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Neurology-Week 3 > Herniation & Coma > Flashcards

Herniation & Coma Flashcards

1
Q

What are the 4 main categories of Cognitive Disorders

A

Delirium
Dementia
Mild Cognitive Impairment
Static Encephalopathy

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2
Q

Type of Cognitive Disorder; memory loss WORSE than normal age-related decline but patients have NO functional impairment, and therefore don’t meet the criteria for dementia

A

Mild Cognitive Impairment

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3
Q

Type of Cognitive Disorder; ACUTE alteration of mental status characterized by abnormal and fluctuating attention; can also have confusion, illusions and hallucinations

A

Delirium

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4
Q

Delirium is a (symptom/disease)

A

Symptom, thus you form a differential from it (drugs, metabolic disorder, infection, etc.)

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5
Q

Differential Diagnosis for Delirium

A 
Metabolic disorders
Drugs
Infections
Neurologic (stroke, tumor, etc.)
Perioperative (hypoxia, hypotension, etc.)
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6
Q

Delirium in (old/young) patients is usually due to medications, infection or metabolic disturbances

A

Old

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7
Q

Delirium in (old/young) patients is usually due to drug or alcohol intoxication/withdrawal

A

Young

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8
Q

What are some tests/procedures you would do to help diagnose a cause of Delirium (remember, a SYMPTOM not a disease)

A 
Neuro exam
Medication History
Electrolytes, Renal and Liver function
CBC
Thyroid and B12
ECG
CXR
Pulse ox
Head CT (then LP or EEG or MRI)
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9
Q

Type of Cognitive Disorder; an ACQUIRED, persistent and PROGRESSIVE impairment in intellectual function in multiple cognitive domains, usually memory

A

Dementia

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10
Q

Type of Neurodegenerative Dementia (3 total)

A 
Alzheimer's
Parkinson's
Frontotemporal ("Pick's Disease")
Lewy Body Dementia
ALS
Huntington's
Friedrich's Ataxia
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11
Q

What is the central pathology for Neurodegenerative Diseases (Alzheimer’s, Parkinson’s, etc.)

A

Deposition of abnormal proteins (amyloid, tau, alpha synuclein)

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12
Q

Which protein is associated with Alzheimer’s Dementia

A

B-amyloid

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13
Q

Which protein is associated with Frontotemporal Dementia (“Pick’s Disease”) and also Chronic Traumatic Encephalopathy

A

Tau

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14
Q

Which protein is associated with Lewy Body Dementia

A

Synuclein

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15
Q

Type of Cognitive Disorder; Neurodegenerative Dementia; MOST COMMON; short term memory loss with many cortical deficits (language, praxis, etc.); atrophy of most lobes of the brain (Occipital usually spared); deposition of “senile plaques” of B-amyloid and neurofibrillary tangles

A

Alzheimer’s Disease

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16
Q

Alzheimer’s Disease affects (men/women) twice as much

A

Women

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17
Q

Alzheimer’s Disease usually involves atrophy of all cerebral lobes EXCEPT…

A

Occipital (usually spared)

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18
Q

Type of Cognitive Disorder; Neurodegenerative Dementia; ASYMMETRIC atrophy of Frontal and Temporal lobes with marked early PERSONALITY CHANGE; see Tau-positive bodies and ballooned neurons with dissolution of chromatin

A

Frontotemporal Dementia (aka “Pick’s Disease”)

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19
Q

Histological finding for Frontotemporal Dementia (aka “Pick’s Disease”)

A

Pick bodies with Tau-positive stain

Ballooned neurons with dissolution of chromatin

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20
Q

What is Frontotemporal Dementia also known as?

A

Pick’s disease

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21
Q

In Pick’s Disease, aka Frontotemporal Dementia, atrophy is (symmetric/asymmetric) and the (occipital/parietal) lobe is usually spared

A

Asymmetric; Parietal

*Alzheimer’s disease is symmetric and spares occipital

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22
Q

Type of Cognitive Disorder; Neurodegenerative Dementia; SECOND most common cause of dementia; cognitive impairment, stiffness and slowness often with visual hallucinations; brain is NOT as atrophic, but has SYNUCLEIN proteinopathy and shows Lewy bodies in cortex, limbic system and brainstem

A

Lewy Body Dementia

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23
Q

Types of NON-degenerative Dementia

A

Vascular
Alcoholic
Creutzfeldt-Jakob Disease

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24
Q

Type of Cognitive Disorder; NON-Degenerative Dementia; step-wise progression of deficits caused by CVD such as numerous microinfarcts

A

Vascular Dementia

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25
Q

Type of Cognitive Disorder; NON-Degenerative Dementia; due to the direct toxicity of chronic alcohol exposures to neurons; associated with Wernicke-Korsakoff Syndrome (thiamine deficiency)

A

Alcoholic Dementia

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26
Q

Encephalopathy associated with chronic alcohol consumption resulting in thiamine deficiency; will experience confusion, ophthalmoplegia (paralysis of eyes) and gait ataxia along with CONFABULATIONS (due to memory disorder); ALWAYS involves lesions in the mammillary bodies

A

Wernicke-Korsakoff Syndrome

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27
Q

Vitamin deficient in Wernicke-Korsakoff Syndrome

A

Thiamine (B1)

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28
Q

Classic Triad of Wernicke Encephalopathy

A
  • confusion
  • opthalmoplegia (eye paralysis)
  • ataxia

*will also see Confabulations due to memory disorder

29
Q

Why is it dangerous to give glucose to a patient with borderline Wernicke-Korsakoff

A

WKS is due to thiamine (B1) deficiency, which is required for oxidative metabolism of pyruvate for ATP production. High alcohol consumption use up thiamine. Intravenous glucose administration to a patient with borderline thiamine deficiency may trigger the WKS

30
Q

Type of Cognitive Disorder; NON-Degenerative Dementia; Prion disease with infectious particles that cause dementia, myoclonus and ataxia; prominent Cortical atrophy and spongiform change on histology; EEG shows Periodic Sharp Wave Complexes

A

Creutzfeldt-Jakob Disease (CJD)

31
Q

Examples of Reversible Dementia

A 
B12 deficiency
Hypothyroidism
Syphilis
Normal Pressure Hydrocephalus
Hematomas
Benign Tumors
HIV???
32
Q

Type of Cognitive Disorder; REVERSIBLE Dementia; idiopathic or due to abnormal CSF absorption (meningitis, subarachnoid hemorrhage, etc.); classic triad of dementia, gait instability and urinary incontinence (“Wacky, wobbly and wet”) due to compression of premotor and ventromedial cortex; treat with LP or CSF shunt

A

Normal Pressure Hydrocephalus

33
Q

Classic traid for the symptoms of Normal Pressure Hydrocephalus

A

Dementia
Gait instability
Urinary incontinence

(“Wacky, wobbly and wet”)

34
Q

Treatment for Normal Pressure Hydrocephalus

A

LP

CSF shunt

35
Q

Portion of cortex associated with emotional meaning, motivation and the initiation of action based on relative emotional importance

A

Ventromedial cortex

36
Q

Lesions of the Ventromedial Cortex results in…

A

Apathy
Dec. spontaneous movement
Gait disturbance
Urinary Incontinence

*remember it’s the region for motivation and associated with Normal Pressure Hydrocephalus

37
Q

Post-traumatic cognitive impairment with reversible functional disturbance without structural damage to be brain; is a spectrum from being dazed to persistent neurological abnormalities and potentially Chronic Traumatic Encephalopathy; associated with AXONAL dysfunction and excitotoxic cascade due to release of glutamate

A

Concussion

38
Q

Syndrome that follows after years of continuous concussions (especially in atheletes); can lead to full blown dementia and parkinsonism; shows atrophy, ventricular dilatation and thinning of the Corpus Callosum; can see Tau deposition in neurons and astrocytes

A

Chronic Traumatic Encephalopathy

39
Q

Key cellular change in Chronic Traumatic Encephalopathy

A

Tau deposition

40
Q

Loss of consciousness; unarousable and unresponsive

41
Q

State of being awake and aware of one’s surroundings

A

Consciousness

42
Q

Portions of the brain critical for Consciousness

A

Cortex

Midbrain (Reticular Activating System)

43
Q

State of unresponsiveness from which a patient CAN be aroused from momentarily by very vigorous or painful stimuli

44
Q

What Neurological examination should you do for a patient with a coma?

A

Glasgow Coma Score
General exam
Cranial Nerves
Reflexes

45
Q

What are the three parts of a Glasgow Coma Scale

A

Eye opening
Verbal Response
Motor Response

46
Q

Minimum and Maximum score on the Glasgow Coma Scale

A

3-15

*no zeros, so minimum is 3

47
Q

Difference between localizing vs. withdrawing from pain (Glasgow Coma Scale)

A

Localizing: “swats your arm away during IV”
Withdrawing: “pulls arm away as you put IV in”

48
Q

What specifically do you do to assess the cranial nerves in a Coma patient

A 
Fundoscopic exam (papilledema)
Pupil size and reflex
Corneal reflex
EOMS
Gag reflex
49
Q

Purpose of Fundoscopic exam in a coma patient

A

Purpose of Fundoscopic exam in a coma patient

50
Q

Small, reactive pupils are seen in.

A

Opioid Intoxication

51
Q

Unequal pupils (one large) and UNreactive means what?

A

Oculomotor nerve lesion (CN III)

*Uncal herniation?

52
Q

Unequal pupils (one small) but REACTIVE means what?

A

Horner’s Syndrome

*damage to sympathetics

53
Q

Unequal size of the pupils of >1mm

A

Anisocoria

54
Q

PEARLA

A

Pupils Equal And Reactive to Light and Accommodation

55
Q

If you have a Coma due to a Frontal Eye Field lesion, the eye points (towards/away) from it

56
Q

If you have a Coma due to a Pontine Lesion, the eye points (towards/away) from it

57
Q

Reflexive eye movement during head movement in order to stabilize images on the retina

A

Vestibulo-Ocular Reflex (VOR)

*can simulate this with cold/warm water in ear

58
Q

How can you simulate the Vestibulo-Ocular Reflex

A

Cold/warm water in the ear

Warm–> same side
Cold–> opposite side

*COWS

59
Q

(Warm/Cold) water irrigation of the ear results in the eyes looking in the same direction (irrigate right ear, eyes look right)

A

Warm

*COWS= Cold Opposite Warm Same

60
Q

(Warm/Cold) water irrigation of the ear results in the eyes looking in the opposite direction (irrigate right ear, eyes look left)

A

Cold

*COWS= Cold Opposite Warm Same

61
Q

In the Corneal reflex, the absence of ANY response indicates cranial nerve (V/VII) dysfunction

A

CN V (Trigeminal)

62
Q

In the Corneal reflex, the absence of a reflex in ONLY ONE eye indicates cranial nerve (V/VII) dysfunction

A

CN VII (Facial)

63
Q

(Decorticate/Decerebrate) posturing involves arms FLEXING and legs EXTENDING

A

Decorticate

64
Q

(Decorticate/Decerebrate) posturing involves BOTH arms and legs extended; due to lesion below red nucleus in Midbrain

A

Decerebrate

65
Q

(Coma/Locked-In) state is characterized by unconscious, no purposeful movement of face, limbs or eyes; NO sleep cycle; caused by lesion in BOTH hemispheres or RAS

A

Coma

*main characteristic is unconscious and no sleep cycle

66
Q

(Coma/Locked-In) state is characterized by CONSCIOUS, no purposeful movement of face or limbs, but CAN look up with eyes; NORMAL sleep cycle and due to lesions in Pons (takes out Corticospinal and Corticobulbar tracts but not RAS)

67
Q

Key differences between Coma and Locked-In state in regards to symptoms

A

Coma: Unconscious, no eye movements or sleep cycle

Locked-In: Conscious, eyes can look up, normal sleep cycle

68
Q

Difference between Coma and Locked-In state based on location of Lesion

A

Coma: Both hemispheres or RAS

Locked in: bilateral Pons (takes out Corticospinal and Corticobulbar tracts, but NOT RAS)

69
Q

Difference between Coma and Persistent Vegetative State

A

PVS has:
Sleep Wake cycle
Auditory/Visual startle reflex
Noxious Stimuli reflex

Neurology-Week 3 (11 decks)

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