Neuro Flashcards
1
Q
What is the hallmark of complex regional pain syndrome?
A
pain & mobility problems more severe than the injury warrants
2
Q
What is the tx for complex regional pain syndrome?
A
directed at restoration of function: physical therapy
3
Q
How can we prevent the development of complex regional pain syndrome?
A
early mobilization after injury or surgery
4
Q
What are some causes of single area involvement in peripheral neuropathies?
A
nerve entrapment, nerve compression from tumor or mass
5
Q
What are some causes of wide area damage to peripheral nerves?
A
DM, long term alcohol use, hypothyroidism, renal insufficiency, drug tx w/ neurotoxic agents
6
Q
What are the S/S of peripheral neuropathy?
A
allodynia
pain that is stabbing, jabbing, burning, shooting
7
Q
What is the goal of tx for peripheral neuropathy?
A
to restore/prevent further nerve damage & alleviate pain
8
Q
Definition for chronic daily headache
A
any HA occurring more than 15 days/month for longer than 3 months
9
Q
What is the most common contributing factor for chronic daily headache?
A
medication overuse
10
Q
What are cluster headaches?
A
migrainous neuralgia
11
Q
What are some S/S for cluster headaches?
A
recurrent episodes of intense unilateral orbital, supraorbital, or temporal pain
12
Q
Besides the headaches, what other S/S are seen with cluster headaches?
A
conjunctival injection, lacrimation, rhinorrhea, nasal congestion
13
Q
How long do the headaches of cluster headaches last?
A
15 minutes to 2 hours & recur daily for days to weeks
14
Q
What are some triggers for cluster headaches?
A
ETOH, stress, glare, foods
15
Q
What is a very effective treatment for cluster headaches?
A
100% oxygen x 15 minutes
16
Q
When is the typical onset of migraines?
When do migraines peak?
A
onset in adolescent
peak ages 30-45
17
Q
What are some triggers for migraines?
A
physical exercise
emotional stress
lack of or excess sleep
foods
odors
missed meals
menstruation
18
Q
What is the neurogenic theory for migraines?
A
the brain activates or sensitizes the trimenical nerve fibers withing the meninges initiating the HA via neurogenic inflammation
19
Q
What is serotonin’s role in migraines?
A
activates pain fibers (brainstem) that contributes to vasoconstriction & inflammation
20
Q
What is migraine w/ aura?
A
transient (15-30 minute) episodes of focal neurologi dysfunction that appears before HA phase
21
Q
Aura is contributed by??
A
a wave of electrical activity that spreaks throughout the brain, depressing cortical activity & resulting in visual & other sxs; initiated by the CNS
22
Q
What is the headache phase of a migraine like?
A
can be lateralized or generalized
usually throbbing & worse w/ physical activity
23
Q
What are some associated symptoms w/ migraines?
A
nausea
photophobia
phonophobia
24
Q
What is a complex migraine?
A
prolonged aura w/ neurologic deficits lasting 1 hour up to a week
25
What can complex migraines cause (although very rare)?
permanent neuro deficits consistent w/ a localized stroke
26
What are some treatments for mild migraine attacks?
ASA
NSAIDs
27
What is the MoA for the triptans?
function as **presynaptic auto receptors whose activation inhibtis the release of serotonin**
28
What should we avoid giving patients with migraines (unless in the ED)?
opiates
29
What is the most common type of headache?
tension headache
30
Do tension headaches get worse with physical exertion?
No
31
What is the treatment for tension headaches?
acetaminophen
NSAIDs
32
How do intracranial mass lesions cause headaches?
usually related to the displacement of vascular structures
33
What are some clues to intracranial mass lesions?
new onset HAs in patients older than 45 yrs
## Footnote
**usually associated w/ other neurological features**
34
How do we diagnose intracranial mass lesions?
CT
MRI
35
What is the main S/S of trigeminal neuralgia?
stabbing/lancing pain in the 2nd/3rd division fo the CN V
pain worse with light touch
36
What is Bell Palsy?
unilateral facial muscle weakness noted without evidence of other neurologic disease & without apparent cause
37
What is the main S/S of Bell Palsy?
abrupt facial muscle weakness
38
What does the paralysis in Bell Palsy include?
forehead & lower face
(patients cannot close eye, raise brow, or smile on affected side)
39
What is the treatment for Bell Palsy?
most resolve spontaneously without treatment
oral predisone may be used for those w/ poorer prognosis
40
resting tremor
body part affected is supported **against gravity**
41
action tremor
produced by voluntary muscle contraction
42
intention tremor
present during visually-guided, target-directed motion
43
What is a physiologic tremor like & what enhances it?
fast, fine tremor
enhanced by hyper-adrenergic states
44
When is the typical onset of benign essential tremor & what is the progression like?
onset in the 60s
**SLOW** progression
45
With benign essential tremor, what will be the other neurologic findings?
**NONE**
all other parts of neuro exam will be normal
46
What is the treatment for benign essential tremor?
patient education
beta blockers
47
What is Huntington Disease?
autosomal dominant
neurodegenerative disorder
48
What is huntington's triad?
motor
cognitive
psychiatric
49
When is the typical onset of Huntington's?
30-50s
50
What are some S/S of Huntington's?
chorea
abnormal eye movements
psych sxs (mania, depression, OCD)
cognitive sxs (dysfunction)
51
What is the treatment for Huntington's?
no cure
no slowing of progression
just attempt to tx symptoms
52
What is Parkinson's Disease?
neurodegenerative disorder resulting from decreased dopaminergic transmission in basal ganglia
53
What is the main neurotransmitter associated with Parkinson's?
**dopamine**
54
What are the classic S/S ofr Parkinson's?
tremor
bradykinesia
rigidity
progressive postural instability
55
What is the classic tremor with Parkinson's?
pill-rolling tremor
56
What is the treatment for Parkinson's?
Levodopa/Carbidopa
57
When should treatment be started for Parkinson's?
start treatment when functional disability begins
58
How long does a stroke last?
greater than 24 hours
59
What are the risk factors for stroke?
**HTN (most powerful)**
smoking (2-4x increase)
atherosclerosis elsewhere
DM
**A fib (cardiac emoboli)**
60
What type of vessels are involved with atherosclerosis?
large
61
What is a lacunar infarct?
**small vessel** disaese
## Footnote
**deep penetrating arterioles occlude/thrombose**
62
What are cerebral emboli?
embolism from heart or artery to brain
63
where do cardiac emboli often lodge?
in medium sized vessels
64
What is the most common cause of cardioembolism?
**A fib**
**\*\*prevention w/ anticoagulation is important\*\***
65
What are the S/S of stroke?
**abrupt onset** of non-convulsive **focal defect in a vascular territory**
66
Do most people have warning signs for a stroke?
NO
67
What is Broca's aphasia?
can understand speech but has trouble getting the words out
68
What is Wernicke's aphasia?
receptive aphasia
fluent words but they don't make sense
69
We do a CT scan in suspected stroke patients to rule out what?
hemorrhage
70
What is the gold standard diagnostic test for stroke?
arteriography
71
What are some ways to modify risk factors for stroke?
agressive control of BP
lipids
diabetes
smoking cessation
exercise
diet
72
When do we consider thrombolytic therapy w/ t-PA?
in onset of sxs are less than 4.5 hrs
73
What are the risks of t-PA?
cerebral hemorrhage 6-7%
half of those will die
74
What is used for immediate & short term anticoagulation (days)?
heparin perparations
75
What is the major risk factor for intracerebral hemorrhagic stroke?
**HTN**
76
What are the S/S of intracerebral hemorrhagic stroke?
**rapid evolution of neuro deficit** often progressing to hemiparesis, hemiplegia, or hemisensory loss
**50% mortality**
**loss of or impaired consciousness** develops in 50%
77
What is the treatment for intracerebral hemorrhagic stroke?
cautious BP reduction
78
What are subarachnoid bleeds most commonly due to?
due to bleeding from **saccular aneurysms**
79
What are the S/S of subarachnoid bleeds?
**sudden onset of severe HA**
followed by N/V
impaired or loss of consciousness
80
How is a subarachnoid bleed diagnosed?
CT identifies blood in subarachnoid space
81
How long do Transient Ischemic Attacks (TIAs) usually last?
less than 24 hours
usually less than 30 minutes
82
What are the S/S of TIAs?
abrupt onset of symptoms w/ **transient** focal neuro deficit dependent on involved anatomy
83
What are the likely etiologies of TIAs?
**embolic** from **carotid stenosis/plaque**
**embolic** from **cardiac source**
84
What is the surgical treatment for TIAs?
**carotid endarterectomy** to remove plaque
85
What age group does Cerebral Palsy usually affect?
young
86
What are the S/S for Cerebral Palsy?
spasticity
lack of coordination
fine motor difficulties
ataxia
lethargy
hypotonia/dystonia
87
What are the S/S of a concussion?
vacant stare
delayed verbal expression
inability to focus attention
slurred speech
emotionality out of proportion
88
What will diagnostic imaging (CT) look like for a concussion?
normal
89
What is second impact syndrome?
diffuse cerebral swelling that leads to increased intracranial pressure
90
What is the treatment for concussion?
observation
91
What are some complications of concussion?
early post-traumatic seizures
post-traumatic epilepsy
post-traumatic vertigo
92
What should be avoided in patients with post-concussive syndrome?
avoid narcotic pain meds
93
What are some common causes of traumatic brain injuries?
MVC/MVA
falls
occupational
accidents
assaults/violence
sports
alcohol
94
What are the 3 types of tissue deformation in a primary injury in TBIs?
1. compression-tissue compression
2. tensile-tissue stretching
3. shear-tissue distortion when tissue slides over tissue
95
What are the classic signs of a basilar skull fracture?
Battle's sign
raccoon eyes
CSF rhinorrhea or otorrhea
hemotympanum
96
Can you get cognitive deficits from repeated TBIs?
yes
97
What is the most common form of dementia?
Azlheimer's
98
What are the S/S of Alzheimer's disease?
progressive memory loss
disorientation
language difficulties
inability to perform complex motor activities
99
What is vascular dementia?
multi-infarct dementia
includes lacunar & multiple cortical infarction
100
What is vascular dementia associated with?
HTN
with or without hx of TIA or stroke
101
What are the S/S of vascular dementia?
forgetfulness in teh absence of depression & inattentiveness
102
What is the treatment for vascular dementia?
control of HTN & metabolic disorders to slow progression
103
What is frontotemporal dementia?
secondary to degeneratio fo the frontal lobe of the brain & may include the temporal lobe
(includes Huntington's, Pick's)
104
What are some S/S of frontotemporal dementia?
behavioral symptoms (euphoria, apathy, disinhibition)
compulsive disorders
105
What is the treatment for frontotemporal dementia?
supportive care
no curative treatment
106
What vitamin deficiency causes Wernicke's encephalopathy?
Thiamine deficiency
107
What is Korsakoff's syndrome?
can't recall recent memory despite immediate memory retention
108
What is delirium?
an acute confusional state w/ **decreased attention**
109
What is the usual pathology behind delirium?
diffuse cerebral dysfunction
110
What is sundowning?
old people who get worse at night
worse if underlying mental health issues
111
What is the treatment sundowning?
maintain day-awake cycle
night-sleep normalcy
reassurance/reorientation
112
What are some S/S of alcohol withdrawal?
delirium
tremor, agitation, anxiety
begins 5-10 hrs after cessation
peaks 2-3 days after
113
What is the treatment for delirium?
supportive
reorientation
safety
114
What is Guillain-Barre's Syndrome?
acute/subacute inflammatory demyelinating polyradiculopathy w/ symmetric -\> upper extremity weakness
## Footnote
**ascending weakness**
115
What are the S/S of Guillan-Barre's Syndrome?
weakness & parasthesias (usually symmetric)
decreased DTRs (LMN lesion)
autonomic: tachy, hypotension or HTN, breathing difficulties
116
How is Guillain-Barre's Syndrome diagnosed?
CSF-high protein w/ normal WBC
117
What is the treatment for Guillain-Barre's Syndrome?
plasmapheresis
Iv Ig
118
What is Multiple Sclerosis?
**inflammation** associated w/ multiple foci of **demyelination in the CNS** white matter
119
What is the pathogenesis of MS?
inflammation -\> demyelination -\> axonal degeneration
120
When do MS symptoms typically begin?
18-45yrs
121
What is the most common presenting symptom for MS?
sensory complaints of the limbs
122
What is Uhthoff's phenomenon?
| (relating to MS)
symptoms are worsened in hot conditions/heat
123
What will the MRI show in somebody w/ MS?
lesion is the cerebral or spinal plaque
discrete region of demyelination w/ initially preserved axon
124
What is Relapsing-Remitting MS?
initial episode then months or years before new symptoms emerge or previous symptoms return
125
What is Secondary Progressive MS?
clinical course changes
126
What is Primary Progressive MS?
symptoms are steadily progressive from onset
127
What is Progressive Relapsing MS?
subset of MS which has some remissions, but steady decline still dominates
128
What is the treatment for MS?
no cure
trying to improve quality of life & limit disability
129
What is Muscular Dystrophy?
**inherited disorders** causing progressive muscle weakness & atrophy due to a **genetic defect**
130
What is Duchenne Muscular Dystrophy?
defective gene of X chromosome responsible for producing dystrophin
131
What does dystrophin do?
protien that protects muscles
132
Where to S/S start for DMD?
start centrally (trunk) then spreads to legs first
133
What is the only differences between DMD and Becker Muscular Dystrophy?
BMD make some dystrophin
134
What is the muscle weakness like in Emergy-Dreifuss Muscular Dystrophy?
usually begins in arms in teens progressing to legs & face
135
What is the classic triad of Emery-Dreifuss Muscular Dystrophy?
1. contractures of elbows, ankle plantar flexors & spine
2. later onset of humeroperoneal weakness
3. cardiac arrhythmias/cardiomyopathies
136
What is the most common form of Muscular Dystrophy?
myotonic dystrophy
137
What are the S/S of Myotonic Dystrophy?
muscle stiffness
inability to relax
muscles are contracted
138
What body parts does Limb-Girdle Muscular Dystrophy affect?
shoulder girdle &/or hip girdle
139
What are the S/S of the class form of Facioscapulohumeral Muscular Dystrophy?
slow progression w/ milder weakness of facial muscles (pouting appearance)
shoulders and arms are usually invovled eventually
140
What are the S/S of Oculopharyngeal Muscular Dystrophy?
ptosis
dysphagia
141
What are the S/S of Congential Muscular Dystrophy?
floppy baby
142
What is Myasthenia gravis?
autoimmune disease
antibody against nicotinic AchR at neuromuscular junction
143
Up to 75% of people with Myasthenia gravis also have ________ abnormalities
thymic
144
What are the S/S of Myasthenia gravis?
**descending** (mind to ground)
ocular sxs (limited to lids, EOM)
facial sxs: ptosis, diplopia
may progress down to respiratory muscles & limb weakness
**sxs usually progress to become more frequent**
145
What will the physical exam be like for somebody with Myasthenia gravies?
fatiguability of muscles
normal sensation
normal reflexes
146
What are some diagnostic tests for Myasthenia gravis?
Tensilon test
ice pack test
blood tests
thymus imaging
electrophysiology testing
147
What is the treatment for Myasthenia gravis?
acetylcholinesterase inhibitors
| (Pyridostigmine & Neostigmine)
148
What is a Mysathenia gravis crisis?
respiratory weakness leading to respiratory failure
149
What are the 2 treatment options for MG crisis?
Iv-Ig
plasma exchange (preferred)
150
What is a seizure?
paroxysmal event due to abnormal CNS discharge w/ resultant manifestations depending on the area involved
151
What is a simple partial seizure?
may be motor, sensory, autonomic, psychic but
## Footnote
**without LOC**
152
What is Jacksonian March?
motor activity begins distally (like fingers) & spreads to whole extremity
153
What is Todd's paralysis?
local paresis lasting minutes to hours
154
What is Epilepsia partialis continua?
continues hours to days
155
What is a complex partial seizure?
focual activity progress to **loss of contact w/ environment**
156
What does a complex partial seizure often being with?
an aura stereotypical for the patient
157
What is a partial seizure w/ secondary generalization?
electrical discharge spreads & both hemispheres become involved
158
What is a generalized seizure?
arise in both cerebral hemispheres simultaneously
159
What is an absence seizure (petit mal)?
brief LOC without postural control
usually lasts a few seconds
160
What are some other subtle findings associated with an absence seizure?
eye blinking
chewing
clonic movements of the hands
161
What might an absence seizure look like?
daydreaming apperance
162
What is an atypical absence seizure & what is it more commonly associated with?
similar to absence seizure but symptoms last longer
may have brain abnormality (such as mental retardation or developmental delay)
163
What is the most common type of seizure due to metabolic derangement?
generalize tonic-clonic seizure
164
What is the tonic phase?
increase muscle tone
165
What is clonic activity?
muscle relax & contract
usually lasts about a minute
166
What are atonic seizures?
1-2 seconds lose motor tone
brief LOC
167
What are myoclonic seizures?
brief contraction/jerk
like when you fall asleep & twitch
168
What are some infection types that may lead to febrile seizures?
otitis media
respiratory infection
gastroenteritis
169
What is status epilepticus?
medical emergency
when seizures fail to cease spontaneously or recur so frequently that full consciousness is not restored between episodes
170
What are some causes of Status Epilepticus?
metabolic problems
drug toxicity
CNS infection
tumor
head injury
refractory epilepsy
171
If suspecting cardiac syncope, what are somethings to think about?
arrhythmias/dysrhythmia
heart block (require pacemaker)
aortic stenosis (severe)
also think meds (orthostasis)
172
What is Tourette's?
inherited neurobehavioral disorder characterized by sudden involuntary, repetitive muscle movements & vocalizatioin
173
What are some initial symptoms of Tourette's?
head & face
blinking
face twitch
head jerk
shrug
neck stretch
sniffing
174
What are some symptoms in Tourette's that develop over time?
change in locations w/ increasing complexity
squatting
jumping
repetitive touching
deep knee bends
175
How often do tic episodes have to occur for a diagnosis of Tourette's?
several times a day
almost everyday
or periodically for longer than 1 year
176
With Tourettes,
what causes a decrease in tics &
what causes an increase in tics?
decrease during absorbing activities
increasing during times of stress/fatigue
177
What is the main treatment for Tourette's?
habit reversal treatment
178
What is vertigo?
sensation of movement (spinning, tumbling, falling) in the absence of any actual movement
or
an over-response to movement
179
What is Meniere's disease?
cochlear disease
progressing hearing loss (**low frequency**)
tinnitus
dizziness
unknown etiology
180
What is the treatment for Meniere's disease?
diuretics (HCTZ)
very low salt restriction
181
What are some problems with Cranial Nerve VII that can cause vertigo?
sound & balance
acoustic neuroma (unilateral hearing loss, tinnitus)
182
What is Benign Positional Vertigo?
due to changes in head position
no clear known cause
may last months
183
What is the treatment for benign positional vertigo?
Epley Manuever
184
What is physiologic vertigo?
abnormal input to stabilize (car sickness)
unfamilar head position (sea sickness)
unusual head position (painting ceiling)
185
What is pathologic vertigo?
disturbace of vision
disturbance of somatosensory system & vestibular system
186
What is the treatment for vertigo?
vestibular suppressants (Meclizine)
187
What state of sleep is predominant when dreaming takes place?
REM
188
What is insomnia?
difficutly falling or staying asleep
intermittent wakefulness during the night
early morning awakenings
or a combo
189
What is hypersomnia?
excessive daytime sleepiness
more severe problem & manifests in patients w/ sleep apnea, narcolepsy, or those w/ nocturnal myoclonus
190
What are parasomnias?
abnormal behaviors during sleep
sleep terrors
nightmares
sleep walking
enuresis
191
What are some things associated with sleep disorders?
depression
alcohol abuse
heavy smoking
inappropriate use of sedatives
medical hx of uremia, asthma, hypothyroidism
192
What is the diagnostic test for sleep disorders?
polysomnography
193
What are some treatments for sleep disorders?
sleep hygiene
weight reduction
CPAP
194
UMN lesions usually produce _____ tone
increased
195
LMN lesions usually produce _____ tone
decreased
196
Hyperactive reflexes are suggestive of what type of disorder?
an UMN disorder
197
Hyporeflexive or areflexia suggests what type of a lesion?
LMN lesion
198
MCA stroke syndrome
1. symptoms if the dominant hemisphere is affected
2. symptoms if the non-dominant hemisphere is affected
1. global aphasia
2. anosognosia-denial, neglect, unawareness of neuro deficit
199
MCA stroke syndrome
Partial occlusion
1. superior division
2. inferior division
1. non-fluent aphasia
2. Wernicke's aphasia
200
ACA stroke syndrome
What are the symptoms if the occlusion is proximal to anterior communicating artery?
no symptoms if COW is intact
201
ACA stroke syndrome
Symptoms if the occlusion is distal to acoma
paralysis of opposite of foot & leg
urinary incontinence
grasp & suck reflex
abulia (slowness to respond)
impairment of gait & stance
behavioral changes
202
PCA stroke syndrome
1. isolated occlusion symptoms
2. occlusion of both vertebrals & basilar artery
3. total occlusion
4. partial occlusion
1. homonymous hemianopsia
2. brainstem & deep tracts/cerebellar dysfunction & cranial nerves
3. pinpoint pupils & flaccid quadraplegia
4. vertigo, visual loss, ataxia
203
What is amaurosis fugax?
transient monocular blindness
micro-embolism to branch of ophthalamic artery
