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Neuro slides Flashcards

1
Q

Apraxia

A

Unable to perform learned motor movements

Eg. Cant use tools - dominant parietal lobe

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2
Q

Agnosia

A

Failure to recognize familiar objects

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3
Q

Aphasia

A

Loss of ability to produce/understand written or spoken language

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4
Q

Gerstmann Syndrome

A

Tetrad:

  • right left orientation
  • finger agnosia (own or anothers fingers)
  • dysgraphia (loss of ability to express thoughts in writing)
  • acalculia

-lesions in posterior left hemisphere

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5
Q

UMN features

A
  • spasticity (increased tone - clasp knife)
  • increased DTR (deep tendon reflexes)
  • no atrophy
  • babinski, Hoffmann
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6
Q

LMN features

A
  • absent reflexes
  • decreased tone
  • atrophy (early)
  • fasciculations
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7
Q

Coma

A

Reduction in arousability and awareness

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8
Q

Sleep

A

Normal physiologic state of no awareness but arousable

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9
Q

Stupor

A

State of deep sleep, where mental and physical activity are at minimum
-difficult to arouse

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10
Q

Obtundation

A

Varying degrees of decreased alertness

-Loss of interest and responsiveness to stimuli

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11
Q

Coma

A

Unarousable for at least one hour

-lack of awareness, wakefulness, movement, closed eyes

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12
Q

Persistent vegetative state

A

No awareness of self or environment

  • no evidence of sustained or reproducible behavioral responses
  • no language comprehension or expression
  • wakeful unconsciousness diagnosed 1 month after coma onset
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13
Q

Mannitol

A

IV osmotic diuretic for elevated ICP

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14
Q

Propofol

A

Sedation in elevated ICP - to reduce metabolic demand

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15
Q

Seizure

A

Paroxysmal electrical disturbance of neurons that disrupt the motor system, sensory system, behavior, consciousness and autonomic function.

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16
Q

Myoclonus

A

Sudden jerking of muscles, usually sufficient to move a joint

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17
Q

Epilepsy

A

At least 2 seizures that are unprovoked more than 24h apart

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18
Q

Status epilepticus

A

A single seizure which lasts more than 30mins
OR
A series of epileptic seizures during which function is not regained between ictal events in a 30 minute period

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19
Q

Management of seizures

A

Airway, breathing, circulation
Determine status + etiology if possible
Test glucose, give 50ml 50% dextrose with thiamine 100mg IV

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20
Q

1st drug status epilepticus

A

Lorazepam 4mg IVI at 2mg/min
OR
Diazepam 10mg IVI at 2mg/min

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21
Q

2nd drug status epilepticus

A

Phenytoin 18mg/kg in 200ml saline at 50mg/min
THEN
Phenytoin 10-12mg/kg in 200ml saline at 50mg/min

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22
Q

3rd drug status epilepticus

A

Sodium valproate 25mg/kg IVI at 5mg/kg/min
THEN
Sodium valproate 15mg/kg IVI at 5mg/kg/min

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23
Q

If drugs fail in status epilepticus

A

Intubate
THEN
Phenobarbital / midazolam / propofol

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24
Q

CADASIL

A

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
-multiples small holes (infarction) subcortical

25
Q

GANS

A

Granulomatous angiitis of the nervous system

-chronic inflammation with giant cells

26
Q

Cavernous sinus syndrome

A

CN3,4,6 with V1 & V2 involvement

27
Q

Horner syndrome

A

Affected side of face has pupil constriction partial ptosis and anhidrosis
-lesion in lateral medulla oblongata (affects sympathetic chain)

28
Q

Seizure

A

Transient occurrence of signs/symptoms due to excessive or synchronous neuronal activity in the brain

29
Q

Epilepsy

A

Enduring predisposition to generate seizures with neurobiological, cognitive, psychological, & social consequences

30
Q

To diagnose epilepsy

A 
>2 unprovoked/reflex seizures >24h apart
OR
1 unprovoked/reflex seizure + probability (>60%) of further seizures over the next 10y
OR
Diagnosis of epilepsy syndrome
31
Q

Parasomnia

A

Unusual experience / behavior during sleep

  • sleep terror disorder
  • sleepwalking
  • nightmare disorder
32
Q

Dyssomnia

A

Abnormality in amount, quality or timing of sleep

  • primary insomnia
  • hypersomnia
  • narcolepsy
  • sleep apnea
  • circadian rhythm sleep disorder
33
Q

Narcolepsy

A
  • Excessive daytime sleepiness
  • cataplexy (loss of muscle tone with emotional stimulus)
  • hypnagogic hallucinations
  • sleep paralysis
34
Q

Obstructive sleep apnea

A

5-15 pauses per hour in breathing each lasting >10s

-associated with sleepiness or difficulty concentrating, unrefreshing nocturnal sleep or nocturia

35
Q

Dysarthria

A

A group of speech disorders resulting from disturbances in muscular control - weakness, slowness or incoordination of the speech mechanism due to damage of the CNS or PNS or both

36
Q

Aphasia Screening

A
  1. Spontaneous speech
  2. Reading
  3. Writing
  4. Comprehension (verbal and written)
  5. Repetition
  6. Naming
37
Q

Basal ganglia

A 
Striatum: caudate nucleus and putamen (inhibitory)
Globus pallidus (inhibitory)
Subthalamic nucleus (excitatory)
Sunstantia nigra (inhibitory)
38
Q

Athetosis

A

Continuous, slow, writhing movements (in children)

39
Q

Akinesia

A

Difficulty initiating movement

40
Q

Extrapyramidal system

A

Controls automated / involuntary movements, modulates muscle tone and movement, and regulates posture
ROLE:
-selective activation of movements and suppression of others
-initiation of movements
-setting rate and force of movements
-coordinating movements

DAMAGE RESULTS IN DISKINESIAS - eg. Parkinsons

41
Q

Features of Parkinsons

A 
TRAP
-Tremor (resting)
-Rigidity 
-Akinesia (bradykinesia)
-Postural instability
NB IN TEST - PHARMS
42
Q

Parkinson’s - other features

A
  • Monotonous speech
  • Blurred vision, impaired upward gaze
  • cognitive impairment, depression, sleep disturbances, anxiety, psychosis, hallucinations
  • shuffling gait with decreased arm swing, freezing
43
Q

Parkinson’s Protective Factors

A
  • Smoking (nicotine - neuroprotective)
  • Coffee (caffeine)
  • Moderate exercise
  • Low dose ibuprofen
44
Q

Warning signs in Paeds headaches

A
  • very severe
  • wakes from sleep, or worse upon waking then gets better
  • chronic progressive (chronic is 3-4h/day for >15 days per month for 3 months)
  • increasing frequency and severity
  • worsened by coughing/sneezing, going to toilet
  • change in personality
  • history of convulsions
  • relieved by effortless vomiting
  • neurological deficit
  • signs of meningeal irritation
45
Q

Causes of Delirium

A 
-medical condition / medication eg. UTI, aspiration pneumonia, hyponatremia, sleep deprivation
VITAMIN
-Vascular (stroke, aneurism)
-infectious (encephalitis, meningitis, UTI)
-Tumor
-Alcohol (and other substances)
-Metabolic and deficiency diseases (B12)
-Iatrogenic (medications)
-Non-organic
46
Q

Amnestic syndrome

A

The “ETERNAL PRESENT TENSE” - Bourne identity
Impaired recent memory (anterograde, retrograde)
Global amnesia, disoriented, confabulation (make up words)
Procedural, immediate, remote memory spared

-posterior circulation bilateral stroke, head injury

47
Q

Transient Global amnesia

A

Sudden loss of short term memory - ask repetitive questions

48
Q

Dementia - aka Major Neurocognitive Disorder

A

Significant cognitive decline from previous level of performance where deficits interfere with independence in everyday activities, where deficits aren’t explained by another mental disorder

49
Q

Dementia can be due to:

A

-the FLAPP V(5) - five birds

Frontotemporal lobar degeneration
Lewy body disease
Alzheimer'z disease
Prion disease
Parkinson's disease

Vascular disease

50
Q

Motor Neuron Disease

A

Synonym for ALS (amyotrophic lateral sclerosis)
-Progressive motor syndrome with UMN + LMN features (half die within 14mo), with weak limbs or bulbar regions

Progressive bulbar palsy (speech, swallowing)
Progressive muscular atrophy (LMN)
Primary lateral sclerosis (UMN)

51
Q

WHO Tumor grading (anat path)

A

Grade 1: Polycystic pleocytoma
Grade 2: diffuse fibrillary astrocytoma
Grade 3: Anaplastic astrocytoma
Grade 4: Glioblastoma, medulloblastoma

52
Q

Contraindications of an LP

A 
Increased ICP
Local infection on skin / abscess
Obstruction to CSF flow
Coagulopathy / thrombocytopenia
Sepsis, HT
53
Q

Myasthenia gravis

A

Acquired autoimmune disease of neuromuscular junction - targeting postsynaptic Ach receptors

-usually eye muscles are affected

Differential: botulism, Lambert-Eaton

54
Q

Myasthenia gravis diagnosis

A

Fatigability testing (esp of eyes) - muscles get weaker with exertion
Edrophonium test - inhibit the enzyme that breaks down Ach
Antibodies against ACh receptors
Repetitive nerve stimulation - the action response fatigues

55
Q

Myathenia gravis treatment

A

ACh esterase inhibitor (pyridostigmine) - symptomatic treatment
Immune treatment: steroids
Methotrexate - reduces production of inflammatory cells

Myaesthenic crisis: Plasmaphresis and infusion of IV immunoglobulin

56
Q

Dysmetria

A

Inaccuracy of movement so desired target is either under-reached or over-reached

57
Q

Dysdiadochokinesia

A

Irregularity of rhythm and amplitude of rapid alternating movements

58
Q

Cerebellar signs (Pillay)

A 
VARNISHDDT
Vertigo
Ataxia
Rebound test
Nystagmus
Intention tremor
Speech
Hypotonia
Dysmetria
Dysdiadochokinesis
Titubation
59
Q

Muscle disorders Picture

A

LMN picture
Cause proximal weakness (neuropathies cause distal)
CK levels elevated (creatine kinase)

Neuro (3 decks)

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