Neuro 5 Flashcards
What is Todd paralysis
o Self-limited, focal weakness that occurs after a focal or generalized seizure
o Presents in the postictal period with a partial or complete hemiplegia involving ipsilateral upper and lower extremity
o Paralysis usually resolves within 36 hours
What is pseudotumor cerebri and potential causes
♣ Aka idiopathic intracranial HTN ♣ Increased intracranial pressure without hydrocephalus ♣ Risk factors: • Woman of childbearing age • Vitamin A excess • Tetracyclines
Presentation of pseudotumor cerebri
♣ Presentation:
• Headache, diplopia, papilledema
• Lumbar puncture shows increased opening pressure with headache relief
Major side effects of valproic acid
NTD, hepatotoxicity, pancreatitis
Major side effects of Lamotrigine
Non-serious skin rash or Stevens Johnson syndrome
Major side effects of Levetiracetam
Agitation/Mood swings, fatigue
Major side effects of Topiramate
Weight loss, kidney stones, glaucoma
Major side effect of phenytoin
Osteoporosis, cleft palate, gingival hyperplasia, hirsutsm, SJS, ataxia, diplopia , drug-induced lupus
What drug is Dilantin
Phenytoin
What is apraxia
Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex), in which the individual has difficulty with the motor planning to perform tasks or movements when asked, provided that the request or command is understood and he/she is willing to perform the task
Definition and presentation of pseudotumor cerebri
♣ Aka idiopathic intracranial HTN
♣ Increased intracranial pressure without hydrocephalus
♣ Presentation:
• Headache, vision loss, diplopia, papilledema
• Lumbar puncture shows increased opening pressure with headache relief
Describe parts of the CNS involved in volitional bladder control
o Dorsomedial frontal lobe connects to the medial region of the pontine micrurition center (PMC), providing volitional control of micturition through a decrease in urethral pressure followed by increased contraction of the destrusor muscle (causing voiding)
o The lateral region of the PMC produces powerful contraction of the urethral sphincter (promoting storage)
Damage to what levels will cause spastic bladder
Spastic bladder implies UMN problem
Lesion involving frontal love, pons, or suprasacral spinal cord
Damage to what levels will cause atonic bladder
Atonic = LMN problem
Lesion at level of conus medullaris, cauda equina, or sacral plexus
Describe which nerves are involved in:
- sensory innervation of penis
- erection
- ejaculation
Pudendal nerve = sensory innervation
Parasympathetic (S2-S4) = erection
Sympathetic (T11-T12) = ejaculation
What physical exam findings indicate a dangerous cause to a HA
Papilledema = ICP
Neck stiffness = meningitis
Temporal artery tenderness = giant cell arteritis
Abortive tx of migraine HA
Triptans
Prophylactic tx of migraine HA
- Beta blockers
- TCAs (amitriptyline)
- Anti-epileptics (Valproic acid, Topiramate)
- Calcium channel blockers
How long do migraines typically last
4-72 hours
How long do tension HAs typically last
4-6 hours
How long do cluster HAs usually last
15 min - 3 hours
Describe presentation of tension HA
♣ Bilateral headache with constant, steady pain (non-throbbing)
♣ Usually in frontal or occipital lobe (band-like)
♣ No throbbing, no photophobia, no phonophobia, no aura
Tx of tension HA
♣ Treatment: NSAIDs, Acetaminophen
• Avoid overuse of caffeine, NSAIDs, and barbiturate-containing compounds
Describe long-term timing of cluster HA
♣ Repetitive (often occur daily at the same time)
♣ May experience periods of high frequency Has followed by month-year HA-free periodss
Associated sx of cluster HA
♣ Associated with lacrimation, rhinorrhea, and Horner syndrome (ptosis and miosis, not anhidrosis)
♣ Individuals are restless and feel the need to get up and move
• Vs. migraines where patients want rest and quiet
Tx of cluster HA
♣ More common in young men and smokers
♣ Treatment: 100% O2, sumatriptan
Important complication of idiopathic intracranial HTN
• Most important complication – visual loss due to compressive optic neuropathy
Tx of pseudotumor cerebri
AKA idiopathic intracranial HTN
• Treatment = repeated LP, diuretics, lumboperitoneal shunting
Tx of giant cell arteritis
High dose steroids
Tx of trigeminal neuralgia
Carbamazepine
Diagnose based on pain:
- “Electric” face pain
- “Burning/itching” face pain
Electric = trigeminal Itch/burn = postherpetic neuralgia
Tx of postherpetic neuralgia
Gabapentin or TCA
Describe presentation of HA associated with idiopathic intracranial HTN
o Worse in the morning
o Worse when sitting up or with increase pressure (e.g. Valsalva)
o May be accompanied by pulsatile tinnitus and ransient visual obscurations
Describe the ice pack test and what it tests for
Test for myasthenia gravis
♣ Ice pack placed over the eyelids leads to improvement in ptosis
♣ Cold temp inproves muscle strength by inhibiting the breakdown of Acetylcholine at the NMJ
Stroke of what artery / part of the brain causes Broca’s aphasia
Stroke of superior division of middle cerebral artery - lesion to posterior inferior frontal lobe (posterior part of inferior frontal gyrus)
Components of language exam
Fluency, repitition, naming, comprehension, reading writing
Stroke of what artery / part of the brain causes Werknicke’s aphasia
Inferior division of MCA - posterior part of the superior temporal gyrus
Describe transcortical motor aphasia
♣ Lesion to frontal lobe slightly superior to Broca’s area
♣ Nonfluent aphasia similar to Broca’s but with preserved repitiion
Describe transcortical motor aphasia
♣ Lesion to frontal lobe slightly superior to Broca’s area
♣ Nonfluent aphasia similar to Broca’s but with preserved repitiion
Describe transcortical sensory aphasia
♣ Lesion in inferior portion of L temporal lobe
♣ Fluent speech with impaired comprehension similar to Wernicke’s but preserved repetition
Damage to what part of the brain causes alexia without agraphia
Inability to read with a preserved ability to write
Due to lesion involving the splenium of the corpus callosum
What symptoms is almost invariably a manifestation of all aphasias
Anomia
