neuro uworld Flashcards
contralateral hemiparesis, homonymous hemianopia, gaze palsy, hemisensory loss
basal ganglia hemorrhage
facial weakness, ataxia, nystagmus, occipital headache, neck stiffness
cerebellar hemorrhage
contralateral hemiparesis, hemisensory loss, nonreactive miotic pupils, upgaze palsy, eyes deviate towards hemiparesis
thalamic hemorrhage
contralateral hemiparesis only
frontal lobe hemorrhage
contralateral sensory loss only
parietal lobe hemorrhage
homonymous hemianopsia
occipital lobe hemorrhage
eyes deviate away from hemiparesis and high occurrence of seizures
cerebral hemorrhage
deep coma, total paralysis, pinpoint reactive pupils
pontine hemorrhage
patient is jogging on treadmill and then start having headache, vomiting, seizures, and AMS
intraparenchymal brain hemorrhage
where do hypeternsive hemorrhage typically occur
small penetrating arteries that are also responsible for lacunar strokes. These are mostly in the basal ganglia, cerebella nuclei, thalamus, or pons.
what does a putaminal hemorrhage affect
it leads to anesthesia of the side and contralateral hemiparesis- due to the disruption of the corticospinal and somatosensory fibers in the posterior limb with conjugate deviation of the eyes to the side of the lesion
who typically has lobar hemorrahge
adults over 60 due to amyloid antipathy. Hemorrhage is often recurrent and involves the occipital lobe and hmonymous hemianopsia whereas partial can cause contralateral hemisensory loss
conditions associated with Wernickes encephalopathy and what is deficient
chronic alcoholism, malnutrition, hyperemesis gravidarum- thiamine deficiency.
encephalopathy, horizontal nystagmus, bilarteral abducens palsy, postural and gait ataxia
werknicke encephalopathy
treatment for werknickes
IV thiamine
risk factors for brain abscess
otitis media, mastoiditits, frontal or ethmoid sinusitis, dnetal infection, bacteremia from other sites of infection, cyanotic heart disase
what is the distribution of brain accesses in bacteria from heart disease (cyanotic )
multiple abscesses along the distribution of middle cerebral artery at the grey-white matter junction.
why does deogeorge cause seizures and what is the other associated problem
they can have hypocalcemia leading to tetany and seizures from hypocalcemia. they also have cyanotic heart disease that risk hematogenous spread of infection into the brain because the blood bypasses the lungs were it can be cleaned. Also, they have poor brain perfusion from chronic hyperemia, metabolic acidosis, and increased blood viscosity from secondary polycythemia.
what is the classic triad of brain abscesses
fevere, severe headaches in the morning or nocturnal, focal neurologic changes.
what is the typical length of absence seizures
length is <20 seconds and lack of response to vocal or tactile stimulation there are also automatisms like eye fluttering or lip smacking, but there are not more complex events in the motor.
what is the typical EEG and treatment of absence seizures
they are 3 hz spike and wave discharge patterns during the episodes. treatment is ethosuxamide
diplopia, bitemporal hemianopsia, vision loss, headache, hormonal deficiencies- what is this
sellar mass
what is the most common seller mass
pituitary adenoma of which the most common is prolactinoma
what is the typical age ranges for craniopharyngiomas and tell me about the tumor
50% are under 20 and the rest are 55-65. These grow gradually over a period of years and cause slow progression of symptoms. Can lead to bitemporal blindness. Confirm it with a MRI or CT, and treatment is surgery and radiotherapy.
headache, hearing loss, vertigo, tinnitus, balance problems- what is the tumors and where are they
acoustic neuromas and meningiomas
tumor causes worsening headache, visual abnormalities, focal motor weakness, and cognitive defects
glioblastoma multiforme
what part of vision is knocked out by temporal lobe stroke
homoynmous superior quadrantanopsia
when does cerebellar degeneration typically occur
it occurs after ten years of heavy alcohol use and is due to the degeneration of the pukinje cells of the cerebellar ermis
what symptoms occur with cerebellar degeneration
truncal coordination decreases and slowly progressive wide-based gait and postural instability.
what are the physical exam findings for cerebellar degeneration
inability to tandem walk and abnormal heel-knee-shin testing with relatively preserved limb coordination so normal finger-nose testing. Cognitive function is preserved
gait dysfunction, extremity weakness, vibratory, propioceptive abnormalities with upper and lower motor nueron problems
spondylotic myelopathy
ataxia, symmetric paresthesia, and loss of vibration and proprioception sensation
B12 deficiency
attention difficulties, concentration, memory and executive function, difficulty completing the testing and put forth poor effort- why is the dementia occurring
pseudo dementia from major depression- use an SSRI.
what is the most common pediatric brain tumor
low grade astrocytoma like pilocytic astrocytoma
what are the symptoms of supratentorial tumors
increased ICP and seizures, morning headaches, papiledema, vomiting, macrocephaly
what are the symptoms of posterior fossa tumors
increased ICP, ataxia, clumsymorning headaches, papiledema, vomiting, macrocephaly
what are the symptoms of brainstem tumors
ataxia, clumsy, cranial nerve palsies
what are the symptoms of spinal cord tumors
back pain, weakness, and abnormal gait
ependymomas
glial cell tumors that arise from the ependymal cells of the ventricles and spinal cord. They are most often in the 4th ventricle posterior fosaa leading to hydrocephalus
medulloblastoma
second most common pediatric tumor- infratentorial tumor that arise from the cerebellar vermis that vomiting, headaches, and ataxia
neuroblastomas
sympathetic ganglion cell tumors that are usually abdominal masses but can spread to the brain
dementia: early, insidious short term memory loss, language deficits, spatial disorientation, later personality changes
AD
dementia: stepwise decline, early executive dysfunction, cerebral infarction and or deep white matter changes on neuroimaging
vascualr dementia
dementia: personality changes, apathy, disinhibition, compulsive behavior, atrophy
frontotemporal
dementia: visual hallucinations, spontenous PD, fluctuating congintion
dementia with levy body
dementia: ataxia, urinary incontience, dilated ventricles
NPH
dementia: behavior, rapid progressive, myoclonus and seizures
prions
typical exam findings with vascular dementia
hemiparesis, pronator drift, romberg sign
what neurological condition do you not give steroids for
GBS
symmetric muscle weakness, decreased reflexes, paresthesias, autonomic dysfunction, respiratory compromise previous illness
GBS
treatment of GBS and the CSF findings
increased protein but normal counts- five plea or IVIG
what is used to treat ALS
riluzole
what do you treat warfarin associated intracerebral hemorrhage
need to reverse the anticoagulation- vitamin K and protehromin concentrate which can do this or FFP
what can cause warfarin associated intracerebral hemorrhage
a lot of drugs like cold medications like acetoaminophen and phenylephrine can alter the metabolism of warfarin leading to supratherapuetic levels of warfarin leading to lots of bleeding
progressive proximal muscle weakness and atrophy without pain or tenderness- lower extremity muscles are more involved- what myopathy is this
glucocorticoid induced= ESR and CK are normal
muscle pain, stiffness in the shoulders and pelvic girdle, tenderness with decreased range of motion at shoulder, neck and hip, responds rapidly to glucocorticoids- what myopathy is this
polymyalgia rheumatica- increased ESR
muscle pain, tenderness and proximal muscle weakness, skin rash, inflammatory arthritis- what myopathy is this
inflammatroy myopathy- increased ESR and CK
prominent muscle pain and tenderness with or without weakness sometimes rhabdo- what myopathy is this
statin induced myopathy- increased CK
muscle pain, cramps and weakness involving the proximal muscles, delayed tendon reflexes and myxedema, occasional rhabdo, hypothyroidism- what myopathy is this
hypothyroid- increased CK
medication with stroke within 3.5-4 hours
alteplase
medication with stroke with no prior anti plate therapy
aspirin
medication with stroke on asa
asa plus dipyrimidole or clopidogrel
medication with stroke on asa and intracranial large artery atherosclepris
asa plus clopidogrel
medication with evidence of afib
warfarin, dabigatran, rivaroxaban
early signs of AD
anterograde memory loss, immediate recall affected but distant memories are preserved, lost in own neighborhood, difficulty finding words, cognitive impairment with progressive decline
late findings of AD
neuropsychiatric hallucinations and wandering, dyspraxia difficulty performing learned motor tasks, lack of insight regarding deficits, non cognitive neurologic deficits like pyramidal and extrapyramidal motor, myoclonus, seizures, urinary incontinence
fluctuating and fatigable proximal muscle weakness that is worse later in the day, and ptosis and diplopia, dysphagia, dysarthria, respiratory compromise
MG
what is the order of testing in MG
tensilon, ice pack, CT scan, acetylcholine receptor antibodies
risk factors of IIH
overweight, fertile, tetracyclines and retoninons
IIH symptoms
headache, vision loss, tints that is pulsaltile, diplopia, papilladema peripheral visal field defect, VI palsy
dx for IIH
MRI or MRV, LP with >250 mm opening pressure
tx for IIH
stop the offending medication, weight loss, acetazolamide
carotid dissection symtpoms
hemiparesis, facial droop, aphasia, neck pain, thunderclap headache, and ischemic stroke
pure motor stroke is in
internal high capsule
pure sensory strokes
thalamic stroke
albuminocytologic dissociation
GBS
14-3-3 protein in CSF
prion disease
vasovagal or neural meidated syncope
trggers: prolonged standing or motional distress, painful stimuli, prodrome of nausea, warmth, diaphresis
sitational syncope
cought, micturition, defecation
orthostatic syncope
postural changes in heart rate and blood pressure after standing suddenly
syncope with exertion or during exercise
aortic stenosis, HCM, anamolous cornary arteries,
gneral sense of warmth with syncope
neurocardiac syncope
levadopa carbidopa side effects
somnolense, confusion, hallucinations- in elderly- dyskinesia
trihexaphenidyl or benztropine side effects
dry mouth, blurred vision, constipation, nausea, urinary retention
side effect of aporophine, bromicriptine, pramipexole or ropinerole- side effects
somnolience, hypotension, confusuon, hallucinations
capone side effects
dyskinesia, hallucination, confusion, nausea, orthostatic hypotension
selegiline side effects
insomnia and confusion in the elderly
neurologic complication of thoracic AA repatir
anterior cord syndrome
what tracks are affected in anterior cord syndrome
spinothalamic and corticospinal tracks.
what arteries are knocked out in the TAA repair
artery of ademkawitz and the radicular arteries
what are the symptoms of anterior cord syndrome
flaccid paralysis and loss of pain and temperature below the injury. Static UMN develops over time. Autonomic can be from intermediolateral cord.
what is perserved with anterior cord syndrome
the vibration and proprioception is preserved
bells palsy face
inability to raise eyebrow and close eye, and droop of mouth. Decreased tearing, hyeracusis and loss of taste over the anterior 2/3 of the tongue
stroke face
the forehead is spared
headache that becomes intolerable, vomiting, papilladema, and binocular palsy, periorbital edema, hypesthesia, and rapidly can become intolerable- what is it, imaging performed for it, and treatment
it is cavernous sinus thrombosis, and there needs to be antibiotics, can use an MRI for it
what nerves run through the cavernous sinus
II, IV< V, VI
sparse, nonfluent speech, some comprehension, impaired reputation, and right hemiparsis
broca aphasia- dom frontal
fluent, columinous, lack of meaning, diminished comprehension, impaired repititon, and right superior field defect
wernicke dom temporal
fluent with phonemic erors, preserved comprehension, poor reputation, no associated features
dom partieel lobe conduction aphasia from the myers loop involvement
