Neuro Flashcards
16 yo presents with decreased hearing, subcutaneous nodules. Father had b/l deafness that was tx with surgery. PE showed hypopigmented spots on back, MRI head showed bilateral cerebellopontine angle masses. What cell types are these?
Schwann cells! Acoustic neuroma’s seen w/neurofibromatosis.`
66 yo M to the ED w/ progressive lower back pain, urinary incontinence, decreased appetite. Recently dx with L4-L5 disc herniation & recieved epidural infection for radicular pain 2 weeks ago. PMH T2DM, HTN. Temp 100.9, 136/88, HR 96. Tenderness on palpation of the spine, poor dentition, absent DTR in b/l LE, decreased sphincter tone & enlarged smooth prostate. WBC 25k, ESR 104. dx? test? tx?
Spinal Epidural Abscess = classic triad(fevers, severe focal back pain, neurologic deficits) test: MRI spine tx: CT guided aspiration w/cultures & abx +/- surgical decompression
Ischemic stroke BP acceptable cap if pt did not receive thrombotic therapy? what if they did?
no thrombolysis: 220/120 thrombolysis: 185/105 *patients without hemorrhagic stroke can be started on DVT ppx as they are high risk for DVT; if hemorrhagic = SCDs
CSF for bacteria vs viral vs fungal infection WBC, protein, glucose?
bacterial: >1000 WBC, glucose <40, protein >250 Viral: 10-500 WBC, Glucose normal, protein <150 Fungal: low WBC, elevated protein, low glucose
62-year-old woman progressive forgetfulness over the last year. She has been less active than normal and is having some difficulty walking. The patient has no urinary incontinence. The patient is oriented to person and place, but not time. She has difficulty with 3-word recall. Her gait is slightly unstable and she has problems balancing when she closes her eyes. Examination of the lower extremities show decreased vibratory sensation, spastic paresis, and hyperreflexia bilaterally. Most likely dx?
Vitamin B 12 deficiency. Alzheimer’s disease or age related dementia/critical atrophy will not present with dorsal column symptoms.
Juvenile Myoclonic Epilepsy Describe its onset, triggers, EEG and 1st line tx
Epilepsy that often presents in adolescence, 1/3 if pt will have absence seizures 5 urs prior. May be preceded by myoclonic jerks in the AM. Exacerbated by alcohol and sleep deprivation. ECG Classically demonstrates “bilateral polyspike and slow wave discharges”. 1st line rx Valproic Acid and avoidance of precipitants
Risk factors for stroke?
HTN, DM, Hyperlipidemia, Tobacco, A-fib, Valvular heart dz, DVT + PFO
Stroke vs TIA
Stroke >24hr TIA<24hrs
sx of ACA stroke
contra muscular weakness, personality changes, urinary incontinence
sx of MCA stroke
contra weakness, eyes deviate tword lesion, contra homonymous hemianopsia with macular sparing, Apraxia/neglect(R infarct), Aphasia(L infarct = language)
PCA stroke sx
ipsilateral face, contra body, vertigo & horners
best initial test for stroke?
CT W/O contrast to check for hemorrhage
CT shows hemorrhagic stroke tx?
no tx! just monitor. reverse anticoagulation(hep = protamine sulfate, war = K & FFP), Target BP: 140-160 = Nicardipine, Labetalol, Statin with target <70.
when do you use thrombolytics for stroke?
<3 hrs of sx
when do you do catheter to retrieve clot?
between 4.5-6/8hrs
partial seizure simple vs complex?
*limited to 1 part of the body simple = no LOC comples = LOC
causes of generalized seizures
hi/low Na, hypoxia, hypoglycemia, CNS infection, trauma, tumor, stroke, decreased Ca, uremia, withdrawal, cocaine toxicity, decreased Mg
tx of status epilepticus?
- Benzo = Lorazepam 2. Fosphenytoin > Phenyltonin(hypotension/heart blk) 3. phenobarbital 4. anesthesia!
tests to run during seizure
- Na, Ca, Glucose, O2, Cr, Mg 2. CT 3. MRI 4. EEG
when can a patient be taken off seizure medications?
2yrs and no seizure but need to do a Sleep deprivation EEG afterward to tell you possibility of recurrance
Lewy body dementia
parkinsons + dementia
Shy-Drager Syndrome
parkinson w/primary orthostasis
Parkinsons Disease
sx?
*loss of substantia nigra causing: - cogwheel rigidity - resting tremor - hypomimia(masklike, underreactive face) - micrographia(small writing) - orthostasis(dizzy when standing up)
*dx confirmed if sx improve with carbidopa-levodopa
**Intact cognition and memory
Tx of mild parkinsons sx
<60 = anticholinergic(benztropine, hydroxyzine): relieves tremors but can worsen dementia >60 = amatadine
tx of severe parkinsons
- D-ag: Pramipexole, Ropinirole, Cabergoline - Levodopa/Carbidopa = great drugs but increased on-off phenomena 2. COMT inhibitors(Tolcapone, Entacapone) = blocks metabolism of dopamine 3. MAO inhibitors(selegiline, rasagiline) 4. deep brain stimulation
Multiple Sclerosis(MS) sx?
*CNS demylination: - optic neuritis - motor and sensory probelms and defects of the bladder - fatigue - hyperreflexia - spasticity - depression - INO - sexual dysfunctions
*Marcus Gunn Pupil: pupil paradoxically dilates to light as result of delayed conduction
dx of MS?
- MRI showing periventricular white lesions 2. CSF showing “oligoclonal bands”(not unique)
tx of MS?
steroids fatigue = amantadine spasticity = baclofen or tizanidine
tx of essential tremor vs parkinsons tremor
essential = propanolol parkinsons = antichol(benztropine/hydroxyzine) if <60 or Amantadine if >60
Alzheimer’s Disease(AD) sx?
*progressive loss of memory in pt >65
Alzheimer’s Disease(AD) dx?
order: head CT, B12, T4/TSH, RPR/VDRL *CT will show diffuse, symmetrical atrophy
Alzheimer’s Disease(AD) & basically all dementia tx
tx?
anticholinesterase medications = donepezil, rivastigmine, galantamine
for advanced disease: memantine
**antipsychotics for behavior probs but they increase the risk of death so wean off if possible
Frontotemporal Dementia(Pick’s Disease) sx? dx? tx?
personality and behavior problems present 1st then they get memory loss CT/MRI shows frontal and temporal atrophy treat just like alzheimers = anticholinesterase(donepezil, rivastigmine, galantamine, memantine)
Normal Pressure Hydrocephalus(NPH) sx? dx? tx?
Wet, Weird, Wobbly! Wet: urinary incontinence Weird: dementia Wobbly: wide based gait ataxia dx: LP & CT tx: shunt
Huntington’s Disease/Chorea sx?
~30s, family history, dementia, psychiatric disturbance with personality changes, Chorea/movement disorder
Huntington’s Disease/Chorea mutation?
AD CAG repeat on Chrom 4
Huntington’s Disease/Chorea tx?
Chorea: benzodiazepines, valproate or dopamine depleating agents such as Tetrabenazine for movement
Parkinson sx: carbidopa/levodopa or dopamine agonist
Antipsychotics for other sx
Tension Headache sx? tx?
constant pressure, lasts 4-6hrs, usually bilateral tx: NSAIDs n shit
Migraine sx? tx?
aura of bright flashing lights, Scotomata, abnormal smells tx: abortive: sumatriptan, Ergotamine ppx: CCB, TCA, SSRI *if 4+ HA per month = propanolol ppx
person gets 4+ HA a month. tx?
propanolol
Cluster HA sx? tx?
HA are exclusively unilateral +/- unilateral with redness and tearing of the eye & rhinorrhea. frequent and high intensity. tx: abortive = triptans or 100% O2 ppx: CCA like verapamil
Trigeminal Neuralgia sx? triggers? tx?
CN5 pain triggers: chewing, touching face, saying Twords tx: carbamazipine, lamotriginine, baclofen or surgical decompression
Post-herpetic Neuralgia sx? tx?
residual pain following resolution of herpes(shingles), vesicular lesions, painful dermatomal rash tx: acyclovir to decrease incidence and Amytrip/gabapent/carbamazapine/phenytonin for pain
when do you vac for shingles?
>60 yoa
Temporal Arteritis sx? tx?
sx: tenderness of the temporal area(pain w/brushing hair), jaw claudication, visual disturbance tx: steroids
Pseudotumor Cerebri sx? dx? tx?
obese young women with a HA & dbl vision on exam = papilledema; associated with Vitamin A use. dx: increased CSF pressure tx: weight loss, ACETAZOLAMIDE, surgery, stop vitA, steroids, decompression
Benign Positional Vertigo(BPV) sx? tx?
vertigo(NV, horizontal nystagmus= peripheral), positive dix-hallpike maneuver(vertigo with changes in position) no hearing loss tx: meclizine
Vestibular neuritis sx? tx?
sx: inflammation of 8CN = vertigo and dizziness not related to positional shit. tx: meclizine
Labyrinthitis sx? tx?
inflammation of cochlear portion of inner ear = vertigo, hearing loss, tinnitus & self limiting tx: steroids & meclizine
Meniere’s Disease sx? tx?
sx: vertigo, hearing loss & tinnitus with remitting and relapsing episodes(MULTIPLE EPISODES). tx: salt restriction and diuretics
Acoustic Neuroma sx? tx?
sx: 8th CN tumor that can be related to neurofibromatosis, hearing loss, tinnitus, vertigo tx: resection
Subarachnoid Hemorrhage(SAH) sx?
sudden or severe HA, stiff neck, photophobia, LOC(50%), FND(30%), fever
Subarachnoid Hemorrhage(SAH) tx?
angiography to determine the site of bleeding, embolize, shunt of hydrocephalus, NIMODIPINE PO to prevent stroke
what drug do you give in subarachnoid hemorrhage that will prevent stroke?
Nimodipine
Syringomyelia sx? tx?
*fluid filled widening of the spinal cord sx: loss of pain, temp in the upper extremities bilaterally in a cape-like distribution over the neck and shoulder and down both arms tx: MRI then surgery
Subacute Degeneration of the Cord
cause: B12 or neurosyphillus sx: no position or vibration
Cord Compression sx? tx?
sx: pain and tenders of the spine + hyperreflexia tx: steroids
Anterior Spinal Artery Infarct sx?
all sensation loss expect Position and vibration(these down posterior column),
Brown-Sequard Syndrome sx?
loss of ipsilateral position, vibratory sense, contralateral pain and temperature.
Amyotrophic Lateral Sclerosis(ALS) sx? UMN? LMN?
ASYMMETRIC! upper and motor neuron sx that often starts in arms. seen in 20-40yoa, death 3-5 yrs afterward – tongue fasciculartion often seen first
*UMN: hyperreflexia, upgoing toes, spasticity, weakness
*LMN: wasting, fasciculations, weakness
**ocular motility, sensory, bowel, bladder + cognitive function preserved even in late disease
tx of Amyltrophic lateral sclerosis(ALS)
riluzole
Charcot-marie-Tooth Disease sx?
*demylination of peripheral nerves - decreased motor and senory - wasting in legs, decreased DTR, tremors, Pes Vavus(HIGH FOOT ARCH), distal weakness & sensory loss
Radial nerve palsy
saturday night palsy = wrist drop *crutches use compresses nerve
Restless Leg Syndrome tx
pramipexole or ropinirole
Myasthenia Gravis
sx? dx? tx? tx crisis?
*ab to post-ACh receptros at NMJ
sx: protosis, weakness, worse at the end of the day, weak muscles of masticaion
dx: endrophonium(AChE inhibitor) test +
tx: pyridostigmine or Neostigmmine(AChE inhibitor), considered thymectomy to reduce sx
Crisis: plasmapheresis or IVIG
person with myasthenia gravis. what do you need to look out for?
thymoma
Tuberous Sclerosis sx? tx?
seizures, mental deterioration, retinal lesions SKIN: adenoma sebaceum(red face nodules), Shagreen Patches(leathery patches on trunk), Ash leaf spots(hypopigmented spots) tx: control seizures
Neurofibromatosis sx? tx?
sx: soft flesh-colored lesions on skin +peripheral nerves, CN 8 tumors, Cafe-au-lait spots +/- gliomas tx: decompress CN8
Sturge-Weber Syndrome tx? sx/
sx: seizures, port wine stain, CNS eye shit, Calcifications of angiomas, hemiparesis tx: control seizures
which 4 causes of vertigo will have hearing loss? whats the big difference between the two?
- Labyrinthitis = acute w/hearing loss and tinnitis - Meniere’s disease = chronic = multiple episodes w/hearing loss and tinnitis - acoustic neuroma = ataxia w/hearing loss and tinnitis - Perilymph Fistula = hx of trauma w/hearing loss and tinnitis
causes of peripheral vertigo?
meniere disease, labyrinthitis, BPPV, perilymphatic fistula
which 2 types of vertigo have no hearing loss ? what the difference between them?
BPPV = veritgo with head movement Vestibular Neuritis = vertigo regardless of head movment
Idiopathic Intracranial HTN rf? sx? dx? tx?
Idiopathic Intracranial Hypertension: - RF: overweight women of childbearing age, possible link to some meds(vit A, tetracyclines) - SX: HA, TRANSIENT VISSION LOSS(PAPILEDEMA), PULSATILE TINNITUS, diplopia - PE: papilledema, peripheral Visual Field defect, CN 6 palsy - DX: MRI & LP(>250) - TX: stop meds, weight loss, acetazolamide
—- nystagmus is highly specific for central vertigo.
vertical
prophylactic abx for epidural abscess?
3rd gen cephalosporin(rocephin) + vancomycin
Spinal Stenosis
sx, tx
SX: neurogenic claudication(pain with bending over), classicly pain improves with walking uphill, pushing shopping cart, going up stairs, back pain referred to buttocks, negative straight leg raise
TX: NSAIDs, PT > steroids or laminectomy
Treansverse Myelitis
Sx? Tx?
SX: weakness, numbness and autonomic dysfunction below the level of the lesion in the spinal cord. can be idiopathic, infectious or autoimmune.
TX: High-dose IV steroids > plasma exchange, if infectious tx infection
Bell’s Palsy
Cause, SX, TX?
SX: upper and lower facial droop on one side = damge to peripheral upper(innnervated from both sides of cortex) & lower CN 7
Causes: idiopathic, viral
TX: steroids & wait as sx resolve on their own, valacyclovir is often given with steroids as VZV is comon cause
Guillain-Barre Syndrome
what is it? sx? tx?
* acute ascending motor paralysis w/areflexia & sensory deficits = AI attack on myelin, can be acute(2-4weeks) or chronic(>8 weeks) often associated with recent GI infection(campylobacter jejuni)
SX: ascending paralysis, decrease or abscent reflexes, parathesias in hands and feet, dysautonomia(orthostatic hypotension, tachy/brady, urinary retention, ileus), facial palsies and bulbar weakness
TX: self limited, IVIG or plasmapharesis - assess respiratory capacity(may need intubation), need PT/OT
Creutzfeldt-jakob DIsease?
acute onset of dementia associated with myoclonic jerks and periodic sharp waves on EEG - prion disease
Vascular dementia
stepwise worsening of sx with evidence of lacunar strokes and/or white matter changes on imaging, may have focal deficits
