Neuro Flashcards
MCC of SAH
rupture of berry aneurysm
MC location for berry aneurysm
Middle Cerebral artery
Give this stroke location:
Major deficit is in the LLE w/ minimal LUE involvement and no involvement of the face
R anterior cerebral artery
Name the location for this stroke:
Pt presents with diplopia, CNS dysfxn, ataxia, vertigo, & BL motor & sensory changes
Vertebrobasilar artery
Give this stroke location:
Pure motor stroke on the CONTRALATERAL side of the lesion, pure sensory stroke CONTRALATERAL to the lesion, & clumsy-hand dysarthria
Lacunar stroke
Patient cannot identify friends and family around them
agnosia
patient loses the ability to perform basic math fxns
Acalcula
What type of memory loss is most pronounced in a pt w/ Alzheimer’s dz?
recent memory
What type of protein deposits occur in the brain of a pt w/ Alzheimer’s dz?
beta amyloid deposits
MC ophthalmologic problem that is seen w/ MS
optic neuritis
What is the underlying infxn in a pt w/ Ramsay Hunt Syndrome?
Herpes zoster
Paralysis or weakness of the muscles supplied by the FACIAL N., typically occurs UNILATERALLY, & is due to inflammation & swelling of the facial n.
Bell’s palsy
What autoimmune dz has a destruction of myelin & or axons by anti-ganglioside Abs?
Guillain-Barre Syndrome (GBS)
What is the most frequent cause of peripheral neuropathy in the developed world?
DM
Dz assoc. w/ ptosis, diplopia, dysphonia, PROXIMAL LIMB WEAKNESS, DYSPHAGIA, & respiratory weakness
Myasthenia gravis
What reflex is initially affected by the polyneuropathy in DM?
Achilles
This is a demyelinating dz of PERIPHERAL NERVES that causes an acute progressive weakens, usu as an ASCENDING PARALYSIS
Guillain-Barre Syndrome (GBS)
This is a disorder of NEUROMUSCULAR JXN resulting in pure motor sx w/ WEAKNESS & FATIGUE
Myasthenia Gravis
What condition does the following medications tx: Zomig, Amerge, Maxalt, Frova, & Relpax?
Migraine HA (these are ALL triptans)
Type of HA that is severe, UNILATERAL, & located in the periorbital area & temple that is assoc. w/ IPSILATERAL LACRIMATION, rhinorrhea, ptosis, miosis, & nasal congestion
Cluster HA
W/o medication, the MC way a migraine HA’s pain is terminated…
sleep
3 hormones that are thought to result in migraine HAs
- serotonin (biggest role)
- dopamine
- NE
2 foods known to cause migraine HA
- Aged cheese
2. wine
This type of HA is MCly described as dull, pressing, or BAND-LIKE that occurs upon arising or shortly thereafter
Tension HA
Category of medication that triptans occur
5HT-1 agonists (serotonin agonists)
This HA has pain in the OCCIPITO-FRONTAL areas of the heal along w/ tenderness of the neck & scalp muscles
Tension HA
What psychiatric condition is commonly present in those w/ daily HA or tension HA?
depression
MCC of endemic encephalitis that is related to a virus
HSV 1 & 2
MC enterovirus causing encephalitis
Coxsackie B
Medication of choice for treating HSV encephalitis
Acyclovir IV
2 MCCs of neonatal bacterial meningitis
- Grp B & D strep
2. E coli
2 MCCs of adult onset bacteral meningitis
- Strep. pneumoniae
2. H. influenzae
What is the ONLY neurodegenerative dz that is treatable long-term?
Parkinson’s dz
Abx TOC for bacterial meningitis in those 0-4 wks of age
Ampicillin + 3rd gen cephalosporin (ex. Rocephin)
This condition involves an involuntary repetitive contraction of agonist & antagonist muscles producing rhythmic oscillation around a joint at a regular frequency
Tremor
MC condition resulting in a resting tremor
Parkinson’s dz
TOC for MS
Immunomodulating meds such as INTERFERON
What MAO B inhibitor is MCly used in the mgmt of Parkinson’s Dz?
Selegine (Eldeprel)
-reversible w/ d/c of tx
The medication Tolcapone use in the mgmt of Parkinson’s dz belongs to what class?
COMT inhibitor (catechol-o-methyl transferase) - it reduces peripheral metabolism of levodopa permitting increased brain concentration of levodopa
The agents Pramipexole & Ropinirole use in the tx of Parkinson’s dz & RLS belong to what classification?
Dopamine agonists
Sinemet is a combination of:
levodopa & carbidopa
Anticholinergics used in the tx of Parkinson’s dz have their best activity against what Parkinson’s sxs?
tremor & rigidity
This is an inherited dz characterized by DEMENTIA & CHOREA that has a gradual onset & SLOW PROGRESSION
Huntington’s dz
Medication of choice used for dyskinesia &/or behavioral problems due to Huntington’s dz?
Haloperidol (Haldol)
This is a recurrent, inflammatory progressive DEMYELINATION OF WHITE MATTER of the brain & spinal cord resulting in multiple & varied neurologic s/sx
Multiple Sclerosis (MS)
What imaging technique is considered to the the gold standard for identifying MS?
Gadolineum enhanced MRI
Radiofrequency rhizotomy is used for what condition?
Trigeminal neuralgia
Drug TOC for relapsing MS
Beta interferon, Copolymer (Copaxone)
TRANSIENT DISTURBANCE of cerebral fxn due to PAROXYSMAL DISCHARGE in the brain
seizure
3 types of generalized seizures
- Absence (petit mal)
- Myoclonic
- Tonic-clonic (grand mal)
2 types of partial seizures
- simple
2. complex
Type of seizure that is MCly assoc. w/ automatisms
Complex partial seizures
Name this seizure:
Pt. has impaired consciousness, sometimes w/ mild, clonic, tonic, or atonic components such as reduction or loss of postural tone
Absence (petit mal)
Abrupt onset of HA assoc. w/ STIFF NECK & PHOTOPHOBIA & may have the development of focal neurologic deficits is usu due to
Cerebral aneurysm
Gold standard diagnostic study for evaluation of a cerebral aneurysm
cerebral angiogram
Imaging modality of choice used in the evaluation of a cerebral aneurysm
non-contrast CT
What is the biggest risk factor for TIAs affecting the small, deep vessels of the brain (lacunar strokes)?
HTN
Name the 3 most important PE findings that are most specific to stroke syndromes
- Facial paralysis
- Arm drift
- AMS
What biochemical markers may be found in a pt who has an intracranial hemorrhage?
Matrix metalloproteinases (MMP) & cellular fibronectin - both are elevated in hemorrhage
3 MCCs of death in the US
- CAD
- cancer
- stroke
Name the condition with the following assoc. sx:
sudden weakness or numbness one one side of the face or body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one eye; sudden trouble w/ walking, dizziness, loss of balance or coordination; & sudden severe HA w/o cause
stroke
DOC for trigeminal neuralgia
Oxycarbazepine (Trileptal)
2 main causes of hemorrhagic stroke
- intracerebral hemorrhage
2. subarachnoid hemorrhage
Imaging study of choice in the initial evaluation of a pt suspected of having a stroke
non-contrast CT
Time frame in which thrombolytics can be given to a pt w/ an ischemic stroke
w/in 3 hrs of sx
What medication is considered to be the first-line agent to reduce stroke recurrence in pts who have prvious cardiac dz
Aggrenox (combination of dypridamole & Aspirin)
preferred agent of choice for stroke prevention in a pt who is at high risk for a stroke & who has a-fib
warfarin (coumadin)
2 non-antiplatelet medication classes that have been used as modifying risk factors for stroke
statins & ACE inhibitors combined w/ diuretics
sudden loss of muscle strength/tone w/ sudden LOC, immediate recovery after lasting only a few seconds
Atonic seizures
spike & wave pattern on EEG at 3 per second is classically seen w/ what type of seizure?
Absence seizure
Gold standard tx for pts w/ myoclonic seizures
Valproic acid (Depakote)
Type of seizure that is MCly assoc. w/ automatisms
complex partial seizures
part of the brain that is MCly assoc. w/ atonic seizures
Corpus callosum
MCC of status epilepticus
abrupt stoppage of antiepileptic medications
1st line antiepileptic medication (after the use of the fast-acting benzodiazepines) for pts with status epilepticus
Fosphenytoin (Cerebyx)
Muscular complication from status epilepticus
Rhabdomyolysis
coordinated, involuntary movements during a period of altered awareness that occurs during a seizure
automatism
What is the name of the condition in which there is temporary paralysis following a general seizure?
Todd’s paralysis
What type of seizure disorder is MCly assoc w/ aura?
complex partial seizures
What type of seizure is assoc. w/ an ABRUPT ONSET, abrupt termination, lasts several seconds, & DOES NOT have a post-ictal state?
Absence seizures
Name 2 1st-line therapies for partial seizures
Carbamazepine (Tegretol) * Valproic acid (Depakote)
Phenobarbital used in kids
What organ is MCly damaged in pts taking carbamazepine (Tegretol) & valproate (Depakote)?
liver
What SE is typically seen w/ topiramate (Topamax) that is not seen w/ other anti-seizure medications?
weight loss
Pt has nocturnal seizure, with UNILATERAL paresthesias of the tongue, lips, & cheeks, w/ UNILATERAL clonic or tonic activity of the face, lips or tongue & there is speech arrest & salivation. Name the condition.
Benign Rolandic Epilepsy
What anesthetic agent is MCly used in the mgmt of status epilepticus?
Midazolam (Versed)
What is the MC neurobehavioral disorder of childhood?
ADHD
2 hormones assoc. w/ the development of ADHD
- dopamine
2. NE
What is the MC type of ADHD?
Combined (inattentive & hyperactive/impulse control)
Familial hemiplegic migraine has a genetic abnormality in what part of the brain?
Calcium channel
What category of medications does methylphenidate (Ritalin) belong?
stimulant
What is the MCC of episodic, disabling HA?
migraine
What is the ONLY FDA-approved medication for Adult ADHD?
strattera (atomoxetine)
Category of medication for atomoxetine (Strattera)
NE reuptake inhibitor
What is the typical presentation for an Arnold-Chiari lesion?
HAs
What neurologic motor problem may get worse w/ the use of stimulants in order to tx ADHD?
Tics
This type of HA presents acutely and the pt claims this is the worst HA of their life:
SAH due to ruptured aneurysm
phenomena seen w/ migraine HA that presents as sensitivity of the scalp when touched
cutaneous allodynia
What antiseizure medication is FDA approved for migraine prophylaxis?
Topamax (topiramate)
desire to move the legs that may abe assoc. w/ paresthesias w/ these sxs becoming overwhelming. These sensations occur when pt is inactive and this is relieved w/ moving the legs. These sxs are worse at night or in the evening. What is this condition?
Restless Leg Syndrome (RLS)
What hormone is used in the tx of RLS?
dopamine agonists (Sinemet MC used)
- Requip (Ropinirole), Mirapex (pramipexole) are also
used
What part of the trigeminal nerve is MCly involved w/ trigeminal neuralgia?
V2 - Maxillary Segment
What neurological condition is MCly seen w/ trigeminal neuralgia?
MS
MCC of dementia
Alzheimer’s dz
Pt presents with mental status changes, ataxia, and urinary incontinence, name the condition
Normal pressure hydrocephalus
pt’s are “wacky, wet, & wobbly”
What class of meds is considered 1st-line therapy for Alzheimer’s dz?
Acetylcholinesterase inhibitors (ex. donepezil [Aricept])
What type of dementia is helped by performing ventriculoperitoneal shunts?
Normal pressure hydrocephalus
What type of IRREVERSIBLE dementia is typified by having ht pt maintain a fluent speech but there is NO comprehension of written or verbal language?
Wernicke’s aphasia
What is the most effective therapy for pain & spasm in an MS pt?
Baclofen or Tizanidine (Zanaflex)
Name this condition: pts have a non-progressive disorder of movement or posture that is a result of CNS abnormality that could have occurred prenatally, perinatally, or during the 1st 3 yrs of life
cerebral palsy
MCC of floppy baby syndrome
Cerebral palsy
Injury to the long thoracic nerve presents as
winged scapula
What never innervates the serratus anterior muscle
long thoracic nerve
What is the clinical manifestation of an injury to the radial nerve?
wrist drop
MC form of idiopathic facial paralysis?
Bell’s palsy
A pt has a FLAT nasolabial fold, CANNOT close the eye, & CANNOT WRINKLE the FOREHEAD or raise the eyebrows. There are VESICLES IN THE EAR CANAL. What is this condition?
Ramsey Hunt Syndrome
MCC of Ramsey Hunt Syndrome
herpes virus infxn
What condition has hemisection of the spinal cord that causes loss of joint position sense & vibraiton sense on the same side as the lesion & pain & temperature on the opposite side a few levels below the lesion?
Brown-Sequard Syndrome
What is the typical pattern of sensory loss for a pt w/ a posterior column loss?
loss of joint position sense & vibration sense
Pt is able to recognize all sensation but localizes them poorly, has loss of 2-point discrimination, astereognosis, and sensory inattention. What area of the brain is damaged?
parietal lobe
MCC of acute flaccid paralysis in the world
GBS
MCC of acute GBS
Campylobacter jejuni
2 MCly utilized tx for GBS
- plasmapheresis
2. infusions of high doses of human immunoglobulin
What disorder is assoc. w/ autoAbs to ACETYLCHOLINE receptor?
Myasthenia gravis
TOC for acute cluster HAs
high flow 100% O2 along w/ ergotamine or sumatriptan
What prophylactic regimen can be given for the prevention of cluster HAs?
CCBs
Young obese premonpausal woman presents with HA, diplopia, & peripheral visual field defect. Name the condition
Pseudotumor cerebri
What rheumatic condition may be associated w/ temporal arteritis?
polymyalgia rheumatica
What is the confirmatory test for temporal arteritis?
temporal artery bx
What clinical condition is classically described as having a wing-beating tremor?
Wilson’s dz
What condition has loss of dopamine-producing neurons in the substantia nigra portion of the brain?
Parkinson’s dz
phenomena by which MS sxs get worse w/ an increase in temperature
Uhthoff’s phenomenon
MC subtype of MS
relapsing remitting MS
stroke that affects the CONTRALATERAL ARM & FACE more than leg weakness, have CONTRALATERAL hemisensory dysfxn, & have paresis of CONTRALATERAL conjugate voluntary gaze & speech is typically NOT affected; which artery is involved?
Middle cerebral artery
stroke that has deficits on the CONTRALATERAL leg, incontinence, & difficulty w/ stereognosis; which artery is involved?
Anterior cerebral artery
TOC for a pt who surives his/her first SAH?
surgical clipping of the involved blood vessel
MCC of epilepsy
idiopathic
What is the best neuroimaging test to perform in a pt who just had a seizure?
MRI of the brain
What medications are typically used in the mgmt of absence seizures?
ethosuximide (Zarontin) & valproic acid
Medication of choice for myoclonic seizures
Valproic acid
TOC for partial seizures
carbamazepine & phenytoin
What is the primary drug of 1st choice used in the mgmt of generalized tonic-clonic seizures?
valproic acid
What antiepileptic medication MCly causes gingival hyperplasia?
phenytoin (Dilantin)
How long must seizures last in order to be classified as status epilepticus?
at least 30 min
What is considered to be the medication of choice for status epilepticus?
lorazepam
What are the various dermatome levels and the sensory nerves that innervate them?
C2 - neck T4 - nipples T10 - umbilicus L2 - lateral thigh L3 - medial thigh/knee L4 - medial calf L5 - lateral calf down over big toe S1 - lateral foot, heal, & back of calf
What sensory nerves supply the various reflexes?
C5 - biceps C6 - brachioradialis C7 - triceps L2-4 - patellar S1 - Achilles
What is the key to making the clinical diagnosis of Alzheimer’s dz?
mental status exam
What is the primary dx for an infant who is slow to reach developmental milestones such as learning to walk, roll over, sit, & crawl?
cerebral palsy
patient presents with intermittent paresthesias in the palmar aspect of the thumb, middle, & index fingers, diminished grip strength & diminished sharp-dull discrimination in the affected digits. Name the condition.
Carpal tunnel syndrome
What nerve is involved w/ Carpal Tunnel Syndrome?
Median nerve
What is the classic triad of meningitis?
- fever
- HA
- nuchal rigidity
intention tremors that occur only during movement
cerebellar tremor
action tremors that primarily affect the upper arms & may also involve the face & vocal cords. The tremor persists throughout the active ROM & increases w/ fine motor activity and stress.
essential tremor
What is the tx of essential tremor?
propranolol (Inderal)
- can also be suppressed by alcohol
Pt presents with a resting tremor that does not affect the head along w/ bradykinesia. When walking, these pts will have a shuffling gait & loss of arm movements w/ postural instability
Parkinson’s dz
MC precipitant of cluster HAs
alcohol use
Type of HA that is assoc w/ sentinel bleed
Subarachnoid bleed
HA type that is MCly assoc w/ jaw claudication
temporal arteritis
Procedure that must be done if subarachnoid HA is suspected & CT scan is negative for bleed
Lumbar puncture - will see gross bleeding or xanthrochromia
TOC for temporal arteritis
high dose, long-term corticosteroids
A 32-yo female pt presents w/ diplopia & ptosis, which are both worse by the end of the day. She also notes dysarthria if she has been talking a lot. What dx test is indicated for the evaluation of this pt?
edrophonium or Tensilon test
A 32-yo female pt presents w/ diplopia & ptosis, which are both worse by the end of the day. She also notes dysarthria if she has been talking a lot. What dx test is indicated for the evaluation of this pt?
edrophonium or Tensilon test
What is the TOC for myasthenia gravis?
pyridostigmine (Mestinon)
A 56-yo man presents w/ a mild-mod. dull HA that has steadily progressed over the past mth. The HA is worse when he gets up in the morning or w/ coughing & sneezing. He also notes the recent onset of N/V. Dx?
intracranial tumor
A 56-yo man presents w/ a mild-mod. dull HA that has steadily progressed over the past mth. The HA is worse when he gets up in the morning or w/ coughing & sneezing. He also notes the recent onset of N/V. Dx?
intracranial tumor
67-yo F complains of intermittent episodes of pain in her cheek & jaw that feel like a “lightning bolt hit her face”. The pain is triggered by eating or touching her face. Her PE is negative. What is the dx?
Trigeminal neuralgia
MCC of meningitis in pts w/ AIDs?
Cryptococcus neoformans
MCC of meningitis in pts w/ AIDs?
Cryptococcus neoformans
Which pathogen assoc. w/ bacterial meningitis presents w/ a petechial & purpuric rash?
Neisseria meningitidis
What are the CSF findings in bacterial meningitis?
- Elevated WBC (>1000 cells/mm3)
- Decreased CSF glucose (200 mg/dL)
What is the recommended Abx tx for an 18 yo pt w/ bacterial meningitis?
3rd gen. cephalosporin & vancomycin
What is the recommended Abx tx for a 60-yo adult w/ bacterial meningitis?
Ampillicin + 3rd gen. cephalosporin + vanc.
What is the recommended Abx tx for a 60-yo adult w/ bacterial meningitis?
Ampillicin + 3rd gen. cephalosporin + vanc.
Chronic & often lifelong syndrome consisting of motor &/or verbal tics
Tourette syndrome
1st line tx for severe Tourette syndrome?
Clonidine
The inability to perform rapid alternating movements
dysdiadochokinesias
A pt w/ MS describes an electric shocklike sensation that runs down her back to her legs when she flexes her neck fwd. What is this phenomenon called?
Lhermitte sign
A pt w/ MS describes an electric shocklike sensation that runs down her back to her legs when she flexes her neck fwd. What is this phenomenon called?
Lhermitte sign
What are the findings on exam of the CSF for a pt w/ MS?
Mild pleocytosis & the presence of oligoclonal bands
What is the TOC for an acute exacerbation of MS?
corticosteroids
What is the MCC of seizures in infants & children?
Febrile seizures
MCC of seizures in adults older than 65 yrs:
Cerebrovascular dz
A pt initially experience clonic movements of the hand, which then spread to involve the forearm & upper arm. What is this phenomenon called?
Jacksonian march
A pt initially experience clonic movements of the hand, which then spread to involve the forearm & upper arm. What is this phenomenon called?
Jacksonian march
A pt presents w/ the loss of vision in the L eye, which he describes as “someone pulling a shade down over his eye”. The episode resolved spontaneously w/in 30 min. What is this neurological sx called?
Amaurosis fugax
A pt presents w/ the acute onset of quadriplegia. He is able to communicate only by blinking or moving his eyes up & down. What is the most likely dx?
Locked-in syndrome
-consistent w/ a pontine stroke