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Neuro Flashcards

1
Q

different types of strokes

A

thrombotic
embolic
hemorrhagic

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2
Q

basics on thrombotic stroke

A

“stem” - distal of clogged vessel affected

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3
Q

risk factors for thrombotic stroke

A 
HTN 
HLD 
DM 
Obesity 
Age 
Smoking 
Family hx
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4
Q

embolic stroke basics

A

clot from the heart due to afib
valve issue
dissection
carotid artery stenosis

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5
Q

MCA supplies

A

Face
Arms and Hands
Speech

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6
Q

ACA supplies

A

legs and feet

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7
Q

PCA supplies

A

visual cortex

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8
Q

basilar Artery compromise leads to

A

locked in

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9
Q

vertebral artery compromise leads to

A

syncope

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10
Q

cerebellum issues lead to

A

ataxia

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11
Q

cushing reflex basics and causes

A

bradycardia along with hypertension

seen in intracerebral hemorrhage

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12
Q

blood in the parenchyma =

A

intracerebral hemorrhage

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13
Q

blood around the brain =

A

Subarachnoid hemorrhage

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14
Q

next step after seeing a hemorrhagic stroke on non con CT head

A

decrease BP
send to ICU
if INR up —> give FFP

contact neurosurg
—> coil (SAH, clip or craniotomy

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15
Q

work up after ischemic stroke is dx on CT head noncon

A

EKG –> afib/a flutter - tx - warfarin or NOAC (no bridge)
2D Echo –> thrombus - tx - warfarin or NOA with bridge

Carotid US - carotid artery stenosis

  • –> <70% and no symptoms - tx - medically
  • –> >80 or >70 with symptoms - tx - endocardectomy or stent with 2weeks
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16
Q

contraindications to TPA

A

prior ICH
recent GI bleed or other major bleed
recent surgery

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17
Q

when can you give TPA

A

< 3 hrs

< 4 hrs if non diabetic

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18
Q

acute stroke tx

A

TPA if they meet requirements
ASA 325m
control DM
BP - permissive HTN (220/120)

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19
Q

chronic stroke tx

A

LMWH - if at risk for DVT
anticoagulate - if afib/flutter or valve
ASA 81 mg +/- dyprimadol or clopridogrel if resistant

HgbA1c < 8%
control BP with ACE-I or diuretics

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20
Q

def of generalized seizure vs partial

A

generalized - whole body is involved

partial - part of the body is involved

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21
Q

complex seizures vs simple seizure

A

complex - LOC

simple - no LOC

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22
Q

1st time seizure causes

A 
V - vascular - CVA
I - infection - meningitis/encephalitis 
T - Trauma - brain bleed
A - autoimmune - SLE 
M - metabolic - BG, O2, Ca, Na, Mg 
I - ingestion/withdrawal ( etoh/benzos) 
N - neoplasm
S - pSych, pSeudoseizures
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23
Q

signs and symptoms of a seizure

A

LOC with limb jerking
bowel and bladder incontinence
tongue biting

post ictal confusion

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24
Q

Most important signs of a seizure

A

post ictal state

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25
Q

work up of a seizure

A

hx of epilepsy?
—> yes –> check med levels –> make adjustments
—-> No –> currently seizing —>
Yes - >5min and/or >30min no return to baseline = status epilepticus –>

NO —> EEG, MRI> CT –> check VITAMINS

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26
Q

tx of status epilepticus

A 
benzo benzo benzo 
no good 
fosphenytoin (IV) 
no good 
midozalam + propofol 
no good 
phenobarbital
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27
Q

antiepileptic drugs

A

valproate (#1 since its cheap)
lamotrigine
levetiracetam (keppra)

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28
Q

types of seizures

A

atonic
myoclonic
absence
trigimenal neuralgia

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29
Q

atonic seizures

A

No LOC
(+) loss of tone - collapse helmet kids

tx - valproate

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30
Q

myoclonic seizures

A

No LOC
Unnecessary tone present

tx - valproate

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31
Q

absensce seizures

A

kids
+ LOC
No loss of tone

tx - ethosuximde

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32
Q

trigimenal neuralgia

A

CN V issues

Tx - carbamezapine

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33
Q

path of parkinsons disease

A

loss of dopaminergic neurons in substantia niagra

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34
Q

presentation of parkinsons disease

A

1) bradykinesia - masked face, trouble getting started
2) cogwheel rigidity - no fluid
3) resting tremor - pill rolling
4) gait/postural instability - shuffling steps

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35
Q

tx of parkinsons disease

A

<70 and function –> dopamine agonist such as ropinerol, promipraxole (bromocriptine)

> 70 or non function –> levodopa + carbodopa –> add COMT-I and/or MAO B-I –> deep brain stim

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36
Q

carbadopa MOA

A

prevents the conversion of levodopa into dopamine in the periphery

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37
Q

essential tremor

A

familial
Male 40-60s
Tremor occurs with movement
No tremor at rest

Tx - propranolol

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38
Q

intention tremor

A

path - Cerebellar dysfunction (CVA) or etoh
No tremor at rest
Tremor with movement that gets worse in amplitude the closer they get to the target

tx - none

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39
Q

huntington disease path

A

anticipation- trinucleotide repeats that get worse each generation
AD
Chr 4

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40
Q

Huntington disease presentation

A

Chorea
- purposeless, ballistic, uncontrolled movement

tx - none - psychosis, depression, suicide

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41
Q

red flags symptoms for a headache

A 
FND 
progressive N/V especially in AM = tumor 
Fever
Thunderclap 
New onset >50y/o
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42
Q

tension headache

A

path - muscular
pt - F>M under stress,
band like pattern around the head (bilateral) - vice like pain can radiate to neck

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43
Q

tx of tension headaches

A

NSAIDs or Acetaminophen

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44
Q

analgeseic rebound

A

path - withdrawal
pt - typically takes meds for HA >10/month
gets HA when they stop

tx - let them withdraw from meds

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45
Q

Cluster headaches

A 
M>F, path = vascular 
wakes pt up from sleep 
unilateral behind one eye 
8-10/day after being asymptomatic for a while 
associated with horners syndrome

dx workup should include a CT or MRI

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46
Q

tx of cluster headaches

A

O2 therapy –> triptans

prophylaxis with CCB such as verapamil

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47
Q

migraine headache

A

F>M, with family history, path = vascular
pulsatile and throbbing
debilitating, photophobia, phonophobia, N/V aura
4-72hrs
HAS A TRIGGER

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48
Q

tx of migraine headache

A

sleep will abort it
tx - mild = NSAIDs
moderate to severe - triptans, ergots (watch out for ADR of vasospasm)

prophylaxis with beta blocker such as propranolol or valproic acid topiramate

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49
Q

idiopathic intracranial hypertension

pseudotumor cerebri

A

path - increased ICP
female, obese taking OCPs

pt - papilledema, FND, N/V

dx - negative CT, LP will be diagnostic showing increased opening pressure >25

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50
Q

tx of idiopathic intracranial hypertension

pseudotumor cerebri

A

LP makes it better

tx - acetazolamide –> still there –> serial LPs –> still there –> VP shunt

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51
Q

musculoskeletal back pain

A

muscle spasms
young male recently lifting heavy things
belt like = dx

dx - clinical
tx - NSAIDs and exercise recheck in 4wks

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52
Q

alarm symptoms in back pain that require further workup

A

bowel/ bladder incontinence
saddle anesthesia
FND that are new or rapidly progressing

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53
Q

workup of back pain + alarm symptoms

A

thinking cord compression –> give steroids –> x-ray –> MRI

hematoma - drain it
abscess - I&D and abx
cancer - radiation
fracture - surgery fix t

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54
Q

disc herniation

A

path - nucleus pulposis pinching the nerve

pt - male 30-50s, recent heavy lifting
(+) sciatica and (+) straight leg test

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55
Q

dx and tx of disc herniation

A

dx - xray but MRI better

tx - neuro sx > conservative therapy at 6months
—-> neuro sx = conservative therapy at 1 yr

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56
Q

Osteophyte

A

older male
no heavy lifting
(+) sciatica (+) straight leg test

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57
Q

path of osteophye

A

bony spur that grows into a nerve canal pinching that nerve

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58
Q

dx and tx of osteophyte

A

dx - xray –> MRI

tx - surgery

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59
Q

compression fracture

A 
path - osteoporosis 
pt - old person, female who fell on her butt 
(-) straight leg test 
(+) vertebral step offs
(+) pinpoint tenderness on mid spine
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60
Q

dx and tx of compression fracture

A

dx - xray (MRI if you need it)

tx - surgery
f/u dexa scan to fix osteoporosis which you could see on xray as osteopenia

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61
Q

spinal stenosis

A

path - narrowing of canal pinching Nerve

pt - old, pseudocladuciation that is positional - worse when upright and walking around

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62
Q

dx and tx of spinal stenosis

A

dx - xray –> MRI

tx - laminectomy

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63
Q

Amnesia basics

A

memory loss

no cognitive impairment

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64
Q

delirium basics

A

AMS that is acute, overt, waxes and wanes

cause = UTI typically

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65
Q

workup to see if reversible dementia

A 
TSH, T4
vit B12
BMP - BUN/Cr
LFTs 
RPR 
Depression 
CT > MRI
66
Q

creutzfeld jacob dz

A

priors
undercooked meat or sporadic mutations

young dementia that progresses rapidly
myoclonus

67
Q

Alzheimer basics

A

path - plaques and tangles, chr 21

memory loss goes 1st (short then long term memory)
down syndrome pts at risk
spares social graces

68
Q

dx and tx of alzheimers

A

dx - clinical - CT may show diffuse cortical atrophy

tx - supportive, family counseling, tacrine, donepezil

69
Q

Picks disease

frontotemporal degernation

A

personality goes frist - hypersexual, hyperaggresive

dx - clinical CT -may show frontotemporal degernation

tx - supportive

70
Q

lewy body dementia

A

path - parkinsons disease
pt - dementia with parkinson symptoms
* visual hallucinations*

mri - loss of substantia nigra - dx = clinical tho

71
Q

vascular dementia

A

path - CVA

stepwise decline with each stroke

72
Q

normal pressure hydrocephalus

A

path - increased ICP
wet- incontinent
wobbly - ataxia
weird - personality/actions

73
Q

dx and tx of normal pressure hydrocephalus

A

dx - CT - hydrocephalus + relief when LP performed

tx - VP shunt

74
Q

central vertigo signs

A

+ brain lesion signs
+ FND

no hearing loss
no tinnitus

75
Q

peripheral vertigo signs

A

+ tinnitus
+ hearing loss

No FND
No brain stem lesion signs

76
Q

causes of central vertigo

A

posterior fossa insults seen on MRI

77
Q

examples of posterior fossa insults

A

MS, CVA, Tumor
Abscess, migraines (complex), weird seizures

pt - FND present and cerebellar signs no ear issue

78
Q

3 causes of peripheral vertigo

A

BPPV
Vestibular neuritis (labrynth neuritis)
Meineires Dz

79
Q

BPPV

A

path - otolith (stone) hits a hair brain thinks body is in motion

pt - recurrent and reproducible vertigo <1min

80
Q

dx and tx of BPPV

A

dx - Dix hallpike - quick turn of head induces vertigo

tx - epley maunvear - get the stone out

81
Q

vestibular neuritis

labrinyth neuritis is the same + hearing loss

A

path - post viral
pt - 4wks post URI

vertigo 1-10 min
+/- hearing loss
+/- N/V

82
Q

tx of vestibular neuritis

A

steroids - shortens duration

meclizine - reduces symptoms

83
Q

Meineres Dz

A

triad

1) hearing loss
2) tinnitus
3) vertigo

84
Q

tx of Meineres Dz

A

salt restriction
HCTZ
Meclizine

85
Q

Coma pt basisc

A

Cerebral function = depression
Brainstem reflexes = (+)
Heart =(+)
Motor = (+)

86
Q

Persistent vegetative stage

A

cerebral function = absent
Brainstem reflexes = (+)
Heart =(+)
Motor = (+)

87
Q

Brain death basics = real death

A

cerebral function = absent
Brainstem reflexes = absent
Heart =(+)
Motor = absent

88
Q

Locked in basics

A

cerebral function = (+)
Brainstem reflexes = (+)
Heart =(+)
Motor = absent - except for eye blinks

89
Q

types of brain stem reflexes

A

corneal reflex
cold water calorics
dolls eyes

90
Q

corneal reflex

A

take a q tip touch eyeball nothing happens = brain death

91
Q

cold water calorics nml person

A

poor cold water in right ear - eyes look right and then have nystagmus to the left and vice versa

92
Q

cold water calorics in PVS

A

cold water in right ear - eyes look right - but no nystagmus to the left

93
Q

cold water calorics in brain death

A

cold water in right ear - eyes dont move

94
Q

warm water calorics in brain death =

A

opposite of cold water calorics

95
Q

dolls eyes reflex

A

move head - eyes stay fixed

96
Q

Multiple sclerosis path and pt presentation

A

autoimmune demyelinating disorder
women 20-40

any neuro symptoms separated by time and space

  • optic neuritis *
  • blurry vision
  • pain with eye movements
97
Q

MS dx

A

MRI - perventricular white matter lesions

LP - oligoclonal bands IgG
evoked potentions - demyelination

98
Q

tx of MS

A

Flare up = steroids
Chronic = interferon, glatirauna, fingolaud

urinary retention - bethanecol
urinary incontince - amitryptilline
spasms - baclofen
neuropathic pain - gabapentin, pregabalin

99
Q

Guillan barre path

A

autoimmune demyelination
Flu shot
recent URI
diarrhea - camplobacter jejuni

100
Q

guillan barre pt presentation dx

A

ascending paralysis
hyperreflexia

dx - LP - lots of proteins but very few cells

101
Q

tx of guillan barre

A

intubate
IVIG = plasmaphoresis

never give steroids - makes it worse

102
Q

myasthenia gravis path

A

auto immune - antibodies against the Ach-receptor

blocks the receptor

103
Q

pt presentation of MG

A 
>50 y/o 
fatigability in most commonly used muscles 
- eyes - blurry vision 
- throat - trouble swallowing 
- distal extremities - coordination off

worse in evening

104
Q

tx of MG

A

Acetylcholinesterase inhibitors to increase Ach

steroids decrease autoimmune factor in resistant disease

105
Q

tx of myasthenic gravis crisis

A

pt having difficulty breathing

IVIG = plasmaphoresis

106
Q

eaton lambert syndrome path

A

typically a paraneoplatic syndrome from small cell lung cancer

abs to presynaptic calcium channels

107
Q

dx of MG

A

anti Ach- receptor antibodies
EMG
GET CT SCAN THymoma – resect = curable sometimes

108
Q

pt presentation in lambert eaton syndrome

A

> 50 y/o,
improvement with use
so muscles not used affected the most - such as proximal weakness - getting up from chair, combing hair

109
Q

dx and tx of eaton lambert syndrome

A

antibodies to presynaptic calcium channels
EMG
CT scan for small cell lung cancer

tx - treat lung cancer

110
Q

ALS

A

sporadic mutations
UMN lesions + LMN lesions (sensation intact)

dx - EMG
tx - Riluzole

111
Q

UMN lesion signs

A

hyperreflexia

weakness chronic

112
Q

LMN lesion signs

A

fasciculations
areflexia
weakness

113
Q

risk factors for ischemic stroke in a younger patient

A

OCPs
hypercoagulable states (antiphospholipid syndrome, protein c and s def)
Cocaine and amphetamines
sickle cell disease

peripheral vascular disease

114
Q

amaurosis fuga

A

transient, curtain like loss of sight in the ipsilateral eye due to microembolic of retina

115
Q

vertebrobasilar TIA

A

Dizziness, double vision, vertigo,
Numbness of ipsy face and contralateral limb
projectile vomiting
drop attacks (aka syncopal episodes)

116
Q

main predisposing risk factor for lacunar strokes (aka small vessel thrombotic dz)

A

HTN

lacunar stroke - affects subcortical structures (basal ganglia - putamen, thalamus, internal capsule, brain stem)

117
Q

pure motor lacunar stroke affects the

A

internal capsule affected

118
Q

pure sensory lacunar stroke affects the

A

thalamus

119
Q

subclavian steal syndrome

A

decreased cerebral blood flow
BP in L arm < BP in R arm (same with pulse)

upper extremity claudication
tx - surgical bypass

120
Q

two possible causes of a carotid bruit

A

1 - murmur referred from the heart

2 - turbulence in the internal carotid artery = serious stroke risk (>70% stenosis –> tx carotid endocardectomy

121
Q

CT scan appearanes of ischemic vs hemorrhagic stroke

A

ischemic stroke - appears dark

hemorrhagic stroke - appears white

122
Q

pts who should receive a carotid US duplex

A

those with a carotid bruit
pts with PVD
pts with CAD

123
Q

complication of ischemic stroke

A

cerebral edema - occurs 1-2 days after stroke and can cause mass affects

management = hyperventilation and mannitol

124
Q

if giving tpa what is the BP criteria

A

BP <185/110

125
Q

two main categories of hemorrhagic stroke

A

ICH - bleeding into brain parenchyma

SAH - bleeding into CSF (outside of brain parenchyma)

126
Q

ICH + pinpoint pupils =

ICH + poorly reactive pupils =

ICH + dilated pupils =

A

ICH + pinpoint pupils = pons

ICH + poorly reactive pupils = thalamus

ICH + dilated pupils = putamen (BG)

127
Q

doc for decreasing BP in a hemorrhagic stroke

A

nitroprusside

128
Q

hallmark finding of SAH

A

blood in the CSF called xanthrochromia (yellowish) meaning blood has bene there for a while and it is not due to a traumatic LP

129
Q

complications of SAH

A

vasospasm - 50% - CCB
rerupture - 30%

hydrocephalus
seizures
SIADH

130
Q

what is something that markedly decreases an essential tremor

A

alcohol

131
Q

the most important risk factor for alzheimers disease

A

is increasing age

other risk factors = down syndrome and early onset alzheimers

132
Q

tx of alzheimers

A

donepezil
rivastigmine
galantamine

133
Q

if asymmetry is noted in a coma pt most likely due to

A

mass lesion

metabolic and systemic causes of coma do not cause asymemetric motor abnormalties

134
Q

brain death cannot be established in the presence of

A

hypothermia

135
Q

EEG of brain death =

A

isoelectric activity )electrical silence)

136
Q

abnormal pupillary light reflex + coma =

A

structural intracranial lesions
or
drugs that affect the pupil

137
Q

bilateral fixed dilated pupils

A

severe anoxia

138
Q

unilateral fixed dilated pupils

A

herniation with CN III compression

139
Q

pinpoint pupils

A

narcotics
or
ICH

140
Q

locked in syndrome

A

mimicks coma
paralyzed except for (breathing and eye blinking)
can feel pain and are aware of their surroundings

cause by an infection or hemorrhage in the ventral pons

141
Q

tx of acute attacks for MS

A

high dose IV corticosteroids

baclofen or dantrolene can be used for muscle spasticity

142
Q

tx of guillan barre

A

IV IG or plasmphoresis if severe

–> never give steroids

143
Q

one thing you should always do with a mysathenic gravis pt

A

CT scan to r/o thymoma

144
Q

medications that can exacerbate MG

A

abx - aminoglycosides, tetracyclines

beta blockers

antiarrhthymics - quinidine, procainamide and lidocaine

145
Q

complications of neurofibramatosis

A

scoliosis
pheochromocytomas
optic gliomas
renal artery stenosis

146
Q

syringomyelia

A

associated with arnold chiari malformation

bilateral loss of pain and temperature in a caple like pattern

147
Q

brown sequard syndorme

A

contralateral loss of pain and temperature
ipsy hemiparesisi
ipsy loss of position and vibration

148
Q

peripheral vertigo vs central vertigo

A

hearing loss and tinnitus only occur in peripheral vertigo

central vertigo only has FND

149
Q

ototoxic drugs

A

aminoglycosides

loop diuretics

150
Q

dx test for vasovagal

A

tilt table test

151
Q

pathophys of vasovagal

A

compensatory sympathetic response is instead replaced by parasympathetic response

152
Q

orthostatic hypotensions

A

defect in vasomotor reflexes
common in elderly
posture is the main cause here

153
Q

complex partial seizures

A

consciousness is impaired
postictal confusion
olfactory or gustatory hallucinations

purposeless involuntary movements

154
Q

generalized seizures

A

+ LOC
disruption of electrical activity of entire brain
begins with sudden LOC

tonic phase - rigid
clonic phase - muscular jerking

155
Q

tx of ALS

A

riluzole - glutamat blocking agent can prevent death for about 3-5 months

156
Q

wernickes aphasia

A

fluent but makes no sense
no comprehension of spoken or written language

TEMPORAL LOBE

157
Q

brocas aphasia

A

not fluent but words make sense
speech is slow and effortful

FRONTAL LOBE

comprehension of spoken and written language = intact

158
Q

conduction aphasia

A

disturbance in repetition

involves arcuate fasciculus between wernicks and broacs

159
Q

bells palsy

A

CN VII weakness/paralysis
affects both upper and lower face

tx - if lyme no steroids if not lyme steroids
eye patch to protect from corneal abrasion

160
Q

DOC for trigeminal neuralgia =

A

carbamezapine

161
Q

UMN signs

A

+ babinskin
spasticity

atrophy comes later

162
Q

LMN signs

A

atrophy
flaccid paralysis
fasciculations

(-) DTRs

Step 2 Rotation Cards (14 decks)

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