Neuro Flashcards
Involuntary spasms/movements and repetitive motions
Dyskinesia
Sustained contraction, abnormal posturing
Dystonia
Rapid involuntary jerky, uncontrolled, purposeless movements?
Chorea
spinal cord tract that controls Voluntary motor activity: Terminates at anterior horn cell: ascends/descends same side
Costicospinal Tract
senses vibration, position and light touch:
Ascends same side, decussates @ medulla
Dorsal Columns tract
Senses pain and temperature and ascends at opposite sides crosses immediately
Spinothalamic Tract
Motor efferent pathway (Away) of spinal cord
Anterior (Ventral Root) (Fast action front)
Sensory Afferent pathway (Towards) of spinal cord
Posterior (Dorsal Root)
Progressive motor degeneration 2T UMN/LMN necrosis: dysphagia, eventually respiratory: fatal 3-5 years
sensation, urinary sphincter, voluntary eye movement spared Tx:
Amyotrophic Lateral Sclerosis (ALS)
Tx: Riluzole
Autosomal dominant nuero-degenerative disease: Chromosome 4 mutation/Abnormal CAG transcription:
behavioral (irritability), chorea, and dementia (<50): Tx? Caudate nucleus (Putamen) Atrophy: Fatal 15-20 years
Huntington Disease
Tx: Chorea (Tetrabenzine Antidopaminorgics)
Idiopathic dopamine depletion–> failure to inhibit acetylcholine in the basal ganglia
(loss of pigment cells in substantia Nigra)
Parkinson’s Disease
- Resting Tremor (MC lessened with voluntary m.)
- Bradykinesia (slow voluntary movement)
- Rigidity
- Flat Facis (Myerson’s nose tap=blink)
- Instability w posture
Parkinson’s disease clinical manifestations X5?
Parkinson’s Disease Tx?
- Levodopa/Carbidopa- converted to dopamine (M.E Tx)
- Bromocriptine (D. Agonists)
- Benztropine (Anticholinergic)
Demyelinating polyradiculopathy of the peripheral nerves. Ascending symmetric weakness/paresthesia
Assoc. w Campylobacter. Tx:
Guillian Barre Syndrome
Autoimmune Inflammatory demyelinating degeneration of white matter. sensory pain/fatigue, cramping,
suspect w young and trigeminal neuralgia, optic neuritis episodic exacerbations; :Tx
Multiple Sclerosis
Tx: IVCS, plasmapheresis, Amantadine (Fatigue) Glatiramer acetate (Reduces relapse severity)
Autoimmune peripheral nerve disorder against Ach Receptors. Thymic hyperplasia/thymoma
General muscle weakness (Ocular, Resp., Bulbar): relieved w rest Tx:
Myasthenia Gravis
Tx: Pyridostigmine or Neostigmine 1st line
Plasmapheresis or IV Ig
Restless leg syndrome treatment?
- Pramipexole
- Ropinirole (Both domapine Agonists)
CSF: High protein (>400) with a normal WBC (Albumin cytological dissociation)
Electrophysiologic decreased motor nerve conduction: Diagnosis studies for?
Guillain Barre Syndrome
MRI with Gadollinium (TOC) confirms disorder showing white matter plaque hyper densities (Periventricular).
Multiple Sclerosis
LP CSF shows increase IgG oligoclonal bands “Pleocytosis”
Multiple Sclerosis
Blood test shows Acetylcholine receptor Antibodies (+) Muscle specific Tyrosine Kinase (Musk)
Myasthenia Gravis
Myasthenia gravis Test that includes a rapid response to short acting IV_______?
Edrophonium
Intentional tremor worse with emotional stress and intentional movement
Tx:
Essential Familial Tremor
Propranolol
Tics associated with obsession-compulsion
Motor, phonetic, self-mutilating.
Tx:
Tourette syndrome
Tx: Risperidone (Clonidine or Haloperidol)
CNS postural muscle tone abnormality 2T brain injury perinatal prenatal. spasticity is hallmark.
Tx:
Cerebral Palsy
Tx: Baclofen
RF with Post URI, DM, pregnancy. Ear pain, UL face paralysis, taste disturbance
Tx:
Bell Palsy (CN VII)
Tx: Prednisone (w/I 72 h of s/x), Artificial tears, Acyclovir
Constant daily Headache: not worse with activity: BL tight-band/vise-like no phono/photo phobia
Tx: Prophylaxis and abortive
Tension Headache
Tx: A-NSAID/APAP Amitriptyline P- BBs
Headache 4-72 hour in duration: pulsatile, lateralized, throbbing. NV, Phono/Photo phobia, worse w activity
Tx: Abortive and Prophylaxis
Migraine Headache
Tx: A- Triptans/Ergotamines (5HT-1) vasoconstrictions
Metoclopramide, Promethazine, Prochlorperazine. (DBs)
P- BBs/CCBs/TCAs
UL Headache: Temporal, periorbital, lancinating, < 2hoursseveral times a day/6-8 weeks. worse night/Etoh
Horner’s syndrome, UL congestion/lacrimation:
Tx: A- P-
Cluster Headache
Tx: A- 100% O2: Triptan/Ergotamines (Sumatriptan nasal)
P- Verapamil
Brief episodic stabbing lancinating pain at eye, nostril and mouth. Worse with touch, wind, eating:
Tx
Trigeminal Neuralgia (Tic Douloreoux)
Tx: Carbamazepine (Anticonvulsant)
Gabapentin
Headache worse with straining, NV, tinnitus, visual changes–> blindness, papilledema. CN6 Palsy, Obese W
LP- Increased CSF pressure (Idiopathic) TX:
Idiopathic Intracranial HTN (Pseudomotor Cerebri)
Tx: Acetazolomide
Concussion syndrome management?
- CT (SOC MRI Sx > 7-14 days)
- Cognitive/Physical rest
Acute abrupt transient confused state (medication or infection)
Delirium
Progressive, chronic, intellectual deterioration. Memory loss. RF > 60
Dementia
2nd MC type of dementia due to chronic ischemia or multiple lacunar infarcts. HTN most important RF
Vascular dementia
MC Dementia 2T amyloid deposition: Neurofibrillary tangles (Tau protein): cholinergic deficiency
Alzheimer Disease
Alzheimer Disease CT scan Dx?
Tx?
Cerebral Cortex Atrophy
Tx: Ach-esterase inh. (Donepezil, Rivastigmine, Tacrine)
Memantine (NMDA reduce glutamate excitotoxicity)
Diffuse Lewy bodies (Protein Deposits) –> hallucinations and delusions.
Diffuse Lewy Body Disease
star shaped Tumor of the brain/spinal cord: primary CNS tumor in adults:
Headaches + wakes patient up at night.
Astrocytoma
MC and aggressive primary CNS tumor in adults: Focal Deficits, headaches that wakes patient up at night.
(+) Cushing’s reflex
Glioblastoma
what is Cushing’s reflex?
Hypertension, bradycardia, and irregular respirations.
Benign Tumor Associated with neurofibromatosis (NF-2)
Meningiomas
Atlas C1 Fracture (Ant/post arches): Increase in predental space > 3mm in adults; >5 mm in children
Jefferson fracture
C2 Axis/pedicle fracture –> spondylolisthesis (forward slipping) between C2-C3 (Unstable Fx)
> 5mm Operative
Hangman’s Fracture
Fracture of Dens that is unstable
Dens fracture Type II ( MC @ base)
Extreme flexion fracture involving C1 and C2 associated with odontoid fracture
Atlanto-occipital dislocation
spinous process avulsion fracture: MC @ the lower cervical C-6 or C-7: Sx- only if non union or pain
Clay- Shoveler’s fracture
Anterior displacement of wedge-shape g=fracture fragment. MC @ C2
Highly unstable that may cause anterior cervical cord syndrome.
Flexion Teardrop Fracture
is stable if all ligaments are intact and there is no posterior displacement of fractured segment
Burst Fractures
BP difference between arms 15mmHg 2T flow reversal at the expense of the basilar artery to arm. L Arm MC
Subclavian Steal Syndrome
Motor and sensory deficits in upper extremities in a “shawl distribution.
Central cord syndrome
Ipsilateral motor vibratory and proprioception deficits and contralateral pain and temperature deficits
Brown Sequard syndrome
Loss of temperature and pain in lower extremities. TEE-Pee
Anterior Cord Syndrome
TIA: Transient episode of neurological deficits las t less than ____ most resolving in __to___ MC due to ____?
<24 hours (resolve in 30-60 minutes) MCC Embolus
Damage Associated with voluminous meaningless effortless speech (Word Soup)
with impaired comprehension of error
Wernicke’s Aphasia
Damage Associated with partial loss or difficulty in ability to produce language: mild comprehension deficit
Broca’s Aphasia
Ischemic strokes includes
- Hemiparesis (Cant’ feel, move, see, talk)
- sensory loss
- Hemianopsia (half field blindness)
- dysarthria
- Aphasia
MC type of stroke and what vessel?
Ischemic (Middle cerebral Artery)
MC Arterial bleed: Between skull and Dura: involves medial meningeal artery: Lens shape (Convex)
Epidural Hematoma (Hemorrhage)
MC Venous bleed: Between dura and arachnoid: involves tearing of bridging veins: Blunt Trauma “elderly”
Slow onset and crescent shape: “Midline shift”
Subdural Hematoma (Hemorrhage)
Bleed between arachnoid and pia: MC Berry Aneurysm rupture: Sudden thunderclap worse HA of life:
Subarachnoid Hemorrhage
Intraparenchymal hemorrhage: HTN, trauma or arteriovenous malformation: LP–> herniation
Intracerebral Hemorrhage
fever, chills, headache, photosensitivity, NV, AMS/seizures, nuchal rigidity Kernig’s and Brudzinki’s
Acute Bacterial Meningitis
MCC of bacterial meningitis 1 month- 18 yo
N. Meningitides
MCC of bacterial meningitis 18-50 yo? what about >50?
S. Pneumoniae (>50 Listeria)
MCC of bacterial meningitis < 1 month
Group B strep Agalactiae
CSF Glucose is decreased with increased lymphocytes, and increased protein.
Fungal or Tuberculosis Meningitis
CSF Glucose is normal with increased lymphocytes, and normal or decreased protein.
Viral Meningitis
CSF Glucose is decreased with increased Neutrophils PNMs, and increased protein .200.
Bacterial Meningitis
MCC is HSV1, Echo or coxsackie: profound lethargy with abnormal focal neurogocal deficits CN II, IV, VI, VII.
CSF Lymphocitosis w normal Glucose Tx:
Encephalitis (Brain Parenchyma infx)
Viral Meningitis highlights
- Nuchal rigidity
- mild meningeal symptoms
- AMS with No focal deficits
what are the Type of seizures?
Partial (Focal)- Simple or complex
Generalized- Absence (Petit) or Tonic-clonic (Grand Mal)
Seizure that involve impaired consciousness with lip smacking, manual picking or patting/ coordinated m.
Complex Partial
Seizures where consciousness if fully maintained
Simple Partial seizure
Seizure involves brief lapse of consciousness stating w eyelid twitching
Absence (petit Mal)
status epilepticus are seizures without recovery for >___?
30 minutes
what is the 1st line Drug for Absence seizure
Ethosuximide
what is the 1st line drug for Status epilepticus?
Lorazepam/Diazepam –> Phenobarbital
Phenytoin LD infused >30 min.
Anticonvulsants include
- Valproate (Lavaca de Mili)
- Lamotrigine
- Carbamazepine
- Benzos, Phenytoin, Phenobarbital
Foot drop suspect injury to what nerve?
Peroneal nerve
Tachycardia, Mydriasis, diarrhea/cramps, Agitation, tremor/twitching, hyperthermia, and hyperreflexia?
Serotonin syndrome