N5 Flashcards
depresion related dementia(psudodementia)?
Depresion symptoms preceds dementia
Resolve when depresion is treated
IE and strock?
can cause stroke by septic emboli
commonley involve MCA–lobar heamorage/infarction
Risk factor for heat stroke?
Strenous activity during hot or humuid weather
DHN and poor acclimatization
Lack of physical fittness and obesity
Medication:Anticolinergic,phenotiazin,Antihistamin,anticychotics, and TCA.
Clinical menifestation?
Core temprature > 40 CNS dysfunction(AMS and seizure) Renal failure Hepatic failure DIC ARDS
Managment?
Rapid cooling Fluid resucitation Electrolyte correction Managment of end organ complication No need of antipyretic
Cause of anterior spinal artery injury during trauma?
disk retropulsion and bone part during vertebral brust #
Anterior circulation?
MCA,ACA and ICA
Posterior circulation?
VA.BA and PCA
Anterior cerebral arthery stroke symptome?
Motor dysfunction and sensory loss pronounced in LE
Urinary incontinence
gait dyspraxia
primitive reflex(gasp,suckling may reaper)
abulia
emotional disturbance
Presbycusis?
Age related high frequancy hearing loss
Age related
Symmetric and bilateral SNHL(weber midline and AC>BC,like normal case)
Hear one to one spech in quite room
Presense of background noise impaire hearing
Conductive hearing loss?
weber latteralize to affected ear
BC>AC on affected ear
SNHL?
weber latteralize to normal ear
AC> BC on affected ear
Treatment of agitation?
Llow dose haloperidol
Should not be used in patient with lewis body dementia
Glucocorticoid induced myophaty?
Proximal muscle weakness and atrophy without pain and tenderness
More involve lower extremity
Normal ESR and CK
Polymyalgia rheumatica?
muscle pain and stiffnes in shoulder and pelvic girdle
tenderness with decrease range of motion at neack,shoulder and hip
respond rapidley to glucocorticoid
increase ESR and normal CK
Inflamatory myophaty?
Muscle pain,tenderness and proximal muscle weakness
Skine rash and inflamatory artheritis may seen
Increase ESR and CK
Statine induced myophaty?
muscle pain and tenderness with or w/o weakness
rare rhabdomyolysis
Normal ESR nd elevated CK
Hypothyroidism myophaty?
Proximal muscle pain,cramp and weakness
Delayed DTR and myoedema
Occational rhabdomyolysis
Normal ESR and elevated CK
Management of idiopatic ICH?
Acetazolamide(inhibit CA in choroid plexus –Decrease CSF production)
Add furosemide if not respond
if not respond to medical treatment–Surgical(Lp shunting and optic nerve sheth aspiration)
Corticosteroid and intermitent LP until surgical intervention done.
What about manitol?
Used for onley cerebral edema
Multiple system atrophy?
also called shy-Drager syndrome
a degenerative disease characterized by
1)Parkinsonism
2)Autonomic dysfunction(generalized)
3)Widespread neurological signs (cerebellar, pyramidal, and LMN lesion)
–accompanied bulbar dysfunction and stridor may be fatal
–antiparkinson drugs is ineffective
–always consider if parkinsonism patients present with generalized autonomic dysfunction
Managment?
Volume expansion using Fludrocortisone Salt supplementation Alpha adrenergic agonist Application of a constrictive garment to LE
Raily-day syndrome?
Also called familial dysautonomia
Autosomal recessive syndrome
Feeding difficulty and low muscle tone
Gross dysfunction of the autonomic nervous system
Features suggesting MS?
Onset age 15-50 Optic neuritis Lhermitte sign Internuclar optalmoplagia Fatigue Uhthoff phenomena (symptom exacerbation with heat) Numbness and Paratsesia Paraparesis and spasticiry Bowel and bladder dysfunction
Memantine?
Block glutamate receptor
Used in mild and moderate Alzheimer
Creuzfeldt-Jakob disease?
Spongiform encephalopathy caused by prion disease
rapidly progressive dementia, myoclonus
behavioral abnormality
sharp, triphasic, and synchronous discharge in EEG
patient dies within one year of diagnosis
Phenytoin toxicity?
Occur in first dosing, dose adjustment, liver disease, renal disease, concomitant CYP450 drug inhibitor, rapid IV fosphenytoin, and factor decrease protein bounding.
Manifestation?
Cerebral dysfunction(horizontal nystagmus,ataxia,dymentria,nausea, slured speech and vomiiting) Sever toxicity:AMS,paradoxical seizure,comma and death Hypothension and bradyarrythemia(Rapid infusion)
Evaluation of first seizure episode?
CBC OFT Serum glucose Drug toxicology screening on urine Routine EEG for risk stratification after above laboratory done normal(epileptiform or non-epileptiform)
Patternof CN III lesion?
Motor and pupillary dysfunction—-Midbrain injury/Compression
Onley motor:–Ischemia
Onley parasympathetic—compression
How to differentiate neuropathy due to pheripherial nerve compression and spinal compression?
In spinal compression, there will be back pain
Cause of corneal abrasion?
factor lead to cornial epithelial injury
Trauma
Contact lenses
spontaneous
Clinical symptoms?
Severe eye pain
Foreign body sensation
Photophobia
Decrease/normal visual acuity
Evaluation?
Pupillary reaction
Inspect presence of foreign body
Assess visual acuity and send to an ophthalmologist if decreased
Corneal staining defect with fluorescein
Presence of corneal abrasion without pain indicates?
CNV or V1 brach lesion
Normal-pressure hydrocephalus clinical manifestations?
Wide based gait, shuffling with frequent fall
Cognitive dysfunction
Urinary urgency/incontinence
Depressed affect
UMNL in LE(but disease common in old>60 the DTR may below)
Diagnosis and managment?
Ventriculomegaly with CT/MRI
Confirm by doing LP: Normal pressure and clinical Improvement ataxia after large volume CSF removal–miller-fisher test
Definitive management is doing a ventriculoperitoneal shunt
Urinary urgency/incontinence with dementia?
NPH, Vascular dementia and late alzimer
What to do before Thymectomy in MG patients?
Thymectomy may result MG crisis–So adequate dose of physostigmine and corticosteroid before surgery
Thalamic pain syndrome?
Also called Dejerine-Rousy syndrome
Develop several weeks to a month following acute stroke
Severe paroxysmal pain in contralateral Body induced by light touch(allodynia) in the face and extremity due to VPL and VPM nuclei injury respectively.
lacunar stroke due to atheroma closure of penetrating branch of PCA
optic neuritis finding?
Common in young wommen Unilateral visual loss Associated with MS Due to demylinating disease Eye pain during movment Afferent pupillary dysfunction Washed out colour vision Central scotoma Colour vision loss Fundoscopy may be normal(Infn occur behind optic disk)(a sign of acute inflammation(hemorrhage) in the acute case and atrophy in chronic case) Diagnose with MRI of brain and optic treat with IV corticosteroid
Sarcoidosis and facial palsy?
A patient will have INFP sign Hypercalcemia Bilateral parotid enlargement Cervical lymphadenopathy Treat with prednisolone
Hemorrhagic transformation?
Occur mainly in the first 48 hr after Ischemic stroke diagnosed.
The patient clinical condition will deteriorate
Common in large size IS or after thrombectomy
Do non-contrast CT of head
Fronto-Temporal dementia?
Also, called pick disease
mainly start the 40s and 50s
40% family history
Due to damage of frontal and temporal lobe–FrontoTemporal atrophy in imaging
Early personality and behavioral change(e.g disinhibition and apathy)
Compulsive behavior(e.g hoarding and hyperorality)
Executive dysfunction
How to D/T from hoarding disorder?
Start as teenage and progress with age
Inability to keep adipose things
what we consider if INFP prolong > 3 month?
Suspect diagnosis other than bells palsy
Bells palsy treatment?
Pridisolone is the main stay
We may consider adding acyclovir/vancyclovir
Cortical blindness?
Normal pupillary reaction
Central artery occlusion?
painless visual loss retinal whitning(cherry-red spot)
Macular degeneration?
Mainly affect older patient
Yellow deposit in the periphery
central visual loss develop progressively
affect both eyes
retinal detachment?
loss pheripherial vision first
Cluster headaches?
Acute, Severe unilateral periorbital headache
Mainly start at sleep and can occur 8-9 times per day and lasts up to 90 min
Autonomic symptoms (miosis, salivation, and lacrimation)
Normal neurologic finding unlike TN involving V1
Treat with 100 % oxygen and we can consider sumatriptan if no C/I(Px or IHD)
Prophylactics(Verapamil.lithium) after the acute attack
herpes encephalitis?
MCC of sporadic encephalitis in the US
MC IS due to HSV1
Fever
Focal neurologic finding(AMS,FCND,ataxia,hyperreflexia and seizure)
Behavioral abnormality(Hypomania, Klevier busy syndrome, and amnesia)
Diagnosis and managment?
CSF: Lymphocytosis, High RBC, High protein, Normal glucose
HSV PCR is the gold standard
Temporal lesion In MRI(preferred than CT)
Treat with IV acyclovir
CJD diagnosis criterion?
Rapidly progressive dementia with >=2 of the following clinical criteria 1-myoclonus 2-akinetic mutism 3-Cerebellar or visual problems 4-pyramidal/extrapyramidal defect
Finding?
one of the following 1-periodic sharp wave complex in EEG 2-Positive 13-3-3 assay 3-Caudate nucleus and putamen atrophy Neuropathology: Spongiform change, neuronal loss without inflammation
Managment?
No treatment available
Fatal within 12 months of diagnosis
Risk factor for drug-related peripheral neuropathy?
Digoxine Metronidazole Amidadrone Floroquinolol Dapsone
CM?
Glove and stock neuropathy
We May have to decrease DTR
The motor will be spared
Management?
STop drug
if persist TCA,Gabapentine/…
