neuro Flashcards
mini mental components
appearance, behavior, cognition, thought process
mini mental peumonic for 11 components
ORArL 2,3,RWD
Oreintatoin to place and time
Rrecognition0 repeat three objects (orange, dog and pencil)
Attnetion - serial 7s
recal - three objects from before 5 mins later
Language
2 names of 2 objects
3 three step commoand,
Read statment aloud, do what it says, dontsay it (close your eyes)
Write a sentance
Design- copy a design
mini mental pneumonic max score
max score is 30, no cog impariment is 24-30- average is 27
deleirum or dementia is 18-23 severe impairment is 0-7
TIA- deff
periods of acute cerebral insufficiency lasting less than 24 hours without residual effects
TIA causes
thrombus vs hemmorage,
cardio embolic event afib etc
TIA is indicative of
impending stroke
appro — % of pt wth TIA will experience a cerebral infarct in —-years
1/3 within 5 years
Tia class vertebrobasilar
innadequate blood flow from vertebral arteries
presentation is vertigo, ataxia, dizzy, visual field defficit, weakness, confusion
TIA class carotid
due to carotid stenosis,
presentation is aphasia, dysarthria, altered LOC, weakness, numbness etc.
TIA lab and DX
CT is best to distinguish between, tumor, bleed or ischemic stroke
TIA CT vs MRI
MRI is superior to CT in detecting ischemic infarcts.
TIA wk up after CT
echo, carotid doppler, cerepbral angioagraphy
TIA managemnt
asa reduces the risk of stroke and death
plavix 75mg QD
Tia problems with ticlid
agranulocytosis, thrombotic thrombocytopenia purpura, and gi intolerance
in TIA assess for hypertension as it is
nuber one cause of heart failure
tia and carotid endartoectmoy
decreases the risk of strok and death in patients with recent TIA, it is indicated for >70-80% stenosis of vessells for symptomatic patients..
CVA definition
rapid onset of neuro deficits lasting longer that 24 hrs (TIA is less than 24 hrs) it remains the 4th leading cause of death in the us
CVA causes
atherosclerotic changes, chronic hypertension, trauma, aneurysm, av malformation, tumor
CVA infarct pearl
can produce subtle, progressive or sudden neurologic deficits
CVA infarct signs and symptoms
change in loc
motor weakness
visual alterations
changes in vitals signs
CVA hemmorage pearl
usually presents with sudden onset focal neuro deficits
CVA hemmorhage S and S
signs associated with inreased ICP, emisis, altered mentation, HA,
CVA bleed Left dominent hemisphere
R hemiparesis, aphasia, dysarthia, difficulty reading or writing
CVA bleed R non dominant hemisphere,
left hemiparesis, right visual field changes, spatial disorientation.
CVA labs and diagnostics
Head CT
cerebral angiography
LP if the pt has a grade I or II annurysm, to detect blood in CSF but CT should be first
CVA and LP contraindication
contra in large bleeds as brain stem herniation can be induced with rapid decompression of the subarachnoid space
more common infarct vs hemmorhage
infarct 80/20
thrombotic stroke management
fibrinolytic threapy indicated 3 is the answer up to -4.5 from last known well is contrverisal but done
stroke indications for ICP monitoring
sever head injury that cant allow for neuro assessment
GCS <8 abnormal CT
GCS
pipils changes are the
same
motor changes are
opposite
MAP and cerebral vasospasm
110-130 to prevent cerebral vasospasm.
door to fibrinolytic strok vs mi
3 vs 6 hrs
cpp formula
map-icp
nimitop role in cva
it si a calcium channel antagonist that helps to counter vasospasm by preventing calcium form entering the smooth muscle cells and causing contraction.
seizure classificaiton is based on
mode of seizure onset and spread
partial seizure
simple partial
(focal local)
no LOC
rarley greater than 1 minute
motor symptoms start in one group and spread to entire side of body
parastethisas, flashing lights, vocalizations, hallucinations common.
complex partial seizure
any simple seizure followed by impaired level of cociousness
may have aura, staring or automatisms such as lip smacking, and picking at clothing.
HHH that increase ICP
hypotension]
hypercapnea
hypoxia
generalized seizure absence (petite mal)
sudden arest of motor activity with blank stare
common discovered in children and adolescents begin and end suddenly
tonic clonic sx grand mal
may have aura
begins with tonic - repititive contraction of muscles,
loc then clonic contractions involantary contraction of muscles
2-5 mins
incontinece my occure
post ictal after.
grand mal seizures are commonly
discovered in children
status epileptics definition
series of grand mal seizures of >10mins in duration
they are a medical emergency
may occur when awake or asleep but pt never regains consciousness between episodes
most uncommon but most life threatening seizure type
labs and diagnostics for seizures/assessment
presence of aura, onset, spread, type of movement, body parts involved,
seizures- eeg and CT
eeg is most important test in determining the seizure classifications
CT is indicated for all new onset seizures
seizure management-
most are self limiting
protect airway
benzos- 2-4mg, at 1-2mg/min
dilantin- 20mg/kg- at 50mg/in continuous
phenobarb is dilantin fails
myasthenia gravis definition
autoimmune disorder resulting in the reduction of the number of acetycholine receptor sites at the neuromouscular junction
durg of choice to break status
valum
MG weakness
better at rest worst after activity
variable clinical course remission and execerbations
MG who gets it
20-40 but can happen at any age, younger for women men in the 50’s and 60’s more common in woman than man
MG s and s
PTOSIS
DIPLOPIA
disarthia, dysphagia, visual changes and extremity weakness
MG labs
antibody test (to acetycholine) tensilin test, edrophonium- if they get wores they had a cholinergic crisis, if they get better then its myasthenic crisis.
MG management
anticholinesterase drugs to block the hydrolosis of acetylcholine and are used for symptomatic improment- prostigmine.
immunosuppressives
plasmapharesis,
vent
Multiple Sclerosis
autoimmune disease marked by numbness, weakness, loss of muscle coordination, and problems with VISION SPEECH AND BLADDER CONTROL
immune system attackes nerve insulator
variable clinical course
MS
young adults between 20-50 mostly western european descent living in temperate zones
MS symptoms MRi
weakness, numbness, tingling, or unsteadiness in a limb, may progress to all limbs spastic paraparesis diplopia, urinary symtoms, optic atrophy nystagmus
MS diag
MRI of brain, cant base diagnosis solely on labs, slight protien elevation in CSF IgG also elevated.
MS treatment
neuro refferal, steroids for acute relapses, antispasmodics, interferon therapy, plasmapharesis
GB definition
acute usually rapidly progressive form of inflammatory polyneuorpathy characterized by demylinaiton of the peripheral nerves resulting in SYMMERICAL ASCENDING PARALYSIS
GB causes
unknown, usually preceded by a suspected viral infection accompanied by fever, 1-3 weeks before the onset of acute bilateral muscle weakness in the lower extremities
flaccid paralysis can result within 48-72 hours
GB incidence
male and female are equal,
GB S and S
typically a rapidly progressive paralysis with cranial nerve involvement.
reflexes are hypoactive or absent
GB labs
CSF protein is usually elevated (especially Immunogloublin G
Meningitis definition
infection of the membranes of the pia matter and arachnoid matter of the brain or spinal cord
Meningitis pearls
should be considerd in any patient with fever adn neuro symptoms especially with history of other infection or head trauma
acute bacterial meningitis is a medical emergency
meningitis bacteria
in 80-90% of the cases it is caused by Streptococcus pneumoniae, H influenze, or nisseriea meningitidis
meningitis symptoms
fever 101-103, severe headache, STIFF NECK, KERNIGS SIGN, pain and spasm of hamstring muscles, Brudzinski- legs flex at both the hips and the knees in response to the flexion of the head and neck to the chest, photophobia and seizures
meningitis dx
LP- CSF will be cloudy or xanthochromic (yellow) with
elevated pressure, protein, decreased glucose, with WBC’s
CT of head is indicated
monroe kelly dosctrine,
when one pressure in head increases another must decrease.
meningitis tx
high does IV abx, Penicillin G, vanc with a thrid generation cephalosporin
cushings
bradycardia hypertention, slow or strange respiration
battles sign
brusing behind ears at mastoid process
labs for head injury
everyone gets c spine
ct head and skull films
Four p’s of spina cord injuries
pain, position, aralysis, paresthesias
lucid interval is what type of hematoma
epidural
C and T
C injury = quad
T can move arms parapalegiea
spinal cord injury
methlprednisolone - 30mg/kg iv bolus followed by 5.4mg/kg infusion per hour for 24 hours withing the first 8 hours of injury
5 complications of spinal trauma
C4 or above equals respiratory compromise
T4-T6 may lead to autonomic dysreflexia- an emergency medical condition
autonomic dysrefleia-
exaggerated autonomic response, to a stimulus, bladder or bowel distention, hot or cold stim, restrictive clothing
symptoms include, diaphoresis and flushing aboe the level of the injury
chills and severe vasoconstriction below the level of the injury
HTN
Bradycardica
Headache
nausea
tx is remove stim and BP control
brown sequard syndrome
caused by damage to one half of the spinal cord
ipsilateral upper motor nuron paralysis and loss of propriaoception
tx is MRI and steroids
cauda equina
compression of nerve roots at the end of the spinal cord
numbness in lowerlegs, or saddle region,
mri,steroids, surgery for decompresssion.
T6 or above-
neurogenic schock may occur
disruption of sympathetic impulses causes uninterupted parasympthetic stim leading to massive vasodilation
hypovolemia
low bp
pressors
parkinsons definition
not enough dopamne 45-65 all groups
parkinsons triad
TREMOR, BRADYKANESIA, AND RIGIDITY
wooden faces,
myersons sign- repetive tapping produces sustained blinking
impaired swallowng
parkisons management
up dopaine
carbidopa-levodopa- sinamet
amantadine
mirapex
help with tremor
cogentin, artane,
dementia causes
atheosclerosis, neurotransmitter deficits cortical atrophy ventricular dilation loss of brain cells possible viral causes alzheimers disease
Dementia pneumonic
drug reactions emotional disorders metabolic or endocrine disorders emotional disorders nutritional problems tumors infection ateriosclerosis
agnosia
cant recognize an object
most common alzheimenrrs drug
aracept
