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)
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)
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
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
5
Q
Causes main causes of stroke (3)
A
ischemia, athersclerosis
Atrial fib w/ clot emboli
septic emboli - endocarditis
6
Q
Most common location of stroke
A
middel cerebral artery 0> contralateral weakenss and sensory loss and hyperreflexia
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
8
Q
Awakens from sleep w/ neuro deficits
A
Thrombotic stroke
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)
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
11
Q
contralateral lower extremity and face symptoms of stroke
lesion?
A
anterior cerbral artery
12
Q
Aphasia and contralateral hemiparesis post stroke
lesion
A
middle cerebral
13
Q
ipsilateral ataxia, diplopia, dysphagia, dysarthria and vertigo
Contralateral hononymous hemianopsia w/ basilar PCA lesion
Lesion of stroke?
A
vertebral/basilar
14
Q
Pure motor hemiparesis, dysarthria, clumsy hand, pure sensory
Stroke lesion?
A
lacunar either
internal capsule - motor
pons - hands
thalamus - sensory
15
Q
Screen all patients w/ carotid duplex if (3)
A
carotid bruit
PAB
CAD
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)
17
Q
Progression of stroke? (3)
A
Cerbral edema 1-2 days -> mass effect (10d)
Tx: hyperventilation and mannitol
Hemorrhage - rare
Siezure - rare
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
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
20
Q
prevent lacunar stroke?
A
HTN control
21
Q
Maine cause of stroke in young person
A
cocaine -> ischemic, ICHemorrhage, Subarachnoid hemorrhage
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
23
Q
Causes of intracranial hemorrhagic stroke?(4)
A
HTN*- (60%)esp sudden increase
Amyloid angiopathy
anticoag use
brain umors
AV malformations
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!!
25
roll of steroids in intercerebral Hemorragic stroke
Rx to decrease pressure in cranium post stroke
NO role
Mannitol
Eval for cerebellar hematomas
26
Causes of subarachnid hemorrhage (3)
ruptured berry aneurism -
Trauma - common cause
AV malfromation
27
Subarachnoid hemorrhage associated w/ ? disease
poly cystic kidney disease
28
Prior to LP what for Sub arach hemorrhage get?
CT noncontrast
OPthamic exam for papilledema r/o
29
IN addition to worst HA of life what also seen in SAH?
Sudden transient loss of consciousness (1/2)
Vomitting**
meningeal irritation, nuchal rigidty, photophobia
retinal hemorrhage
30
Xanthochromia
yellow CSF-> gold standard of subarachnoid hemorrhage (RBC lysis)
Blood in CSF is also hallmark
31
Complications of sub arachnoid hemorrage(5)
```
Rerupture - 30%
vasospasm - 50%
hydrocephalis - communicating 2/2 blood w/in
Siezures
SIADH
```
32
Parkinson's results loss of ?? where?
System that is messed up
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
33
Tx of subarachnoid hemorrhage?
Surgical- berry aneurysms are clipped
Medical -bed rest, quiet room, Analgesia(tylenol), IV fluids, Contral HTN, CCB (nifedipine for vasospasm)
34
Shy drager syndrome
parkinsonian + autonomic insufficiency
35
Features of Parkinson(8)
```
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
```
36
Tx classes for parkinson (5)
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
37
Drugs causing parkinson like effects
neuroleptics -chlopromazine, haloperidol, perphenazine,
Metoclopramide
Reserpine
38
Huntington's Chorea pathophys
Auto dominant w/ onset 30-50
15yrs death
Chromosome 4 mutation -> CAG expansion and loss of GABA producing neurons
39
Features of Huntintons CHorea (5)
Chorea- face/neckongue/trunk
Altered behavior - irritable, personality changes, antisocial
Impaired mentation- progressive dementia (90%)
Unsteady gait(bradykinesia)
Incontinence
40
Atrophy of the caudate nucleus on MRI
Huntingtons disease
DNA testing confirms
41
Tx for huntingtons?
No cure-> dopaine antogonists
Tetrabenazine
Antipsychotics
42
Physologic tremor causes?(3)
Fear/anxiety/fatigue
Metabolic - hypoglycemia/hyperthyroidism/pheo
Toxic - alcohol wthdrawal, vlproic acid, lithium
43
Essential tremor
Decreases w?
common - Auto dom
intentional activity(use of utensils etc..)
Decreased w/ alcohol use
TX w/ propranolol
44
Ataxia DDx (9)
acquired- alcoholism, Vit B12 or thiamine def, cerebellar infarct, neoplasm, demyelinating disease (MS), tertiary syphilis(tapes dorsal)
inherited
- Fredriechs ataxia
- Ataxia telangectasia
45
Inherited causes of ataxia (2)
Fredreichs - Auto recessive, young onset,
- Ataxia, nystagmus, impaired vib sense, proprioception
Ataxia telangiectasia- auto recessive, younger onset,
- Frederichs + telangectases and increased CA risk
46
Tourette syndrome
onset?
associations?
obsessive compulsive assoc
onset before age 21
Auto dom inheritance,
Motor tics- face grimace, blinking, head jerking, shrugging
phonic tics- grunt, sniff, word repeating
47
Tourette Tx (3)
clonidine,
Pimozide
Haloperidol
48
Forgetfulness vs dementia
demential affects day to day living and baseline function
49
Dementia
progressive deterioration intellectually w/ preservation of consciousness
50
Reversible causes of dementia(8)
```
hypothryrodism
heurosyphilus
Vit B12/folate/thiamine def
meds
normal pressure hydrocephalus
depression
subdural hematoma
```
51
Irreversible causes of dementia (9)
```
alzeimers
parkinsons/huntingtons
multi-infarct
Lewi body, Picks
unresctable brain mass
HIV
Kosakoff
Progressive multifocal leukoencephalopathy
creutzfeldt Jacob
```
52
Stepwise decline in mental status in the setting of HTN
multiinfarct demetia
53
Normal pressure hydrocephalus triad
Incontinence
gait disterburbance
dementia
54
Risk of alzheimers (3)
age
family Hx - early onset
Downs (chromosome 21 linked)
55
Pathology of alzheimers (2)
senile plaques - focal collection of dilated, tortuous, neurotic processes surrounding central amyloid core (amyloid beta)
neurofibrillary tangles- neurofilament bundles, neuronal degen
56
Diagnosis of Alzheimers?
clinical diagnosis of exclusion
CT/MRI shows diffuse cortical atrophy and enlarged ventricles
57
Tx of alzheimers (2)
Cholinesterase inhibitors- -( doneprizil, rivastigmine, galantamine)
AVOID anticholinergic
Vit E- slowed progression
58
Lewi body dementia
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
Delerium characteristics
acute cognitive dysfunction
altered/fluctating conciousness w/ hallucinations
maybe a tremor
waxing and waning symptoms- >sundowning(worse at night)
60
AMS - altered mental status
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
Causes of delirium
| - 8
P. DIMM WIT
```
Postop
Dehydrated
INfection
Medication/druf (TCAs, corticosteriods, anticholinergics)
Metals
Inflammation
Trauma/burns
```
62
Ddx of coma/stupor- SMASHED
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
Approach to coma
ABCs
assume truam - c percautions
Assess consciousness (gasgow)
Approach Dx - motor exam abnormality (mass lesion) vs sytemic metabolic or systmenic
64
Pupil response
Bilateral fixed dialated
Unilateral fixed, dialated
Pinpoint pupils
severe anoxia, cocaine/meth, opiod withdrawal,
herniation w. CNIII compression
narcotics, ICH
65
Glasgow coma scale
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
Pupillary light reflex
PERRL - midbrain intact and not coma cause
Aniscoria - uncal herniation?
Doll eyes- move opposite of head w/ intact brainstem
67
locked in syndrome 2/2 commonly
infarction or hemorrhage of ventral pons
68
MS pathology
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
Dx of MS clinically and Lab
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
Clinical Features of MS (9)
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
MS affects who?
Progression?
women>M
20s-30s w/ optic neuritis, 1 sided weak/numb
either relapsing remitting or progressing
avg 1 episode/year
72
Tx of MS
Acute
Disease modifying
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
Gullian Barre Syndrome
characterisitc and causes
CSF changes?
inflam demylinating polyneuropathy - affects MOTOR
viral, mycoplasma GI/URI precursor
maybe hodgkins, lupus, surgery, HIV
CSF - isolated elv protein
Electromylograms -> decrease nerve conduction
74
Prognosis of gallon barre
Do not give?
signs of recovery 1-3 wks is good prognosis, >6 bad
Concern for resp failure, Mechanical ventilation. IV immunoglobulin if weakness.
NO steriods
75
Features of gullain barre
ascending symmetric weakness/paralysis (rapid onset) -> resp arrest
extremities maybe painful
sphinter and mentation spared
76
Myasthenia gravis
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
symptoms of weakness worsen at the end of the day w/ spared sensation
myasthenia gravis
- cranial muscles (extraocular**, eyelids, chewing, speech)
78
Lambert Eaton myasthenic syndrome
Small cell lung CA
Antibodies against presynaptic Ca channels -> proximal muscle weakness and hyporelfexia
Symptoms IMPROVE w/ use
79
Associated tumor w/ Myasthenia gravis
Thmoma - 10-15% get a CT scan
80
Edophonium -tensilin test
for myasthenia graves - anti cholinesterase medication (short actin)
81
Tx of myasthenia gravis(4)
ACheE inhibitor - pyridiostigmine, symptomatic only
Thymectomy - thyoma concerns
Immunosuppression: First Corticosteriods, next azathioprine/cyclosporine
Plasmaphoresis - All else fails
intubate if in resp distress
82
Drug exacerbatiors of myasthenia graves (3)
antibiotics - ahminoglycosides and tetracycline
beta blockers
Antiarrhythmics- quinidine, procainamide, lidocaine
83
Duchenne muscular dystophy
Cause?
Features
X linked -> mutated dystrophin protein
NO inflammation
progressive proximal muscle weakness, symmetric, in childhood
Pelvic weak -> gowers maneuver
calf pseudohypertophy
84
Tx of duchenne muscular dystrophy
X linked dystropin dysfunction
Prednisone helps, only for boys <5 yrs
Surgery for progressive scoliosus
85
Beckers muscular dystrophy
less common than duchenne
Also X linked
some distortion
86
Inherited muscle weakenss(4)
Duchenne - xlinked
Beckers- x linked
McArdles - Auto recessive, cramping after exercis (glycogen phosphorylase def)
Mitochondrial diorder - maternal pattern, ragged red fibers
87
Neurofibromatosis Type I
Characteristics (5)
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
Neurofibomatois II
See?(5)
Auto Dom
```
bilateral/unilateral acoustic neuromas,
mtpl meningiomas,
cafe au lait spots
neurofibromas
cataracts
```
89
cognitive impairment,
epilepsy,
skin lesions(facial angiofibromas, adenoma sebaceum)
Retinal harmatomas, enal angiomyolipomas, heart rhabdo?
tuberous sclerosis
90
Capillary antimatoses of the pia matter
Classic facial vascular nevi - port-wine stain?
What are you treating normally
Sturge Weber syndrome
epilepsy (Treated)and mental retardation usually present
91
Cavernous hemangiomas of the brain/brainstem, renal angiomas and cysts
associated w/ 2 CAs
Von Hippel Lindau disease
Renal cell carcinoma and pheos
92
Syringomyelia
Associated w/?
Symptoms
Dx?
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
Brown Sequard syndrome (3 )
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
Transverse myelitis
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
Horner's syndrome
Cause and Triad
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
Poliomyolitis affects?
Features
anterior horn cells and motor neurons (Lower motor)
ASYMMETRIC muscel weakness(legs), Absent deep tendon, Flaccid, Atrophic muscles, NORMAL sensation
No Tx
97
Dizziness DDx
presyncope - lightheaded
Vertigo
Multisensory stimuli - vasovagal
Conditions associated - cerebellar disease, CV disease, TIAss, Hyperventilation, anxiety, panic attacks, phobis
98
Vertigo - 2 types
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
Types of peripheral vertigo (5)
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
Menieres disease -
Triad
Tx?
Vertigo
Tinnitus
hearing loss (perm)
hrs -days symptoms
Tx w/ Na restriction and Diuretics
101
Syncope vs siezure
syncope is temporary and bladder function maintained
102
Syncope DDx(6)
```
Siexure
Cardiac(arrythmia, obstruction, MI)
Vasovagal
Orthostatic hypotension
severe cerebrovascular disease
Other - metabolic(hypoglycemia, hyper vent), hypersensitivity, meds
```
103
Puts face hits the floor w/ syncope think of what etiology
Causes
Cardiac
arrythmias (sick sinus, V tach, AV block, SVT)
Obstructive - aortic stenosis, hypertophic cardiomyopathy, pulm HTN, atrial myxoma, prolapses Mitral valve, MI
104
Clues to vasovagal syncope
emotional stress, pain, fear, fatigue prior
pallor, diaphoesis, light headed, N, diminished vision
TILT TABLE study
105
Sever serebrovascular disease
rare case of syncope
| TIA involving vertebrobasilar circulation -> drop attacks
106
Evaluating syncope look for
Underlying heart disease - EKG**, maybe echo, hotter monitor,
107
Causes of Siezures 4Ms + 4Is
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
Types of seizures
| 2 groups w/ 2 types each
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
Partial seizures(simple and complex) may progress to generalized seizures called
secondary generalized
110
Tonic clonic seizure characterization
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
Absence seizure
Tx?
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
Tx for Partial seizures (simple/complex) and tonic clonic
phenytoin, carbamazepine first choice
also: phenobarbital, valproate, primidone
113
Known seizure disorder and presents w. seizure get what test?
Unclear? Tests
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
Status epilepticus
Tx?
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
Tx for absence seizures
ethosuximide and valproic acid
116
Pregancy and siezures
STOP anticonvulsents
~ alcohol
117
Amylotrophic Lateral Sclerosis
Hallmark lesion
Onset?
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
Features of ALS
```
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
Dx of ALS w/
Tx?
Clinical evidence
- EMG?
- 2 regions probable, 3-4 regions definite ALS
none, Riluzole delays death 305 months
120
Wernickes aphasia
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
brocas aphasia
Expressive nonfluent aphasia
Speech is slow and effortful
Short sentences w/limited grammar
Good comprehension -> frustration
122
Conduction aphasia
disturbance in repition
| pathology between wrenches and brocas
123
global aphasia
all areas of language - comprehension, speaking, reading, fluency)
R hemiparesis assoc
124
Bells Palsy?
Prognosis
Causes
hemofacial weakness along CN 7 2/2 swelling
good - 80% w/in wks -months
unknown cause, viral ? herpes simplex, URI precedes commonly**
125
Tx of Bells?
Usually none, can use steroids and acyclovir as necessary
NO steroids if Lymes suspected
126
Ddx of facial paralysis(7)
```
Trauma - temporal bone
Lyme
Tumor - acoustic neuroma, cholesteatoma
Gullan Barre - bilateral
Herpes zoster
Stroke - move eyebrows
Bells palsy - URI prior, no eyebrow
```
127
Trigeminal neuralgia
VERY PAINFUL
idiopathic
touch jaw, lips, gum maxillary
recurrent attacks, no paralysis
Clincal Dx
128
Tx of trigeminal neuralgia
carbamezpine
also baclofen, phenytoin
Surgical decompression
129
Lesion at cerebral cortex see:(2)
contralateral motor/sensory deficits + aphasia
Face, arms, run, maybe legs
130
Lesion at subcortical see?(1)
internal capsul, cerebral peduncles, thalamus, pons
hemiparesis is complete (face, arm, leg), neurons merge together
131
lesion at cerebellum see
incoordination, interion tremer, ataxia
132
lesion at the brainstem see
crossed hemiplegia - ipsilateral face and contralateral body
corticospinal tract, dorsal coloumns and spinothalamic tract cross, cranial nerves do NOT
133
Lesion of spinal cord see?
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
Plexus lesion see?
location
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
Roots lesion see?
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
Peripheral nerve lesion see?
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
neuromuscular juntion lesion see?
fatiguablity
muscles weak w/ use - no atrophy
138
Myopathy see?
acquired disease
symmetric weakness, w/ proximal muscles > distal
normal reflexes, sensation
NO fascinations
Atrophy w/ disuse slow (vs rapid in Motor neuron disease)
