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Herkimer 2021 > Neurology > Flashcards

Neurology Flashcards

1
Q 
tremor
stiffness
slowness
balance problems
gait disturbance 
in question stem  --- most likely diagnosis?
A

Parkinson disease

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2
Q

symptoms of Parkinson disease

A

Bradykinesia - / hypokinesia/ akinesia

  • limb bradykinesia
  • loss of facial expression
  • loss of arm swing
  • difficulty with fine movement, “micrographia”

Rigidity (stiffness)
- cogwheeling

Tremor
- resting tremor 4-6Hz, suppressed by initiating movement

Trouble turning in bed 
Trouble opening jars 
Shuffling gate 
Trouble rasing from a chair
Glabellar Tap 
difficulty walking heel-to-toe
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3
Q

Late symptoms of Parkinson disease

A
  • Postural instability (e.g. pull test)/ frequent falls
  • cognitive impairment / dementia/ psychotic symptoms/ depression
  • sleep disturbance - daytime hypersomnolence + nocturnal akinesia
  • autonomic dysfunction (GI, orthostatic hypotension, excessive sweating)
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4
Q

DDx of tremor

A
  • essential tremor
  • hyperthyroidism
  • drug induced (e.g. beta agonist)
  • cerebellar disorder
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5
Q

DDx of Parkinsonian syndrome

A
  • Alzheimer’s
  • Multiple cerebral infarcts
  • drug induced (e.g. metaclopramide, antipsychotics, lithium)
  • multiple system atrophy
  • progressive supranuclear palsy
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6
Q

MDS clinical diagnosis of Parkinsonism

A

bradykinesia plus rest tremor or rigidity

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7
Q

clinical criteria of clinically established PD

A

All of the 3:
1 ) No absolute exclusion criteria
2) = or > 2 supportive criteria
3) No red flags

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8
Q

Clinically Probable PD diagnostic criteria

A
  1. Absence of absolute exclusion criteria

2. Presence of red flags counterbalanced by supportive criteria

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9
Q

Absolute exclusion criteria of PD

A
  • Cerebellar sign
  • Supranuclear gaze palsy
  • Established diagnosis of behavioural variant fronto-temporal dementia
  • Parkinsonism restricted to the lower limbs only for >3 yrs
  • Tx with an antidepaminergic or w/ dopamine-depletion agent
  • Absence of response to levodopa
  • Sensory-cortical loss
  • No evidence for dopaminergic deficiency on functional imaging
  • Other parkinsonism-inducing condition
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10
Q

If using ergot-dopamine agonists, what regular investigations are needed?

A

Annually

  • Cr
  • ESR
  • CXR
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11
Q

what are the risks of quick withdrawal of sudden fail of PD medical treatment?

A
  • risk of acute akinesia

- neuroleptic malignant syndrome

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12
Q

What are the symptoms of neuroleptic malignant syndrome?

A

> > Muscular rigidity (typically, “lead pipe” rigidity)
Shuffling gait
Tremor
Dysphagia

> > Hyperthermia (temperature >38°C)

>>  Autonomic dysregulation 
Diaphoresis
Pallor
Tachycardia 
Dyspnea
Incontinence

> > Changes in the level of consciousness
Psychomotor agitation
Delirium progressing to lethargy, stupor, coma

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13
Q

Management of neuroleptic malignant syndrome ?

A
  • discontinue all neuroleptic agents
  • mainly supportive, monitoring and management in an ICU suggested
  • controlling the rigidity and hyperthermia and preventing complications (eg, respiratory failure, rhabdomyolysis, renal failure)
  • trial of dantrolene and bromocriptine to hasten clinical response
  • amantadine, lorazepam, and electroconvulsive therapy
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14
Q

classes of PD medications

A

First-line
1 ) Levodopa
2) dopamine agonist
3) MAOB inhibitors

2nd line

  • Anticholinergics
  • Beta adrenergics for postural tremor
  • Amantadine
  • selective and reversible inhibitor of the enzyme catechol-O-methyltransferase (COMT) - Entacapone (for late Parkinson’s)
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15
Q

symptoms of dopamine dysregulation syndrome

A

on dopaminergic medications, associated with

  • impulse control disorder
  • abnormal behavior
  • hypersexuality
  • pathological gambling
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16
Q

Non-pharmacological treatment for PD

A
  • deep brain stimulation of the STN
  • GPi
  • unilateral pallidotomy
  • refer to PT/OT/SLP
  • consider most of daily protein in last meal ( NO decrease total protein) if on levodopa AND having motor fluctuations
  • take vitamin D
17
Q

list common cormorbid illness with PD

A
  • depression: do not treat psychotic symptoms, only consider quetiapine or clozapine
  • dementia
  • sleep disorder
  • drooling/ salivation
  • urinary urgency/ incontinence
  • constipation
  • orthostatic hypotension
  • erectile dysfunction
18
Q

Migraine prophylaxis - classes of meds

A
  • beta blocker (metoprololor/ propranolol)
  • anticonvulsants (topiramate or valproic acid - teratogenic)
  • tricyclic antidepressants (amitriptyline)
  • calcium channel blocker (Verapamil)
  • ACE inhibitor or ARB (Candesartan)
  • Gabapentin
19
Q

First line Rx of moderate - severe migraine

A

Triptan +/- NSAIDs (triptan at onset of pain)

20
Q

contraindication of using triptans

A
  • CVD (CVA, TIA, MI, PVD, coronary spasm, Prinzmetal angina)
  • WPW
  • pregnancy
  • basilar migraines
  • ergotamine in previous 24 hours
21
Q

Migraine diagnosis criteria

A

A) At least 5 attacks fulfilling criteria B, C, and D

B) Attack lasting 4 to 72 hours (untreated or unsuccessfully treated)

C) Having at least two of these characteristics:

  • aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
  • moderate or severe pain intensity
  • pulsating quality
  • unilateral location

D) Having at least one of these conditions during the headache:

  • nausea and/or vomiting
  • phonophobia or photophobia
22
Q

conditions when NO CT needed to diagnose migraine

A

4 of 5 POUND

  • pulsatile
  • duration 4-72 hours
  • unilateral
  • nausea
  • disabling
23
Q

Red flags of headache (SNOOP) - needs CT

A

S - systemic (HTN, fever, wt loss, myalgia, scalp tenderness)
N - neuro symptoms, focal neuro deficits, LOC, visual field defect, CN asymmetry
O - onset: sudden, abrupt, split second
O - older: new or progressive > 50 y/o
P - previous hx: 1st? new/ different, change nature/ severity
S - 2nd risk factors: HIV, CA, ***precipitated by Valsalva (cough, sneeze, bending over)

24
Q

Nonpharmacologic therapies for migraine prophylaxis

A
  • Relaxation training
  • Thermal biofeedback combined with relaxation training
  • Electromyographic feedback
  • Cognitive behavior therapy (CBT)
25
Q

Febrile seizure age group

A

6 mo to 5 y/o

26
Q

Criteria of complex febrile seizure

A
  • 15 minutes or more
  • associated with focal neurologic findings
  • recurs within 24 hours
27
Q

feature of febrile seizure that does not need lab work or neuroimaging

A
  • simple febrile seizure
  • well-appearing
  • no residual neurological symptoms
    DO NOT require routine diagnostic testing
28
Q

Risk factors for recurrence of febrile seizure

A
  • Age younger than 18 months
  • Fever duration of less than one hour before seizure onset
  • First-degree relative with a history of febrile seizures
  • A temperature of less than 104°F (40°C)
29
Q

risk factors of developing febrile seizure

A
  • had febrile seizure in the past
  • family history of febrile seizure
  • age ( 6 mo to 5 y/o)
30
Q

Criteria of simple febrile seizure

A

All of the following:

  • Duration of less than 15 minutes
  • Generalized
  • No previous neurologic problems
  • Occurs once in 24 hours
31
Q

Risk Factors for Future Unprovoked Seizure After a Febrile Seizure

A
  • Age older than three years at the time of the first febrile seizure
  • Complex febrile seizure
  • Family history of epilepsy
  • Fever duration of less than one hour before seizure onset
  • Neurodevelopmental abnormality

Herkimer 2021 (21 decks)

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