Neuro Flashcards
list all 12 cranial nerves with function
Oh Oh Oh To Touch And Feel A Very Good Vagina Such Heaven
I. Olfactory: Smell
II. Optic: Vision/pupil response
III. Oculomotor: Eyeball/lid movement
IV: Trochlear: Eyeball/lid movement
V: Trigeminal: Facial sensation and movement
VI: Abducens: Extraoccular eye movements
VII: Facial: movement and taste
VIII: Auditory: hearing
IX: Glossopharyngeal: gag/swallow
X: Vagus: gag/swallow/ taste
XI: Spinal: Shrug shoulders
XII: Hypoglossal: stick out tongue
12 Sensory vs Motor vs Both of cranial nerves
Some Say Marry Money But My Brother Says Big Bras Matter Most
What is the MMSE and the score interpretation
Assess cognitive impairment
Oral, One, Two, RWD (Orientation, Recognition, List two objects, follow three commands, recognize objects, write a sentence, draw a design)
>24 no impairment
<23 cognitive impairment
TIA treatment
Aspirin and plavix for the first few days then switch to mono therapy
S/S of ischemic stroke
Subtle, progressive or sudden usually a rolling out process that progresses
S/S of SAH vs SDH
SAH: arterial bleed, thunder clap headache, nuchal rigidity, transient LOC
SDH: venous bleed, headache, gradual LOC, seizures
What is the sign of increased ICP
Cushing’s triad: bradycardia, widening pulse pressure, apnea
Vomiting, altered mentation, headache
What are the 3 Hs of herniation risk
Hypotension, hypoxemia, hypercapnia
What is the goal CO2 for bleed patients
CO2 35
What is the goal MAP to prevent vasospasm
110-130
CPP formula
MAP-ICP
How to treat/prevent vasospasm
Increase MAP, nimodipine, CCB
GCS
15 point max
Less than 8 intubate
Eyes: 4
Verbal: 5
Motor: 6
Difference between simple vs complex focal seizures
Simple: no loss of conciousness
Complex: impaired conciousness
Seizure treatment
Initial: IM midazolam, or lorazepam, or diazepam (may repeat x1)
Second: Phenobarbital, OR rectal diazepam OR intranasal midazolam
Third: Fosphyentoin, OR valproic acid OR keppra, OR Phenobarbital
Fourth: Repeat third line OR intubate and sedate
S/S, Labs, and Treatment for Myasthenia Gravis
Weakness worse after exercise, improves with rest
Droopy eyelid, extremity weakness, normal sensory
LAbs: ACTH antibodies positive, CT/MRI to rule out thymoma
Tx: pyridostigmine, immunosuppressants, thymenectomy, plasmaphoresis, IVIG
MS symptoms, tests, and treatment
i. Autoimmune attacks myelin sheath
ii. Numbness, weakness, vision, speech, bladder, unsteadiness, spastic
iii. Young adults most common, more common in people of Western European decent
iv. MRI***
v. Tx: no treatment for progression, neuro referral, steroids, antispasmodics, plasmapheresis, immunosuppressants, interferon
GB symptoms, labs, treatment
a. Polyneuropathy, demyelination of peripheral nerves, progressive symmetrical ascending paralysis
b. Preceded by viral infection with a fever
c. Flaccid paralysis can result in 24 hours
d. Labs: CSF protein elevated, elevated IgG, leukocytosis, LP, MRI, CT
e. Tx: supportive care
CSF comparison in viral vs bacterial meningitis
Bacterial: Cloudy, xanthochromatic, elevated opening pressure (>180), elevated protein, WBC (10-10000), decreased glucose (<40)
Viral: normal/elevated opening pressure, normal protein, normal glucose, positive immunoglobulins
S/s and treatment for bacterial and viral meningitis
S/S: Consider in any patient with fever and neuro symptoms , Typical Strep pneumoniae E , Fever, severe headache, n/v, nuchal rigiditiy, positive kernigs (pain and spasm of hamstring), positive brudinski (flex of head and neck cause leg flex), photophobia, seizures
Bacterial tx: <50 : vanco plus ceftriaxone, >50: Vanco plus amipicillin and ceftriaxone, Dexamethasone
Viral: Acyclovir, Valcyclovir, Vaccinate
Battle sign vs Raccoon eye
Battle sign: bruising behind the ear, increased ICP
Raccoon eye: basilar skull fx
Parkinson’s s/s, labs, and tx
a. Dopamine deficiency
b. Idiopathic
c. Tremor, rigidity, and bradykinesia*
d. Wooden faces: smile looks like Mardi grads mask
e. Myerson sign: blink when you tap over the bridge of the nose
f. Labs: diagnosis of exclusion
g. Management: Carvidopa/levodopa, premipexole, selegiline, resagiline*
S/S of dementia and treatment
a. Lewy Body dementia linked with Parkinson’s
b. Alzheimer’s dementia: most common
i. DEMENTIA (drug reactions, emotional disorders, metabolic, ENT, nutritional, tumors, infections, art.scler.)
ii. S/S: Aphasia, apraxia, agnosia in addition to memory defects
iii. Earliest complaints of family is a loss of short-term memory
iv. Unknown cause; women more than men
v. ACTH deficiency
vi. MEDS: Cholinesterase inhibitors (donepazile, ritastigmine), Namenda ***
c. Unexplained Dementia
d. Delirium is sudden and transient
e. Dementia: gradual irreversible memory loss
i. Viral, CAD
Which CN controls extraoccular movements, opening eyelids, pupillary constriction
CN: III Occulomotor
Which CN controls down and inward eye movement
CN IV Trochlear
Which CN is responsible for chewing
CN V Trigeminal
Which CN is responsible for lateral eye movement
CN VI Abducens
Which CN is responsible for puffing cheeks
CN VII Facial
Which CN is responsible for swallowing
CN IX Glossopharyngeal
How long do symptoms last in a TIA
Typically <1 hr with no residual
S/S of a TIA
Ipsilateral monocular blindness (amaurosis fugax)
Homonymous hemianopia (half vision)
Paresthias of contralateral side
S/s of Vertebralbasilar TIA
Vertigo, ataxia, dizziness, visual cuts, weakness, confusion
S/s of carotid TIA
Aphasia, dysarthria, altered LOC, weakness, numbness
Who can get a carotid endarectomy
Symptomatic with 50-90% stenosis or asymptomatic patients with >70% stenosis
Differentiate left and right sided CVA symptoms
Left: aphasia, dysarthria, and difficulty reading/writing
Right: right visual field changes
When can TPA be abministered
Up to 4.5 bars after LKW
Indication for ICP monitoring
Severe head injury
GCS <8 + abnormal scan
What is the goal MAP to treat vasospasms
110-130
What do you give in a seizure if the bg <60
100 thiamine and D50
What is a positive Kernig sign
Pain and spasms of the hamstring muscle
Sign of meningitis
What is a positive Brudzinski sign
Legs flex at both hips and knees in response to flexion of the head
Positive meningitis sign
What s/s suggest an expanding hematoma
Occurrence of a lucid interval
At what spinal injury can a patient still extend their elbow, feed, and dress themselves
C6-C7
At what spinal level does a patient lose their lower leg, feet, and perineum abilities, including incotninence of bowel/bladder/ and sexual function
L1-L2
Managment of Acute spinal cord injury
Methylprednisolone sometimes but referr to neuro
Which spinal level does Autnomic dysreflexia become a concern
T4-T6
Exaggerated autonomic response to a stimulus
What spinal level does respiratory compromise happen
C4 or above
What is Brown Sequard syndrome
Caused by damage to one half of the spinal cord
Ipsilateral upper motor neuron paralysis and loss of proprioception
Contralateral loss of pain and temperature
Cauda Equina syndrome
Compression of nerve roots at end of spinal chord
Saddle region numbness
Steroids and surgery
MAOB inhibitor examples
Rasagilline
