Neurologic Flashcards
Bell’s Palsy cause
herpes simplex virus; trauma, neoplasia, toxins; frequent in pregnancy, DM
Bell’s Palsy s/s
abrupt unilateral facial muscle weakness (mainly right side) progressing over 2 hours; paralysis of forehead, lower face; cannot close eye, raise brow, smile (CN VII); pain of ipsilateral ear precedes; peaks in 21 days, full recover in 6 months
Bell’s Palsy dx
clinical; EMG (complicated); r/o stroke, tumors, Lyme disease, AIDS, sarcoidosis w/ CXR/CT/MRI
Bell’s Palsy tx
oral prednisone, antiviral; lubricating eye drops
Myasthenia Gravis cause
insidious; coincidental infection
Myasthenia Gravis s/s
ptosis, diplopia; difficulty chewing/swallowing, respiratory difficulties, limb weakness; normal sensation/reflexes; fluctuate in intensity, longer term spontaneous relapses/remissions
Myasthenia Gravis dx
CT/MRI (r/o coexisting thymoma); EMG/repetitive nerve stimulation; serum assay of circulating acetylcholine receptor antibodies (positive); MuSK antibodies (positive); marked clinical improvement after short-acting anticholinesterase (edrophonium)
Myasthenia Gravis tx
cholinesterase inhibitor (pyridostigmine); thymectomy; corticosteroids, immunosuppressive, IVIG, plasmapheresis (refractory)
Trigeminal Neuralgia (Tic Douloureax) cause
aging, tumor, multiple sclerosis
Trigeminal Neuralgia (Tic Douloureax) s/s
brief, unilateral, stabbing facial pain in area of divisions of trigeminal nerve (cheek, jaw, teeth, gums, lips, eye, forehead); pain triggered by touch, movement, eating; normal physical exam normal
Trigeminal Neuralgia (Tic Douloureax) dx
neuro exam (reflex exam, determine which part of nerve); MRI
Trigeminal Neuralgia (Tic Douloureax) tx
anticonvulsants (Carbamazepine, Phenytoin, topiramate, oxcarbazepine); antispasmodics (baclofen); botox injections; microvascular decompression
Generalized Convulsive Seizures cause
idiopathic (5-20yo); secondary (congenital abnormalities, perinatal injury, metabolic disorders, trauma, tumors, vascular disease, infectious disease, degenerative diseases, Alzheimer disease, s/p stroke)
Generalized Convulsive Seizures s/s
sudden LOC, convulsive (grand mal or tonic-clonic); postictal obtundation, confusion (last min-hrs); status epilepticus (fail to cease spontaneously or regain consciousness >5 min between seizures)
Generalized Convulsive Seizures dx
EEG (normal); r/o metabolic/toxic cause (CBC, glucose, electrolytes, Ca, Mg, LFTs, renal function, syphilis)
Generalized Convulsive Seizures tx
carbamazepine, phenytoin, valproic acid (first line); diazepam, lorazepam IV (stop current seizure); gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonisamide
Generalized Non-Convulsive Seizures cause
idiopathic (5-20yo); secondary (congenital abnormalities, perinatal injury, metabolic disorders, trauma, tumors, vascular disease, infectious disease, degenerative diseases, Alzheimer disease, s/p stroke)
Generalized Non-Convulsive Seizures s/s
sudden LOC, non-convulsive (absence); minor motor activity (blinking, facial twitching)
Generalized Non-Convulsive Seizures dx
EEG (bilaterally synchronous, symmetric 3-Hz spike and wave activity); r/o metabolic/toxic cause (CBC, glucose, electrolytes, Ca, Mg, LFTs, renal function, syphilis)
Generalized Non-Convulsive Seizures tx
valproic acid, ethosuximide
Simple Partial Seizures s/s
○ S/S: no LOC; isolated tonic/clonic activity of limb or transient altered sensory perception (Jacksonian march)
Simple Partial Seizures dx
EEG (focal rhythmic discharge at onset of seizure, no ictal activity)
Simple Partial Seizures tx
carbamazepine, phenytoin, valproic acid (first line); gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonisamide
Complex Partial Seizures s/s
no LOC; aura (transient abnormalities in sensation, perception, emotion, memory) followed by impaired consciousness lasting sec-min; N/V, focal sensory perceptions, focal tonic/clonic activity
Complex Partial Seizures dx
EEG (interictal spikes, spikes associated w/ slow waves in temporal or frontotemporal areas)
Complex Partial Seizures tx
carbamazepine, phenytoin, valproic acid (first line); gabapentin, topiramate, lamotrigine, oxcarbazepine, levetiracetam, zonisamide
Cluster Headache cause
middle aged men; vascular etiology, disturbance of serotonergic mechanisms; triggers (alcohol, stress, foods, glare)
Cluster Headache s/s
severe unilateral periorbital pain (occur daily 4-8wks, last 15min-3hrs); ipsilateral nasal congestion, rhinorrhea, lacrimation, eye redness, horner’s syndrome (sympathetic nerve problem); restlessness, agitation
Cluster Headache dx
clinical (ipsilateral symptoms); labs/imaging/LP r/o other causes
Cluster Headache tx
administer 100% oxygen; sumatriptan; ergotamines, intranasal triptans, analgesics (intranasal butorphanol); prophylactic (verapamil; valproate, lithium, steroids)
Migraine Headache cause
family history, menstrual pattern; seizures, essential tremor, Tourette’s syndrome, depression, anxiety, stroke; triggers (chocolate, red wine, MSG, hard cheese, hormones, exertion, nitrites, stress, fatigue)
Migraine Headache s/s
unilateral throbbing/pulsating discomfort; N/V, photophobia, phonophobia; aura (visual changes, flashing lights); prefer dark, quiet spaces
Migraine Headache dx
clinical; labs/imaging/LP to r/o other causes
Migraine Headache tx
avoid triggers; Reglan + Benadryl; Triptans (abortive); TCAs, b-blockers (preventative)
Tension Headache cause
stress, fatigue, noise, glare, poor posture, smoking, sleep deprivation, hunger, eye strain; trauma
Tension Headache s/s
bilateral band-like pain around head, steady, aching, vise-like, tight quality; poor concentration, neck pain; worse at end of day or w/ stress; no neuro deficits, N/V, photophobia, phonophobia
Tension Headache dx
clinical; pericranial tenderness
Tension Headache tx
ASA, acetaminophen, NSAIDs; heat, muscle relaxers, PT, relaxation, psych therapy
Temporal Arteritis cause
large/medium vasculitis; blood vessel inflammation; associated w/ polymyalgia rheumatica
Temporal Arteritis s/s
new onset headache, abrupt onset of visual disturbance, jaw claudication, unexplained fever/anemia
Temporal Arteritis dx
temporal artery biopsy; ESR >50; angiography/US/MRI/MRA
Temporal Arteritis tx
high-dose glucocorticoid steroids (40-60 mg prednisone)
Transient Ischemic Attack (TIA) cause
carotid or vertebral vascular occlusion
Transient Ischemic Attack (TIA) s/s
lasts a few min-hour, resolves without intervention; contralateral hand, arm weakness with sensory loss, ipsilateral visual symptoms or aphasia, carotid bruits (carotid); diplopia, ataxia, vertigo, CN palsies, lower extremity weakness, dimness or blurring of vision, perioral numbness and drop attacks (vertebral)
Transient Ischemic Attack (TIA) dx
CT angiography (definitive study); US doppler; CT head/MRI r/o hemorrhage; cardiac workup w/ echo; PT/PTT
Transient Ischemic Attack (TIA) tx
prophylactic antiplatelet therapy (ASA, clopidogrel, dipyridamole); heparin w/ warfarin, long term control of BP, glucose, stop smoking and alcohol
Cerebrovascular Accident (CVA) cause
thrombotic vs embolic vs hemorrhagic; HTN, hypercholesterolemia, atrial fib, DM, oral contraceptive, smoking, alcohol use
Cerebrovascular Accident (CVA) s/s
abrupt onset; aphasia, apraxia, hemiparesis, hemisensory loss, visual field deficits (anterior); coma, drop attacks, vertigo, N/V, ataxia (posterior); increased ICP, headaches (hemorrhagic)
Cerebrovascular Accident (CVA) dx
CT head (r/o hemorrhage); MRI; CBC, PT/PTT, ESR, platelet count; LP
Cerebrovascular Accident (CVA) tx
thrombolytic treatment w/in 3 hours onset; antiplatelet therapy (thrombolytic); HTN management, antiedema therapy w/ mannitol and corticosteroids (hemorrhagic); endovascular repair/surgical clipping; long-term supportive care
Syncope cause
arrhythmias, aortic stenosis, carotid sinus hypersensitivity, MI, hypoglycemia, orthostatic hypotension, postprandial hypotension, psychogenic disorders, PE, vagal faint
Syncope s/s
sudden transient LOC w/o trauma
Syncope dx
clinical; EKG, Holter monitor, echo, tilt-table test, CT/MRI
Syncope tx
varies w/ cause
Guillian-Barre Syndrome (acute idiopathic polyneuropathy) cause
minor infections of lungs or GI tract (campylobacter, EBV, CMV, HIV), immunizations, surgical procedures
Guillian-Barre Syndrome (acute idiopathic polyneuropathy) s/s
acute symmetrical extremity weakness (begins distally then ascends, proximal muscles affected more often than distal); DT reflexes decreased absent; CN deficit; sensory abnormalities, pain; tachycardia, cardiac irregularities, disturbed sweating, impaired pulmonary function, sphincter disturbances, paralytic ileus; difficulty swallowing/breathing
Guillian-Barre Syndrome (acute idiopathic polyneuropathy) dx
electrophysiologic studies (nerve conduction velocities, denervation, axonal loss); CSF (elevated protein, normal WBC)
Guillian-Barre Syndrome (acute idiopathic polyneuropathy) tx
admit to hospital for ABCs; plasmapheresis, IVIG; PT/OT/ST
Meningitis cause
group B strep, e. Coli, listeria (neonates); H. influenza, s. Pneumo, n. Meningitidis (infants/children), s. Pneumo, n. Meningitidis, H. influenza, staph (adults)
Meningitis s/s
headache, AMS, phonophobia, photophobia, neck rigidity/stiffness, high fever, nonblanching petechiae
Meningitis dx
Kernig’s sign, Brudzinski’s sign, lumbar puncture; blood cultures, CT
■ LP results: high WBC, low glucose, high protein (bacterial); low WBC, high glucose, high protein (viral); low WBC, low glucose, high protein (fungal)
Meningitis tx
IV abx specific to organism (Vancomycin + Ceftriaxone, ampicillin), corticosteroids (dexamethasone), IV hydration
Multiple Sclerosis cause
immunologic disorder associated w/ CNS immunoglobulin production and alteration of T lymphocytes; viral infection; genetic (HLA, HLA-DR2)
Multiple Sclerosis s/s
sensory complaints and vision loss; focal weakness, numbness/tingling, optic neuritis, blindness, blurry vision, diplopia, focal neuralgias, balance problems, fatigue, urinary symptoms; last days-weeks, relapsing-remitting pattern
Multiple Sclerosis dx
McDonald criteria (attacks vs lesions); lab studies (underlying disease); MRI (white matter lesions in CNS); CSF (inflammation, mild elevated WBC or protein, elevated immunoglobulin G index, oligoclonal bands, increased myelin basic protein); visual, auditory, somatosensory evoked potentials
Multiple Sclerosis tx
high-dose IV corticosteroids (optic neuritis); plasma exchange (acute); interferon-b or subQ glatiramer acetate (prevent relapse); immunosuppressive (cyclophosphamide, azathioprine); amantadine, pemoline (fatigue); baclofen, diazepam (spasticity); anticholinergics/oxybutynin (urologic symptoms)
Parkinson’s Disease cause
idiopathic; deficiency in dopamine; imbalance of dopamine and acetylcholine
Parkinson’s Disease s/s
: “pill rolling” tremor; slowed movements, difficulty arising from seated position, difficulty ascending and descending stairs, trouble getting dressed, difficulty w/ hand writing; tremor in limbs, mouth, lips; shuffling gait, infrequent blinking, masklike facies; cogwheel rigidity, increased resistance to passive motion; depression/cognitive impairment
Parkinson’s Disease dx
resting tremor, bradykinesia, rigidity, postural instability; blood/imaging r/o other causes
Parkinson’s Disease tx
anticholinergic (amantadine) + Levodopa (precursor of dopamine); Levodopa/Carbidopa (ADEs: N/V, hypotension, somnolence); Dopamine agonist/Bromocriptine (ADEs: orthostatic hypotension, nausea, HA); Sergeline (MOBI) and tolcapone, entacapone (COMT)
Alzheimer’s Disease cause
older age, genetic (chromosomes 1, 14, 19, 21), lower education level, female gender
Alzheimer’s Disease s/s
otherwise alert pt exhibits progressive memory loss and cognitive deficits such as disorientation, language difficulties, inability to perform complex motor activities, inattention, visual misperception, poor problem-solving abilities, inappropriate social behavior, hallucinations
Alzheimer’s Disease dx
intracellular neurofibrillary tangles, extracellular neuritic plaques; CBC, heavy metal screens CMP, Ca, glucose, TSH, vit B12, renal/LFTs, etoh, drug screen (r/o other causes)
Alzheimer’s Disease tx
anti aging*) acetylcholinesterase inhibitors (tacrine, donepezil, galantamine, rivastigimine); NMDA receptor agonists; daycares
Encephalopathy cause
alcohol, thiamine/B1 deficiency (Wernicke-Korsakoff); AIDS, cancer, renal dialysis, hyperthyroidism; anoxic/hypoxic; hypertension; infectious (encephalitis, meningitis)
Encephalopathy s/s
decreased levels of consciousness, minimal lethargy, coma, confusion, poor memory, hallucinations, psychotic thinking; may mimic stroke with unilateral weakness, facial droop, and speech problems
Encephalopathy dx
clinical; CBC (infection, anemia, B12 deficiency); CMP (electrolytes, glucose, liver function); CT/MRI/Xray; LP (infection, inflammation)
Encephalopathy tx
treat underlying cause; oxygen, dialysis or kidney transplant, antibiotics, etc
