Neuro Flashcards
Most significant and treatable risk factor for stroke?
HTN
Strokes involving anterior circulation are likely to produce what signs and symptoms?
Hemispheric: aphasia, apraxia, hemiparesis, hemi-sensory loss and / or visual field defects
Strokes involving posterior circulation are likely to produce what signs and symptoms?
Brainstem: coma, drop attacks, vertigo, nausea, vomiting and / or ataxia
Best imaging to differentiate ischemic from hemorrhagic stroke - recommended during acute phase?
Noncontrast CT
Thrombolytic therapy is most effective if given within how long of symptom onset?
3 hours
What is the indication for carotid endarterectomy?
> 70% stenosis of the common or internal carotid artery
What two diseases are associated with cerebral aneurysms?
polycystic kidney disease
coarctation of the aorta
A patient presents to the ER with a generalized sudden onset headache, “the worst headache in my life.” What must you suspect / rule out?
subarachnoid hemorrhage
Treatment for status epilepticus?
IV diazepam or lorazepam until seizure stops, with a loading dose of phenytoin or fosphenytoin
What is pathogenesis of multiple sclerosis?
inflammation associated with multiple foci of demyelination in CNS white matter
True / False: age of onset for MS is 18-45 years, and is more common in women than men.
True
Two most common presenting symptoms of MS?
sensory complaints in the limbs and vision loss (high correlation with optic neuritis)
What diagnostic test allows for visualization of white matter lesions in CNS?
MRI with gadolinium
What is commonly found in CSF of patients with MS?
oligoclonal bands
What two meds have been shown to improve spasticity commonly seen with MS?
Baclofen and diazepam
Most common form of dementia?
Alzheimer’s
What class of medication may be used to delay progression of Alzheimer disease and improve memory function?
acetylcholinesterase inhibitors
What med has been used in treatment of moderate to severe Alzheimer disease?
memantine (Namenda)
What is a potential cause of fronto-temporal dementia, and what disease is this associated with?
Pick disease, associated with ALS
Common frontal lobe symptoms associated with frontotemporal dementia?
behavior symptoms: (euphoria, apathy, disinhibition) and compulsive disorders
Most common type of headache?
tension headache
Treatment of choice for cluster headaches?
oxygen and / or SC sumatriptan
Preferred therapy for prophylaxis of cluster headaches?
verapamil
What med is used to help control benign essential tremors?
propranolol
Essential clinical features that establish a diagnosis of Parkinson disease?
Resting tremor
bradykinesia
rigidity
postural instability
When considering bradykinesia in patients with Parkinson disease, what are common facial features?
infrequent blinking
mask-like facies
When testing passive ROM in a suspect Parkinson patient, what would you expect to find?
cogwheel rigidity
One which chromosome is the gene responsible for Huntington disease found?
chromosome 4
Characteristic features of Huntington’s?
progressive chorea
dementia
Most common initial manifestation seen with Tourette syndrome?
Phonic tics: grunts, barks, hisses, coughing or verbal utterances
What disease process is characterized by chronic impairment of muscle tone, strength, coordination or movements?
Cerebral Palsy
When do symptoms of restless leg syndrome most commonly occur?
during periods of prolonged inactivity or rest
In addition to prescription drugs, a trial of what else is recommended in all restless leg syndrome patients?
Iron (except in patients with iron overload)
On which side of the face is Bells Palsy most common?
Right: 60% of cases
In what two patient populations is Bells Palsy more prominent?
pregnant women
diabetics
What cranial nerve supplies the muscles affected in Bells palsy?
CN VII
When does the facial weakness of Bells palsy peak?
about 21 days or less
What other disease processes lead to facial palsy that should be ruled out prior to a diagnosis of Bells palsy?
Stroke Tumors Lyme AIDS Sarcoidosis
Most common neuropathy in western hemisphere?
diabetic neuropathy
What med has recently been approved for treatment of diabetic neuropathy?
Duloxetine (Cymbalta): SNRI
Most common precipitant of Guillain-Barre syndrome (acute idiopathic polyneuropathy)?
Campylobacter jejuni
Pattern of weakness with Guillain-Barre syndrome?
symmetrical extremity weakness, beginning distally and ascending.
In what percentage of patients with Guillain-Barre syndrome are cranial nerves affected?
45-75%
What treatment has been shown to reduce the recovery time and may reduce likelihood of residual deficits in Guillain-Barre syndrome?
plasmapheresis
What form of treatment of Guillain-Barre syndrome is preferred over plasmapheresis in children, and adults with cardiovascular instability?
IV immunoglobulin (IVIG)
Characteristics of myasthenia gravis?
muscle weakness and fatigability, which improves with rest
What is the mainstay of treatment for myasthenia gravis?
cholinesterase inhibitors, such as pyridostigmine
Three primary causes of bacterial meningitis?
Strep pneumo
Group B strep
Neisseria meningiditis
Most common bacterial cause of meningitis in neonates <1m old?
group B strep
Clinical feature of neisseria meningiditis?
petechial rash
Prompt lumbar puncture (LP) and CSF analysis are essential in making the diagnosis of bacterial meningitis. Prior to LP, what diagnostic test needs to be performed, and why?
Head CT to rule out space-occupying lesion
Neonates with bacterial meningitis are commonly treated with what antibiotic?
ampicillin and cefotaxime
Treatment of choice for bacterial meningitis in immunocompetent children >3m old, and adults <55yrs old?
Cefotaxime or Ceftriaxone PLUS vancomycin
What two potential med combos are used for bacterial meningitis in patients >55yrs old, or with Hx of alcoholism / debilitating illness (regardless of age)?
ampicillin + cefotaxime OR
ceftriaxone + vancomycin
What med is recommended in adults with meningitis secondary to strep pneumo, and in children >1m old with meningitis secondary to H. flu type B (HIB)?
dexamethasone
Treatment for suspect herpes viral meningitis?
acyclovir
Presenting symptoms in patient with brain abscess?
vomiting, fever, altered mental status, focal neurologic signs
Lumbar puncture is contraindicated in patients with what type of presenting symptoms / signs?
focal neurological symptoms or signs - brain stem herniation may occur
In head trauma patients, loss of consciousness greater than what duration implies a worse prognosis?
2 minutes
What would you expect to find on exam in a patient with central cord syndrome?
Lower motor neuron deficit, loss of pain / temperature with sparing of posterior column functions
Most common primary intracranial neoplasms?
gliomas
Most common sources of intracranial metastasis?
Lung, breast, kidney and GI cancers
6 major hormones produced by anterior pituitary?
ACTH TSH LH FSH GH prolactin
Two hormones stored in posterior pituitary?
ADH (vasopressin)
oxytocin
