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Neurologic Disorders Flashcards

1
Q

Delirium

describe

A
  • acute, confused state that occurs in response to a trigger
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2
Q

Delirium

common triggers for delirium

8

A
  • withdrawal
  • alcohol/drug intoxication
  • med side effects
  • infection
  • electrolyte abnormality
  • high/low glucose
  • sleep deprivation
  • neurologic disorders
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3
Q

Delirium

signs & sx

4 likely sx, 5 +/- sx

A
  1. acute, rapid onset
  2. confusion
  3. poor short-term memory
  4. fluctuates between awake, drowsy, agitation
  5. +/- anxiety, irritability, visual hallucinations, restlessness, insomnia
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4
Q

Delirium

dx

A

nothing specific, just need to find cause (electrolytes, metabolic issues, intoxication)

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5
Q

Delirium

tx

A

treat the underlying cause

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6
Q

Delirium

describe sundowning

A

type of delirium at night associated w/ pre-existing dementia

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7
Q

Wernicke Encephalopathy

pathophys

A
  • thiamine deficiency (biologically active form of vitamin B1)
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8
Q

Wernicke Encephalopathy

risk factors

5

A
  1. dialysis
  2. AIDS
  3. hyperemesis gravidarum
  4. anorexia
  5. bariatric surgery
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9
Q

Wernicke Encephalopathy

signs/sx

3

A
  1. confusion
  2. ataxia
  3. tingling in fingers/toes
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10
Q

Wernicke Encephalopathy

PE findings

3

A
  • nystagmus
  • ophthalmoplegia (eyes can’t move together in direction of muscle weakness)
  • peipheral neuropathy
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11
Q

Wernicke Encephalopathy

Dx

A
  • thiamine diphosphate
  • must use whole blood for testing
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12
Q

Wernicke Encephalopathy

tx

A
  • 200-500mg thiamine hydrochloride IV over 30 mins TID for 2-3 days
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13
Q

Wernicke Encephalopathy

what not to do prior to thiamine IV

A
  • do not give IV glucose before thiamine because it can make the sx worse
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14
Q

Wernicke Encephalopathy

when does Korsakoff Syndrome occur

A
  • severe Wernicke Encephalopathy for extended period of time
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15
Q

Korsakoff Syndrome

sx

A
  • anterograde and retrograde amnesia
  • delirium
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16
Q

Korsakoff Syndrome

tx

A

thiamine, but may take longer to heal/may have permanent damage

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17
Q

Dementia

4 main types

A
  1. Alzheimer’s
  2. Vascular
  3. Dementia w/ Lewy Bodies
  4. Frontotemporal
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18
Q

Dementia

3 largest risk factors

3

A
  1. age
  2. family hx
  3. vascular disease
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19
Q

Dementia

describe

A
  • chronic deterioration of mental functions
  • progressive intellectual decline
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20
Q

Dementia

when is typical onsest?

A
  • begins at age 60
  • increases w/ age
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21
Q

Dementia

modifiable risk factors

9

A
  1. low education level
  2. midlife HTN
  3. midlife obesity
  4. hearing loss
  5. late life depression
  6. DM
  7. sedentary
  8. smoking
  9. social isolation
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22
Q

Dementia

Associated w/ dementia but not definitive causes

7

A
  1. a fib
  2. alcoholism
  3. CKD
  4. TBI
  5. obstructive sleep apnea
  6. air polluation
  7. gait impairment
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23
Q

Dementia

what is first sign most often?

A

functional impairment (difficulties planning meals, managing finances, taking meds, driving)

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24
Q

Dementia

list the 6 cognitive domains

A
  1. complex attention
  2. executive function
  3. learning and memory
  4. language
  5. perceptual-motor function
  6. social cognition or behavior
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25
Q

Dementia

describe complex attention domain

A

staying focused with distractions or parallel tasks

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26
Q

Dementia

describe executive function domain

A

reasoning and planning

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27
Q

Dementia

describe learning and memory domain

A

retaining new info, recalling old info

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28
Q

Dementia

describe language domain

A

word finding, comprehension

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29
Q

Dementia

describe perceptual motor function domain

A

spatial ability, orientation, ability to recognize objects & manipulate them

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30
Q

Dementia

describe social cognition or behavior domain

A
  • maintaining appropriate behavior on social norms
  • recognizing social cues
  • making safe decisions
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31
Q

Dementia

what are considered basic ADLs

6

A
  • bathing
  • dressing
  • toileting
  • mobility
  • continence
  • feeding
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32
Q

Dementia

what are considered instrumental ADLs

6

A
  • phone use
  • shopping
  • food preparation
  • housekeeping
  • laundry
  • transportation, med use, finances
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33
Q

Dementia

what are considered advanced ADLs

6

A
  • recreation
  • spiritual pursuits
  • education/training
  • work
  • intimacy
  • family caregiving
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34
Q

Dementia

H&P components

A
  1. PMH & SH
  2. FH
  3. ability to perform ADLs
  4. physical impairments (new onset balance problems, gait problems, vision problems, incontinence)
  5. mental status exam, memory testing
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35
Q

Alzheimer’s

Warning Signs of Alzheimer’s

10

A
  1. memory loss that disrupts daily life
  2. challenges in planning or solving problems
  3. difficulty completing familiar tasks
  4. confusion w/ time or place
  5. trouble understanding visual images and spatial relationships
  6. new problems w/ words in speaking or writing
  7. misplacing things & losing ability to retrace steps
  8. decreased or poor judgement
  9. withdrawal from work or social activities
  10. changes in mood/personality
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36
Q

Alzheimer’s

Alarm signs of Alzheimer’s

3

A
  1. inability to perform personal self care
  2. impaired judgement w/ potential to harm self or others
  3. concerns about personal safety or ability to seek help in unsafe situations
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37
Q

Alzheimer’s

Dx

3 components

A
  1. new MMSE or MOCA-B compared to baseline
  2. r/o other causes: hypoglycemia, CBC, CMP, TSH, VitB12
  3. Brain MRI
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38
Q

Alzheimer’s

findings of MRI

4

A
  • generalized and focal atrophy
  • white matter lesions
  • reduced hippocampal volume
  • medial temporal lobe atrophy
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39
Q

Alzheimer’s

goal of tx

3 components

A
  • slow progression
  • reduce mortality
  • improve quality of life for pt or family
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40
Q

Alzheimer’s

Tx in mild to mod disease

A
  • cholinesterase inhibitor (galantamine first choice, then rivastigmine or donepezil)
  • tx of other disorders PRN (hearing loss, vision disturbances)
  • encourage socialization, brain games
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41
Q

Alzheimer’s

Tx for moderate to severe disease

A
  • galantamine + memantine for additional cognitive benefit
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42
Q

Vascular Dementia

cause

A
  • multi-focal ischemic changes
  • ex: SAH, ICH, large artery atherosclerosis, cardioembolic event, small vessel dz
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43
Q

Vascular Dementia

describe progression

A
  • after first event: sudden onset of deficits
  • stepwise/progressive cognitive deficits w/ each stroke
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44
Q

Vascular Dementia

signs & sx

4

A
  • physical signs of a stroke
  • gait disturbance/balance issues
  • urinary frequency, urgency, incontinence
  • personality/mood changes (depression) followed by psychosis
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45
Q

Vascular Dementia

Dx & what is seen

A
  • MRI or CT
  • shows evidence of cerebrovascular disease
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46
Q

Vascular Dementia

tx

3

A
  • not really successful
  • can try cholinesterase inhibitors or NMDA but limited evidence for use
  • prevention is key (management of HTN, hyperlipidemia)
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47
Q

Frontotemporal Dementia

what behavioral issues may be seen

6

A
  1. lack of empathy
  2. doesn’t follow social norms
  3. lack of abstract thought and executive function
  4. impulsive/apathetic
  5. focal right frontal atrophy
  6. memory not typically impacted
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48
Q

Dementia

what is pseudodementia

A
  • occurs in severely depressed people
  • involves memory loss and confusion which improves w/ treating depression
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49
Q

Dementia

why should memory drills be avoided?

A

can cause frustration and does not help pt regain lost skills

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50
Q

Dementia

what to use for sleep aid? what to avoid?

A
  • trazodone
  • anti-histamines or benzos (can cause delirium)
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51
Q

Creutzfeldt-Jakob Disease

describe

A

rapidly progressing dementia and movement disorder

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52
Q

Creutzfeldt-Jakob Disease

dx

A
  • usually via brain biopsy post mortem
  • MRI or EEG while alive
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53
Q

Creutzfeldt-Jakob Disease

MRI findings

A

cortical ribboning pattern

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54
Q

Creutzfeldt-Jakob Disease

EEG findings

A

sharp wave complexes

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55
Q

Creutzfeldt-Jakob Disease

tx

A

supportive care, no cure

56
Q

Cerebral Edema

pathophys

A
  • fluid builds up in the brain and increases intracranial pressure
  • categorizes into vasogenic, cellular, osmotic, and interstitial causes
57
Q

Cerebral Edema

common causes

9

A
  1. head trauma
  2. hepatitis/liver disease
  3. vascular ischemia
  4. intracranial lesions
  5. obstructive hydrocephalus
  6. hypoxia
  7. infection
  8. metabolic derangements
  9. acute HTN
58
Q

Cerebral Edema

sx w/ focal edema

5

A
  • weakness
  • visual disturbances
  • seizures
  • sensory changes
  • diplopia
59
Q

Cerebral Edema

sx w/ diffuse edema

7

A
  1. HA
  2. n/v
  3. seizure
  4. lethargy
  5. altered mental status
  6. confusion
  7. coma
60
Q

Cerebral Edema

Physical Exam

6- (can vary based on severity/location)

A
  • altered mental status
  • pupils fixed/dilated
  • delusions, hallucinations
  • asterixis (negative myoclonus)
  • some pts may be agitated, others lethargic
  • other: fever, ascites, jaundice, tachycardic)
61
Q

Cerebral Edema

Dx

4 components

A
  • ICP monitor if increased intracranial pressure
  • general labs to r/o metabolic cause/infection
  • Head CT to r/o ICH, hydrocephalus, tumors
  • Brain MRI to r/o encephalitis, tumor, acute stroke, autoimmune process
62
Q

Cerebral Edema

steps of tx

A
  1. prevent further injury
  2. fix the underlying cause of edema
63
Q

Cerebral Edema

Tx which can prevent further injury

8 options

A
  • glucocorticoids for edema but NOT for trauma
  • reduce ICP w/ positioning
  • hyperosmolar therapy
  • sedatives/paralytics
  • can consider surgery
  • mannitol for middle cerebral artery stroke
  • hypertonic saline can help
  • induced hypothermia
64
Q

Brain Herniation

describe

A

high pressure in one cranial compartment which causes the brain tissue to be pushed into a compartment w/ lower pressure

65
Q

Brain Herniation

most common

A

herniation of temporal lobe which compresses 3rd CN, midbrain, posterior cerebral artery

66
Q

Brain Herniation

complications

4

A
  • stupor
  • coma
  • posturing
  • respiratory arrest
67
Q

Stupor & Coma

define stupor

A

pt is unresponsive expect when subjected to vigorous stimuli

68
Q

Stupor & Coma

define coma

A

pt unarousable and unable to respond to external events or internal needs; reflex movements and posturing might be present

69
Q

Stupor & Coma

potential causes

5

A
  1. seizure
  2. hypothermia
  3. metabolic disturbances
  4. structural lesions
  5. disturbance of brainstem reticular activating system
70
Q

Stupor & Coma

PE Components

A
  • test painful stimuli
  • test flexor/extensor posturing
  • check pupils
  • look for corneal reflex
  • EOM
  • respiratory patterns
71
Q

Stupor & Coma

findings with painful stimuli on PE

A
  • if pt withdraws limb, it shows sensory and motor pathways are intact
72
Q

Stupor & Coma

purpose of flexor/extensor posturing

A

to determine location of dysfunction

73
Q

Stupor & Coma

describe oculocephalic relfex (EOM exam)

A

passively moving pt’s head briskly w/ eyes held open & tracking the eyes
(if brainstem is affected, eyes will move in a wonky way)

74
Q

Stupor & Coma

describe oculovestibular reflex

A

stimulate irrigating ear w/ cold water which causes different types of nystagmus

75
Q

Stupor & Coma

what respiratory pattern changes may be seen

4 components

A
  1. Cheyne Stoke Respiration (periods of alternating deep breathing and apnea)
  2. central neruogenic hyperventilation
  3. apneustic breathing (prominent end-inspiratory pauses)
  4. ataxic breathing (irregular pattern of breathing w/ random deep & shallow breaths)
76
Q

Stupor & Coma

Dx

5 components

A
  1. blood draw (glucose, electrolytes)
  2. ABG
  3. liver/kidney function panels
  4. tox screen
  5. urgent non-contrast CT of head
77
Q

Stupor & Coma

tx

3 components

A
  1. supportive therapy for respiration and BP
  2. hypothermia
  3. give thiamine and then dextros/naloxone
78
Q

Stupor & Coma

what should you suspect if rapid onset

A
  • SAH
  • brainstem stroke
  • ICH
79
Q

Stupor & Coma

what to suspect if slow onset

4

A
  • structural disorders
  • masses
  • lesions
  • slow bleeds
80
Q

Stupor & Coma

two structural lesions which can cause stupor or coma

A
  1. supratentorial lesions (on diencephalon)
  2. subtentorial lesions (on brainstem)
81
Q

Stupor & Coma

dx is structural lesion is suspected cause of stupor/coma

A
  • start with CT
  • don’t do lumbar puncture due to risk of cerebral herniation
82
Q

Stupor & Coma

sx of supratentorial lesions

A
  • progressive
  • begins w/ drowsiness, then stupor, then coma
83
Q

Stupor & Coma

sx of subtentorial lesions

A

early or abrupt disturbance of consciousness

84
Q

Stupor & Coma

signs of stupor/coma due to metabolic disturbances

A
  • patchy, diffuse, symmetric neurologic issues (not related to a problem at any specific location)
  • pupillary reactivity is usually preserved, but may be smaller than normal
85
Q

Stupor & Coma

what is stupor/coma due to metabolic disturbances typically preceded by?

A
  • intoxicated state
  • agitated delirium
86
Q

Locked In Syndrome

describe

3 components

A
  • mute, quadriparetic but conscious state
  • pt can move eyes and has intact pupillary response to light
  • pt is fully aware of their surroundings
87
Q

Locked In Syndrome

causes

3

A
  • stroke
  • guillan-barre
  • cocaine
88
Q

Locked In Syndrome

pathophys

A

acute, destructive lesions that involve the pons

89
Q

Locked In Syndrome

THIS IS NOT A COMA, it’s easy to confuse them.

90
Q

Locked In Syndrome

prognosis

A

Poor, some can recover but not fully

91
Q

Brain Death Criteria

what is this dx equivalent to?

A

declaration of death

92
Q

Brain Death Criteria

what does brain death mean

A

complete and irreversible cessation of all brain function

93
Q

Brain Death Criteria

components of establishing brain death

6

A
  1. cause of coma must be established, irreversible, and known cause of brain death
  2. must be warm and dead before being considered dead
  3. must have clean tox screen for sedative meds
  4. cannot have severe BP, electrolyte, acid-base, or endocrine derangements
  5. neuro exam should demonstrate that pt is in true coma (no brainstem reflexes, no respiratory drive)
  6. can perform EEG or test cerebral circulation (not required)
94
Q

Intracranial and Interspinal Space Occupying Lesions

examples

5

A
  1. primary intracranial tumors
  2. metastatic intracranial tumors
  3. intracranial mass lesions
  4. spinal tumors
  5. brain abscesses
95
Q

Intracranial and Interspinal Space Occupying Lesions

signs/sx/PE findings

12

A
  1. altered state of consciousness
  2. nystagmus
  3. pupil inequality
  4. irregular eye movements
  5. bradycardia
  6. dyspnea
  7. severe HA
  8. intractable vomiting
  9. positive expanding intracrandial lesion tests (lateralizing)
  10. pos coordination tests
  11. decreasing muscle strength
  12. seizures
96
Q

Intracranial and Interspinal Space Occupying Lesions

what do frontal primary intracranial tumors result in? (sx)

4

A
  1. intellectual decline
  2. personality changes
  3. loss of smell
  4. seizures
97
Q

Intracranial and Interspinal Space Occupying Lesions

what do temporal primary intracranial tumors cause? (sx)

6

A
  1. seizures
  2. sensation hallucinations
  3. smacking lips w/out realizing it
  4. personality changes
  5. feeling of deja vu
  6. if R sided: disturbs perception of musical notes
98
Q

Intracranial and Interspinal Space Occupying Lesions

what do parietal primary intracranial tumors result in? (sx)

6

A
  1. disturbance of sensation contralaterally
  2. seizure
  3. sensory loss
  4. inattention
  5. spontaneous pain
  6. anosognosia (negelct or denial of paralyzed limb)
99
Q

Intracranial and Interspinal Space Occupying Lesions

what do occipital primary intracranial tumors result in? (sx)

3

A
  1. significant visual changes/hallucinations
  2. blindness if bilateral
  3. preserved pupillary reflex to light
100
Q

Intracranial and Interspinal Space Occupying Lesions

what do brainstem/cerebellum intracranial tumors result in? (sx)

3

A
  1. CN palsies
  2. incoordination/ataxia
  3. nystagmus
101
Q

Intracranial and Interspinal Space Occupying Lesions

describe primary intracranial tumors

A
  • begin in the spot they are found
  • can be malignant or benign
  • 1/3 of these are meningiomas
  • 1/4 are gliomas
102
Q

Intracranial and Interspinal Space Occupying Lesions

dx

A
  1. CT or MRI
  2. LP (can do, rarely needed)
103
Q

Intracranial and Interspinal Space Occupying Lesions

tx

A
  1. varies dependent on type of mass, location, sx
  2. refer to neuro
104
Q

Intracranial and Interspinal Space Occupying Lesions

describe metastatic intracranial tumors

A
  • they are tumors which travelled to the brain after beginning somewhere else
  • always cancerous
105
Q

Intracranial and Interspinal Space Occupying Lesions

two metastatic intracranial tumor types

A
  1. cerebral metastases
  2. leptomeningeal metastatses (carcinomatous meningitis)
106
Q

Intracranial and Interspinal Space Occupying Lesions

describe cerebral metastases

A
  • present similarly to primary tumors
  • most common source is lung cancer
107
Q

Intracranial and Interspinal Space Occupying Lesions

dx cerebral metastases

A
  • CT/MRI
  • but also identify primary site of cancer (CXR, mammogram, ect)
108
Q

Intracranial and Interspinal Space Occupying Lesions

tx cerebral metastases

A
  • tx varies on type & number of metastases
109
Q

Intracranial and Interspinal Space Occupying Lesions

describe leptomeningeal metastases

A
  • most common primary sites are breast, lung, lymphoma, leukemia
  • cause multifocal neurologic deficits
110
Q

Intracranial and Interspinal Space Occupying Lesions

tx of leptomeningeal metastases

A
  • LP
  • MRI w/ contrast preferred over CT
111
Q

Intracranial and Interspinal Space Occupying Lesions

tx

A
  • radiation, +/- chemo
  • very poor prognosis
112
Q

Intracranial and Interspinal Space Occupying Lesions

types lesions in pts w/ AIDS

3

A
  • primary cerebral lymphoma
  • cerebral toxoplasmosis
  • cryptococcal meningitis
113
Q

Intracranial and Interspinal Space Occupying Lesions

sx of lesions in AIDS pts

5

A
  1. LOC
  2. motor/sensory deficits
  3. aphasia
  4. seizures
  5. CN deficits
114
Q

Intracranial and Interspinal Space Occupying Lesions

dx/tx

A
  • CT or MRI (cannot distinguish between lesion types though)
  • refer to neuro or AIDS specialist
115
Q

Intracranial and Interspinal Space Occupying Lesions

describe spinal tumors

A
  • can be primary or metastatic
  • can lead to spinal cord dysfunction because of direct compression, ischemia, or invasive infiltration
116
Q

Intracranial and Interspinal Space Occupying Lesions

sx of spinal tumors

5

A
  1. odd pain
  2. motor deficits
  3. numbness
  4. bladder or bowel dysfunction
  5. sexual dysfunction
117
Q

Intracranial and Interspinal Space Occupying Lesions

dx of spinal tumors

3

A
  • MRI w/ contrast
  • CT myelogram
  • CSF abnormal on LP
118
Q

Intracranial and Interspinal Space Occupying Lesions

tx of spinal tumors

A
  • varies on type of tumor
119
Q

Intracranial and Interspinal Space Occupying Lesions

describe brain abscesses

A
  • likely comes after infection of the ear/nose
  • can travel from another area of the body to the brain
  • can result from infection introduced by trauma or surgery
120
Q

Intracranial and Interspinal Space Occupying Lesions

most common bacterial causes of brain abscesses

3

A
  1. strep
  2. staph
  3. anaerobes
121
Q

Intracranial and Interspinal Space Occupying Lesions

sx of brain abscesses

6

A
  1. HA
  2. drowsiness
  3. confusion
  4. seizure
  5. signs of increased ICP
  6. +/- signs of systemic infection
122
Q

Intracranial and Interspinal Space Occupying Lesions

dx of brain abscess

A
  • CT easier to obtain
  • MRI can dx earlier
123
Q

Intracranial and Interspinal Space Occupying Lesions

tx of brain abscess

3 components

A
  • IV abx (ceftriaxone, vanco, metronidazole)
  • surgical drainage if large or not responding to tx
  • consider steroids of mannitol if severe
124
Q

Pseudotumor Cerebri

pathophys

A
  • increased ICP
  • often idiopathic and resolves spontaneously
125
Q

Pseudotumor Cerebri

Causes

7

A
  1. thrombosis of transverse venous sinus
  2. sagittal sinus thrombosis
  3. chronic pulmonary dz
  4. lupus
  5. uremia
  6. endocrine dz
  7. corticosteroid withdrawal
126
Q

Pseudotumor Cerebri

signs/sx

4

A
  1. HA
  2. diplopia
  3. visual disturbances (large blind spot)
  4. pulse- syncronized tinnitus
127
Q

Pseudotumor Cerebri

PE findings

2

A
  1. papilledema
  2. enlarged blind spot
  3. otherwise normal
128
Q

Pseudotumor Cerebri

Dx

3

A
  • CT or MRI for mass
  • MR venography to look for thrombosis
  • LP to check pressure (fluid should be normal)
129
Q

Pseudotumor Cerebri

primary tx

A
  • neuro referral
  • acetazolamid (250-500mg PO TID)
130
Q

Pseudotumor Cerebri

other tx that could work

A
  • topiramate: can work, added benefit of wt loss
  • furosemide: adjunct therapy, but not mono
  • corticosteroids: can cause relapse with withdrawal
  • LP: helps temporarily alleviate pressure (only use for severe, those not responding to pharm therapy)
131
Q

Pseudotumor Cerebri

how is tx monitored for effectiveness?

A
  • checking visual acuity, visual fields, fundoscopic exams, CSF pressure
132
Q

Pseudotumor Cerebri

Surgical Option

A
  • placement of lumboperitoneal shunt
  • optic nerve sheath fenestration

last resorts

133
Q

Pseudotumor Cerebri

idiopathic most commonly occurs in who?

PPP

A

overweight women aged 20-44

134
Q

Pseudotumor Cerebri

why is wt loss an added benefit of topiramate?

A

because obese pts must lose wt as part of tx

135
Q

Pseudotumor Cerebri

what happens if left untreated?

A
  • permanent vision loss or optic atrophy

CMT (78 decks)

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