Neuro Flashcards
Status epilepticus
- define
- 5+ min continuous seizure OR more than 1 seizure without full return to consciousness between
Status epilepticus
- mgmt
- 1st: Benzodiazepines (lorazepam, etc.)
- 2nd: Phenytoin or fosphenytoin, valproic acid, phenobarbital, levetiracetam
- 3rd: Pentobarbital, propofol
Myasthenia Gravis
- patho
- MC age/sex
- assoc with what
- autoimmune ab vs. acetylcholine postsynaptic receptors
- MC young F
- Assoc with thyme tumors, thyrotoxicosis, SLE, RA
Myasthenia Gravis
- clinical
- ptosis (External ocular muscles MC affected
- diplopia
- diff chew/swallow
- diff breathing
- extremity weakness
- sx worse with use, better with rest
Myasthenia Gravis
- dx
- Blood serum assay: acetylcholine receptor ab
- additional testing: Tensilon test, electrophysiologic studies
Myasthenia Gravis
- mgmt
Anticholinesterase drugs: neostigmine and pyridostigmine
Levels of consciousness (5)
- alert
- lethargic/somnolent: dries to sleep, drowsy, responds to Q or commands
- Obtunded: mostly sleeps, hard to wake, confused, mumbles
- Stupor: unconscious, motor response, groans
- Coma: unconscious, no response to pain or stimulus
Horner syndrome
- 3 sx
- miosis
- ptosis
- anhidrosis
Alzheimer’s Disease
- patho
- deficient in acetylcholine
Alzheimer’s Disease
- mgmt
- want to increase acetylcholine
- cholinesterase inhibitors: Donepezil, rivastigmine, galantamine
- NMDA receptor antagonist: memantine
Pick’s Disease
- aka
- clinical
- frontotemporal dementia
- disinhibition, hyperorality, compulsive behavior, loss of empathy, apathy
Diabetic neuropathy
- screening
Type 1 for more than 5 years and type 2 immediately: annual screening
Diabetic neuropathy
- mgmt
- Glycemic control
- TCAs and anticonvulsants (gabapentin)
TIA
- dx
- clinical, CT to rule out stroke
- sx <60 minutes
TIA
- mgmt
- prevent future stroke/TIA
- antiplatelet therapy, control HTN, DM, lipids
- possible carotid revascularization
SAH
- overview
- MC rupture of aneurysm
- sentinel HA 6-20 days before rupture
- exertion may trigger rupture
SAH
- clinical
- LOC > HA worst of life
- Neck stiff, nausea, AMS
- Blood in CSF
- +/- seizures
SAH
- dx
- Noncontrast CT
- LP - xanthochromia
SAH
- mgmt
- coil/clip aneurysm
- Nimodipine (CCB) to reduce vasospasm
Concussion
- clinical
- +/- brief LOC
- dizzy
- confused
- amnesia
- lack coordination
- HA
- n/v
- slurred speech
- mood disturbance
- light/sound disturbance
- sleep disturbance
Concussion
- when to return to care
- persistent vomiting
- Worse HA
- blurry vision
- seizure/incontinence
- excessive sleepy/confusion
- neuro deficits (weakness, numbness)
Concussion
- mgmt
- NSAIDs
- Rest
- return to sport after ll sx have completely resolved without aid of medication
Intracerebral Hemorrhage
- overview
- older >50 yo
- Hx HTN and atherosclerotic RF
- neuro defects (like ischemic)
Intracerebral Hemorrhage
- mgmt
- HTN control
- ICP control
- reverse coagulopathies
Tourette Syndrome
- overview
- hyperkinetic movement disorder
- motor and phonic tics: can be voluntarily suppressed
Tourette Syndrome
- common comorbidities
- OCD
- ADHD
Tourette Syndrome
- dx
- mgmt
- clinical, all imaging normal
- antidopaminergic drugs: tetrabenazine preferred, alpha-adrenergic: clonidine, topiramate
- habit reversal training
Meningitis
- MC bacteria
- strep pnuemo
- Neisseria meningitis
- Listeria
Meningitis
- clinical
- fever
- nuchal rigidity
- HA
- AMS
- elevated WBC
- thrombocytopenia
Meningitis
- dx
- LP for CSP analysis
Meningitis
- mgmt
- empiric abx as soon as LP and cultures done
- 3rd gen ceph + vancomycin
- ampicillin if >50 to cover for listeria
- Dexamethasone
What type bacteria is N. Meningitis
gram-negative diplococci
Wernicke Encephalopathy
- cause
Thiamine (B1) deficiency
Wernicke Encephalopathy
- clinical
- encephalopathy
- oculomotor dysfunction
- gait ataxia
Wernicke Encephalopathy
- mgmt
- IV thiamine
- ALWAYS thiamine before glucose!!
Rabies Exposure
- mgmt postexposure
- Rabies immune globin: day 0
- Rabies vaccine: Days 0, 3, 7, 14
Rabies
- type of bug
- transmission
- RNA virus > CNS
- exposure to saliva from infected animal: bats, raccoons, skunks, foxes
Rabies
- clinical
- prodrome: nonspp
- Paresthesias that travel proximal from bite
- encephalitis: fever, hydrophobia, pharyngeal spasm, hyperactivity
- Paralytic: ascending paralysis and flaccid limbs
- coma then death
Febrile seizure
- MCC
- ages
- temp
- viral illness
- 3 mo to 5 years
- Temp > 38C
MS
- overview
- immune-mediated inflammatory dz attacks myelinated axons in CNS
- F > M
- 15-45 years
MS
- Sx
- neurologic manifestations: weakness, numbness, gait issues, diplopia, etc.
- Urinary hesitancy or urgency
- fatigue, worse with heat
- optic neuritis (unilateral eye pain worse with movement, diplopia, scotoma, color vision loss, blurry vision)
MS
- type of pupil response
Marcus-Gunn
MS
- MC form
relapsing-remitting
MS
- dx
- 2+ diff regions central white matter affected at two different time periods
- MRI: dx test of choice, ovoid-shaped plaques
- LP: oligoclonal bands and Ig
MS
- mgmt
- methyprednisolone for acute relapses
- Plasmapheresis
- interferon beta-1a/ib
Lewy Body Dementia
- clinical
- attention, executive function, visual perceptual ability defects
- *visual hallucinations
- parkinsonism
- cog fluctuations
- REM sleep behavior disorders
Guillain-barre Syndrome
- overview
- RF
- immune-mediate polyneuropathy of peripheral nerves
- RF: c. jejune infection, immunizations, sx, trauma
Guillain-barre Syndrome
- clinical
- symmetrical ascending weakness, difficulty walking
- spread proximally to UE
- autonomic and respiratory dysfunction
- absent reflexes
Guillain-barre Syndrome
- dx
- CSF: elevated protein (albuminocytologic dissociation)
Guillain-barre Syndrome
- mgmt
- plasmapheresis
- IVIG
- mechanical ventilation if needed
Brain abscess
- MC pathogenesis
- direct extension
Encephalitis
- MCC
Herpes simplex virus (HSV 1)
- dx via PCR of CSF
Adult brain tumor
- MC type
- MC location
- glioblastoma
- supratentorial
Child brain tumor
- MC type
- MC location
- medulloblastoma
- infratentorial
Brain tumor
- clinical
chronic HA worse when wake up
Tonic Clonic seizure
- mgmt
- lamotrigine
- levetiracetam
- topiramate
- valproate
Parkinson’s Disease
- patho
- decreased dopamine
- lack of acetylcholine inhibition
Parkinson’s Disease
- clinical
- pill rolling, resting tremor
- bradykinesia
- cogwheel rigidity
- postural instab
- gait dysfunction
- masked facies
Parkinson’s Disease
- mgmt
- 1st line: carbidopa-levodopa
- adjunct: bromocriptine, pramipexole, ropinirole
- anticholinergic for younger its: benztropine
GCS
- score range
- Each section
3-15 EYES - spontaneous - opens to command - opens to pain - none TALKS - oriented - confused, but can answer - inappropriate response - incomprehensible - none MOTORS - obeys commands - purposeful movement to pain - withdraws from pain - abnl flexion - abnl extension - none
cerebral aneurysm is linked to what non-neuro dz
polycystic kidney dz
Pseudotumor Cerebri
- overview
- aka
- MC affected
- idiopathic elevated ICP
- idiopathic intracranial HTN
- Obese women in childbearing years
Pseudotumor Cerebri
- clinicla
- HA
- photopsia
- visual disturbance/loss
- back pain
- pain behind eyes
- visual field defects
- papilledema
Pseudotumor Cerebri
- dx
- dx of exclusion
- LP: always, elevated opening pressure with normal CSF analysis
- MRI/CT: nl
Pseudotumor Cerebri
- mgmt
- lose weight
- stop drugs
- acetazolamide to dec CSF fluid production
