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Neuro > Movement disorders > Flashcards

Movement disorders Flashcards

1
Q

Tx of anti-DA induced akathisia?

A

BB (Propranolol)

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2
Q

Tx of anti-DA induced dystonia?

A

decr antipsychotic
amantadine
Benadryl
Benztropine

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3
Q

AEs of anti-histamine/adrenergic/muscarinic’s?

A
  • Wt gain
  • incr AST/ALT/jaundice
  • Rash
  • Photosensitivity
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4
Q

What is Withdrawal Dyskinesia?

A

symptoms will increase initially when antipsych drug is stopped

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5
Q

Predisposed to neuroleptic malig syndrome?

A

genetic mutation @ chr 19

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6
Q

What is an Acute Dystonic Reaction?

A

Unwanted, continuous contraction of a group of muscles

can be caused by anti-psychotics or metaclopromide

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7
Q

S/s of Acute Dystonic Reaction?

A

tongue hanging out + eye looking upward (typically young men)

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8
Q

Tx of Acute Dystonic Reaction?

A

Benadryl 50 mg IV once to tx acute dystonia, can also give a small dose of Atropine

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9
Q

Etiology of cervical dystonia in peds?

A

hemivertebral vs. TB vs. self-correction for diplopia

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10
Q

Spared in myasthenia gravis?

A

pupils

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11
Q

More likely to be seronegative myasthenia gravis?

A

Purely ocular

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12
Q

Pathophys of myasthenia gravis

A

Abs link to receptors and cause endocytosis and complement mediated damage to membrane

*Fewer folds and widened synaptic cleft

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13
Q

Antibodies and proteins associated with myasthenia gravis?

A
  1. muscle specific kinase
  2. muscle protein titin
  3. ryanodine in pts with thymoma
  4. anti-nAch receptor
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14
Q

70% of pts with myasthenia gravis have…

A

lymphofollicular hyperplasia

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15
Q

Myasthenic Crisis =

A

diaphragmatic and intercostal weakness causes respiratory complications + bulbar symptoms

  • intubate, d/c anti-cholinesterase and corticosteroids, treat with plasmaphoresis/IVIgG
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16
Q

When should a pt with MG be intubated?

A

FVC if <1.2 L

*Atropine to minimize secretions, B2 agonists to minimize bronchospasms

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17
Q

OPTIC NEURITIS: S/s?

A
  • Pain around one eye (particularly on movement)
  • Blurred vision (may proceed complete monocular blindness by days or weeks)
  • Loss of color vision (red desaturation)
18
Q

OPTIC NEURITIS: Exam?

A
  • Impaired visual acuity
  • Pink/swollen optic disc w pale optic n
  • Visual field defect
  • Relative afferent pupil defect (affected eye may respond directly to light, but not as well as the other side)
19
Q

only field defect in papilledema is:

A

incr physiologic blind spot

20
Q

Tx for Acute MS Related Optic Neuritis:

A

**GIVE IV Metyhlprednisolone (solu-medrol); do NOT give oral prednisone, makes it worse!

21
Q

Causes of non-compressive CN III palsy?

A

MG (Diurnal Variation) & DM

22
Q

What should you order for CN III palsy?

A

1. CT w/o contrast (or w/?)
2. If blood then load with NS (for hemodilution, need to counteract the contrast and help decr BP)
3. treat for hypervolemia, hemodilution, htn

23
Q

Dx of giant cell arteritis?

A

ESR
normocytic normochromic anemia
incr LFTs
Biopsy (skip lesions)

24
Q

Tx of giant cell arteritis?

A
  1. IV hydrocortisone (after ESR taken)

2. 40-60mg prednisolone req initially (responds well w/in 1-2 days)–continue for 18-24mo

25
Q

Associated with giant cell arteritis?

A

Polymyalgia Rheumatica: girdle pains + morning stiffness w/ some constitutional sx
**NO cranial symptoms like GCA

26
Q

How does hyperthyroidism –> stroke?

A

Hyperthyroid => Afib can cause embolic stroke + recurrent TIAs (will show perfect vessels, etc)

** just as big a risk as someone with constant afib

27
Q

Conditions associated with hyperthyroidism?

A
  1. myasthenia gravis

2. pseudotumor cerebri

28
Q

pseudotumor cerebri:
chronic complications?
seen on exam?

A

Chronic: optic nerve can be affected –> acetazolamide
(Surgical drainage or fenestration of CN 2 may be req)

exam: bil papilledema, 6th nerve palsy

29
Q

Stroke in a paired venous sinus is likely due to:

Stroke in an unpaired venous sinus is likely due to:

A

Paired sinus: likely infection

Single sinus: likely hypercoag state

30
Q

Thrombosis of entire sup. venous sinus: symptoms/presentation?

A 
Overlies para-sagittal areas => 
  Sz 
  Paraplegia
  incr ICP 
  Papilledema

P/w:
HA + Papilloedema and other ICP features; Seizures + Bilateral signs of neurological deficit (progressive w/ impaired consciousness)

31
Q

Thrombosis of entire sup. venous sinus: Predispositions?

A
  • pregnancy/labor/OCPs
  • Dehydration and Cachexia
  • Cancer and anti-cancer meds (tamoxifen, hydroxyurea)
  • Sickle cell + protein C/S coagulopathy
32
Q

LATERAL SINUS THROMBOSIS:

signs/symptoms?

A
  • infection in mastoid/inner ear
  • incr ICP
  • Seizures
  • Drowsiness
33
Q

CAVERNOUS SINUS THROMBOSIS: signs/symptoms?

A
  • Red swollen eyelid and conjunctiva
  • III, IV, Va/ Vb , VI palsies
  • Papilledema
34
Q

Cause of lateral and cavernous sinus thrombosis?

Treatment?

A

spread of infection
(face and Orbit –> Cavernous –> Ear –> Lateral)

Heparin + Abx

35
Q

CEREBELLO-PONTINE ANGLE TUMORS:
Involves what CN’s?
Symptoms?
MC type?

A

5 + 7 + 8

sensorineural hearing loss (weber to healthy ear)

acoustic neuroma

36
Q

Origin of acoustic neuroma?
Presentation?
Dx?

A
  • sheath of Schwann cells of CN VIII
  • unilateral progressive SN hearing loss + tinnitus
  • CN VII palsy and facial drooping
  • MRI of internal auditory canals with and without contrast
37
Q

HSV ENCEPHALITIS:
EEG?
Dx?

A

EEG: severe slowing on temporal lobes (triphasic waves, unilateral)

  • MRI of brain lit up on temporal lobes
  • Positive PCR
    (temporal lobes + broca’s)
38
Q

HSV ENCEPHALITIS:

Signs/symptoms?

A 
Sz 
AMS 
peech output bad x5 days 
fever 
obtunded
39
Q

HSV ENCEPHALITIS:

ER management?

A
  1. ABC’s
  2. CT w/o contrast to r/o stroke –> assume inf
  3. tx with broad specrum abx
  4. MRI head (temporal lobe*)
40
Q

HSV ENCEPHALITIS:

Tx?

A

ICP management, fluids, ACV therapy, do NOT use steroids, seizure control

Neuro (7 decks)

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