Neuro and optho from Step Up Flashcards
ALS affects what tracts
corticospinal tract and ventral horn
poliomyeltisis affects what tracts
ventral horn causing flaccid paralysis
tertiary syphilis or tabes dorsalis affects what tracts
dorsal columns impairing proprioception and pain
what is spinal artery syndrome
bilateral loss of pain and temp below lesion and bilateral spastic paresis below with flaccid paralysis at the level
whats affected in spinal artery syndrome
corticospinal track, spinothalamic tract, ventral horn, lateral gray matter
What tracts does Vit B12 deficieny affect
dorsal columns and corticospinal tract leading to bilateral loss of vibration and discrimination with bilateral spastic paresis affecting legs before arms
what tracts are affected in syringomyelia
ventral horn and ventral white commissure
Signs of syringomyelia
bilateral loss of pain and temp below and flaccid at the level
what is brown sequard syndrome
ispi loss vibration and discrimination blow. ipsi spastic paresis below
ipsi flaccid paralysis at level
contra loss pain and temp below
what tracts are affected in brown sequard syndrome
all tracts on one side of the cord
Brudzinski
neck flexion in supine causes hip flexion
What rash is seen in N meningitis
petechiae
Tx meningtitis bacterial
cephalosporins usually 3rd gen
close contacts given rifampin or cipro for porphylaxis
what are signs of incrreased intracranial P
papilledema, focal neurologic deficits, pupil asymmetry
why no do LP if signs of intracranial P
increased risk of uncal herniation
Tx fungal meningitis
amphotericin B
Tx TB meningitis
RIPE
most common cause meningitis in newborn
Group B strep
common meningitis in 1 mo-2 year
strep pneumo and N meningitis
common cause meningitis 2-18 year
N meningitis
cause meningitis in 18-60+ y.o
S pneumo
CSF bacterial meningitis
increased PMNs
increased pressure
decrease glucose
increase protein
CSF in viral meningitis
increased lymphocytes
increased pressure
normal glucose
normal protein
Malaise, HA, comiting, neck pain, dec consciousness and change in mental status with focal neurologic deficitis
encephalitis
encephalitis due to mumps, sign
partodi swelling
West nile virus encephalitis Presentation
flaccid paralysis with maculopapular rash
LPs in encephalitis
increased WBCs and normal glucose
Tx encephalitis
maintain ICP, supportive care
What medication can cause encephalitis in children
Aspirin during viral illness- reyes
Radiology sign of brain abscess
ring enhancing lesion
Tx brain abscess
empiric until Bx back and surgical drainage
labs for poliomyelitis
polio specific Ab
What happens with rhabdovirus (rabies)
severe encephalitis with neuronal degeneration and inflammation
fear of water ingestion
rabies from laryngeal spasm
foaming at mouth
rabies
what you would see on Bx of rabies
negri bodies, round eosinophilic inclusions in neurons
Tx trigeminal neuralgia
carbamazepine, baclofen, phenytoin, gabapentin, valproate, clonazepam, other anticonvulsants
most common adult HA
tension
pain characteristic of migrain
unilateral and throbbing
which HA can cause periorbital pain and horners
cluster
Sx of tension HA
bilateral tightness, occipital or neck pain
what helps with cluster HA
100%O2 ergots and sumatriptan
Tx migraines
NSAID, ergots, sumatriptan, IV antiemetics, proph of TCA, beta blockers, CCBs
harsh systolic murmur
aortic stenosis
when to do carotid endarterectomy
> 60% males with no Sx
50% in Sx males
70% in Sx women
most common artery involved in embolic ischemic strok
middle cerebral a
if losing sensation to legs feet and toes, strok affected what a
anterior cerebral
lacunar a infarct cause
focal motor or sensory deficits loss coordination and difficulty speaking
basilar a infarct cause
CN abnormalities, contra full body weakness and decreased sensation, vertigo, loss coordination, difficulty speaking and visual abnormalities
may cause coma
imagin for suspected stroke
CT without contrast
Tx stroke
thrombolytic if within 3 hours of onset and no contraindications
What should you give to prevent additional strokes
antiplatelet Tx
Acute Tx hemorrhagic stroke
reverse anticoagulation, control BP monitor ICP with mannitol, hyperventilation and anesthesia
patient with stroke and high BP
do NOT Tx BP because need to maintain cerebral perfusion
What can cause parenchymal hemorrhage
HTN, AV malformation, brian aneurysm, stimulant abuse
Berry aneurysms are associated with what
ADPKD and ehlers danlos
LP in subarachnoid hemorrhage
RBC, xanthochromia and increased P
If SAH is suspected but negative CT
do LP
declining RBC count over successive collection tubes
traumatic LP
convex hyperdensity compressing brain
epidural
what artery is common cause epidural hematoma
middle meningeal
which hematoma can appear to cross midline
epidural
lens shape hematoma
epidural
what causes subarachnoid hemorrhages
rupture vessels between pia and arachnoid layers
what causes subdural hematoma
ruptured bridging veins after trauma between arachnoid and dura
signs subdural hematoma
slowly progressive HA and change in mental status, contra hemiparesis, increased DTRs
concave hyperdensity on CT
subdural hematoma
what is hurt in brocas aphasia
frontal gyrus
what is hurt in wernickes
posterior superior temporal gyrus
what is conduction aphasia
fluent speech, word substitutions, attempts to correct words, word finding pauses
what is global aphasia
nonfluent speech, poor comprehension, limb ataxia and difficulty producing words
meaningless phrases with poor comprehension
wernickes
generalized vs partial seizures
generalized involve entire cortex and partial is focal
what can cause status epilepticus
withdrawal anticonvulsants, alcohol withdrawal, trauma, preexisting seizure disorder, metabolic abnormalities
>20 minutes
which seizure has no LOC
simple partial
which seizure has hallucinations and automatisms
complex partial
EEG shows 3 cycle spike and wave pattern
absence seizure
what drug is given to stop status epilepticus
benzo
signs of PArkinson
shuffling gait masked facies akinesia rigidity cogwheel tremor resting
pill rolling resting tremor
parkinsons
how to Dx ALS
Dx of exclusion
LMN signs at least 2 extremities and UMN in one region
Tx ALS
riluzole
what is main cause death in ALS patients
respiratory failure
Inheritance Huntington and mutation
auto dominant. CAG repeats on chromosome 4. more repeats = earlier disease
signs huntingtons
progressive rapid irregular involuntary movements (chorea) dementia, possible seizures
adverse effects levodopa
nausea vomiting, anorexia, tachycardia, hallucination, modd changes, dyskinesia!!!
how does amantadine work
increase synthesis and release or reuptake dopamine
what helps with rigidity and bradykinesia in parkinsons
amantadine
Radiology of huntingtons
CT or MRI show cuadate nucleus atrophy
Tx for huntingtons
dopamine antagonists may improve chorea
initial complains MS
vertigo, visual abnormalities, paresthesias, weakness, urinary retention
late Sx of MS
poor movement control, difficulty speaking, sensory abnormalities, postural and positional instabilities, spasticity, increased DTRs and + babinski
LP of MS
increased protein, mildly increased WBCs, oligoclonal bands and increased IgG
what to order is suspect MS
MRI looking for white matter lsions
LP looking for oligoclonal bands
Tx syringomyelia
surgical decompression, shunting and supportive care
what causes labert eaton
Ab to presynaptic Ca channels
tensilon test
when edrophonium is given, Myasthenia Sx improve
What are the anticholinesterase drugs
neostigmine and pyridostigmine
what must you do if you Dx someone with myasthenia gravis
do a chest CT looking for thymoma
athetosis
writhing snakelike, cerebral palsy, huntington, wilson
what causes hemiballismus
stroke in subthalamic nucleus. give haloperidol
Most common brain tumor in adults
glioblastoma
most common primary brain tumor in children
astrocytoma
what is the most common Malignant brain tumor in children
medulloblastoma
metastasis to brain go where
supratentorial
if find intracranial tumor
search rest of body for primary
NF1, con recklinghausen
Auto dominatnt on chrom 17
NF2
auto dominant on chrom 22
which NF causes bilateral acoustic neuromas
NF2
signs NF 1
cafe au lait spots neurofibromas axillary or inguinal freckles optic glioma iris hamartoma bone lesions relative with NF1
half of sleep is in what stage
intermediate with sleep spindles and K complexes on EEG
hwo do benzos work on sleep schedule
increase N2 decrease N3(deep sleep)
Tx narcolepsy
modafinil, methylphenidate, pemoline
patient in coma with pinpoint pupils
opioid overdose
patient in coma with large nonreactive pupils
damage below midbrain, possible unclahernation
if patient in coma, put ice water in ear and they have conjugate deviation toward water
intact midbrain
decorticate
elbow flexed, legs extended
cortical or thalamic compression
decrebrate
elbows extended and legs extended
midbrain involvement
no response to pain in coma
pontine and medullary involvement
most common seizure in children
febrile
hydrocephalus in children with anatomic defects
arnold chiari type II and dandy-walker
tay sachs
auto recessive
absence hexosaminidase A needed for lipid ganglioside metabolism
risk factors tay sachs
ashkenazi jew, french canadian
cherry red spot on retina
tay sachs
prognosis tay sachs
death first few years
risk factors for Neural tube defects
anticonvulsant use or poor folate intake, maternal DM
how does quad screen detect NT defects
increased AFP and ACE
risk factors Cerebral palsy
prematurity, IUGR, birth trauma, neonatal seizures or hemorrhage, perinatal asphyxia, multiple births, intrauterine infection
types of CP
spastic– pyramidal tracts: increased tone, increased DTRs, weakness, gait abnormalities, mental retardation
dyskinetic– extra pyramidal: choreoathetoid, dystonic, ataxic that worsen with stress
what maintains conjugate gaze when one eye abducts
Medial longitudinal fasciculus
accomodation to near objects and nonreactive to light
argyll robertson pupil: syphilis, SLE or DM
minimally reactive dilated pupil
adie pupil from abnormal innervation iris
what can cause an absent ipsilateral eye adduction with lateral gaze
MLF lesion or MS
myopia vs hyperopia
myopia focal point is anterior to retina
hyperopia focal point is posterior to retina
amblyopia
developmental defect causing poor visual acuity and spatial differentiaion
Tx amyblyopia
correct visual acuity in affected eye and patch unaffected eye to promote use of affected
Anterior uveitis
pain and photophobia, slit lamp show inflammation of eye and keratin deposits on cornea
posterior uveitis
mild vision abnormalities, eye inflammation and retinal lesions
most common cause conjunctivitis
adenovirus
risk factors open angle glaucoma
age, increased IOP, DM, black, myopia, family Hx
vision loss in open angle
chronic from peripheral to central. see halo around light. cupping of optic disc
Dx open agnle glaucoma
tonometry every 2-4 weeks
Tx open angle glaucoma
topical beta blocker, alpha agonist(decrease production), PG analogues, cholinergic agonists(remove aqueous humor)
risk factors closed angle glaucoma
increased age, asian, hyperopia, dilated pupils
eye is inflamed and hard with dilated nonreactive pupil
closed angle glaucoma
patient needing frequent changes of lens prescriptions
suspect open angle glaucoma
Tx closed angle glaucoma
timolol, apraclonidine, pilocarpine eyedrops oral IV acetazolamide or IV mannitol
most common cause bilateral vision loss in elderly
macular degeneration
risk factors macular degeneration
white tobaco, FMH, inc age, prolonged sunlight, HTN female>male
vision loss in macular degeneration
central to peripheral
possible retinal detachment
Tx macular degeneration
Vit C E and beta carotene, copper and zine
intravitreal ranibizumab
Tx retinal detachment
laster photocoagulation or crytotherapy
what causes retinal vessel occlusion
atherosclerosis
DM HTN, thromboembolic disease
sudden painless loss vision
retinary artery occlusion
what you see on retinal a occlusion on fundoscopi
cherry red spot in fovea
descriptions presentation retinal vein occlusion
more gradual painless loss vision
fundoscope shows cotton wool spots, edema, retinal hemorrhages and dilated veins
what is used for otitis externa
polymyxin, neomycin, hydrocortisone, oral cephalosporins, cipro
meniere disease
vertigo from distension of endolymphatic compartment of inner ear
acute vertigo for hours, nausea, vomiting, decreased hearing, tinnitus
will lose low frequency!
conductive hearing loss
preserved bone conduction, air conduction shows low hearing threshold
abnormal rhinne
sensorinueral hearing loss
impaired bone and air conduction. asymmetric weber, normal rhinne
from neural pathway deficit
what type of hearing loss with acoustic neuroma
sensorineural
risk factor alzheimer
increased age, FMH, trisomy 21, F>M
cortical atrophy dementia
alzheimers
what type med for alzheimer
cholinesterase inhibitors like donepezil and rivastigmine
pick disease, frontotemporal
intracellular inclusions tau protein
has behavioral variant and aphasia variant
bilateral frontal atrophy
Tx picks disease
SSRI trazadone, atypical antipsychotics
lewy body dementia
intracell cortical inclusions lewy bodies (alpha synuclein)
fluctuating congnition, impaired attention, visual hallucinations, syncope, frequent falls, limb rigidity, bradykinesa or akinesia, gait distubrance
which dementia has parkinsonian Sx
lewy body
NPH
wet weird wobbly
LP show normal P but improves symptoms
Tx NPH
VP shunt
what not to use in delierium
benzos or anticholinergics
