Neuro Flashcards
1
Q
What can unilateral HA be
A
Migraine, trigeminal neuralgia
2
Q
What can temporal HA be
A
Temporal arteritis
3
Q
What can occipital HA be
A
Tension HA
4
Q
What can HA with eye association be
A
Acute glaucoma, temporal arteritis, sinusitis, migraine
5
Q
What is the difference between HA with gradual vs sudden onset
A
Gradual = usually benign Sudden = may be more serious
6
Q
HA characterized as pounding/pulsatile =
A
Migraine
7
Q
HA characterized as sharp/stabbing =
A
Trigeminal neuralgia or cluster HA
8
Q
HA characterized as pressure/squeezing =
A
Tension HA
9
Q
HA associated with anxiety =
A
Tension HA
10
Q
HA associated with auras =
A
Migraine
11
Q
HA associated with vision change =
A
Temporal arteritis or gluacoma
12
Q
HA associated with n/v =
A
Increased ICP or Migraine
13
Q
HA associated with lacrimation/rhinorrhea =
A
Cluster HA
14
Q
HA associated with photophobia/phonophobia =
A
Migraine or Meningitis
15
Q
Migraines affect men or women more?
A
Women
16
Q
At what age do migraines usually start? Disappear?
A
Onset = 10-14 y/o
Disappear in the 50’s
17
Q
Depolarization theory of migraines =
A
Depressed activity areas lead to platelet and mast cell activation
18
Q
Seratonin release may cause migraines how?
A
Fluctuations in catecholamine levels cause alternating vasoconstriction/vasodilation which causes wall stretching & pain
19
Q
What are the types of migraines (the most often seen)
A
Common (w/o aura) or classic (with aura)
20
Q
What are the indications for imagining in pt presenting with a migraine?
A
1st/worst migraine
New onset w/ age > 50y/o
Sudden onset HA ("thunderclap")
Abnormal neuro exam
Rapid onset with strenuous activity
HA awakens from sleep
Meningea signs (n/v, altered mental status, personality changes)
21
Q
What is the 1st line Tx of acute migraine?
A
Excedrin migraine or NSAIDs
22
Q
What is 2nd line Tx for acute migraine?
A
Triptans or Dihydroergotamine (DHE-45)
23
Q
What is the best Tx of migraine (not acute)
A
Triptans = Sumatriptan (Imitrex) or Treximet (sumatriptan + naproxen)
24
Q
What are RFs for migraines
A
Family hx, obesity, sleep apnea, head injury, female,, analgesic overuse, & caffeine
25
What may cause a rebound HA
Overuse of medication for migraine (> 10 days of the month) especially Narcotics!
26
What is the Tx of rebound HA
Go cold turkey from the meds that are causing it, try triptan or steroids
27
When should you start migraine prophylaxis
> 2 HAs/week
Severe HA
Prolonged duration > 2 days
28
What is the best migraine prophylaxis med?
| What else is an option?
```
Best = Propranolol LA (beta blocker)
Other = tricyclic antidepressants or antiseizure drugs (not in preggos though!)
```
29
What is a major side effect of the antiseizure drugs?
Unwanted weight gain
30
What are common features of a Common Migraine
```
Pulsatile throbbing (50%)
Unilateral HA (50%)
Lasts hrs - days
Associated with n/v
Photophobia/phonophobia
```
31
What are common features of a Classic Migraine
Aura (20%)
Scintillating scotomas
Fortification spectrum
32
What is the prodrome phase
Increased excitability/irritability, fatigue, depression, appetite changes/cravings
33
Aura that occurs without a HA is called...
Acephalgic migraine
34
Sensory aura =
Numbness, paresthesia, dysphasia
35
What artery do basilar migraines effect?
| What are the SxS?
```
Artery = basilar artery
SxS = HA, vertigo, slurred speech, impaired coordination (younger pts) NO MOTOR DEFECTS
```
36
SxS of hemiplegic migraine =
Paralysis on one side of body, may persist x 24hrs w/ or w/o HA
37
SxS of ophthalmoplegic migraine =
HA, eye pain, vomitting, ptosis
38
Catemenial migraines occur with...
Menses
Usually disappear with menopause & pregnancy
Occurs 2-3x a day during menses
39
If a migraine is VERY refractory what might you try to use?
Lidocaine, caffeine protocols, or propofol infusions
40
What sex is cluster HA more common in
Men (4X more)
41
What is the main RF for cluster HA
Tobacco use - MUST QUIT
42
What are possible causes of cluster HA
Vascular dilation
Trigeminal nerve stimulation
Circadian rhythms
43
Pts with cluster HA will often complain they are triggered by...
Alcohol ingestion
44
Cluster HA SxS/description =
Excruciating stabbing pain (suicide HA)
Unilateral behind the eye, jaw, or teeth
Last 15min - 3hrs
45
What are the requirements to Dx cluster HA
Must have one of the following:
- Lacrimation, ipsilateral flushing/sweating, ipsilateral nasal DC, conjunctival redness, horner's syndrome (ipsilaterl ptosis or miosis)
46
What is the Tx of cluster HA
Triptans
OXYGEN (20min) = complete relief in 78% of pts
Prophylaxis = break the cycle
47
What are the SxS of tension HA
Vice-like, gripping HA that forms a band across the forehead bilat
Radiates into posterior neck/trapezius
NO n/v, photo/phonophobia & not worse with activity
48
What is the Tx of tension HA
```
Non-pharm = exercise, relaxation therapy/counseling, yoga, PT, acupuncture
Pharm = NSAIDs, Tylenol, myofascial trigger point injections, TCAs or SSRI
```
49
What is the origin of tension HA
It has a myofascial origin
50
RFs for tension HA
Stress/anxiety, depression, overwork, lack of sleep, posture, conversion syndrome
51
When does post-traumatic HA occur (be specific not a smart ass)
Within the first 7 days of the injury
| Acute: < 2mo after injury; Chronic: >2mo after
52
What type of HA is it characterized as
Mix of migraine and tension HA
53
What do pts with post-traumatic HA often develop
Rebound HAs
54
How do you Tx post-traumatic HA
Hard to treat; treat as the HA it presents as and if that doesn't work adjust Tx
55
What is idiopathic intracranial HTN (IIH) also called
Psuedotumor cerebri or benign intracranial HTN (BIH)
56
Who is most likely to have IIH
Women 15-44 y/o that are obese
57
What are the SxS of IIH
```
Retro-orbital pain (worse with movement)
Throbbing (worse in morning)
N/V
Monocular/binocular vision loss
Pulsatile tinnitus (60% of pts)
```
58
What is the MC PE finding with IIH
Papilledema
59
What are the diagnostics for IIH
LP opening pressure > 200
| MRI neg for masses/hydrocephalus
60
What is the Tx of IIH
```
Lifestyle changes
Diuretics
NSAIDs/TCAs for HA management
Large volume LP
Sx in extreme cases
```
61
Prevelance of trigeminal neuralgia...sex & age =
```
Sex = women
Age = >40y/o with peak of 60-70 y/o
```
62
What is the biggest risk for trigeminal neuralgia
Multiple Sclerosis (MS)
63
Which side is more commonly affected in trigeminal neuralgia
Right side
64
How is trigeminal neuralgia described
Stabbing, lancinating, electric shock pain that lasts about 2min and occurs multiple times a day or month but becomes more frequent over time
65
What causes trigeminal neuralgia
Demyelination of trigeminal nerve that causes pain even with light touch
66
What branches of the trigeminal nerve are MC affected in trigeminal neuralgia
Maxillary and mandibular
67
Temporal arteritis AKA...
Giant cell arteritis
68
What is GCA commonly associate with
Polymyalgia rheumatic (50%)
69
What are the SxS of temporal arteritis
Temporal HA
Jaw claudication
+/- diplopia, visual field cuts, and systemic manifestations
70
What will PE reveal for temporal arteritis
Tenderness over temporal arteries
| Diminished pulses
71
How is temporal arteritis Dx
Temporal artery biopsy (pos 2 days after starting Tx)
72
What is the immediate Tx of temporal arteritis
Corticosteroids while biopsy results are being processed
73
What are the causes of a traumatic brain injury (TBI)
Penetrating injury or closed head injury
74
What is primary damage in TBI
Skull fx, contusion/bruising, hematomas/blood clots, lacerations, nerve damage (diffuse axonal injury)
75
What is secondary damage in TBI
Edema & infection
76
What are the main causes of concussion
Deceleration injury or coup-countercoup injury
77
Who is most likely to suffer a concussion
Athletes especially in contact sports
78
What are the main SxS of a concussion
Disorientation
Amnesia
Confusion (vacant stare, delayed answers, poor concentration)
79
What % of concussions result in LOC
10% will have LOC
80
What are the MOST COMMON SxS of concussion
HA, dizziness, & impaired executive function
81
What are the diagnostic tests for consussion
CT or MRI (although minor will appear normal)
82
What is a Grade 1 concussion
"Ding" concussion, confusion, no LOC, SxS last for < 15min
83
What is a Grade 2 concussion
No LOC, SxS last > 15min
84
What is a Grade 3 concussion
LOC
85
What is the gold standard for determining severity of a concussion
Gasglow Coma Scale
86
What constitutes as minor, moderate, and severe on the gasglow scale
Minor: 13-15
Moderate: 9-12
Severe: < 8
87
What is the best Tx of concussion
Rest
88
Who needs a CT with concussion
There is a long list. Main one to know is seizure, neruo deficits, and anticoagulation ABSOLUTELY requires CT
89
What is the problem with multiple concussion
It will take longer to heal each time, will result in more easily being concussed again, may lead to more severe issues (like post-concussion syndrome)
90
The typical course for an athlete to be cleared to resume play takes 5 days. What happens if the symptoms return at any point in that time
Player MUST STOP and rest until they are asymptomatic for 24hrs then they return to the level that they were at before
91
What is a basal skull fx
Fx at the base of the skull; accounts for % of Fx
92
What are the most prevalent SxS
Hemotympanum
Battles sign = mastoid process ecchymosis
Raccon eyes = periorbital ecchymosis
CSF leakage from nose/ears
93
Bleeding between the dura mater and arachnoid layer is called...
Subdural hematoma
94
Subdural hematoma is caused by...
Tearing of the "bridging veins" during a shearing injury (acceleration-deceleration injury)
95
What are major RFs for subdural hematoma
Age (elderly) and anticoagulation are major
96
SxS of subdural hematoma are...
```
Confusion
Slurred speech
HA
Lethargy
LOC
N/V
Weakness
```
97
What is the main diagnostic test? What is its classic result
CT scan
| Crescent shape with midline shift of ventricle
98
What is the Tx of subdural hematoma
Small one = burr holes
| Larger one = craniotomy to evacuate clots
99
Bleeding between the dura mater and skull is called
Epidural hematoma
100
Epidural hematoma is due to...
Trauma/skull fx
101
Epidural hematoma is caused by...
Tearing of the middle meningeal artery
102
What is the classic presentation of epidural hematoma
Initial LOC followed by lucid state
| "Talk and die"
103
What is the diagnostic test of choice? What is the finding/result
CT
| Shows biconcave lens (looks like lens with part outside and part inside skull)
104
What is the Tx for epidural hematoma
Surgical evacuation & ligation of bleeding vessels
105
Bleeding into the subarachnoid space is...
Subarachnoid hemorrhage
106
Subarachnoid hemorrhage is usually due to...
Rupture of a cerebral aneurysm (but can also be due to trauma)
107
What is the classic presentation of subarachnoid hemorrhage
Thunderclap HA or HA of a lifetime
108
What are other SxS of subarachnoid hemorrhage
```
HA
N/V
Stiff neck
Confusion
Seizure
May report popping/snapping prior to HA
```
109
What is the diagnostic of choice for subarachnoid hemorrhage?
CT without contrast (best within 12hrs then sensitivity decreases)
110
What is the diagnostic test to do if CT is inconclusive for suspected subarachnoid hemorrhage
Lumbar puncture (LP); presence of blood is positive result
111
What is the Tx of subarachnoid hemorrhage
Depends on size, location, etc.
| Tx includes clipping or coiling procedures
112
Which type of stroke is more common; hemorrhagic or ischemic?
Ischemic (87% of all strokes)
113
Which causes more hemorrhagic strokes...intracerebral hematoma (ICH) or subarachnoid hematoma (SAH)
Intracerebral hematoma
114
What is the main cause for hemorrhagic stroke
Ruptured berry aneurysm (80%)
115
AV malformations also cause hemorrhagic stroke; what are the SxS of this
Pulsatile tinnitus, HA, & seizures
116
Where do most aneursyms occur/develop
Develop at the branching points of arteries
117
Where is the most common location for an aneurysm to occur
Anterior communicating artery
118
Why is hemorrhagic stroke so important (think prognosis)
B/c 10-15% die before reaching the hospital and 25% within the 1st 24hrs
1/3 of survivors will have neuro deficits
119
What are the management goals for hemorrhagic stroke
SBP < 140-160 w/o fluctuations
Monitor cardiac dysrythmias
ICP monitoring (< 20mmHg)
Normothermia
120
What is a sentinel bleed
A small bleed or warning leak at the site several days before the larger event; accompanied by milder HA, neck stiffness, and nausea
121
What are complications of hemorrhagic stroke
Rebleeding
Hydrocephalus
Cerebral ischemia (d/t vasospasm)
122
What are the two causes/types of ischemic stroke
Thrombotic or embolic
123
Which is more common...thrombotic or embolic ischemic stroke
Thrombotic
124
What causes thrombotic ischemic stroke
Atherosclerosis (injured endothelial lining allows platelets to adhere -> plaque formation)
125
What is the origin of most embolic ischemic strokes
Carotid arteries & heart (a-fib vegetation)
126
What is the least common cause of ischemic stroke
Lucunar infarcts
127
What is a TIA
Transient ischemic attack; sudden onset of neurological deficit including speech, hemiparesis, and monocular blindness
128
What is amaurosis fugax
Sudden, monocular blindness described as a shade/curtain being pulled over the affected eye
129
What diagnostic test do you do for ischemic stroke
Head CT (or MRI)
TEE for uspected cardiac source
Carotid US for carotid artery stenosis
130
What is the main way to differentiate TIA vs CVA
TIA = symptoms resolve within 24hrs (most within 10 minutes)
131
Why is TIA cause for concern
Stroke follows TIA within 90 days in 20-25% of cases
132
If ischemia occurs at the anterior circulation what artery is commonly invovled
Anterior cerebral artery
133
What are the SxS of anterior circulation ischemia
Confusion, amnesia, personality change, cognitive change, contralateral hemiparesis & sensory impairment, if left there is expressive aphasia, & eyes deviate TOWARD affected side
134
If ischemia occurs at the anterior circulation what artery is MOST commonly invovled
Middle cerebral artery
135
What is a common SxS of middle cerebral artery infarct
Neglect of the affected side
136
If ischemia occurs in the posterior circulation what arteries are commonly affected
Posterior inferior cerebellar artery
Vertebrobasilar artery
Posterior cerebral artery
137
What are SxS of posterior ischemic stroke
Nystagmus, ataxia, vertigo, dysphagia, dysarthria
138
What is TPA
Tissue plasminogen activator = clot buster
139
What are the indications for TPA
Age > 18
NIH stroke scale of 5+
< 3hrs since onset of SxS
140
How quickly should TPA Alteplase be given
10% of dose as immediate bolus and remainder given within 60min
141
Are there risks with TPA? If so why use it?
Yes there are risk; increases risk for ICH but we still use it since it prevents 11-13 deaths and disability for every 100 pts (benefit > risk)
142
What is the most common complication in stroke pts
Depression (30%)
143
What are the scores for the NIH stroke scale
```
0 = no stroke
1-4 = minor stroke
5-15 = moderate stroke
16-20 = moderate-severe stroke
21-42 = severe stroke
```
144
Major TPA contraindications include
Score < 5 on scale, seizure, glucose abnormalities, previous head injury/CVA (90 days), Hx of ICH, recent major trauma/Sx, GI or GU hemorrhage, bleeding condition
145
What causes carotid artery stenosis
Plaque formation/build up in the carotids
146
Where does carotid artery stenosis typically occur
The bifurcation and flow into the internal carotids
147
What diagnostic tests are used to determine carotid artery stenosis
Can use carotid US or MRA ($$$) however; current GOLD STANDARD = angiography (invasive)
148
When does carotid artery stenosis Tx require Sx
Asymptomatic pt with > 80% stenosis
| Symptomatic pt with > 50% stenosis
149
When does carotid artery stenosis Tx require medical management
Asymptomatic pts with > 60% stenosis
| Symptomatic pts with < 80% stenosis
150
What drugs are used in carotid artery stenosis Tx
Plavix or Dipyridamole + ASA = 37% RR reduction which is the best
151
Occlusion of a single deep penetrating artery is...
Lacunar infarct
152
Lacunar infarcts typically affect...
Deep nuclei (caudate, thalamus, putamen)
153
What is the most commonly affected area for bacterial meningitis
Subarachnoid space
154
What is the typical cause of bacterial meningitis
Hematogenous spread from OM, sinusitis, PNA, or immmunocompromised
155
What are the causative organisms of bacterial meningitis in neonates
Group B beta hemolytic strep and enteric gram neg bacilli
156
What are the causative organisms of bacterial meningitis in children
```
MC = H influenzae
Others = Neisseria meningitidis & S pneumoniae
```
157
What are the causative organisms of bacterial meningitis in adults
```
MC = S pneumoniae & N meningitidis
Others = Staph, H influenzae, Gram neg bacilli, Listeria
```
158
What are the causative organisms of bacterial meningitis in elderly
S pneumoniae, E coli, Klebsiella, Listeria
159
What are the classic SxS of bacterial meningitis
HA
Stiff neck
Fever
Photophobia
160
What are other SxS of bacterial meningitis
Mental status change, n/v, seizures, lethargy, and confusion
| Infants = high pitched crying, refusal to eat, bulging fontanelles
161
What are the classic PE findings for bacterial meningitis
Nucchal rigidity, kerning's sign, brudzinski's sign, and maybe skin rash (65%)
162
What is the diagnostic choice for bacterial meningitis
LP
| Cloudy is poor result
163
What is the 1st line Tx of bacterial meningitis
Pt under 50 y/o = vancomycin + ceftriaxone
| Over 50 y/o = add ampicillin
164
What are some preventions of bacterial meningitis
Vaccines (pneumococcal & meningococcal)
165
When is bacterial meningitis contagious
7 days before illness and 24 hrs after Abx started
166
Which is more common...viral or bacterial meningitis
Viral
167
What are common causitive agents for viral meningitis
Enterovirus, HSV
168
Pt with viral meningitis may present with...
Flu like symptoms, HA, fever, malaise, photophobia, & meningeal irritation
169
How do you differentiate viral and bacterial meningitis
Impossible to determine from H&P so treat as bacterial until proven otherwise
170
Inflammation of the brain =
Encephalitis
171
What is the most common type of encephalitis
Herpes simplex encephalitis
172
Common SxS of encephalitis are
HA
Fever
Mental status change
173
What is the MC causative agent of herpes simplex encephalitis and where is it found
HSV1; primarily in trigeminal ganglion
174
Presence of the HSV1 causes severe...
Inflammation, edema, necrosis, and hemorrhage
175
What is the diagnostic of choice for herpes encephalitis? What other test is commonly done?
Gold standard = PCR PCE for HSV
| Other test = LP to check CSF leukocytes, protein, and glucose
176
What is the imaging of choice for herpes encephalitis
MRI preferred over CT
177
What is the Tx of herpes encephalitis
Acyclovir +/- steroids
178
What is the leading cause of epidemic encephalitis
Arbovirus
179
West nile virus has an abrupt onset of SxS what are they
Fever, malaise, profound fatigue, weakness
| +/- HA, eye pain, and n/v
180
What is the classic finding for west nile on PE
Occipital LAN
| Other = conjunctivitis and flushing
181
What is the diagnostic of choice for west nile
IgM ELISA (positive 8-21 days post onset)
182
What type of encephalitis is common in HIV pts
CMV encephalitis
183
What commonly presents in conjuction with CMV encephalitis
Retinitis
184
What is the Tx of CMV encephalitis
Ganciclovir & foscarnet
185
What pathogen is in cat bite infections
Pasteurella multocida
186
What are the stages of syphilis
```
Primary = chancre, 21-90 days
Secondary = macular rash, 2-8 weeks
Latent = 1-20 years
Tertiary = 1-20 years
```
187
A common neuro complication of syphilis is tabes dorsalis...what is it and what are its SxS
It is peripheral neuropathy, an inflammatory process involving the dorsal root ganglion
SxS = lightening pains (abs & legs), decreased proprioception, vibratory sense, & DTRs, Argyll-Robertson pupil, and syphilitic paresis (dementia paralytica)
188
How do you Dx neurosyphilis
LP for CSF with FTA-ABS test
189
How do you Tx neurosyphilis
PCN and monitor CSF
190
What is the MCC of cerebral mass lesions in HIV pts with CD4 < 100
Toxoplasmosis (parasitic infection)
191
What is the diagnosic of choice and result for toxoplasmosis
CT scan = ring enhancing lesions
192
What sex is more likely to develop brain CA? What is the peak age
Men > women
| Peak age = 65-79 y/o
193
What is the only truly proven risk factor for brain CA
High dose ionizing radiation
194
What is the most common type of brain CA
Meningioma
195
Who is more likely to develop a meningioma
Women 3X more
196
Where do meningiomas arise from
The meninges in the subarachnoid space
197
What are the 2 locations for meningiomas? What are the associated SxS of each
Intraventricular: SxS = ICP
| Posterior fossa: SxS = CN abnormalities
198
What are the distinct radiological characteristics of meningiomas
Dura tail & indentation of the brain
199
What are the grades of meningiomas
Grade 1 = meningioma; bening
Grade 2 = atypical meningioma; not benign or malignant
Grade 3 = anaplastic meningioma; malignant & invasive
200
What is the Tx for meningioma
Watchful waiting
Craniotomy
Radiation (sterotactic radiation/radiosurgery, gamma knife)
201
What is the familial link of pituitary adenoma
Multiple endocrine neoplasia 1 (MEN1)
202
What is the most common type of pituitary adenoma
Prolactinoma
203
What cells are involved in prolactinomas? What are the SxS
```
Cells = lactotrophs
SxS = gallactorrhea & gynecomastia
```
204
What is the size classification for pituitary adenomas
Macroadenoma: 10+ mm
Microadenoma: <10 mm
205
This type of brain CA is not common, occurs near the pituitary gland, and is classified as a pituitary tumor even though it differs from a pituitary adenoma. What is it?
Craniopharyngioma
206
Where do pituitary adenomas arise from?
| Where do craniopharyngiomas arise from?
```
Adenoma = cells in anterior lobe
Craniopharyngioma = cells in Rathke's duct
```
207
What are the SxS of craniopharyngioma
May disrupt pituitary fxn, may result in optic nerve compression, may have increased ICP
208
Where are schwannomas (accoustic neuromas) found?
Tumor of CN8
209
What/where do schwannomas arise from
Schwann cells
210
What is a major complication of a schwannoma
Involvement/impingement of CN7 which runs along CN8
211
Are schwannomas usually uni or bilateral
Unilateral except with neurofibromatosis
212
What is the main SxS of schwannomas
Unilateral hearing loss
213
What will the results be of the Rhine and Weber test with schwannoma
Rinne: AC > BC
Weber: lateralize to the unaffected side
214
What is the imaging study of choice for schwannoma
MRI
| Will see growth in internal acoustic canal
215
What is the Tx of schwannoma
Keyhole Sx or retromastoid/retrosigmoid craniotomy
216
Where do gliomas arise from
Glial cells
217
What is the most common type of malignancy (glioma)
Astrocytoma
218
What are the grades for astrocytomas
Grade 1 = pilocytic; benign
Grade 2 = low grade; benign
Grade 3 = anaplastic; malignant
Grade 4 = gliobalstoma multiforme; very malignant
219
Who are brainstem gliomas MC in
MC in children
220
What is the most devestating pediatric malignancy
Diffuse Intrinsic Pontine Glioma (DIPG)
221
What is the Tx of brainstem glioma
Sx if possible but often resort to XRT
222
Where do ependyomas arise from
Ependymal cells
223
What is the problem with ependyomas
They block the CSF flow and cause hydrocephalus
224
What are the common locations of ependyomas
4th ventricle for kids (more common)
| Spine for adults
225
What is the diagnostic test of choice for ependyoma
MRI
226
What is the Tx for ependyoma
Sx if possible
| May or may not use XRT or chemo
227
Where do oligodendrogliomas arise from
Oligodendrocytes
228
What is the key characteristic of oligodendrogliomas
They are slow growing
229
What is the Tx for oligodendrogliomas
Watchful waiting or Sx if possible
XRT
Chemo = temozolamide
230
What is often involved in optic nerve gliomas
Optic chiasm
231
What condition are optic nerve gliomas associated with
Neurofibromatosis
232
What are the SxS of optic nerve gliomas
Vision changes & maybe hormonal disturbances
233
What is the imaging of choice for optic nerve gliomas
MRI
234
What are the 2 grades of pineal tumors
Low grade = pineocytoma (benin)
| High grade = peneoblastoma (malignant)
235
What is the MC pediatric tumor
Medulloblastoma
236
Where are medulloblastomas found
ALWAYS in cerebellum
237
What are characteristics of medulloblastomas
Fast growing, high grade tumors
238
What is the Tx of medulloblastomas
Sx, radiation, +/- chemo
239
What are the most common primary CAs to met to the brain
Lung and breast CA
240
What are the types of neurofibromatosis
Type 1 = von Recklinghausen disease; 1/3,000
| Type 2 = 1/25,000; autosomal dominant
241
What are the main SxS of type 1 neurofibromatosis
All the skin manifestations (pretty obvious)
| 15% will develop malignant gliomas
242
What is the most common cause of dementia
Alzheimer's
243
What are the 3 types of dementia
Cortical (AD, metabolic)
Subcortical (vascular dementia)
Mixed (Parkinson's, lewy body)
244
What are the main findings with AD
Amyloid plaques
| Neurofibrilliary tangles
245
Which neurotransmitter is the problem with AD
Decreased ACh due to death of cholinergic neurons
246
How do you Dx AD
Dx of exclusion
247
What is the Tx of AD
```
Cholinesterase inhibitors (Aricept, Exelon, Reminyl)
NMDA receptors (Namenda)
```
248
What are RFs for multi infarct dementia
DM, CAD, HTN, CVA, smoking, men
249
What is the Tx of multi-infarct dementia
Manage RFs
250
Who is affected more by dementia with lewey bodies
Men
251
What are lewy bodies
protein deposits in nerve cells that can develop into plaques & tangles
252
What is the most prevalent SxS of lewy body dementia
Visual hallucinations
253
What is the Tx of lewy body dementia
```
Same meds as AD, may use Parkinson's meds too
Poor prognosis (dead 5-7years)
```
254
Picks disease is also known as
Frontotemporal lobar degeneration (FTD)
255
Why is FTD called picks disease
B/c of the abnormal protein-filled structures found in the pathology
256
What is the classic triad for normal pressure hydrocephalus
Gait instability
Urinary incontinence
Dementia
"Wobbly, wet, wacky"
257
What is the diagnostic study of choice for normal pressure hydrocephalus? What is the result
```
MRI
Shows ventriculomegaly (enlargement of ventricles)
```
258
What is the Tx of normal pressure hydrocephalus
Shunting may be best if responsive to LP
259
_________ is lacking in EtOH dementia
Thiamine (B1)
260
What are the tell tale SxS of wernicke's encephalopathy
Opthalmoplegia and verticle & horizontal nystagmus
261
The key finding in progressive supranuclear palsy is...
Paralysis of verticle gaze
262
What is the diagnostic test of choice for evaluation of new onset seizures
MRI unless suspected bleed
263
When can a pt stop taking seizure meds
When they are seizure free for 2 years and have a normal EEG
264
What are the SxS of absence seizures
NO AURA
Vacant, dazed expression
Staring
Pallor
Timing (10 seconds max, many times during day)
Post-ictal (picking clothes, pursing lips)
265
What is Tx for absence seizures
Zarontin
Depakote
Tx for 2 years then if seizure free wean off
266
What is generalized tonic clonic called
Grand mal seizure
267
What often precedes a grand mal
Aura with irritability, apathy, HA, scintillating scotoma, nausea, choking sensation, paresthesias
268
What are the SxS of grand mal
Sudden LOC, tonic, clonic, incontinence, tongue biting
269
What is the 1st line Tx of grand mal
Valproic acid (depakote)
270
What is the 2nd line Tx of grand mal
Dilantin or Tegretol
271
What seizure is characterized by sudden single or multiple jerks AKA infantile spasms
Myoclonic seizures
272
What are the SxS of atonic seizures
LOC, head drop w/ loss of posture, "drop attack" & falls
273
Simple partial seizures have _______ areas but may spread
Focal
274
Sensory SxS of simple partial seizures
Visual, auditory, olfactory, gustatory
275
Autonomic SxS of simple partial seizures
GI SxS, flushing
276
Motor SxS of simple partial seizures
Jerking limbs & paresthesias
277
Other SxS of simple partial seizures
Hallucinations, deja vu, jamais vu
278
Are simple partial seizures unilateral or bilateral
Unilateral
279
What is the Tx of simple partial seizures
Dilantin, Tegretol, Depakote
280
What is the most common type of seizure
Complex partial
281
Where do complex partials start? Where might they travel
Start = temporal
| Travel to frontal
282
What may complex partials progress to
Grand mal
283
What are the SxS of complex partial
LOC
Aura (GI symptoms, sense of fear)
Stare, automatisms, facial movements
284
How long do complex partial seizures last
Lasts 30 sec - 2 min
285
What is the Tx of complex partial seizures
Tegretol, Dilantin, temporal lobe resection if meds fail for 2 years
286
Who gets rolandic epilepsy
ONLY children
287
What are the SxS of rolandic epilepsy
Face/cheek twitch
Drooling
Difficulty speaking
Often only occur during sleep
288
What is the Tx of rolandic epilepsy
Tegretol, Trileptal, Neurontin
289
Gelastic seizure is characterized by
Laughing outburst
290
Dacrystic seizure is characterized by
Crying outburst
291
Postictal period typically lasts_______ and has what SxS
Last 5-30 minutes
| SxS = HA, exhaustion, confusion, drowsiness
292
What are the RFs for status epilepticus
```
MEDICATION WITHDRAWL
Alcohol withdrawl
Drug overdose
Intracranial infections
Neoplasms
```
293
What are the SxS of status epilepticus
Seizure lasting > 30min and/or 2+ seizures w/o recovery period
294
What is the 1st line Tx of status epilepticus
Lorazepam or daizepam
295
What seizure drugs should NOT be used in pregnant pts
Depicote & tegretol
296
What are cateminal seizures
Seizure in women with epilepsy due to progesterone withdrawl or mid-cycle estrogen surge
297
What drug is polycystic ovary disease related to
Valproate (Depakote)
298
Psychogenic nonepileptic seizure is AKA
"pseudoseizures"
299
Causes of pseudoseizures are...
Anxiety attacks/PTSD
| Conversion disorder
300
What is atypical seizure activity
```
Nonfocal (opposite arm/leg)
Pelvic thrusting
Head turning side to side
Eyes closed (tight)
Tongue biting limited to tip
Postictal crying
Memory of event
May be triggered by emotional/stressful situation
```
301
Who is more likely to get MS
White > black
Female > male
Age 15-60
302
MS is an __________ disease resulting in.....
Autosomal disease results in demyelination of white matter
303
What are the types of MS
Relapsing remitting
Secondary progressive (Most Common!)
Primary progressive
Progressive relapsing
304
What is the presentation of MS
Sensory loss
Optic neuritis
Weakness
Paresthesias
305
What are other SxS of MS
```
Ataxia
Diplopia
Lhermitte sign
Telegrapghic speech
Dementia
Facial palsies
Impotence
```
306
What is the diagnostic of choice for MS
MRI shows spotty irregular demyelination
307
What is the 2nd diagnostic test for MS. What does it show
LP shows oligoclonal bands (bands of Ig)
308
What is the Tx of MS acute exacerbation
Methylprednisone IV x3days then switch to oral prednisone
309
What is the 1st line management of MS
Betaseron
Avonex
Rebif
Glatiramer
310
What is 2nd line management of MS
Mitoxantrone (Novantrone)
311
What is 3rd line management of MS
Natalizumab
312
What other things need to be managed in MS
```
Spasticity (Baclofen)
Pain (Amitriptyline)
Urinary (Ditropan or Detrol)
Constipation
Fatigue (Provigil)
Depression (SSRI)
```
313
What is the benign course of MS
1-2 relapses then recovery
314
What is commonly lost in pts with MS
Independent walking
315
What condition is a common development/association of MS
Optic neuritis
316
Is optic neuritis usually uni or bilateral?
| What visual acuity constitutes
Usually unilateral with acuity of 20/100
317
What is the onset of optic neuritis
Usually hours to days
318
What are the PE results for optic neuritis
Optic nerve pallor
| NORMAL pupillary reflex
319
This is an idiopathic, inflammatory neuropathy that affects men more than women and usually follows infection
Gullain barre
320
What neurons are affected by guillain barre
Sensory and motor
321
Gullain barre is an example of....
Antigen mimicry
322
What is the typical presentation of Guillain barre
```
Proximal muscle weakness
Legs affected more than arms
Myalgias (shoulder, back, thighs)
Paresthesias
Decreased DTRs
```
323
What are the types of Gullain barre
Acute inflammatory demyelinating polyadiculoneuropathy (AIDP) = 90%
Acute motor axonal neuropathy (AMAN)
324
What are the Txs for Gullain barre
Supportive or IVIg or plasmapheresis
| Vaccinations (H1N1, tetanus, hepatitis)
325
What are long term effects of Gullain barre
Long term foot drop and hand weakness
326
What is the chronic form of Gullain Barre
Chronic idiopathic demyelinating polyneuropathy (CIDP)
327
Neuromuscular autoimmune disease with antibody formation to nicotinic ACh receptors
Myasthenia gravis
328
Drug induced myasthenia gravis
Tetracycline, aminoglycosides, propranolol, lithium
329
What are the main SxS of myasthenia gravis
```
Asymmetric proximal limb weakness
CN weakness (lid lag, ptosis, diplopia, facial weakness, slurred speech, fatigability)
```
330
What is the Tx of myasthenia gravis
```
Anticholinesterase inhibitors (Mestinon)
Immunosuppression (prednisone)
```
331
Bad complication of myasthenia gravis
Paralysis of respiratory muscles
332
Disorder characterized as persistent pain in dermatomal distribution
Postherpetic neuralgia
333
Degeneration of dopaminergic neurons in substantia nigra
Parkinson's
334
What are the SxS of Parkinson's
Rest tremor
Bradykinesia
Rigidity
335
What are common aspects of Parkinson's tremor
Rest tremor & pill rolling
336
What are common features of Parkinson's rigidity
Cogwheeling & lead pipe resistance
337
What are common features of Parkinson's bradykinesia
Micrographia & slow, shuffling gait
338
What is the diagnostic test of choice for Parkinson's
Spect imaging to see dopaminergic pathways
339
What is the primary Tx of choice for Parkinson's
Levodopa
| Levodopa/carbidopa (Sinemet)
340
What are side effects of levodopa
Dyskinesias/choreiform movements
341
What is important to remember regarding Parkinson's Tx
After 5-10 years effectiveness wears off, pt experiences "on-off" stages
342
How do you get benign essential tremor
Autosomal dominant inheritance
343
What are exacerbating factors of benign essential tremor
Stress, fatigue, stimulants
344
What are alleviating factors of benign essential tremor
Alcohol & rest
345
Is benign essential tremor a rest or action tremor
Action tremor
346
What areas are commonly affected in benign essential tremor
Hands and head
347
What is the Tx of benign essential tremor
```
Beta blockers (propranolol, metoprolol)
Anticonvulsants (Primidone)
```
348
Autosomal dominant disease with mid-life onset
Huntington's chorea
349
What are classic SxS of huntington's chorea
Choreiform movements, mental decline/dementia
350
Which type of diabetes is more likely to develop diabetic polyneuropathy
Type 2
351
What is diabetic polyneuropathy associated with
Elevated HgbA1c
352
PE results of diabetic polyneuropathy
Decreased monofilament sensation, sharp/dull sensation, vibratory & proprioception sense, DTRs
353
What is the Tx of diabetic polyneuropathy
```
Optimize glucose control
TCA
Anticonvulsants
SNRI
Opiods (last resort)
```
354
Inflammation at the geniculate ganglion facial nerve linked with OM & herpes zoster
Bell's palsy
355
Red flags of bell's
Gradual onset > 2wks, no forehead involvement, bilateral involvement
356
What are the PE results of Bell's
```
Loss of nasolabial fold
Corner of mouth droops
Inability to close eye
Decreased lacrimation
INTACT SENSATION
```
357
What is the Tx of Bell's
Steroids and antivirals within 72hrs (acyclovir)
