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Neuro Flashcards

1
Q

Types of strokes (3)

A

Embolic (ischemic)
thrombotic (ischemic)
Hemorrhagic (SAH and IPH)

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2
Q

Seizure: causes

A 
Vascular (stroke)
Infection (meningitis/encephalitis)
Trauma (TBIs and brain bleeds)
Autoimmune (lupus cerebritis)
Metabolic (ca, Na, glucose)
Ingestion/withdrawal(benzos/EtoH)
Neoplasm
Psychiatric

VITAMINS

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3
Q

Status epilepticus: TX progression

A

Benzos (a lot of lorazepam) –> IV fosphenytoin and intubation –> midazolam and propofol –> phenobarbital

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4
Q

Broad spectrum anti-epileptics good for general epilepsy

A

valproate, lamotrigine, levetiracetam

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5
Q

Myoclonic: features and tx

A

no LOC and no loss of tone

valproate

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6
Q

Atonic: features and tx

A

No LOC, but loss of tone

valproate

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7
Q

Parkinsons disease: clinical features (4)

A

bradykinesia
cogwheel rigidity
resting tremor
gait/postural instability

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8
Q

Parkinsons disease: TX

A

NOTE: amantadine is wrong

COMT-inhibitors (-capones)
MOA-B inhibitors (selegeline)
Dopamine agonists (ropimerole, promipexole)
carbidopa/levodopa

If <70 and functional: start with dopamine agonist
If >70 or not functional: start with levodopa/carbidopa, then COMT and MOA-B inhibitors as dopaminergic neurons continue to degenerate in substantia niigra

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9
Q

Types of primary headaches (4)

A

Tension

Analgesic rebound

cluster

migraine

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10
Q

Tension HA: clinical features and TX

A

features: BL vice-like, with radiation down to neck

TX: NSAIDs, acetominenophen

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11
Q

Cluster HA: clinical features and TX

A

vascular pathology
asymptomatic for months, but then HA 8-10x/day with unilateral eye pain with a Horner syndrome-type presentation

TX: abortive–O2, then sumitriptan
ppx–ccbs (verapamil)

F/U with 1x brain imaging

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12
Q

Migraine HA: clinical features and TX

A

pathology is vascular

unilateral, pulsatile pain that is debilitating and lasts 4-72 houyrs w/o abortion

TX:
Abortive
mild–NSAIDs
mod-severe–triptans and ergots

PPX
propranolol
valproate
topiramate

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13
Q

Idiopathic intracranial HTN

A

female taking OCPs and/or acne meds with ICP (papilledema, FND, N/V, HA especially in morning)

negative CT
LP with high opening pressure (>25cmH20) and symptomatic relief

TX: acetazolamid, serial LPs, VP shunt

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14
Q

Reflexes to assess for brain stem function

A

corneal reflex (with Q-tip)
cold-water calorics (cold water causes opposite beating nystagmus in normal brainstem, and warm water same)
Dolls eye reflex (eyes should move when you turn head

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15
Q

Alzheimers: initial impairment

A

memory

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16
Q

Picks disease: initial impairment

A

personality (memory is retained)

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17
Q

Picks: CT finding

A

fronto-temporal atrophy

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18
Q

Lewy-Body dementia: features

A

parkinsonian type features albeit predominantly with dementia and also with visual hallucinations

Fluctuating cognition

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19
Q

Alzheimers: treatment

A

donepezil

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20
Q

Normal pressure hydrocephalus

A

Path: increased ICP
Wet, wacky, wobbly (ataxia early in disease)

DX: CT showing hydrocephalus and dilated ventricles
LP provides improvement

TX: VP shunt

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21
Q

CJD: DX

A

MRI

Clinically: behavioral change and myoclonus +/- seizures

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22
Q

Peripheral vertigo causes (3)

A

BPPV
labrynthitis/vestibular neuritis
Menieres

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23
Q

Menieres: clinical features and tx

A

Triad of hearing loss, vertigo, and tinnitus lasting <1hr but >30 minutes

Tx: salt restriction, thiazide duiretics, and meclizine

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24
Q

Labrynthitis/vestibular neuritis: clinical features and tx

A

4wks after a viral URI

vertigo with hearing loss, N/V lasting up to a week

TX: steroids and meclizine

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25
Q

BPPV: path, clinical features, and Dx/TX

A

path from otolith in vestibular system

recurrent, reproducible vertigo lasting <1 minute with positional changes

Dx: dix-hallpike maneuver
Tx: Epley maneuver

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26
Q

Multiple sclerosis: MRI findings

A

Periventricular white matter

NOTE: get this for initial diagnosis of MS before committing to high dose steroids

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27
Q

Multiple sclerosis: chronic tx

A

IFN
glatiraner
fingolonod
Bethanocol for urinary retention

amitriptyline for urinary iconinence

baclofen for spasms
gabapentin for neuropathic pain

28
Q

Ascending paralysis and hyporeflexia in s/o recent diarrheal illness

A

GBS

NOTE: can also proceed URI and be accompanied by paresthesias and dysarthria

29
Q

GBS: managment

A

NEVER steroids

give IVIG or do plasmapharesis, or try one then the other

30
Q

Myasthenia gravis: TX

A

Chronic: cholinesterase-inhibitor, give steroids, remove thymoma if diagnosed on CT

Acute crisis: IVIG or plasmaphoresis

31
Q

Eaton lambert disease: clinical features

A

Initial fatiguability, improvement with use

Issues with proximal muscles

EMG shows increased amplitude of impulses with more attempts

CT can show small cell lung cancer (paraneoplastic syndrome)

32
Q

Neuromuscular junction diseases

A

MG
Lambert eaton syndrome
organophosphate poisoning
botulism

33
Q

Muscle fibers

A

muscular dystrophies

polymyositis and dermatomyositis

hypothyroidism

corticosteroids

HIV myopathy

34
Q

Peripheral nerve diseases (5)

A

hereditary primary motor sensory neuropathy

GBS

diabetic neuropathy

amyloid neuropathy (MM)

Lead poisoining

35
Q

Anterior horn cell neuropathies (4)

A

Poliomyelitis

spinal muscular atrophy

ALS

paraneoplastic syndromes

36
Q

Upper motor neuron disorders

A

leukodystrophy

vasculitis
brain mass
vit B12

37
Q

Non eccymotic swelling in scalp on newborn that was not present at birth and involves one cranial bone

A

cephalohematoma

caput succedaneum is eccymotic and crosses suture lines

38
Q

Serotonin syndrome vs neuroleptic malignant syndrome

A

Serotonin syndrome: triad of AMS, autonomic instability, and neuromuscular excitability (tremor, hyperreflexia, and myoclonus)

Neuroleptic malignant syndrome: tetrad of AMS, autonomic instability, rigidity, and fever

39
Q

Lithium toxicity

A

coarse tremors, ataxia, AMS, N/V, hypotension

40
Q

Cholinesterase inhibitors used in alzheimers disease

A

donepezil, galantamine, and rivastigmine

41
Q

Normal CSF values

A

Cells: O-3
glucose: 50-100
protein: 20-45
Pressure: 100-200

42
Q

CSF values in viral/aseptic meningitis

A

Cells: >100 lymphocytes
glucose: 50-100
protein: 20-45
Pressure: 100-200

43
Q

CSF values in bacterial meningitis

A

Cells: >1000 PMNs
glucose: <50
protein: 100
Pressure: >200

44
Q

pseudotumor cerebri =

A

idiopathic intracranial HTN

45
Q

peripheral nerve lesion: EMG findings

A

fasciculations/fibrilations at rest

46
Q

Intrinsic muscle disease: EMG findings

A

no muscle activity at rest

Decreased amplitude of muscle contraction upon stimulation

47
Q

Broca vs wernickes area: location

A

Broca: dominant frontal lobe
Wernicke: dominant temporal lobe

48
Q

Midbrain cranial nerves

A

3 and 4

49
Q

Pons cranial nerves

A

5,6,7, &8

50
Q

Medulla cranial nerves

A

9-12

51
Q

Seizure with no post-ictal state

A

absence seizure

52
Q

Normal age range for febrile seizure

A

6months old - 5 years old

53
Q

25 year old with pmh of mr who has inability to relax grip =

A 
myotonic dystrophy (autosomal dominant)
Tx involves genetic counseling
54
Q

Shy-Drager syndrome =

A

Parkinsoism predominantly with orthostasis

55
Q

Medication used chronically in multiple sclerosis that can cause progressive multifocal leukoencephalopathy

A

Natalizumab

56
Q

Paralysis of entire side of the face, involving forehard

A

bells palsy

57
Q

Paralysis on one side of face, but can still wrinkle forehead =

A

stroke until proven otherwise

58
Q

Bells palsy: TX

A

prednisone +/- acyclovir

59
Q

Herpes simplex encephalitis: CSF findings and most accurate imaging

A 
CSF
Cells: >100 WBCs (90% lymphocytes)
glucose: 50-100
protein: elevated (>100)
Pressure: 100-200
RBCs present (from destruction of temporal lobe)

Imaging
MRI most accurate (CT nl in 50% of cases)

60
Q

Wernickes encephalopathy: clinical features

A

triad of sxs
encephalopathy (confusion)
oculomotor dysfunction (nystagmus)
gait disturbance (broad based)

61
Q

Spinal epidural abscess: TX

A

vancomycin and ceftriaxone (staph aureus most likely causative organism)

62
Q

Contralateral hemiparesis and sensory loss due to ___

A

putaminal hemorrhage and involvement of adjacent internal capsule

63
Q

Transient, focal neurologic deficit occurring after a seizure

A

Todd paralysis

64
Q

Digoxin toxicity

A

N/V, diarrhea, vision changes, and arrythmias (percieved as palpitations)

65
Q

Small-vessel lipohylanosis is caused by ____ and inturn causes___

A

atherosclerosis

thrombotic small-vessel occlusions–> lacunar strokes and pure contralateral motor or pure sensory deficits

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