Neurology Flashcards
Feaetures of Lennox-Gastaut syndrome (3)
(1) multiple seizure types (usually including general- ized tonic-clonic, atonic, and atypical absence seizures);
(2) an EEG showing slow (<3 Hz) spike-and-wave discharges and a variety of other abnormalities; and
(3) impaired cognitive function in most but not all cases
Most common syndrome associated with focal seizures with impairment of consciousness
Mesial temporal lobe epilepsy
*with characteristic hippocampal sclerosis on MRI
Chronic migraine definition
episodes of migraine on 8 or more days per month and with at least 15 total days of headache per month
Only proven treatment for chronic tension type headache
Amitryptyline
Phases of migraine
Premonitory (prodromal)
Aura
Headache phase
Postdrome
Intraneuronal proteinaceous inclusions in cell bodies that stain for alpha synuclein
Lewy bodies
Found in Parkinson’s
Approved for on-demand treatment for off periods in Parkinsons (3)
Inhaled levodopa
Subcutaneous injections of apomorphine
Sublingual apomorphine
Only drug that has been demonstrated to treat dyskinesia without worsening parkinsonism
Amantadine
Most common cause of proximal MCA occlusion
Embolus (»atherothrombosis)
Presentation of MCA occlusion at its origin
Contralateral hemiplegia, hemianesthesia, homonymous hemianopia, and a day or two of gaze preference to the IPSILATERAL side
(+) Dysarthria
If dominant hemisphere - global aphsia
If nondominant hemisphere- anosognosia, constructional apraxia, neglect
Presentation of proximal SUPERIOR division of MCA occlusion
Sensory disturbance + MOTOR weakness, nonfluent aphasia
Presentation of INFERIOR division of MCA occlusion
Fluent (wernicke’s) apasia
Without weakness
Jargon speech and inability to comprehend
Nondominant hemisphere - Hemineglect or spatial agnosia without weakness
Presentation of lenticulostriate vessel
Pure motor stroke or sensory-motor contralateral to the lesion
at the genu - Primarily facial weakness –> arm –> leg
*produces small vessel (lacunar) stroke within the internal capsule
Presentation of anterior choroidal artery occlusion (arises from ICA, supplies ipsoterior limb of internal capsule and white matter posterolateral to it)
Contralateral hemiplegia
Hemianesthesia (Hypesthesia)
Homonymous hemianopa
*Frequently from in situ thrombosis of the vessel
Affected areas in P1 syndrome
Ipsilateral subthalamus and medial thalamus
Ipsilateral cerebral pdeuncle and midbrain
Presentations of P1 syndrome
Claude’s syndrome - third nerve palsy with contralateral ataxia
Weber’s syndrome - third nerve palsy with contralateral hemiplegia
Subthalamic nucleus affected (+) contralateral hemiballismus
Occlusion of artery of Percheron (+) paresis of upward gaze and drowsiness and often abulia
Thalamic Dejerine-Roussy syndrome
contralateral hemisensory loss followed later by an agonizing, searing, or burning pain in the affected areas
Tx: anticonvulsants - carbamazepine or gabapentin, or TCA
Affected areas in P1 syndrome
Medial temporal and occipital lobes
Presentation of P2 syndromes
Contralateral homonymous hemianopia WITHOUT macula sparing
*vs MCA stroke which often spare the macula
Presentation of embolic occlusion of the top of the basilar artery
Hallmark: Sudden onset of bilateral signs, including ptosis, pupillary asymmetry or lack of reaction to light, and somnolence
+posturing, myoclonic jerking that stimulates the seizure
Presentation of bilateral infarction in the distal PCA
Cortical blindness (blindness with preserved pupillary reaction)
Anton’s syndrome - patient unaware of the blindness
Features of lateral medullary syndrome (Wallenberg’s syndrome)
Vertigo
Numbness of the ipsilateral face and contralateral limbs
Diplopia
Hoarseness
Dysarthria
Dysphagia
Ipsilateral Horner’s syndrome
Most cases d/t ipsilateral vertebral artery occlusion (V4), PICA occlusion
Components of ABCD2 score for TIA
A: Age =/> 60 (1)
B: SBP >140 or DBP >90 (1)
C: Clinical symptoms (unilateral weakness2, speech disturbance without weakness1)
Duration >60 mins (2)
Diabetes (1)
Most common sites of hypertensive ICH
Basal ganglia (putamen)
Thalamus
Cerebellum
Pons
common cause of lobar hemorrhage in elderly
Cerebral amyloid angiopathy (CAA)
Most common locations of giant (>2.5cm) berry aneurysm
Terminal ICA
Bifurcation of MCA
Top of the basilar artery
Most common site of rupture of aneurysm
DomeH
Hallmark of aneurysmal rupture (lab finding)
Blood in the CSF
Four major causes of delayed neurologic deficits in SAH
Rerupture
Hydrocephalus
Delayed cerebral ischemia (vasopasm) - appear 4-14 days after hemorrhage, most often at 7 days
Hyponatremia
Treatment of DCI from SAH
Nimodipine 60mg PO every 4 hours
-may case significant hypotension in some patients
Management of brain abscess
High dose parenteral antibiotics for minimum of 6-8 weeks
Neurosurgical drainage
Prophylactic anticonvulsants, and continued 3 months after resolution of abscess then EEG
Steroids should NOT be routinely given - only for px wiht substantial periabsccess edema and associated mass effect and increased ICP
