neurologia Flashcards
stroke:
brocas afasia que es y que arteria afecta?
brocas afasia: habla con palabras cortas, entiende bien, no puede repetir
Middle cerebral artery (motor+senstivo contralateral, ojos ven hacia el lado de la lesion)
tx para cataplexia presente en narcolepsia que se toma en la noche?
Sodium oxybate and/or pitolisant
cataplexia: symptom of narcolepsy characterized by sudden muscle weakness in a fully conscious patient that is triggered by strong emotions (e.g., patients may experience buckling of the knees upon laughing). Self-resolves in < 2 minutes.
patient presents with cataplexy, hypnagogic hallucinations, sleep paralysis, and excessive daytime sleepiness despite good sleep hygiene. These symptoms are characteristic of narcolepsy.
parkinson, patologia?
destruccion dopamina en sustancia nigra (basal ganglia)
sino hay dopamina no se controlan los movimientos de la corteza motora, lo q causa los sintomas motores como tremor, rigidez etc
el tremor mejora al hacer movimientos voluntarios
pronator drift, donde esta la lesion?
upper motor neuron lesion,
middle cerebral artery
local anesthetic, amide group, long acting?
bupivacaine
what is acute cerebellar ataxia?
cerebellar disfunction usually en menores de 6 años que sucede después de enfermedad febril
clinical manifestations depend on the structure affected within the cerebellum.
a) Vermis of the cerebellum:
- broad-based gait and gait instability
-truncal ataxia
-dysmetria (which can also result from damage to the cerebellar hemispheres)
-saccadic intrusions
-vertigo
b)cerebellar hemispheres:
-scanning speech
-dysdiadochokinesis
-intention tremor
-limb ataxia
-nystagmus
Acute cerebellar ataxia commonly affects both midline cerebellar structures and cerebellar hemispheres.
Although now uncommon in the US because of widespread vaccination, VZV infection was once the most common cause of acute cerebellar ataxia.
crisis de ausencia tx? en menor de 8 años
Ethosuximide
Reproduction of these findings via hyperventilation and EEG findings of a 3-Hz spike and wave pattern further support the diagnosis
crisis de ausencia tx en mayor de 9 años
valpron
Von Hippel Sindau disease caracteristicas y patron genetics?
mnemonic “HARP”:
- Hemangioblastoma (retina, brainsteam, cerebello, medula espinal)
- Angiomas (piel, mucosa, organos)
- Renal carcinoma bilateral
- Pheocromositoma
Autosomal dominante
Any patient presenting with CNS or retinal hemangioblastoma before the age of 50 years should undergo testing for VHL disease.
Parkinson monotherapy in patients < 65 years of age with tremor as the main symptom?
Benztropine
Trihexyphenidyl
Biperiden
parkinson tx that can cuase livedo reticularis + peripheral edema + ataxia as side effect?
amantadine
miestenia gravis: patologia, que pasa con el ejercicio y tx?
a que se asocia?
anticuerpos contra acetilcolina
sx: diplopia, ptosis, proximal weakness
ptosis mejora al ponerle hielo
EMPEORA sx a traves del dia/ejercicio
tx: pyridostigmine
asocia a timoma (hacer tac de tórax) y tiroditis Hashimoto
CSF en guillan barre muestra? y q patogeno lo causa?
albuminocytologic dissociation (CSF with a high protein level but normal WBCs)
ascending flaccid paralysis after bloody diarrhea caused by campylobacter causa demilinizacion autoinmune segmentada (molecular mimicry)
The bugs that are associated with Guillain-Barré syndrome are ICE MyCZ: Influenza virus, Cytomegalovirus, EBV, Mycoplasma pneumoniae, Campylobacter, Zika virus
Migraine prophylaxis indications?
frequent attacks (≥ 3 attacks/month),
long-lasting attacks (e.g., > 12–24 hours),
migraine that is preceded by an aura.
First line
Propanolol
anticonvulsivantes: topiramate/valpron
Second line
antidepresiv triciclicos: amitriptilina
lateral and inferior eye deviation at rest +dilated pupil that does not react to light
Que CN esta afectado?
oculomotor nerve (CN III) palsy. Somatic and parasympathetic involvement.
afectacion somatica y parasimatica del CN III (oculomotor) donde esta la lesion?
posterior communicating artery
CN III, leading to an ipsilateral dilated pupil with a “down and out” gaze
Compressive lesions are characterized by pupillary involvement due to injury to the outer parasympathetic layer of CN III (which controls pupil dilation, light reactivity, and accommodation). Additional injury to the deeper somatic fibers of the nerve (which control extraocular muscles) is responsible for this patient’s ptosis and “down and out” gaze. Acute CN III palsy due to a cerebral aneurysm is very concerning for imminent rupture. A patient presenting with dilated pupils and a history of recent headaches should undergo an urgent MRI with MR angiography.
tx malignant otitis externa?
IV ciprofloxacina =+ otro antiseudomonas (cefepime, ceftazidime o pip/tazo)
malignant otitis externa most commonly cause by pseudomonas aeruginosa
Malignant otitis externa is an emergency that can progress to osteomyelitis of the skull base
inherited retinoblastoma gene mutations have a significantly increased risk of ____?
osteosarcomas and pinealomas.
inherited retinoblastoma gene mutations (Rb gene mutations) have a significantly increased risk of developing osteosarcomas and pinealomas.
The characteristic clinical features of retinoblastomas are leukocoria (white fundal reflex instead of the usual red) and strabismus.
Cerebral venous thrombosis aguda y aseptica (causa no infecciosa). First line tx?
Low weight heparin ejemplo deltaparin
edema subcortical en sustencia blanca del cerebro
IMPORTANTE
encefalopatía posterior reversible
CSF: midly elevated proteins, everything else normal
asociado a:
tx imunosupresor y antineoplasico
hipertension severa
encefalopatía posterior reversible. Sx, MRI and lumbar puncture findings? associated to?
Sx:
convulsiones,
visual disturbances
altered mental status
headache constant that doesnt improve with analgesics
se diferencia de CVT porq no hay aumento en ICP Y EN CVT si, EPR esta mas asociado a imunosupresores y CVT a anticonceptivos
associated to? inmunosupresores, antineoplasicos, hipertension severa
MRI: edema subcortical en sustancia blanca
LP: proteins midly increased, everything else normal
Acute disseminated encephalomyelitis findings on CSF?
WBC ^
Proteins ^
headache, altered mental status, impaired vision, and multiple bilateral lesions in the white matter on MRI imaging.
mostly affects children and young adults and is typically preceded by vaccination or viral infection.
immune-mediated, demyelinating CNS disease caused by cross-reaction hypersensitivity between viral antigens and myelin. It usually develops after viral infections or, rarely, after vaccination.
que hace la cocaina en los vasos y cuales son las consecuencias?
cocaina causa vasoespasmo, consecuencias:
stroke isquémico o hemorragico
cardiac ischemia, prinzmetal angina
hipertension (porq inhibe la recaptura de serotonina, noepinefrina, dopamina)
Charcot triat de esclerósis multiple decir los sx?
scanning speech, nystagmus, and intention tremors.
Often used to describe cerebellar involvement in multiple sclerosis but can occur with any cerebellar lesion.
diabetic neuropathy sx
parestesias
debilidad simetrica distal
perdida propiocepcion
perdida temperatura
Diabetic neuropathy may cause cranial nerve palsies, especially affecting extraocular muscles [CN III, IV, and VI]
Wilsons disease. Tx?
Penicillamine
normal pressure hydrocephalus (NPH) sx? dx y findings? tx?
3W:
Wacky (demencia)
Wet (urinary incontinence)
Wobbly: (inestabilidad al caminar +magnetic gait que es shuffling as if the feet are glued to the ground
DX
MRI: ventriculos grandes, sulci disminuido
CSF ^ en openinf pressure
Tx: ventriculoperitoneal shunt
head trauma > initial loss of consciousness > LUCID INTERVAL
Dx? que se ve en imagen? arteria afectada?
EPIDURAL hemorrhage
tac sin contraste: CONVEXO
A. meningea media
hemorragia subaracnoidea complicación y como evitarla?
vasoespasmo (4-10 d después)
dar nimodipina oral
subdural hematoma? epidemiología y com ose ve en ct
truma, viejos, alcoholicos, shaken baby sd
ct: hemiluna
worst headache of my life precedido por ___?
hemorragia subaracnoidea
precedido por sentinel bleed “warning leak”
Which type of cranial hematoma involves a fixed dilated pupil and contralateral hemiparesis?
Acute epidural hematoma
essential tremor tx?
propanolol (preferido)
primidone ( could trigger acute intermittent porphyria)
worsens with action/voluntary movement
convulsion de ausencia
que se ve en EEG y tx?
EEG: 3 Hz spike-and-slow-wave complexes on EEG
tx: ethosuximide
no presenta posictal, dura 5-10 segs. can be triggered by hypoventilation
Parkinson ≤ 65 y.o if the main symptom is resting tremor. Tx?
Trihexifenidilo, Benztropina
severe unilateral headache + ipsilateral cranial autonomic symptoms (conjunctival injection, lacrimation)
dx, tx?
dx: cefalea en racimos
last from 15 minutes to 3 hours
tx: oxygen therapy
multiple ring enhancing lesions in ct scan + hiv <100 cd4
DX? tx?
Toxoplasmosis cerebral
tx? sulfadiazine + pirimetamina
aura+staring+posinctal. dx?
Focal seizure with impaired awareness
eeg: temporal
neuropathy in DM causes:
1)incomplete bladder emptying > ^ UTI and overflow incontinence
2) gastroparesis: sensation of fullness pospandrial, nausea, vomit, bloating
3) constipation
4) erectile dysfunction
5) postural hypotension due to damage to small-fiber autonomic nerves.
In diabetes, peripheral neuropathy and autonomic neuropathy occur as a result of osmotic damage to Schwann cells
stabbing, unilateral facial pain lasting several seconds. dx?
neuralgia del trigemino (episodios duran< 1 minuto)
tx:
1* carbamazepina // ozcarbazepina
2* descompresión microvascular
esclerósis leteral amiotrofica. tx?
riluzol (mechanism: decreases glutamate excitotoxicity)
Cortical laminar necrosis is a hallmark of prolonged seizures and can lead to persistent neurologic deficits and recurrent seizures. Verdadero o falso??
verdadero
associated with repeated seizures, hypoxia, and hypoglycemia. The clinical features depend on the affected cortical area and may include motor dysfunction, vision impairment, and aphasia. CLN can also result in additional seizures, increasing the risk for further cortical damage.
ring enhancing lesion+EBV association+ HIV
dx?
CNS lymphoma
CNS lymphoma tx?
metrotexate high dose + leucovin
quimioterapia
que screening se le hace a todos los Amilotrophic lateral sclerosis?
bedside swallowing test aka detección a pie de cama del riesgo de aspiración asociado con la disfagia
most common cause of watershed infarct?
systemic hypotension
Increased methylmalonic acid. dx?
vitamin b12 deficiency
cual es la diferencia entre Dtap y Tdap?
DTaP: ninos 6 weeks-7 years. tanto para inmunidad como para postexposure profilaxis
Tdap: individuals ≥ 7 years of age for routine Tdap boosters, postexposure tetanus prophylaxis, and catch-up immunization for those with incomplete DTaP vaccination.
localize the lesion. stroke:
sx motores contralateral UNICAMENTE + + weakness in the lower half of the face
arteria afectada?
Contralateral lenticulostriate artery located in posterior limb of the internal capsule,
localize the lesion. stroke:
sx motores contralateral + sensory changes, gaze deviation, and aphasia (dominant hemisphere) or hemineglect (non-dominant hemisphere).
arteria afectada?
A. cerebral media contralateral
afecta mas upper limb
localize the lesion. stroke:
sx motor + impaired pain / proprioception + hypoglossal nerve palsy (e.g., inability to protrude the tongue, tongue deviation).
arteria afectada?
A. espinal anterior
stroke localizar lesion”
contralat motor/sensitivo miembro INFERIOR solamente + se orina + abulia
arteria lesionada?
A. cerebral anterior contralateral
afecta mas lower limb
localiza stroke
Contralateral sensory loss + Contralateral homonymous hemianopsia with macular sparing
A. posterior cerebral contralat
stroke ubicar lesion:
horner ipsi (miosis + ptosis) +
pain and temperature loss ipsi face
body contra
se cae ipsi
decreased gag reflex
A. cerebelar posterior inferior (wallenberg sd)
que atb pueden causar polineuropatia distal simetrica?
fluoroquinolonas.
isoniazida
metronidazol
atb que causa boca con sabor a monedas + dolor de cabeza +dolor de barriga ?
metronidazole
natalizumab aumenta riesgo de :
Progressive multifocal leukoencephalopathy
What is the likely cause of anion gap metabolic acidosis in a patient with a recent generalized tonic-clonic seizure?
Post-ictal lactic acidosis
bicarbonato serico elevado, se quita en dos horas no requiere manejo
multiple sclerosis CSF findings?
Oligoclonal bands
Lymphocytic pleocytosis
Increased myelin basic protein levels.
stroke: donde esta la lesion?
Miotic and nonreactive pupils + gaze deviation downward and TOWARDS the AFFECTED side of the body
lesion is: thalamic hemorrhage.
lesion is called “wrong way eyes” (porq los ojos estan viendo HACIA el lado de la lesion, es decir, la hemiparesia y los ojos estan en el mismo lado), la lesion es contralateral
What is the recommended empiric treatment for suspected bacterial meningitis in neonates (<1 month old)?
Ampicillin + gentamicin AND/OR cefotaxime
empiric therapy of choice for immunocompromised patients with suspected bacterial meningitis?
Ampi + vanco + cefepime OR meropenem
Additionally administering dexamethasone to reduce the risk of hearing loss may be considered for children with bacterial meningitis, especially if infection with Haemophilus influenzae type b is suspected
Bilateral temporal lobe involvement on an MRI of the brain is pathognomonic of ?
HSV encephalitis
alzheimer neurotrasmisor afectado?
acetilcolina
extra: Alzheimer is caused by the degeneration of cholinergic neurons leading to decreased acetylcholine synthesis and impaired cholinergic transmission to the cortex.
First-line pharmacotherapy for mild to moderate AD is acetylcholinesterase inhibitors (e.g., donepezil).
parkinson neurotransmisor afectado?
dopamina
India ink stain
dx y tx?
dx: Cryptococcus neoformans
tx: Amphotericin B and flucytosine
alzheimer patofisiologia?
extracellular amyloid plaques and intracellular neurofibrillary tangles
Acetylcholine deficiency
presentacion temprana en pt con down sd.
lewys bodies patofisiologia
alfa-sinucleína agregacion intracelular
Creutzfeldt-Jakob diseas patofisiologia
prion protein pre synaptic build up
frontotemporal dementia fisiopatologia?
Cytoplasmic inclusions of ubiquitinated TDP-43
profilaxis de migraña, tension headache, cluster headache?
migraña: propanolol
tension headache: amitriptilina
cluster headache: verapamil
tumor cerebral en niños que obstruye/deforma/invade el 4to ventriculo y causa hidrocefalia?
ependimoma
MALIGNO
obstructive hydrocephalus and will appear as a mass with scattered calcifications most commonly within the 4th ventricle
restless leg syndrome tx?
intermitente (ess than twice per week): Carbidopa-levodopa
cronico: gabapentin / pregabalin
restless leg syndrome associated with iron deficiency and chronic kidney disease?
stroke: where is the lesion?
pure motor stroke
internal capsule posterior limb
contralateral
The most common subtype of a(n) lacunar stroke is a pure motor stroke, resulting in contralateral hemiparesis of the face, arm, and leg
Lipohyalinosis of the lenticulostriate arteries is the most common cause of pure motor strokes and typically affects the posterior limb of the internal capsule, i
stroke: where is the lesion
pure sensory stroke
talamo
contralateral
contralateral numbness and paresthesia of the face, arm, and leg
alzheimer tx?
mild-moderate “DON RIVA forgot GALA”: inhibitors de acetilcolesterasa
Donepezil
Rivastigmine
Galantamine
Moderate-severe: (≤ 18/30 MMSE) NMDA receptor antagonist:
Memantine (se combina con donepezil)
Esclerosis lateral amiotrófica. como se confirma el dx?
electromiografia
tremor that worsens with purposeful voluntary movement (e.g., finger-to-nose test) and Improves with alcohol
dx and tx?
tremor essential
tx Primidona o Propanolol (no usar si hay asma)
diferencia con Parkinson: the tremor in parkinson is typically asymmetrical and improves rather than worsens with purposeful voluntary movement.
Parkinson tremor = worse during rest Essential tremor = worse during movement
Transient ischemic attack (TIA), dx?
MRI
caso de N. meningitidis, tx del paciente y tx de los contactos?
pt: Vanco+ceftriaxona o cefotaxime (3 gen cefalosporina)
contactos: TODOS rifampicina, ciprofloxacin, or ceftriaxone
Rifampin is indicated for PEP in all close contacts (i.e., the patient’s brother and parents). PEP is important to prevent infection, and to eliminate nasopharyngeal carriage of N. meningitidis, thus limiting disease transmission.
What is the empiric treatment for suspected bacterial meningitis in adults and children >1 month?
Vancomycin + ceftriaxone If >50 years old, add ampicillin
ataxia de Friedrich
etiologia, sx? causa #1 de muerte?
FRiedreich ATAXia have ATAXic GAAit due to the expansion of the triplet GAA in the FRATAXin gene.
auto rest, cromosoma 9,
pies cavus (arco alto)
dedos en martillo
ataxia
cause #1 de muerte: heart failure due to cardiomiopatia HIPERtrofica
hallazgo en liquido cefalórraquideo en guillan barre y que significa? tx?
disociación albuminocitológica
significa: aumento de proteínas sin un aumento similar en el recuento de glóbulos blancos (< 10)
recuerda: proteina normal en LCR 20-40 y leucos <5
immunoglobulina iv+ plasmaferesi
Progressive memory impairment in an individual with cardiovascular disease+focal neurologic deficits
diagnostico? q sale en el tac?
vascular dementia
CT scan: hypodense periventricular lesions
importante: puede haber deficits neurologicos focales
Hunginton disease: neuroimaging findings? genetica?
Neuroimagen:
- atrofia de caudado y putamen
- ventriculomegalia
Genetica:
-Aut Dominant. CAG repet in Cromosoma 4:
-“CAG”: Caudate loss, Ach loss, Gaba loss.
-Perdida de GABA y Ach
tx Amyotrophic lateral sclerosis?
riLOUzole (disminuye glutamato)
esclerosis lateral amiotrófica tambn le dicen enfermedad de LOU Gehrig «
hand pain paresthesia that worsens at night and by hand elevation over head?
dx? etiologia?
carpal tunnel sd, MEDIAN nerve compression
etiologia: Pressing Down HARD
P: pregnancy
D: dialisis related amyloidosis
H: hipotiroidismo
A: acromegalia
R: rheumatoid arthriti / Repetitive movement
D: diabetes
miestenia gravis tx?
piridostigmina
MG: acetilcolina antibodies
apenas se dx hacer tac de pecho para rule out timoma
Management of facial nerve paralysis after TRAUMATIC facial injury depends on symptom onset
cuales son los tx?
Acute: surgical repair
Delayed (1-2 days after trauma): steroid therapy, if doesnt work do surgical decompression of facial nerve
Peripheral facial nerve palsy following facial trauma is caused by temporal bone fracture or trauma.
MRI of the brain often reveals hyperintensity of the cerebral cortex (ie, cortical ribboning) and the putamen and caudate head (ie, hockey stick sign)
this is charactristic for what disease?
Creutzfeldt-Jakob disease
