N2 Flashcards
pseudodementia?
Is when an elderly patient with a depressed mood present with dementia
Defect in attention, concentration, executive function, and memory with poor effort during testing
reversible with treating the underlying depression
Differential?
Alzheimer(Dementia and may have depression)
But the absence of other dementia symptoms like apraxia, agnosia, and aphasia absent in pseudodementia
Parkinsons (may have depression and dementia) but will have a movement disorder
Aging (will have depression but no cognitive impairment)
Apraxia?
Is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement?
Both the desire and the capacity to move are present but the person simply cannot execute the act.
Agnosia?
is the loss of the ability to recognize objects, faces, voices, or places.
Hallucination inpatient with Parkinson’s?
If Post mediation Dopamine agonist(Premipixole) Dopamin precursor(Levodopa) If not started medication By disease itself
Managment?
Changing pramipexole to levodopa
Low dose second-generation antipsychotic(e.g quintapin)
Lewis body dementia diagnosis criterion?
2 of 4 criterion Visual hallucination Parkinsonism REM sleep disorder fluctuation of cognition Diagnose in Parkinson if symptoms occur before 1 year after Parkinson diagnosis
Alzheimer fetcher?
Early Insidious short-term memory loss Language deficit Apraxia Late Spatial disorientation Latter personality change middle/late Psychotic fetcher (Paranoid delusion common)
Risk factor?
Female Old age Head trauma Family history Down syndrome
Brain imaging?
Cortical atrophy
Reduced hippocampal volume
Medial temporal lobe atrophy
General paresis?
dementing illness occur in late or tertiary syphilis
decrease concentration, memory loss, personality change, dysarthria, tremor of hand and lip, and mild headache
RPR may be negative but need FTA test
What to investigate in patients with dementia?
syphilis
hypothyroidism
B-12
Lweis bodie dementia pathology?
Lewis bode( Intracytoplasmic eosinophilic inclusion(Alpha synuclin) in substantia nigra,rapha nucli,loccus cerilous and substansia inanimota)
Managment?
Levodopa-Carbidopa for parkinson
Anticholinesterase inhibitor for dementia
Low dose second-generation antipsychotic for persistent psychotic symptom
Treatment of myasthenia crisis?
intubate for sign of RF
Corticosteroid or another immunosuppressant if CS ineffective
Plasmapheresis
Immunoglobulin
Hold the physostigmine if the patient intubated to reduce secretion and aspiration risk
Brain tumor manifestation?
Headache with one of the following Nausea and vomiting Focal nurologic deficit Symptoms worsen during the night and factor increase ICP(bending and coughing) Sign of ICP support diagnosis
Hemiplegic migraine?
Occur in children
neurologic deficit lasts within hours
Nuroglycopinia?
Lasts within hour
headache and nausea
Focal nurologic deficit
When do we consider stoping phenytoin?
Seizure free for > 2 year and if
Low seizure recurrence risk
Wants to be pregnant
Low seizure recurrence risk?
Normal MRI
Normal EEG
absent family history
positive initial response to therapy
Fetal hydantoin syndrome?
orofacial cleft microcephaly dysmorphic facial feucher cardiac defect nail/digit hypoplasia
managment of brain metastasis?
surgery in a patient with good survival
followed by stereotactic radiosurgery or whole-brain radiation therapy for non-responsive one
SR or WBR for difficult for access tumor,small and disseminated
Common location?
gray and white matter junction
dystonia characteristics?
repetitive
rhythmic
sustained muscle contraction
abnormal posture
how to D/t from chorea?
chorea is not repetitive or rhythmic
movement from one part to other
vascular dementia neurologic finding?
Cortical(large area involvement)–hemispheric lesion presentation as stroke
Subcortical–small area(urinary incontinence,abnormal gait,psychiatry symptome,focal neurologic symptome0
Tetanus clinical manifestation?
musle spasm trigerd by stimuli
lockjaw
Autonomic dysfunction(HTN.tachycardia,Fever)
pathogenesis?
toxin-mediated inability to release inhibitory neurotransmitter(GABA and Glycine)
cause of spinal compression?
Trauma
Infection
malignancy
D/t spinal compression from a degenerative disease?
compression case back pain worse at night unlike degenerative one
epidural abscess symptoms?
fever
back pain
neurologic finding
cause?
S.A is a common etiology
Distal infection
Spinal procedure
IV drug user
What about transverse myelitis?
Both common in immunocompromised but TM Segmental inflamation Sensory level flaccid weakness and no fever both can cause urinary retention
urinary retention and sensory level indicate lesion site?
Urinary retention–lesion above S2
sensory deficit level indicates 2 spinal roots above lesion level.
managment of epidural compresion?
Immediate neurosurgical evaluation
MRI of the spine while evaluated
High dose steroid for metastatic compression
Angle-closure glaucoma symptoms?
Headache Nausea Vomiting Occular pain decrease visual acuity conjunctival redness corneal opacity mid dilated pupil
Initiating event for closure?
Factor increase pupillary dilation
anticholinergic
sympathomimetics
deem light
Diagnosis?
Tonometry(IOP measurment)
Gonioscopy(angle measurment)
how to differentiate AACG from cluster headaches and migraines?
M and CH has
recurrent attack
start at a young age
in cluster horner syndrome(pupillary constriction)
Optic neuritis?
acute eye pain
visual loss
afferent pupillary defect
common in MS
corrected ESR?
(age + 10)/2
common mood disorder in PD patients?
MDD
Multiple sclerosis future?
women age 15-50
disseminated in time and space lesion
pathophysiology?
The demyelinating disease involves the cerebrum, brain stem, optic nerve, and spinal cord.
Managment?
Acute attack with high dose corticosteroid and plasma exchange if not respond to corticosteroid
immunomodulatory(natalizumab,interferon-alpha and galatamir) for persistent symptoms
Imaging and LP?
hyperintense white matter lesion in the area affected
LP:if diagnosis dilemma–oligoclonal IgG band
Intraparenchimal heamorage?
commonly occur while on activity
commonly affect basal ganglia, cerebellar nuclei, pons, and thalamus.
rapidly progress(unlike IS, SAH–maximal at onset)
headache, nausea, and vomiting
Putamen injury sign?
contralateral Hemi motor /sensory deficit-IC injury
Eye gaze towards the lesion–Frontal eye field injury
symptoms of CN 3 palsy?
pupillary dilation
eye down and outward
Cause?
Pupil sparing
ischemia–HTN, DM, hyperlipidemia, and advanced age
Pupil Involving
Compression-aneurysm, tumor–Do MRI or CT angiography
indication for thrombolytic in ischemic stroke?
ischemic stroke with the measurable deficit
present within 3-4.5 hr of symptom
No contraindication
after hemorrhagic stroke ruled out by non contrast CT
