Neuro Flashcards
complex regional pain syndrome
follows an injury to extremity
pain, swelling, color/temp changes. Pain is burning, exacerbated by light tough
severe tenderness to light touch
tx: early intervention is best
saids, steroids, PT/OT, pain management, gabapentin
regional nerve block
peripheral neuropathy
caused by anything
motor, sensory, autonomic
acute: infectious, GB
Motor: weakness, distally and ascent proximal
lower ext: dorosflexion of foot, foot drop
sensory sx; stocking glove distribution, numbness/ pain
Muscle atrophy
PE: diminished DTR
Dx: EMG and nerve conduction
Nerve/ skin bx: for vasculitis
labs; glucose, BUN/Cr, CBC, vitamin b6 /b12 RPR
diabetic neuro
distal symmetric polyneuropahty autonomic: erectile dysfunction no tx control sugars tx: gabapentin, TCA, lyrics, cymbals, lidoderm patch
charcot-marie tooth dz
complain of motor sxs
foot drop
no tx: use ankle foot orthrosese, genetic counseling
trigeminal
shooting pain in the corner the mouth and goes to mandible
worse with chewing
tx: gabapentin
post herceptic neuralgia
tx: acyclovir and steroids
Bell’s Palsy
no clear etiology follow a stress to body ( dm, pregnancy, infection) ipsilateral ear pain loss of motor control of mouth pt recover all the way
start steroids in 5 days
the worst it looks the better it is ( bells palsy vs. stroke)
cluster headaches
men in 40’s
retroorbital, red, tearing of eye, ptosis, myosis
at night and clusters
triggers: similar to migraines
tx: abortive: oxygen, SC triptans, steroids
prophylactic: verapamil
topirmate, lithium
migraine
nervous dysfunction
women ( teen to 30s)
fix
unit, throbbing, n/v, motion worse, photophobia, photophobia
auras( zigzags, flashes of lights)
triggers: stress, foods, smells, bright lights, menstruation
imaging: not warranted
tx: avoid triggers, dark/quite room
abortive: NSAIDs, ASA, APAP
ergotamine with caffeine
triptans
preventing: antileptitus
antihypertensives
tension HA
generalized, constant
gripping, vice-like
triggers: stress, fatigue
tx: reduce stress, improve sleep, ASA, APAP, NSAiDs
caffeine, butabial
amitriptyline for prophylaxis
encephalitis
infection of brain tissue
viral causes
happens with meningitis
herpes simples
west nile
If immunocompromised: HIV, Varicella/ zoster
fever, malaise, n/v, rash,
headache, seizures
lumbar puncture: elevated opening pressure, elevated ptn, and lymphocytes, normal glucose
CT head first if risk for cerebral herniation
MRI, EEG
Tx: acyclovir supportive: ICU, seizure monitor, hydrate, fever anti-emetics west nile: ribavirin weeks to months for recovery
meningitis
infection of arhachoid membrane, pia matter, and css
bacterial and viral
incidence is lower with vaccine
h. flu- children
strep pneuma- adults
neisserira- dorms, barracks, jails
listeria:
presentation: stiff neck, fever, headache,
Kerning/ Brudzinksi signs
petechiae/ ecchyotic rash
seizure, hydrocephalus, CN abxn
lumbar puncture: elevated opening pressure, CSF w/ decreased glucose, grain stain, cx
tx: IV abx and dex
Vanco and 3rd gen cephaosporin
continue to examine-give mannitol for elevated ICP
viral: enterovirus, coxsackie
fever, ha, stiff neck, don’t look as sick
csf: normal glucose, normal protein, run PCP,
tx: supportive tx, fluids,
treated as outpatient
essential tremor
postural tremor of hands, head, and voice
fix
may be being at any age
ETOH relieves sx
no disabling
tx: propanalol
primidone
huntington dz
autosomal dominance
gradual:chorea, dementia, and behavior changes
30- 50 y/o, fatal
no diagnostic tools
genetic test available
tx: sxs:
tetrabenzaine for dyskinesias
parkinson dx
second most common neuro-degenerative
45-65
cardinal: pill rolling tremor, rigidity ( cogwheel), bradykinesia( hard to stand up)
masked faces, reduced to blink
no muscle weakness or reflex changes
tx: levodopa-coveted to dopamine
combine with levodopa
other meds: amantadine, anticholinergics, dopamine agents,
deep brain stimulation
cerebral aneurysm
berry aneurism
anterior circle of willis
asymptomatic until they rupture
RF:
diagnosis : CT or MRA,
angiography ( gold standard)
monitor :
stroke
ischemic- 85%
RF: AA/Hispanic, men, HTN, DM/ smoking , carotid stenosis, A.fib
ishchemic: plaque
emboli-
lacunar: smaller arterioles
TIA 24 hours, brain infarction
Need an accurate timeline
usually painless
exam: focal neuro déficit
MCA- middle cerebral artery( contralateral hemiparesis, arm/face, sensory loss, expressive aphasia)
dx: CT brain
investigate etiology of stroke
cardiac investigation
ABC:
correct glucose
thrombolytic therapy:
3-4 hours– too late
ASA effective for acute ischemia stroke
tPA contraindication:
BP 180/ 110, major surgery or trauma w/in 2 weeks, active GI, recent anti coagulated, evidence of CH,
prevention: ASA, plavix, control lipids, control BP, smoking cessation, anti-coags for a. fib, OT/PT therapy
ischemic stroke diagnosis
CT head
check for coagulopathy, autoimmune disorders, cardiac evaluation
subdural hematoma
crescent saved collection on CT brain
tx: wath/watch, evacuate with burr hole, tx for seizure
epidural hematoma
what is it?
blood accumulates below the skull but above dural
-looks convex on CT
evolve faster than SDH
may have a lucid vessel but not common in real world
tx: rapid surgical cautery and ligation of damaged vessel
tx skull fx
Altered mental status
4 conditions
stupor= transient arousal by vigorous stimuli
comatose= arousable, not response to ext events-
vegetative state: wakefulness is retained but awareness of self
results from: seizure, hypothermia, drugs, metabolic disorders
exam of ALC
exam: response to painful stimuli, pupil reactions, ice water caloric
ox sat
EKG
serum glucose, calcium, LFT’s, BUN/Cr, toxicology
EEG, brain imaging ( CT/MRI), lumbar puncture
glasgow coma scale
memorize
severe head injury- 8 or less
moderate : 9-12
mild 13-15
testing eye opening, verbal response, and motor response
how to approach ALC
depends on disorder
stabilize c-spine
control seizures
coma cocktail:
dextrose, naloxone, thiazmie
concussion
transient trauma-induced change in mental status
watch carefully to detect hematoma or edema
s/sx: ha, n/v, disoriented, lethargic, amnesia, glascow coma scale
ct scan
Grade 1- transient confusion, sxs last 15, no loss consciousness
grade 3- severe- ER evaluation, consider admission
concussion of sports
grade 1: remove from consent
grade 2; remove for 1 weeks
grade 3- to ed, CT/MRI daily exams
post concussion syndrome
lasts weeks to > 1 yr
ha- primary sxs neuro psycho sxs tx: NSAIDS, acetaminophen, triptans vestibular maneuvers for dizziness increased risk for Alzheimer, Parkinson, CTE
cerebral palsy
trauma during birth ( hypoxia,
chronic and static impairment of mm tone
high risk for premature
exam: spasticity in common
ataxia, chorea, seizure disorder, mental retardation
exam: hyperreflexia
MRI brain
tx: maximize physical function- PT/OT
baclofen
px depends on how bad it is
dementia
progressive decline in intellecutal/ cognitive function
not due to psychiatric illness
typically 60 y/o
reversible dementia- low thyroid, b12 deficient, thiamine
vascular demential
lewy body dementia
alzheimer d
anterograde amnesia first and most intense sx
short term memory loss
language difficulty- word findings
executive dysfunction
apathy
exam: reversible causes
Mini mental state exam
Neuro psych exam
screen for depression
no genetic
consent to death -some years to a couple of years
at risk for delirium
cease driving
alzheimer dx
exercise
aricept, exelon named trazadone for sleep agitation r/o delirium last resort: low dose atypical antipsychotic
other types of dementia
vascular- multiple strokes
lewy body dementia: parkinsonism
frontotemporal lobar- disorder of behavior
rude, sexually explicit, impulsive, binging
delirium
acute state of confusion
check for some systemic problem
rapid onset
sundownig- pm onset of delirium in demented pt
RF: age, dementia, sleep deprivation, immobilization, psychiatric meds, impaired vision
causes; correct alcohol withwrar, infection,
anterograde and retrograde- impaired short-term memory and recall
delirium evaluation
history
PE
labs
EKG
identify and tx disorder
prevention
avoid anticholingerics
Guillain-Barre syndrome
acute onset of weakness being in the legs following viral infection
seen with C. jejune
start in the legs and move upwards
dx; clinical,
tx: plasmapheresis , IVIG, steroids not that effective, breathing support
recovery over months
MS
young women of western- europe
autoimmune- white matter dz
s/sx: weakness, double vision, migrate from limb to limb
exam: hyperreflexia, nystagmus, pregnancy will help
relapsing remitting- period of remission after into episodes
secondary progressive- initially have relapsing- reciting an then persistent
primary progressive- steady decline
have to have 2 or more sxs lasting > 24 hours and appear in a different site and then happen again
has to be dissemination in time and space
MRI brain- dawson’s fingers
lumbar puncture- oligoclonal bands, myeline basic pix
EMG
tx: acute attacks with coritocsterods
beta interferon
immune modulators
Myasthenia graves
weakness of voluntary mm
sxs: double vison, ptosis,
dx: weakness on exam, receptive nerve stimulation
dx: serum acetylcholine receptor
tx: pyridostigme,neostigmine
avoid aminoglycosides
thymectomy if pt
seizure
epilepsy- recurrent unprovoked seizure
etiology: genetic
focal or general
complex partial
simple partial
switching or jerking in one limb
Jacksonian March
generalized seizure
absence seizure- brief impairment of consciousness - childhood
grand mal- tonic clonic , shaking, jerking, up going toes ( post-ictal) state, tongue biting
produce
dx: brain imaging, EEG, labs, lumbar puncture
meds: ETOH withdrawal
classics: valproic acid
keppra-dont’ have to measure
phenytoin
pregnancy: make sure to check contra indications
status epilepticus
medical emergency!
repeated seizures w/o recovery > 30 minutes
maintain airway
50% dextrose
benzodiazepines
( phenytoin, fosphenytoin)
respiratory depression and hypotension possible
may need to intubate
syncope
no blood flow to brain
causes: carotid stenosis, orthro static hypotension, vasovagal
s/sx: faints
dm common cause
vassal syncope
fear, emotion/ anxiety
pt get faint,light headed
avoid triggers
work up: head injury, cardiac work up, carotid imaging
evaluation: vasoconstrictor, treat cardiac abn
tourette syndrome
frequent motor/ phobic tics
motor tics most common
tx: CBT
clonidine
haloperidol
