to side of lesion

Anosognosia

Aphasia, wernicke or broca

175
Q

Wernicke aphasia

A

Posterior branch, defect in understanding what others are saying

176
Q

Broca aphasia

A

Anterior branch, motor defect, cant express what they are thinking

177
Q

ACA infarct

A

Usually embolism

178
Q

ACA infarction presentation

A

Contralateral findings of leg weakness and sensory loss, grasp reflex

Paratonic rigidity- resisted movement

Abulia- no motivation

Frank confusion

Urinary incontinence

179
Q

Ophthalmic artery infarct

A

Asymptomatic in most

Transient emblic obstruction- amaurosis fugax

180
Q

Posterior cerebral artery infarct

A

Around 5%

Contralateral strength and sensory deficits are MILD

Contralateral homonymous hemianopsia

Color anomia (can’t name them)

Visual agnosia (can’t name objects)

181
Q

Lateral medullary syndrome

A

Posterior inferior cerebellar artery occlusion

Facial weakness, Horner syndrome, ataxia/incoordination IPSILATERAL

Sensory loss in trunk and limbs CONTRALATERAL

182
Q

Thalamic pain syndrome

A

Stoke within posterior circulation

Chronic pain on the same side of the stroke

Could also have intention tremor and hand spasm

183
Q

Vertebrobasilar infarct

A 
Vertigo
Vertical nystagmus
Contralateral hemiplegia and sensory deficit
Ipsilateral CN palsy
Ipsilateral ataxia
184
Q

Cerebellar stroke

A 
Vertigo, dizziness
NV
Nystagmus
Ipsilateral limb ataxia
Contralateral sensory loss in limbs

Coma, brain herniation and death!

185
Q

Door to stroke unit admission

A

Less than 3 hours!

186
Q

Avoid lowering BP in the first…

A

2 weeks after CVA

After 2 weeks can be reduced to <140/90

187
Q

Intracerebral hemorrhage

A

Usually from HTN

Spontaneous, nontraumatic sudden onset

Putamen is the most common site

If amyloid of blood- lobar/cortex most common

188
Q

Intracerebral hemorrhage presentation

A

Loss or altered level of consciousness
Vomiting
Headache

May terminate fatally within 2 days

189
Q

Intracerebral hemorrhage imaging

A

CT without contrast

CTA MRA later when stable

190
Q

What should you not do with intracerebral hemorrhage?

A

Lumbar puncture!

Monitor ICP

191
Q

ICH treatment

A

Mechanical ventilation
Treat HTN
Control fever
FFP if blood dyspraxia

192
Q

ICH score and mortality rates

A 
1- 13%
2- 26%
3- 72%
4- 97%
5- 100%
193
Q

Subarachnoid hemorrhage

A

Rupture of aneurysm or arteriovenous malformation

Worst headache of my life, thunderclap
Meningismus

194
Q

Mycotic aneurysms

A

Septic emboli more distal vessels

Often at cortical surface

195
Q

AVM

A

Congenital vascular malformation

Smaller ones are more likely to bleed!

Usually supratentorial

196
Q

Imaging in SAH

A

CT is positive in 85%
LP positive in 95%
Cerebral angiogram is the gold standard!

197
Q

Degenerative motor neuron dz presents as…

A

Weakness and muscle wasting with sensation intact

30-60 years old

198
Q

Bulbar/pseudobalbar palsy

A

Degeneration of medulla and CN IX-XII nuclei

Bulbar affects the motor nuclei causing dropping palate, decreased gag, pooling secretions, etc

Pseudobulbar is fits of laughing and crying, UMN defect

199
Q

ALS general

A

Upper and lower motor neuron disease

In 3 of 4 of these tracts:
Bulbar
Cervical
Thoracic
Lumbosacral
200
Q

ALS presentation

A

Asymmetric limb weakness

Hand weakness, foot drop

201
Q

Degenerative motor neuron dz diagnosis

A

Electromyography

202
Q

Myasthenia gravis general

A

Limit ability to reach action potential threshold in the NMJ from autoantibodies against AchR

203
Q

Myasthenia gravis features

A

Thymoma in 15% of patients

Insidious onset

Significant fatigability of muscles, ptosis and diplopia common

204
Q

Myasthenia gravis diagnosis

A

Tensilon/edrophonium challenge or ice pack challenge

Serum AchR antibody testing

205
Q

MG prognosis

A

Respiratory failure, progressive

206
Q

Lambert eaton syndrome

A

Defective release of Ach

Paraneoplastic in 40% of cases

Handgrip to differentiate from MG, LE pateints will get stronger as the squeezes continue

207
Q

Botulism

A

Canned foods , clostridium botulinum toxin prevents Ach release

Resp difficulty and limb weakness later

208
Q

Organophosphate poisoning

A

Pesticides, buildup of Ach

Parasympathetic overload (SLUDGE/BBB)

209
Q

Organophosphate poisoning treatment

A

Wash with soap, aspirate gastric contents

Atropine reverses parasympathetic sx

2-PAM reverses binding to AchE if quickly given

210
Q

Myotonic dystrophy

A

Autosomal dominant

Muscle stiffness and delayed relaxation

211
Q

Duchenne muscular dystrophy general

A

All males

Absent dystrophin protein from muscle fiber plasma membrane

CK elevations

Degenerative and regenerative changes

DNA probe

212
Q

DMD presentation

A

2-3 years of age

Slow to attain motor milestones

Calf hypertrophy and proximal leg weakness

Gower sign- climbing up legs and body to stand

213
Q

Charcot Marie tooth disease

A

Autosomal dominant

Progressive polyneuropathy with weakness and muscle wasting

214
Q

Charcot Marie tooth disease presentation

A

Foot drop, foot deformities, early gait disturbance

215
Q

Guillan barre general

A

Campylobacter jejuni enteritis, demyelination 2-3 weeks post insult

Ascending weakness and paralysis

Can involve respiratory muscles!

Protein in CSF

216
Q

Mononeuritis multiplex

A

Nerve infarcts

Multiple nerve trunks

Painful, asymmetrical and sensory!

217
Q

Saturday night palsy

A

Compressive, paralysis of distal limb

Sleeping with arm over back of chair

Improves over a few months

218
Q

Bell’s palsy

A

LMN facial nerve paresis

Abrupt onset, can be preceded by ear pain and taste disturbance

Steroids

Most have full recovery

219
Q

CVA versus bell’s

A

If you cannot elevate 1 eyebrow, its a facial nerve issue. Bell’s!

220
Q

General dementia considerations

A

Gradual and progressive

Previously normal cognition

Risk doubles every 5 years after 50 yeras old

221
Q

Dementia signs and symptoms

A

Short term memory loss(hippocampal damage)

Aphasia (wernickes)

Visuospatial dysfunction

Apraxia (loss of learned behaviors)

222
Q

With dementia presentation you must rule out…

A

Reversible causes!!

Not a normal part of aging

223
Q

Dementia testing

A

Mini cog- 3 word recall, clock drawing

MMSE, Montreal

224
Q

Testing for dementi

A

MRI indicated for progressive decline in cognition

Rules out other CNS dz

225
Q

Alzheimer’s disease general

A

Most common cause of dementia

Very rare if younger than 60

Different proteins, Ach levels drop

226
Q

AD presentation

A

Memory impairment- immediate memory preserved early on, then lose recent memory first

Visuospatial skills lost early

Personality changes

227
Q

AD diagnosis

A

Clinical

Genetic testing

Analysis of brain tissue

228
Q

Vascular dementia

A

2nd most common dementia

Multiple infarcts, like lacunar

229
Q

Frontotemporal dementia

A

Focal degeneration of frontal and or temporal lobes

Changes in personality social behavior or language

230
Q

Kluver bucy sydrome

A

Emotional blunting
Hyperphagia
Visual agnosia

In frontotempral dementia

231
Q

Lewy body dementia general

A

2nd most common cause of degenerative dementia

Lewy bodies are intraneuronal protein tangles, seen in Parkinson’s and LBD

232
Q

LBD presentation

A

Hallucinations
Parkinsonism
Cognitive fluctuations
Antipsychotic sensitivity

233
Q

Normal pressure hydrocephalus

A

Cause of dementia symptoms

Impaired absorption of CSF

Wet, wacky and wild

Magnetic gait, apathy, incontinence

234
Q

Prion disease

A

Misfolding prion proteins causing neurodegenerative disease

Difficult to sterilize! Fatal in 1 year

235
Q

CJD

A

Mad cow disease

Rapidly progressive dementia is the main sign

236
Q

Meningitis general

A

Inflammatory dz of the meninges and CSF

Rapid clincal progression

237
Q

Big causes of meningitis

A

Strep pneumo
Neisseria meningitidis

*listeria in adults over 50 and neonates or those with immunodeficiency

238
Q

Meningitis presentation

A

Fever
Stiffness
altered mental status
headache

239
Q

Austrian triad

A

Pneumonia, meningitis and endocarditis from strep pneumo

240
Q

Meningococcal rash

A

Fever and rash, if it doesn’t blanch its meningitis

Could lead to Waterhouse Frederick son syndrome

241
Q

Less common meningitis pathogens

A

H flu in kids

Staph Aureus and gram negative in nosocomial and health care settings

242
Q

Neonatal meningitis

A

More common in the first month than any other time of life

Always LP!

243
Q

Aseptic meningitis

A

Signs and symptoms of meningitis but negative cultures, need a LP

Self limited

244
Q

Causes of aseptic meningitis

A 
Enterovirus
HIV
HSV
Syphilis- later onset
Tb
245
Q

Encephalitis

A

Impaired cerebral function

Viral often times

AMS, seizures, neuro deficits

246
Q

West Nile

A

Mosquitoes

Flaccid paralysis, maculopapular rash, tremor

247
Q

Primary intracranial tumor types

A

Gliomas are half of all brain tumors, from glial cells

Then meningiomas

248
Q

Symptoms of primary intracranial tumors

A 
Progressive CNS deficits
Headache
Personality changes
Malaise
Seizures 
Brain herniation
249
Q

Frontal lobe signs

A

Intellectual decline, mental activity slowing, personality changes, grasp reflexes

250
Q

Temporal lobe symptoms

A

Seizures, hallucinations, motor phenomena, depersonalization

251
Q

Parietal lobe symptoms

A

Contralateral disturbances of sensation, asterognosis, depressing apraxia, loss of tactile discrimination

252
Q

Occipital lobe changes

A

Crossed homonymous hemianopia or partial field defect, visual agnosia, color anomia, visual hallucinations

253
Q

Brainstem and cerebellum symptoms

A

CN palsies, ataxia, incoordination, nystagmus

254
Q

Intracranial tumor imaging

A

MRI with contrast!

255
Q

Most common source of intracranial metastasis is carcinoma of…

A

The lung

256
Q

Most cerebral metastasis are located…

A

Supratentorial

257
Q

Leptomeningeal metastases

A

Cancer of the pia and arachnoid mater

258
Q

Leptomeningeal metastases causes neuro deficits by..

A

Infiltration of cranial and spinal nerve roots

Invasion of brain or spinal cord

Hydrocephalus

259
Q

Leptomeningeal mets diagnosis

A

CSF confirms: increase pressure, pleocytosis, increased protein and decreased glucose

260
Q

Most common spinal tumor is…

A

Extradural

Then intradural/extramedullary

261
Q

Signs/symptoms of spinal tumor

A

Focal pain aggravated by valsalva

Radicular pain

Motor and sensory deficits

Sphincter disturbances

262
Q

Brain abscess general

A

Within brain parenchyma, from infection, trauma or surgery

Bacteria is the most common pathogen

263
Q

Brain abscess symptoms

A

Dx after 14 days of symptoms

Headache usually, fever in half, AMS, seizures, CN deficits

264
Q

Imaging of brain abscess

A

CT/MRI with contrast

Earlier recognition with MRI

265
Q

How big can an abscess be before it needs to be drained?

A

Less than 2 cm and can be treated medically

266
Q

Modified dandy criteria

A

To dx idiopathic intracranial hypertension

Signs and symptoms of ICP
No neuro abnormalities
Normal CSF
Normal imaging

267
Q

IIH symptoms

A

Headache, lateralized, throbbing, ass’t with NV

Diplopia, photopsia, loss of vision

Pulsatile tinnitus

Changes precipitated by standing and valsalva

268
Q

3 hallmark signs of IIH

A

Papilledema
Visual field loss
6th nerve palsy

Clin Med 2 (8 decks)

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