n4 Flashcards
Etiology for brain abscess?
Ataph aureus
Viridian streeptococus
anrobs
pathogenesis?
Direct spread(OM,mastoditis,dental infection and sinusitus) Hematogenous spread(IE)
Clinical finding?
Headache(unilateral, severe, and not respond to analgesic) vomiting Fever Focal neurologic deficiet Ring enhancing lesion on MRI
Treatment?
Aspiration/surgical removal
Prolonged antibiotic treatment
CT feuter of stroke?
Hemorrhagic: Hyperdense lesion, visible immediately
Ischemic;Hypodence lesion ,after 24 hr
Postconcusive syndrome?
Occur post any level traumatic brain injury
Start within the hour to days post-TBI
The constellation of symptoms are headache, confusion, amnesia, difficulty of concentration, vertigo, mood alteration, sleep disturbance, and anxiety
Negative all basic tests
Resolve with symptomatic treatment within few weeks to months.
In some case may persist for more than a month
Risk factor lead poisoning?
Gastrointestinal (constipation, abdominal pain, and anorexia)
Neurologic (cognitive deficiency and pheripherial neuropathy)
Haematologic (Anemia & possible basophilic striping)
Hypertension due to nephrotoxicity
Laboratory?
Anemia
Elevated venous lead level
Elevated serum zink protoporphyrin level
Basophilic stippling on pheripherial smear
Other manifestations of cervical spondylosis other than compressive myelopathy?
Cervical radiculopathy
Cervical radiculophaty feucher?
Common in old age
Physical activity like shoveling snow, golf, and diving increases risk.
Due to degeneration and osteophyte formation zygapophysial and uncovertebral joint–IVF narrowing–compressive nerve root symptome.
Shoulder, neck, and or arm pain
weakness in myotome(e.gaxillary nerve) and sensory loss in dermatome(e.g C6)
MRI of the cervical spine
Subarachnoid hemorrhage feuter?
Sever thunderclap headache(maximal within 1 min)
Sign of meningeal irritation(nausea/vomiting and photophobia)
Seizure and FND(uncommon)
Berry aneurysm is MCC of non-traumatic SAH
CT(hemorrhage around brainstem and basal cisterna)
LP: elevated pressure and xanthochromia(do if strong suspicion and negative CT)
Angiography(For aneurysm diagnosis and managment(clumping and stent)
Hypertensive encephalopathy?
Headache, nausea, and vomiting
Confusion and restlessness
D/t spinal compression from diabetic neuropathy?
IN DN
Motor symptom develop lateley exept reflex)
Disease progress in a long period
Global aphasia symptoms?
Difficulty in comprehension(sensory)
Difficulty in word-finding(motor)
Frontal eye field damage?
The eye gaze to the ipsilateral side to the lesion
How to differentiate TIA from multiple sclerosis exacerbation?
TIA neurologic deficit resolve within 30 min, max–24 hr
IN MS –Stays days to weeks
TIA managment?
Treat risk factor
Asprine
Statine
Benign paroxysmal positional vertigo feuctre?
Pheripherial vertigo(have a short episode, fatigable nistagmus inhibited by gaze fixation) Due to crystalline debris (canaliths) in the semi-circular channel --disrupt the normal flow of fluid in the vestibular system Since only affect the cemicircular channel no hearing oss Diagnose with Dix-hall pike maneuver (quick supine positioning with rotate headed 45 degrees.
Broca aphasia?
Due to a lesion in the frontal gyrus
Middle cerebral artery lesion
Dominant hemisphere for verbal and written language(left hemisphere in 95% of right-handed and 70 % of left-handed) lesion.
Patient committee commands but difficulty in verbal formation, repetition, and writing
Conduction aphagia symptoms?
Fluent with phonemic error
preserved comprehension
Poor repetition
Due to isolated arcuate fiber injury
Nondominant frontal lobe lesion and speech?
Affect person way of conveying emotion through speech
Nondominant temporal lobe lesion and speech
Inability to comprehend the gesture
Pain managment?
first NSAID if not respond then opioids(morphine) even addicted or not
Status epileptics?
The seizure lasts for more than 30 min
But seizure > 5 min is associated with brain injury due to excitatory cytotoxicity–cortical laminar necrosis–increase risk of neurologic deficits and recurrent seizure
Brain MRI will diagnose it
May cause increase ICP
Tabes dorsalis?
TP directly damage the dorsal sensory root
Damage may extend to the dorsal column
Rapidly develop in HIV patient
clinical symptoms?
Impaired vibration and proprioception
Sensory ataxia(Positive Romberg test)
Diminished pain and To sensation
Reduced/absent DTR
Lancing (shooting and burning)pain in the face, back, or extremity)
Argyl Roberston pupil(miotic, irregular pupil that reacts to accommodation but no light)
Treat with IV penicillin for 10-14 day
amyotrophic lateral sclerosis?
Devastating progressive neurodegenerative disease
Present both UMNL and LMNL
asymmetric limb weakness
UMNL?
Spasticity and exajurated DTR
Due to lesion frontal motor neuron and their axon
Cortico bulbar lesion (Pseudobulbar palsy)-dysarthria, dysphagia, and pseudobulbar affect(inappropriate laughing and crying)
LMNL?
LMN lesion in the brain stem and spinal cord
Fasciculation (feeling of movt in face and toungue)
weakness and atrophy in LE
Dysarthria, dysphagia and tongue paresis
Parkinson’s disease diagnosis?
Clinical
Having 2 of 3 cardinal symptoms corroborated by physical examination.
Tremor in PD caracterstich?
A resting
Pill rolling quality(4-6 HZ)
Start one hand then generalized and involve LE
Rigidity In PD character?
Defective passive movement at joint
Can be uniform(lead pipe) or oscillating (cogwheel)
Bradykinasi?
Inability to start a movement Narrow based shuffling gait, short strides without arm movement(fascinating gait) Small writing(micrographia) Hypomania(decrease facial expression) Hypophonia(soft speech)
Postural instability?
Flexed axial fetcher
Loss of balance during turning or stop walking
Loss of balance when pushed on standing position
Frequent fall
ALS treatment?
Riluzole(glutamate inhibitor)
Prolong survival and time of tracheostomy
Its S/E: dizziness, nausea, weight loss, elevated LFT, and muscle weakness.
Descending aortic dissection neurologic complication?
Thoracic cord ischemia which is generally caracterized by
T10-T12 vertebra is at risk due to its low blood flow
All
ALL neurologic function except position and vibration sensation will be affected
Reflex decrease in early lesion but increase therafter
Arterial supply of spinal cord?
Anterior part: Anterior spinal artery(from VA) and segmental artery from the aorta.
Posterior part: Posterior spinal artery(from VA and PISA)
What causes posterior corf ischemia?
Vertebral artery dissection/occlusion
Hypokalemia symptoms and signs?
Weakness, fatigue, and muscle cramp in a mild case
Flaccid paralysis, hyporeflexia, tetany, rhabdomyolysis, and arrhythmia in severe cases.
ECG: Flat T wave, U wave.Depressed ST and premature ventricular beat.
Acute herpitic nuralgia?
Present <=30 days from rash
NSAID,analgesics
Due to hemorrhagic inflammation
Subacute herptic nuralgia?
Present >=30 days from rash and resolve within 4 months from rash onset
NSAID,analgesics
Post herpetic nuragia?
Pain persists for more than 4 months from rash onset
allodynia (pain exacerbated by a simple touch)
sensory examination(paraesthesia and anesthesia)
Gabapentine
TCA
Pregabaline
Intrathecal glucocorticoid in refractory case
Brain death diagnosis?
It is a clinical diagnosis
Absent cortical snd brain stem function
Spinal cord activity may present(Like DTR)
fibromyalgia symptom and sign?
Middle-aged women
Widespread somatic pain
Fatigue
Cognitive and mood disturbance
Tenderness in trapezius, lateral epicondyle, costovertebral junction, and greater trochanter.
Normal PE/Normal Lab and no family history
managment?
Patient education. aerobic regular exercise and sleep hygiene.
If not respond TCA
If not respond to TCA -SNRI or pregabalin
If persist combination therapy or referral to pain managment, rehabilitation, and CBT.
Brown squad syndrome?
Spinal cord hemisection
Ipsilateral motor dysfunction at the level of injury and below
Ipsilateral Position, vibration, and light touch dysfunction at the level of injury and below
Contralateral pain and to 1-2 cords below the lesion level
If involve spinal level there will be horner syndrome
Reflex absent at first due to spinal shock but present after spinal shock resolved
Managment of lead poisoning?
chelation with Calcium disodium EDTA
Avoid further lead exposure during chelation b/c it further increase lead absorption
Diferencial?
Hypothyroidism (BUT normal or macrocytic anemia)
Hypocalcemia(no anemia)
Lead poisoning and gout?
Lead–affect purin metabolism–hyperuricimia–gout
an early symptom of each type of dementia?
Vascular --executive function Alzheimer--Anteerograde memory loss FTD--personality(aggressive) behavior Lewis body--cognitive fluctuation Normal aging:--gradual decline in mental processing
Spinal stenosis diagnosis?
MRI
the patient will have a low pack and leg pain exacerbated on standing and relieved by sitting b/c flection widen spinal channel and extension will narrow it.
10% of patients will have positive straight leg test +
weakness, sensory symptoms, and paraesthesia may present.
Gait type and specific lesion?
PD: Hypokinetic gait, narrow-based
Cerebellar: fall on one side
Gait disequilibrium: Frontal lobe
Spastik gait: UMNL
Sensory ataxia: wide spaced and steeping gait
Vestibular ataxia: minimal head with staggering
Subacute combined degeneration?
Dorsal column injury
Spastic paralysis
Reduced DTR
Macrocytic anemia
Mercury toxicity?
Parastesia
Motor deficiet
loss of DTR
When to consider imaging in patients with headaches?
Neurologic finding: seizure, FND, and AMS
Change in frequency, character, and intensity of headache
New at age >40
Sudden onset
Present in awakening
Tension headache?
More common in female No family history Onset under stress Band like pattern around the head(temporal & occipital) Dull,tight and persistent 30 min to 7 days Induced by stress Muscle tenderness in the head,neck and shoulder
Managment?
NSIAD and acetaminophine(<=1 day /month)
TCA and CBT prophylaxis for frequent,persistent or disabling pain.
Most segnificant complication of idiopatic intracranial HTN if left untreated?
Blindness
Shunting optic nerve shite can prevent thise risk if medical therapy failed.
Treatment ?
Disease occur b/C of lose of cholinergic nurone in CNS
Donopezil,rivastegmin snd galatamine(ACh ihibitirs
