Neuro 7 Flashcards
What is an “aura” when it comes to seizures
Aura = simple partial seizure that precedes progression to bigger seizure
What is Lennox-Gastaut syndrome
Pediatric seizure syndrome associated with intellectual disability
Major trigger for seizures in Juvenile myoclonic epilepsy (JME)
Sleep deprivation
During a seizure, do eyes usually turn toward towards or away from the affected side?
Away (“wrong way eyes”)
What is Todds paralysis and what is it often confused with
Postictal partial or complete hemiplegia
Can mimic stroke
Where in the brain is seizure: “deja-vu” sx, epigastric rising, nausea, vertigo, lip smacking
Temporal lobe
Where in the brain is seizure: neglect, aphasia
Parietal lobe
Where in the brain is seizure: nocturnal (looks like patient wakes up and acts weird), often without postictal state, fencing posture
Frontal lobe
Describe presentation of progressive supranuclear palsy
♣ Supranuclear ophthalmoplegia, with limitation of vertical more than horizontal gaze
♣ Axial rigidity and neck extension
♣ Early falls as a consequence of impaired postural reflexes, neck extension, and inability to look down
What are peripheral side effects of Levodopa
Nausea and vomiting, cardiac arrhythmias, orthostatic hypotension
What are the central side effects of Levodopa
Neuropsychiatric sx (anxiety, agitation, hallucinations, confusion)
MOA of Carbidopa
DOPA decarboxylase inhibitor (prevents peripheral conversion of L-Dopa to Dopamine)
Drug category and MOA of Entacapone
COMT inhibitor
Prevents conversion of L-Dopa to inactive metabolite in the periphery
MOA of Tolcapone
COMT inhibitor both peripherally and centrally
Prevents conversion of L-Dopa to inactive metabolite
MOA of Selegiline as Parkinson tx
Monoamine oxidase inhibitor (MAO-B), preventing metabolism of DA
MOA of Ropinirole
D2 receptor agonist
MOA of Pramipexole
D3 receptor agonist
MOA of Amantadine
NMDA antagonist - enhances effects of endogenous DA
What antimucarinics are used in the tx of Parkinsons
Benztropine
Trihexyphenidyl
What type of tremor is present in Essential tremor
Postural tremor (emerges during sustained maintenance of a posture)
What limbs are preferentially effected in Essential tremor
hands > arms > head»_space; legs
What can decrease sx of Essential tremor
Alcohol
Tx of essential tremor
Beta-blockers (Propranolol)
Primidone (barbiturate)
Action tremor is caused by dysfunction of what?
Cerebellum and cerebellar outflow tract
What is chorea and what is the signature associated disease
Chorea = involuntary, abrupt, and irregular movements that flow randomly from one body part to another
Huntingtions
What causes hemiballismus
Usually from contralateral lesion in the subthalamic nucleus, caudate, or putamen
What is dystonia
Sustained muscle contraction leading to repetitive twisting movements or abnormal postures
Example of and treatment of dystonia
Ex = torticollis
Tx = Botox
Hiccup is what type of movement
Myoclonus
Tx of myoclonus
Clonazepam
Tx of tics
Dopamine antagonists (Haloperidol or SGA)
Presentation of Wilson disease
Liver dysfunction and neuropsychiatric sx
Kayser-Fleishcer rings, renal disease
Describe possible neuro sx seen in Wilson disease
Tremor, ataxia, dysarthria, dyskinesia, parkinsonism, cognitive dysfunction, disturbances of mood and personality
Lab values seen in Wilson disease
- Increased serum copper
- Decreased serum ceruloplasmin
- Increased urine copper excretion
Tx of Wilson disease
Copper chelation with D-penicillamine
4 components of presentation is Sturge-Weber syndrome
- Seizures
- Port-wine stain of CN V1/V2 distribution
- Intellectual disability
- Glaucoma
Think: guy has seizure and spills wine on face. Wine gets in eye (glaucoma) and he goes whoops
Triad of sx in Tuberous sclerosis
- Intellectual disability
- Seizure
- Angiofibroma
Can hyperventilation precipitate focal seizures
No
Only absence seizures, which are generalized seizures
Describe pathophys of Guillain-Barre syndrome
o Demyelinating polyradiculoneuropathy (of peripheral nerves)
Describe presentation of Guillain Barre
o Ascending symmetrical paralysis over days to weeks
o Autonomic dysfuction (e..g tachycardia, urinary retention, and arrhythmias) occur in 70% of patients
CSF findings of Guillain Barre
o CSF is usually abnormal and may show high protein with few cells
Tx of Guillain Barre
o Treatrement = IV immunoglobulin or plasmapheresis
Sx present in Meniere disease - other than vertigo, what are the ear sx?
Due to increased pressure and volume of endolymph
- Episodic vertigo with nausea and vomiting
- Ear fullness/pain
- Unilateral sensorineural hearing loss
- Tinnitus
Describe post-concussion syndrome
HA, dizziness, sleep disturbance, cognitive impairment, behavioral abnormalities (e.g. irritability)
What is the value of normal ICP
<15
What percentage of severe post-head trauma patients experience seizure
25%
Presentation and tx of neurosarcoidosis
♣ Presentation
• Cranial neuropathy due to basal meningitis
• Facial and optic nerves most frequently affected
♣ Treatment:
• Steroids
Cause of Wernicke encephalopathy
Thiamine (B1) deficiency
Triad of Wernicke’s
Ophthalmoplegia, (truncal) ataxia, confusion
Tx of Wernicke’s
Administer thiamine BEFORE glucose
What is Korsakoff syndrome
Isolated memory disturbance and confabulation, personality change
Will Methylmalonic acid be increased or decreased in B12 deficiency
Increased
B12 is needed to convert MMA to Succinyl CoA
Presentation of B12 deficiency
Damage to posterior and lateral columns of the spinal cord
Paresthesias, weakness, gait problems
