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Neuro Flashcards

1
Q

complex regional pain syndrome

A

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

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2
Q

peripheral neuropathy

A

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

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3
Q

diabetic neuro

A 
distal symmetric polyneuropahty
autonomic: erectile dysfunction 
no tx
control sugars
tx: gabapentin, TCA, lyrics, cymbals, lidoderm patch
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4
Q

charcot-marie tooth dz

A

complain of motor sxs
foot drop
no tx: use ankle foot orthrosese, genetic counseling

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5
Q

trigeminal

A

shooting pain in the corner the mouth and goes to mandible

worse with chewing

tx: gabapentin

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6
Q

post herceptic neuralgia

A

tx: acyclovir and steroids

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7
Q

Bell’s Palsy

A 
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)

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8
Q

cluster headaches

A

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

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9
Q

migraine

A

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

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10
Q

tension HA

A

generalized, constant
gripping, vice-like

triggers: stress, fatigue

tx: reduce stress, improve sleep, ASA, APAP, NSAiDs
caffeine, butabial

amitriptyline for prophylaxis

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11
Q

encephalitis

A

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
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12
Q

meningitis

A

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

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13
Q

essential tremor

A

postural tremor of hands, head, and voice
fix
may be being at any age
ETOH relieves sx

no disabling

tx: propanalol
primidone

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14
Q

huntington dz

A

autosomal dominance
gradual:chorea, dementia, and behavior changes

30- 50 y/o, fatal

no diagnostic tools

genetic test available

tx: sxs:
tetrabenzaine for dyskinesias

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15
Q

parkinson dx

A

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

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16
Q

cerebral aneurysm

A

berry aneurism
anterior circle of willis
asymptomatic until they rupture

RF:

diagnosis : CT or MRA,
angiography ( gold standard)

monitor :

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17
Q

stroke

A

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

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18
Q

ischemic stroke diagnosis

A

CT head

check for coagulopathy, autoimmune disorders, cardiac evaluation

19
Q

subdural hematoma

A

crescent saved collection on CT brain

tx: wath/watch, evacuate with burr hole, tx for seizure

20
Q

epidural hematoma

what is it?

A

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

21
Q

Altered mental status

A

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

22
Q

exam of ALC

A

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

23
Q

glasgow coma scale

memorize

A

severe head injury- 8 or less
moderate : 9-12
mild 13-15
testing eye opening, verbal response, and motor response

24
Q

how to approach ALC

A

depends on disorder

stabilize c-spine
control seizures

coma cocktail:
dextrose, naloxone, thiazmie

25
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
26
concussion of sports
grade 1: remove from consent grade 2; remove for 1 weeks grade 3- to ed, CT/MRI daily exams
27
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 ```
28
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
29
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
30
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
31
alzheimer dx
exercise ``` aricept, exelon named trazadone for sleep agitation r/o delirium last resort: low dose atypical antipsychotic ```
32
other types of dementia
vascular- multiple strokes lewy body dementia: parkinsonism frontotemporal lobar- disorder of behavior rude, sexually explicit, impulsive, binging
33
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
34
delirium evaluation
history PE labs EKG identify and tx disorder prevention avoid anticholingerics
35
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
36
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
37
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
38
seizure
epilepsy- recurrent unprovoked seizure etiology: genetic focal or general complex partial simple partial switching or jerking in one limb Jacksonian March
39
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
40
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
41
syncope
no blood flow to brain causes: carotid stenosis, orthro static hypotension, vasovagal s/sx: faints dm common cause
42
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
43
tourette syndrome
frequent motor/ phobic tics motor tics most common tx: CBT clonidine haloperidol

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