Neuro 6 Flashcards
Define apraxia and what part of the brain causes it
o Inability to carry out a learned motor task despite preservation of the primary functions need to carry out the task, such as comprehension, motor ability, sensation, and coordination
o Caused by lesions in the frontal or parietal lobes of the dominant hemisphere – cortical lesion
Describe agnosia and what part of the brain causes it
o Inability to recognize objects despite preservation of the basic sensory modalities being used
o Caused by lesions in the sensory associated areas of the brain – processing areas that lie next to the primary sensory areas – cortical lesion
4 components of Gerstmann syndrome
♣ 1. Agraphia (inability to write)
♣ 2. Acalculia (inability to calculate)
♣ 3. Finger agnosia (inability to distinguish fingers)
♣ 4. Left-right disorientation
Part of the brain affected in Gerstmann syndrome
o Damage to dominant parietal cortex
Part of the brain affected in hemispatial neglect
o Damage to non-dominant frontal or parietal cortex (usually R-sided)
o Will cause neglect to contralateral (L) side
Describe tests that should be done in a patient with dementia
♣ Hematologic screening including ESR
♣ Vitamin B12 and Folate
♣ Calcium
♣ LFTs, including ammonia
♣ Electrolytes
♣ Serum urea nitrogen and creatinine levels
♣ Infection workup: Syphilis, HIV, TB, etc.
♣ Thyroid function tests
♣ EEG – look for seizuers
♣ CT or MRI – structural abnormalities (tumor, hematoma, hydrocephalus)
♣ Brain biopsy – CJD, HIV, CNS vasculitis
Presentation of Lewy body dementia
Early onset dementia with visual hallucinations followed by Parkinsonian features
Clinical findings of Progressive Supranuclear Palsy (PSP)
- Supranuclear ocular palsy (failure of vertical gaze), dysarthria, dysphagia, extrapyramidal rigidity, gait ataxia, dementia
- Earliest signs are falls and gait abnormality
Which parts of the brain are affected by PSP
• Atrophy of dorsal midbrain, globus pallidus, and subthalamic nucleus
o Hummingbird sign
Presentation of Huntingtons
Chorea, dementia, personality and behavioral changes
Part of the brain affected in Huntingtons
Caudate and putamen
Presentation of frontotemporal dementia
- Early = Behavior/personality changes (frontal lobe) and/or aphasia (temporal lobe)
- Late = Dementia
Presentation of CJD
• Rapidly progressive dementia + ataxia + startle myoclonus
What will be seen on EED in CJD
• Periodic sharp waves on EEG
What will be seen in CSF in CJD
Presence of protein 14-3-3
Ddx for neurological causes of facial pain
Trigeminal neuralgia
Postherpetic neuralgia
Giant cell arteritis
Cluster HA
Definition of dystonia
Sustained muscle contraction (e.g. torticollis)
What is hemiballismus and what part of the brain is it caused by
Unilateral violent arm flinging
Caused by damage to the contralateral subthalamic nucleus
Where do hypertensive hemorrhages usually occur in the brain
Lacunar stroke = basal ganglia, cerebellum, thalamus, pons
Presentation of myasthenic crisis
- Increased generalized and oropharyngeal weakness
* Respiratory insufficiency/dyspnea
Tx of myasthenic crisis
- Intubation for deteriorating respiratory status
* Plasmaphoresis or IVIC and corticosteroids
Presentation of Wilson disease
♣ Copper accumulation leads to:
• Kayser-Fleisher rings copper deposition in the cornea
• Liver disease
• Neurologic manifestations (behavioral changes, dementia, chorea, parkinsonian symptoms)
Diagnosis of Wilson disease
- Low ceruloplasmin
* Increased urinary copper excretion
Describe EEG features of sleep cycle
BATS Dream Big
Awake (eyes open) = beta Awake (eyes closed) = alpha N1 = theta N2 = K spindle fibers N3 = delta REM = beta
What lab value should always be gotten in patients with restless leg syndrome
Ferritin - RLS is often associated with iron deficiency
Tx of RLS
Dopamine agonists - Ropinirole and Pramipexole
Lab value used to diagnose narcolepsy
CSF with low hypocretin
Tx of narcolepsy
Modafinil
Cause of Myasthenia gravis
Autoantibodies against ACh receptor
What is the triad of sx in MS
♣ Charcot triad of symptoms - SIN:
• Scanning speech
• Intention tremor, Incontinence, Internuclear ophthalmoplegia
• Nystagmus
Describe potential sensory or motor sx associated with MS
♣ Sensory symptoms (numbness and paresthesia)
♣ Motor symptoms (paraparesis and spasticity)
♣ Bowel/bladder dysfunction
Tx of choice for agitation in the elderly
Haloperidol
What part of the brain do complex partial seizures usually arise from
Temporal or frontal lobe
Most common cause of seizures in:
- Children
- Young adults
- Elderly
Children = fever
Young adults = head injury and alcohol
Elderly = stroke
What type of seizure can be triggered by hyperventilation
Absence
Brand name and major side effects of phenytoin
Dilantin
Gingival hyperplasia, ataxia, osteoporosis, diplopia, hirsutism, teratogenic = cleft palate, SJS
Brand name and major side effects of Carbamazepine
Tegretol
Hyponatremia, agranulocytosis, diplopia, ataxia, NTD, SJS
Brand name and major side effects of Valproic acid
Depakote
NTD, hepatotoxicity, pancreatitis, weight gain, GI sx, tremor
MOA and side effects of Gabapentin
Bind and block voltage-gated Ca2+ channels
Ataxia, sedation
Brand name and side effects of Lamotrigine
Lamictal
Rash, SJS, diplopia
Brand name and side effects of Topiramate
Topamax
Fatigue, weight loss, kidney stones, glaucoma, confusion (DOPAmax)
Brand name and side effects of Levetiracetam
Keppra
Fatigue, anxiety/agitation
What is the order of meds given to treat status epilepticus
Lorazepam (Ativan)
Phenytoin
Phenobarbital
What disorder is associated with central scotoma, washed out colors, afferent pupillary defect, monocular vision loss, pain with eye movement
Optic neuritis
