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 (
