Neuro 3 Flashcards
What is blepharospasm?
Type of focal dystonia characterized by recurrent forceful contraction of the eyelid muscles
Features of blepharospasm?
Typically bilateral and symmetric, commonly affected by sensory input (triggered by bright lights, terminated by touching or brushing the skin around the eye)
What is Meige syndrome?
Blepharospasm of the lower face (eg, jaw or tongue)
Causes of blepharospasm?
Certain movement disorders (eg, Parkinson) or medications (antipsychotics), most are idiopathic
Manage blepharospasm?
Mild - trigger avoidance
More severe - botulinum toxin injection
Presentation of acute uveitis?
Ocular pain, light sensitivity
Pupillary constriction and redness at the limbus (ciliary flush)
What is myotonic dystrophy?
AD disorder causing weakness and delayed relaxation of muscle; involvement of the facial muscles may lead to ophthlamoparesis
Initial interventions for all patients with carotid artery stenosis?
Intensive medical management (ie, aspirin, statin, BP control)
Counseling on lifestyle changes (eg, exercise, smoking cessation)
Who should be considered for a carotid endarterectomy?
Symptomatic patients (ie, TIA or ischemic stroke in the distribution of the affected vessel within 6 months) with high-grade stenosis (70-99%)
If persistently disabling neuro deficits, 100% occlusion, or life expectancy <5 years -> unlikely to benefit
Antiplatelet therapy for patients with carotid artery stenosis?
All patients -> aspirin (first-line), clopidogrel if aspirin is not tolerated
Risk factors for cerebral palsy?
Prematurity
Low birth weight
What is cerebral palsy?
Non-progressive motor dysfunction, multifactorial etiology
Causes of cerebral palsy?
Usually caused by prenatal insults to brain development, with prematurity as the greatest risk factor -> more likely to have periventricular leukomalacia (white matter necrosis from ischemia/infection), and IVH (germinal matrix bleeding due to fragile vasculature and unstable cerebral blood flow)
Clinical features of cerebral palsy?
Delayed motor milestones (commando crawl commonly seen)
Abnormal tone, hyperreflexia
Comorbid seizures, intellectual disability
Most common subtype of cerebral palsy?
Spastic cerebral palsy with hypertonia and hyperreflexia predominantly involved in the lower extremities (spastic diplegia), equinovarus deformity (feet point down and inward)
Dx work-up of cerebral palsy?
MRI of brain
+/- EEG
+/- genetic/metabolic testing
Management of cerebral palsy?
PT/OT/ST
Nutritional support
Ant-spastic medications
Inclusion criteria for thrombolytics in stroke?
Ischemic stroke with measurable neurodeficits
Symptom onset <3-4.5 hours before treatment initiation
Strict exclusion criteria for thrombolytics in stroke?
Hemorrhage or multilobar infarct involving >33% of cerebral hemisphere on CT scan
Stroke/head trauma in past 3 months
Hx of intracranial hemorrhage, neoplasm, or vascular malformation
Recent intracranial/spinal surgery
Active bleeding or arterial puncture in the last 7 days at non-compressible site
BP >185/110
Platelets <100,000 or glucose <50
Anticoagulant use with INR >1.7, PT >15, or increased aPTT
Relative exclusion criteria for thrombolytics in stroke?
Minor or rapidly improving neuro deficits Major surgery/trauma in past 14 days MI in the past 3 months GU or GI bleeding in the past 21 days Seizure at stroke onset Pregnancy
DDx - neck pain?
- Strain
- Facet OA
- Radiculopathy
- Spondylitic myelopathy
- Spondyloarthropathy
- Spinal mets
- Vertebral osteomyelitis
Clinical clues suggesting strain as a cause of neck pain?
Antecedent history of neck injury
Pain/stiffness with neck movement
Clinical clues suggesting facet OA as a cause of neck pain?
Older individuals
Pain/stiffness worse with movement
Relieved with rest
Clinical clues suggesting radiculopathy as a cause of neck pain?
Pain radiates to shoulder/arm
Dermatomal sensory/motor/reflex findings
Positive Spurling test
Clinical clues suggesting spondylitic myelopathy as a cause of neck pain?
LE weakness, gait/bowel/bladder dysfunction
Lhermitte sign
Clinical clues suggesting spondyloarthropathy as a cause of neck pain?
Young men
HLA-B27
Relieved with exercise
Prolonged morning stiffness
Clinical clues suggesting spinal mets?
Constant pain
Worse at night
Not responsive to position changes
Clinical clues suggesting vertebral osteomyelitis?
Focal tenderness
Fevers and night sweats
IVDU, immune compromise, recent infection
Most cases of cervical radiculopathy are caused by what two conditions?
Acute cervical disc herniation
Underlying cervical spondylosis
What is cervical spondylosis?
Degenerative condition of the spine marked by osteophyte formation in the facet and uncovertebral joints -> neural foramina narrowing -> nerve root compression
What can be seen on imaging in patients with cervical spondylosis?
Sclerotic facet joints with osteophytes
Atlantoaxial subluxation can occur in patients with ___, leading to compressive cervical myelopathy. How does this present?
RA; neck pain radiating to the occiput, frequently develop progressive spastic paresis, Lhermitte sign, lower extremity manifestations
Odontoid process fracture usually occurs in the setting of high-impact trauma and results in ___, not radiculopathy.
Myelopathy
Vertebral body squaring is an early sign of ___.
Ankylosing spondylitis
Management of myasthenic crisis with respiratory failure?
Endotracheal intubation
Hold AChE inhibitors (reduce excess airway secretions/risk of aspiration)
Plasmapheresis or IVIg + corticosteroids
