Neuro Flashcards
what is acute colonic pseudoobstruction?
Autonomic disruption of the colon causes painful abdominal distension, the inability to poop, and vomiting
what causes acute colonic psuedoobstruction
- electrolyte imbalances
- trauma, recent surgery, infections
- medications
- Neurological disorders
imaging for acute colonic psuedoobstruction shows what
X-Ray will show colonic dilation, normal haustra, and a non dilated small bowel
CT scan will sow colonic dilation and NO anatomic obstruction
what are the symptoms of acute colonic pseduoobstruction
abdominal distension, vomiting, inability to poop, decreased bowel sounds, tympanic to percussion
complications of acute colonic psuedoobstruction
bowel perforation (gaurding, rigidity, reboudn tenderness)
management of acute colonic psuedoobstruction
NPO (bowel rest), nasogastric decompression and IV neostigmine if there is no improvement within 2 days
after an MI what interventions are aimed at achieving the most improvement for a patient’s long term prognosis?
time it takes to restore coronary blood flow - this will limit myocardial damage and improve cardiovascular mortality
*this is done by PCI or fibrinolysis
SIADH serum osmolality and urine osmolality levels
serum <275 mOsm/kg H20
urine <100 mOsm/kg H20
a patient with a hilar mass in the setting of weight loss, cough, and a significant smoking history is concerning for?
small cell lung cancer
small cell lung cancers can cause what paraneoplastic syndrome
SIADH
types of SIADH
mild hyponatremia: nausea and forgetfulness
severe hyponatremia: seizures and coma
Euvolemia: most mucus membranes, no edema
managemtn of SIADH
fluid restriction with salt tablets
for severe Na<120 - hypertonic saline
when adminsitering hypertonic saline you want to correct the sodium levels slowly with a rate of <8 mEq/L over the first 24 hours to prevent what complication
osmotic demyelination syndrome
what are the two most important risk factors for stroke on USMLE
hypertension and AFIB
ACA stroke signs
motor and sensory abnormalities of the contralateral leg
MCA stroke signs
motor and sensory abnormalities of the contralteral arm and face
dominant MCA strokes are usually on which side
left sided
dominant MCA stroke can lead to?
Wernicke or Broca Aphasia
nondominant MCA stroke can cause?
hemispatial neglect
what is hemispatial neglect
the inability to draw clockface
PCA stroke signs
prospagnosia ( inability to recognize faces)
contralateral homonymous hemianopsia with macular sparing
lateral medullary syndrome is caused by?
posterior inferior cerebellar artery (PICA) or vertebral artery ischemia
lateral medullary syndrome is also known as?
wallenberg syndrome
what are the symptoms of lateral medullary syndrome
dysphagia and ipsilateral horner syndrome
what is horner syndrome
ipsilateral miosis, partial ptosis, and anhidrosis
horner syndrome can be caused by what two things?
pancoast tumor, or lateral medullary syndrome
what is the artery involved in medial medullary syndrome
anterior spinal artery
what are the signs of medial medullary syndrome
ipsilateral tongue deviation
what is the artery involved in lateral pontine syndrome
anterior inferior cerebellar artery (AICA)
signs of lateral pontine syndrome
ipsilateral Bells Palsy (facial droop, ptosis)- cranial nerve 7
weber syndrome is a stroke in what location
the midbrain
what are the symtoms of weber syndrome
ipsilateral CN III palsy (down and out eye) with contralateral spastic hemiparesis (weakness)
locked in syndrome is a stroke of what artery
Basilar artery
signs of locked in syndrome
inability to move enitre body expect for the eyes
gerstmann syndrome is a stroke of?
the angular gyrus of the parietal lobe
what is the tetrad of syndrome from gerstmann syndrome
- agraphia (inability to write)
- acalculia (inability to do math)
- finger agnosia (cant identify fingers)
- left-right dissociation (cannot differentiate between left and right sides of the body)
Hemiballismus is a stroke of what location?
subthalamic nucleus
signs of a hemiballistic stroke
ballistic flailing of contralateral arm or leg
what is the mechanism of lacular infarcts?
hypertension causes liphyalinosis which is atheromas in the small lenticulostriate (deep) arteries in the brain
this plaques cause ischemia in the brain which can lead to necrosis and reabsorption of tissue and forms tiny cavities called lacunae
symptoms of a lacunar infarct
specific syndromes based on their location
pure motor hemiparesis, purse sensory stroke, ataxic hemmiparesis
cortical stroke symptoms
aphasia, neglect, visual field losses
what is wenicke aphasia
fluent aphasia where the patient can speak with a normal pace and use lots of words but it doesnt make any sense
“WORD SALAD”
comprehension is impaired, repition is impaired
where is wernickes area located
what causes it
temporal lobe; caused by a L sided MCA infarct
what is brocas aphasia
non-fluent aphasia
there is frustration in not being able to make sense
comprehension is NORMAL
repetition is impaired
brocas area is located where and caused by what infarct
frontal lobe
caused by a L sided MCA infarct
Conductive aphasia
stroke of the arcuate fasciulus which connects wernicke and brocas areas
repetition is impaired only
global aphapsia
bascially brocas, acrcuate fasciculus and wenickes at the same time
no repetition, no comprehension, no word salad
transcortical sensory aphasia
same presentation as wernicke but repeittion is intact
transcorticol motor apahsia
same presentation as broca but repeptition intact
what imaging is done to look for a stroke
non-contrast CT
how does blood appear on a non contrast CT
hyperdense (bright)
for an ischemic stoke what is given if symptom onsent has been within the past 4.5 hours ?
tPA (tissue plasminogin)
what does the 4.5 hour window refer to
when the patient was last observed as normal
if the 4.5 hour window has elapsed what do you do for an ischemia stroke
give aspirin
ischemia strokes bp should be rapidly be broght down below the threshold of what? After meeting this threshold slower blood pressure control is done. AN increase in blood pressure can actually help perfusion of penumbric areas on ischemia
185/110
what is the treatment of a hemorrhagic stroke (hyperdense CT)
do NOT give tpa
- lower the blood pressure rapidly so that systolic is less than 140mmhg
- reverse anticoagulation if the patient is on it (FFP for patients on warfarin)
correction of hypernatremia too quickly with hypotonic aline can cause
cerebral edema
correcting hyponatemia too quickly with hypertonic saline can cause
central pontine myelinolysis aka osmotic demyelination
causes locked in syndrome
what is a hypercalcemic crisis
a deliruium like state caused by SEVERE hypercalcemia usually caused by malignancy or primary hyperparathyroidism
treatment of hypercalcemia
normal saline
bisphophonates
what is psuedotumor cerebri
increased intracranial pressure with no structural cause
causes: obesity, idopathic intracranial hypertension, OCP, isotretinonin, danazol
reye syndrome
cerebral edema and hepatotoxicity from giving aspirin to children during a viral infection
diffuse aconal injury
acceletation, deceleration, contact brain injury that causes axonal shearing and tearing and subsequent brain swelling
can have severe cognitive defects, motor or sensory dysfunction
