Neuro Flashcards
What eye movement is limited with a CN IV palsy?
Cannot converge eyes
What is the classic complaint of a patient with a CN IV palsy?
- Cannot read a book
- Trouble walking down stairs
Why is CN VI considered a false localizing sign?
Increased ICP can cause a palsy, rather than an anatomically specific lesion
What are the CNs that are associated with the midbrain?
1, 2, 3, 4
What are the CNs that are associated with the pons?
5, 6, 7, 8
What are the CNs that are associated with the medulla?
9, 10, 11, 12
What is the presentation of a patient that has a stroke in the pons?
Locked in with pinpoint pupils
What are the three major areas of bleeding in the brain?
- Deep nuclei
- Pons
- Cerebellum
Where is the most common location for a intracranial artery aneurysm?
Anterior communicating artery
What is difference in the appearance of a traumatic vs spontaneous subarachnoid hemorrhage on CT scan?
Spontaneous will be blood diffusely throughout the brain, whereas a traumatic will be localized to area of trauma.
When is xanthochromia reliably present on LP for diagnosing SAH?
12 hours
What is the CCB used to treat SAH?
nimodipine–specifically for brain vasculature, and only given orally
What type of fluids should NEVER be given to stroke patients? Why?
Hypotonic fluids, since this will worsen any cerebral edema.
Why should all patients with a stroke be reversed on their anticoagulation (even those with mechanical valves)?
Risk of bleeding very high in ischemic area
What is the major difference between lacunar strokes vs cortical strokes?
Lacunar have either motor or sensory, whereas cortical strokes have both.
What are the tests that all patients with TIAs need to help prevent future strokes?
- PFO/ECHO study
- EKG/holter for a-fib
- Carotid dopplers
How does the presentation of a venous sinus thrombosis differ from a stroke?
Venous clots can cause bilateral symptoms
What is the “delta sign” on a non-contrast head CT that is diagnostic of venous sinus thrombosis?
Bright white appearance (clot) in the posterior confluence of sinuses
What is the treatment for a carotid artery dissection?
AC
What is the scoring system for predicting a stroke following a TIA?
ABCD2 scoring system
What is the role of steroids in the treatment of meningitis?
Should be given before abx are given
What are the four indications to obtain a head CT prior to performing an LP?
Old
Immunocompromised
AMS
Focal neuro findings
What are the three major abx given to adult meningitis pts?
Ceftriaxone
Vanco
Ampicillin
Why can you not give infants less than 1 month old ceftriaxone? What can you give instead?
- Can cause kernicterus
- Cefotaxime
What are the major viruses that cause aseptic meningitis (4)
- Enterovirus
- West nile
- HSV2
- VZV
Where does TB infect the brain, typically? Why?
Brainstem since this is the highest oxygenated area
What can clinically differentiate TB meningitis from other bacterial meningitis? What treatment benefits TB meningitis the most outside of abx?
- CN s/sx
- Steroids early
India ink stain = ?
Cryptococcal meningitis
What is the most common cause of a mass lesion in AIDS pts?
Toxoplasmosis
What blood test is pretty sensitive for CNS spinal cord infections?
ESR
What is the myotome level for the: biceps?
C5
What is the myotome level for the: Triceps?
C7
What is the myotome level for the: Quads?
L4
What is the myotome level for the: ankle?
S1
What is the myotome level for the: abdominal muscles
T8-T12
What is the myotome level for the: cremaster
L1-L2
What is the myotome level for the: anus
S2-S4
How many CCs of urinary retention is supportive of diagnosing cauda equina?
100-150 cc
Is having bilateral symptoms more or less specific for cauda equina?
More, since it has to be higher than a peripheral nerve root
What are the symptoms of syringomyelia?
Loss of pain/temp in hands
Why are chiari malformations associated with recurrent headaches?
Tonsillar “herniation” blocks CSF flow intermittently
What are the two major infections that precipitate Guillain barre syndrome?
Mycoplasma pneumonia and campylobacter diarrhea
What is the treatment for Guillain barre?
Plasmapheresis
What is the difference between tick paralysis and Guillain barre syndrome?
GBS has sensory deficits, whereas tick paralysis does not
What are the three major cause of ptosis?
Horner’s syndrome
Third nerve palsy
Myasthenia Gravis
Which muscles are primarily affected with myasthenia gravis: proximal or distal?
Proximal
What is the diagnostic test for myasthenia gravis?
Edrophonium test or ice pack test
What are the major risks of edrophonium?
Cardiac arrhythmias and heart blocks
How do you differentiate between myasthenia gravis and lambert-eaton syndrome?
Myasthenia gravis gets worse with repetitive action, whereas Lambert-Eaton syndrome gets worse
What is Lambert-Eaton syndrome associated with?
Cancer (it’s a paraneoplastic syndrome)
Who is usually affected with acute periodic paralysis?
Young men with thyroid disorders
Why must you be careful with replacing potassium in patients with acute periodic paralysis?
Not a problem of total body loss, rather of maldistribution. Thus you may overshoot potassium if giving too much
What is the pharmacologic long term treatment for acute periodic paralysis?
Beta blockers
