FA - Neuro Chapter Flashcards
Riluzole
Think treatment for ALS b/c decreased presynaptic glutamate release.
Tabes dorsalis affects what 2 spinal areas.
1) Degeneration of posterior column (p/w: impaired sensation, proprioception)
2) Demyelination of dorsal nerve roots (p/w: progressive sensory ataxia so inability to sense or feel the legs)
3) Together lead to poor coordination, + Romberg, absent DTRs
Workup for Bell palsy.
Typically history and PE is enough to establish diagnosis but if paralysis lasts over 6-8 wks then explore other conditions like: AIDS, Lyme Disease, Sarcoidosis, Tumors or Diabetes
Other causes of stroke that should also be worked up for in addition to cardioemobolic and thrombotic causes.
Hypercoaguable state
Sickle cell disease
Vasculitis
Clinical features of MCA stroke.
Contralateral paresis and sensory loss in face and arm
Hemiparesis
Aphasia (dominant)
Neglect (non-dominant)
Gaze preference toward the side of the lesion
Biceps are innervated by what nerve root.
C5 nerve root
Triceps are innervated by what nerve root.
C7 nerve root
Patella innervated by what nerve root.
L4 nerve root
Achilles innervated by what nerve root.
S1 nerve root
Nerve roots responsible for Achilles reflex.
S1-2, tie your shoes
Nerve roots responsible for patellar reflex.
L3-4, kick the door
Nerve roots responsible for biceps reflex.
C5-C6, pick up sticks.
Nerve roots responsible for triceps reflex.
C7-8, lay them straight.
What BP is the limit for tPA administration.
SBP
Common symptoms of ACA stroke.
Contralateral paresis and sensory loss of LEG
Cognitive or personality change
PCA strokes distal to P-Comm affects what regions of the brain
Cortical temporal, occipital p/w P2 syndromes.
Types of Lacunar infarcts.
1) Pure motor [lesion in posterior limb of internal capsule containing corticospinal tract]
2) Pure sensory [lesion in Thalamic VPL nucleus p/w contralateral hemianesthesia/parathesia OR can also p/w Dejerine-Roussy syndrome = Thalamic pain syndrome (allodynia) seen after several weeks following a pure sensory thalamic stroke]
3) Ataxia hemiparesis [lesions in Internal capsule anterior limb, where injury to frontopontocerebellar tract causes Ataxia while injury to corticospinal tract causes hemiparesis]
4) Dysarthria/ clumsy hand [Anterior pons or basis pontis lesion]
5) Mixed [lesions in thalamus and internal capsule]
PCA stroke proximal to P-Comm affects what regions of the brain.
Midbrain, subthalamic nucleus, thalamus p/w P1 syndromes.
P1 syndromes are associated with proximal PCA strokes and include:
Midbrain strokes p/w:
1) ipsilateral oculomotor nerve [CN3] palsy [droopy eyelid + Down/Out + fixed pupil]
2) Injury to superior cerebellar peduncle [ataxia]
3) Injury to cerebral peduncle [contralateral hemiparesis]
Subthalamic nucleus injury p/w: Hemibalismus
Midbrain stroke p/w CN III palsy with contralateral ataxia is called.
Claude’s syndrome
Midbrain stroke p/w CN III palsy with contralateral hemiplegia is called.
Weber’s syndrome (Superior alternating hemiplegia), can also present with contralateral parkinsonism (substantia nigra)
P2 syndromes are associated with distal PCA strokes and include:
1) Contralateral homonymous hemianopsia with macula sparing
2) Bilateral: cortical blindness (blind with intact pupillary reflex). Can be unaware (Anton’s)
Dejerine-Roussy syndrome
Thalamic pain syndrome seen after several weeks of having a pure sensory thalamic stroke p/w: burning pain over the affected area exacerbated by light touch (allodynia)
Occlusion of the anterior spinal artery causes what syndrome? Features include:
Medial medullary syndrome:
1) injury to medial pyramid t/f corticospinal fibers affected [p/w: Contralateral hemiparesis 2/2 injury before it decussates in the low medulla/cord]
2) injury to medial lemniscus t/f dorsal column fibers affected [p/w: Contralateral ataxia, loss of tactile vibration/position sense]
3) injury to Hypoglossal nucleus, CN XII t/f ipsilateral tongue weakness [p/w: tongue deviation to side of the lesion]
Medial Pontine Syndrome.
1) Injury to corticospinal fibers p/w: Contralateral spastic hemiparesis [injury before decussates in low medulla/cord]
2) Injury to Medial lemiscus p/w: Contralateral ataxia, loss of tactile/position sense from injury to posterior column pathway
3) Injury to CN 6 or Abducens nerve p/w: Strabismus or ipsilateral lateral rectus muscle paralysis
Conditions associated with berry aneurysms.
Marfan syndrome Aortic coarctation Kidney disease (AD, polycystic) Ehlers-Danlos syndrome Sickle cell anemia Smoking
Early management of SAH:
1) Reduce bleeding via control of SBP (
Late management of SAH:
1) Seizure prophylaxis w/ Phenytoin, Valproic acid, Levetiracetam
2) Manage ICP w/ reverse Trendelenberg, Mannitol (hypertonic solution), Hyperventilation or craniotomy
3) Vasospam prevention [to prevent ischemic episodes] w/ CCB like Nimodipine and leaving BP ELEVATED to maintain CPP [= BP-ICP]
Abortive tx for migraines.
Sumatriptans.
Prophylaxis tx for frequent migraines.
Anticonvulsants like gabapentin, topiramate.
TCA like amitriptyline.
Beta-blockers like propanolol.
CCBs.
Young woman with >30 BMI, p/w n/v/HA/tinnitus and papilledema think.
Idiopathic intracranial HTN or pseudotumor cerebri 2/2 obesity, tetracylines, growth hormone, excess Vit A but to treat FIRST start out with weight loss! Then acetazolamide, topiramate or if really bad serial LPs or shunt.
Tx for cluster HA.
High flow O2
Onset of HA after the age of 50 in a woman but rule out.
Temporal arteritis, via obtaining an ESR
First line anticonvulsant in children with partial or tonic-clonic (grand mal) seizures.
Phenobarbital.
First line anticonvulsant in children with absence seizures (petit mal).
Ethosuximide.
Acute vestibular neuritis
P/w vertigo + vomiting/nystagmus 1 wk after a viral infection w/o auditory sxs.
Labyrinthitis.
P/w tinnitis, ear fullness, or hearing loss, + severe vertigo with n/v/nystagmus.
Meniere disease.
Vertigo + Tinnitis + Hearing loss + EAR FULLNESS
Pt experiences nausea, warmth and diaphoresis prior to what type of syncope.
Vasovagal syncope.
Autonomic neuropathy associated with which type of syncope.
Orthostatic hypotension syncope.
Myasthenic crisis
IVIG or plasmapheresis.
Tx Meniere disease.
Acute: Meclizine
Chronic: Diuretics and low SALT diet
Tx of Labyrinthitis/Vestibular Neuritis.
If within 72 hrs, steroids.
If after 72 hrs, meclizine for vertigo episodes.
What is spared in Lambert-Eaton syndrome (that is not spared in MG)?
1- Extraocular muscles
2- Respiratory muscles
3- Bulbar muscles (hence why MG pts can have dysarthria, dysphagia)
Charcot’s Triad.
Seen in MS:
1) Scanning speech
2) Internuclear opthalmoplegia
3) Nystagmus
Multiple Sclerosis MRI.
Multiple, asymmetric, often periventricular white matter lesions (Dawson fingers), especially in the corpus callosum. Active lesion enhance with gadolinium.
Multiple Sclerosis CSF.
Increase IgG index or at least 2 oligoclonal bands.
Acute MS exascerbations.
IV steroids or plasma exchange if do not respond to corticosteroids.
Long term tx of MS.
Immune-modulating agents: Interferon Beta 1-a/1-b, Copaxone. (ABCs)
Presentation of Guillain-Barre.
Ascening paralysis
Areflexia
Paresthesias (2/2 sensory nerve demyelination)
Autonomic dysregulation (2/2 autonomic nerve demyelination)
Dx of Guillain-Barre.
Nerve conduction studies.
Guillian-Barre CSF.
High CSF protein > 55, albuminocytologic dissociation.
What is spared in Amyotrophic Lateral sclerosis?
Sensation
Extraocular movements (high cranial nerves)
Sphincter tone
Pick bodies
Round intraneuronal inclusions, tau
Lewy bodies
Clumps of alpha-synuclein proteins
Features of normal aging with regards to memory.
Patients can perform ADLs, complain of their memory loss yet provide detailed information about their forgetfulness, MMSE score >24.
Gait associated with NPH.
Magnetic gait with feet “glued” to the floor.
Type of myoclonus associated with CJD.
Startle-induced myoclonus.
Bilateral tremors in person with family history of tremors.
Think Essential Tremor.
Tx for essential tremor.
Propanolol or primidone (anticonvulsant of barbiturate class).
Chromosome 9
Friederich ataxia
Chromosome 4
Huntington disease
Reserpine or tetrabenazine.
Huntington disease , used to reduced release of DA vesicles.
Festinating gait.
Small, shuffling steps seen in Parksinson’s patients along with ABSENCE of arm swing.
Tx for early/temporary Parksinsonian activity.
Amantadine.
Side effects of Amantadine.
Ankle edema, ataxia, livedo reticularis.
Side effects of Levodopa/carbidopa.
Nausea, vomiting, hallucinations, agitation.
Side effects of Dopamine agonists.
Confusion, hallucinations, compulsive gambling
Tx of tremor dominant Parkinson.
Anticholinergics (trihexyphenidyl or benztropine)
