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Med 1 > Neuro > Flashcards

Neuro Flashcards

1
Q

Transiet ischemic Attack

type?

Symptoms

A

neuro der lasting few min -24hrs; usually 30 min

Hard to tell from stroke other than time

Usually embolic.
HIGH risk of subsequent stroke (30% 5yr risk)

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2
Q

Risk factors for TIA?

A

Age and HTN**

smoking, DM, hyperlipidemia, A fib, CAD,

YOung - OCP, hypercoaguable state, vasoconstricitve drug use (cocaine, amphetamine)

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3
Q

TIA in carotic vs verterbrobasiler

A

Carotid - temp loss in speech, paralysis, parenthesis of contralat extremity, clumsy. Amaurosis fugax:transient cutting like loss of sight in ipsilateral eye -> retina

Vertebrobasilar system - decreased perfusion of posterior fossa
- dizzy, double vission, vertico, numb ipsilateral face and contralateral limb, dysarthria, hoarse, dysphagia, vomiting HA

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4
Q

Pahophys of Ischemic stroke(3)

A

embolic stroke - HEART
internal carotic, aorat, paradoxical emboli

thrombotic

Lacunar - small vessel thrombotic disease(20%)
** Hx of HTN, DM important too

Nonvascular - Low CO, anoxia

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5
Q

Causes main causes of stroke (3)

A

ischemia, athersclerosis
Atrial fib w/ clot emboli
septic emboli - endocarditis

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6
Q

Most common location of stroke

A

middel cerebral artery 0> contralateral weakenss and sensory loss and hyperreflexia

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7
Q

Subclavian steal syndrome

A

stenosis of subclavian proximal to origin of vertebral artery -> exercise of L arm causes reversal of flow down through ipsilateral vertebral artery to fill subclavian

vertebrobasilar arterial insufficiency
BP in L< R, decrease pulse

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8
Q

Awakens from sleep w/ neuro deficits

A

Thrombotic stroke

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9
Q

MCA involved in stroke you see?(3)

A

contralateral hemiparesis and hemisensory loss
aphasia if L hemisphere( dom 90%)

Apraxia, contralateral body neglect, confusion(non dom)

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10
Q

features of lacunar stroke?

Locaion?

A

focal and contralateral

Pure motor- internal capsule
or
pure sensory - thalamus

ataxic hemiparesis- incoordination ipsilaterally
cumsey hand

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11
Q

contralateral lower extremity and face symptoms of stroke

lesion?

A

anterior cerbral artery

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12
Q

Aphasia and contralateral hemiparesis post stroke

lesion

A

middle cerebral

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13
Q

ipsilateral ataxia, diplopia, dysphagia, dysarthria and vertigo

Contralateral hononymous hemianopsia w/ basilar PCA lesion

Lesion of stroke?

A

vertebral/basilar

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14
Q

Pure motor hemiparesis, dysarthria, clumsy hand, pure sensory

Stroke lesion?

A

lacunar either
internal capsule - motor
pons - hands
thalamus - sensory

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15
Q

Screen all patients w/ carotid duplex if (3)

A

carotid bruit
PAB
CAD

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16
Q

Imaging for stroke

A

CT* w/o contrast, takes 24-48 hrs to see

MRI more sensitive but not emergent

Alos - ECG, Carotid duplex, MRA(magnetic resonance arteriogram)

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17
Q

Progression of stroke? (3)

A

Cerbral edema 1-2 days -> mass effect (10d)
Tx: hyperventilation and mannitol

Hemorrhage - rare
Siezure - rare

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18
Q

When to give tPA in stroke?

A

w/in 3 hrs in acute ischemic,

NOT given w/ stoke time unknown, >3hrs, HTN, bleeding disorder, Hx of trauma/surgery

ASA if later

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19
Q

Acute treatment of Stoke (3)

Prevention

A

1st - tPA if 220 or diastolic >120, MAP >130

Prevention- carotid endarterectomy -f carotids >70%* stenoses, ASA, risk control

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20
Q

prevent lacunar stroke?

A

HTN control

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21
Q

Maine cause of stroke in young person

A

cocaine -> ischemic, ICHemorrhage, Subarachnoid hemorrhage

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22
Q

Iintracranial hemorrhage pupillary findings/location

Pinpoing pupils
poor reactive pupils
dialated pupils

A

pons

thalamus

putamen

basal ganglia is 66% but no sign

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23
Q

Causes of intracranial hemorrhagic stroke?(4)

A

HTN*- (60%)esp sudden increase

Amyloid angiopathy
anticoag use
brain umors
AV malformations

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24
Q

abrupt onset of focal deficit that worsens over 30-90 min

AMS, HA, vomitting?

Imaging?

A

incercerebral hemorrhage

could be ischemic - need CT!!

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25
Q

roll of steroids in intercerebral Hemorragic stroke

Rx to decrease pressure in cranium post stroke

A

NO role

Mannitol

Eval for cerebellar hematomas

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26
Q

Causes of subarachnid hemorrhage (3)

A

ruptured berry aneurism -

Trauma - common cause

AV malfromation

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27
Q

Subarachnoid hemorrhage associated w/ ? disease

A

poly cystic kidney disease

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28
Q

Prior to LP what for Sub arach hemorrhage get?

A

CT noncontrast

OPthamic exam for papilledema r/o

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29
Q

IN addition to worst HA of life what also seen in SAH?

A

Sudden transient loss of consciousness (1/2)

Vomitting**
meningeal irritation, nuchal rigidty, photophobia
retinal hemorrhage

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30
Q

Xanthochromia

A

yellow CSF-> gold standard of subarachnoid hemorrhage (RBC lysis)

Blood in CSF is also hallmark

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31
Q

Complications of sub arachnoid hemorrage(5)

A 
Rerupture - 30%
vasospasm - 50%
hydrocephalis - communicating 2/2 blood w/in
Siezures
SIADH
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32
Q

Parkinson’s results loss of ?? where?

System that is messed up

A

loss of dopamine containing neurons located in substantia nigra and locus ceruleus in the midbrain

Cholinergic system acts unopposed (basal ganglia/striatal region)

usually older than 50

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33
Q

Tx of subarachnoid hemorrhage?

A

Surgical- berry aneurysms are clipped

Medical -bed rest, quiet room, Analgesia(tylenol), IV fluids, Contral HTN, CCB (nifedipine for vasospasm)

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34
Q

Shy drager syndrome

A

parkinsonian + autonomic insufficiency

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35
Q

Features of Parkinson(8)

A 
Pill rolling tremor at REST (action relieves)
Bradykinesia
Cogwheel rigidity
poor postural reflexes (shuffling step)
Masked face
Dysarthrya, micrographia (small writing)
dementia
Autonomic dysfunction
Personality changes- withdraw/depression
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36
Q

Tx classes for parkinson (5)

A

Carbidopa-levodopa - - most effective, SFx: dyskinesias w/in 5-7 yrs, N/V anorexia; ON/OFF phenom

Dopamine receptor agonists(bromocriptine, pramipexole*) delays levodopa need, used for hesitancy and immobility

Selegiline - MAOI - increases dopamine and reduces levodopa degradation, adjunct

Amantadine - Antiviral - mild

Anicholinergic - tremors
- amytriptylin

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37
Q

Drugs causing parkinson like effects

A

neuroleptics -chlopromazine, haloperidol, perphenazine,

Metoclopramide

Reserpine

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38
Q

Huntington’s Chorea pathophys

A

Auto dominant w/ onset 30-50

15yrs death

Chromosome 4 mutation -> CAG expansion and loss of GABA producing neurons

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39
Q

Features of Huntintons CHorea (5)

A

Chorea- face/neckongue/trunk

Altered behavior - irritable, personality changes, antisocial

Impaired mentation- progressive dementia (90%)

Unsteady gait(bradykinesia)

Incontinence

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40
Q

Atrophy of the caudate nucleus on MRI

A

Huntingtons disease

DNA testing confirms

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41
Q

Tx for huntingtons?

A

No cure-> dopaine antogonists

Tetrabenazine

Antipsychotics

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42
Q

Physologic tremor causes?(3)

A

Fear/anxiety/fatigue

Metabolic - hypoglycemia/hyperthyroidism/pheo

Toxic - alcohol wthdrawal, vlproic acid, lithium

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43
Q

Essential tremor

Decreases w?

A

common - Auto dom

intentional activity(use of utensils etc..)

Decreased w/ alcohol use
TX w/ propranolol

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44
Q

Ataxia DDx (9)

A

acquired- alcoholism, Vit B12 or thiamine def, cerebellar infarct, neoplasm, demyelinating disease (MS), tertiary syphilis(tapes dorsal)

inherited

  • Fredriechs ataxia
  • Ataxia telangectasia
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45
Q

Inherited causes of ataxia (2)

A

Fredreichs - Auto recessive, young onset,
- Ataxia, nystagmus, impaired vib sense, proprioception

Ataxia telangiectasia- auto recessive, younger onset,
- Frederichs + telangectases and increased CA risk

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46
Q

Tourette syndrome

onset?
associations?

A

obsessive compulsive assoc

onset before age 21

Auto dom inheritance,

Motor tics- face grimace, blinking, head jerking, shrugging
phonic tics- grunt, sniff, word repeating

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47
Q

Tourette Tx (3)

A

clonidine,
Pimozide
Haloperidol

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48
Q

Forgetfulness vs dementia

A

demential affects day to day living and baseline function

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49
Q

Dementia

A

progressive deterioration intellectually w/ preservation of consciousness

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50
Q

Reversible causes of dementia(8)

A 
hypothryrodism
heurosyphilus
Vit B12/folate/thiamine def
meds
normal pressure hydrocephalus
depression
subdural hematoma
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51
Q

Irreversible causes of dementia (9)

A 
alzeimers
parkinsons/huntingtons
multi-infarct
Lewi body,  Picks
unresctable brain mass
HIV
Kosakoff
Progressive multifocal leukoencephalopathy
creutzfeldt Jacob
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52
Q

Stepwise decline in mental status in the setting of HTN

A

multiinfarct demetia

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53
Q

Normal pressure hydrocephalus triad

A

Incontinence
gait disterburbance
dementia

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54
Q

Risk of alzheimers (3)

A

age
family Hx - early onset
Downs (chromosome 21 linked)

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55
Q

Pathology of alzheimers (2)

A

senile plaques - focal collection of dilated, tortuous, neurotic processes surrounding central amyloid core (amyloid beta)

neurofibrillary tangles- neurofilament bundles, neuronal degen

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56
Q

Diagnosis of Alzheimers?

A

clinical diagnosis of exclusion

CT/MRI shows diffuse cortical atrophy and enlarged ventricles

57
Q

Tx of alzheimers (2)

A

Cholinesterase inhibitors- -( doneprizil, rivastigmine, galantamine)
AVOID anticholinergic

Vit E- slowed progression

58
Q

Lewi body dementia

A

Progression more rapid vs alzheimers w/ elements of parkinson

Visual hallucinations predominate

extrapyramidal features, fluctuating mental status

Selegiline + demoralize and other antocholinesterase (rixvatigmine galantamine_

59
Q

Delerium characteristics

A

acute cognitive dysfunction

altered/fluctating conciousness w/ hallucinations

maybe a tremor

waxing and waning symptoms- >sundowning(worse at night)

60
Q

AMS - altered mental status

A

arousal needs brainstem, cognition needs cerebral cortex

AMS-> diminished consciousness and confusion caused by variations of same theme

Diffuse injury(metabolic, systemic, toxic) vs focal lesion(infarction, tumor)

61
Q

Causes of delirium

- 8

A

P. DIMM WIT

Postop
Dehydrated
INfection
Medication/druf (TCAs, corticosteriods, anticholinergics)
Metals
Inflammation
Trauma/burns
62
Q

Ddx of coma/stupor- SMASHED

A

SMASHED

Structural brain path - stroke/ hematoma, tumor, herniation, access

Meningitis - Mental illness

Alcholol - Acidosis

Seizures - Substrate def (thiamine)

Hypercapnia, Hyperglycemua, hyperthermia, hyponatremia, hypoxia, hypoperfusion,

Endocrine (addisons, thyrotoxicosis, encephalitism encephalopathy - Extreme Ca, Mg, Phos

Drugs (opiates, benzos, barbs,)

63
Q

Approach to coma

A

ABCs
assume truam - c percautions
Assess consciousness (gasgow)

Approach Dx - motor exam abnormality (mass lesion) vs sytemic metabolic or systmenic

64
Q

Pupil response

Bilateral fixed dialated

Unilateral fixed, dialated

Pinpoint pupils

A

severe anoxia, cocaine/meth, opiod withdrawal,

herniation w. CNIII compression

narcotics, ICH

65
Q

Glasgow coma scale

A

E 1- None, 2-pain, 3-voice, 4 spontaneous

V 1- none, 2 -grunts, 3- inapprop words, 4- Approp but confused, 5- Oriented

M 1- none, 2-decelebrate, 3- decorticate, 4- withdraws from pain, 5 - localizes pain, 6- obeys commands

66
Q

Pupillary light reflex

A

PERRL - midbrain intact and not coma cause

Aniscoria - uncal herniation?

Doll eyes- move opposite of head w/ intact brainstem

67
Q

locked in syndrome 2/2 commonly

A

infarction or hemorrhage of ventral pons

68
Q

MS pathology

A

selective demylination of CNS -> multifocal zones throughout white matter

angles of lateral ventricles classically

pyramidal, cerebellar paths, medial longitudinal fasiculus, optic nerve, posterior columns

69
Q

Dx of MS clinically and Lab

A

Clinically - 2 episodes of symptoms and evidence of 2 white matter lesions on imaging(MRI*)

Laboratory - 2 episodes of symptoms, evidence of 1 white matter lesion, abnormal CSF (oligoclonal bands)

70
Q

Clinical Features of MS (9)

A

transient sensory defecits ((parathesia in up/low limbs)
fatigue*
Motor (weak/spastic)
visual distubance - Optic neuritis **
Internuclear opthalmoplegia- lesion in medial longitudinal fasiculus -> (horizontal nysagmus in abducting eye w/ lateral gaze)
cerebellar involve(ataxia, intention tremor)
loss of bladder
autonomic involve
cerbral involvement (advanced)
neuropathic pain

71
Q

MS affects who?

Progression?

A

women>M

20s-30s w/ optic neuritis, 1 sided weak/numb

either relapsing remitting or progressing

avg 1 episode/year

72
Q

Tx of MS

Acute

Disease modifying

A

Acutely High dose IV corticosteroids, NOT oral
- most resolve w/in 6 wks on own

Disease mod - Interferon therapy - recombinant interferon beta 1-a and recombinant 1b and glatiramer acetate, reduce relapse SFX (flu like symptoms)

Cyclophosphamide for rapidly progressive disease

Symptoms

  • baclofen /dantrolene - muscle relax
  • carbamazepine/gabapentin - neuro pain
  • Depression
73
Q

Gullian Barre Syndrome

characterisitc and causes

CSF changes?

A

inflam demylinating polyneuropathy - affects MOTOR

viral, mycoplasma GI/URI precursor
maybe hodgkins, lupus, surgery, HIV

CSF - isolated elv protein
Electromylograms -> decrease nerve conduction

74
Q

Prognosis of gallon barre

Do not give?

A

signs of recovery 1-3 wks is good prognosis, >6 bad

Concern for resp failure, Mechanical ventilation. IV immunoglobulin if weakness.

NO steriods

75
Q

Features of gullain barre

A

ascending symmetric weakness/paralysis (rapid onset) -> resp arrest

extremities maybe painful
sphinter and mentation spared

76
Q

Myasthenia gravis

A

autoimmune - Abs against nicotinic acetylcholine receptors-> reduced post synaptic response and fatigue

fatigue w/ use
Periodic exacerbations-> emergency and need of mech ventilation

ages 20-30W - 50-70M

77
Q

symptoms of weakness worsen at the end of the day w/ spared sensation

A

myasthenia gravis

  • cranial muscles (extraocular**, eyelids, chewing, speech)
78
Q

Lambert Eaton myasthenic syndrome

A

Small cell lung CA

Antibodies against presynaptic Ca channels -> proximal muscle weakness and hyporelfexia

Symptoms IMPROVE w/ use

79
Q

Associated tumor w/ Myasthenia gravis

A

Thmoma - 10-15% get a CT scan

80
Q

Edophonium -tensilin test

A

for myasthenia graves - anti cholinesterase medication (short actin)

81
Q

Tx of myasthenia gravis(4)

A

ACheE inhibitor - pyridiostigmine, symptomatic only

Thymectomy - thyoma concerns

Immunosuppression: First Corticosteriods, next azathioprine/cyclosporine

Plasmaphoresis - All else fails

intubate if in resp distress

82
Q

Drug exacerbatiors of myasthenia graves (3)

A

antibiotics - ahminoglycosides and tetracycline

beta blockers

Antiarrhythmics- quinidine, procainamide, lidocaine

83
Q

Duchenne muscular dystophy

Cause?

Features

A

X linked -> mutated dystrophin protein

NO inflammation

progressive proximal muscle weakness, symmetric, in childhood

Pelvic weak -> gowers maneuver

calf pseudohypertophy

84
Q

Tx of duchenne muscular dystrophy

A

X linked dystropin dysfunction

Prednisone helps, only for boys <5 yrs

Surgery for progressive scoliosus

85
Q

Beckers muscular dystrophy

A

less common than duchenne

Also X linked

some distortion

86
Q

Inherited muscle weakenss(4)

A

Duchenne - xlinked

Beckers- x linked

McArdles - Auto recessive, cramping after exercis (glycogen phosphorylase def)

Mitochondrial diorder - maternal pattern, ragged red fibers

87
Q

Neurofibromatosis Type I

Characteristics (5)

A

Auto Dom -

cafe au lait spots, neurofibromas, CNS tumors (gliomas, meningiomas), axillary inguinal freckling, iris harmatomas (LISCH’S Nodules)

cutaneous neurofibromas

Siezures, mental retard, short, macrocephalic

88
Q

Neurofibomatois II

See?(5)

A

Auto Dom

bilateral/unilateral acoustic neuromas,  
mtpl meningiomas, 
cafe au lait spots
neurofibromas
cataracts
89
Q

cognitive impairment,
epilepsy,
skin lesions(facial angiofibromas, adenoma sebaceum)
Retinal harmatomas, enal angiomyolipomas, heart rhabdo?

A

tuberous sclerosis

90
Q

Capillary antimatoses of the pia matter

Classic facial vascular nevi - port-wine stain?

What are you treating normally

A

Sturge Weber syndrome

epilepsy (Treated)and mental retardation usually present

91
Q

Cavernous hemangiomas of the brain/brainstem, renal angiomas and cysts

associated w/ 2 CAs

A

Von Hippel Lindau disease

Renal cell carcinoma and pheos

92
Q

Syringomyelia

Associated w/?

Symptoms

Dx?

A

Central cavitation of cervical cord 2/2 abnormal collection of fluid

Arnald chiari malformation

Bilateral loss of PAIN and TEMP sensation - cavelike (lateral spinothalamic tract)- muscle atrophy?

touch preserved,

MRI, Tx depends on size

93
Q

Brown Sequard syndrome (3 )

A

Spinal cord hemisection usually 2/2 trauma/crush injury

Contralateral loss of pain and temp (spinothalamic tract)
Ipsilateral hemiparesis (corticospinal tract)
Ipsilateral loss of position/vibration (dorsal columns)

Good prognosis

94
Q

Transverse myelitis

A

affects the tracts across the horizontal aspect of the spinal cord (Thoracic)

Cause is unknown, post viral

See LE weakness, back pain, sensory def, sprinter disturbance

MRI

Steriods given

95
Q

Horner’s syndrome

Cause and Triad

A

Disrupted cervical sympathetic nerves- pre or post ganglionic

2/2 pancoast tumors, internal carotid dissection, brainstem stroke, neck trauma

Ipsilateral ptosis, anhydrosis and miosis(pinpoint pupil)

96
Q

Poliomyolitis affects?

Features

A

anterior horn cells and motor neurons (Lower motor)

ASYMMETRIC muscel weakness(legs), Absent deep tendon, Flaccid, Atrophic muscles, NORMAL sensation

No Tx

97
Q

Dizziness DDx

A

presyncope - lightheaded
Vertigo
Multisensory stimuli - vasovagal

Conditions associated - cerebellar disease, CV disease, TIAss, Hyperventilation, anxiety, panic attacks, phobis

98
Q

Vertigo - 2 types

A

Central - gradual onset*

  • w/ other near findings(weak, hemiplegia,diplopia, dysphagia, faciacial numb)
  • CV risk factors, nystagmus multidirectional**

Peripheral - lesions cochlear/retrocochlear,
Abrupt onset*, N/V head position affects, tinnitus?

99
Q

Types of peripheral vertigo (5)

A

Benign positional vertigo - specific position induces- nystagmus - unilateral

  • > 60yrs, Abrupt onset
  • Meclizine - NO hearing loss,tinnitus

Menieres disease - vertigo/tinnitus/hearing loss
- lasts hrs-days,
Tx Na and diuretics

Acute labyrinthitis - viral infection , days

Ototoxic drugs - aminoglycosides and diuretics

Acoustic neuromas - ataxia, nystagmis, hearing loss, tinnitus

100
Q

Menieres disease -

Triad

Tx?

A

Vertigo
Tinnitus
hearing loss (perm)

hrs -days symptoms

Tx w/ Na restriction and Diuretics

101
Q

Syncope vs siezure

A

syncope is temporary and bladder function maintained

102
Q

Syncope DDx(6)

A 
Siexure
Cardiac(arrythmia, obstruction, MI)
Vasovagal
Orthostatic hypotension
severe cerebrovascular disease
Other - metabolic(hypoglycemia, hyper vent),  hypersensitivity,  meds
103
Q

Puts face hits the floor w/ syncope think of what etiology

Causes

A

Cardiac

arrythmias (sick sinus, V tach, AV block, SVT)

Obstructive - aortic stenosis, hypertophic cardiomyopathy, pulm HTN, atrial myxoma, prolapses Mitral valve, MI

104
Q

Clues to vasovagal syncope

A

emotional stress, pain, fear, fatigue prior

pallor, diaphoesis, light headed, N, diminished vision

TILT TABLE study

105
Q

Sever serebrovascular disease

A

rare case of syncope

TIA involving vertebrobasilar circulation -> drop attacks

106
Q

Evaluating syncope look for

A

Underlying heart disease - EKG**, maybe echo, hotter monitor,

107
Q

Causes of Siezures 4Ms + 4Is

A

Metabolic/electolyte disturbance (hyponatremia, hypo/hyperglycemia, hypocalcemia, uremia, thyroid storm, hyperthermia_
Mass lesion
Missing drugs (noncompliance, acute withdrawal alcohol, benzos, barbs
Miscellaneous (pseudoseizures, eclampsia, HTN encephalopathy)

Intoxication - cocaine, lithium, lidocaine,
Infection - septic, meningitis
Ischemia - stroke, TIA(elderly)
increased ICP- truama

108
Q

Types of seizures

2 groups w/ 2 types each

A

Partial (one part of the brain -temporal- to the cortex)
- simple - conscious intact*, localized but may evolve

  • complex - conscious impaired*, automatisms (1-3m) involuntary/purposeles movements, olfactory/gustory hallucinations

Generalized - loss of consciousness**, entire brain

  • Tonic Clonic(grand mal)
  • Absence(petit Mal)
109
Q

Partial seizures(simple and complex) may progress to generalized seizures called

A

secondary generalized

110
Q

Tonic clonic seizure characterization

A

bilaterral symmetric
- sudden loss of consciousness

Tonic - rigid, trunk/limb extension, (apneic)

Clonic - muscular jerking min 30s

Flaccid and comatose

Postictal confustion 10-30min

lacerated tongue, vomit, incontinence

111
Q

Absence seizure

Tx?

A

school age kids, resolves w/age

disengage and return in few seconds
brief but frequent

NO loss of postural tone/incontinence, maybe had nodding, blinking

Ethosuximide or valproic acid

112
Q

Tx for Partial seizures (simple/complex) and tonic clonic

A

phenytoin, carbamazepine first choice

also: phenobarbital, valproate, primidone

113
Q

Known seizure disorder and presents w. seizure get what test?

Unclear? Tests

A

anticonvulsant levels
- one dose may be toxic for one patient and therapeutic for another

CBC, lytes(Ca, Na, glucose, BUN), LFTs, renal function, EEG, CT, MRI, LP (if febrile)

114
Q

Status epilepticus

Tx?

A

prolonged unconciousness w/ persistent convulsions

medical emergency

2/2 poor compliance, withdrawal, overdose

Airway(roll to side), IV diazepam, IV phenytoin and dextrose

Phenobarbital if resistant

115
Q

Tx for absence seizures

A

ethosuximide and valproic acid

116
Q

Pregancy and siezures

A

STOP anticonvulsents

~ alcohol

117
Q

Amylotrophic Lateral Sclerosis

Hallmark lesion

Onset?

A

Upper and lower motor neuron signs - anterior horn cells and corticospinal tracts at many levels

50-70 normal, w/ 10% familial

80% dead 5yrs

118
Q

Features of ALS

A 
progressive weakness, no pain (legs/arms -> others)
Cramps/spacitiy - upper
Fasiculations - lower
impaired speech/swallow
Resp muscle weakness
Weight loss and fatigue

Unaffected: bowel/bladder, sensation, cognitive, extraocular muscles, sex

119
Q

Dx of ALS w/

Tx?

A

Clinical evidence

  • EMG?
  • 2 regions probable, 3-4 regions definite ALS

none, Riluzole delays death 305 months

120
Q

Wernickes aphasia

A

Receptive fluent aphasia
*impaired comprehension of written or spoken language

Word salad, grammatically correct and fluid but wrong words w/ Pts not understanding their own words

121
Q

brocas aphasia

A

Expressive nonfluent aphasia

Speech is slow and effortful

Short sentences w/limited grammar

Good comprehension -> frustration

122
Q

Conduction aphasia

A

disturbance in repition

pathology between wrenches and brocas

123
Q

global aphasia

A

all areas of language - comprehension, speaking, reading, fluency)
R hemiparesis assoc

124
Q

Bells Palsy?

Prognosis

Causes

A

hemofacial weakness along CN 7 2/2 swelling

good - 80% w/in wks -months

unknown cause, viral ? herpes simplex, URI precedes commonly**

125
Q

Tx of Bells?

A

Usually none, can use steroids and acyclovir as necessary

NO steroids if Lymes suspected

126
Q

Ddx of facial paralysis(7)

A 
Trauma - temporal bone
Lyme
Tumor - acoustic neuroma, cholesteatoma
Gullan Barre - bilateral
Herpes zoster
Stroke - move eyebrows
Bells palsy - URI prior, no eyebrow
127
Q

Trigeminal neuralgia

A

VERY PAINFUL
idiopathic

touch jaw, lips, gum maxillary
recurrent attacks, no paralysis

Clincal Dx

128
Q

Tx of trigeminal neuralgia

A

carbamezpine

also baclofen, phenytoin

Surgical decompression

129
Q

Lesion at cerebral cortex see:(2)

A

contralateral motor/sensory deficits + aphasia

Face, arms, run, maybe legs

130
Q

Lesion at subcortical see?(1)

A

internal capsul, cerebral peduncles, thalamus, pons

hemiparesis is complete (face, arm, leg), neurons merge together

131
Q

lesion at cerebellum see

A

incoordination, interion tremer, ataxia

132
Q

lesion at the brainstem see

A

crossed hemiplegia - ipsilateral face and contralateral body

corticospinal tract, dorsal coloumns and spinothalamic tract cross, cranial nerves do NOT

133
Q

Lesion of spinal cord see?

A

Acute -> spinal shock and upper moto neuron signs
-spasicity, increased deep tendon reflexes, clonus, positive babinskii

decrease sensation and pin prick is felt above the level but not below

134
Q

Plexus lesion see?

location

A

deficits in motor and sensory, involve more than one nerve

Trauma for brachial plexus most common, post surgical hematoma in pelvis

Erb Duchenne - Upper trunk C5-C6
Lumbrosacral plexus L5-S3

135
Q

Roots lesion see?

A

Pain is key

affects group of muscles supplies by spinal root (myotome and sensory area supplied by spinal root (dermatome)

Weakness, atrophy, senstry def in dermatime pattern - dim DTRs and fasiculations (UMN and LMN lesions)

136
Q

Peripheral nerve lesion see?

A

weakness more prom vs muscle myopathy

Asymmetric, DTR diminshed (LMN), sensory changes, atrophy, fasiciualtions

SM, truama, entrapment, vasculitis

radial.ulnar/median/musculocutaneous/long thoracic/axillary/common perennial/femoral

137
Q

neuromuscular juntion lesion see?

A

fatiguablity

muscles weak w/ use - no atrophy

138
Q

Myopathy see?

A

acquired disease

symmetric weakness, w/ proximal muscles > distal

normal reflexes, sensation

NO fascinations

Atrophy w/ disuse slow (vs rapid in Motor neuron disease)

Med 1 (11 decks)

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