Misc. Flashcards
pseudotumor cerebri px
- severe headache
- obese woman on OCP*
- papilledema*
- Cr VI palsy –> diplopia
-vit A toxicity is a less common cause
pseudotumor cerebri test results
- negative CT, MRI
- LP –> increased CSF pressure
~70% have empty sella on CT
pseudotumor cerebri tx
- weight loss
- acetazolamide (to dec CSF fluid production)
-optic nerve sheath decompression (when refractory to medical therapy)
trigeminal neuralgia px, tx
- severe pain over trigeminal distribution of Cr V
- exacerbated by chewing, talking, touching area
-tx: carbamazepine, surgical resection of nerve
Guillian-Barre syndrome px
- ascending paralysis
- post Campylobacter jejuni infection
- autoimmune: Ab against myelin
- acute, inflammatory, polyneuropathy
- absent DTRs
-death from diaphragm paralysis –> resp failure
Guillian-Barre syndrome tx
- IVIG = best initial
- plasmapheresis (remove Ab against myelin)
- both have equal efficacy, but don’t combine
- NO steroids
-intubate if FEV1 dec
Guillian-Barre syndrome dx
-lumbar puncture = best initial
(inc protein, normal cell count; albumin-cytologic dissociation)
-electromyelography = most accurate
(nerve conduction velocity study)
-PFTs to assess diaphragm strength (FVC)
myasthenia gravis =?
antibodies against ACh-R in neuromuscular junction
- dec impulse conduction –> dec strength
- autoimmune
myasthenia gravis px
- weakness: diplopia, ptosis, dysphagia
- nasal speech, snarling smile
- intact DTRs, normal pupillary reflex
myasthenia gravis dx
-acetylcholine-receptor antibodies = best initial
(less diagnostic with symptoms limited to eyes compared to generalized symptoms)
- edrophonium (tensilon, ACh-E-I) test –> sensitive, but not specific
- CXR (rule out thymoma)
- EMG = most accurate
Eaton-Lambert syndrome px
-initial weakness, which improves over time with repetitive movement (builds up [Ca] –> overcomes Ab)
- antibodies against Ca-channels
- small cell lung cancer association
myasthenia gravis tx
-pyridostigmine or neostigmine = best initial
(long term ACh-esterase-inhibitors –> inc [ACh])
- thymectomy (13-60 YO)
- steroids vs azathioprine, cyclosporine, cyclophosphamide (>60 YO)
acute myasthenic crisis px, tx
- significant paralysis –> resp symptoms
- tx: plasmapheresis & IVIG
antibiotic class that causes myasthenia gravis-like symptoms?
aminoglycosides
gentamicin, tobramycin, amikacin
amylotrophic lateral sclerosis
=motor neuron disease
- motor cell bodies die
- UPPER & LOWER motor neuron affected
- sensory, cognition, bowel/bladder all intact
UMN px
- weakness
- hyperreflexia –> from lack of inhibition
- spasticity –> from hyper reflexive arc
“squeezing b/t two fat ppl”
LMN px
- muscle wasting
- muscle atrophy
- fasciculations
“puppet-like”
ALS tx
- supportive
- riluzole –> slows destruction of motor neurons
(often die from respiratory paralysis or repeated infections)
multiple sclerosis
- autoimmune demyelinating disease
- white matter plaques
- optic neuritis = most common px
- motor –> weakness
- sensory, bowel/bladder
- can px with trigeminal neuralgia
MS causes
- genetic
- areas away from malaria (cold regions)
MS types
- relapsing remitting
- primary progressive
- secondary progressive
progressive disability; RR improves slightly during this downgrade
MS px
- multiple neurological deficits
- optic neuritis
- paresthesias
- bowel/bladder spasticity
-mentation intact the longest
MS dx
-MRI = best initial, most accurate
(multiple plaques in the WHITE matter)
-LP: inc protein, mildly inc cell count
- oligoclonal bands = IgG in CSF; used in an inconclusive MRI
- evoked potentials: old test
MS tx
- steroids: acute severe
- plasma exchange (those refractory to steroids)
-disease-modifying –> interferon-beta & glatiramir: acute exacerbations
(replaces myelin basic protein)
MS symptomatic tx? spasticity trigeminal neurlagia bladder hypperreactivity urinary retention fatigue erectile dysfunction
- baclofen*; tizanfine, diazepam
- carbamazepine, gabapentin, phenytoin, TCA
- oxybutynin (blocks ACh)
- bethanechol (gives ACh)
- amantidine, fluoxetine (SSRI)
- sildenafil
lacunar stroke cause? location? types?
- HTN
- posterior limb, VPN, anterior limb, pontis
pure motor stroke location? symptoms?
- posterior limb of internal capsule
- unilateral motor deficit, mild dysarthria
pure sensory stroke location? symptoms?
- VPN of thalamus
- unilateral numbness, paresthesias (face & body)
ataxic-hemiparesis stroke location? symptoms?
-anterior limb of internal capsule
- lower extremity weakness
- ipsilateral arm/leg incoordination
dysarthria-clumsy hand syndrome?
- lacunar stroke at basis pontis (where the basilar artery runs)
- hand weakness, mild motor aphasia
heat stroke px?
- acute confusion
- hyperthermia (>105F)
- tachycardia
- coagulopathic bleeding
Lhermitte’s sign
transient electric-like shock down spinal, triggered by flexion of neck
