N1 Flashcards
Wernicke encephalopathy risk factors?
alcoholism(MC)
malnutrition
hyperemesis gravidarum
pathophysiology?
Vit B1 thiamin deficiency)
Clinical fetcher?
encephalopathy
oculomotor dysfunction
postural and gait ataxia
managment?
IV thiamine followed by glucose
Korsakov syndrome?
aterograde and retrograde amnesia
confabulation
less common than WE,80%
irreversible
Wernicke-Korsakoff syndrome?
Damage to medial dorsal nucleus of the thalamus, mammillary bodies.
Presentation is the combination of
Wernicke encephalopathy and Korsakoff syndrome.
Cerebellar examination?
finger to nose
heel to shine
If positive it indicates a cerebellar lesion
medication-induced delirium?
anticholinergic
benzodiazepins
opiates
Migraine symptom?
Episodic, severe,unilateral and throbbing headache
associated photophobia, phonophobia, and N/V
stay 4-24 hr
Aura
Aura symptom?
Focal, reversible neurologic symptom preceding or accompany the headache Occur in 25% of patients Visual(loss of vision, a wavy line) Sensory(paraesthesia or numbness) Auditory(sound hearing and hearing loss) Motor(tremor and weakness)
What risk increase with a patient who has migraine with aura?
Ischemic stroke risk
Stop factor that increases thrombosis risk(like OCP)
managment?
abortive
preventive
abortive?
NSAID
Triptans
Dihydroergotamine
Antiemetics
Preventive?
Proflaxix Lifestyle change(sleep,exercise diet) Beta-blocker Amitriptyline Topiramate Valproate Botulinum toxin Anti CGRP monoclonal Ab
pathogenesis?
release of vasoactive peptides (like Sub. P and CGRP) due to irritation of CNV.menings or B/D vessels.
Chemotherapy-induced neuropathy characteristics?
Usually, start a week of treatment
Symmetrical paresthesia of finger and toe sparing proximal one(Glove -Stock)
Early loss of ankle reflex/jerk
Loss of pain and To
Occasionally motor symptoms result in weakness and bilateral foot drop
causative drug?
Vinca alkaloid(vincristine)
PBD(e,g cisplatin)
Taxan(e.g-peclitaxin)
Anterior cerebral artery occlusion?
Sudden
contralateral loss of motor and sensation in lower extremity
Upper motor sign
How to differentiate from diabetic neuropathy?
IN DP–Motor Weakness comes late, years after the glove-stocking symptoms
What about in the case of spinal cord compression?
Gradual Sever back pain that worsens in a recumbent position/night.
UMN sign
early symmetric motor and sensory deficit
Decrease rectal sphincter tone
The diagnostic criterion for restless leg syndrome?
Urge to move leg and
Unpleasant sensation in legs or other bodies part that begins/worse during inactivity(lying down and sitting).
Unpleasant sensation in the leg that
relieved by movt,(walking and stretching)
worsen or only occur at night
A symptom not explained by another disease
The normal symptom are dysteasia (itching or crawling sensation), poor sleep, and No symptom of pheripherial neuropathy.
Secondary causes?
IDA Uremia DM MS and Parkinson disease Pregnancy Medication(antidepresant,metocloperamide
Treatment?
Mild/intermittent
suplement with Iron if ferritin <75
Use supportive measure(like massage, heating pad, and exercise)
Avoid triggering factors9medication)
Sever/persistent
First-line–Dopamine agonist–Pramipixol
Alternative–Alpha-2-delta-CC ligand(Gabapentin,encapril)
Cancer pain managment?
Mild
Moderate
Severe
Mild?
Non–opioid
Acetaminophen and NSAID
Moderate?
weak opioid +- non-opoid
Codeine
Hydrocodone
Tramadol
Sever?
Short-acting opioid
Morphin
Hydromorphone
Then(If patient need a frequent injection and pain not controlled at night)
Calculate total daily need and convert to long-term (especially patient not took opioid to reduce risk of respiratory depression)
fentanyl patch
oxycodone
plus Short-acting opioid for breakthrough pain
Common tumor metastasize to bone(mainly back)
breast prostate lung renal multiple myeloma
Diffuse axonal injury fetcher?
The most common cause of death in traumatic brain injury
Instantaneous loss of consciousness
persistent vegetative state
punctate hemorrhage with loss of white and gray matter differentiation on CT
But MRI is more sensitive
Pathophysiology?
Acceleration–deceleration–rotational injury in brain part with high-density reference(gray and white matter)
Lacunar stroke symptoms?
Pure contralateral motor lesion(common)
Contralateral arm, LE weakness –Posterior limb of IC
Contralateral UM Facial bulsy–Genu of IC
Pure sensory syndrome
Ataxic hemiparesis
Dysarthria–Clumsy hand syndrome
Absent sensory, MS change, seizure, and cortical sign
CT scan may be negative in first 6 Hr
If striatum involved –movt disorder
pathophysiology?
HTN,DM, Hyperlipidemia and smoking—lipohyalinisis and atheroma formation in lenticular-striate artery–Ischemic infarction
Carotid artery dissection symptom?
due to brain hypoperfusion and embolism–hed/neck pain followed by horner syndrome(SG injury)
Internal capsule
Subcortical white matter(e.g IC,CR)
Pons
carotid artery thrombosis?
Visual symptom
All sign of brain hemisphere injury
Clumsy hand syndrome?
The symptoms in the pure sensory type of lacunar syndrome are limited to “a persistent or transient numbness and mild sensory loss over one side of the body, including face, arm, and leg,” without associated hemiparesis, visual field defect, brainstem dysfunction, memory loss, dyslexia, or other deficits.
the base of pons or IC
Evidences for vascular demensia?
Early forgetfulness(unlike AD(memory deficit) Late-onset memory impairment Stepwise decrease in functioning Having risk for ischemic stroke Focal nurologic deficit In the early phase transient improvement
Imaging?
multiple Cortical and subcortical infarction with/without white matter injury
In the case of NPH?
Ataxia followed dementia and urinary incontinence
Tremor that occurs on activity?
Essential T
Physiologic T
cerebellar lesion
Essential tremor?
usually Bilateral involvement of hand, not leg
Possible head involvement without dystonia
Usually no other neurologic deficit
improves with alcohol
Cerebellar lesion?
Usually have associated ataxia, dysmetria, and gait disorder
Tremor increase when reaching the target
Physiologic one?
Low amplitude-usually not visible under normal condition
Acute onset with increase sympathetic activity
(e.g drug, caffeine, anxiety, and hyperthyroidism)
usually worse with movement and involve face and UE
essecial tremor managment?
Beta blocker-propranolol
Anticonvulsant(Primidone and topiramate)
BZD–restricted b/c of possible dependence
Deep brain stimulation and thalamotomy–For significant
Type of gait?
Cerebral Gait apraxia(frontal get) Parkinsonian steppage Parkisonian
Cerebellar?
Staggering(to walk in an uncontrolled way, fall ver)
Wide based
Cerebellar swings from side to side(trunkal ataxia)
Gait apraxia(frontal get)?
Magnetic(freezing)--Difficulty in initiating foot Start and turn hesitation Dementia Incontinence frontal lobe sign
parkinsonian?
Short step
Shuffling ( dragging one’s feet along or without lifting them fully from the ground)
Parkinson symptom
steppage(high steping)?
excessive flection of hip and knee slapping quality fall due to distal nerve injury/neuropathy Usually due to LS radiculopathy or Common peroneal nerve injury resulting in foot drop
Vestibular?
Unsteady Usually, fall one side nausea and vertigo Normal sensory, motor, and reflex Due to labyrinthitis and meniere disease
Gillian-Barie syndrome?
Paraesthesia or neuropathic pain
Symmetric ascending weakness
decrease/absent DTR
Autonomic dysfunction(e.g arrhythmia and ileus
Bulbar symptoms(dysarthria and respiratory compromise)
recent URT or GI infection
Dysarthria?
difficult or unclear articulation of speech that is otherwise linguistically normal.
Diagnosis?
Clinical
LP: High protein with normal WBC
Abnormal electromyography and nerve conduction
managment?
Monitoring the autonomic and respiratory condition
IV Ig or plasmapheresis
normal CSF analysis value?
WBC:1-5
Protein < 40
Glucose 40-70
Medication-induced headache characteristics?
Nead daily headache insetting of acute headache meication
Occur inpatient with underlying headache(e.g migraine)
present > 3 month
change in the pattern/worsening of an existing headache
present upone awakening that improves for short period and rebound.
most common drugs that cause this and management?
butalbital containing product
acetaminophen
opioids
managment is to stop the culprit drug and use preventive therapy for the underlying headache
Symptom of myasthenia crisis?
Sign of respiratory failure
Exacerbation of generalized (proximal muscle weakness) and bulbar symptoms(e,g fatigable chewing, dysphagia, and nasal speech prior to the RF
Presence of precipitating factors
precipitating factors and managment?
Infection surgery pregnancy medication manage this patient in ICU and intubate them
Medication?
Aminoglycoside
Floroquinolol
Beta blocker
Macrolide
what about botulism?
prodromal GI symptoms will be there
West-Nile encephalitis?
Headache
Fever
Confusion
Asymmetric limb paralysis
face motor innervation?
Upper part: Bilateral cerebral cortex
Lower part: from the contralateral cortex
symptoms of bells palsy?
Upper and lower face palsy
Hyperacusis(weakness of stapedius)
Loss of taste in anterior 2/3 (loss of Corda tympani nerve)
Ipsilateral decreased lacrimation9due to parasympathetic nerve injury)
cryptococal meningitis feuture?
In HIV patient with CD4 < 100
Sign of Increased ICP
Centrally umblicated skin lesion mimicking MC(due to hematogenous dissimination.
Diagnose with LP(also used as therapeutic)
On imaging, the patient may have no lesion except ventriculomegaly (due to yeast obstruct arachnoid vili)
Goldinium enhanced MRI used in?
PML(see white matter lesion)
acute dystonia?
sustained and sudden contraction of neck, mouth, eye, and tongue muscle.
Present as torticollis, blepharospasm, and trismus
Occur mainly after usage of first-generation antipsychotics(HTF) or metoclopramide
managment?
Anticholinergic (Benzothropin and trihexyphenidyl)
stop or reduce the dose of the inciting drug
Medial medullary syndrome sign?
contralateral paralysis(PT injury)
Tongu deviate to the side of the lesion(hypoglossal nerve lesion)
defect in position and vibration sensation(medial laminiscus)
Is due to anterior spinal artery /Vertebral artery injury
