Neurologie Flashcards
contrindication of TPA in stroke(11)
systolic BP>185 and diastolic >110
prior intracranial hemorrage
stroke or head trauma within the last 3 months
recent MI
current anticoagulation with INR>1,7 or prolonged PTT
platelet count< 100000
major surgery in 14 days
GI or unrinary bleeding in the past 21 days
seizures present at the onset of the stroke
blood glucose< 50 or> 400
age < 18
clue for SAH
worst headache of my life
complication of berry aneurism in eye
CN 3 palsy with pupil involvement
3 common cerebral aneurisms
ACA 30%
PSA 25%
MCA 20 %
Apres combien de tempa you can have mental changes in epidural hematoma(2)
within minutes to hours
classic lucid interval
Apres combien de tempa you can have mental changes in sub dural hematoma
within days to weeks
quid of blown pupil
fixed and dilated pupil
disease with blown pupil
epidural hematoma
CT for epidural hematoma
biconvex lens shaped
recent onset of headaches next step
immediate work up
most common type of headache in adults
tension headaches
causes of seizure in infant(4)
perinatal injury
infection
metabolic
congenital
causes of seizure in children 2-10 ans(4)
idiopathic
infection
trauma
febrile seizure
causes of seizure in adolescent(4)
idiopathic
trauma
drug withdrawal
AVD
cause of seizure in adult 18-35 ans(3)
trauma
alcohol
brain tumor
5 A for dementia
aphasia apraxia agnosia amnesia abstract thought disturbance
cause of seizures in adult > 35 ans(4)
stroke
metabolic disorder
alcoholism
brain tumor
triad of MS(3)
scanning speech
intranuclear ophtalmoplegia
nystagmus
physiologic condition associated with decreased frequence of MS episode
pregnancy
CSF protein level in GBS
> 55 mg/dl
5 A for GBS
acute inflammatory demyelinatingpolyradiculopathy ascending paralysis autonomic neuropathy arrythmias albuminocytologic dissociation
most common CNS tumor
metastatic
most common CNS tumor in adult(2)
glioblastoma
meningioma
most common CNS tumor in children(2)
meduloblastoma
astrocytoma
localisation of brain tumor in kids
1/3 supratentorial
localisation of brain tumor in adults
2/3 supratentorial
other name of neurofibromatosis type 1
von recklinghausen disease
association of NF2
acoustic neuroma
genetic problem in NF 2
chromosome 22
quid of Lysh nodules in NF1
pigmented iris hamarthoma
criteria for NF 1(5)
six cafe au lait spots freckling in axillary or inguinal area optic glioma 2 lish nodules first degree relative with NF 1
triad for wernicke encephalopathy(3)
encephalopathy
ophtalmoplegia
ataxia
classic patient with b1 deficiency(5)
alcoholics hyperemesis dyalisis starvation aids
what can elicited wernicke encephalopathy
large dose of glucose administration
quid of ophtalmoplegia in Wernicke encephalopathy(3)
nystagmus
lateral rectus palsy
conjugate gaze palsy
risk factor for dementia(4)
age
positive family history
head trauma
down syndrome
mutation associated with the most severe form of NF2(2)
nonsense
frame shift mutation
quid of same sense mutation (2)
silent mutation
not severe
clue for normal pressure hydrocephalus(3)
gait disturbance
dementia’
urinary incontinence
PL in normal pressure hydrocephalus
normal opening pressure
MRI of NPH
enlarged ventricle
MRI of PML
multiple non enhancing lesions
CT of alzheimer
diffuse cortical atrophy greater in temproal and parietal lobe
side effect of trihexyphenidil
anticholinergic effect
quid of anticholinergic effect(7)
dry skin dry mouth constipation urinary retention flushing visison changes confusion
disease associated with vascular dementia
stroke
CSF analysis in herpes encephalitis(3)
lymphocytosis pleiocytosis
high erythrocytes
high protein
symptomatic hypokaliemie
< 2,5 meq/l
EKG of hypokaliemia(3)
U waves
flat and broad T waves
premature ventricular beats
initial imaging in the setting of unprovoked seizure
CT of head without contrast
Dx of epidural abcess
MRI with gadolinium
types of stroke(4)
ischemic thrombotic
ischemic embolic
intra cerebral hemorrage
spontaneous sub arachnoid hemorrage
treatment of of myasthenie gravis crisis(2)
endotracheal intubation
withdrawal of anticholinesterase inhibitor
site of lesion for myasthenie gravis
neuromuscular
criteria to declare brai death in the setting of mechanical ventilation(2)
absent cranial nerves reflexes
fixed and dilated pupils
no spontaneous breath
agreement of 2 physicians
quid of glioblastome multiforme(2)
astrocytoma de grade 4 or
high grade astrocytoma
CT for glioblastoma multiforme
butterfly appearance
early symptom in normal pressure hydrocephalus
gait impairment
differenciate NPH from alzheimer(2)
in NPH first symptom gait impairment
in alzheimer gait impairment comes later
pill rolling tremor
parkinson disease
CT for high grade astrocytoma
heterogenous and serpiginous contrast enhancement
predisposing factor for delirium(5)
dementia parkinson prior stroke advanced age sensory impairement
precipitating factors for delirium(6)
drugs infections electrolyte disturbances metabolic derangements systemic illness central nervous system necrosis
drugs percipitating delirium(5)
narcotics sedatives antihistamines muscles relaxers polypharmacy
infections precipitating delirium(3)
pneumonia
IGU
meningitidis
electrolytes disturbances precipitating delirium(2)
hyponatremia
hypercalcemia
metabolic disturbances precipitating delirium(3)
volume depletion
B 12 deficiency
hyperglycemia
systemic disturbances precipitating delirium(3)
CHF
hepatic failure
Malignancy
CNS disturbances precipitating delirium(3)
seizures
head injury
subdural hematoma
quid of delirium(3)
confusion
desorientation
reduced or fluctuate level of consciousness
Symptom accompany delirium(3)
agitation
anxiety
hallucination
only abnormality in CSF analysis in GBS
increased protein
other appelation peripheral facial paralysis
Bell’s palsy
other symptom of bell’s palsy(3)
decreased tearing
hyperacusis
loss of taste sensation over the 2/3 ant of the tongue
most common cause of subdural hematoma
blunt trauma
finding in CSF in MS
oligoclonal bands
quid of conus medularis
spinal cord termination
what cauda equina syndrome will give
lower motor neuron
finding in cauda equina syndrome(6)
usually unilateral radicular pain asymetric muscular weakness hypo or areflexia late onset of bowel and bladder dysfunction saddle hypo or anesthesia
finding in conus medullaris syndrome(5)
sudden onset of severe back pain perianal hypo/ oranesthesia symetric motor weakness hyperreflexia early onset of bowel or bladder dysfunction
rx of conus medullaris syndrome(3)
MRI
IV glucocorticoids
neurosurgical evaluation
quid of cauda equina syndrome
lumbo sacral nerve roots from cauda equina
what consequence will have a lesion in cauda equina syndrome
lower motor neurone
what consequence will have in conus medullaris syndome
both upper and lower motor neuron
sensory role in cauda equina
saddle area
motor role in cauda equina
control of sphincter anal and uretral
parasympathetic to bladder and lower bowel
congenital foot drop
charcot marie tooth disease
first rx of NPH
large volume of lumbar puncture
failure in large volume lumbar puncture in NPH
ventriculoperitoneal shunt
symptom for Cauda equina syndrome(4)
weakness of both legs
numbness from buttocks to feet
loss of rectal tone
retention d’urine
retention d’urine in USMLE
foley catheter ramene 800 CC d’urine
next step in in cauda equina syndrome(2)
MRI
surgical in emergency
clue for ACA stroke(2)
controlateral motor and sensory deficits
more pronounced in the lower limbs than the upper
bloof supply of the brain(2)
ant circulation
post circulation
quid of anterior circulation of the brain
internal carotid arteries
and its branches
brain branches of carotid arteries(2)
ACA
MCA
Post circulation of the brain
paired of vertebral arteries
forms basilar artery
origin of post cerebral arteries
from basilar arteries
med used in thrombotic stroke(2)
TPA
tissue plasminogen activator
example of TPA
alteplase
cause of lacunar strokes(2)
microatheroma
lipohyalinosis of the small penetrating arteries of the brain
risk factor for lacunar infarct(2)
HTA
diabetes
most common site of lacunar infarct
post internal capsule
lacunar stroke type(2)
thrombi
not embolic
conduction aphasia(2)
fluent spontaneous speech but phonemic errors
comprehension relatively preserved
repetition in wernicke and broca
impaired
repetition in conduction aphasia
very poor
associated features with broca
right hemiparesis
associated features with wernicke
right superior visual field defect
associated features with CONDUCTION APHASIA
none
clue for broca
broken speech
artery in broca
MCA
complication of subarachnoid hemorrage
hyponatremia
clue for lacunar infarct(3)(post limb interbnal capsule)
unilaterla motor impairment
no sensory or cortical deficits
no visual field defect
clue for MCA
controlateral somato sensory motor weakness in face arm and legs conjugate eye deviation toward side of the infarct aphasia hemineglect syndrome
aphasia in MCA occlusion
dominant sphere atteint
hemineglect syndrome in MCA occlusion
non dominant sphere
ACA occlusion(6)
controlateral somato sensory motor weakness predominat in lower extremities abulia dyspraxia urinary incontinence emotionnal disturbances
quid of abulia
lack of will and initiation
vertebro basilar system occlusion(3)
alternate syndrome with controlateral hemiplegia
ipsilateral cranial nerve involvement
possible ataxia
best tool to confirm parkinsonism
physical exam
torticolis in USMLE(2)
periodic involuntary head turning
hypertrophied STERNO CLEIDO MASTOID muscle
synonym of torticolis
focal dystonia
acute agitation in elderly and demented people(2)
antipsychotics
no benzodiazepines
risk in status epilepticus
cortical laminar necrosis
quid of status epilepticus
seizures for more than 5 mn
consequence of cortical laminar necrosis
persistent neurologic deficits
recurrent seizures
ischemic stroke on CT
hypodense area
hemorragic stroke on CT
hyperdense area
broad based shuffling gait
NPH
cause of NPH in USMLE
decreased CSF absorption
physiopatho of amaurosis fugax
cholestrerol emboli from plaques in carotid artery
next step after dx myasthenia gravis and why(2)
chest CT
look for thymoma
most common cause of of hemorragic intraparenchymal(2)
uncontrolled HTA
amyloid angioplasty
most common site of hTA bleeding(2)
basal ganglia
specially in putamen
stroke with no prior antiplatelet rx
aspirin
stroke on aspirin ,rx
aspirin plus dypiridamole or clopidogrel
stroke on aspirin plus large intracranial artery atherosclerosis
aspirin plus clopidogrel
stroke with AFIB ,management
long term anticoagulation
memory loss ,constipation and weight gain
hypothyroidism
gait in parkinsonism(2)
hypokinetic
shuffling gait
quid of shuffling gait
patient is chasing his center of gravity
problem in parkinson
underactivity of dopaminergic neuron in substantia nigra
clue for parkinson (extra)
fixed facial expression
resistance to passive flexion
cause of CN 3 neuropathy
nerve ischemia
target in pharmacotherapy restless leg syndrome
dopamine
firs line rx of restless leg syndrome
dopamine agonist
second line rx of restless leg syndrome
gabapentin
quid of gabapentin
alpha 2 delta calcium channel ligands
cause of RLS
iron deficiency anemia uremia diabetes mellitus MS parkinson pregnancy drugs
drugs causing RLS(2)
antidepressants
metochlopramide
rx of intermittent mild symptom of RLS(3)
iron supplementation
supportive measures
avoid aggravating factors
supportive measures in RLS(3)
leg masssage
heating
exercice
aggravating factor in mild intermittent RLS(2)
sleep deprivation
medications
when to give medication in RLS
persistent moderate to severe form
