Neuro Flashcards
concussion sx
HA, dizzy, confusion, amnesia, blurred vision
no focal neuro findings
concussion TestOC
TBI w/ LOC: CT w/o contrast (negative)
MRI if sx 7-14d
concussion tx
abnormal test: inpatient admission
normal: admit if GCS <15/ bleeding diathesis or oral anticoags, assoc seizure
no high risk: outpt f/u w/o imaging
avoid sports 1wk, reveal for clearance
rest for at least 24h
post concussive syndrome tx
analgesics, antiemetics
cognitive therapy
TBI MCC
MVA
TBI sx
focal neuro deficits
confusion, HA, dizzy
seizures, cerebral edema
TBI test
TBI w/ LOC: CT w/o contrast (fx, midline shift, bleed)
GCS
closed injury: dura mater intact
open injury: dura mater injured
TBI tx
mild: monitor 24h, refer to cognitive therapist
athletes: no contact sports 1wk, reeval gradual recovery
bells palsy nerve
CN7 facial nerve
CN7 exits out the skull where
stylomastoid foramen
bells palsy sx
does not spare forehead
loss of wrinkle
bells palsy tx
prednisone w/in 72h
severe: valacyclovir x 1wk
traumatic facial nerve palsy tx
surgical decompression of nerve repair
lateral rectus palsy nerves
CNVI abducens nerve - motor
LR6, SO4
MC ocular nerve palsy
lateral rectus palsy
lateral rectus palsy sx
horizontal diplopia
estropia (medial deviation of affected eye)
strabismus
trigeminal neuralgia TOC
carbamazepine
reversible complication of liver failure
hepatic encephalopathy
hepatic encephalopathy tx
lactulose 1st line
rifaximin
reyes syndrome MCC
kid who took aspirin
reyes syndrome sx
sudden N/V/D
delirium, seizures, hepatomegaly, minimal jaundice
reyes syndrome test
CT head: diffuse cerebral edema
dec glu, inc ammonia, inc hepatic enzymes
reyes syndrome tx
1st line: mannitol, glycerol, dexamethasone (neuro protection)
supportive
wernicke encephalopathy due to
thiamine (B1) deficiency
MCC wernickes encephalopathy
chronic alcoholism
wernicke encephalopathy sx
triad: ataxia, confusion, bilateral horizontal nystagmus
gait: slow wide based small steps
wernicke encephalopathy tx
supportive
agressive high dose IV thiamine
wernicke encephalopathy complication
Korsakoff syndrome (chronic irreversible), amnesia, disorientation
cluster HX sx
unilateral periorbital pain
lasts <2h
cluster HA tx
initial: sumatriptan subQ, 100% oxygen
cluster HA prophylaxis
verapamil (CCB)
migraine ha tx
sumatriptan or ergotamine
prochlorperazine (antiemetic)
NSAID
prophylaxis migraine HA
BB
topiramate
TCA
valproic acid
sumatriptan or ergotamine CI
HTN, CVD
migraine in pregnancy tx
acetaminophen
promethazine (antiemetic)
NSAIDS
metaclopramide, promethazine (dopamine blocker) AE
EPS/dystonic reaction: give w/ diphenhydramine
tension HA tx
Acute: NSAIDS or acetaminophen
tension HA prophylaxis
amitriptyline (TCA)
MCC encephalitis
HSVI
encephalitis sx
AMS (24+h)
F, HA, focal neuro deficits (hemiparesis, CN palsy)
encephalitis test
CT of head or MRI (most sensitive for HSV): temporal lobe edema
LP
encephalitis involves cn
CN II, IV, VI, VII
encephalitis tx
supportive
HSV: acyclovir IV ASAP
monitor if give acyclovir IV
kidneys
AIDS + meningitis
cryptococcus neoformans
cryptococcus neoformans meningitis test
CSF: inc opening pressure, variable pleocytosis, inc protein, dec glucose
india ink stain: encapsulated yeast forms
meningitis <1mo
GBS (streptococcus agalactiae)
ampicillin + cefotaxime or amino glycoside
MCC meningitis 1mo-18yo
N. meningitidis (assoc w/ petechial rash)
S. pneumo
MCC meningitis 18y-50y
S. pneumo
N. meningitidis (assoc w/ petechial rash)
meningitis tx 1mo-50yo
ceftriaxone/ cefotaxime + vanco
meningitis >50yo
S. pneumo
listeria
ampicillin + ceftriaxone/ cefotaxime +/- vanco
MCC bacterial meningitis
S. pneumo
N. meningitidis
meningitis sx
F, stiff neck, AMS
+brudzinski
+kernig
petechial rash w/ neisseria
s. pneumo cough
hx of sinusitis/pneumonia
meningitis test
1st: blood culture (neutrophils)
2nd: abx
3rd: CT of head + LP (definitive)
meningitis tx
steroids (dexamethasone) before abx
adult: vanco + cef
infant: ampicillin + cefotaxime
>50/ immunocomp: vanco + cef + ampicillin
viral aseptic meningitis MCC
enterovirus (Echovirus, coxackie)
HSV
viral aseptic meningitis sx
+meningeal sx
+brudzinski
+kernig
sx not as intense as bacterial
no focal neuro deficits/ seizures
HSV meningitis sx
skin lesion (primarily involves temporal lobe)
aphasia, olfactory hallucinations, personality changes
Mumps meningitis sx
parotid swelling
west nile meningitis sx
flaccid paralysis w/ rash
RMSF meningitis sx
red maculopapular rash on wrists and ankles
lyme meningitis sx
erythema migrans
bilateral facial nerve palsy
circa arrhythmias
VZV meningitis sx
vesicles in dermatomal distribution
viral aseptic meningitis test
LP: lymphocytes, normal glucose
patchy lobe enhancement
HSV meningitis test
RBC in CSF
viral aseptic meningitis tx
empiric abx until viral cause confirmed
supportive: NSAIDS for fever
HSV meningitis tx
IV acyclovir
meningococcemia MCC
N. meningitidis
meningococcemia sx
meningitis + septicemia
sudden onset, rapid progression. F, hypoTN, HA, nuchal rigidity
AMS, petechial rash w/ grey necrotic centers
meningococcemia test
clinical
confirm w/ BC w/ gram stain and LP
meningococcemia tx
vancomycin + ceftriaxone
essential tremor tx
propranolol + primidone
huntington dz MOA
autosomal dominant
HTT (repeated CAG) on chromosome 4
more repeats = earlier onset w/ each generation
CAG: caudate loses ACh and GABA
huntington dz sx
initial: chorea, hyperreflexia, athetosis, irribilitity, personality changes, inappropriate laughing/crying
advanced: progressive dementia
athetosis
slow snakelike movements in Huntington’s
huntington dz test
huntington disease test
definitive: genetic testing (PCR) and counseling
CT: cerebral and caudate atrophy
PET: dec glu metabolism in caudate nucleic and putamen
huntington tx
sx and supportive
tetrabenazine
antipsychotics, SSRI, psychotherapy
Parkinson MOA
depletion of dopaminergic neurons in basal ganglia
substantia nigra
Lewy bodies
Parkinson sx
resting tremor (pill rolling)
cogwheel rigidity
bradykinesia
postural instability, shuffling gait
masked facies
dementia: late finding
myerson sign
parkinsons
tapping bridge of nose causes blinking
Parkinson tx
no cure
1st line: levodopa/carbidopa (if new psychosis, dec dose)
<65yo: pramipexole or ropinerole +/- levo/carb
>65: + amantadine
levodopa AE
induce psychosis in elderly pts w/ dementia
COMT (entacarpone, tolcapone) AE
brown colored urine
anticholinergics AE
BPH
glaucoma
Tourettes assoc w/
ADHD
OCD
tourettes dx
clinical
motor ticks and at least 1 vocal tic for >1y
onset before 18yo
not explained by substance or other med conditions
tourettes tx
CBT
guanfacine
clonidine (can be adjunct)
haloperidol
risperidone
tetrabenazine
meningioma assoc w/
neurofibromatosis (NF2)
menengioma sx
benign, slow growing
chronic HA worse upon awakening
seizure, focal deficit, AMS
meningioma test
MRI of head w/ contrast: intensely enhancing well defined lesion attached to the dura
brain bx: spindle cells in whirled pattern psammoma bodies
meningioma tx
surgical resection
radiation if unresectable
glioblastoma multiforme sx
rapid progression w/ poor prognosis
MC in adults
chronic HA worse upon awakening
triad: irregular respirations, HTN, bradycardia
inc ICP
visual disturbances
glioblastoma multiforme test
MRI w/ contrast: single lesion
variable ring of enhancement surrounded by edema, may cross midline. butterfly glioma
brain bx: necrotizing tissue
glioblastoma multiforme tx
surgery, chemo rad
MC malignant primary brain tumor
glioblastoma multiforme
medulloblastoma sx
MC in children
HA, vomiting, ataxia
CN VI palsy
dysmetria
medulloblastoma test
MRI: solid homogenous contrast enhanced mass
obstruction of 4th ventricle
hydrocephalus
medulloblastoma tx
surgical w/ chemo rad
pseudotumor cerebri sx
young obese female w/ hx vitamin A toxicity, use of OCP, steroids, or tetracyclines
inc ICP w/ unidentifiable cause
HA worse w/ straining, visual disturbance
CN VI palsy, diplopia w/ lateral gaze
retrobulbular pain, tinnitus
pseudotumor cerebri test
CT r/o mass
MRI usually normal
Most accurate: LP (inc opening pressure)
pseudotumor cerebri tx
acetazolamide
operative: optic nerve sheath fenestration
MC form of dementia
alzheimers
alzheimers MOA
dec Ach
slow and progressive
alzheimers sx
short term progressive memory loss
functional impairment
alzheimers test
mini COG/MMSE
MRI
CT: brain atrophy, narrowing of gyro and widening of sulci, ventricles enlarged
CSF: tau protein
definitive: brain bx (neurofibrillary tangles and amyloid plaques)
alzheimers tx
donepezil, galantamine, rivastigmine
late stage: memantine
delirium criteria
confusion assessment method algorithm
3/4
acute onset/ fluctuating course
inattention
disorganized thinking
altered level of consciousness
delirium sx
tx underlying, DC causative meds
avoid restraints or atypical antipsychotics
haloperidol/risperidone if life threatening
benzo worsen delirium
dementia test
MMSE 24 or less, PHQ9
CT: cerebrocortical atrophy, ventricular dilation, prominent cortical sulci
dementia tx
no cure
memantine
types of dementia
alzheimers
vascular
frontaltemporal
diffuse lewy body
creutzfelt Jakob
creutzfeldt Jakob disease sx
dementia at a early age from misfolded proteins
rapid progressing, cognitive impairment
seizures, myoclonic jerks triggered by startling
creutzfeldt Jakob disease test
LP (14-3-3 protein in CSF)
EEG: sharp triphasic wave complexes
brain bx: spongiform encephalopathy
creutzfeldt Jakob disease tx
N/A
onset to death within months
frontotemporal dementia (picks dz) MOA
degeneration of frontal and temporal lobes of brain
abn nerve cell proteins (pick bodies)
frontotemporal dementia (picks dz) sx
personality and social behavior changes
aphasia, memory deficits
+ palmomental and palmar grasp reflexes
frontotemporal dementia (picks dz) tests
clinical
MRI: atrophy of frontotemporal lobes
definitive: brain bx (pick bodies)
frontotemporal dementia (picks dz) tx
supportive
SSRI
monitor for development of ALS
Lewy body dementia MOA
accumulation of Lewy bodies
Ach and Dopamine
Lewy body dementia sx
visual hallucination (children/animals)
Parkinsonism (bradykinesia, rigidity)
delusions, cognitive fluctuations, trembling
Lewy body dementia test
clinical
brain autopsy: Lewy bodies
Lewy body dementia tx
cognitive sx: donepezil, galantamine, rivastigmine
motor sx: levodopa
avoid dopaminergic rx
quetiapine for AVH
normal pressure hydrocephalus MOA
dec CSF absorption
normal pressure hydrocephalus sx
wet, weird, wobbly
urinary incontinence, dementia, shuffling/ wide based gait/ ataxia
normal pressure hydrocephalus test
inial: MRI (ventriculomegaly)
confirm: high volume LP (normal opening pressure)
normal pressure hydrocephalus tx
shunt placement
vascular dementia RF
HTN
CAD
atherosclerosis
HLD
smokers
vascular dementia MOA
damage to brain cells d/t lack of blood/oxygen
vascular dementia sx
sudden stepwise decline
focal neuro deficits
vascular dementia temporal sx
memory problems
vascular dementia parietal sx
loss of speech (aphasia)
vascular dementia frontal sx
personality changes
vascular dementia tests
CT/MRI: ischemia
MMSE
vascular dementia tx
prevent future stroke (anticoagulant tx)
ASA, clopidogrel, statin, ACE)
PT/OT
cerebral palsy MCC
prematurity
cerebral palsy sx
spastic (MC, hallmark) = inc muscle tone, inc DTR, seizures, toe walk
non-spastic: dystonia, chorea, dysphasia
ataxic: shaky uncoordinated movements, poor balance
all types: intellectual disability, seizure, joint contracture, ADHD
cerebral palsy test
cranial US: neonates- hemorrhage, hypoxic injury, structural abnormalities
MRI: Infants- detect causative lesion
cerebral palsy tx
improve quality of life
baclofen- muscle relaxer
diazepam
anti epileptics for seizures
multiple sclerosis MOA
chronic progressive demyelination of brain and spinal cord
oligodendrocytes disorder
episodic relapsing remitting
multiple sclerosis sx
optic neuritis (MC)
trigeminal neuralgia
babinski
uhthoffs phenomenon
Lher mitts sign
charcots neuro triad
charcots neuro triad
nystagmus
staccato speech
intensimal tremor
seen in MS
uhthoffs phenomenon
worse w/ heat
Lher mitts sign
neck flexion causes lighting rod to spine down leg
seen in MS
Marcus gunn pupil
pupils dilate when light from unaffected eye to affected eye
multiple sclerosis test
BIT and MAT: T2 weighted MRI w/ ngaldinium
LP and CSF: oligoclonal glands (inc IgG), lymphocytic pleocytosis
MRI: Dawsons fingers, white matter plaques
multiple sclerosis tx
exacerbation 1st line: cyclophosphamide or methylprednisolone
2nd: plasma exchange
spasticity: baclofen
multiple sclerosis maintenance tx
1st line: Beta interferon, glatiramer acetate
myasthenia gravis associated w/
Thomas and thyrotoxicosis
myasthenia gravis MOA
autoimmune destruction of Ash receptors at neuromuscular junction and blocks transmission
myasthenia gravis sx
easy fatigue
ptosis (ice pack test= improves)
proximal muscle weankess
improved w/ rest, worse w/ activity
diplopia, normal DTR, prolonged chewing
myasthenia gravis test
initial: AChR ab test
MAT: edrophonium tension test
myasthenia gravis tx
1st line: pyridostigmine
procedural: IVIG or plasmaphoresis
myasthenia gravis complication
thyme
thymectomy <60 then prednisone if thymectomy or initial tx doesn’t work
myasthenia gravis avoid
FQ
aminoglycosdes
pyridostigmine AE
cholinergic crisis
carpal tunnel test
hand elevation test
tinel
phalan
durkans test
confirm: nerve conduction study
tinel test
carpal tunnel
tap on solar side of hand
phalens test
back of hands placed together
carpal tunnel
carpal tunnel tx
volar splint
definitive: surgical release of transverse carpal ligament
carpal tunnel MOA
medial nerve trapped by transverse carpal ligament
complex regional pain syndrome sx
previous soft tissue injury
extreme pain to light touch, skin changes, swelling
allodynia
dec ROM and strength
complex regional pain syndrome tx
clinical
complex regional pain syndrome tx
1st line: PT/OT + NSAIDS, gabapentin. psych intervention
complex regional pain syndrome prevention
vitamin C can help
Guillain barre syndrome MOA
demyelinating polyneuropathy of peripheral nerves
Schwann cell demyelination
Guillain barre syndrome MCC
bacterial (campylobacter jejuni)
Guillain barre syndrome sx
hx of GI infx or URI
ascending flaccid paralysis (ground to brain)
dec/ absent DTR
bilateral facial nerve palsy
potential respiratory failure
Guillain barre syndrome test
LP: inc CSF protein, albuminocytologic dissociations but normal WBC
check vital capacity (r/o respiratory failure)
EMG: dec conduction velocity
Guillain barre syndrome tx
high dose IVIG
plasmapheresis
CS
Guillain barre syndrome complications
respiratory failure d/t diaphragm = needs ventilation in ICU.
prednisone CI
neuralgia parenthetica
upper thigh numbness
obese/pregnant
tx” loose clothing, weight loss
common peroneal neuropathy
proximal fibula injury
foot drop
tx w/ ankle splint
radial nerve palsy
Saturday night palsy
from drinking, crutches, or humeral shaft fx
wrist drop, can’t extend wrist
tx w/ wrist splint
ulnar nerve palsy
elbow injury
decreased finger adduction/ thumb grasp
4th/5th digit paresthesia
central cord syndrome sx
upper extremities affected more than lower
complete loss motor function upper extremities
focal onset seizures
involves single cerebral hemisphere at onset
aware
impaired awareness
generalized onset seizures
involves both hemispheres at onset
tonic clonic
myoclonic
absence
tx focal onset seizures
carbamazepine
phenytoin
tx tonic clonic and myoclonic seizure
levetiracetam
valproic acid
tx absence seizures
ethosuxamide
valproic acid
status epileptics criteria
seizure lasting more than 5 min or >2 seizures w/o resolution of post ictal state
status epileptics causes
withdrawal from anti epileptic drugs
hyponatremia
TCA toxicity
brain lesion/injury
status epilepticus tx
ABC –> IV access + rectal diazepam
first line: benzo (IV lorazepam)
if does not respond in 1min, additional lorazepam
unresponsive 10-20m” IV fosphenytoin or IV phenytoin
benzos –> phenytoin -> phenobarbital
IV phenytoin AE
hypotension if administered quickly
childhood exanthem that can cause febrile seizures
HHV6 roseola
high grade fever for 3-5d then rash
febrile seizure MRI indication
meningeal signs (stiff neck, AMS)
incomplete immunization (H. flu type B or s. pneumo 6-12mo)
antecedent abx use (can mask meningitis sx)
MC type cerebral aneurism
berry
cerebral aneurism sx
enruptured: asx, HA/pain behind one eye, vision problems, ptosis, unilateral facial weakness/numbness, speech difficulty
ruptured: sudden severe HA (thunderclap), LOC, vision prob, neck stiffness, emergency
cerebral aneurism test
initial: CT angiography, MRI/ MRA
cerebral aneurism tx
enraptured: surgery or observation
ruptured: surgical clipping or end-vascular coiling
most significant cause of morbidity in pts w/ TBI
diffuse axonal injury
diffuse axonal injury sx
traumatic deceleration injury, results in vegetative state
sx out of proportion w/ CT
LOC instant and later develop vegetative state
diffuse axonal injury test
CT: minute punctate hemorrhages w/ blurring go of gray white interface
MRI more sensitive
cause of epidural hematoma
head trauma -> pterion- MMA damage
epidural hematoma sx
LOC then lucid interval (slow bleed several hrs before onset sx)
N/V, HA, focal deficits
arterial bleed: fast
epidural hematoma test
non contrast CT: hyper dense mass, biconvex (lemon) shape
ballot cross suture lines
shift of midline
epidural hematoma tx
emergency
craniotomy
subdural hematoma MOA
bleeding between dura mater and arachnoid mater
rupture of bridging veins
subdural hematoma RF
elderly (brain atrophy)
alcohol abuse
shaken baby syndrome
subdural hematoma sx
days to weeks
venous bleeding: slow
increased ICP sx
any elderly w/ neuro sx
child: shaking baby= child abuse
subdural hematoma test
non contrast CT: crescent shape (banana), concave
crosses suture lines
subdural hematoma tx
evacuation
small: catheter
large: craniotomy
subarachnoid hemorrhage MCC
trauma, AV malformation
non traumatic: ruptured (berry) aneurism: MC location ACA
subarachnoid hemorrhage genetic causes
autosomal dominant PKD
marfan
Ehlers danlos
subarachnoid hemorrhage sx
work HA of my life “thunderclap”
no focal neuro sx
rapid progression
vision changes, confusion, seizures
subarachnoid hemorrhage test
non contrast CT: do LP if CP negative
cerebral angiogram
gold standard: LP = xanthochromia (yellow color of CSF d/t breakdown of RBC)
subarachnoid hemorrhage LP CI
traumatic subarachnoid hemorrhage
subarachnoid hemorrhage tx
surgical clipping
control BP: PO nimodipine Q4h
supportive
intracranial hemorrhage MOA
due to hemorrhagic stroke
bleeding inside brain
inc ICP
intracranial hemorrhage MC location
basal ganglia
intracranial hemorrhage MCC
trauma
non traumatic: HTN (location: putamen of basal ganglia)
intracranial hemorrhage sx
abrupt
AMS, coma, dizzy, N/V
neuro sx worsen within 30-90m
intracranial hemorrhage test
stat CT of brain
LP for xanthochromia
coag panel (PT, PTT, INR) and plt
intracranial hemorrhage tx
ICU, ABC
DOC nitroprusside
mannitol, diuretics
no steroids
stroke/ CVA MC type
thrombotic
stroke/ CVA RF
HLD
Afib
recent MI
DM
Smoking
HTN
stroke/ CVA ACA
feet and legs
contralateral hemiparesis
LE and trunk weakness/numb
stroke/ CVA MCA
hands/arm/face
language weakness, dec sensation
bilateral vision abnormalities
aphasia, neglect, cannot perform learned actions
stroke/ CVA PCA
visual abnormalities
blindness
stroke/ CVA lacunar
focal motor/sensory deficits
loss of coordination
difficulty speaking
contralateral hemiparesis
stroke/ CVA basilar
CN abnormalities
full body weakness, dec sensation
vertigo
locked in syndrome
plegia of head, body, muscles
can blink and vertical movement
stroke/ CVA test
non contrast CT: loss of grey white interface
MRI, CTA
CBC, coag, plt
cardiac monitor, EKG
NIH stroke scale
stroke/ CVA tx
ABC
thrombolytics: TPA/alteplase (w/in 4.5h of onset)
ASA
swallow assessment
TPA indictions
<4.5h of onset
BP<185/110
low bleed risk
TIA MOA
brain w/o blood supply for brief period of time (<24h)
blood flow restored before permanent damage occurs
TIA RF
uncontrolled HTN
smoking
afib
MC d/t embolus
TIA sx
unilateral facial palsy
arm weakness, speech difficulty
transient monocular blindness
sx resolve <1-2h
TIA internal carotid sx
amaurosis fugax
weakness contralateral hand
TIA ICA/MCA/ACA sx
cerebral hemisphere dysfunction
TIA PCA sx
somatosensory deficits
TIA vertebrobasilar sx
brainstem/cerebellar sx
TIA test
NIH stroke scale
BIT: head CT w/o contrast (negative)
resolve <24h
MRI/MRA of head/neck
carotid doppler
TIA tx
monitor
statin + anti HTN + anti plt (ASA or plavix) + anticoagulant (heparin)
thrombolytics CI
triptan CI
ergot derivatives (dihydroergotamine)
CAD, PAD, HTN
pregnancy/breastfeeding
triptan AE
inc BP
paresthesia
dizziness
coronary ischemia
migraine prophylaxis
> 3 attacks/mo or long lasting attacks >12h
BB (propranolol/metoprolol)
TCA: amitriptyline
anti convulsant: topiramate/valproate
CCB: verapamil
phenytoin MOA
blocks voltage gated Na channels
stops seizure propagation
phenytoin AE
CNS depression
SLE like syndrome
gingival hyperplasia
carbamazepine MOA
inc refractory period of voltage gated Na channels
inhibits action potential generation
carbamazepine AE
hepatotoxic
SIADH
teratogenic
drug induced hyponatremia
lamotrigine MOA
blocks voltage gated Na channels and glutamate receptors
lamotrigine AE
SJS
ethosuximide MOA
blocks thalamic Ca channels
ethosuximide AE
GI distress
SJS
med used for seizures in pregnant woman and children
phenobarbital
valproic acid AE
pancreatitis
hepatotoxicity
iatrogenic
tremor
DOC myoclonic seizure
valproic acid
topiramate AE
weight loss
intermenstrual spotting
dec efficacy of OCP
paresthesia
ALS MOA
leu Gehrigs disease
necrosis of both upper and lower motor neurons -> progressive motor degeneration
ALS sx
muscle weakness
loss ability to initiate control motor movements
mixed upper and lower motor signs
bulbul sx
sensation, urinary sphincter, and voluntary eye movement spared
ALS tx
riluzole reduces progression up to 6mo
fatal within 5y of onset
astrocytoma location
infratentorial in children
supratentorial in adults
astrocytoma types
pilocytic (grade I)
diffuse (grade II)
anapestic (grade III)
glioblastoma multiforme (grade IV)
subependymal giant cell
pilocytic ast rocytoma
juvenile astrocytoma (grade I): localized. most benign. MC children and young adults
diffuse astrocytoma (grade II)
types: fibrillary, gemistocytic, protoplasmic
invade surrounding tissues but grow relatively slow
anapestic astrocytoma
grade III
rare but aggressive
MC primary CNS tumor in adults
glioblastoma multiforme (grade IV astrocytoma)
subependymal giant cell astrocytoma
ventricular tumors associated w/ tuberculosis sclerosis
astrocytoma test
CT or MRI w/ contrast (I-II non enhance), III-IV enhance
brain bx
pilocytic astrocytoma brain bx
form sacs of fluid (cystic) or enclosed within cyst
Rosenthal fibers: eosinophilic corkscrew fibers
diffuse astrocytoma brain bx
contain micro cysts and mucus like fluid
anaplastic astrocytoma brain bx
tentacle like projections that grow into surrounding tissue
difficult to remove during surgery
glioblastoma astrocytoma brain bx
may contain cystic material, calcium deposits, blood vessels of mixed grade of cells
pilocytic astrocytoma tx
surgical excision
+ rad if not completely removed
diffuse astrocytoma tx
surgery if tumor is accessible and can be completely removed
rad for adjunct or unresectable tumors
anapestic astrocytoma tx
surgery -> XRT +/- chemo after rad or tumor recurrence
astrocytoma grade IV astrocytoma tx
surgery -> XRT (radiation therapy + chemo
CNS lymphoma RF
immunosuppression
EBV
CNS lymphoma sx
focal deficits
ocular sx
CNS lymphoma test
CT/MRI w/ contrast: ring enhancing lesino
bx
CNS lymphoma tx
chemo: MTX more effective chemo (give w/ colonic acid/leucovorin)
radiation, CS
surgery usually ineffective
oligodendroglioma brain bx
soft grayish pink calcified tumors
areas of hemorrhage or cystic
chicken wire capillary pattern w/ fried egg shaped tumor
ependymoma etiology
cells that one the ventricles and part of the spinal column
MC seen in 4th ventricle and spinal cord
ependymoma sx
infant: inc head size, irritability, sleeplessness, vomiting
older child/adult: N/V/H
ependymoma test
CT/MRI w/ contrast
brain bx: perivascular pseudorosettes
retinal hemangioma associated w/
von hippel Lindau syndrome
neurofibromatosis type I sx
need 2 of the following
>6 fate au lait spots
freckling: esp axillary, inguinal
lisch nodules of iris
>2 neurofibromas or > plexiform neurofibroma
optic pathway gliomas
neurofibromatosis type 2 sx
neurologic lesions: bilateral vestibular schwannomas, meningiomas
optic lesions
skin lesions
fibromyalgia tx
TCA (amytriptiline)
