Neuro Flashcards
1
Q
MCA Stroke symptoms
A
Contralateral paralysis and sensory loss in face and upper limb. Aphasia if stroke is dominant lobe (left) or hemineglect if nondominant (right side). Homonymous hemianopsia (loss of visual field on opposite side of stroke in each eye so left side has right field loss in both eyes so eyes deviate to left)
2
Q
How do you know what side of the brain speech is controlled by?
A
Determined by handedness where right handed ppl have left brain dominant
3
Q
ACA stroke symptoms
A
motor/sensory loss of contralateral lower limb. can have urinary incontinence
4
Q
PCA stroke symptoms
A
Ipsilateral sensory loss of face 9th and 10th CN, contralateral sensory loss of limbs, limb ataxia. Contralateral sensory loss of limbs. Limb ataxia
5
Q
Best initial/most accurate test for stroke?
A
Initial: CT scan, Accurate: MRI
6
Q
Tx for stroke
A
3-4.5 for ischemic/TIA-aspirin; if on aspirin, add dipyramidole or switch to clopidogrel
Hemorrhage: nothing, but control BP and reverse anticoag
7
Q
What drug is essential for all stroke patients?
A
Statin regardless of LDL level
8
Q
Appearance of hemorrhage vs ischemic on CT scan
A
Hemorrhage-white, Ischemic-black
9
Q
Follow up tests for stroke to find cause
A
1) ECHO
2) EKG and Holter if EKG normal
3) Carotid duplex
10
Q
Strongest risk factor with strokes
A
HTN
11
Q
Major causes of intracerebral vs subarachnoid hemorrhage
A
Intracerebral-uncontrolled HTN, Subarachonid-Sacular/ berry aneurysm or AV malformation rupture
12
Q
Tx for stroke with evidence of AFIB
A
Long term anticoagulation (eg warfarin, dabigatran, rivaroxaban)
13
Q
Strict contraindication tPA
A
Hemorrhagic stroke, stroke/head trauma 185/110, Platelet1.7 INR, PT>15, Increase PTT
14
Q
Basal ganglia hemorrhage neurologic findings?
A
Contralateral hemiparesis and hemisensory loss, homonymous hemianopsia, gaze palsy
15
Q
Cerebellum hemorrhage neurologic findings?
A
Medial vermis-vertigo and nystagmus
Later vermis-dizziness, ataxia, and weakness
-Ataxia, nystagmus, facial weakness, occipital headache and neck stiffness
16
Q
Thalamus hemorrhage neurologic findings?
A
Contralateral hemiparesis and hemisensory loss, nonreactive miotic pupils, upgaze palsy, eyes deviate Towards hemiparesis
17
Q
Cerebral lobe hemorrhage neurologic findings?
A
Contralateral hemiparesis (frontal lobe), contralateral hemisensory (parietal lobe), homonymous hemianopsia (occipital lobe), eyes deviate away from hemiparesis, high incidence of seizures
18
Q
Pons hemorrhage neurologic findings?
A
Deep coma and total paralysis within minute with pinpoint reactive pupils.
19
Q
SAH complications?
A
Rebleeding in 1st 24 hours and cerebral vasospasm after 3 days (prevent with nimodipine)
20
Q
Cushing reflux to increased ICP?
A
Hypertension, bradycardia, decreased resp rate
21
Q
When is imaging done for tension, migraine, cluster?
A
Unsure of diagnosis or recent started syndrome indicates head CT or MRI
22
Q
Test pseudotumor cerebri and tx.?
A
CT or MRI to exclude mass and opening pressure >250 on LP. Tx. acetazolamide to decrease CSF and stop offending medication if applicable
23
Q
Test giant cell?
A
Best initial: ESR. Most accurate: Biopsy
24
Q
Tx/prophylaxis tension headache?
A
NSAIDs/acetaminophen as tx and no prophylaxis
25
Tx./ prophylaxis migraine headache?
tx. Triptans, IV antiemetics (chlorpromazine). Prophylaxis >3 attacks/month: propranolol
26
Tx./prophylaxis cluster headache?
tx.100%o2 as abortive, subcutaneous sumitriptan, octreotide. prophylaxis: verapamil, phenytoin, ergot prednisone
27
Tx. protocol 1,2,3 for trigeminal neuralgia?
1) Carbamazepine/oxcarbamazepine
2) Baclofen/Lamotrigine
3) Gamma knife surgery
28
When is shingles vaccine indicated?
>60
29
What electrolyte does not cause seizures?
Potassium disorder
30
Tests before EEG with 1st unprovoked seizure
CMP (electrolyte, glucose, kidney func, renal function), CT/MRI, Urine drug screen
31
Tx. of status epilepticus?
1) Benzos
2) Phenytoin or fosphenytoin
3) Phenobarbitol
4) NM Blockade (succinylcholine, vecuronium) followed by intubation and general anesthesia after (propofol or midazolam)
32
Pheyntoin side effects?
- AV block
| - Hypotension
33
Consequence of prolonged seizure >5 minutes seen in status epilepticus?
Excitatory cytotoxicity (cortical laminar necrosis) especially common in those noncompliant to therapy
34
Complication of tonic clonic seizure?
Shoulder dislocation
35
Exception to rule where you should not start epileptic drug after single seizure?
Family hx, status epilepticus, abnormal EEG or CT lesion
36
Best test to tell if possibility of seizure recurrence?
Sleep deprivation EEG
37
What differentiates SAH from meningitis?
Loss of consciousness in 50% and very sudden onset
38
Best initial/most accurate SAH?
Noncontrast CT, LP showing blood w/ 1:500-1000 WBC to RBC ratio
39
Head CT w or w/o contrast indications?
CT w/o-suspecting blood. CT w/ cancer or infection
40
Tx. SAH?
1) Nimodipine, 2) Embolization (coiling), 3) VP shunt (if hydrocephalus develops), 4) Seizure prophylaxis with phenytoin
41
ASA infarction presentation?
Loss of all function except for the posterior column (position and vibration sensation)
42
Subacute combined degeneration presentation?
Loss of position and vibratory sensation (ataxic gait, paresthesia, impaired position and vibration sense)
43
Presentation and Treatment of spinal trauma?
Loss of reflex and motor function, hypotension. IVGlucocorticoids
44
Brown sequard presentation?
Pain and temp on contralateral side from injury 2 levels below and position and vibratory sense lost on ipsilateral side of injury
45
Best tx syringomyelia?
Surgical removal of tumor if present and drainage of fluid from cavity.
46
Best initial/most accurate brain abscess?
CT/MRI initial and biopsy accurate
47
Empiric tx brain abscess?
Penicillin + metro + ceftriaxone
48
Tuberous sclerosis symp?
HAMARTOMAS-Hamartomas, Ash leaf, mit regurg, angiofibroma, rhabdomyosarcoma (cardiac), tuberous sclerosis, auto dOm, mental redard, renal Angiomyolipoma, Seizure, shahgreen
49
Best diagnosis of NF2 acoustic schwannomas
MRI w/ gadolinium
50
NF1 presentation
Cafe au lait, neurofibromas (cutaneous), optic gliomas, lisch nodules (iris hamartomas),
51
NF2 presentation
Bilateral acoustic schwannomas, meningioma, juvenile cataracts, ependymomas
52
Sturge Weber presentation?
STURGE (Seizures/Stain, Tram track opposing gyri, Unilateral, Retardation, Glaucoma, Epilepsy)
53
Tx essential tremor?
1) propranolol 2) anticonvulsant (primodine/topiramate)
54
Parkinsons symptoms?
TRAPS (Tremor, Rigidity, Akinesia/brady, Postural instability (orthostatic hypotension), Shuffling gait)
55
What is shy drager (multiple system atrophy)?
Parkinsonism, autonomi dysfunction (cholinergic), widespread neurologic signs (cerebrellar) tx. volume expansion with hydrocortisone
56
Mild disease parkinsons tx >60 or
>60: amantadine (increases dopamine release from snpc) and
57
Severe disease w/ inability to care and orthostasis parkinson best initial/most effective therapy
Best initial: dopamine agonists (pramipexole, ropinirole) used with COMT inhibitor (tolcapone/entacopone) to reduce "on/off" phenomenon
Most effective: Levodopa/carbidopa
58
Best tx to prevent progression parkinson?
MAO inhibitor (rasagiline, selegiline)
59
Tx of spasticity (painful muscle contractions)?
Baclofen, dantrolene, and tizanadine (alpha agonist)
60
Tx RLS?
Mild/intermittent: Iron with
61
Symptom triad and tx in huntington?
Memory (dementia), Mood (psychosis w/haloperidol or quetiapine), Movement (dyskinesia tx with tetrabenazine)
62
Tourette tx?
Fluphenazine, pimozide, clonazepam (Cloning pimp on tour w/ flu). Methyphenidade and ADHD intrinsic to Tourette
63
LP for MS?
Increase protein, 50-100 WBC, increase IgG, oligoclonal bands
64
Tx for acute episode vs preventing relapse MS?
Acute-high dose steroids, plasmapharesis (if steroids not effective)
Relapse-B-interferon or Glatiramer
65
Patient hs worsening neurological defecits with use of chronic suppressive medication for MS with new mutiple white matter lesions. What caused it?
Natalizumab-alpha 4 integrin inhibitor also associated with PML
66
Diagnostic test/tx ALS?
Test-EMG and CPK (secondary to muscle wasting). Riluzole decreases glutamate buildup in neurons and baclofen treats spasticity. CPAP and BiPAP help with resp difficulties
67
Characteristics and Most accurate test charcot marie tooth?
Inverted champagne bottle legs, high arch (pes cavus), and motor and sensory loss. EMG
68
Tx. peripheral neuropathy?
Pregablin/gabapentin, TCA
69
Lateral cutaneous nerve percipitating event and presentation?
Obesity, pregnancy, and sitting with crossed legs. Pain/numbness of outer aspect of one thigh
70
Peroneal neruopathy pericpitating even and presentation?
High boots and pressure on back of knee. Weak foot with decreased dorsiflexion and eversion (footdrop)
71
Stroke vs bell palsy presentation"
stroke paralyze only lower half of face and can wrinkle forehead. Bell palsy is entire face and CANNOT wrinkle forehead
72
Presentation bell palsy
Paralysis entire half of face, hyperacusis (no innervation to stapedius), and taste disturbances (loss of sensation to anterior 2/3 of tongue)
73
Best test/tx for bell palsy?
Test-EMG, tx is prednisone
74
GBS presentation and tests?
Ascending weakness and decreased reflexes, best initial (PFT), EMG most accurate. CSF increased protein normal cell count (albuminocytologic dissassociation)
75
Tx GBS?
IVIG (children) OR plasmapheresis (adults), NOT prednisone
76
Best initial and most accurate test MG?
Best initial-acetylcholine receptor antiboides and most accurate is EMG
77
Best initial and best next step treatment MG?
Initial: Neostigmine or pyridostigmine
If not work 60: Prednisone w/ azthioprine tacrolimus cyclophosphamide and mycophenalate used to get patient off steroids before serious adverse events
78
Myasthenia crisis tx?
1) Endotracheal intubation
| 2) Meds (IVIG or plasmapharesis PLUS glucocorticoids) and hold neostigmine or pyridostimine to avoid excess.
79
Workup dementia?
MRI, VDRL/RPR, B12, TSH
80
Tx alzheimers?
Rivastimine, galantamine, donepezil or memantine
81
Tx lewy body
Levodopa or carbidopa
82
Tx frontotemporal
acetylcholine medication
83
CJD tx and signs?
None, Rapidly progressive dementia w/ 2 of 4 clinical (myoclonus, akinetic mutism, cerebellor or visual disturbance, pyramidal/EPS dysfunction), sharp triphasic on EEG or 14-3-3 CSF. Definitive biopsy or PRNP mutation
84
Triggers of vasovagal syncope?
Emotional distress, painful stimuli, and prolonged standing
85
Why do you have peripheral visual field defect?
CN VI palsy (lateral rectus muscle)
86
Symp of diabetic neuropathy?
Peripheral neuropathy (numbness, tingling and feeling of imbalance). Mononeuropathy (CNIII, ptosis and down and out with light reflex/accomodation intact)
87
Differentiating essential, parkinson, cerebellar, and physiologic tremmor
Essential-resting and intention, hands, worse with caffeine and better with alcohol
Parkinson-restin and improve with intention than restarts, hands and legs, increase with mental tasks
Cerbellar-intention, assoc with ataxia, dysmetria and chronic alcoholic
Physiologic-acute (eg drugs, hyperthyroid, anxiety, caffeine) and not visible under normal conditions. Worse with activity
88
What is tick borne paralysis?
Ascending paralysis (asymmetrical) more pronouned in 1 leg or arm with ABSENCE of fevery, sensory, and normal CSF. No autonomic dysfunction (unlike majority of patients with GBS (like lack of sweating, urinary retention, orthostasis, arrhythmias))
89
Wernicke triad?
Encephalopathy, oculomotor dysfunction (ophthalmopletgia) and gait ataxia
90
Korsakoff?
Present with wernicke and irreversible amnesia, confabulation
91
What test may be abnormal in pseudodementia?
Dexamethasone suppression (abnormal) to detect endogenous depression in 50%
92
Alzheimer presentation?
Early insidious short term memory loss followed by later personality changes. May see subcortical atrophy in parietal and temporal lobes predominate.
93
Tx. delirium
Tx underlying condition. Typical or atypical antipsychotics for agitation and benzo for alcohol withdrawal
94
Preservation of what in brain death?
DTR may be present b/c preservation of spinal cord function
95
Most significant cause of morbidity in patients with traumatic brain injuries?
Diffuse axonal injury due to deceleration injury-->vegetative state
96
Most common medications to cause dystonia?
Typical antipsychotics, metoclopramide, prochlorperazine
97
Evaluation of corneal abrasion?
1) Penlight for defect/foreign body identification and pupillary function
2) Fluorosceine after to show corneal staining defect
98
Location and management of brain metastasis?
Location-gray-white junction or watershed zones. Solitary (surgery) and multiple (whole brain radiation)
99
MCC brain abscess from direct spread of head and neck infection?
Viridans or anaerobic
100
MCC brain abscess after nuerosurgery or penetrating trauma direct inoculation?
S. aureus
101
MCC brain abscess from hematongenous spread via endocarditis or osteomyelitis infection?
S aureus
102
What level does spinal cord end at?
L1-L2
103
Presentation of sellar masses?
Bitemporal hemianopsia, headache, diplopia, pituitary hormonal deficiency
104
Presentation of central cord syndrome?
weakness more pronounced in upper extremities than lower and possible pain and temp sensation loss due to damage of spinothalamic tract seen in hyperextension injuries with preexisting degenerative changes to cervical spine
105
Presbycusis symptoms?
High freq hearing impariment difficulty hearing in crowded or noisy environments and trouble hearing high pitched noises
106
Metoclopramide MOA, effect, and side effects?
MOA prokinetic agent that is a dopamine receptor antagonist, treat nausea vomiting and gastroparesis, side effects: agitation, loose stools, drug induced EPS (tardive dyskinesia, dystonic rxns, and parkinsonism) tx. with benztropine or diphenhydramine
107
Best test for detecting vasopasm in SAH patients
CT Angiography
108
Aminoglycoside toxicity?
Ototoxicity (hearing loss) by damaging the cochlear cells and in some cases vestibulopathy (motion-sensitive hair cell damage)
109
What are lewy bodies?
Eosinophilic intracytoplasmic inclusions representing alpha-synuclein protein
110
Cause of myasthenic crisis?
1) infection or surgery
2) Pregnancy or childbirth
3) Tapering immunosuppressive drugs
4) Medications (eg aminoglycosides, fluoro, macro, B-blocker)
111
Symptoms myasthenia gravis?
Extraocular (ptosis, dipolia), bulbar (eg fatigable chewing, dysphagia, nasal speech), proximal limb, and resp muscles
112
What does motor control of eye muscles?
LR6SO4R3
113
Most common sacular (berry) aneurysm location and symptoms?
Located at branch points of circle of willis. Most commonly ACom and Anterior cerebral . Can present with bitemporal hemianopsia because of optic chiasm compression
114
Second most common saccular (berry) aneurysm location and symptoms?
Located at PCA and PCom can lead to CNIII palsy (Down and out with blown pupil and no afferent light reflex)
115
Glucocorticoids vs PMR myopathy?
Glucocorticoid progressive proximal muscle weakness and atrophy without pain or tenderness, lower extremity more with normal ESR/CK, PMR with pain and stiffness in shoulder and pelvic girdle with rapid steroid response and increased ESR with normal CK
116
What situation is LP contraindicated?
Acute head trauma, signs of intracranial HTN (ie papilledema) or suspicion for SAH. only do w/ NEG CT/MRI
117
What causes conduction velocity to be slowed?
Demyelination. watch out in GBS and MS
118
What causes EMG to show fasiculations or fibrillations at rest?
LMN (peripheral nerve problem)
119
What causes EMG with no muscle acivity at rest and decreased amplitude of muscle contraction with stimulation?
Intrinisc muscle disease as muscular dystrophies and inflammatory myopathies (Eg polymyositis)
120
Area involved when ignoring one side of body, trouble with dressing
nondominant parietal lobe
121
CN for midbrain, pons, medulla respectively?
CN III/IV-midbrain
V, VI, VII, VIII-pons
IX,X,XI, and XII-medulla
122
Direct spread via otitis media/mastoiditis affected area in brain?
Temporal lobe/cerebellum
123
Direct spread via frontal or ethmoid sinusitis affected area in brain?
Frontal lobe
124
Direct spread via dental infection affected area in brain?
Frontal lobe
125
Bacteremia from other sites of infection, cyanotic, heart disease?
Multple abscesses along distribution of middle cerebral artery (gray-white matter junction)
126
TOF heart disease increased risk?
Bacterial abscess secondary to R-->L shunt w/o bypassing pulm circulation where bacteria typically filtered and removed by phago
127
Gene mutation in NF1 and NF2 respectively
NF1 tumor suppressor gene codes for neurofibromin on chromosome 17. NF2 tumor suppressor codes for merlin on chromosome 22
128
Broca and Wernicke aphasia?
Broca-motor aphasia
| Wernicke-receptive aphasia
129
Posterior limb of internal capsule (lacunar infarct) clinical presentation?
Unilateral motor impairment (face, arm and to lesser extent leg), no sensory or cortical deficits, no visual field abnormalities
130
MCA occlusion?
Contralateral hemiparesis and hemisensory loss predominantly in upper limp and face. Homonymous hemianopsia with deviation of eye toward infarct
131
ACA occlusion?
Contralateral hemiparesis and hemisensory predom in lower extremity. Abulia (lack or willor initiative). Dyspraxia, emotional disturbance, urinary incontinence
132
Vertebrobasilar system lesion (supplying brain stem)
-Alternate syndromes with contralateral hemiplegia and ipsilateral CN involvement with possible ataxia
133
Stroke in the VPL nucleus of thalamus?
Unilateral numbness, paresthesias, and hemisensory deficit involving face, arm, trunk, and leg (pure sensory)
134
Lacunar infarction of anterior limb of internal capsule?
Weakness more prominent in lower extremity along with ipsilateral arm and leg incoordination
135
Lacunar stroke at the basis pontis?
Dysarthria-clumsy hand syndrome with hand weakness, mild motor aphasia, no sensory abnormalities.
136
Vestibulocerebellar symptoms of wallenberg syndrome (lateral medullary infarct)?
Vertigo, falling to side of lesion, difficulty sitting upright without support, diplopia and nystagmus, ipsilateral limb ataxia
137
Sensory symptoms of wallenberg syndrome?
Loss of pain and temp on ipsilateral face and contralateral trunk and limps
138
Ipisilateral bulbar muscle weakness of wallenberg?
Dysphagia and aspiration. Dysarthria and hoarseness
139
Autonomic dysfunction of wallenberg?
Ipsilateral Horner's (PAM), lack of autonomic respiration during sleep
140
Posterior (dorsal) cord syndrome?
Bilateral loss of vibratory and propioceptive sensation, often with weakness, paresthesias, and urinary incontinence or retention
141
Anterior (ventral) cord syndrome?
Bilateral spastic motor paresis distal to lesion nad loss of pain and temp on both sides below the lesion with intact propioception
142
Differences in conus medullaris vs cauda equina?
Cauda (peripheral LMN)-hyporeflexia, asymmetric motor weakness and late-onset bowel/bladder dysfunction
Conus-hyperreflexia, symmetric motor weakness, early-onset bowel/bladder dysfunction
143
Ataxic, staggering, wide-based gait area affected?
Cerebellum
144
Magnetic (freezin) start and turn hesitation gait?
Gait apraxia (frontal lobe signs)
145
Short steps, shuffling that is hypokinetic
Parkinsonian
146
Footdrop, excessive hip and knee flexion with slapping quality?
steppage from motor neuropathy commonly the peroneal nerve
147
Unsteady, falling to one side with sensation of ear fullness due to abnormal accumulation of endolymph?
Acute labyrinthitis or meniere disease (vestibular gait)
148
Cause of BPPV?
crystalline deposits (canaliths) in the semicircular canals that disrupt the normal flow of fluid in the vestibular system
149
Meniere disease presentation?
Ear fullness causing unilateral tinnitus and hearing loss with episodic vertigo
150
BPPV presentation?
Brief positional changes causing vertigo WITHOUT neurologic or auditory symptoms
151
Vestibular neuritis vs Labyrinthitous presentation?
Post viral with vertigo. Hearing loss in labyrinthitis and no hearing loss in neuritis.
152
What is otosclerosis?
Bony overgrowth of stapes associated with low-frequency hearing loss found in middle aged 20s-30s
153
Side effect levodopa plus carbidopa?
Somnolence, confusion, hallucinations (older patients), dyskinesia
154
Trihexyphenidyl or benztropine side effects?
Anticholinergic (hot as hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, and full as a flask)
155
Amantadine side effect?
Ankle edema nd livedo reticularis
156
Entacapone or tolcapone side effects?
Dyskinesia, hallucinations, confusion, nausea and orthostatic hypotension
157
Selegeline side effect?
Insomnia and confusion
158
EPS effects and treatments?
Acute dystonia (4hour)-tx with benztropine or diphenhydramine, Akathisia(restlessness). tx with benzo. Parkinsonism (4 week) with no effective tx. Tardive dyskinesia (4 months) with no effective tx.
159
Pronator drift is a sensitive and specific finding for what?
UMN disease
160
Right anopsia location of lesion?
Right optic nerve
161
Left homonymous hemianopsia location of lesion?
Right optic tract
162
LUQ anopsia?
Right optic radiation in right temporal lobe
163
LLQ anopsia
Right optic radiation in right parietal lobe
164
Left homonymous hemianopsia with macular sparing?
Right occipital lobe (from PCA occlusion)
165
Lesion causing loss of gag reflex and loss of taste in posterior 2/3rd of tonuge?
CN IX lesion
166
Recurrent laryngeal nerve palsy and hoarseness dysphagia and loss of gag or cough reflex?
CN X lesion
167
CN XI lesion?
Look away from lesion and ipsilateral shoulder droop secondary to loss of innervation of SCM and trapezius
168
CN XII lesion?
Protruded tongue deviates to same side as lesion
169
First line agents of simple seizure?
Carbamazepine, lamotrigine, oxcarbazepine, and levetiracetam
170
First line complex partial/tonic clonic?
Valproate, lamotrigine, levetiracetem
171
First line absence?
Ethosuximide and valproate
172
Secondary seizure tx.
Benzo and/or phenytoin or fosssphneytoin
173
What is hemiballismus (random,violent, unilateral flailing of limbs) caused by?
Subthalamic nucleus lesion
174
Test for peripheral neuropathy?
Nerve conduction studies
175
Tx organophosphate (inhibition of AChE) poisoning?
Atropine or pralidoxime
176
4 Classic signs of basilar skull fracture?
-CSF otorrhea or rhinorrhea, hemotympanum, postauricular ecchymosis, periorbital ecchymosis ("raccoon eyes")
177
#1 sign og increased ICP?
Bilateral dilated and fixed pupils
