Neurological Flashcards
What bacteria is often immunized AGAINST in meningitis and Epiglottis
HIB
Parkinson’s usually in who and what do they have [2]
Men with Head trauma
Postural instability // pill rolling tremor
What is myersons sing
Tap on the bridge of the nose = repetitive blink
Essential tremor vs. Parkinson’s
Essential = worse with activity
Parkinson’s = improves with activity
Essential tremor treatment
Propanolol
When can you confirm diagnosis of Parkinson’s
Lewy bodies post mortam
Management of Parkinson’s
Clinical Dx : bradykinseia + tremor or rigidity
Levodopa ; but be weary of wearing off periods —> dyskinesia side effects
Ropinrole [dopamine agonist] = used in young adults for monotherapy
Refractory = deep brain stimulation
MAOi concerns in Parkinson’s
Blood pressure spikes especially with alcohol
Glioblastoma common presentation ; due to
Chronic headache ; transformation of the glial cells
Worse lying supine or in the morning N/V vision changes // seizure
1 year survival rate
RADIATION OF THE HEAD
Biopsy of Glioblastoma
Psuedopalisading pleomorphic tumor
Parallel wall to each other making a WALL
MRI with what contrast is best to see Glioblastoma
Gadoliunium
Dementia vs. Delirium
Dementia = chronic insidious ; not caused by illness ; SHORT TERM MEMORY LOSS ; course slow decline
Delirium = short term cognitive defects ; often have recent illness ; course fluctuates ; disorganized thoughts
What type of dementia occurs with Alzheimer’s to = mixed dementia
Vascular dementia
Vascular dementia often follows what
Stroke
what type of dementia often has hallucination
Lewy body dementia
Behavior changes and word difficulty occurs in what type of dementia
Frontotemporal
Check what labs for dementia workup
CBC
TSH
B12
What supplement can help Alzheimer’s
Vitamin E supplements [decreases rate of decline]
MS ocular sxs
Optic neuritis = color vision loss, central vision loss
Inter nuclear opthalmoplasia = cant look to left or right but can go cross eyed
3 stages of MS
Relapsing remitting
Primary progressive
Secondary progressive
MS sxs can be exacerbated by what
HEAT
Imaging studies for MS
MRI w/ G = Dawson’s fingers, Hyperintense T2 plaque
LP = IgG oligoclonal bodies
MS treatment
High dose IV Steriods = acute exacerbations
MABs IV for long term therapy
Myasthenia Gravis most common sxs
Ptosis and Diplopia
MG affects who?
Younger women
Older men
MG affects what cellular structure
Post synaptic membrane of the acetylcholine
MG muscle weakness is what?
Fatiguable worse with movement
ICE pack test for MG
Improves ptosis
Lab test for MG
Increase with serum levels of acetylcholine receptor antibodies
Rule out what if you think MG
Thymoma
MG Management
ACHe Inhibitor = pyridostigmine or neostigmine
Thymectomy
TIA how quick must sxs resolve?
Within 24 hours !
1 eye vision loss with TIA to think of
Amaurosis fugax = mono ocular vision loss
Calculate what for TIA treatment
ABCD ^ 2
Carotid TIA management
Carotid endartectomy
Most common type of stroke
Ischemic stroke
Anterior circulation issues
Lowe extemity
Shuffling gate - wernickees ecenphalopathy
Sensory loss
MCA = middle cerebral artery infarct sxs
FAST ; classic stroke
PCA = posterior cerebral artery infarct think what sxs
Visual agnosia
Homonymous hemnaopsia
Basilar artery stroke
Locked in syndrome
Verterbral artery sxs
Horners syndrome
Ischemic / non ischemic / hemm stroke best image
Non con CT
then, MRI or CTA
Most important thereapy for ischemic stroke
TPA = Thrombolytics
How long can you wait to use TPA in stroke
Less than 4.5 hours of symptom onset
Lower BP less than waht in ischemic stroke
220/120
Ischemic stroke gets DAPT for how long
21 days
area of the brain MC effected in hemmorhgic stroke
Putamen !
What is Cushings reflex ; assoc with what?
Elevated BP
Bradycardia
Irregular respirations +/- stupor coma ‘
Hemm stroke
Management Hemm Stroke
Reverse any anticoagulation
Control Bp
HOB to 30 degrees
Anti seizure if epileptic
SAH is a rupture of what
Anuerysm ; circle of Willis = saccular area
Sudden headache ; photophobia and neck stiffness
N/V worse headache of life
SAH
SAH with bleeding may have what
Cushing reflex
SAH get a CT normal ; get what and what is it gonna show
LP- xanthochromia
SAH with coil or clip what is the complication ; how do you decrease risk
Re bleed of anuerysm ; nimodipine [CCBs]
Subdural hematoma is common in what
Alcohol use disorder
Bridging VIENS
Crosses suture LINES
A,B,C
Subdural hematoma also can have what
Cushing’s syndrome
Subdural hematoma is what shape ; management
Crescent shape —> Crosses suture lines
5mm = midline’s shift of 10 mm = craniotomy with burr holes
Epidural hematoma associated with what findings and what arteries
Basilar skull fracture
Middle Cerebral artery
Think what for epidural hematoma
Lucid interval of normalancy
Epidural hematoma looks like
Convex that does not cross suture lines
Epidural treatment
Neuro emergency! Craniotomy
Both hemisphere involved in seizures = ; and only one =?
Generalized
Focal = impaired or retained awareness
Generalized seizure risk factors
Alcohol
Family history
2 types of focal seizures
Simple vs. Complex
Simple = maintnatined awareness
Complex = altered level of awareness
Diagnosis of epilepsy
2 or more unprovoked seizure more than 24 hours apart
1 unprovoked seizure that has a high change of reoccurrence
1st line focal seizures mangement ; prophylactic
Benzo’s
Vlaprioc
Carbamazepine
Lamotrogine
Transient paralysis persists less than 48 hours after focal seizure is called
Todds paralysis
EEG for generalized absent seizures
3Hz spike and wave discharges
1st line for absent seizures and alternate
Ethosuxaximide
Valproate = alternate
1st thing to think of when seziure folks have a relapse
Didn’t take their medications
Tonic clonic seizures
Loss of consciousness —> muscle contraction —> rhythmic jerk
Lasts less than 5 mins
+/- Bowel bladder incontinence
Myoclonic seizure
Brief muscle contraction or jerk
Atonic seizure
Sudden loss of muscle tone collapse
Labs to get for seizures
Glucose
Tox screen
EEG for generalized seizures
Spikes no waves ; sharp waveform
1st line active seizure ; alternate
Benzos
2nd = valproic acid , levitirecam [GOOD IN PREG, RECTAL] ; fosphenytion ; topiramate
Generalized seizure usually has what
Post ictal state ; very confused
Posterior shoulder dislocation
Status epilepticus lasts how long and what mangement
Longer than 5 mins or repeat without return to level of consciousness [think ETOH]
IV Benzos
liver vs. kidney encephlopathy
liver = ETOH
kidney = ammonia
2 endogenous labs in Altered level consciousness
CBC / CMP
GCS mild mod severe
13-15
9-12
3-8
GCS usually in concussion
13-15
admission for concussion criteria
Age over 65 ; intoxication ; soft tissue injury above the clavicle ; distractor injury present
sxs longer than 14 days or worsen do what
get MRI with neuropsych eval
primary sxs in post concussion syndrome
headache
post concussion syndrome are more at risk for what later in life
Alzheimer’s
parkinsons
tearing of bridging veins
subdural hematoma
subdural hemtoma is what shape
concave ;
lucid interval before AMS
Older patient
aphasi ; hemiplesia
weakness
–> course to herniation : blown pupils
MC location of subdural hematoma
frontotemporal region
epidural hematoma [4]
-middle meningeal artery
-skull fx [temporal region]
-Lucid then LOC
Rapid deterioration
CRESCENT SHAPE
cerebral contusion CT scan course
altered GCS 10-11 –> 24 hours later BLEEDS and BLOSSOM
TXM = medical > surgery
diffuse axonal injury think what force
shear of axon ; jumping off a building
-usually comatose
-micro hemorrhages
TXM = medical > surgical [decrease the swelling]
DAI shows what lesions
punctate black hole lesions
what valvular abnormality is a common cause of syncope
aortic stenosis
lacunar infarct think
small occlusions
long standing HTN / DM
TIA is usually a result of what
Embolic stroke
3 meds that are good post TIA
Statin ; ASA ; clopiogrel x 90 days
+/- AC = afib
*carotid endardectomey over 70% occlusion
ischemic stroke MC
middle cerebral artery [ typical stroke sxs ]
middle cerebral artery stroke
contralateral hemiparesis ; homonymous hemianopia
posterior cerebral artery stroke
memory impairment ; homonymous hemianopia
basilar artery infarct
ipsilateral bulbar or cerebellar signs
vertebral artery infarct
ipsilateral sensory loss in face ; ataxia contralateral hemiparesis
CTA is going to be helpful to look for what
occluded vessel in the setting of ruled out hemorrhage
seizure –> weakness
todds paralysis ; get CT non con
when can you give thrombyltics for ischemic stroke
4.5 hours of sxs onset
[last known normal]
what is the Bp cut off for rTPA
185/110
best imaging for ischemic stroke
MRI
inter cranial atherosclerosis stroke prevention
Plavix- Clopidogrel
MC of intraparenchymal hemorrhage
HTN ; present with headache–>comatose
MC location for hypertensive stroke
basilar ganglia
best Bp lowering drugs for ICH management
labetolol // nicardipine = 140 systolic goal
ICP osmotic agent
mannitol
hyperventilation = decreases ICP
MC cause SAH
trauma > anneurysmal
aneurysmal SAH can develop
3rd CN palsy; anisocoria and ptosis
def test for SAH
cerebral angio
–> LP = xanthochromia
what is a good prophlyactic for SAH workup
keppra for anti seizure care
MC locations for cerebral aneurysm
anterior communicating artery
posterior communicating artery
Most AVM lie where
MCA
Bells Palsy can t do what
raise their eyebrows
lower motor neuron issue
seizure that starts in one area then progresses over the rest of the body
jacksonian march
top 3 meds for generalized seizures
Levetiracetam = safe in pregnancy
valproic acid
phenytoin
focal seizure 3 meds
carbamazepine
valproic acid
phenytoin
complex partial seizure medication management
lacosamide
renally vs liver processed seizure meds
renal = keppra
liver = valproic acid
minor neuro cognitive disorders drug of choice + lifestyle
Donepazil
4 types of reversible dementias
hypothyroidism
b12 deficiency
thiamine deficieny
Normal pressure hydrocephalus
beta amyloid plaques think what
Alzheimer’s
2 drugs for alzheimers disease
donepazil
memantine
lewy body vs. frontotemporal demtentia
lewy body = parkinsonion movements ; little strokes
frontotemporal = angry
delirium can have what types of amnesia
anterograde and retrograde
confabulation think what
korotsakoffe syndrome
uremic encephalopathy treatment of choice
dialysis
MS ; [4]
motor weakness, optic neuritits
MRI = ologlonal bands ; white plaques around the ventricles
ptosis diplopia chewing difficulties
myasthenia gravis
cerebral palsy
spasticity and hyperreflexia
PT and Speech therapy
Botox or Baclofen
essential tremor
exacerbated by stress
not as disabling
ETOH helps
proponal treatment
huntingtons
autosomal dominant; high children effected ; need to counsel
chorea dementia
parkinsons is a lack of
dopamine
treatment parkinsons
levedopa /carvodopa–>
amantidine first
coprolalia
tics - yelling obsentities
CRPS happens after what
a single limb after trauma
guillain barre [4]
post campylobacter
weakness in the “rubbery” legs
txm = Plasmapheresis ; IVIG
may require intubation; good prognosis
if you suspect vasculitis peripheral neuropathy what is the diagnostic
bx
MC type of encephalitis
Viral
fever–> LOC –> stiff neck
get LP ; + Leukocytosis
MC bacterial meningitis
strep pneumonia
Listeria = pregnant pts
bacterial meningitis Community acquired TXM
cephalosporin + vanco + acyclovir
-ceph + vanco + ampicillin = listeria TXM
cefipime + vanco = Staph A. TXM
“ Think CAVs or Cv for Staph. “
opening pressure in encephalitis and bacterial meningitis are both what
elevated !
cells that predominate bacterial meningitis
PMNs!
bacterial meningitis has ___ glucose
DECREASED
MC brain tumor
glioblastoma
benign brain tumor commonly
meningioma
semmes wienstein filament represents what
the proective threshold ; that will show defecits in diabetic patients in various areas of the feet and hands
huntingtons does not have what
seizures
essential tremor genetics
autosomal dominant
myasthenia gravis usually has a what that you have to get a what for
thymoma
CT of the chest
immediate post ictal suspect what
up going plantar reflex
cerebral palsy most commonly presents with what sxs
spasticity of the limbs [starting in the legs]
in treatment of bells palsy dont forget what management
artificial tears
diplopia difficulty chewing ptosis and arm weakness think what two things
myasthenia gravis
thymectomy
Can a MCA stroke result in aphasia
YES ; reactive ; nonsensical aphasia
Can a MCA stroke result in aphasia
YES
What is a good intervention for hospitalized dementia patients
Uninterrupted sleep
CSF analysis Guillenne Barre
Post URI or Campy infection ; bilateral leg paralysis/weakness upper spread; peripheral paresthesias
Normal = WBCs, RBCs, Glucose
Low = Protein
Loss of anocutaneous reflex = what nerve roots
S2-S4 ;
Positive straight leg test and lumbosacral pain
Gait pattern of Parkinson’s
Narrow base ; small stride gait
If you give prochlorperazine for migraine what three things should you consider
IV administration
You can +/- give with NSAIDS, APAP
Give it also with IV benedryl to decreased akathisia sxs
Migraine 1st line in pregnancy
APAP
JME treatment option
Juvenile myoclonic epilepsy
Valprioc acid; may require life long therapy
2 drugs of choice for Alzihiemers treatment
Donepazil
Rivastigmine
Why do nerve conduction studies not help radiculopathy
Because they don’t work at the root, they work further down and can be normal if the lesion is proximal to the root ganglia [dorsa]
Because the action potential at the SNAP is still normal [good conduction] when a signal is sent
Describe lithium tremor
Likely starts after med start.
Limited to the hands and UE.
Non progressive.
Decreases over time.
Lacunar infarct Risk factor and location
RF = HTN
Location = deep brain matter; sprain the white/gray matter junction
Fluent aphasia is a result of a lesion where?
Wernickes ; posterior ; temporal lobe ; supplied by the MCA
Vestibulocerebellar sxs are consistent with an infarct where [ataxia, dizzy, nystagmus]
Posterior or Anterior Inferior Cerebellar
PAIC
Posterior cerebral artery injuries generally have what defect prominent
Visual
What is the ABCD2 score for TIA
It established admission criteria
A=age over 60
B= Bp [high]
C=clinical sxs consistent
D= duration of sxs over 60 mins to less than 10 mins
D= presence of Diabetes
2 = Admit.
Guillen Barre is a demyelination of what features
Peripheral nerves w/ autonomic features that are worse with progressive nerve disturbances.
If Parkinson’s motor sxs are not well controlled on L/C do what
Add amantadine or selegelline
Why is NCS the next step of carpal tunnel does not improve with splinting
To confirm nerve compression = decreased nerve conduction
To confirm tunnel release surgery efficacy
B12 vs. ETOH dependency
Decreases B12
Leading to progressive bilateral muscle weakness—> paralysis
Gait impairment common
B12 = a produce of MEAT , DAIRY , and EGGS
With cerebral artery infarct think
Contralateral weakness
MC etiology of cerebral artery infarct
Cardiac embolization due to AFIB ; = thrombus in the left atrial appendage
Ischemia of the spinothalmic tract results in what
Pain and temperature deficits
What can cause Parkinson’s psychosis
Progression of disease
High doses of L/C [ dopamine precursor ]
or
Pramipexole [ dopamine agonist ]
if due to meds = decrease the dose
other sxs should be normal // Psychosis most concerning
if sxs are brutal and require above meds + Antipsychotic
Good Parkinson’s medication in younger patients with tremors
Benztropine [anticholinergic]
Older Patient Risk - cognitive impairment and urinary retention
What nerve is at risk in temporal bone fractures
Facial nerve
Where do trigeminal nerve branches exit and what injuries put it at risk
Sphenoid bone, mid face
Orbital or Anterior facial trauma
Thalamic hemmorhage in a middle aged individual think what
Cocaine use
Best imaging for MS brain
MRI showing lesions in white matter; periventricular areas
Does diffuse Axonal injury show up on CT
YES
HIV neuropathy is most commonly treated with
Gabapentin
Fatiguable weakness think
Myasthenia gravis
Infraoribital fx affects nerve areas where
Lips and cheeks
