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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
# Dementia describe complex attention domain
staying focused with distractions or parallel tasks
26
# Dementia describe executive function domain
reasoning and planning
27
# Dementia describe learning and memory domain
retaining new info, recalling old info
28
# Dementia describe language domain
word finding, comprehension
29
# Dementia describe perceptual motor function domain
spatial ability, orientation, ability to recognize objects & manipulate them
30
# Dementia describe social cognition or behavior domain
* maintaining appropriate behavior on social norms * recognizing social cues * making safe decisions
31
# Dementia what are considered basic ADLs | 6
* bathing * dressing * toileting * mobility * continence * feeding
32
# Dementia what are considered instrumental ADLs | 6
* phone use * shopping * food preparation * housekeeping * laundry * transportation, med use, finances
33
# Dementia what are considered advanced ADLs | 6
* recreation * spiritual pursuits * education/training * work * intimacy * family caregiving
34
# Dementia H&P components
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
35
# Alzheimer's Warning Signs of Alzheimer's | 10
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
36
# Alzheimer's Alarm signs of Alzheimer's | 3
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
37
# Alzheimer's Dx | 3 components
1. new MMSE or MOCA-B compared to baseline 2. r/o other causes: hypoglycemia, CBC, CMP, TSH, VitB12 3. Brain MRI
38
# Alzheimer's findings of MRI | 4
* generalized and focal atrophy * white matter lesions * reduced hippocampal volume * medial temporal lobe atrophy
39
# Alzheimer's goal of tx | 3 components
* slow progression * reduce mortality * improve quality of life for pt or family
40
# Alzheimer's Tx in mild to mod disease
* cholinesterase inhibitor (**galantamine** first choice, then rivastigmine or donepezil) * tx of other disorders PRN (hearing loss, vision disturbances) * encourage socialization, brain games
41
# Alzheimer's Tx for moderate to severe disease
* galantamine + memantine for additional cognitive benefit
42
# Vascular Dementia cause
* multi-focal ischemic changes * ex: SAH, ICH, large artery atherosclerosis, cardioembolic event, small vessel dz
43
# Vascular Dementia describe progression
* after first event: sudden onset of deficits * stepwise/progressive cognitive deficits w/ each stroke
44
# Vascular Dementia signs & sx | 4
* physical signs of a stroke * gait disturbance/balance issues * urinary frequency, urgency, incontinence * personality/mood changes (depression) followed by psychosis
45
# Vascular Dementia Dx & what is seen
* MRI or CT * shows evidence of cerebrovascular disease
46
# Vascular Dementia tx | 3
* not really successful * can try cholinesterase inhibitors or NMDA but limited evidence for use * prevention is key (management of HTN, hyperlipidemia)
47
# Frontotemporal Dementia what behavioral issues may be seen | 6
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
48
# Dementia what is pseudodementia
* occurs in severely depressed people * involves memory loss and confusion which improves w/ treating depression
49
# Dementia why should memory drills be avoided?
can cause frustration and does not help pt regain lost skills
50
# Dementia what to use for sleep aid? what to avoid?
* trazodone * anti-histamines or benzos (can cause delirium)
51
# Creutzfeldt-Jakob Disease describe
rapidly progressing dementia and movement disorder
52
# Creutzfeldt-Jakob Disease dx
* usually via brain biopsy post mortem * MRI or EEG while alive
53
# Creutzfeldt-Jakob Disease MRI findings
cortical ribboning pattern
54
# Creutzfeldt-Jakob Disease EEG findings
sharp wave complexes
55
# Creutzfeldt-Jakob Disease tx
supportive care, no cure
56
# Cerebral Edema pathophys
* fluid builds up in the brain and increases intracranial pressure * categorizes into vasogenic, cellular, osmotic, and interstitial causes
57
# Cerebral Edema common causes | 9
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
# Cerebral Edema sx w/ focal edema | 5
* weakness * visual disturbances * seizures * sensory changes * diplopia
59
# Cerebral Edema sx w/ diffuse edema | 7
1. HA 2. n/v 3. seizure 4. lethargy 5. altered mental status 6. confusion 7. coma
60
# Cerebral Edema Physical Exam | 6- (can vary based on severity/location)
* altered mental status * pupils fixed/dilated * delusions, hallucinations * asterixis (negative myoclonus) * some pts may be agitated, others lethargic * other: fever, ascites, jaundice, tachycardic)
61
# Cerebral Edema Dx | 4 components
* 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
# Cerebral Edema steps of tx
1. prevent further injury 2. fix the underlying cause of edema
63
# Cerebral Edema Tx which can prevent further injury | 8 options
* 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
# Brain Herniation describe
high pressure in one cranial compartment which causes the brain tissue to be pushed into a compartment w/ lower pressure
65
# Brain Herniation most common
herniation of temporal lobe which compresses 3rd CN, midbrain, posterior cerebral artery
66
# Brain Herniation complications | 4
* stupor * coma * posturing * respiratory arrest
67
# Stupor & Coma define stupor
pt is unresponsive expect when subjected to vigorous stimuli
68
# Stupor & Coma define coma
pt unarousable and unable to respond to external events or internal needs; reflex movements and posturing might be present
69
# Stupor & Coma potential causes | 5
1. seizure 2. hypothermia 3. metabolic disturbances 4. structural lesions 5. disturbance of brainstem reticular activating system
70
# Stupor & Coma PE Components
* test painful stimuli * test flexor/extensor posturing * check pupils * look for corneal reflex * EOM * respiratory patterns
71
# Stupor & Coma findings with painful stimuli on PE
* if pt withdraws limb, it shows sensory and motor pathways are intact
72
# Stupor & Coma purpose of flexor/extensor posturing
to determine location of dysfunction
73
# Stupor & Coma describe oculocephalic relfex (EOM exam)
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
# Stupor & Coma describe oculovestibular reflex
stimulate irrigating ear w/ cold water which causes different types of nystagmus
75
# Stupor & Coma what respiratory pattern changes may be seen | 4 components
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
# Stupor & Coma Dx | 5 components
1. blood draw (glucose, electrolytes) 2. ABG 3. liver/kidney function panels 4. tox screen 5. urgent non-contrast CT of head
77
# Stupor & Coma tx | 3 components
1. supportive therapy for respiration and BP 2. hypothermia 3. give thiamine and then dextros/naloxone
78
# Stupor & Coma what should you suspect if rapid onset
* SAH * brainstem stroke * ICH
79
# Stupor & Coma what to suspect if slow onset | 4
* structural disorders * masses * lesions * slow bleeds
80
# Stupor & Coma two structural lesions which can cause stupor or coma
1. supratentorial lesions (on diencephalon) 2. subtentorial lesions (on brainstem)
81
# Stupor & Coma dx is structural lesion is suspected cause of stupor/coma
* start with CT * don't do lumbar puncture due to risk of cerebral herniation
82
# Stupor & Coma sx of supratentorial lesions
* progressive * begins w/ drowsiness, then stupor, then coma
83
# Stupor & Coma sx of subtentorial lesions
early or abrupt disturbance of consciousness
84
# Stupor & Coma signs of stupor/coma due to metabolic disturbances
* 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
# Stupor & Coma what is stupor/coma due to metabolic disturbances typically preceded by?
* intoxicated state * agitated delirium
86
# Locked In Syndrome describe | 3 components
* mute, quadriparetic but conscious state * pt can move eyes and has intact pupillary response to light * pt is fully aware of their surroundings
87
# Locked In Syndrome causes | 3
* stroke * guillan-barre * cocaine
88
# Locked In Syndrome pathophys
acute, destructive lesions that involve the pons
89
# Locked In Syndrome THIS IS NOT A COMA, it's easy to confuse them.
just FYI
90
# Locked In Syndrome prognosis
Poor, some can recover but not fully
91
# Brain Death Criteria what is this dx equivalent to?
declaration of death
92
# Brain Death Criteria what does brain death mean
complete and irreversible cessation of all brain function
93
# Brain Death Criteria components of establishing brain death | 6
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
# Intracranial and Interspinal Space Occupying Lesions examples | 5
1. primary intracranial tumors 2. metastatic intracranial tumors 3. intracranial mass lesions 4. spinal tumors 5. brain abscesses
95
# Intracranial and Interspinal Space Occupying Lesions signs/sx/PE findings | 12
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
# Intracranial and Interspinal Space Occupying Lesions what do frontal primary intracranial tumors result in? (sx) | 4
1. intellectual decline 2. personality changes 3. loss of smell 4. seizures
97
# Intracranial and Interspinal Space Occupying Lesions what do temporal primary intracranial tumors cause? (sx) | 6
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
# Intracranial and Interspinal Space Occupying Lesions what do parietal primary intracranial tumors result in? (sx) | 6
1. disturbance of sensation contralaterally 2. seizure 3. sensory loss 4. inattention 5. spontaneous pain 6. anosognosia (negelct or denial of paralyzed limb)
99
# Intracranial and Interspinal Space Occupying Lesions what do occipital primary intracranial tumors result in? (sx) | 3
1. significant visual changes/hallucinations 2. blindness if bilateral 3. preserved pupillary reflex to light
100
# Intracranial and Interspinal Space Occupying Lesions what do brainstem/cerebellum intracranial tumors result in? (sx) | 3
1. CN palsies 2. incoordination/ataxia 3. nystagmus
101
# Intracranial and Interspinal Space Occupying Lesions describe primary intracranial tumors
* begin in the spot they are found * can be malignant or benign * 1/3 of these are meningiomas * 1/4 are gliomas
102
# Intracranial and Interspinal Space Occupying Lesions dx
1. CT or MRI 2. LP (can do, rarely needed)
103
# Intracranial and Interspinal Space Occupying Lesions tx
1. varies dependent on type of mass, location, sx 2. refer to neuro
104
# Intracranial and Interspinal Space Occupying Lesions describe metastatic intracranial tumors
* they are tumors which travelled to the brain after beginning somewhere else * always cancerous
105
# Intracranial and Interspinal Space Occupying Lesions two metastatic intracranial tumor types
1. cerebral metastases 2. leptomeningeal metastatses (carcinomatous meningitis)
106
# Intracranial and Interspinal Space Occupying Lesions describe cerebral metastases
* present similarly to primary tumors * most common source is lung cancer
107
# Intracranial and Interspinal Space Occupying Lesions dx cerebral metastases
* CT/MRI * but also identify primary site of cancer (CXR, mammogram, ect)
108
# Intracranial and Interspinal Space Occupying Lesions tx cerebral metastases
* tx varies on type & number of metastases
109
# Intracranial and Interspinal Space Occupying Lesions describe leptomeningeal metastases
* most common primary sites are breast, lung, lymphoma, leukemia * cause multifocal neurologic deficits
110
# Intracranial and Interspinal Space Occupying Lesions tx of leptomeningeal metastases
* LP * MRI w/ contrast preferred over CT
111
# Intracranial and Interspinal Space Occupying Lesions tx
* radiation, +/- chemo * very poor prognosis
112
# Intracranial and Interspinal Space Occupying Lesions types lesions in pts w/ AIDS | 3
* primary cerebral lymphoma * cerebral toxoplasmosis * cryptococcal meningitis
113
# Intracranial and Interspinal Space Occupying Lesions sx of lesions in AIDS pts | 5
1. LOC 2. motor/sensory deficits 3. aphasia 4. seizures 5. CN deficits
114
# Intracranial and Interspinal Space Occupying Lesions dx/tx
* CT or MRI (cannot distinguish between lesion types though) * refer to neuro or AIDS specialist
115
# Intracranial and Interspinal Space Occupying Lesions describe spinal tumors
* can be primary or metastatic * can lead to spinal cord dysfunction because of direct compression, ischemia, or invasive infiltration
116
# Intracranial and Interspinal Space Occupying Lesions sx of spinal tumors | 5
1. odd pain 2. motor deficits 3. numbness 4. bladder or bowel dysfunction 5. sexual dysfunction
117
# Intracranial and Interspinal Space Occupying Lesions dx of spinal tumors | 3
* MRI w/ contrast * CT myelogram * CSF abnormal on LP
118
# Intracranial and Interspinal Space Occupying Lesions tx of spinal tumors
* varies on type of tumor
119
# Intracranial and Interspinal Space Occupying Lesions describe brain abscesses
* 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
# Intracranial and Interspinal Space Occupying Lesions most common bacterial causes of brain abscesses | 3
1. strep 2. staph 3. anaerobes
121
# Intracranial and Interspinal Space Occupying Lesions sx of brain abscesses | 6
1. HA 2. drowsiness 3. confusion 4. seizure 5. signs of increased ICP 6. +/- signs of systemic infection
122
# Intracranial and Interspinal Space Occupying Lesions dx of brain abscess
* CT easier to obtain * MRI can dx earlier
123
# Intracranial and Interspinal Space Occupying Lesions tx of brain abscess | 3 components
* IV abx (ceftriaxone, vanco, metronidazole) * surgical drainage if large or not responding to tx * consider steroids of mannitol if severe
124
# Pseudotumor Cerebri pathophys
* increased ICP * often idiopathic and resolves spontaneously
125
# Pseudotumor Cerebri Causes | 7
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
# Pseudotumor Cerebri signs/sx | 4
1. HA 2. diplopia 3. visual disturbances (large blind spot) 4. pulse- syncronized tinnitus
127
# Pseudotumor Cerebri PE findings | 2
1. papilledema 2. enlarged blind spot 3. otherwise normal
128
# Pseudotumor Cerebri Dx | 3
* CT or MRI for mass * MR venography to look for thrombosis * LP to check pressure (fluid should be normal)
129
# Pseudotumor Cerebri primary tx
* neuro referral * acetazolamid (250-500mg PO TID)
130
# Pseudotumor Cerebri other tx that could work
* 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
# Pseudotumor Cerebri how is tx monitored for effectiveness?
* checking visual acuity, visual fields, fundoscopic exams, CSF pressure
132
# Pseudotumor Cerebri Surgical Option
* placement of lumboperitoneal shunt * optic nerve sheath fenestration | last resorts
133
# Pseudotumor Cerebri idiopathic most commonly occurs in who? | PPP
overweight women aged 20-44
134
# Pseudotumor Cerebri why is wt loss an added benefit of topiramate?
because obese pts must lose wt as part of tx
135
# Pseudotumor Cerebri what happens if left untreated?
* permanent vision loss or optic atrophy

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