Neuro AHN 572

Question 1

Loss of blood supply to brain, causing loss of function is…

Answer 1

Stroke

Question 2

Severity of the stroke depends on

Answer 2

The vessel and the amount of brain area involved

Question 3

Cause of ischemic stroke

Answer 3

atrial fibrillation
Heart attack
atherosclerosis

Question 4

Causes of hemorrhagic stroke

Answer 4

hypertension (ICH)
aneurysms
arteriovenous malformations

Question 5

Risk factors for stroke

Answer 5

Hypertension
Atrial fibrillation
hyperlipidemia
diabetes
smoking
PVD/CAD/Carotid disease

Question 6

Other modifiable risk factors for stroke, less well documented

Answer 6

Obesity 
physical inactivity
Alcohol
Drug
Hypercoagulability
HRT
Oral contraceptives
Inflammatory processes

Question 7

Seven step stroke chain of survival and recovery

Answer 7

detection
dispatch
delivery
door
data
decision
drug

Question 8

Hold anticoagulants and fibrinolytic until…

Answer 8

Ct has ruled out hemorrhage

Question 9

Stroke mimickers

Answer 9

seizures
confusional states
syncope
toxic and metabolic disorders (electrical imbalances)
hypoglycemia
brain tumors
subdural hematomas

Question 10

Absolute contraindications for t-PA

Answer 10

ICH or history of
SAH
Neurosurgery, head trauma or stroke in past 3 months
uncontrolled HTN
Known AVM, aneurysm or neoplasm
active internal bleeding
suspected endocarditis
Abnormal BG < 50 > 400

Question 11

Relative contraindications

Answer 11

improving stroke symptoms
major surgery in previous 14 days
history of GI or GU hemorrhage in 21 days
Recent arterial puncture at a non compressible site
recent LP
post MI
pregnancy

Question 12

NINDS time target door to doctor

Answer 12

10 minutes

Question 13

NINDS time target door to CT

Answer 13

25 minutes

Question 14

NINDS time target door to CT read

Answer 14

45 minutes

Question 15

NINDS time target door to treatment

Answer 15

60 minutes

Question 16

Tension HA account for…

Answer 16

90% of all HA’s

Question 17

Etiology of HA

Answer 17

Tension (90%)
migraine
cluster
toxic
SDH
SAH
Meningeal irritation
Giant cell arteritis
structural lesions
referred pain
visual strain
narrow angle glaucoma
hypertensive headache

Question 18

Components of HA evaluation

Answer 18

Chronology
location, duration, quality
associated activity
timing in menstrual cycle
associated symptoms
presence of trigger
age of onset

Question 19

Tension headache treatment

Answer 19

stress reducing techniques
explore cause of stress
when other measures fail, a trial of anti migraine agents is appropriate

Question 20

Theories for the cause of migraine headaches

Answer 20

Dilation and excessive pulsation of external carotid artery

excessive release of the neurotransmitter serotonin, leading to an inflammatory process involving the trigeminal nerve

Question 21

Migraine triggers

Answer 21

emotional or physical stress
lack of or excessive sleep
missed meals
specific foods
alcohol
menstruation
weather changes
nitrate containing foods

Question 22

Migraine management

Answer 22

avoid triggers
relaxation and stress management
drugs for migraine to abort migraine or prevent the migraine

Question 23

Migraine abortive therapy

Answer 23

Treatment should commence at the earliest sign of migraine
For mild to moderate sx- ASA, Ibuprofen, Acetaminophen, Excedrine migraine
If milder treatments are ineffective then you can use “triptans” (SSRIs), ergot alkaloids, or an opioid in that order

Question 24

Triptans

Answer 24

First line drug for terminating migraine

Relieve pain by constricting intracranial blood vessels and suppressing release of inflammatory neuropeptides

Question 25

Triptan SE

Answer 25

Greatest concern is coronary vasospasm

Question 26

Cluster HA

Answer 26

Among the most painful of all HA

Question 27

Cluster HA etiology

Answer 27

Histamine mediated dilation of external carotid artery | Cycles occur the same time each time each year most often during fall and spring

Question 28

Parkinsons disease is...

Answer 28

a progressive, neurodegenerative disease

Question 29

Neurons loss in parkinsons

Answer 29

dopamine neurons

Question 30

dopamine neurons live in the...

Answer 30

substantia nigra

Question 31

Parkinsons movement trouble

Answer 31

shakiness, stiffness, slowed movements, balance trouble

Question 32

Risk factors for parkinsons

Answer 32

``` genetics some pesticides cleaning chemicals gender history of concussions heavy metal exposure ```

Question 33

treatment for parkinson's

Answer 33

medication- dopamine replacement | Later in disease can try surgery

Question 34

Parkinson movement disoder

Answer 34

tremor-"resting" rigidity- "cogwheel rigidity" Slowed movement- "bradykinesia" postural instability "

Question 35

non movement symptoms of parkinsons

Answer 35

``` depression anxiety memory concentration sense of smell ```

Question 36

Types of CNS infections

Answer 36

Meningitis Cerebral abscess encephalitis

Question 37

Meningitis pathology

Answer 37

inflammation of the pia and arachnoid mater begins with entry of a microorganism into the CNS The meninges attempt to destroy the m/o Neutrophils gather and cause thickened CSF which doesn't flow well

Question 38

Causes of meningitis

Answer 38

``` Bacteremia from pneumonia, empyema, osteomyelitis, endocarditis sinusitis, otitis media, encephalitis brain abscess viral infection idiopathic trauma or invasive procedure ```

Question 39

Bacterial meningitis is...

Answer 39

Life threatening

Question 40

Exudate forms in..

Answer 40

Bacterial meningitis- neutrophil Does not form in viral meningitis where lymphocytes gather

Question 41

S/sx of meningitis

Answer 41

``` Fever Tachycardia Hypotension Petechial hemorrhage, ecchymosis of skin Photophobia, diplopia deafness and vertigo Nuchal rigidity headache seizures sensory loss ```

Question 42

Diagnostic testing for meningitis

Answer 42

LP with CSF analysis CT brain to rule out edema Culture urine, sputum, nasopharynx if suspected as possible source

Question 43

LP data for bacterial meningitis

Answer 43

``` Growth on culture Gram + in >70% of patients >1000 molymorphonuclear cells Protein increased > 100 Glucose decreased < 40 Pressure- increased Color- turbid, cloudy ```

Question 44

LP data for viral meningitis

Answer 44

``` No growth on culture Gram stain negative WBC increased lymphocytes Protein elevated Glucose normal Opening pressure moderate to high Color clear to bloody ```

Question 45

Treatment for bacterial meningitis

Answer 45

Antibiotic therapy must be started IMMEDIATELY Empiric treatment begins with Cefotaxime If immunocompromised or over 50- Ampicillin If no improvement in 24 hours- intrathecal treatment Then treat s/sx of meningitis fever, seizures, hydration

Question 46

Cerebral abscess definition

Answer 46

An infected space occupying lesion in the brain

Question 47

Cerebral abscess causes

Answer 47

``` infection from a different sit in or near the brain otitis media mastoid infection sinusitis oral surgery ```

Question 48

s/sx of cerebral abscess

Answer 48

``` depends on the location of the abscess speech, visual disturbances hemiparesis seizures severe HA ```

Question 49

Hydrocephalus definition

Answer 49

A condition in which CSF builds up around the brain

Question 50

Causes of hydrocephalus

Answer 50

``` Spina bifida brain infections hemorrhage tumors brain trauma ```

Question 51

Types of hydrocephalus

Answer 51

Communicating- problem is in the subarachnoid space | noncommunicating-problem is in the ventricles

Question 52

Normal pressure hydrocephalus

Answer 52

Seen in elderly due to obstruction of the CSF pathways- communicating hydrocephalus ventricles enlarged no increase in pressure

Question 53

S/S of normal pressure hydrocephalus

Answer 53

urinary incontinence Mental status change- mild dementia Gait disturbances Mimics alzheimers

Question 54

Encephalitis definition

Answer 54

Acute inflammation of the brain caused by viral or other infection, often carried by mosquitos

Question 55

Causes of encephalitis

Answer 55

``` HSV- most common cause in US Varicella-zoster virus influenza tick infestation Toxoplasmosis- more common in AIDS patients ```

Question 56

West nile virus s/sx

Answer 56

``` fever nystagmus, ocular paralysis N/V nuchal rigidity severe HA, ataxia, dysphagia, hemiparesis, seizures ```

Question 57

Guillian-Barre syndrome (GBS) definition

Answer 57

Acute, rapidly progressive form of inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss Causes: infectious disorder, surgery or an immunization

Question 58

s/sx of GBS

Answer 58

``` symmetrical distal muscle weakness beginning in legs, ascends rapidly to the arms hypotonia loss of DTR's Difficult swallowing urinary retention respiratory paralysis Autonomic dysfunction ```

Question 59

GBS diagnostic

Answer 59

CSF- very high protein elevation (> 1000) | CBC- leukocytosis