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FALL15 N757 Primary Care Adults 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

CNS involvement: WHERE + symptoms

A
  • Upper motor neuron: Sx in face, arm, leg
    • Stroke, brain, neoplasm
  • Spinal cord: BL, sensory level, brisk reflexes
    • transverse myelitis
  • *always consider bowel and bladder w/spinal cord!
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2
Q

PNS involvement: WHERE + symptoms

A
  • Radicular pattern: dermatome, e.g., shingle, radiculopathy. Radiculopathy changes with position!
  • Neuropathy: Localized to distribution of nerve, weakness, loss of sensation, e.g., carpal tunnel
  • Polymyositis: localized to muscle, muscle tenderness. E.g., statin myopathy
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3
Q

2 main questions for yourself when pt presents with a HA

A
  1. Primary vs secondary
  2. Dangerous to wait?
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4
Q

Examples of primary HAs

A
  • Migraine
  • Cluster headache
  • Autonomic cephalgia
  • Tension Type Headache
  • Chronic daily Headache
  • HA syndrome associated
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5
Q

Examples of secondary HAs

A
  • Giant cell arteritis
  • Brain infections
  • Brain hemorrhage
  • Idiopathic, intracranial HTN
  • Low CSF pressure
  • Car accidents – HA s/t muscle spasms
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6
Q

Sx & diagnostics of low CSF pressure HA

A
  • Severe throbbing HA w/bending, lying down
  • Nausea
  • Normal neuro
  • Possible CSF rhinorrhea
  • May happen s/t car accidents, surgeries
  • Imaging: cerebellum going into foramen magnum. CSF pressure is low, so brain sinks when stand.
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7
Q

Tx for Low CSF pressure HA

A
  • Look for CSF leak (often cannot find)
  • May heal on their own
  • Managed w/pain meds
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8
Q

Cluster HA and gender

A

More women than men

BUT if men have HA, more likely to be cluster

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9
Q

Why do people often have visual symptoms (e.g., stars, black, flashes) before syncope?

A

Retina is highly vascular and metabolic, senses any difference in circulation

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10
Q

Types of partial seizures

A

Simple partial, complex partial, partial seizures with secondary generalization

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11
Q

Types of Generalized seizures

A
  • Tonic-clonic (grand mal)
  • Absence (petit mal)
  • Myoclonic
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12
Q

S/S of stroke

A
  • Sudden numbness or weakness of the leg, arm, or face
  • Sudden confusion or trouble understanding
  • Sudden trouble seeing in one or both eyes (amaurosis fugax – carotid artery plaque lands in central retinal artery then body clears)
  • Sudden trouble walking, dizziness, loss of balance or coordination (brain hemorrhage)
  • Sudden severe HA w/no known cause
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13
Q

2 types of stroke

A

Ischemic

Hemorrhagic: sudden is almost always vascular

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14
Q

Multiple mechanisms of stroke

A
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15
Q

4 cardinal signs of parkinsonism

A
  • TREMOR
  • Bradykinesia: most disabling
  • Rigidity
  • postural instability: late sign

Need 2 for Dx

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16
Q

3 clinical types of multiple sclerosis

A
  • Relapsing
  • secondary progressive: more insidious
  • primary progressive: chronically progressive from onset
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17
Q

Tempo of cerebral mass lesions (tumor, subdural)

A

Progressive but fluctuating

(Cecil)

18
Q

Tempo of seizures and migraines

A

Episodic course

(Cecil)

19
Q

Tempos of strokes

A

Abrupt ictal onset with worsening for 3-5 days followed by partial or complete recovery

(Cecil)

20
Q

Acute onset of neuro sx suggests

A

Vascular cause of seizure

(Cecil)

21
Q

Subacute onset of neuro sx suggests

A

Mass lesion, e.g., tumor or abscess

(Cecil)

22
Q

Waxing and waning course w/exacerbations and remissions of neuro sx indicates

A

Demyelinating cause

(Cecil)

23
Q

Chronic and progressive neuro sx suggests

A

Degenerative cause

(Cecil)

24
Q

What does fatigue indicate, in terms of neuro diagnosis?

A
  • Not likely to reflect definable dz
  • More likely outside of PNS or CNS
  • Exceptions: neuromuscular junction DOs such as myasthenia gravis, UMN dz e.g., MS, diseases that cause EPS (e.g., parkinson’s), or impair sleep

(Cecil)

25
Q

Imaging recommended for low back pain, with or w/o radiculopathy?

A

Not typically necessary unless red flags

  • Recent significant trauma or minor trauma at >50yo
  • Unexplained wt loss
  • Unexplained fever
  • Immunosuppression
  • Hx cancer
  • Hx prior local surgery
  • Systemic do, bone or arthritic do
  • IV drug use
  • Age >70yo
  • Focal neuro deficit w/progressive sx
  • Duration >6w
  • Thoracic spine pain
26
Q

Most common causes of low back pain by age

A

Mechanical!!

  • 20-40: muscle strain (back, unilateral, acute onset, worse w/standing and bending)
  • 30-50: herniated nucleus pulposus (back, unilateral, acute onset w/prior episodes, worse w/sitting and bending)
  • >50: OA (back, unilateral, insidious onset, worse w/standing)
  • >60: spinal stenosis (leg, bilateral, insidious, worse w/standing)

(Cecil)

27
Q

Most common cause of cardioembolic stroke

A

Afib

(Cecil)

28
Q

Clinical manifestations / neuro deficits in setting of ischemic stroke

A
  • Depends on involved vascular territory
  • Embolic: usually maximal deficit at onset
  • Atherothrombotic: may be stuttering onset
  • “Abrupt onset of focal neuro deficit in distribution of a specific vascular territory”

(Cecil)

29
Q

Initial labs for suspected stroke

A

At ED

  • Partially to R/O other causes
  • CBC & PLT
  • PT/INR, aPTT, Glc, electrolytes, renal function tests, troponin, O2 sat
  • Urgent ECG
  • CT or MRI as soon as stable

Other tests depend on pt (pregnancy, tox screen, etc)

30
Q

Significance of CBC in evaluation of stroke

A

WBCs: infective cause, e.g., Infective endocarditis; infection can also cause recurrence of sx in setting of prior stroke

31
Q

Significance of polycythemia in setting of suspected stroke

A

Hyperviscosity can lead to occlusion of small intracranial vessels

32
Q

Significance of thrombocytopenia in setting of suspected stroke

A

May reveal underlying coagulation disorder / contraindictation to tPA

33
Q

Significance of glucose in setting of suspected stroke

A

Hypo and hyperglycemia may cause strokelike sx

34
Q

Significance of impaired renal function in setting of suspected stroke

A

Risk factor for ischemic stroke, may increase risks of using thrombolytic and anticoagulant agents

35
Q

Significance of electrolyte abnormalities in setting of suspected stroke

A

Can cause neuro sx, e.g., hyponatremia

36
Q

Brain CT vs MRI in setting of suspected stroke

A
  • CT: more accessible
  • MRI: more likely to show acute ischemic injury, but not for pts w/metal implants, cardiac pacemakers, difficult in unstable pts
37
Q

Treatments for ischemic stroke

A

tPA or endovascular therapy (if not tPA candidate)

38
Q

How much time between symptom onset and tPA administration?

A

< 3 hours

No more than 4.5 hours

(Cecil)

39
Q

Primary prevention of ischemic stroke

A

Healthy lifestyle

Treat RFs (afib, HTN, DM, carotid stenosis)

(Cecil)

40
Q

Secondary prevention after TIA or stroke

A
  • Lifestyle
  • Antiplatelet if not C/Is – esp short term dual antiPLT tx (asa & clopidogrel)
  • Tx risk factors
  • Stenting or endarterectomy

(Cecil)

FALL15 N757 Primary Care Adults 2 (13 decks)

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