Neurology Flashcards
What is the most common brief, quantitative screening tool used to evaluate dementia and how is it commonly used?
Mini Mental Status Exam (MMSE) - commonly used as a baseline for future comparison to evaluate progression of the disease.
Describe the common S/S associated with early onset of Alzheimer’s disease.
Memory loss that giving clues doesn’t help, visual-spatial deficits, language defects.
What S/S are associated with lewy body dementia?
cognitive flucutaitons, visual hallucinatinos, Parkinsonism
What S/S are associated with frontotemporal dementia?
personality, and social behavior changes, nonfluent speech
What key factors differentiate delirium from dementia?
Delirium = rapid onset, fluctuating course
What pharmacological treatments may be used in Alzheimer’s disease?
Controversial - memantine, anti-Ach meds
How is delirium treated?
Address the underlying cause –> minimize use of physical restraints
What artery is most often involved in an ischemic stroke?
Middle cerebral artery
Differentiate S/S of ischemic stroke involving anterior, middle, and posterior cerebral arteries.
Ant: apraxia, contralateral paralysis (lower > upper)
Mid: contralateral paralysis (upper > lower), hemianopsia, aphasia
Post: LOC, N/V, ataxia, visual agnosia
Define the terms apraxia, hemianopsia, aphasia, ataxia, and agnosia.
apraxia: inability to perform purposeful actions
hemianopsia: loss of one half of vertical visual field
aphasia: inability to understand or express speech
ataxia: loss of full control of body movements
agnosia: inability to interpret sensations
What will a CT scan show in ischemic stroke?
loss of grey-white interface, acute hypodensity
Define transient ischemic attack.
Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction
What is the most significant sequelae of TIA and how common is it?
10% of TIA patients will have an ischemic stroke within 90 days.
What test is used to determine the risk of stroke after a TIA and what does it predict?
ABCD2 score: predicts likelihood of subsequent stroke within 2 days of a TIA
What treatment is given to TIA patients to prevent a subsequent stroke
Anti-platelet therapy –> ASA + dipyridamole or clopidogrel monotherapy
Differentiate signs of stroke from Bell’s palsy.
Stroke: facial droop that is often forehead sparing with loss of smile line
Bell’s: loss of smile line, unable to raise eyebrows, smaller eye opening.
What is the pathophysiology of Bell’s palsy and what is the most common causative agent?
Sudden onset of unilateral facial nerve (CN VII) paralysis –> often caused by HSV
When do S/S of Bell’s palsy usually peak?
48 hours - often after a viral illness prodrome
What is essential in treatment of Bell’s palsy?
Prednisone plus lubricating eye drops and eye patch at bedtime –> inability to close eye can lead to corneal exposure keratitis.
In what patient population is idiopathic intracranial hypertension most common?
Young, obese female
What in a patient’s medical history places them at risk for idiopathic intracranial hypertension?
Vitamin A toxicity, use of steroids or tetracyclines
What S/S and lab findings are most commonly associated with idiopathic intracranial hypertension?
C/O HA and visual changes, papilledema and CN VI palsy on PE, inc opening pressure on LP.
Identify the S/S associated with CN VI palsy.
CN VI (abducens) controls lateral rectus muscle of the eye. CN VI palsy causes the eye to turn inward toward the nose.
What is the treatment for idiopathic intracranial hypertension?
Acetazolamide, serial LPs, weight loss
Describe S/S associated with essential tremor.
Postural tremor (usually of the hands worsened by stress. The patient’s voice may shake if laryngeal muscles are involved.
Define postural tremor.
When a person maintains a position against gravity, such as holding the arms outstretched
Identify aggravating and alleviating factors for essential tremor.
Improves with intake of ETOH, worsens with activity or stress.
When and how is essential tremor treated?
Only when symptoms impact lifestyle. 1st line is propranolol. May also treat with primidone, alprazolam, topiramate, or gabapentin.
Describe the presentation of a cluster headache.
Excruciating unilateral periorbital and temporal pain occuring in short lived (< 2hr) clusters that occur dauily for a period followed by remission –> most commonly presents in a male.
Other than the description of the HA itself, describe common S/S associated with cluster HA.
Ptosis, miosis, lacrimation, conjunctival injection, rinorrhea, nasal congestion.
What is the treatment for cluster HA?
Acute attacks: 100% O2, sumatriptan
Prophylaxis: CCB
Describe the presentation of a tension headache.
Bilateral, non-pulsating band-like pain often associated with neck muscle tenderness.
What is the treatment for tension HA?
NSAIDs, smoke cessation
Describe the presentation of a migraine headache.
Throbbing, pulsating pain that is more commonly unilateral and accompanied by N/V, photophobia and phonophobia.
T/F: Migraine HAs are more common in women.
True
Describe the aura that may be associated with migraine HAs.
Scotoma (blind spot), flashing lights, or sound the precedes the HA by about 30 minutes.
What is the treatment for migraine HA?
Acute: triptans, ergotamines, antiemetics, NSAIDs
Prophylaxis: BBs, CCBs, TCAs
What are the contraindications for the use of triptans and ergotamines?
HTN, CAD, vascular disease
Define status epilepticus.
One seizure lasting > 5 minutes or more than one seizure with no lucid interval between.
What is the most common cause of status epileptics in a patient with history of epilepsy?
Change in medication
What are two common non-epileptic causes of seizure that should always be ruled out?
Hypoglycemia, isoniazide toxicity (give pyridoxine - B6)
What are the treatment options for status epilepticus?
1st line –> BZDs
Other –> phenytoin, pentobarbital
In what patients is an absence seizure most common and what is the treatment?
ages 5 - 10 –> tx = ethosuximide
List and define medical terms associated with the symptoms of Parkinson’s disease.
Bradykinesia: slowness of movement
Postural Instability: inability to maintain equilibrium
Micrographia: abnormally small handwriting
Rigidity: resistance throughout range of motion
What findings on physical exam are commonly associated with Parkinson’s disease?
resting pill-rolling tremor, mask-like facies, cog-wheeling of extremities, shuffling gait.
What is the pathophysiological cause of Parkinson’s?
Dopamine depletion in basal ganglia
What is most commonly used to treat Parkinson’s?
Levodopa, carbidopa
Define vertigo.
Perception of movement resulting from dysfunction in the peripehral or central components of the vestibular system.
Describe the S/S associated with vertigo.
feeling of swaying, spinning, etc., N/V, nystagmus lateralizing to the affected side.
Describe S/S more consistent with central vertigo than peripheral vertigo.
Limb ataxia (lack of coordinated movement) is the most common differntiating sign. Generally, S/S of central vertigo are less acute, more persistent, and associated with other neurologic deficits.
What are the common causes of central vertigo?
Vertebrobasilar insufficiency, brain stem or cerebellar infarct, basilar artery migraine, degenerative diseases (MS for ex)
What imaging tests are used to evaluate for suspicion of central vertigo?
Initial = non-contrast CT to r/o ICH
Definitive: MRI with angiography –> only imaging able to visualize cerebellum
What are common causes of peripheral vertigo?
Benign paroxysmal positional vertigo (BPPV), acute otitis media, labrynthitis, Meniere’s, vestibular neuroma, trauma.
Descrieb common S/S associated with BPPV.
Rapid onset with N/V –> elicited by moving head to a certain position.
Name and describe the test used to identify BPPV.
Dix-hallpike –> Start with patient sitting up and head turned to side. Quickly lower patient supine with head extended over edge of bed. If nystagmus begins within one minute, test is positive for BPPV.
Name and describe the maneuver used to treat BPPV.
Epley maneuver –> after Dix-Hallpike, with patient supine, turn head 90 deg in opposite direction, then place patient on their side to further rotate the head.
What are some common causes of central vertigo?
Meningitis, encephalitis, vertebral-basilar insufficiency, cerebellar hemorrhage, tumor, temporal lobe epilepsy.
