Neuro Flashcards
1
Q
What are the 3 branches of the trigeminal nerve affected in trigeminal neuralgia?
A
- ophthalmic branch (V1)
- maxillary branch (V2)
- mandibular branch (V3)
2
Q
What aggravates trigeminal neuralgia attacks?
A
eating, tapping on the affected nerve, brushing teeth, temperature change
3
Q
1st line tx for trigeminal neuralgia
A
carbamazapine (anticonvulsant)
4
Q
What kind of medication is carbamazapine?
A
anticonvulsant
5
Q
sudden unilateral electric shock-like pains in gums, cheek, chin, temporal forehead
A
trigeminal neuralgia
6
Q
seizure confined to small area of brain (focal part of one hemisphere)
A
partial (focal) seizure
7
Q
simple partial seizure
A
consciousness preserved
8
Q
complex partial (temporal lobe)
A
aura → impaired consciousness
9
Q
What physical movements are associated with partial (focal) seizures?
A
automatism:
- lip smacking
- manual picking
- patting
- coordinated motor movement (walking)
10
Q
2 forms of partial (focal) seizures
A
simple & complex
11
Q
2 types of generalized seizures
A
absence & tonic clonic (grand mal)
12
Q
seizure where both hemispheres are involved(diffiuse brain involvement)
A
generalized seizures
13
Q
brief lapse of consciousness & eyelid twitching
No Post Ictal Phase
A
absence
14
Q
1st stage: LOC → rigidity→ arrest of respiration
2nd stage: repetitive rhythmic jerking for 2-3 mins → post ictal phase (flaccid coma/sleep, variable duration)
A
Tonic Clonic (grand mal) seizures
15
Q
Which type of seizure is most common in childhood?
A
Absence seizure
16
Q
Tx for absence seizure
A
- Ethosuximide
- Valproic Acid (2nd line)
17
Q
Tx for tonic clonic (grand mal) seizures
A
- Valproid acid
- Phenytoin
- Carbamazapine
- Lamotrigine
18
Q
sudden, brief, sporadic involuntary twitching
No LOC
What kind of seizure?
A
Myoclonus
“myo” = muscle
19
Q
“drop attacks”
sudden loss of postural tones
What type of seizure?
A
Atonic
20
Q
Repeated, generalized seizures w/o recovery > 30 mins
A
Status Epilepticus
21
Q
Tx for status epilepticus
A
- Lorazepam or diazepam
- Phenytoin
- Phenobarbital
22
Q
SES of Phenytoin
A
gingival hyperplasia, SJS, hirsutism
23
Q
What hormone levels increase during seizure activity?
A
prolactin levels
24
Q
Dx for seizures
A
EEG: localizes the lesion
25
SES of valproic acid
pancreatitis, hepatotoxicity
26
Which 3 anti-seizure meds can cause SJS?
1. **Lamotrigine**
2. **Carbamazapine**
3. **Phenytoin**
27
Which anti-seizure medication is used for seizure prophylaxis?
Phenytoin
28
SES of Lamotrigine
SJS
29
SES of Phenytoin
**erythema multiforme (SJS)**
**gingival hyperplasia**
hirsutism
hypotension
arrhythmias w/rapid admin
30
SES of carbamazepine
**Hyponatremia** (MOA is blocking Na+ channels) → **SIADH**
31
Which benzo is most affective for seizures?
Lorazepam (shorter half life)
32
What reverses side effect of sedation when taking Benzo for seizure?
flumazenil
33
Dx for intracranial/intracerebral hemorrhage
Immediate non-contrast CT
34
Tx for intercerebral hemorrhage
1. **elevate** head of bed
2. anti-seixure PPX (**Phenytoin**)
3. **IV Mannitol** if ↑ ICP
35
Cause of Parkinsons
idiopathic **dopamine depletion**--\> failure to inhibit Ach in **basal ganglia**
36
Lewy bodies
Parkinsons
37
loss of pigment cells seen in **substantia nigra**
Parkinsons
38
1st sx of parkinsons
**Resting tremor** (pill rolling)
39
**Myerson's sign**
associated with Parkinsons: **tapping the bridge of nose repetitively causes a sustained blink**
40
pull test
stand behind pt & pull shouldlers: patient falls or takes steps backwards
seen in parkinsons
41
most effective tx of parkinsons
levodopa/carbidopa
42
What medication can you use in young patients to delay the use of Levodopa in pts with Parkinsons?
Dopamine agonists: **Bromocriptine, Pramipexole, Ropinirole**
43
What medication would you use in a pt w/ Parkinsons who is **\<70 y/o w/ tremor predominance?**
antocholinergics: Trihexyphenidyl, Benztropine
blocks excitatory cholinergic effects
44
CI to use of anticholinergics for Parkinsons
**BPH, glaucoma**
45
**"wearing off phenomenon"**
associated with levodopa, which is why it is given with carbidopa in parkinsons
46
caudate nucleus atrophy
huntingtons disease
47
chromosome 4 mutation
huntingtons disease
48
clinical presentation of tourettes
motor tics: face, head, neck
verbal tics: grunts, throat clearing, obscene words
49
Tx for tourette syndrome
habit reversal therapy
antipsychotics
alpha adrenergics
50
Patho of ALS
necrosis of upper and lower motor neurons that leads to progressive motor degeneration
51
presentation of ALS
cannot initiate and control **motor movements**
Mixed **upper and lower motor neuron** signs:
Upper motor neurons: **spasticity, stiffness, hyperreflexia**
Lower motor neurons: **progressive fasiculations, muscle atrophy, hyporeflexia**
52
**Upper motor neuron** presentations of ALS
**spasticity, stiffness, hyperreflexia**
53
**Lower motor neuron** presentation of ALS
**progressive fasiculations, muscle atrophy, hyporeflexia**
54
What movements are spared in ALS?
sensation
urinary sphincter
voluntary eye movements
55
Tx for ALS
Riluzole
56
Tx for restless leg syndrome
Dopamine agonists: **Pramiprexole, Ropinirole**
**Gabapentin**
57
this disease has an increased incidence with campylobacter jejuni infection
guillan barre syndrome
58
ascending symmetric weakness and paresthesias
GBS
59
CSF findings in GBS
**high protein** with normal WBC
can rmr this becase campylobacter jejuni is found in meat (protein)
60
Tx for GBS
**Plasmapheresis:** removes harmful circulating auto-antibodies that cause demyelination
**IVIG**
61
what medication is contraindicated in GBS?
prednisone
62
**autoimmune antibodies against Ach**
Myasthenia Gravis
63
progressive muscle weakness with repeated muscle use & recovery after periods of rest
Myasthenia Gravis
64
typical findings in myasthenia gravis
ocular weakness: diplopia, ptosis
Generalized muscle weakness: worsened w/use and relieved w/rest, respiratory musle weakness
65
myasthenic crisis
respiratory failure
66
How is a diagnosis made in Myasthenia Gravis?
**+ Ach receptor antibodies**
**Edrophonium Tensilon test:** rapid response to short acting IV edrophonium
67
1st line Tx of Myasthenia Gravis
Ach inhibitors: **Pyridostigmine or Neostigmine**
68
Pyridostigmine MOA
increases Ach by preventing breakdown of Ach
69
Most worrisome S/E of Pyridostigmine
cholinergic crisis: **weakness, N/V/D, pallor, sweating, salivation, diarrhea, miosis, bradycardia, resp failure**
70
How can you tell whether respiratory failure is due to a myasthenic crisis or cholinergic crisis?
Administer **IV edrophonium**
if flaccid paralysis _improves_: **myasthenic crisis**
If flaccid paralysis _worsens_: **cholinergic crisis**
71
How to tx myasthenic crisis
plasmapheresis or IVIG
72
myasthenic syndrome (Lamert eaton)
associated with **small cell lung cancer**
**weakness improves with repeated use**
73
Lumbar puncture results of MS
Increased IgG in CSF
74
what neuron involvement is seen in MS?
upper motor neuron involvement: **spasticity and positive babinski (upwards)**
75
charcot's neuro triad
1. nystagmus
2. staccato speech
3. intentional tremor
76
MS acute exacerbation Tx
**Corticosteroids**
**plasmapheresis if unresponsive to CS**
77
Chronic mgmt of relapse-remitting/progressive MS disease
**B-interferon** or **glatiramer acetate**
78
Tx for fatigue in MS
amantadine
79
Bell Palsy
idiopathic unilateral CN 7/facial nerve palsy --\> **hemifacial weakness/paralysis**
**strong association with HSV reactivation**
**Lower motor neuron lesion**
80
Greatest risk factor of Bell Palsy
post URI
81
Typical findings of Bell Palsy
sudden onset of **ipsilateral hyperacusis (ear pain)-**-\> unilateral **facial paralysis (unable to lift affected eyebrow)**, **taste disturbance (anterior 2/3)**
82
Tx for bell palsy
**prednisone** if started w/in 1st 72hrs
**artificial tears**
83
headaches and papilledema
suspect **idiopathic intracranial hypertension**
84
what drug can cause idiopathic intracranial hypertension?
tetracycline
85
This HA is MC in obese women of childbearing age
idiopathic intracranial HTN
86
HA worse with straining
visual changes that may lead to blindness if not treated
idiopathic intracranial HTN
87
what will you see on fundoscopy in pt w/ idiopathic intracranial HTN?
papilledema
88
diagnostic test of choice for Idiopathic intracranial HTN
**CT scan 1st to r/o CNS mass**
**Lumbar puncture**
89
increased CSF pressure
what HA?
IIH
90
Tx for IIH
acetazolamide
91
Subarachnoid hemorrhage Tx
nimodipine
92
study of choice if you suspect **concussion syndrome** in the **acute setting**
**CT scan**
93
study of choice is prolonged symptoms of concussion syndrome \>1-2 weeks
MRI
94
Tx for concussion syndrome
cognitive and physical rest
95
main clinical manifestations of concussion syndrome
**amnesia and confusion**
96
1st line PPX for migraines
propanolol
97
Other PPX meds for migraines
**antiepileptics** (topiramate, valproic acid), **calcium channel blockers** (verapamil), and **antidepressants** (amitriptyline)
98
MC side effect of topiramate
paresthesias
99
If O2 isnt effective in a cluster HA, what med should be used
sumatriptan
100
**amyloid deposition (senile plaques)** in the brain, **neurofibrillary tangles (tau protein)**
**alzheimer disease**
101
What does CT scan of Alzheimer's show?
**cerebral cortex atrophy**
102
**cholinergic deficiency** --\> memory, language, visuospatial changes
alzheimers
103
Tx for alzheimers
**Ach-esterase inhibitors: Donepezil, Rivastigmine**
**NMDA Antagonist: Memantine**
104
**Spastic Paralysis (hypertonia), Increased DTR**
**upward Babinski Reflex**
Upper Motor Neuron
105
**Flaccid Paralysis (loss of muscle tone/hypotonia)**
**Decreased DTR**
**Fasiculations**
**Downward Babinski Reflex**
**Muscle Atrophy**
**Lower Motor Neuron** Lesions
106
What are examples of Upper Motor Neuron Lesions?
Stroke
MS
Cerebral Palsy
TBI
107
Lower Motor Neuron Examples
GBS
Botulism
Polio
Cauda Equina Syndrome
Bell Palsy
108
**_Transient_** episode of neuro deficits **_w/o acute infarction_**
TIA
109
Cpx of TIA
amaurosis fugax**: monocular vision loss** (temporary "lamp share down on one eye")
weakness of _contralateral hand_
**Vertibrobasilar:** brainstem/cerebellar sxs (gait, proprioception)
110
Initial test of choice in TIA
CT scan
111
Tx for TIA
**ASA + Dipyridamole** or **Clopidogrel**
112
**contralateral hemiparesis** (weakness) + **hypesthesia** (decreased sensation)
**ipsilateral hemianopsia** gaze preference towards side of lesion
**UE** \> LE
**facial droop** + **aphasia**
What kind of stroke?
Middle Cerebral Artery (YMCA)
113
**speech _preserved_**
**AMS, impaired judgement**
**contralateral weakness**
**LE\>** UE
What kind of stroke?
Anterior Cerebral Artery (ACA)
114
Affects **vision & thought**
**contralateral homonymous hemianopsia**
**Cortical blindness**
What kind of stroke?
Posterior Cerebral Artery Occlusions
115
affects the base = trunk so it can effect everything: vertigo, nystagmus, diplopia, dysphagia, syncope etc.
**\*crossed findings\***
**ipsilateral CN deficits**
**contralateral motor deficits**
**INC morbidity**
What kind of stroke?
**Vertebrobasilar artery occlusions**
116
This stroke is MC in DM and HTN
small vessel infarct
no impairments in cognition, speech, LOC or memory
Lacunar Strokes
117
Dx for all strokes
**1st test: Noncon CT**
**CT angiogram within 1st 6 hrs**
**Door to tPA in 90 min**
118
Tx for all strokes
**IV tPA (onset s/s --\> tPA = \<4 hrs)**
**ASA or Ticlopidine (ASA allergy) + Heparin (ischemic strokes)**
119
BP cut off for Strokes
no lower than 160/100
120
You can give Alteplase only when
there is no evidence of hemorrhage on non contrast CT
121
Tx when a-fib found on ECG during a stroke
Heparin --\> Warfarin INR 2.0 - 3.0
122
Tx for SAH
Nimodipine
123
