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Neurology > Misc. > Flashcards

Misc. Flashcards

1
Q

pseudotumor cerebri px

A
  • severe headache
  • obese woman on OCP*
  • papilledema*
  • Cr VI palsy –> diplopia

-vit A toxicity is a less common cause

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2
Q

pseudotumor cerebri test results

A
  • negative CT, MRI
  • LP –> increased CSF pressure

~70% have empty sella on CT

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3
Q

pseudotumor cerebri tx

A
  • weight loss
  • acetazolamide (to dec CSF fluid production)

-optic nerve sheath decompression (when refractory to medical therapy)

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4
Q

trigeminal neuralgia px, tx

A
  • severe pain over trigeminal distribution of Cr V
  • exacerbated by chewing, talking, touching area

-tx: carbamazepine, surgical resection of nerve

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5
Q

Guillian-Barre syndrome px

A
  • ascending paralysis
  • post Campylobacter jejuni infection
  • autoimmune: Ab against myelin
  • acute, inflammatory, polyneuropathy
  • absent DTRs

-death from diaphragm paralysis –> resp failure

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6
Q

Guillian-Barre syndrome tx

A
  • IVIG = best initial
  • plasmapheresis (remove Ab against myelin)
  • both have equal efficacy, but don’t combine
  • NO steroids

-intubate if FEV1 dec

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7
Q

Guillian-Barre syndrome dx

A

-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)

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8
Q

myasthenia gravis =?

A

antibodies against ACh-R in neuromuscular junction

  • dec impulse conduction –> dec strength
  • autoimmune
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9
Q

myasthenia gravis px

A
  • weakness: diplopia, ptosis, dysphagia
  • nasal speech, snarling smile
  • intact DTRs, normal pupillary reflex
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10
Q

myasthenia gravis dx

A

-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
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11
Q

Eaton-Lambert syndrome px

A

-initial weakness, which improves over time with repetitive movement (builds up [Ca] –> overcomes Ab)

  • antibodies against Ca-channels
  • small cell lung cancer association
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12
Q

myasthenia gravis tx

A

-pyridostigmine or neostigmine = best initial
(long term ACh-esterase-inhibitors –> inc [ACh])

  • thymectomy (13-60 YO)
  • steroids vs azathioprine, cyclosporine, cyclophosphamide (>60 YO)
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13
Q

acute myasthenic crisis px, tx

A
  • significant paralysis –> resp symptoms

- tx: plasmapheresis & IVIG

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14
Q

antibiotic class that causes myasthenia gravis-like symptoms?

A

aminoglycosides

gentamicin, tobramycin, amikacin

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15
Q

amylotrophic lateral sclerosis

A

=motor neuron disease

  • motor cell bodies die
  • UPPER & LOWER motor neuron affected
  • sensory, cognition, bowel/bladder all intact
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16
Q

UMN px

A
  • weakness
  • hyperreflexia –> from lack of inhibition
  • spasticity –> from hyper reflexive arc

“squeezing b/t two fat ppl”

17
Q

LMN px

A
  • muscle wasting
  • muscle atrophy
  • fasciculations

“puppet-like”

18
Q

ALS tx

A
  • supportive
  • riluzole –> slows destruction of motor neurons

(often die from respiratory paralysis or repeated infections)

19
Q

multiple sclerosis

A
  • autoimmune demyelinating disease
  • white matter plaques
  • optic neuritis = most common px
  • motor –> weakness
  • sensory, bowel/bladder
  • can px with trigeminal neuralgia
20
Q

MS causes

A
  • genetic

- areas away from malaria (cold regions)

21
Q

MS types

A
  • relapsing remitting
  • primary progressive
  • secondary progressive

progressive disability; RR improves slightly during this downgrade

22
Q

MS px

A
  • multiple neurological deficits
  • optic neuritis
  • paresthesias
  • bowel/bladder spasticity

-mentation intact the longest

23
Q

MS dx

A

-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
24
Q

MS tx

A
  • steroids: acute severe
  • plasma exchange (those refractory to steroids)

-disease-modifying –> interferon-beta & glatiramir: acute exacerbations
(replaces myelin basic protein)

25
Q 
MS symptomatic tx?
spasticity
trigeminal neurlagia
bladder hypperreactivity
urinary retention
fatigue
erectile dysfunction
A
  • baclofen*; tizanfine, diazepam
  • carbamazepine, gabapentin, phenytoin, TCA
  • oxybutynin (blocks ACh)
  • bethanechol (gives ACh)
  • amantidine, fluoxetine (SSRI)
  • sildenafil
26
Q

lacunar stroke cause? location? types?

A
  • HTN

- posterior limb, VPN, anterior limb, pontis

27
Q

pure motor stroke location? symptoms?

A
  • posterior limb of internal capsule

- unilateral motor deficit, mild dysarthria

28
Q

pure sensory stroke location? symptoms?

A
  • VPN of thalamus

- unilateral numbness, paresthesias (face & body)

29
Q

ataxic-hemiparesis stroke location? symptoms?

A

-anterior limb of internal capsule

  • lower extremity weakness
  • ipsilateral arm/leg incoordination
30
Q

dysarthria-clumsy hand syndrome?

A
  • lacunar stroke at basis pontis (where the basilar artery runs)
  • hand weakness, mild motor aphasia
31
Q

heat stroke px?

A
  • acute confusion
  • hyperthermia (>105F)
  • tachycardia
  • coagulopathic bleeding
32
Q

Lhermitte’s sign

A

transient electric-like shock down spinal, triggered by flexion of neck

Neurology (10 decks)

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