Neuro Flashcards
absence
childhood onset and characterized by brief starring spells
myasthenia gravis
proximal weakness that extends peripheral with time
concussion
traumatic head injury with altered mental status with or without LOC
simple seizure
focal neuro deficits with preserved consciousness
complex seizure
confusion and bizarre behavior
locked in syndrome is associated with what brain injury
bilateral brainstem
Locked-in-syndrome is caused by destructive bilateral brainstem lesions, most commonly ischemic infarction of the ventral pons, leading to quadriplegia, loss of speech/swallow with retained cognition/consciousness. Often the supranuclear ocular motor pathways are spared and patients can still blink and move their eyes
tension
most common
band around head
frequent and bilateral
stress, situation, work, etc
migraine
female predominance strong association with menstrual cycle usually unilateral can be associated with photophobia classic- w/ aura (scotomas) (vision/smells) common- w/out aura
cluster headaches
middle age men
intense pain around 1 eye
can get tearing (lacrimation, sweating, miosis, ptosis)
occur in clusters
smoking, alcohol, and nitroglycerine can precipitate
tx- O2
medication overuse headache
3rd most common HA
can happen w/ OTC meds
take meds everyday
tx stop meds
labrinthitis
after viral infection
similar to vestibular neuritis
vestibular neuritis no hearing loss
labrinthitis has hearing loss
1st line tx for HA
dopamine antagonist (droperidol, prochlorperazine (compazine) ,metoclopramide) also use triptans, nasaids, opioids
most common complication of a fib
cerebrovascular event
number 1 cause of disability
stroke
middle cerebral artery
face and arm
anterior cerebral artery
legs
posterior strokes
verterbral and basilar artery
brainstem and cerebellum
usually involve cranial nerves
one side of body and opposite side of body
5’ds (dizziness, diplopia, dysarthria (trouble speaking), dysphagia, ataxia)
tx for tia
antiplatelet angent (aspirin, and some plavix)
carotid endarectomy for stenosis >70% in 2 weeks
anticoagulation for a fib, or thrombus in LV
subarachnoid hemorrhage
most common cause- ruptured aneurysm
thunder clap headache/ worst headache of life
sudden onset w/ maximal pain at onset/different then past HA
syncope
xanthochromia or rbc on lp
workup and tx for subarachnoid hemorrhage
CT scan. If negative then LP tx- tx pain decrease BP seizure prophylaxis reverse blood thinner clip or put coil on aneurysm
bells palsy
palsy of CN 7 (facial) ipsilateral ear pain precedes paralysis lacrimation/change in taste can't wrinkle forehead (stroke can) tx- acyclovir w/or w/out steroids
diabetic polyneuropathy
sxs more common in lower extremities
pain, numbness, tingling, burning
usually symmetric. usually polyneuropathy
can get autonomic problems (postural hypotension, arrhythmia, problems in bowel or bladder, sexual dysfunction)
dx- usually clinical but can do nerve conduction studies
tx- control hyperglycemia, pain (gabapentin, tca)
for autonomic problems (compression stocking, midodrine)
Guilian Barre
can occur after flu vaccine can occur after campylorbacter jejuni inflammatory demyelinating polyneuropathy lower muscle weakness that ascends decreased or absent DTR elevated protein can get sensory abnormalities LP will show elevated protein tx- IVIG, plasmapheresis
Myasthenia Gravis
improves with rest and gets worse throughout day
CXR to rule out thymoma
associated with hyperthyroid
antibodies against acetylcholine receptor
proximal muscle weakness
dx- edrophonium (tensilon test), serum test for acetylcholine receptor antibodies
tx- pyrodstigmine, neostigmine (cholinesterase inhibitors), immunosuppresants, plasmapheresis, thymectomy
lambert eaton syndrome
opposite of Myasthenia gravis (get better with stimulation)
associated w/ small cell lung cancer
due to defective release of acetylcholine
tx- plasmapheresis, immunosuppressive thearpy
complex regional pain syndrome
part of the body feels pain, edema, skin changes, and limited ROM following injury, stroke, or surgery.
amyotrophic lateral sclerosis
lou gherig
neurodegenration of neurons in spinal cord and brain that lead to muscle weakness.
most common cause of meningitis
viral
aseptic meningitis
inflammation of meninges
usually caused by nsaids
culture and no organisms
most common form of meningitis of pregnancy or farm workers (raw milk, eating cheese)
listeria
most common meningitis in neonates
group b strep, e coli, listeria (GEL)
neonates presentation on meningitis
poor feeding
bulging fontaneles
irritable
lethargic
> 6 years for meningitis
strep pneumoniae, neiseria menigitdes
meningitis
if pt is on abx already (cause tap will be sterile) can send latex agglutination or PCR
dx- LP
meningitis tx-
3 months including adults- ceftriaxone + vancomycin
immunocompromised/alcohol abuse/>50 years- ceftriaxone +vancomycin +ampicillin
head trauma/vp shunt/cns surgery- vancomycin + ceftazidime
dexamethasone +/-
2 months- 6 years
strep pneumo, h flu type b, neiseria menigites
waterhouse- friderichsen syndrome
adrenal failure after meningitis
encephalitis from HSV
mri temporal lobe
csf analysis
bacterial- increased protein, decreased glucose, elevated opening pressure, elevated PMN
viral- normal elevated pressure, normal pressure, normal glucose, predominately lymphocytes
TB- increased protein, decrease glucose, elevated OP, PREDOMINATELY LYMPHOCYTES
traumatic tap can increase protein by rbc (rbc are protein)
cerebral abscess
insidious onset
FOCAL neurological signs
usually pt had bad ear infection, mastoiditis, sinusitis, endocarditis
to tell encephalitis from meningtis
encephalitis usually have AMS and possibly seizures/focal neurological signs
ct before LP to rule out something that will cause herniation
essential tremor
worsens w/ age, stress, caffeine
improves w/ alcohol
tx- propanolol, primidone
parkinson
loss of dopaminergic neurons in substantra nigra
antipsychotics can cause
TRAP- tremor (resting), rigidity (cogwheel;difficulty moving arm/legs), akinesia(slow moments/bradykinesia), postural instability
masked facies, pill rolling, micrographia, shuffling gait, don’t swing arms
tx- levodopa +carbidopa (carbidopa presents levodopa from being broken down in periphery), selegiline, rasagiline (MAOB), anticholinergics, bromocriptine, surgery- deep brain stimulator
SALAD (selegiline, anticholinergic, L dopa, amantadine, dopamine agonist (bromocriptine and pergolide)
huntington disease
autosomal dominant
degeneration of neurons w/ atrophy in caudate nucleus/ putamen
psychotic fxs
tx- antipsychotics/antidepressant
brain stem stroke
pontine stroke- pinpoint pupils
cerebellar stroke- extensor posturing, lost pupillary reflex
uncal herniation
temporal lobe herniates onto brainstem
dilated non reactive ipsilateral pupil
central herniation
both sides of brain herniate through tentorium
loss of brainstem reflexes
decorticate posturing
irregular respiration
delirium
disturbance of consciousness w/ reduced ability to focus
change in cognition
fluctuating and develops quickly
most common cause of dementia
alzheimers
2nd- vascular dementia (multiple small strokes)
dementia
problem w/ recent memory (usually)
remote memory usually intact (long term)
alzheimer
neurofibriliary tangles due to abnormal tau protein
amyloid plaques (senile plaques) in hippocampus
atrophy (usually temporal lobe)
big risk factor is age
dx- can check level of tau and amyloid (not usually done)
most common guillan barre syndrome
aidp (acute inflammatory demyelinating polyneuropathy)
miller Fischer variant
areflexia, opthamoloplegia, ataxia
multiple sclerosis
optic neuritis (painful unilateral vision loss) pain with EOM LP shows oligoclonal pattern MRI T1- black holes and atrophy T2- UBO (hyperintensities) tx- acute- steroids, plasma exchange chronic- interferon, immunosuppresive sxs fatigue (amantadine) incontinence (oxybutin) spasitisity (baclofen)
most common MS subtype
relapse remitting
abx that precipitate g6pd deficiency
nitrofurantoin and bactrim
also aspirin, nsaids, antimalarial drugs
concussion
headache/dizziness
irritability, amnesia, insomnia/sleep a lot, slowed rxn time
behavioral chagnes
usually get better in 10 days
can start returning to activities after 24 hours of being asymptomatic
return in graded portion w/ each stage lasting 24-48 hrs
post concussive syndrome
3 sxs >3 months after concussion headache- most common dizziness fatigue irritability impaired memory insomnia
cerebral palsy
begins
vasovagal syncope
have a couple min of prodrome (nausea, diaphoresis, lightheadedness, graying of vision)
usually due to emotional stress or pain
different then cardiac which only have 3 second prodrome
fixed event thearpy
post orgasm syncope
micturition
tight shirt collar on carotid sinus
autonomic depressor causes orthostatic hypotension
how to check for orthostatic hypotension from poor autonomic system
tilt table test- symptoms reproduction or drop in bp, hr
partial seizure
focal epileptiform spike
simple- preserved consciousness, sterotyped aura w/ eeg
complex- impaired consciousness, staring
general
altered thalmocortical rhythms
absence- brief staring spells, childhood onset
myoclonic (arhythmic) clonic (rhythmic), tonic
atonic (loss of tone)- happen in patients w/ severe neurologic abnormalities
tx for absence seizure
ethosuximide
partial seizure tx
carbamazepine, lamotrigine
tonic, myoclonic, clonic seizure tx
valproate, lamotrigine, topiramate
tourette syndrome
must have both motor and vocal tics for at least a year. can’t go longer then 3 months w/out a tic
