neuro 2 Flashcards
does essential tremor and tremor of PD have opposite presentations?
yes - PD is resting, whereas essential is worse with activity
this reflex is concerning for brainstem compression
cushing reflex - hypertension, bradycardia, respiratory depression
*** sensory ataxia, lancinating pains, urinary incontinance, argyll robertson pupils
tabes dorsalis of syphilis - give penicillin for tx
fluctuating cognitive impairment, recurrent visual hallucinations, parkinsonism
dementia with lewy bodies
*** decreased sensation over 4th and 5th fingers, prolonged leaning on elbows
ulnar nerve entrapment at epicondylar groove of the elbow
fasiculations
LMN damage
spasticity, bulbar symptoms, exaggerated DTR
UMN damage
ALS is a mix of both _____
LMN and UMN damage
*** which patients with vertigo should have non contrast CT of head
prominent stroke risk factors
new onset HA
neurologic signs/symptoms
eosinophillic intracytoplasmic inclusions
Lewy bodies
key differentiation between LBD and PD
LBD = early appearance of cognitive fluctuations and dementia; comes LATE with PD
tx of pseudotumor cerebri
acetazolamide
tx of trigeminal neuralgia
carbamazepine
tx of temporal arteritis
glucocorticoids
*** What is the single most POWERFUL risk factor for stroke
hypertension
erythema migrans, HA, arthralgias, myalgias
burgedorfi, lymes
periodic sharp wave complexes on EEG, 14-3-3 CSF assay, caudate nucleus and putamen, spongiform changes on path, rapid deterioration with dementia and muscle movement
CJD
*** old homes, microcytic anemia with basophilic stippling, calcium disodium EDTA
chronic lead toxicity
*** what is major cause of death in first 24 hours of SAH presentation?
REBLEED
Day 3-10 after SAH, what’s patient at risk for?
Vasospasm
*** role of nimodipine in SAH
prevent vasospasm
*** bilateral motor function loss, diminished pain and temperature sensation, preserved proprioception, vibratory sensation, light touch
anterior cord syndrome - damage to anterior spinary arter
*** painless, rapid, transient monocular vision loss “curtain coming down over visual field”
amaurosis fugax - atherosclerotic emoboli from carotid artery
first thing to do with someone who has amaurosis fugax episodes
duplex US of the neck
unilateral HA, jaw claudication, fever, fatigue, monocular vision loss
think giant cell arteritis - check ESR
*** stroke with sudden-onset contralateral sensory loss involving all sensory modalities
thalamic stroke
stroke in this area is called a “pure sensory stroke”
thalamus
after a thalamic stroke, can patients develop a burning pain over the affect area, exacerbated by light touch?
yes - thalamic pain syndrome
stroke with contralateral pure motor or combined sensorimotor deficits
internal capsule
stroke with ipsilateral oculomotor nerve palsy, ataxia, contralateral hemiparesis
midbrain
is the internal capsule often involved in stroke to putamen?
yes - contralateral hemiparesis, sensory loss, conjugate gaze palsy toward side of the lesion
this medication inhibits choroid plexus carbonic anhydrase and is mainstay of pseudotumor cerebri treatment
acetazolamide
*** lateral medullary infarction, intracranial vertebral artery, sx of nystagmus, vertigo, difficulty sitting upright, loss of pain and temp sensation of ipsilateral face and contralateral trunk, ipsilateral bulbar, dysphagia, hoarseness, diminished gag reflex
Wallenberg syndrome
lateral mid-pontine lesions
motor and sensory fibers of trigeminal nerve
Which nerves are typically involved in lateral medullary infarction and lateral mid-pontine lesions
lateral medullary = 9 and 10 (dysphagia, hoarseness, diminished gag)
lateral mid-pontine - 5 (weak mastication, diminished jaw jerk reflex, impaired face sensation)
contralateral paralysis of the arm and leg and tongue deviation toward the lesion
medial medullary syndrome
contralateral ataxia and hemiparesis fo the face, trunk and limbs
medial mid-pontine infarction
*** cortical laminar necrosis
hallmark of prolonged seizures, results in persistent deficits and recurrent seizures
*** periorbital edema, unable to move the eye, HA, vomiting
cavernous sinus thrombosis
hemineglect syndrome
non-dominant parietal lobe
left temporal lobe involvement
receptive aphasia
frontal cortex lesion
hemiparesis
occipital lobe damage
visual disturbance
urinary incontinence/urgency, broad-based shuffling gait, memory/cognitive deficits, decreased CSF absorption by arachnoid granulations
normal pressure hydrocephalus - ultimately need VP shunt for tx
accumulation of alpha-synuclein within dopaminergic neurons
PD
charcot-bouchard aneurysm, lenticulostriate arteries, deep intracerebral hemorrhgae (basal ganglia/putamen, cerebllar nucle, thalamus, pons)
hypertensive vasculopathy
nipple dermatome
T4
*** corneal sensation
CN 5
*** CN for swallowing, palate elevation, phonation
CN X
*** CN that carries visual information and mediates the afferent limb of the pupillary light reflex
CN II
*** CN for eyelid opening, pupillary constriction, eye movement
CN III
crohn disease/ileal resection/gastritis, chronic malabsorption, macrocytic anemia, smear with macro-ovalocytes + hypersegmented neutrophils, methylmalonic acid, build-up of homocysteine
B12 deficiency
suspect this kind of stroke if pt presents initially with focal symptoms which then progress to signs of elevated ICP (vomiting, HA, bradycardia, decreased alertness)
hemorrhagic stroke
pt with solitary brain metastases and in good function health with stable extracranial disease. tx option?
surgical resection - if more than one, whole-brain radiation
gait instability, truncal ataxia, difficulty with rapid movements, hypotonia, intention tremor
cerebellar dysfunction - common in alcoholics
atrophy of frontal lobes
frontotemporal dementia
atrophy of TEMPORAL lobes
alzheimer disease
broad flat T waves, U waves, ST depression, PVR, a fib, torsades de pointes, v fib
cardiac abnormalities 2/2 hypokalemia <2.5
muscle wekaness, fatigue, cramps and cardiac abnormalities
think electrolyte abnormalities - potassium!
weakness, difficulty chewing, swallowing, coughing, breathing, hyperreflexia, spasticity, fasiculations
ALS
