Neuro Flashcards
Common bugs that cause meningitis in ppl > 60 yo? ABX coverage?
This patient has classic findings of bacterial meningitis: fever, confusion, Brudzinski sign, and CSF analysis showing ↑ cell count, ↑ protein, and ↓ glucose. The most common causes of community-acquired bacterial meningitis in patients older than 60 years are the gram-positive bacteria S. pneumoniae and L. monocytogenes, and the gram-negative bacteria H. influenzae and E. coli.
Coverage: 3rd gen cephalosporin, vancomycin, ampicillin.
Third generation cephalosporins (e.g., cefotaxime, ceftriaxone) are broad-spectrum antibiotics that are effective against most gram-negative and gram-positive bacteria with the exception of Enterococcus and Listeria. Since L. monocytogenes is an important cause of bacterial meningitis in patients > 60 years, empiric antibiotic therapy in this group should include ampicillin, an anti-listerial antibiotic. Ampicillin would also provide coverage against gram-positive and gram-negative bacteria, but its spectrum of activity is not as broad as 3rd generation cephalosporins. Vancomycin, which acts only against gram-positive bacteria, should be included in the antibiotic regimen because the incidence of penicllin- and cephalosporin-resistant pneumococcal infection has increased in recent years. Vancomycin, while effective in Listeria bacteremia, is not very effective against CNS Listeria infections. Therefore, ampicillin should be used despite the addition of vancomycin to the regimen.
Alzheimers drugs + MOAS
Patients with mild-to-moderate Alzheimer’s disease show improved cognition and ability to perform everyday activities when treated with acetylcholinesterase inhibitors, such as donepezil, galantamine, or rivastigmine, because they promote an increase of the neurotransmitter acetylcholine, which is decreased in Alzheimer’s disease. If this patient’s disease progresses to moderate-to-severe (≤ 18/30 MMSE), memantine (an NMDA-receptor antagonist) is also indicated, which may be given in addition to an acetylcholinesterase inhibitor.
Crescent-shaped hyperdensity on CT that does not cross midline. Ex?
Subdural hematomoa-torn bridging vein
PPX tx for migraine
antihypertensives (beta-blockers), antidepressants (TCAs), anticonvulsants (topiramate or valproate), diet changes
50 yo w broken speech pattern. what type of aphasia? lobe? vascular distribution?
Broca aphasia. frontal lobe. left MCA most likely
Confusion, ophthalmoplegia, ataxia. Dx?
Wernicke Encephalopathy. 2/2 Thiamine deficiency
What % lesion in a symptomatic pt is an indication for carotid endarderectomy?
70%
Most common causes of dementia?
Alzheimer disease and vascular/multi-infarct dementia
Hyperphagia, hypersexuality, hyperorality, and hyperdocility. Dx?
Kluver-Bucy syndrome (amygdala)
Drug used to dx myasthenia gravis
erdrophonium.
Define internuclear ophthalmopelegia
A disorder of conjugate gaze in which the affected eye shows impairment of adduction.
Define optic neuritis
painful unilateral vision loss, red color desaturation
Normal CSF Findings?
Opening pressure: 100-200
Protein 20-45
Glucose 50-100
Cells 0-3
Sensory/wernicke aphasia. Location in brain?
Dominant temporal lobe
Memory impairment, hyperaggression, hypersexuality. lobe impacted?
Temporal
Inability to read, write, name, or do math. lobe impacted?
Dominant parietal lobe
Ignoring one side of body, trouble dressing. lobe affected?
nondominant parietal lobe
Visual hallucinations/illusions. lobe affected?
occipital
CN III and IV. Area of brain?
midbrain
CN 5, 6, 7, 8. Area of brain?
pons
CN 9, 10, 11, 12. Area of brain?
medulla
Ataxia, dysarthria, nystagmus, intention tremor, dysmetria, scanning speech. Area of brain?
cerebellum
What treatable causes of demetia must always be ruled out?
B12 deficiency and hypothyroidism
What part of the brain is affected in Huntington Dz?
Caudate nucleus
What part of the brain is affected in Parkinsons dz?
Loss of dopaminergic neurons of the substantia nigra
Common disease w cerebellar findings in kids?
Neoplasms: Medulloblastoma, pilocytic astrocytoma
Hydrocephalus (enlarging head under 6 months), think arnold-chiari malformation or dandy walker malformation
Friderech-Ataxia
Cushing triad? What does it represent?
Bradycardia, HTN, respiratory irregularity/depression. Represents increased ICP.
Pt w unilateral motor impairment, no sensory or cortical deficits, no visual field abnormalities. Where’s the lesion?
Posterior limb of internal capsule (lacunar infarct)
Pt with contralateral somatosensory and motor deficits (face, arm, leg), conjugate deviation towards side of infarct, homonymous hemanopia, aphasia (dominant hemisphere), hemineglect (nondominant hemisphere). Where’s the lesion?
MCA occlusion
Pt with contralateral somatosensory and motor deficit, predominantly in lower extremity, abulia (lack of will or initiative), dyspraxia, emotional disturbances, urinary incontinence. Where’s the lesion?
ACA occlusion
Pt with ataxia and either contralateral hemipelegia or ipsilateral cranial nerve involvement. Where’s the lesion?
Vertebrobasilar system (brainstem supply)
______ is characterized by recurrent vertigo attacks associated with ear fullness, tinnitus, and hearing loss.
Meniere disease
The first imaging test in acute stroke is a __________.
The first imaging test in acute stroke is a noncontrast CT scan of the head. At 12 hours out, it may show ischemic strokes, but more importantly, it will diagnose hemorrhagic strokes, for which reperfusion and antiplatelet therapies are contraindicated.
Dx of GBS
Cerebrospinal fluid
Albuminocytologic dissociation: elevated protein levels and normal cell counts in cerebrospinal fluid (CSF)
Electroneurography: reduced nerve conduction velocity (NCV) due to demyelination
Definition of Lacunar Stroke
A subcortical stroke that is primarily associated with hypertension and diabetes mellitus. Lipohyalinotic thickening of vessel walls results in the occlusion of small, penetrating arteries that supply the subcortical regions of the brain (internal capsule, pons, thalamus, putamen, and caudate). Typically presents as specific lacunar syndromes that are characterized by the absence of cortical signs (e.g., aphasia, hemianopsia, agnosia, apraxia).
Most common type of lacunar stroke: location and sx?
Pure Motor: Posterior limb or the angle of the internal capsule
Often caused by occlusion of the lenticulostriate artery
Contralateral hemiparesis of the face, arm, and leg
