NEURO Flashcards
Which imaging modality is most sensitive for diagnosing acute ischemic stroke?
A. CT scan without contrast
B. CT angiography (CTA)
C. Conventional angiography
D. MRI with diffusion-weighted imaging (DWI)
D. MRI with diffusion-weighted imaging (DWI)
A 45-year-old female presents with a severe headache and photophobia. A non-contrast CT scan is performed, which
shows no evidence of hemorrhage, obstructive hydrocephalus or masses. What is the next best step in imaging to rule
out a subarachnoid hemorrhage?
A. Lumbar puncture
B. MRI with contrast
C. CT angiography
D. Conventional angiography
A. Lumbar puncture
What imaging modality is most sensitive for diagnosing acute ischemic stroke?
MRI with diffusion-weighted imaging (DWI) is the most sensitive imaging modality for diagnosing acute ischemic stroke.
What is the role of CT scan without contrast in diagnosing ischemic stroke?
CT scan without contrast is often used as the initial imaging modality for suspected acute stroke due to its rapid availability but it is less sensitive than MRI with DWI for detecting early ischemic changes.
What is the purpose of CT angiography (CTA) in stroke assessment?
CT angiography (CTA) is utilized to visualize the cerebral blood vessels and help identify vascular occlusions or abnormalities that may cause ischemic strokes.
What does conventional angiography entail and when is it used in stroke diagnosis?
Conventional angiography involves catheter-based imaging of blood vessels and is used in specific cases where detailed vascular assessment or intervention is needed such as in the presence of suspected arterial blockage.
What key symptoms did the 45-year-old female patient with a severe headache present with?
The patient presented with a severe headache and photophobia which are indicative of potential neurological issues such as a cerebral hemorrhage or other forms of increased intracranial pressure.
What is the significance of performing a non-contrast CT scan in patients with severe headaches?
A non-contrast CT scan is crucial in the emergency setting to quickly rule out hemorrhagic stroke or other acute intracranial conditions before considering further imaging or treatment.
In the context of stroke assessment what does photophobia indicate?
Photophobia can indicate meningeal irritation or elevated intracranial pressure which may be related to various conditions including meningitis subarachnoid hemorrhage or migraines.
What follow-up procedures might be recommended if a non-contrast CT shows no evidence of hemorrhage in a patient with severe headache?
If the non-contrast CT shows no hemorrhage further imaging such as MRI or additional evaluation for other causes of headache (like lumbar puncture) may be indicated.
What is the next best step in imaging to rule out a subarachnoid hemorrhage in suspected cases of hydrocephalus or masses?
Lumbar puncture
Which patient population is at risk of nephrogenic systemic fibrosis?
Patients on chronic dialysis for cranial MRI with contrast.
What imaging modality is most appropriate for evaluating suspected dementia in a 55-year-old male with a history of smoking who presents with progressive memory loss and behavioral changes?
MRI without contrast.
What imaging test should be avoided in a patient at risk for nephrogenic systemic fibrosis?
MRI with gadolinium contrast.
What are the common symptoms of hydrocephalus?
Symptoms may include headache nausea vomiting blurred vision balance problems cognitive changes and gait disturbances.
What is the significance of a lumbar puncture in the diagnostic process for subarachnoid hemorrhage?
A lumbar puncture can analyze cerebrospinal fluid (CSF) for the presence of blood which may confirm a subarachnoid hemorrhage if detected.
What are the primary complications associated with nephrogenic systemic fibrosis?
Complications include fibrosis of the skin joints and internal organs which can lead to severe mobility limitations and organ dysfunction.
What type of imaging can provide the best view of brain structure and aid in the diagnosis of dementia?
MRI without contrast provides detailed images of brain structure making it the preferred imaging modality for evaluating suspected dementia.
What differentiates conventional angiography from CT angiography?
Conventional angiography involves catheter-based injection of contrast material to visualize the blood vessels directly while CT angiography uses computed tomography to visualize blood vessels non-invasively.
What are the potential risks of gadolinium-based contrast agents?
Gadolinium-based contrast agents can lead to allergic reactions nephrogenic systemic fibrosis in at-risk populations and transient effects such as headache or nausea.
Which imaging modality is most appropriate for evaluating a patient with suspected intracranial aneurysm?
The most appropriate imaging modality is Magnetic Resonance Angiography.
A 30-year-old male with a history of seizures presents with a first-time generalized tonic-clonic seizure. What is the most appropriate initial imaging study?
The most appropriate initial imaging study is MRI without contrast.
A 25-year-old man presents with sudden brief episodes of staring and unresponsiveness lasting a few seconds with no postictal confusion. What is the most likely diagnosis?
The most likely diagnosis is Absence seizure (typical seizure).
What are the characteristics of absence seizures?
Absence seizures are characterized by brief episodes of staring a lack of awareness and typically last a few seconds. There is no postictal confusion associated with these seizures.
What is the role of MRI in evaluating seizures?
MRI is used to evaluate potential structural causes of seizures such as tumors malformations or scarring in the brain.
What is the typical first-line imaging study for acute headache with suspected underlying cerebral pathology?
The first-line imaging study for acute headache with suspected underlying cerebral pathology is a CT scan without contrast.
What is the difference between a CT scan and MRI?
CT scans use X-rays to create images of the body usually best for detecting acute hemorrhagic events. MRIs use magnetic fields and radio waves to produce detailed images of soft tissues better for evaluating brain structures.
In what situations might a PET scan be indicated in neurology?
A PET scan may be indicated in cases of evaluating brain metabolism in conditions such as epilepsy Alzheimer’s disease and brain tumors.
What is the significance of postictal confusion?
Postictal confusion refers to the altered state of consciousness and disorientation that follows a seizure providing important clinical information that can help differentiate seizure types.
What is the primary difference between tonic-clonic seizures and other seizure types?
Tonic-clonic seizures involve loss of consciousness muscle stiffness (tonic phase) followed by jerking movements (clonic phase) whereas other seizures like absence seizures may not involve loss of awareness or postictal confusion.
What are the immediate management steps for a patient undergoing a seizure in the emergency department?
Immediate management includes ensuring patient safety protecting the airway providing oxygen if needed and administering benzodiazepines if the seizure lasts longer than 5 minutes.
Describe the clinical presentation of typical absence seizure.
Typical absence seizures present as brief episodes of unresponsiveness staring and may include subtle automatisms; they commonly occur in children and are often mistaken for daydreaming.
Which factors can increase the risk of developing seizures?
Factors that can increase the risk of developing seizures include head trauma history of strokes infections genetic predispositions substance abuse and certain metabolic disturbances.
Explain the term ‘ictal state’.
The ictal state refers to the period during a seizure when the electrical activity in the brain is abnormal resulting in the signs and symptoms associated with the specific type of seizure.
What is a typical absence seizure?
A typical absence seizure is a type of generalized seizure characterized by brief sudden lapses in awareness usually lasting only a few seconds. The patient may appear to stare off into space and may not respond to stimuli during the episode. These seizures often begin in childhood and can occur multiple times a day.
What is the correct monitoring parameter for a patient started on valproic acid?
The most important monitoring parameter for a patient started on valproic acid is liver function tests. Valproic acid can cause hepatotoxicity and it’s crucial to monitor liver enzymes to prevent potential liver damage.
What are the key characteristics of an atonic seizure?
An atonic seizure is characterized by a sudden loss of muscle tone which can lead to a sudden fall or drop. This type of seizure can result in injuries due to falls and it typically occurs in individuals with epilepsy. It is often classified under generalized seizures.
Define generalized tonic-clonic seizure.
A generalized tonic-clonic seizure is a type of seizure that involves two phases: the tonic phase where the body stiffens and the clonic phase where there are rhythmic jerking movements of the limbs. This seizure type affects the entire brain and results in a loss of consciousness.
What distinguishes a focal seizure with impaired awareness from other types of seizures?
A focal seizure with impaired awareness is characterized by a seizure that begins in a specific area of the brain and leads to impaired consciousness. Patients may exhibit unusual behaviors such as repetitive movements confusion or a lack of responsiveness during the episode.
List common side effects of valproic acid.
Common side effects of valproic acid include nausea vomiting weight gain hair loss tremors drowsiness and in more severe cases liver damage or pancreatitis.
What is the importance of monitoring serum sodium levels in seizure patients?
Monitoring serum sodium levels in seizure patients is critical especially for those on certain anticonvulsants like carbamazepine and oxcarbazepine which can cause hyponatremia (low sodium levels) as a side effect. Low sodium can lead to seizures and other neurological complications.
What are potential signs of liver dysfunction in patients taking valproic acid?
Potential signs of liver dysfunction include jaundice (yellowing of the skin and eyes) fatigue abdominal pain dark urine and elevated liver enzymes in blood tests.
What is the general mechanism of action for valproic acid?
Valproic acid works mainly by increasing the availability of gamma-aminobutyric acid (GABA) an inhibitory neurotransmitter in the brain thus stabilizing neuronal activity and reducing seizure occurrences.
What are the potential complications of frequent atonic seizures?
Frequent atonic seizures can lead to injuries due to falls social limitations potential for depression or anxiety due to the unpredictability of episodes and can affect the patient’s quality of life severely.
What are muscle contractions affecting the entire body often occurring in the morning after awakening commonly indicative of?
Juvenile myoclonic epilepsy.
Which seizure disorder is characterized by muscle contractions that affect the entire body and are often seen upon awakening?
Juvenile myoclonic epilepsy.
What are the primary characteristics of Juvenile myoclonic epilepsy?
It typically includes myoclonic jerks generalized tonic-clonic seizures and may also involve absence seizures usually beginning in adolescence.
What is the EEG finding most consistent with typical absence seizures?
Generalized 3-Hz spike-and-wave discharges.
What seizure disorder is associated with generalized 3-Hz spike-and-wave discharges on EEG?
Typical absence seizure.
What are common characteristics of typical absence seizures?
They involve brief lapses of consciousness often with subtle motor activity such as blinking or twitching.
What is typically seen in the EEG of someone experiencing an atypical absence seizure compared to typical absence seizure?
Atypical absence seizures typically show slower spike-and-wave discharges (less than 2.5 Hz) and have more prolonged episodes.
What is a consistent pathologic finding in patients with mesial temporal lobe epilepsy?
Loss of specific cell populations within the hippocampus.
What specific changes occur in the hippocampus due to mesial temporal lobe epilepsy?
There is often loss of pyramidal cells and possible sclerosis of the hippocampus.
What type of infiltration is noted in mesial temporal lobe epilepsy?
Lymphocytic infiltration of the deep brain structures.
What is the typical age of onset for Juvenile myoclonic epilepsy?
The typical age of onset is between 12 and 18 years.
What medications are commonly used to treat Juvenile myoclonic epilepsy?
Valproate Lamotrigine and Levetiracetam are commonly used.
How does the clinical presentation of myoclonic seizures differ from those of generalized tonic-clonic seizures?
Myoclonic seizures are brief shock-like muscle jerks while generalized tonic-clonic seizures involve a loss of consciousness and violent muscle contractions.
What is the hallmark symptom of generalized tonic-clonic seizures?
The hallmark symptom is the combination of tonic (stiffening) and clonic (jerking) phases.
What distinguishing feature characterizes seizures in Lennox-Gastaut syndrome?
A variety of seizure types alongside cognitive and behavioral disturbances.
What is the significance of a patient’s EEG findings in diagnosing seizure disorders?
EEG findings are crucial for differentiating between types of seizures and guiding treatment.
What risk does untreated epilepsy pose?
Untreated epilepsy can lead to increased seizure frequency and severity potential for brain injury and psychosocial challenges.
What type of necrosis is associated with the medial temporal lobe in certain pathologies?
Caseation necrosis is commonly associated with the medial temporal lobe in certain pathologies often linked to infections like tuberculosis.
What is a common consequence of losing specific cell populations within the hippocampus?
The loss of specific cell populations within the hippocampus can lead to memory impairment and is a characteristic feature in conditions like epilepsy and Alzheimer’s disease.
From which lobe of the brain do focal seizures that spread to involve both cerebral hemispheres typically originate?
Focal seizures that spread to both cerebral hemispheres typically originate from the Frontal lobe.
What are focal seizures with impaired awareness commonly characterized by?
They are commonly characterized by automatisms such as lip smacking or picking movements.
List some common features of seizures originating from the Frontal lobe.
Features of seizures originating from the Frontal lobe can include: sudden loss of postural tone contralateral muscle jerking complex movements and in some cases aggressive behaviors.
What clinical features distinguish ‘Automatisms’ found in focal seizures with impaired awareness?
Automatisms may include repetitive movements such as lip smacking hand wringing or other non-purposeful actions indicative of altered awareness.
What is the difference between generalized seizures and focal seizures?
Generalized seizures involve both hemispheres of the brain from onset while focal seizures start in one localized area before potentially spreading.
What role does the amygdala play in seizure disorders?
The amygdala when hypertrophied can contribute to the emotional and behavioral manifestations of seizure disorders particularly in temporal lobe epilepsy.
What is a common occurrence after a focal seizure has subsided?
Postictal confusion a period of altered consciousness and cognitive function is a common occurrence following a focal seizure.
Describe caseation necrosis in the context of the medial temporal lobe. What might it imply clinically?
Caseation necrosis in the medial temporal lobe might imply a granulomatous infection like tuberculosis potentially leading to altered cognition or memory issues.
What types of movements might occur during generalized tonic-clonic seizures as opposed to focal seizures?
Generalized tonic-clonic seizures typically include sustained muscle contractions (tonic phase) followed by rhythmic jerking movements (clonic phase) while focal seizures may involve localized non-rhythmic movements.
What are the clinical implications of brief lapses of consciousness without motor activity?
Brief lapses of consciousness without motor activity may be characteristic of absence seizures which could lead to learning difficulties if frequent.
Identify the significance of the hippocampus in seizure disorders. Why is it clinically relevant?
The hippocampus is significant in seizure disorders as it is crucial for memory formation and can be a site of structural changes leading to epilepsy particularly temporal lobe epilepsy.
What can be a consequence of hypertrophy of the amygdala in a patient with seizures?
Hypertrophy of the amygdala can lead to increased emotional responses and may contribute to changes in behavior or anxiety in patients with seizure disorders.
What are common postictal findings in patients with focal seizures involving the dominant hemisphere?
Common postictal findings in patients with focal seizures involving the dominant hemisphere include transient aphasia.
Which drug is considered first line in the management of status epilepticus?
Lorazepam IV infusion is the first line drug in the management of status epilepticus.
What are the first-line treatments for focal seizures?
The first-line treatment for focal seizures includes Lamotrigine.
What is the most common cause of seizures in older adults?
The most common cause of seizures in older adults is cerebrovascular disease.
What is transient aphasia?
Transient aphasia is a temporary loss or impairment of the ability to communicate effectively through speech or writing commonly observed after seizures that involve the dominant hemisphere.
What is the role of Lorazepam in status epilepticus management?
Lorazepam works as a benzodiazepine that enhances the effect of the neurotransmitter GABA leading to sedation and anticonvulsant effects making it effective in stopping ongoing seizures.
What factors can lead to seizures in older adults?
Factors that can lead to seizures in older adults include degenerative CNS diseases alcohol withdrawal brain tumors and cerebrovascular disease.
Why is Lamotrigine used as a first-line treatment for focal seizures?
Lamotrigine is effective for focal seizures due to its mechanism of reducing the release of excitatory neurotransmitters and stabilizing neuronal membranes making it a preferred treatment.
Describe how focal seizures can present clinically.
Focal seizures may present with symptoms that relate to the area of the brain affected and can include focal motor symptoms sensory changes or dysphasia depending on whether they involve the dominant or non-dominant hemisphere.
What are the clinical implications of visual field cuts following seizures?
Visual field cuts following seizures indicate possible involvement of the occipital lobe or pathways related to vision and they can result in a loss of vision in specific fields affecting the patient’s ability to navigate their environment.
How do hemiparesis and memory loss manifest postictally?
Hemiparesis postictally manifests as weakness or paralysis on one side of the body due to focal seizure activity in the motor areas. Memory loss can occur due to disruption in brain function during the seizure.
What are the criteria for the withdrawal of anti-epileptic therapy in patients with completely controlled seizures?
The withdrawal of anti-epileptic therapy can be done if: A. Seizure has been controlled for at least 6 months B. There is a normal neurologic examination even if with subpar intelligence C. There is minimal electrographic activity on EEG D. After at least two years of meeting discontinuation criteria. The correct criteria is D: After at least two years of meeting discontinuation criteria.
Which of the following is a risk factor for recurrent seizures?
The risk factor for recurrent seizures is A: Nocturnal seizure.
What symptoms might a patient present with during a cerebrovascular event?
A patient may present with sudden-onset left-sided weakness left hemianesthesia (loss of sensation on one side) left homonymous hemianopia (loss of vision in the same visual field in both eyes) and preferential gaze to the right side.
What does the term ‘homonymous hemianopia’ refer to?
Homonymous hemianopia refers to a visual field loss on the same side of both eyes typically caused by lesions in the optic tract or the occipital lobe of the brain.
What does ‘hemianesthesia’ mean?
Hemianesthesia refers to a loss of sensation affecting one half of the body typically caused by neurological conditions or injuries.
What is the significance of an EEG showing a decrease in alpha waves in seizure patients?
A decrease in alpha waves on EEG in seizure patients may indicate a disruption in normal brain function and could be a precursor or indicator of seizures.
What are the common triggers or risk factors associated with seizures?
Common triggers or risk factors for seizures include sleep deprivation alcohol use stress specific visual stimuli and certain medications.
What is the general guideline on how long seizures should be controlled before considering withdrawal of anti-epileptic therapy?
Seizures should be controlled for at least 6 months before considering withdrawal of anti-epileptic therapy.
How would a neurologic examination appear for a patient eligible for withdrawal from anti-epileptic drugs?
A neurologic examination would appear normal even if the patient has subpar intelligence.
What is often observed in patients with neurologic deficits such as stroke?
Patients may exhibit unawareness of their neurologic deficits a condition known as hemispatial neglect.
What is global aphasia?
Global aphasia is a severe form of language impairment where patients are unable to produce or comprehend language due to extensive damage in the dominant hemisphere of the brain.
What is meant by delayed verbal and motor response?
Delayed verbal and motor response refers to a slowing down in the speed at which an individual is able to respond verbally or move physically often seen in patients with neurological conditions affecting cognitive functions.
What is contralateral hemiballismus?
Contralateral hemiballismus is a movement disorder characterized by violent flailing movements of one side of the body typically due to damage in the subthalamic nucleus on the opposite side of the brain.
In a patient with sudden onset of vertigo nausea and difficulty swallowing what additional findings might you see?
You may also see symptoms such as hoarseness ipsilateral Horner’s syndrome and contralateral loss of pain and temperature sensation.
What does ipsilateral Horner’s syndrome indicate in a clinical setting?
Ipsilateral Horner’s syndrome typically indicates a disruption in sympathetic pathways often due to lesions affecting the neck or brainstem.
What are the common symptoms associated with posterior inferior cerebellar artery occlusion?
Common symptoms include vertigo nausea swallowing difficulties and Horner’s syndrome along with contralateral loss of pain and temperature sensation.
What does the presence of hoarseness in a neurological exam suggest?
Hoarseness can suggest involvement of cranial nerve IX (glossopharyngeal) and X (vagus) which can occur in certain brainstem syndromes.
What is the significance of contralateral loss of pain and temperature sensation in neurological diagnosis?
Contralateral loss of pain and temperature sensation suggests damage to the spinothalamic tract often seen in strokes or lesions affecting the brainstem.
What is the most likely diagnosis for a patient with sudden onset vertigo and the described clinical features?
The most likely diagnosis is posterior inferior cerebellar artery occlusion.
What is the typical presentation of middle cerebral artery occlusion?
Middle cerebral artery occlusion typically results in contralateral hemiparesis sensory loss and in some cases aphasia if the dominant hemisphere is affected.
What distinguishes anterior cerebral artery occlusion from others?
Anterior cerebral artery occlusion typically presents with contralateral lower limb weakness and sensory loss due to its distribution affecting the medial aspect of the frontal and parietal lobes.
What are other common symptoms indicative of a basilar artery occlusion?
Basilar artery occlusion may lead to bilateral symptoms including ataxia altered consciousness and cranial nerve dysfunctions.
What syndrome is characterized by a patient being unaware of their blindness and confabulating when describing their surroundings?
Anton’s syndrome. It involves individuals being blind due to damage in the visual cortex but still insisting they can see often fabricating stories about their surroundings.
What is the most likely diagnosis for a patient who is blind and confabulates their surroundings?
Anton’s syndrome.
What are the main characteristics of Anton’s syndrome?
Patients with Anton’s syndrome deny their blindness and often provide incorrect information about their environment demonstrating confabulation.
A 50-year-old male presents with sudden onset of right arm weakness and difficulty speaking along with a history of hypertension and smoking. What kind of stroke is indicated by imaging showing a small infarct in the left internal capsule?
Small-vessel lacunar stroke.
What is the mechanism of stroke associated with small infarcts in the left internal capsule?
Small-vessel lacunar stroke is due to lipohyalinosis of small penetrating arteries often related to chronic conditions such as hypertension and diabetes.
What are the common risk factors for small-vessel lacunar strokes?
Hypertension diabetes mellitus and smoking are common risk factors.
Which characteristic feature is associated with a posterior cerebral artery (PCA) stroke?
Homonymous hemianopia.
What is homonymous hemianopia?
Homonymous hemianopia refers to visual field loss on the same side in both eyes typically due to damage to the visual pathways in the brain.
List three common clinical manifestations of posterior cerebral artery (PCA) strokes.
- Homonymous hemianopia 2. Visual agnosia (inability to recognize familiar objects) 3. Memory deficits due to involvement of temporal lobe structures.
What are some other types of strokes besides lacunar strokes?
- Embolic strokes which originate from a thrombus in the heart and travel to the brain. 2. Large-vessel atherosclerotic strokes resulting from atherosclerosis of major cerebral arteries. 3. Hemorrhagic strokes which occur due to bleeding in the brain.
Which stroke type is the most common caused by heart-related embolism?
Embolic stroke.
Why is it important to quickly identify the type of stroke a patient is experiencing?
Timely identification of stroke type is crucial for effective treatment and management as different types of strokes require different interventions.
What is the characteristic feature of an anterior cerebral artery (ACA) stroke?
Leg weakness is a characteristic feature of an anterior cerebral artery (ACA) stroke.
Which mechanisms are involved in cell death in the ischemic penumbra during a stroke?
Apoptosis is the most likely mechanism of cell death in the ischemic penumbra.
What is the most likely cause of stroke in a patient with a history of recent myocardial infarction?
Thrombus in the left ventricle is the most likely cause of stroke in a patient with a history of recent myocardial infarction.
List the common symptoms associated with an anterior cerebral artery stroke.
Symptoms of an anterior cerebral artery (ACA) stroke may include leg weakness sensory loss and in some cases behavioral changes or cognitive deficits.
What is necrosis and how does it differ from apoptosis?
Necrosis is a form of cell death resulting from acute cellular injury and leads to inflammation while apoptosis is a programmed controlled process that leads to cell death without inducing an inflammatory response.
Define autophagy and its relevance in cell death mechanisms.
Autophagy is a cellular process that recycles damaged or unnecessary cellular components. It can play a protective role and may delay apoptosis or necrosis under certain conditions.
What is free radical injury and how does it relate to stroke?
Free radical injury occurs when reactive oxygen species (ROS) damage cellular components contributing to the pathophysiology of ischemia and reperfusion injury in stroke.
What are the major types of strokes and how do they differ?
The major types of strokes are ischemic stroke (due to blood clots blocking blood flow) and hemorrhagic stroke (due to bleeding in or around the brain). Ischemic strokes are more common.
What role does thrombus formation in the heart play in strokes?
Thrombus formation in the heart particularly in the left ventricle can lead to embolic strokes when a part of the thrombus breaks free and travels to the brain blocking blood flow.
What specific risk factors increase the likelihood of a stroke?
Risk factors for stroke include hypertension diabetes smoking high cholesterol atrial fibrillation and a history of cardiovascular diseases.
What is the most common location for a thrombus in a patient with a cardioembolic stroke?
The most common location for a thrombus in a patient with a cardioembolic stroke is the Middle Cerebral Artery.
What symptoms did the 65-year-old male patient exhibit during his presentation?
The 65-year-old male patient presented with sudden onset of left-sided weakness and slurred speech.
What significant medical history did the 65-year-old male patient have?
The patient had a history of hypertension and atrial fibrillation.
What does a non-contrast head CT show in the 65-year-old male patient with a cardioembolic stroke?
The non-contrast head CT shows no hemorrhage.
In the case of the 65-year-old male patient with a cardioembolic stroke what is the most appropriate immediate treatment?
The most appropriate immediate treatment for this patient is to administer IV rtPA (recombinant tissue plasminogen activator).
What is the dosage of aspirin recommended for immediate treatment in stroke patients?
Aspirin 325 mg may be administered but is not the immediate treatment of choice for a patient presenting with an acute ischemic stroke.
What other treatment options were considered in the case of the 65-year-old male patient besides IV rtPA?
Other treatment options considered were starting intravenous heparin and performing an MRI of the brain.
What symptoms did the 70-year-old female patient exhibit during her presentation?
The 70-year-old female patient presented with sudden onset of vertigo vomiting difficulty walking and neck pain.
What is the significance of neck pain in the 70-year-old female patient with stroke symptoms?
Neck pain may indicate possible vascular issues such as vertebral artery dissection or be related to the stroke itself.
What is the most likely diagnosis for the 70-year-old female patient with her symptoms?
The most likely diagnosis is Cerebellar Stroke.
What other diagnoses were considered for the 70-year-old female patient?
Other potential diagnoses considered were Labyrinthitis Migraine with aura and Vestibular neuritis.
What role does chronic medical history play in diagnosing stroke patients?
A chronic medical history such as diabetes and hypertension increases a patient’s risk factors for stroke and aids in diagnosing the type of stroke when symptoms present.
What is the purpose of a non-contrast head CT in acute stroke evaluation?
A non-contrast head CT is used to rule out hemorrhagic stroke and assess for early signs of ischemia or other abnormalities.
Why is intravenous thrombolysis (IV rtPA) an important treatment for ischemic strokes?
Intravenous thrombolysis (IV rtPA) dissolves blood clots and restores blood flow to the brain making it a critical treatment for patients with ischemic strokes if administered within the appropriate time window.
What is the clinical significance of a Cerebellar stroke?
Cerebellar strokes can lead to coordination problems loss of balance and dizziness. They may also cause nausea and vomiting due to vestibular disturbances. In some cases cerebellar strokes can result in increased intracranial pressure due to edema.
Identify the main risk factors for ischemic strokes particularly MCA infarctions.
Main risk factors for ischemic strokes include hypertension smoking diabetes high cholesterol obesity atrial fibrillation and a sedentary lifestyle. These factors can lead to the development of atherosclerosis which narrows blood vessels and increases the risk of emboli.
What are the key clinical features of a left middle cerebral artery (MCA) infarction?
Key clinical features of a left MCA infarction include right-sided weakness (hemiparesis) right-sided sensory loss and aphasia due to involvement of language centers in the dominant hemisphere.
What common complication may arise by day 3 post-stroke particularly in cases of MCA infarction?
Cerebral edema is a common complication after an MCA infarction that can lead to further deterioration of the patient’s condition including decreased consciousness and increased intracranial pressure.
What is the initial management approach for a patient presenting with transient ischemic attack (TIA) symptoms?
The appropriate management for a patient presenting with symptoms of TIA includes scheduling an MRI for detailed imaging of the brain and subsequent evaluation; carotid ultrasound may be performed to assess for stenosis.
In the case of the 45-year-old female with transient episodes of right arm weakness what was the most appropriate next step in management according to the flashcard?
Perform a carotid ultrasound to evaluate for potential carotid artery stenosis or occlusion as it can contribute to transient ischemic attacks.
What is the function of the middle cerebral artery (MCA) in providing blood supply to the brain?
The MCA supplies blood to large areas of the lateral surface of the cerebral hemisphere including parts of the frontal temporal and parietal lobes which are critical for motor function sensory perception and language.
Explain the term ‘hemorrhagic transformation’ as a complication of ischemic stroke.
Hemorrhagic transformation occurs when a previously ischemic brain tissue becomes necrotic and blood vessels rupture leading to bleeding within the infarcted area. This is a serious complication that can worsen the patient’s condition.
List the key management strategies for a patient with acute ischemic stroke within the first few hours of onset.
Key management strategies include administering intravenous thrombolytics (if within the appropriate time window and no contraindications) performing CT or MRI imaging to rule out hemorrhagic stroke and starting antiplatelet therapy for secondary prevention.
What is the role of aspirin and clopidogrel in the management of transient ischemic attacks?
Aspirin and clopidogrel are antiplatelet agents commonly used for secondary prevention of stroke in patients with TIA to reduce the risk of future ischemic events.
What is the most appropriate management for a patient with symptomatic carotid stenosis of 80%?
The most appropriate management for a patient with symptomatic carotid stenosis of 80% is Carotid endarterectomy.
What are the treatment options for symptomatic carotid stenosis?
Treatment options for symptomatic carotid stenosis include: A. Medical management with aspirin B. Carotid endarterectomy C. Thrombolysis with rtPA D. Intravenous heparin but the most appropriate is carotid endarterectomy.
What is a common cause of subarachnoid hemorrhage in a 45-year-old male with a history of cocaine use?
The most likely cause of subarachnoid hemorrhage in this patient is a ruptured saccular aneurysm.
What symptoms are associated with a subarachnoid hemorrhage caused by a ruptured saccular aneurysm?
Symptoms of a subarachnoid hemorrhage can include sudden onset of a severe headache (often described as the worst headache of the patient’s life) neck stiffness light sensitivity and neurological deficits such as hemiparesis.
What are common causes of subarachnoid hemorrhage?
Common causes of subarachnoid hemorrhage include ruptured saccular (berry) aneurysms arteriovenous malformations (AVMs) traumatic brain injury and cerebral amyloid angiopathy.
What is cerebral amyloid angiopathy and how does it relate to subarachnoid hemorrhage?
Cerebral amyloid angiopathy is a condition where amyloid protein builds up in the walls of the blood vessels in the brain increasing the risk of hemorrhage including subarachnoid hemorrhage particularly in elderly people.
What is this the typical presentation of a ruptured saccular aneurysm?
A typical presentation of a ruptured saccular aneurysm includes sudden onset of a severe headache often followed by signs of meningeal irritation such as neck stiffness and acute neurological deficits.
What is the difference between hypertension-related hemorrhage and subarachnoid hemorrhage?
Hypertensive hemorrhage occurs due to chronic high blood pressure leading to vessels rupturing typically presenting with focal neurological deficits and can occur within brain tissue (intracerebral hemorrhage) whereas subarachnoid hemorrhage generally refers to bleeding in the space surrounding the brain often due to ruptured aneurysms.
How are carotid stenosis and cerebrovascular accidents related?
Carotid stenosis narrows the arteries that supply blood to the brain leading to reduced blood flow and increasing the risk of cerebrovascular accidents (strokes) particularly if symptomatic.
What imaging modality is commonly used to evaluate carotid stenosis?
Ultrasound particularly carotid duplex ultrasound is commonly used to evaluate carotid stenosis along with CT or MR angiography in certain cases.
What is the most likely cause of a hemorrhage in the frontal lobe of a patient with no history of hypertension?
A. Arteriovenous malformation
What is the most likely cause of a lobar hemorrhage in an 80-year-old patient with no history of hypertension?
B. Cerebral amyloid angiopathy
What blood pressure target is appropriate for a patient with an acute intracerebral hemorrhage and an initial systolic blood pressure of 200 mmHg?
B. 140 mmHg
What are the common causes of lobar hemorrhage in elderly patients?
Common causes include cerebral amyloid angiopathy hypertensive hemorrhage metastatic brain tumors and arteriovenous malformations.
What is cerebral amyloid angiopathy?
Cerebral amyloid angiopathy is a condition characterized by the deposition of amyloid protein in the walls of the blood vessels in the brain leading to vessel fragility and an increased risk of lobar hemorrhages particularly in older adults.
What is an arteriovenous malformation (AVM)?
An arteriovenous malformation is a congenital disorder that consists of a tangle of abnormal blood vessels connecting arteries and veins which can lead to hemorrhage due to vessel rupture.
Describe the management of blood pressure in patients with acute intracerebral hemorrhage.
Management typically involves careful monitoring of blood pressure with a target often set between 140-160 mmHg to prevent further bleeding while maintaining perfusion.
What is the significance of a patient having a history of hypertension in the context of intracerebral hemorrhage?
A history of hypertension is a major risk factor for intracerebral hemorrhage as it contributes to the weakening of blood vessel walls and increases the likelihood of rupture.
Why is it important to control blood pressure in patients with acute intracerebral hemorrhage?
Controlling blood pressure is crucial to minimize the risk of re-bleeding limit further hematoma expansion and improve overall outcomes in patients with acute intracerebral hemorrhage.
What diagnostic imaging is typically used to assess a suspected intracerebral hemorrhage?
CT (computed tomography) scans are typically used for rapid assessment of intracerebral hemorrhage as they can quickly identify the presence and location of bleeding.
What is the most appropriate treatment for a patient with cerebral amyloid angiopathy-related hemorrhage?
Avoid oral anticoagulants.
What is the immediate treatment for a 60-year-old female with atrial fibrillation on warfarin who presents with a large left parietal hemorrhage?
Administer prothrombin complex concentrate and vitamin K.
What is the role of IV rtPA in the treatment of hemorrhagic strokes?
IV rtPA (recombinant tissue plasminogen activator) is not appropriate for patients with hemorrhagic strokes including those related to cerebral amyloid angiopathy.
What is the rationale for avoiding oral anticoagulants in a patient with cerebral amyloid angiopathy?
Oral anticoagulants can worsen the hemorrhage and increase the risk of further bleeding in patients with cerebral amyloid angiopathy.
When is protamine sulfate used in management of hemorrhagic conditions?
Protamine sulfate is used to reverse the effects of heparin not warfarin and is therefore not appropriate in this scenario involving a patient on warfarin.
What is the function of idarucizumab in the context of anticoagulation?
Idarucizumab is a specific reversal agent for dabigatran not warfarin.
What is prothrombin complex concentrate and when is it indicated?
Prothrombin complex concentrate contains vitamin K-dependent clotting factors and is indicated for rapid reversal of warfarin in cases of significant bleeding.
What does the administration of vitamin K achieve in anticoagulated patients?
Vitamin K is essential for the synthesis of clotting factors; its administration is necessary to allow for the production of new factors when reversing warfarin.
Describe the significance of CT scans in patients presenting with sudden onset confusion and weakness.
CT scans are crucial for identifying hemorrhagic strokes and differentiating them from ischemic events providing immediate information for treatment decisions.
What are the common symptoms of a large parietal hemorrhage?
Common symptoms include confusion weakness (often unilateral) sensory deficits and sometimes seizures.
What immediate action should be taken in a patient with a large hemorrhage?
Immediate action typically includes correcting coagulopathy possible surgical intervention and supportive care.
Which location of saccular aneurysms is at greatest risk of rupture?
Top of the basilar artery.
What are the major causes of delayed neurologic deficit in subarachnoid hemorrhage (SAH)?
Hyponatremia is among the major causes of delayed neurologic deficit in SAH.
What is the most appropriate imaging modality for detecting vasospasm in a patient with subarachnoid hemorrhage?
Conventional x-ray angiography is the most appropriate imaging modality for detecting vasospasm in SAH.
What is the recommended blood pressure target in patients with acute intracranial hemorrhage?
While the specific target blood pressure was not provided it is generally aimed at keeping systolic blood pressure below 160 mmHg to reduce the risk of rebleeding.
What is a saccular aneurysm?
A saccular aneurysm also known as a berry aneurysm is a localized outpouching of a blood vessel wall that most often occurs at the bifurcations of the cerebral arteries.
What role does hyponatremia play in subarachnoid hemorrhage?
Hyponatremia can occur due to various mechanisms including cerebral salt wasting or inappropriate secretion of antidiuretic hormone (SIADH) leading to delayed neurologic deficits in patients with SAH.
What are the symptoms of vasospasm following subarachnoid hemorrhage?
Symptoms include new-onset headache confusion weakness seizures or focal neurological deficits that occur days after the initial hemorrhage.
How is vasospasm typically managed in patients with subarachnoid hemorrhage?
Management of vasospasm can include fluid hydration calcium channel blockers (like Nimodipine) and in some cases endovascular interventions.
What are common diagnostic methods for subarachnoid hemorrhage?
Common diagnostic methods include CT scan lumbar puncture (to detect xanthochromia) and angiography to identify the source of bleeding.
What is the typical initial management for subarachnoid hemorrhage?
Initial management includes stabilizing the patient controlling blood pressure prevention of rebleeding and addressing potential complications such as vasospasm.
What factors increase the risk of cerebral aneurysm rupture?
Risk factors include size of the aneurysm location prior history of subarachnoid hemorrhage hypertension smoking and family history of aneurysms.
What is the initial target systolic blood pressure for a patient with subarachnoid hemorrhage?
The initial target systolic blood pressure for a patient with subarachnoid hemorrhage is 160 mmHg.
What is the most appropriate treatment for a patient with subarachnoid hemorrhage and delayed cerebral ischemia (DCI) due to vasospasm?
The most appropriate treatment for a patient with subarachnoid hemorrhage and delayed cerebral ischemia due to vasospasm is to induce hypertension.
Which brain structure is responsible for dopaminergic symptoms in Parkinson’s disease?
The Substantia nigra is responsible for dopaminergic symptoms in Parkinson’s disease.
Which structure is NOT responsible for the occurrence of nondopaminergic symptoms in Parkinson’s disease?
The Substantia nigra is NOT responsible for the occurrence of nondopaminergic symptoms in Parkinson’s disease.
What are the key symptoms of Parkinson’s disease associated with nondopaminergic pathways?
Nondopaminergic symptoms in Parkinson’s disease may include cognitive impairment depression and autonomic instability.
What is the role of the Nucleus basalis of Meynert in Parkinson’s disease?
The Nucleus basalis of Meynert is involved in cholinergic dysfunction leading to cognitive deficits which contribute to nondopaminergic symptoms.
What is the function of the Locus coeruleus in the context of Parkinson’s disease?
The Locus coeruleus produces norepinephrine and its dysfunction is linked to mood disturbances and cognitive impairments in Parkinson’s disease.
How do the Raphe nuclei contribute to Parkinson’s disease symptoms?
The Raphe nuclei are involved in serotonin production and their impairment can contribute to mood disorders and sleep disturbances in Parkinson’s disease.
What are the common features of atypical parkinsonism?
Common features of atypical parkinsonism may include symmetric onset of symptoms early cognitive decline falls and no response to dopaminergic therapy.
What finding in Parkinsonism would likely support a diagnosis of atypical parkinsonism?
A finding such as early onset of dementia significant postural instability or features of corticobasal degeneration would likely support a diagnosis of atypical parkinsonism.
What age is significant in diagnosing certain movement disorders including Parkinson’s disease related symptoms?
Onset before age 40 years is significant as it may indicate a different etiology or a diagnosis of juvenile parkinsonism.
What is a key clinical feature that might suggest a diagnosis of certain types of neurological disorders?
Presence of liver disease can suggest Wilson’s disease or other specific movement disorders.
What early symptoms characterize the onset of Parkinson’s disease?
Early speech and gait impairment are notable initial symptoms in Parkinson’s disease.
What is a common cause of involuntary choreiform movements in Parkinson’s disease patients during ‘on’ periods?
Peak-dose dyskinesia is the most likely cause of choreiform movements during ‘on’ periods in Parkinson’s disease.
Define peak-dose dyskinesia in the context of Parkinson’s disease.
Peak-dose dyskinesia refers to involuntary movements that occur when the peak blood level of dopaminergic medication (like levodopa) is reached.
What factors are associated with the development of dyskinesias in Parkinson’s disease adjustment?
Factors include long-term treatment with dopaminergic medications particularly levodopa and variations in individual responsiveness.
What is levodopa and how does it function in the treatment of Parkinson’s disease?
Levodopa is a precursor to dopamine that once in the brain converts to dopamine helping to alleviate the symptoms of Parkinson’s disease.
What is the mechanism of action of levodopa in treating Parkinson’s disease?
The mechanism of action of levodopa is converting to dopamine in the brain.
What is the wearing-off phenomenon in relation to Parkinson’s disease medication?
The wearing-off phenomenon refers to a return of Parkinson’s symptoms as the effects of medication diminish before the next dose is due.
What is diphasic dyskinesia in Parkinson’s disease?
Diphasic dyskinesia refers to involuntary movements that occur often at the beginning and the end of a dose of dopaminergic medication.
What should be noted about the use of neuroleptics in patients with Parkinson’s disease?
Neuroleptics can worsen parkinsonism since they block dopamine receptors which are already deficient in Parkinson’s disease.
What are the other potential side effects associated with dopaminergic treatments in Parkinson’s disease besides dyskinesia?
Other side effects may include nausea orthostatic hypotension hallucinations and sleep disturbances.
Describe the importance of recognizing gait and speech impairments in older patients.
Recognizing early speech and gait impairments in older patients can aid in the timely diagnosis of Parkinson’s disease and other neurodegenerative disorders.
Why is it essential to understand the correct mechanisms of Parkinson’s disease treatments?
Understanding the correct mechanisms of Parkinson’s therapies is essential for optimizing treatment and managing side effects in patients.
What differential diagnoses should be considered when a patient develops choreiform movements in context of Parkinson’s disease?
Differential diagnoses include Wilson’s disease Huntington’s disease and other secondary causes of dyskinesia.
What is the role of neurotransmitters such as dopamine in Parkinson’s disease?
Dopamine is crucial for coordinating smooth and controlled movements; its deficiency leads to the characteristic motor symptoms of Parkinson’s disease.
What are common physical examination findings in patients with Parkinson’s disease?
Common findings include resting tremor rigidity bradykinesia and postural instability.
When assessing gait in Parkinson’s disease patients what specific features might be noted?
Specific features include shuffling gait festination and difficulty initiating or stopping movement.
What is the most appropriate treatment for a patient with Parkinson’s disease who develops severe anxiety during ‘off’ periods?
Give inhalational levodopa.
What are the pathological hallmarks of Alzheimer’s disease?
Neurofibrillary tangles and amyloid plaques.
What is the most likely genetic risk factor for late-onset Alzheimer’s disease?
APOE 4 allele.
What are neurofibrillary tangles?
Neurofibrillary tangles are aggregations of hyperphosphorylated tau protein found in the brains of Alzheimer’s disease patients indicating neurodegeneration.
What are amyloid plaques?
Amyloid plaques are abnormal clusters of protein fragments that accumulate between nerve cells in the brain a characteristic feature of Alzheimer’s disease.
What role does the APOE 4 allele play in Alzheimer’s disease?
The APOE 4 allele is associated with an increased risk of developing Alzheimer’s disease particularly late-onset Alzheimer’s.
What are Lewy bodies and in which condition are they primarily found?
Lewy bodies are abnormal aggregates of protein primarily alpha-synuclein found in the brains of patients with Parkinson’s disease and Lewy body dementia.
What is the significance of TDP-43 inclusions?
TDP-43 inclusions are found in conditions like frontotemporal lobar degeneration and amyotrophic lateral sclerosis (ALS) indicating a type of neurodegeneration.
What are vascular infarcts and how are they related to dementia?
Vascular infarcts refer to areas of brain tissue death due to insufficient blood supply and can lead to vascular dementia distinct from Alzheimer’s disease.
What is the main purpose of using short-acting benzodiazepines in anxiety?
Short-acting benzodiazepines can provide quick relief from acute anxiety symptoms but are not a long-term treatment option.
Why might discontinuing levodopa not be appropriate for Parkinson’s patients with severe anxiety?
Discontinuing levodopa may worsen motor symptoms and overall quality of life in a Parkinson’s patient as levodopa is critical for managing these symptoms.
What is the mechanism of action for dopamine agonists in the treatment of Parkinson’s disease?
Dopamine agonists stimulate dopamine receptors in the brain mimicking the effects of naturally occurring dopamine.
What condition is diagnosed in a 50-year-old male presenting with rapid cognitive decline myoclonus rigidity showing periodic sharp waves on EEG and no significant atrophy on MRI?
Creutzfeldt-Jakob disease.
In diagnosing Alzheimer’s Disease what imaging findings would make it unlikely for the patient to have this condition?
A negative amyloid PET scan.
What is the most appropriate initial treatment for a patient with mild cognitive impairment to delay progression to Alzheimer’s Disease?
None of the above.
What are common symptoms of Creutzfeldt-Jakob disease?
Rapid cognitive decline myoclonus and rigidity.
Describe the significance of EEG findings in diagnosing Creutzfeldt-Jakob disease.
EEG typically shows periodic sharp waves which are indicative of the disease.
What imaging technique is used to observe hippocampal atrophy in Alzheimer’s Disease and what finding would be unusual in the diagnosis of Alzheimer’s?
MRI is used to observe hippocampal atrophy; an absence of hippocampal atrophy would be unusual in Alzheimer’s.
List one of the differential diagnoses for rapid cognitive decline and myoclonus.
Lewy body dementia.
What is the difference in treatment intention between Donepezil and Memantine when it comes to cognitive impairment?
Donepezil is used to treat symptoms in Alzheimer’s disease whereas Memantine is often prescribed for moderate to severe Alzheimer’s Disease.
What role does amyloid PET scan play in the diagnosis of Alzheimer’s Disease?
A positive amyloid PET scan indicates the presence of amyloid plaques which supports the diagnosis of Alzheimer’s.
What are periodic sharp waves on EEG associated with?
These are typically associated with Creutzfeldt-Jakob disease.
What does a negative FDG PET scan indicate in the context of dementia?
It indicates absence of hypometabolism in the temporal-parietal cortex which may suggest that Alzheimer’s Disease is less likely.
What is myoclonus and in which neurodegenerative condition is it often observed?
Myoclonus is a sudden involuntary muscle jerk and it is often observed in Creutzfeldt-Jakob disease.
What might be seen on an MRI of a patient with Alzheimer’s Disease?
Typically MRI findings would show hippocampal atrophy.
Would Levodopa be appropriate for treating mild cognitive impairment? Why or why not?
No Levodopa is primarily used for Parkinson’s disease and is not appropriate for treating mild cognitive impairment.
What is the typical age range for onset of Creutzfeldt-Jakob disease?
Typically occurs in individuals aged 50s and 60s.
Which condition is characterized by a gradual decline in memory and cognitive function often associated with deposits of amyloid plaques?
Alzheimer’s Disease.
What is the clinical significance of detecting absence of hypometabolism in a FDG PET scan?
It decreases the likelihood of diagnosing Alzheimer’s disease.
What initial therapy regimen is not commonly recommended for patients with mild cognitive impairment to prevent Alzheimer’s progression?
Any of the following: Memantine Donepezil or Levodopa.
What is the appropriate treatment for a patient with Alzheimer’s disease who develops severe agitation and hallucinations?
The most appropriate treatment is Risperidone.
What are the main symptoms of Lewy body dementia when experiencing REM sleep behavior disorder?
Symptoms include significant disruptions in REM sleep often manifesting as acting out dreams which may involve violent movements or vocalizations during sleep.
Which medication is recommended for treating REM sleep behavior disorder in patients with Lewy body dementia?
Melatonin is the recommended treatment for REM sleep behavior disorder in patients with Lewy body dementia.
What is the most likely diagnosis for a 35-year-old woman experiencing recurrent severe unilateral headaches associated with nausea photophobia phonophobia and visual disturbances lasting 12-24 hours?
The most likely diagnosis is Migraine.
Define the term ‘photophobia’.
Photophobia is an abnormal sensitivity to light causing discomfort or pain in bright light often experienced during migraine attacks.
What does ‘phonophobia’ refer to in the context of migraines?
Phonophobia is an increased sensitivity to sound which can cause discomfort or pain commonly associated with migraine attacks.
What is the duration of a typical migraine attack as described in the case?
A typical migraine attack can last from 12 to 24 hours.
What are common premonitory symptoms that may occur before a migraine?
Common premonitory symptoms include mood changes fatigue food cravings neck stiffness and visual disturbances.
What is the role of Donepezil in treating dementia?
Donepezil is a cholinesterase inhibitor used to treat symptoms of Alzheimer’s disease by increasing levels of acetylcholine in the brain.
What is Memantine and how does it function in the treatment of Alzheimer’s disease?
Memantine is an NMDA receptor antagonist that helps regulate glutamate activity in the brain often prescribed for moderate to severe Alzheimer’s disease.
List the side effects associated with the use of Risperidone in dementia treatment.
Side effects of Risperidone may include sedation weight gain metabolic syndrome extrapyramidal symptoms and increased risk of stroke in elderly patients.
What differentiates Lewy body dementia from Alzheimer’s disease?
Lewy body dementia is characterized by the presence of Lewy bodies in the brain often exhibiting visual hallucinations fluctuating cognition and REM sleep behavior disorder whereas Alzheimer’s primarily involves progressive memory loss.
What treatment options are generally considered for managing agitation in patients with Alzheimer’s disease?
Options for managing agitation in Alzheimer’s include behavioral interventions environmental modifications and if necessary pharmacological treatments such as atypical antipsychotics (e.g. Risperidone) with caution.
What is a migraine with aura?
A migraine with aura is a type of migraine headache that is preceded or accompanied by neurological symptoms known as ‘aura’. These symptoms can include visual disturbances (such as flashes of light or blind spots) sensory changes (including tingling or numbness) and speech difficulties. The aura typically lasts for a short duration usually less than an hour and is followed by a headache phase.
What are the characteristics of a cluster headache?
Cluster headaches are characterized by recurrent episodes of severe unilateral (one-sided) headaches that occur in clusters often at the same time each day or night. They are typically associated with autonomic symptoms such as watering of the eye (lacrimation) nasal congestion and sweating on the affected side of the face. The headaches can last from 15 minutes to 3 hours and may occur multiple times a day.
What is the most likely diagnosis for a 50-year-old woman presenting with continuous unilateral headache associated with autonomic features that completely resolves with indomethacin?
The most likely diagnosis is Hemicrania continua a headache disorder characterized by continuous unilateral headache that responds to indomethacin a nonsteroidal anti-inflammatory drug.
What is the characteristic presentation of acephalgic migraine?
Acephalgic migraine also known as a migraine without headache presents with recurrent episodes of vertigo and nausea or other aura symptoms but without the typical headache phase. Patients may experience aura symptoms such as visual disturbances or sensory changes without the subsequent headache.
What is a key feature of Hemicrania continua?
A key feature of Hemicrania continua is that it is a continuous headache that can be unilateral and responds dramatically to indomethacin. Unlike other headache types the pain is persistent rather than episodic.
What can be a hallmark feature of cluster headaches?
A hallmark feature of cluster headaches is their pattern of occurrence which involves attacks that happen in ‘clusters’ over weeks or months followed by periods of remission. Additionally the severe pain is commonly located around one eye and can be accompanied by autonomic symptoms on the same side such as ptosis (droopy eyelid) and miosis (constricted pupil).
What are the primary autonomic symptoms associated with cluster headaches?
The primary autonomic symptoms associated with cluster headaches include lacrimation (tearing) rhinorrhea (nasal discharge) nasal congestion facial sweating and miosis (pupil constriction) on the affected side.
What is the typical duration and frequency of cluster headache attacks?
Cluster headache attacks typically last from 15 minutes to 3 hours. They can occur multiple times a day (often several times a day) during each cluster period which can last for weeks to months. These periods of attacks are interspersed with periods of remission that can last for months to years.
What treatments are commonly used for cluster headaches?
Common treatments for cluster headaches include acute therapies such as oxygen therapy triptans (like sumatriptan) and intranasal therapies. Preventative treatments may include calcium channel blockers corticosteroids and sometimes indomethacin.
What are the characteristics of excruciating non-fluctuating pain in migraine diagnosis?
Excruciating non-fluctuating pain is indicative of severe migraines. This type of pain is typically intense persistent and does not vary in intensity signifying a potential migraine attack particularly migraine without aura.
What is a key diagnostic criterion for migraine without aura?
A key diagnostic criterion for migraine without aura is that the headache is aggravated by routine physical activity such as walking or climbing stairs.
What is the first-line treatment option for cluster headaches?
The first-line treatment option for cluster headaches is oxygen inhalation. This can provide rapid relief of cluster headache attacks.
What is the treatment of choice for primary CNS lymphoma?
The treatment of choice for primary CNS lymphoma is high-dose methotrexate therapy.
List the common features of migraine without aura. What differentiates it from migraine with aura?
Common features of migraine without aura include unilateral location pulsating quality moderate to severe intensity and aggravation by routine physical activity. Unlike migraine with aura there are no preceding visual sensory or other neurologic disturbances.
What are the different treatment strategies for migraine management apart from acute treatments?
Treatment strategies for migraine management can include prophylactic medications such as beta-blockers anticonvulsants (like topiramate) and antidepressants (like amitriptyline) as well as lifestyle modifications and alternative therapies.
What role does oxygen therapy play in the management of cluster headaches?
Oxygen therapy plays a crucial role in the management of cluster headaches as it provides immediate relief by vasoconstricting cranial blood vessels during an active headache attack.
Discuss the importance of high-dose methotrexate in treating primary CNS lymphoma.
High-dose methotrexate is crucial in treating primary CNS lymphoma due to its ability to penetrate the blood-brain barrier effectively and target malignant cells leading to improved survival rates.
Identify the autonomic symptoms often assessed in headache disorders. Why are they significant?
Autonomic symptoms include unilateral nasal congestion rhinorrhea ptosis miosis and lacrimation. They are significant as they can help distinguish between different types of headaches such as cluster headaches versus migraines.
What makes indomethacin a less favorable treatment option for cluster headaches?
Indomethacin is less favorable for treating cluster headaches because it is not as effective as oxygen therapy or triptans and it is more commonly utilized for other types of headaches such as analgesic rebound headaches or hemicrania continua.
What is the hallmark pathological feature of multiple sclerosis (MS)?
Perivenular inflammation and demyelination.
Which immune cell type is most implicated in the pathogenesis of multiple sclerosis?
B cells.
What characterizes progressive multiple sclerosis (MS)?
Diffuse inflammation with microglial activation.
What are oligoclonal bands and in which condition are they commonly present?
Oligoclonal bands are a marker of abnormal immunoglobulin production and are commonly present in the cerebrospinal fluid (CSF) of patients with multiple sclerosis.
Which treatment is considered a high-dose therapy for multiple sclerosis?
High-dose methotrexate.
What is the role of neutrophils concerning multiple sclerosis?
Neutrophils are not primarily implicated in the pathogenesis of multiple sclerosis; rather B cells and T cells play a more significant role.
How does acute perivenular inflammation differ from the pathological findings in progressive MS?
Acute perivenular inflammation is typically associated with relapsing forms of MS characterized by episodes of acute inflammation while progressive MS features diffuse inflammation without distinct acute episodes.
What is the significance of neuronal loss without inflammation in MS pathology?
Neuronal loss without inflammation suggests neurodegeneration that may occur independently of autoimmune mechanisms typically found in multiple sclerosis.
Describe the typical inflammatory response observed in MS lesions.
The typical inflammatory response in MS lesions includes infiltration by activated lymphocytes particularly B cells and T cells leading to perivenular inflammation and demyelination.
What is the difference between gray matter lesions and white matter involvement in the context of MS?
Gray matter lesions in MS refer to damage that occurs in the neuronal cell bodies while white matter involvement pertains to the loss of myelin in the nerve fibers contributing to the overall pathology of the disease.
What type of inflammation is associated with microglial activation in multiple sclerosis (MS)?
Diffuse inflammation with microglial activation.
Which genetic risk factor confers the greatest risk for multiple sclerosis (MS)?
HLA-DRB1.
What is the term for the phenomenon where a patient with multiple sclerosis experiences worsening of symptoms after a hot shower?
Uhthoff’s phenomenon.
What is one of the diagnostic criteria for clinically definite multiple sclerosis (MS)?
Two attacks with evidence of two lesions in non-contiguous central nervous system (CNS) areas.
What is Lhermitte’s sign in relation to multiple sclerosis?
Lhermitte’s sign is a symptom experienced in MS that involves an electric shock-like sensation that runs down the spine when the neck is flexed.
What are the commonly known symptoms of multiple sclerosis?
Common symptoms include fatigue numbness coordination and balance issues vision problems and cognitive changes.
How is multiple sclerosis primarily diagnosed?
Diagnosis of MS is primarily based on clinical symptoms MRI findings of lesions and sometimes lumbar puncture analysis of cerebrospinal fluid.
What is the role of microglia in the central nervous system (CNS)?
Microglia act as the immune cells of the CNS monitoring the environment responding to injury and contributing to inflammation.
What is the potential impact of temperature on MS symptoms?
Higher temperatures can worsen neurological symptoms in MS patients as seen in Uhthoff’s phenomenon.
What does the presence of HLA-DRB1 indicate in relation to MS?
The presence of HLA-DRB1 is associated with an increased genetic risk for developing multiple sclerosis.
What is the first-line treatment for relapsing-remitting multiple sclerosis (RRMS)?
Ocrelizumab is the first-line treatment for relapsing-remitting multiple sclerosis (RRMS).
What are the other treatment options for RRMS besides Ocrelizumab?
Other treatment options for RRMS include interferon beta formulations (like Avonex Rebif Betaseron) glatiramer acetate (Copaxone) dimethyl fumarate (Tecfidera) and natalizumab (Tysabri).
What are the common symptoms of multiple sclerosis (MS)?
Common symptoms of multiple sclerosis include fatigue difficulty walking numbness or tingling muscular spasms vision problems and cognitive changes.
What is the primary mechanism by which bacteria gain access to the cerebrospinal fluid (CSF) in bacterial meningitis?
The primary mechanism is colonization of the nasopharynx followed by hematogenous spread.
What are the main causes of bacterial meningitis?
Common causes of bacterial meningitis include Streptococcus pneumoniae Neisseria meningitidis and Haemophilus influenzae particularly in unvaccinated children.
What are typical clinical features of bacterial meningitis?
Typical clinical features of bacterial meningitis include fever headache nuchal rigidity photophobia and altered mental status.
What additional findings would most strongly suggest meningitis in a 25-year-old patient presenting with fever headache and nuchal rigidity?
A positive Brudzinski’s sign or Kernig’s sign would suggest meningitis. Additionally a lumbar puncture revealing elevated white blood cells particularly lymphocytes and possibly positive cultures would be indicative.
What is the significance of presenting symptoms such as fever headache and nuchal rigidity in a patient with suspected meningitis?
These symptoms are characteristic of meningitis and indicate inflammation of the membranes surrounding the brain and spinal cord requiring prompt medical evaluation and treatment.
Name some risk factors for developing bacterial meningitis.
Risk factors for developing bacterial meningitis include age (particularly infants and young adults) living in crowded environments (like college dormitories) and having certain medical conditions or immunocompromised states.
What is the role of lumbar puncture in diagnosing meningitis?
Lumbar puncture is performed to obtain cerebrospinal fluid (CSF) for analysis which can reveal findings consistent with meningitis such as elevated white blood cell counts low glucose levels and the presence of bacteria.
What is the primary clinical feature that distinguishes bacterial meningitis from viral meningitis?
The primary clinical feature that is often highlighted in bacterial meningitis is the presence of a petechial rash which may suggest meningococcemia whereas viral meningitis often presents with milder symptoms.
List the classic symptoms associated with bacterial meningitis.
Classic symptoms of bacterial meningitis include: fever headache neck stiffness (nuchal rigidity) photophobia altered mental status nausea/vomiting and potentially a petechial rash.
What are the CSF findings that are most consistent with viral meningitis?
The CSF findings most consistent with viral meningitis include lymphocytic pleocytosis normal glucose levels and elevated protein levels.
What CSF analysis findings are indicative of bacterial meningitis?
CSF findings indicative of bacterial meningitis typically include neutrophilic pleocytosis low glucose levels and elevated protein levels.
Define ‘pleocytosis’ as it pertains to meningitis.
Pleocytosis refers to an increased number of white blood cells (WBCs) in the cerebrospinal fluid (CSF); in meningitis it indicates an inflammatory response in the central nervous system.
What significance does a low glucose level in CSF have when evaluating a patient for meningitis?
A low glucose level in the CSF is highly indicative of bacterial meningitis because bacteria consume glucose leading to decreased levels while viral infections typically maintain normal glucose levels.
Identify the CSF findings for a 60-year-old woman with diabetes who presents with fever headache and neck stiffness showing mononuclear cells low glucose and elevated protein.
The CSF findings described are suggestive of bacterial meningitis possibly due to an underlying condition such as diabetes which may predispose her to infections.
What is the most common pathogen associated with bacterial meningitis in adults?
The most common pathogens associated with bacterial meningitis in adults include Streptococcus pneumoniae and Neisseria meningitidis.
What symptoms might lead a clinician to suspect meningitis in a patient?
Symptoms that prompt suspicion of meningitis include severe headache fever nuchal rigidity (stiff neck) photophobia (sensitivity to light) and altered mental status.
What is the role of a lumbar puncture in the context of suspected meningitis?
A lumbar puncture is performed to analyze the cerebrospinal fluid (CSF) to diagnose meningitis and differentiate between bacterial and viral causes based on cell count glucose level and protein concentration.
What laboratory test findings could suggest a more severe case of bacterial meningitis?
Laboratory test findings suggesting a more severe case of bacterial meningitis would include high WBC counts with neutrophils predominating significantly low glucose levels and markedly elevated protein levels.
Explain the importance of performing CSF analysis in a patient with suspected meningitis.
CSF analysis is crucial in suspected meningitis as it helps identify the causative agent (bacterial vs viral) guides treatment decisions and helps assess the severity of the infection.
What complications can arise from untreated bacterial meningitis?
Complications from untreated bacterial meningitis can include neurological deficits seizures hearing loss and may ultimately lead to coma or death.
Name some preventive measures against bacterial meningitis.
Preventive measures include vaccination (e.g. meningococcal pneumococcal and Haemophilus influenzae type b vaccines) and prophylactic antibiotics in cases of exposure to diagnosed bacterial meningitis.
What is the most common cause of viral meningitis?
Enteroviruses are the most common cause of viral meningitis accounting for the majority of cases.
What are the common symptoms of meningitis?
Common symptoms of meningitis include fever headache stiff neck nausea vomiting sensitivity to light (photophobia) and altered mental status.
What differentiates bacterial meningitis from viral meningitis?
Bacterial meningitis typically presents with more severe symptoms including a higher fever rapid onset altered mental status and can lead to severe complications such as seizures and permanent neurological damage. Viral meningitis is usually milder.
What is the typical management for bacterial meningitis?
Management of bacterial meningitis involves the administration of empirical intravenous antibiotics supporting care and monitoring for complications. Early treatment is critical for improving outcomes.
What are the first-line empirical antibiotics for community-acquired bacterial meningitis in a 30-year-old adult?
The first-line empirical antibiotic therapy for community-acquired bacterial meningitis in a 30-year-old adult is Ceftriaxone combined with Vancomycin.
What clinical complication might a patient with bacterial meningitis experience 24 hours after admission?
A patient with bacterial meningitis may develop seizures as a complication due to cerebral infarction.
What is cerebral infarction and how is it related to meningitis?
Cerebral infarction refers to a blockage of blood flow to the brain which can occur in patients with bacterial meningitis due to inflammatory processes increased intracranial pressure or other factors.
What adjunctive therapy has been shown to reduce neurologic sequelae in bacterial meningitis?
Corticosteroids (such as dexamethasone) are the adjunctive therapy shown to reduce neurologic sequelae in bacterial meningitis.
What are the risks associated with antibiotic toxicity in the treatment of meningitis?
Antibiotic toxicity can lead to complications such as nephrotoxicity ototoxicity and hematological abnormalities which may compromise patient recovery and increase mortality.
List the types of meningitis and their corresponding pathogens.
- Viral meningitis - typically caused by enteroviruses. 2. Bacterial meningitis - commonly caused by Streptococcus pneumoniae and Neisseria meningitidis. 3. Fungal meningitis - often seen in immunocompromised patients caused by organisms such as Cryptococcus neoformans. 4. Tuberculous meningitis - caused by Mycobacterium tuberculosis.
What is the most appropriate treatment for bacterial meningitis?
Dexamethasone is the most appropriate treatment for bacterial meningitis as it reduces inflammation and complications related to the condition.
Which antifungal treatment is indicated for cryptococcal meningitis in an HIV patient?
The most appropriate treatment for a patient with cryptococcal meningitis and HIV is Amphotericin B and Flucytosine.
What is the most common cause of viral meningitis in immunocompetent adults?
Enteroviruses are the most common cause of viral meningitis in immunocompetent adults.
What should be done for a patient with recurrent aseptic meningitis?
For a patient with recurrent aseptic meningitis the most appropriate management is to investigate for HSV-2 (Herpes Simplex Virus type 2).
What is the role of dexamethasone in treating bacterial meningitis?
Dexamethasone is used in bacterial meningitis to decrease the inflammatory response associated with the meningitis potentially improving outcomes and reducing complications.
Explain the significance of Amphotericin B and Flucytosine in treating cryptococcal meningitis.
Amphotericin B is an antifungal that treats serious fungal infections while Flucytosine enhances the efficacy of Amphotericin B together they are the standard treatment regimen for cryptococcal meningitis especially in immunocompromised patients like those with HIV.
What are the common pathogens that cause meningitis in immunocompetent adults?
Common pathogens causing meningitis in immunocompetent adults include Enteroviruses Herpes Simplex Virus and Arboviruses with Enteroviruses being the most prevalent.
How does the clinical management of recurrent aseptic meningitis differ from that of acute bacterial meningitis?
While acute bacterial meningitis often requires immediate antibiotic therapy and possibly corticosteroids recurrent aseptic meningitis management may involve identifying underlying causes such as viral infections (e.g. HSV) rather than initial empiric treatment.
What are the potential complications of untreated bacterial meningitis?
Complications of untreated bacterial meningitis may include brain damage hearing loss learning disabilities and seizures due to the inflammation and pressure on the brain.
What are the typical clinical manifestations of meningitis?
Typical clinical manifestations of meningitis include fever headache stiff neck photophobia nausea vomiting and altered mental status.
What is the most sensitive imaging modality for detecting early cerebritis in a brain abscess?
MRI with gadolinium.
What are the common imaging modalities used to detect a brain abscess?
CT scan without contrast MRI with gadolinium FDG PET scan and ultrasound of the brain.
What is the most common presenting symptom of a brain abscess?
Headache.
List the potential presenting symptoms of a brain abscess.
Fever headache seizures and nuchal rigidity.
What is the first-line empirical antibiotic therapy for a community-acquired brain abscess in an immunocompetent patient?
Ceftriaxone combined with Metronidazole.
Why is MRI with gadolinium preferred for detecting early cerebritis?
MRI with gadolinium has higher sensitivity and contrast-enhanced imaging capabilities that allow for better visualization of early inflammatory changes associated with cerebritis.
What role does CT imaging play in brain abscess detection?
CT scans are useful for identifying larger abscesses and can provide an initial overview but they are not as sensitive as MRI with gadolinium for early-stage cerebritis.
What factors influence the choice of antibiotic therapy for a brain abscess?
The choice of antibiotics depends on the patient’s immunocompetence the likely organism based on the patient’s history and local epidemiology and any previous antibiotic use.
Which antibiotic when combined with ceftriaxone is typically recommended for the treatment of community-acquired brain abscesses?
Metronidazole.
How does the presentation of fever vary among patients with a brain abscess?
While fever can be present it is not the most common symptom; headache is typically more prominent in these cases.
What condition does a 45-year-old male with a history of frontal sinusitis present with that includes fever headache and ptosis?
The patient presents with cavernous sinus thrombosis.
What imaging modality is used to show thrombosis of the cavernous sinus in this case?
MRI (Magnetic Resonance Imaging) is used.
What are the common symptoms of cavernous sinus thrombosis?
Common symptoms include severe headache fever proptosis visual disturbances and cranial nerve deficits.
What is the most likely causative organism for a case of cavernous sinus thrombosis originating from frontal sinusitis in a patient presenting with ptosis?
Staphylococcus aureus is the most likely causative organism.
List other possible organisms that may cause cavernous sinus thrombosis.
Other possible organisms include Streptococcus pneumoniae Pseudomonas aeruginosa and Streptococcus viridans.
What type of infections can lead to cavernous sinus thrombosis?
Infections of the face sinuses teeth and ears can lead to cavernous sinus thrombosis.
Define cavernous sinus thrombosis. Why is it considered a medical emergency?
Cavernous sinus thrombosis is a rare but potentially fatal condition where a blood clot forms in the cavernous sinus causing increased intracranial pressure and potential damage to the cranial nerves and brain. It requires immediate medical intervention.
What are the risk factors for developing cavernous sinus thrombosis?
Risk factors include sinusitis facial infections dehydration and certain systemic illnesses such as hypercoagulable states.
Explain why Staphylococcus aureus is associated with cavernous sinus thrombosis from sinus infections.
Staphylococcus aureus is frequently found as part of the normal flora of the skin and mucous membranes and it can cause opportunistic infections particularly after sinusitis or when there is a breach in the skin or mucosa.
What treatments are typically indicated for cavernous sinus thrombosis?
Treatment generally involves antibiotics management of complications anticoagulation therapy in certain cases and surgical intervention in severe cases.
Describe the anatomical relationship of the cavernous sinus to the surrounding structures and its clinical significance.
The cavernous sinus is located on either side of the sella turcica and contains cranial nerves and the internal carotid artery. Its close relationship to these structures is clinically significant because infections can easily spread and cause nerve damage or stroke-like symptoms.
