Neurologic Flashcards
What is coma
– state of reduced alertness and responsiveness; patient cannot be aroused
MCC AMS in ED
hypoglycemia
Causes of miosis
COPS clonidine & cholinergics opiates & organophosphates pilocarpine & phenothiazines & pontine bleed/lesion sedative hypnotics (benzos)
+ Horner Syndrome
Causes of mydriasis
anticholinergics
sympathomimetics
fixed dilated pupil
temporal lobe herniation on same side or if alert, could be from drops or compression of CN III
apneustic breathing
prolonged pause after inspiration –
pontine infarct
ataxic breathing
irregular, no pattern,
preterminal
MC location of HA in SAH
occipitonuchal
Life threatening causes of HA
Subarachnoid Hemorrhage Meningitis Intraparenchymal Hemorrhage and Cerebral Ischemia Subdural Hematoma Brain Tumor Cerebral Venous Thrombosis
Risk Factors for SAH
HTN smoking excessive EtOH fhx polycystic kidney dis coartaction of aorta Marfan Syndrome
T or F:
uncomplicated syncompe w/out trauma or other sxs should persue SAH
False
every syncope does not need CT
Remote trauma with HA
+anticoag/alcohol/elderly
suspected dx & how to dx
Subdural hematoma
Noncontrast Ct
- may need contrast if subacute or chronic
HA worse in AM think
Brain tumor
Hypercoaguable state:
oral contraceptives, postpartum/post op, etc
+
HA, vomiting, seizures
Cerebral Venous Thrombosis
60 yo F HA and jaw claudication
Temporal Arteritis
Start on prednisone
Tx for benign intracranial htn (pseudotumor cerebri)
Acetazolamide
– young patient with chronic HAs. N/V, visual problems, papilledema, normal CT, elevated CSF pressure
Benign Intracranial Hypertension
DHE in contraindicated for migraine treatment in
pregnancy,
uncontrolled HTN,
CAD
Tx tension HA
analgesics or NSAIDs
Tx cluster HA
high flow oxygen
DHE, triptans, analgesics
Tx trigeminal neuralgia
Carbamazepine
Contralateral hemiparesis, facial plegia, and sensory loss. Homonymous hemianopsia and gaze preference toward side of infarct (away from the deficit). Face and upper extremity affected more than lower. If dominant hemisphere involved, aphasia (receptive, expressive, or both) present. If nondominant hemisphere involved, inattention, neglect, often present.
Middle Cerebral Artery Stroke
Contralateral sensory and motor symptoms in lower extremity, sparing of hands and face. May have aphasia neglect, incontinence
Anterior Cerebral Artery stroke
unilateral headache, contralateral homonymous hemianopsia and unilateral cortical blindness.
Posterior Cerebral Artery stroke
vertigo (with cerebellar or brainstem signs), HA, nausea, visual disturbances, oculomotor palsies, ataxia, sensory disturbance, bilateral limb weakness
Vertebrobasilar stroke
MC artery affected in ischemic stroke
middle cerebral artery
Stroke pt who is a candidate for thrombolytics. Lower BP to___ via which drugs___
SBP <110
labetalol, nicardipine, esmolol
tPA must be given within
3hrs of onset sxs
(some places 4.5-6)
must know last baseline!
ED tx of TIA
antiplatelet therapy – aspirin alone
clopidogrel
or aspirin plus dipyridamole
Dx cervical artery dissection
MRI/MRA and CT/CTA
ED tx cervical artery dissection
heparin followed by Coumadin
admit for monitoring
Nystagmus with ataxia suggests
pathology is central, not in the cord or periphery
Apraxic gait is
lost ability to initiate walking – seen with nondominant hemispheric lesions
Festinating gait is
narrow based shuffling steps - Parkinson’s
Worsening (+) Romberg suggests
sensory ataxia with problem in posterior column, vestibular dysfunction, or peripheral neuropathy
perception of movement when none exists
Vertigo
transient loss of consciousness due to loss of postural tone with spontaneous recovery
Syncope
light-headedness with concern for syncope
Near Syncope
– feeling of unsteadiness, imbalance, or sensation of floating while walking
Disequilibrium
MCC vertigo in elderly
Benign paroxysmal positional vertigo
Hallpike maneuver diagnoses
A (+) result=
Benign paroxysmal positional vertigo
(+) nystagmus toward AFFECTED ear
Treatment for BPPV
antihistamines
Acoustic schwannoma affects cranial nerve
VIII (8)
Vertigo with head movement and accompanied nausea.
NO hearing loss or tinnitus
BPPV
status epilepticus lasts more than ____ minutes
5
initial treatment of status epilepticus
IV Lorazepam or Diazepam
not working:
Phenytoin or Fosphenytoin
If a neuromuscular blocker (Vecuronium) is used in status epilepticus, what must you do?
EEG monitoring
drug does not affect neuronal activity.
Body will not demonstrate seizure even though they are still experiencing it
Pt complains of lateralized weakness and on exam is hyper-reflexive with a + Babinski.
What kind of lesion is most likely?
Central lesion
“floppy infant” with poor feeding and lethargy
Botulism
Gi sxs- n,v,d, cramps
+ descending symmetric paralysis
diplopia, dilated pupils
Botulism
Sub acute ascending symmetric weakness or paralysis and loss of DTR’s
Guillain-Barre Syndrome
Most common plexopathy and nerve roots involved
Brachial plexopathy
C5-T1 nerve roots
best way to dx MS
MRI T2 weighted showing multiple lesions in white matter, ventricles, or spinal cord
acute treatment for MS flare-up
IV steroids
Urine dipstick says + for blood but no RBCs found on microscopic exam
Rhabdomyolisis
MC presenting symptoms of myasthenia gravis
what kind of weakness does this symptom have?
ptosis and diplopia
also see proximal weakness relieved by rest
What cholinergic inhibitor drug used in myasthenia gravis?
pyridostigmine
neostigmine
Dx myasthenic crisis/ myasthenia gravis?
Edrophonium IV push
if muscle weakness improves then myasthenic crisis
Pt presents with hyperthermia, rigidity, and AMS
exam shows “lead pipe” rigidity
neuroleptic malignant syndrome
what causes neuroleptic malignant syndrome
dopamine antagonism/depletion
Treatment for neuroleptic malignant syndrome
ABCs Cooling measures Fluids & alkaline diuresis Bromocriptine- dopamine agonist Dantrolene- prevents muscle contraction Nipride of CCB for HTN Paralyze and intubate pt with nondepolarizing neuromuscular blockers
