Neuro Flashcards
a left MCA stroke results in what visual field deficit?
Right homonymous hemianopsia: loss of right visual fields in both eyes
eyes deviate to the left since they cannot see right
“look towards the side of lesion”
speech is on what side of brain
dominant: typically LEFT in Right handed individuals
ACA stroke
Leg more than arm weakness
Personality/cognitive defs
Urinary incontinence
PCA stroke
SAME side face sensory loss + CN 9/10
OPPOSITE limb sensory loss
limb ataxia
best treatment for nonhemmorhagic stroke
less than 3 hrs: tPa
more than 3 hrs: ASA, if already on, add dipyridamole OR switch to clopidogrel
NOT ASA and clopidogrel together
everybody gets a statin
treatment if cardiac thrombi
heparin followed by warfarin for INR 2-3
alternatives: rivaroxaban, dabigatran
more than 70% but not 100% carotid stenosis?
endarterectomy > carotid angioplasty
unique HA findings
red, tearing eye with rhinorrhea, Horners?
papilledema with diplopia from 6th CN palsy?
Cluster HA
pseudotumor cerebri
How to abort migraine and cluster headaches
Both: ergot or triptans
Only cluster: 100% oxygen, prednisone, lithium, prophylaxis with verapamil
Best migraine prevention
Propranolol, then CCBs, TCAs, SSRI, topiramate, Botox injections, Sodium valproate
When can patients discontinue seizure medication
Seizure free for two years
Severe headache, stiff neck, photophobia, fever
SAH, may present with fever due to blood irritating the meninges
Very similar to meningitis, but more sudden in onset and LOC in 50%
CSF wbc: rbc ratio
How is this different between SAH and meningitis
Normal: 1 WBC : 500 RBC
SAH: both increased but normal ratio
Meningitis: elevated (more WBCs)
EKG findings in ICH
Large or inverted T waves suggestive of myocardial ischemia
Cape like distribution of loss of pain and temp bilaterally across upper back and arms
Syringomyelia
Differentiating between cancer and abscess with imaging
How to treat if abscess
Both are ring enhancing, need biopsy
Empiric: penicillin plus metronidazole plus ceftriaxone/cefepime, vancomycin if risk of MRSA
Switched more specific regimen when culture results get back
Tuberous sclerosis
Neuro abnormalities Adenoma sebaceum – red facial nodules Shagreen patches – leathery on trunk Ash leaf spots Retinal lesions Cardiac rhabdomyomas
Neurofibromatosis
Neurofibromas
Eighth cranial nerve tumors
Café au lait spots
Meningioma and gliomas
Sturgeon – Weber
Port wine stain on face, seizures, Visual changes, hemiparesis, mental delays, calcification of angiomas on skull x-ray
Treatment for mild Parkinson’s
Anti-cholinergic: benztropine, trihexyphenidyl
Amantadine
Treatment for severe Parkinson’s
Dopamine agonist: pramipexole and ropinirile
Levodopa/carbidopa: most effective
COMT inhibitors: Tolcapone, entaCapone
MAO inhibitors: selegiline, may slow progression
Deep brain stimulation: highly effective for tremors and rigidity
What to do if Parkinson’s patient and levodopa/carbidopa presents with psychosis
Start clozapine or other antipsychotics with few EPS side effects, do not stop Parkinson’s meds the patient will become locked in with severe bradykinesia
Parkinsonism with orthostasis
Shy – Drager syndrome
Treatment for Huntington’s disease
Tetrabenazine for dyskinesia
Psychosis: haldol, seraquel, other antipsychotics
Tourette disorder treatment
Antipsychotics:Fluphenazine, clonazepam
Also methylphenidate and other ADHD treatments
Most common presentation of MS
Focal sensory symptoms with gait and balance problems, no longer visual disturbances
MS patient develops worsening neuro deficits with new, multiple white matter hypodense lesion is think what medication is causing this?
Natalizumab, has been associated with development of PML
ALS, most worrisome presentation? What is not lost?
Most serious: difficulty and chewing and swallowing and decreased gag reflex
No sensory loss in sphincters are spared
EMG for diagnosis, elevated CPK
Distal weakness and sensory loss, wasting in legs, decreased DTRs, hi foot arch, abnormal leg contour, think?
Charcot – Marie – tooth disease diagnosed with EMG, no treatment
Additional features in bell palsy
Since it is seventh cranial nerve palsy, may see hyperacusis, and taste disturbances as it supplies taste of the anterior 2/3 of the tongue
Also, difficulty with closing the eye, so corneal ulcerration may occur, tape shut at night
Diagnosis of myastenia gravis
Initial: acetylcholine receptor antibodies, better than edrophinium
If negative get anti-– MUSK antibodies
Best: EMG, it shows decreased strength with repeated stimulation
Imaging: chest x-ray, CT or MRI to look for thymoma or thymic hyperplasia, CT with contrast is best
Myasthenia gravis treatment
Neostigmine or Pyridostigmine
Thymectomy if patient under 60, if over, prednisone, other into metabolites to suppress T cell function
Acute myasthenia crisis
Treat with IVIG or plasmapheresis
Management of cerebral palsy, comorbidities?
PT, OT, ST, baclofen and Botox for spasticity
Intellectual disability, epilepsy, strabismus, scoliosis
