Neuro Flashcards

Question

Canadian C-Spine Rule

Answer 1

Determines if patient should receive dedicated spinal CT Any high risk factors? (If yes, CT) --Age >65 --Dangerous mechanism --Parasthesias in extremities Any low risk factor which allows safe assessment of range of motion? (If not able to range, CT) --Simple rearend MVC --Sitting position in the ED --Ambulatory at any time --Delayed onset of neck pain --Absence of midline c-spine tenderness Are they able to actively rotate neck 45 degrees? --If no, CT --If yes, no radiography

Answer 2

Zoster - Shingles, reactivation of varicella zoster virus in a specific dermatomal pattern. ---Treatment is Valacyclovir 1000mg PO TID x 7 days Bell's Palsy - facial paralysis of CN VII (facial nerve) ---Often caused by preceding viral infection (or bacterial - Lyme). ---Often improves with no treatment but steroids can help speed the recovery Guillain-Barre Syndrome - inflammation of the motor neurons, usually following a viral infection. ---Increasing numbness and paralysis sometimes as far as the diaphragm, causing the need to intubation ---Treatment is either plasmapheresis or steroids

Answer 3

Muscle weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine. Most often arise from a tumor of the thymus - thymoma Symptoms include ptosis, diplopia, difficulty chewing or swallowing, respiratory difficulties, limb weakness Symptoms are worse when the patient is tired If sxs are severe, they can cause difficulty breathing, this is called Myasthenic Crisis Diagnosis is made by administering anticholinesterase inhibitor, Edrophonium 10mg IV x1 and if the sxs abruptly stop, the diagnosis can be made Treatment includes: ---Maintenance doses of pyridostigmine several times per day ---Thymectomy ---Immunosuppressive therapy ---Plasmapheresis in Myasthenic Crisis

Answer 4

Gene mutation of the dystrophin gene located on the short arm of the X chromosome DMD is a progressive disease which eventually affects all voluntary muscles and involves the heart and breathing muscles at later stages Life expectancy is approximately 25 years old. No treatment but steroids can help delay the eventual progression to complete immobilization

Answer 5

The toxin Clostridium botulinum prevents the release of ACh at the neuromuscular junction and autonomic synapses Often occurs from ingestion of home canned foods containing the bacteria Symptoms begin within 72 hours and involve total cranial nerve palsy that leads to difficulty breathing Treatment is supportive care and request for the antidote

Answer 6

Priority diagnostic is CT Head in order to distinguish between ischemia, hemorrhage and tumor MRI can better visualize ischemic infarcts however takes longer Cerebral angiography - can be done after a CT shows an ischemic stroke.

Answer 7

In the first few days: ASA and Clopidogrel (Plavix) After discharge: Usually will choose one agent Treat HTN

Answer 8

Up to 6 hours from last known well

Answer 9

Severe head injury (GCS <8) with an abnormal Head CT Severe head injury (GCS <8) with a normal head CT with two of the following: -Age >40 -SBP <90 -Abnormal motor posturing

Answer 10

Should be maintained between 110-130 to prevent cerebral vasospasm Can help increase MAP by giving more fluids

Answer 11

CPP=MAP-ICP Want to keep ICP <20 Good CPP is 70

Answer 12

Nimodipine

Answer 13

Sxs: -Weakness, numbness, tingling or unsteadiness -Spastic paraparesis -Diplopia -Disequilibrium -Urinary urgency or hesitancy -Optic atrophy -Nystagmus

Answer 14

Body's immune system attacks myelin therefore causing decrease in the speed in which nerves interact.

Answer 15

LP: Slightly elevated protein and IgG in CSF MRI of the brain Management: No treatment to prevent progression of the disease Recovery from acute phases is hastened by steroids Immunosuppressive therapy Plasmapheresis in severe cases Interferon Antispasmotics

Answer 16

Strep pneumoniae Hemophilus influenzae Neisseria meningitidis

Answer 17

Pain and spasms of the hamstrings found in meningitis

Answer 18

Legs flex at both the hips and knees in response to flexion of the head and neck to the chest found in meningitis

Answer 19

LP should be done immediately: ---If bacterial, CSF will be cloudy or xanthochromic (yellow in color) with: -----elevated pressure ------elevated protein ------decreased glucose ------presence of WBC CSF in viral will have normal glucose and normal protein Head CT

Answer 20

If the pt is <50 years old: Vancomycin + Ceftriaxone If the pt is >50 years old: Vancomycin + Ceftriaxone + Ampicillin

Answer 21

Seen in traumatic brain injury patients that are decompensating: -Widening pulse pressure -Decreased respiratory rate -Decreased heart rate

Answer 22

Cervical spine - tetraplegia Thoracic spine - paraplegia C4 injury and above: respiratory compromise T4-T6: May lead to autonomic dysreflexia -emergency conditions -Caused by exaggerated autonomic response to a stimulus (bladder or bowel distention, hot or cold stimulus, restrictive clothing) --Diaphoresis and flushing above the level of injury --Chills and severe vasoconstriction below the level of injury --HTN --bradycardia --Headache --Nausea Treatment is stimulus removal

Answer 23

Caused by damage to one half of the spinal cord: Sxs: -Ipsilateral upper motor neuron paralysis and loss of proprioception -Contralateral loss of pain and temperature Order MRI and give steroids

Answer 24

MRI Steroids Surgery for decompression

Answer 25

Alzheimer's

Answer 26

Memory impairment and one or more of the following: -Aphasia -Apraxia -Agnosia - inability to recognize an object -Inability to plan, organize, sequence and make abstract difference

Answer 27

Cholinesterase inhibitors: -Donepezil (all stages of AD) -Galantamine (mild-moderate disease) -Rivastigmine (mild-moderate disease) NMDA antagonist: -Memantine (Namenda) - moderate to severe disease Combinations: -Memantine and donepezil - moderate to severe disease