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PANCE > Neuro > Flashcards

Neuro Flashcards

1
Q

New unexplained migraine in female > or = 40 years old =

A

think patent foemen ovale

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2
Q

Migraine prophylaxis

A
  • Beta blockers (best)
  • CCB
  • TCA
  • AED
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3
Q

Migraine abortives

A

-Ergotamine tartrate/caffeine
(avoid in pregnancy and cardiovasc dz)
-Sumatriptan
(contra = coronary/peripheral vascular dz)

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4
Q

When are imaging studies indicated for concussion?

A

-loss of consciousness
-evidence of skull fracture
-focal neuro deficits
-cervical spine injury
(CT of brain WITHOUT contrast = tx of choice)

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5
Q

Tx of concussion

A

Complete cognitive and physical rest

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6
Q

About post concussive headache

A
  • appears w/in a day or so
  • may worsen over time
  • disequilibrium, poor concentration, impaired memory, increased irritability, emotional lability (may last for months)
  • Tx: simple analgesics, amitriptyline, propranolol, ergot derivatives
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7
Q

Jacksonian March

A

Starts as a tremble in one limb and moves to other parts of body

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8
Q

About Absence Seizures

A

-misses words in conversation
-brief impairment (<20sec)
impaired consciousness = blank stare
-starts in childhood
(Petit mal)

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9
Q

About Tonic-Clonic Seizures

A

Tonic is <1min

  • rigid, falls to the ground
  • *respiration is arrested

Clonic ~2-3min

  • lips or tongue bitten, urinary or fecal incontinence
  • flaccid coma, then consciousness, then sleep
  • sluggish postictal for min-hrs
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10
Q

How does status epilepticus cause harm?

A

-permanent brain damage secondary to hyperthermia, circulatory collapse, or excitotoxic neuronal damage

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11
Q

Tx of SE

A
  • ABCs
  • manage hyperthermia
  • break seizure w/ lorazepam or diazepam
  • give phenytoin to prevent further seizures
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12
Q

Valproic Acid SE

A

Teratogenic

blood monitoring

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13
Q

Phenobarbital SE

A

blood monitoring

effects cognition

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14
Q

Lamotrigine SE

A

skin rash

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15
Q

Topirimate SE

A

weight loss

affects cognition

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16
Q

Oxcarbazepine SE

A

hyponatremia

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17
Q

Most common type of stroke

A

85% = ischemic
15% = hemorrhagic
(A.A. have higher mortality than other ethnicities)

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18
Q

Ischemic Stroke-Thrombic

A

50-60% are thrombic

  • occurs during sleep, present upon awakening
  • *occur over time**
  • more progressive, worsens over several hours
  • often have TIA prodrome
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19
Q

Ischemic Stroke-Embolic

A 
10-20% are embolic
-cardiac or atherothrombic
-occurs at anytime, progresses rapidly
**suden**
RF: afib, dilated cardiomyopathy, MI in previous 4-6wks
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20
Q

Anterior circulation =

A

Carotid Arteries

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21
Q

Posterior circulation =

A

Vertebral arteries

Basilar arteries

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22
Q

Carotid Artery occlusion =

A

contralateral body weakness

  • visual loss: amaurosis fugax (lamp shade over eye); gaze deviation toward infarcted hemisphere
  • numbness or parasthesias
  • lethargy, stupor
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23
Q

Anterior Cerebral Artery Occlusion

A
  • contralateral paralysis leg > arm
  • contralateral sensory loss leg > arm
  • apraxic gait
  • absent spontaneity, lack of initiative
  • lack of concern that something is wrong
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24
Q

Middle Cerebral Artery Occlusion

A

-contralateral motor and sensory loss
-cortical function loss:
Dominant hemisphere = aphasia, agarphia, aclaculia, alexia
Nondominant = neglect, apraxia, confusion
-gaze deviation toward infarcted hemisphere
-contralateral hemiplegia Arm > Leg
Homonymous Hemianopsia

25
Q

tPA indications

A
  • w/in 4.5hrs of symptom onset
  • 18years of age
  • not pregnant
  • significant neuro deficit, repeated exam
  • no improvement on repeated exam, no seizure activity at onset, no recent arterial puncture or LP
26
Q

Contraindications to thrombolytics

A
  • BP >185/110
  • recent surgery
  • recent hemorrhage
  • admin of anticoagulants
  • arterial puncture at non-compressible site
  • internal bleeding
  • Hx ICH or suspicion of SAH
  • platelets <100,000
  • head trauma, period stroke, cranial surgery
27
Q

Tx of TIAs

A
  • long term modification of risk factors

- surgery for focal carotid stenosis (70-98%)

28
Q

About Hemorrhagic Strokes

A
  • 15% of all strokes
  • 10% = ICH RF: HTN
  • 5% = SAH = aneurysm rupture RF: smoking
29
Q

Subdural Hematomas

A

Concave lesions on brain CT
-bleed btwn dura and arachnoid membranes
-presentation = headache or confusion
Tx: supportive care, monitor w/ CT, surgery in severe

30
Q

Epidural Hematomas

A

Convex lesions on brain CT

Tx: supportive care, monitor w/ CT, surgery in severe

31
Q

Essential Tremor

A

-cause unknown or may be autosomal dominant

=intention tremor

32
Q

Tx of essential tremor

A
  • propranolol
  • primidone
  • alprazolam
  • topirimate
  • gabapentin
  • or surgery (thalamotomy, deep brain stimulator)
33
Q

Parkinson’s Dz

A

-tremor at rest
-rigidity
-bardykinesia
-progressive postural instablity
(dementia and depression are very common)

34
Q

First line tx of parkinsons

A

Dopaminergics

-Levodopa w/ carbidopa

35
Q

Second line tx of parkinsons

A

Anticholinergics
-benztropine
-Amantadine
(helpful in early, mild parkinsonism; reduces dyskinesias due to chronic levodopa therapy)

36
Q

Other Meds for tx of parkinsons

A

COMT inhibitors (stop break down of levodopa)
-entacapone
-tolcapone
Dopamine agonists (activate dopamine receptors in basal ganglia)
-bromocriptine
-pergolide
MAOB Inhibitors (inhibits breakdown of domain in the brain)
-selegiline

37
Q

About Huntington’s Dz

A
  • Autosomal dominant
  • 100% penetrance
  • Chromosome 4
  • insidiously after 30y/o
  • suicide is very common (psychosis then suicide, then chorea)
38
Q

CT/MRI in Huntington’s Dz

A

Cerebral atrophy

39
Q

Myasthenia Gravis

A

Autoimmune disorder

  • PURE MOTOR SYNDROME
  • blockage of transmission at Ach receptors
  • young females > males @ 20-40y/o
  • worsens in evenings
  • especially in extra ocular, pharyngeal, facial
40
Q

How to test for Myasthenia Gravis

A

-Ach receptor antibody assays for elevated levels

41
Q

Tx of Myasthenia Gravis

A
  • Anticholinesterase therapy (pyridostigmine bromide; neostigmine)
  • Steroids
  • Thymectomy (b/c 10% have thymoma cancer)
42
Q

Guillian Barre Syndrome

A
  • destruction of myelin and or axon by ganglioside antibodies
  • ascending paralysis
  • distal to central
  • *associated w/ campylobacter jejuni**
  • viral URI
  • diarrhea illness (campylobacter)
  • surgery
  • immunization
  • malignancies (lyphoma, leukemia)
43
Q

Guillian Barre Syndrome workup

A 
LP
-albuminocytologic dissociation
-increased protein >45
-pleocytosis, WBC normal
Electrophysiology
-marked slowing of conduction
44
Q

Guillian Barre Tx

A

Symptomatic, immunosuppressive, supportive tx

45
Q

MS

A
  • inflammatory process
  • Multifocal demyelination of the white matter of the brain and spinal cord
  • relapsing-remitting pattern w/ chronic progressive course
46
Q

Presentation of MS

A
  • blurred, double vision in a single eye
  • ataxia
  • babinski sign
  • new neuro symptoms in a young person key pres
47
Q

MS on MR/CT

A 
MRI = Dawson's fingers
CT = plaques
48
Q

MS CSF

A
  • increased IgG levels
  • increased lymphocytes
  • oligoclonal bands
  • myelin basic protein may be elevated
  • glucose is usually normal
49
Q

Tx of MS

A
  • Corticosteroids for acute attacks
  • to reduce freq and relapses = Interferon, IV gamma globulins
  • regular exercise
50
Q

RF for Alzheimer’s Dz

A

Advancing age, family history, head trauma

also possibly: HTN, hyperlipidemia, smoking, DM

51
Q

Diagnosis of AD

A
  • functional impairment
  • MRI to evaluate for vascular dz
  • brain biopsy = gold standard (post-mortem = neurfibrillary tangles, beta-amyloid plaques)
52
Q

Tx of AD

A 
Acetylcholinesterase inhibitors (donepezil, rivastigmine, glantamine)
NMDA antagonist (memantine)
53
Q

Bell Palsy

A

U/L paralysis or weakness of facial muscles supplied by CN 7w/o evidence of neuro dz or apparent cause
U/L total or partial paralysis of facial muscles

54
Q

Bell Palsy can be associated w/

A
  • reactivation of HSV or Varicella Zoster
  • Viral infection
  • Lyme Dz
  • Cancer
  • DM
  • Pregnancy
  • Other
55
Q

Tx of Bell Palsy

A
  • most resolve spontaneously

- oral prednisone w/ acyclovir

56
Q

Diabetic Peripheral Neuropathy

A

Occurs secondary to vascular insufficiency, nerve infarct; associated w/ hyperglycemia

  • stocking and glove distribution
  • rule out other causes of polyneuropathy
57
Q

Other causes of polyneuropathy

A
  • uremia
  • ETOH and nutritional deficits
  • connective tissue deficits
  • vasculitis
  • vitamin b12 deficiency
  • hypothyroidism
  • amyloidosis
58
Q

Tx of diabetic neuropathy

A
  • tight control of serum glucose
  • TCA (amitriptyline, nortriptyline)
  • AED (carbamazepine, gabapentin)
  • Aggressive Mgmnt (lidocaine patch, tramadol)

PANCE (18 decks)

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