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Neuro Flashcards

1
Q

Posterior cerebral artery supplies what? what is deficit do?

A

Visual cortex affected. 4 star

middle cerebral is brocas and stuff, and and the anterior supplies legs

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2
Q

AICA occlusion?

A

Facial paralysis, vertigo, nystagmus, deafness tinnitus. NO MOTOR OR LIGHT TOUCH DEFICIT

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3
Q

PICA occlusion?

A

Wallenberg. Contralateral body and ipsilateral loss of pain and temp on face. Ipsilateral cerebellar defects like ataxia and past pointing

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4
Q

Broca aphasia

A

Nonfluent aphasia. Can comprehend but can’t speak.

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5
Q

Wernicke aphasia

A

Can produce words but can’t understand

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6
Q

Conduction aphasia

A

Can’t repeat. no ifs and or buts

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7
Q

Dorsal columns carry leg and arm sensation where?

What about in the corticospinal?

A

Arms outside, legs inside, just like a person. (arms are outside of legs)

Legs are lateral, so it is opposite.

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8
Q

What is not fed blood supply from anterior spinal artery?

A

The dorsal columns

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9
Q

Amyotrophic lateral sclerosis affects what tracks?

A

corticospinal (UMN symptoms: spastic paralysis EVERYTHING IS UP(per) so up spasticity and reflex)

Anterior horn: LMN symptoms
so flaccid paralsis as well (because synapsed before getting to anterior horn)

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10
Q

Poliomyelitis affects where?

A

Polio means gray, so it affects gray matter (anterior horn)

Flaccid paralysis

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11
Q

Tabes dorsalis affects where? Useful test for it

A

DORSALis affects dorsal, so impaired proprioception and gait/balance problems

Romberg test. Vision eliminated and patient has poor proprioception and they will tip over

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12
Q

*** B12 deficiency affects what?

WORK ON THAT

A

Dorsal columns and corticospinal tract.

So spastic bilateral and vibe sense loss

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13
Q

Brown squared is what?

A

ipsilateral loss of vibration and discrimination

Ipsilateral loss of vibe and discrimin
Ipsilatral spastic paralysis, ipsilateral flaccid paralysis
contralateral loss of pain and temp below the lesion

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14
Q

Argyll robertson pupil?

A

Tertiary syphilis. Accommodates but nonreactive to light.

Also have tabes dorsalis.

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15
Q

What brain lesion causes hemiballismus?

A

Subthal nucleus. It is flailing of the limbs.

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16
Q

*** What lesion causes agraphia?

A

Dominant parietal lobe

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17
Q

What lesion causes hemispatial neglect?

A

Nondom parietal lobe

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18
Q

Where does dorsal column decussate?

A

Medulla

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19
Q

Latreal corticospinal tract crosses wehre?

A

medullary pyramids

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20
Q

Meningitis and purpura?

A

Think neisseria

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21
Q

*** Meningitis with gram positive rods and coccobacilli is what bug?

A

Listeria list of shapes

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22
Q

Small pleomorphic gram negative coccobacilli in meningitis is what?

A

H influ

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23
Q

CSF is different in fungal/tb than it is in bacterial meningitis how?

A

WBCs are lymphocytes in fungal/tb where in bacterial it is neut

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24
Q

*** CT before lumbar puncture is when?

A

Seizure or focal defects or papilledema

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25
*** What causes meningitis in less than a month old baby? What do you give?
E coli, GBS (always consider in sick kid) or listeria Give amp with cefotaxime or gent
26
*** Over age of 60 meningitis? or debilitating disease
S pneumo is one, then listeria, then N meaning then gram negative Treat empirically with Ampicillin (listeria coverage), vanc, cefotaxime/ceftriaxone GIVE IV DEXAMETHASONE
27
Longterm complicaitons of mening? How do you help prevent them
Hearing loss, seizure disorder, intellectual disability, spastic paralysis (especially in kids) DEXAMETHASONE
28
What causes viral meningitis?
enterovirus, so think echovirus, coxcaki, enterovirus. Herpes can sometimes
29
Tx of viral meningitis?
Tylenol pain, IV fluids, bacterial meningitis excluded, ACYCLOVIR if suspicion of HSV or focal findings
30
Encephalitis HP?
Malaise headache neck pain vomit (just like meningitis) BUT ALTERED Consciousness, or or change mental status or focal defects
31
What causes temporal lobe encephalitis?
Herpes
32
*** West nile can cause severe symptoms which include what? How do you dx? How do you treat?
Flaccid paralysis by anterior horn involvement. Alterations in consciousness (encephalitis) and possible death Dx serology for IgM Tx supportive
33
Reye sydnrome affects what? H and P?
Encephalitis brain and liver. Significant hypoglycemia Rash, vomit, elevated LFTs headache and lethargy From aspirin after viral illness
34
Brain abscess is caused by what? They are ring enhancing lesions on MRI! b/c cavitation
think about history. IF ear infection, s pneumo. If in hospital with neuro surg think staph
35
Treatment of abscess if from oral spread?
metronidazole with 3rd gen cep corticosteroids drainage
36
If from hematogenous spread or near procedure in brain abscess give what?abscess?
Give cef and vanc corticosteroids drainage
37
Poliomyelitis cause what symptoms? Dx?
Muscle weakness and flaccid paralysis b/c motor neurons (MAKES SENSE B/c remember atrophied leg) anterior horns Dx b/c antibody LP for viral meningitis Viral culture
38
Reye syndrome does what three things?
Hypoglycemia, liver and brain issues
39
*** Toxoplamosis is suspected if? Dx? Tx?
Encephalitis in HIV with CD4 less than 100. Positive Toxo IgG antibody Multiple ring enhancing lesions Tx with sulfadiazine, pyrimethamine
40
Tx of headaches Tension headache: Cluster Migraine
tension: NSAIDs usually, maybe triptans Cluster: 100% oxygen Migrain: triptan, ergots (they are both constrictors, be careful with symptoms and pregnancy!!! can't vasospasm preggers!
41
***Migraine prophylaxis
``` CCBs (verapamil) Beta blockers TCAs NSAIDs Antiseizure meedslike valproate ``` CONSIDER comorbiditis
42
***Tx of psuedotumor cerebra?
Confirm with LP and rule out others with CT/MRI D/c vitamine A, TCAs Weight loss ACETAZOLAMIDE Invasive option: serial lumbar punction, shunting
43
**** Headache with extra ocular muscle palsy?
Cavernous sinus thrombosis, REMEMBER THE NERVES RUN THROUGH IT
44
Bilateral trigeminal neuralgia? How do you treat if not due to the pathology?
MS tx anticonvulsants FIRST LINE is carbamazapine
45
Lacunar TIA?
occlusion of small arteries from middle cerebral to deep part of the brain
46
TIA prompts what tests?
CT (faster for bleeding) or MRI (better for infarct), US of carotid, Echo for embolus eval, MRI or CT angiogram Patent foramen or heart aneurysm
47
Tx of TIA?
Antiplatelet, antilipid, anti htns Antiplatelet: Clop or aspirin and dypyridamole Antilpid: high statin in all patients BP if over 140/90 Embolic: warfarin (Need bridge as following) and HEPARIN or dabigatran, rivaroxaban or apixaban
48
What is dabigatran?
one of the embolic therapies to bridge with warfarin
49
Carotid endarterectomy indications?
Symptomatic patients with narrowing of 70-99%, no need if 100% b/c compensated Symptomatic men 50-70% Asymptomatic if 80 or more and surgeon is experienced and life is expected 5+ years
50
*** basilar artery occlusions cause what symptoms?
contralateral weakness. If complete occlusion, you get hemiparesis and vertigo
51
Lacunar arteries lesions
Variety of symptoms, focal or motor sensory deficits. They are affecting just one side of the body. ABSENT CORTICAL SIGNS
52
Stroke contraindications for alteplase?
More than 4.5 hours old. Recent hemorrhage or surgery, hypertensive urgency
53
What length of time is required for thrombolytics?
4.5 for systemic, if you can do it localized, you have up to 6 hours but need a specialist
54
Other meds for strokes? Acute vs long term? Read last line of this
Aspirin ASAP unless thrombolytis, then you wait 24 hours Long term prevention of clop or aspirin and dyspyrdamole High statins in all patients Don't treat hypertension acutely unless 220/120 or if have CAD
55
Hemorrhagic brain bleeds keep BP at what? What else do you do?
``` less than 200 Mannitol Hyperventilation: PaCO2 of 25 Surgical decompression if necessary Elevate bed ```
56
First line treatment for trigeminal neuralgia?
Carbamazapine
57
Two syndromes associated with berry aneurysms?
Ehler danlos and ADPKD
58
Subarachnoid dx?
CT scan and if negative, getLumbar Puncture. Blood or yellow! Cell count of first and last in lumbar puncture to make sure it is not from traumatic puncture!
59
*** Meds to lower BP in subarachnoid? What is bp goal?
Goal is below 150 if cognitive function intact. Labetalol is used, no nitros b/c they increase ICP Nimodipine can be used Tx is surgical clipping or coil
60
Do you give phenytoin if subarachnoid hemorrhage?
no!
61
Parenchymal hemorrhage is hemorrhagic stroke. BUT NOT SUBARACHNOID HEMORRHAGE! What is CT finding?
Focal motor or sensory deficits, headache, seizures, LOOK FOR CT for BRIGHT COLOR
62
Adult with new seizure? What caused it?
Idiopathic, metabolic like hyponatremia or hypoglycemia, drugs, drug withdrawal, trauma, neoplasm
63
*** Famous adult infections causing seizures?
Toxoplasmosis, neurocysticercosis, HSV
64
What do you give to patients getting isoniazid?
B6 b/c it gets absorbed and could get seizures!
65
Big time drugs causing med induced seizure?
Theophyline, Bupropion, narcotics, Psychostim, phenycyclidine (PCP), antipsych, antibiotics,
66
*** Partial seizure is what? What part of brain affected?
Only in part of the brain. Preceded by aura like burning tires Temporal affected
67
Simple partial vs complex?
Simple does not lose consciousness, but have purposeless movements or parenthesis Complex partial: hallucinations POST ICTAL STATE! temporal lobe
68
Petite mal EEG finding?
Aka absence seizures Three cycle per second spike wave pattern. no post octal state
69
Tx for status epilepticus How do you prevent recurrence in acute setting?
ABCs IV/IM benzo IV barb if no working Phenytoin to prevent recurrance
70
*** Phenytoin side effects
Phenytoin Has Given MDs Frustration ``` Peripheral neropathy Hirsutism GINGIVAL HYPERPLASIa metabolic anemia from folate absorption issue Drug induced Lupus Steven Johnson Fetal hydantoin ```
71
fetal hydantoin syndrom is what?
Cleft lip, palate, congee heart disease, developmental delay
72
*** Stephens johnson drugs?
Seizure drugs including lamotrigine, SULFAs and PENICILLINS and ALLOPURINOL
73
Drugs that cause agranulocytosis?
``` C drugs Carbamazepine Clozapine Colchicine PTU and methimazole ```
74
What are two big side effects to remember for valproic aid and carbamazepine?
Hepatotoxic and spina bifida
75
Cyp p450 inducers?
Coronas Guiness and PBRs induce chronic alcoholism ``` Carbamazepine Griseofulvan Phenytoin Barbiturates Rifampin St. Johns Wart ```

DIT Step 2 (77 decks)

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