Neuro Flashcards
Posterior cerebral artery supplies what? what is deficit do?
Visual cortex affected. 4 star
middle cerebral is brocas and stuff, and and the anterior supplies legs
AICA occlusion?
Facial paralysis, vertigo, nystagmus, deafness tinnitus. NO MOTOR OR LIGHT TOUCH DEFICIT
PICA occlusion?
Wallenberg. Contralateral body and ipsilateral loss of pain and temp on face. Ipsilateral cerebellar defects like ataxia and past pointing
Broca aphasia
Nonfluent aphasia. Can comprehend but can’t speak.
Wernicke aphasia
Can produce words but can’t understand
Conduction aphasia
Can’t repeat. no ifs and or buts
Dorsal columns carry leg and arm sensation where?
What about in the corticospinal?
Arms outside, legs inside, just like a person. (arms are outside of legs)
Legs are lateral, so it is opposite.
What is not fed blood supply from anterior spinal artery?
The dorsal columns
Amyotrophic lateral sclerosis affects what tracks?
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)
Poliomyelitis affects where?
Polio means gray, so it affects gray matter (anterior horn)
Flaccid paralysis
Tabes dorsalis affects where? Useful test for it
DORSALis affects dorsal, so impaired proprioception and gait/balance problems
Romberg test. Vision eliminated and patient has poor proprioception and they will tip over
*** B12 deficiency affects what?
WORK ON THAT
Dorsal columns and corticospinal tract.
So spastic bilateral and vibe sense loss
Brown squared is what?
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
Argyll robertson pupil?
Tertiary syphilis. Accommodates but nonreactive to light.
Also have tabes dorsalis.
What brain lesion causes hemiballismus?
Subthal nucleus. It is flailing of the limbs.
*** What lesion causes agraphia?
Dominant parietal lobe
What lesion causes hemispatial neglect?
Nondom parietal lobe
Where does dorsal column decussate?
Medulla
Latreal corticospinal tract crosses wehre?
medullary pyramids
Meningitis and purpura?
Think neisseria
*** Meningitis with gram positive rods and coccobacilli is what bug?
Listeria list of shapes
Small pleomorphic gram negative coccobacilli in meningitis is what?
H influ
CSF is different in fungal/tb than it is in bacterial meningitis how?
WBCs are lymphocytes in fungal/tb where in bacterial it is neut
*** CT before lumbar puncture is when?
Seizure or focal defects or papilledema
*** 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
*** 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
Longterm complicaitons of mening?
How do you help prevent them
Hearing loss, seizure disorder, intellectual disability, spastic paralysis (especially in kids)
DEXAMETHASONE
What causes viral meningitis?
enterovirus, so think echovirus, coxcaki, enterovirus.
Herpes can sometimes
Tx of viral meningitis?
Tylenol pain, IV fluids, bacterial meningitis excluded, ACYCLOVIR if suspicion of HSV or focal findings
Encephalitis HP?
Malaise headache neck pain vomit (just like meningitis)
BUT ALTERED Consciousness, or or change mental status or focal defects
What causes temporal lobe encephalitis?
Herpes
*** 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
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
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
Treatment of abscess if from oral spread?
metronidazole with 3rd gen cep
corticosteroids
drainage
If from hematogenous spread or near procedure in brain abscess give what?abscess?
Give cef and vanc
corticosteroids
drainage
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
Reye syndrome does what three things?
Hypoglycemia, liver and brain issues
*** 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
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!
***Migraine prophylaxis
CCBs (verapamil) Beta blockers TCAs NSAIDs Antiseizure meedslike valproate
CONSIDER comorbiditis
***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
** Headache with extra ocular muscle palsy?
Cavernous sinus thrombosis, REMEMBER THE NERVES RUN THROUGH IT
Bilateral trigeminal neuralgia?
How do you treat if not due to the pathology?
MS
tx anticonvulsants
FIRST LINE is carbamazapine
Lacunar TIA?
occlusion of small arteries from middle cerebral to deep part of the brain
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
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
What is dabigatran?
one of the embolic therapies to bridge with warfarin
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
*** basilar artery occlusions cause what symptoms?
contralateral weakness.
If complete occlusion, you get hemiparesis and vertigo
Lacunar arteries lesions
Variety of symptoms, focal or motor sensory deficits.
They are affecting just one side of the body.
ABSENT CORTICAL SIGNS
Stroke contraindications for alteplase?
More than 4.5 hours old. Recent hemorrhage or surgery, hypertensive urgency
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
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
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
First line treatment for trigeminal neuralgia?
Carbamazapine
Two syndromes associated with berry aneurysms?
Ehler danlos and ADPKD
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!
*** 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
Do you give phenytoin if subarachnoid hemorrhage?
no!
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
Adult with new seizure? What caused it?
Idiopathic, metabolic like hyponatremia or hypoglycemia, drugs, drug withdrawal, trauma, neoplasm
*** Famous adult infections causing seizures?
Toxoplasmosis, neurocysticercosis, HSV
What do you give to patients getting isoniazid?
B6 b/c it gets absorbed and could get seizures!
Big time drugs causing med induced seizure?
Theophyline, Bupropion, narcotics, Psychostim, phenycyclidine (PCP), antipsych, antibiotics,
*** Partial seizure is what?
What part of brain affected?
Only in part of the brain. Preceded by aura like burning tires
Temporal affected
Simple partial vs complex?
Simple does not lose consciousness, but have purposeless movements or parenthesis
Complex partial: hallucinations POST ICTAL STATE! temporal lobe
Petite mal EEG finding?
Aka absence seizures Three cycle per second spike wave pattern. no post octal state
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
*** 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
fetal hydantoin syndrom is what?
Cleft lip, palate, congee heart disease, developmental delay
*** Stephens johnson drugs?
Seizure drugs including lamotrigine, SULFAs and PENICILLINS and ALLOPURINOL
Drugs that cause agranulocytosis?
C drugs Carbamazepine Clozapine Colchicine PTU and methimazole
What are two big side effects to remember for valproic aid and carbamazepine?
Hepatotoxic and spina bifida
Cyp p450 inducers?
Coronas Guiness and PBRs induce chronic alcoholism
Carbamazepine Griseofulvan Phenytoin Barbiturates Rifampin St. Johns Wart
