Intro to Neurology Flashcards
What grade is a normal reflex
2+, Active Response
What is a hemiplegic gait
affected leg is held extended and internally rotated, the foot is inverted and plantar flexed and leg moves in circular direction at hip (circumduction)
What is a diplegic gait
slow and stiff with legs crossing in front of each other (scissoring)
What type of patient do you normally see a diplegic gait
Cerebral Palsy
What is a cerebellar ataxic gait
wide based and may be associated with staggering/reeling as in drunkeness
What is a sensory ataxic gait
wide based, the feet are slapped onto the floor, and patient may watch his feet
What is a neuropathic (steppage) gait
inability to dorsiflex foot, often due to peroneal nerve lesion. Results in exaggerated elevation hip/knee to allow foot to clear floor
What is a dystrophic gait
Pelvic muscle weakness produces lordotic/waddling gait (with Trendelenberg tilt)
What is the Parkinsonian (Festinating) gait
Flexed posture, starts are slow, steps are small and shuffling, there is reduced arm swing, and involuntary acceleration (festination) may occur
What is a Choreic gait
jerky and lurching yet falls are suprisingly rare
What is a Apraxic gait
Difficulty initiating walking and may appear to be glued to the floor. Once started, gait is slow and shuffling. However, no difficulty performing leg movements when lying down and not bearing weight
What is an Antalgic gait
Favoring one leg over other to avoid pain (limp)
What is the normal color of CSF
clear/colorless (champagne colored tap)
Why are there no RBC’s in CSF
Because of the blood brain barrier
How do you differentiate glucose levels in viral meningitis vs. bacterial?
Viral Meningitis glucose is normal, Bacterial Meningitis it is low (<45 mg/dL)
What WBC predominantly shows in viral meningitis
Lymphocytes
What WBC predominantly shows in bacterial meningitis
Neutraphils
What are contraindications for doing an LP
-Infection in tissue near puncture site (L4)
-Space occupying lesion, especially brain abscess
-Anticoagulation
-Thrombocytopenia with PLT#<50K
-Complete spinal block
-Non-communicating hydrocephalus
What are indications for doing an LP
-CNS infection, concern for meningitis
-Suspected SAH
-Unexplained seizures/SE
-Intrathecal chemotherapy/contrast
-Thoraco-abdominal aortic aneurysm repair
-Idiopathic intracranial hypertension (psuedotumor cerebri)
What are the labs to diagnose stroke?
CBC
Inflammatory markers (ESR/CRP)
Serum glucose
Lipids
What is the usefulness of CT in diagnosing neurological conditions
- progressive neurologic disorders
- focal neuro deficits with suspected lesions
- elvated ICP
- patients with suspected stroke/head injuries
What imaging modality is better at detecting an acute bleed
CT, because it is better at differentiating from other cause (bleed)
Indications to order a CT for neurologic conditions
- Stroke
- Tumor
- Trauma
- Dementia
- SAH
What is within the grey matter of the brain?
cell bodies
What is within the white matter of the brain?
nerve fibers
Does MRI or CT provide better contrast of white/grey matter?
MRI
Indications for MRI in neurological disorders?
- Stroke
- Tumors
- Trauma
- Dementia
- Multiple Sclerosis
- Infections
- Seizures
Why is MRI useful in diagnosing dementia
more sensitive in identifying abnormal white matter signal and associated atrophy
Why is MRI useful in diagnosing MS
It is possible to detect lesions in cerebral white matter or cervical cord. Can use GAD to distinguish between lesions of different ages. (Identifying lesions are critical to proper diagnosis)
Why is MRI useful in diagnosing a brain infection
Very sensitive in detecting white matter edema likely attributing to earlier detection of cerebrites/abscess
How quickly can DW-MRI Sequencing detect an acute stroke
Within an hour of onset with high specificity
What is DW-MRI Sequencing used for
to discriminate between cytotoxic (strokes) and vasogenic edema (cerebral lesions)
What are the indications for a PET scan in neurological disorders
- Medical refractory epilepsy and evaluation for surgery
- Dementia
- Grading gliomas
- Confirmatory evidence of Huntington’s disease
Types of Angiography in Neurology
- Formal Cerebral Angiography
- CT Angiography
- MR Angiography
What are the indications for angiography in neurology
- Acute stoke to evaluate for LVO
- Intracranial aneurysms/AVM’s/Fistula’s
- SAH
- Venous sinus thrombosis
- Space occupying lesions
What are the indications for EMG’s
When you suspect diagnosis such as:
- myopathic disorders (especially in inflammatory disorders like polymyositis)
- ALS
- Muscular dystrophies
Indications for Evoked Potentials (EP)
- Detection of lesions in MS
- Evaluating efficacy of treatment in MS
- Lesion detection in CNS disorders
- Assessment of trauma/hypoxia
- Intraoperative monitoring
- Evaluation of visual/auditory acuity (not first line)
What are the types of evoked potentials
Visual, Auditory, and Somatosensory
