NEURO Flashcards
What is the most common form of dementia?
Alzheimer’s
What form of dementia has a slow/gradual onset, over 8-10 years?
Alzheimer’s
If a patient is having difficulties with memory, they can’t seem to learn new info but their motor and sensory function is spared – what disorder?
Alzheimer’s
What form of dementia has gradual onset, but also involves hallucinations, visuospatial fluctuations along with Parkinsonism?
Lewy Body dementia
If a patient is having difficulties with language and executive functioning – what disorder?
Frontotemporal dementia
If on MRI a pt has cortical & subcortical changes with sudden almost stepwise changes in function – what disorder?
Vascular dementia
What should be done on PE in a pt with dementia?
neuro exam, mental status, functional status (SLUMS, mini-cog, MMSE)
What type of labs should we order in a pt we suspect dementia?
CBC Na BUN/Cr Fasting Glucose RPR TSH B12 Possible UA folic acid and liver function
In a pt we suspect dementia, when would we consider imaging?
onset <65; focal sxs; concern from hydrocephalus; recent fall or head trauma
What are some non-pharm options for tx dementia?
cognitive rehab
therapy
physical & mental activity
attention to safety
What is being broken down too quickly with dementia?
Acetylcholine
What medications slow the breakdown of acetylcholine and are prescribed for dementia? Give some examples
Cholinesterase inhibitors
Ex: Donepezil or memantine
What should you always keep on your DDx in a patient you’re concerned has dementia, and thus we may treat them for this as well?
Depression
Parkinson’s disease is a disease involving what NT?
Dopamine
What are some of the hallmark sxs of Parkinsons? (5)
- Tremor = worse at REST – pill rolling
- Bradykinesia = slowness of voluntary movements (lack of swinging arms, slow speech)
- Rigidity = Cogwheel (normal DTRs)
- Fixed Face
- *Festination Gait = turn “en bloc”
At what point do we start to treat Parkinson’s?
When sxs interfere with function
With what meds can we treat Parkinson’s?
- Dopamine reuptake inhibitors = Amantadine
- Dopamine = Levodopa
* Start low and titrate up
If a pt is presenting with acute changes in mental status – what should you always think of first?
MEDICATIONS
What 3 meds a classic for causing acute changes in mental status?
anticholinergics, prednisone, benzo’s
Besides medications, what other things may we need to change in order to help with mental status changes?
sleep deprivation immobility visual/hearing impairment INFECTION DEHYDRATION
What are some of the risk factors to a stroke?
HTN!! (MOST POWERFUL RF) Smoking* atherosclerosis elsewhere DM* AFib
Other: male, ETOH, hyperlipidemia, AIDS, previous stroke
A lacunar infarct is occurring where? What type of sxs are associated with these?
SMALL VESSEL Disease
May be without findings – incidental on CT
A cerebral emboli stroke is what?
Embolism from heart or artery breaks off and occludes a distant vessel à in the brain
What type of stroke is often associated with Afib and is the reason why it’s so important to anticoagulate pt’s with afib?
Cardioembolism
What artery is affected when a pt has contralateral hemiplegia (hemiparalysis) after a stroke?
Middle Cerebral Artery
What artery is most commonly occluded during a stroke?
Middle Cerebral Artery
If this artery is occluded during a stroke it can lead to loss of several reflexes (grasp, suck), paralysis of foot/leg, urinary incontinence, and behavioral changes.
Anterior Cerebral Artery
If an occlusion occurs in this area of the brain it will results in visual deficits and changes in pupils/sensations?
Posterior Circulation
If a pt has transient monocular blindness – what does that mean, what is it called?
Embolism of ophthalmic artery
Amaurosis Fugax
If it is an acute stroke, what imaging do you need? What are you ruling out?
CT scan
R/O Hemorrhage
After a CT scan what’s the next imaging needed? What’s technically the gold standard?
MRI
Gold Standard = Arteriography
During an acute stroke what do we do if their BP is 180/90?
LEAVE IT – avoid rapid BP reduction
During an acute stroke what do we do if their BP is 203/100?
Okay now you need to lower it – SLOWLY!
So, how do we treat an acute stroke?
Once hemorrhage has been ruled out…
<3 hours = TPA + full anticoagulation
What are contraindications to TPA?
- Previous stroke or recent bleeding/major surgery
- BP >185/110
- Neoplasm
- Glucose <50 & platelets <100,000
- Heparin use within 48 hours
What’s the difference between a stroke & TIA?
Stroke = sxs >24 hours, irreversible damage TIA = sxs <24 hours, reversible
What surgical treatment is available for a TIA?
carotid endarterectomy or carotid angioplasty/stenting
What pharm Tx is available for TIA? When do we initiate it?
ASA
If Pt is a poor operative candidate, <70% stenosis
