Neurology Flashcards
what is thiamine used for
wernickes encephalopathy
What makes up the Glasgow Coma Scale?
Eye-opening
Verbal
Motor
a GCS of less than 9 is indivative of what?
coma
what is the presentation of Bells Palsy
sudden onset unilateral facial nerve paralysis with no other focal neurologic or systemic findings
what is the treatment of Bells palsy
prednisone
artificial tears
tape eyelid shut
how does encephalitis present
begins wtih flu-like symptoms
fever, HA, AMS, Seizure, personality changes and exanthema
how is encephalitis differentiated from meningitis
altered brain functioning
what is Reye’s syndrome
rapid progressive encephalopathy with hepatic dysfunction, usually post-flu/URI
babinski positive and hyperreflexia noted
what are diagnostic tests used for diagnosing reye’s syndrome
Liver enzymes (elevated)
PTT (elevated)
Hyperammonemia
hypoglycemia
metablic acidosis
how is encephalitis diagnosed
LP and MRI
PCR for virues
Kernig and Brudzinski is usually absent
what is the treatment of encephalitis
supportive care and acyclovir 10mg/kg IV Q8hrs
what is the treatment of status epilepticus
Benzo (lorazepam, diazepam, midazolam)
phenytoin/fosphenytoin
phenobarbital and lacosamide
what is the treatment of focal seizures
pheytoin and carbamazepine
what are diagnostic tests for seizure workup
check electrolytes
glucose
pregnancy test
ECG
EEG
neuroimaging for adults with first seizure (CT/MRI)
a 27yo mountain biker strikes a tree and was not wearing a helmet. he loses consciousness for several minutes but later regains consciousness and reports feeling fine. several hours later his neurological state decompensates acutely.
what is his most likely diagnosis
epidural hematoma
what is the treatment of epidural hematoma
surgical craniotomy / medical management of increased ICP (mannitol, hyperventilate, steroids/ventricular shunt)
what is the most common artery involved with epidural hematoma
middle meningeal artery - blood fills space between dura and skull
what type of head injury occurs when there is injury to the bridging veins
subdural hematoma
where does blood collect with subdural hematoma
between dura and arachnoid mater
how is subdural hematoma diagnosed
non-con head CCT (crescent-shaped, concave hyperdesnisty)
what is anterior cord syndrome
loss of pain/temperature below the level of the lesion preserved joint position/vibration
what is central cord syndrome
loss of apin and temperature sensation at the level of the lesion, where spinothalamic fibers cross the cord with other modalities preserved (dissociated sensory loss)
what is complete cord transection
rostral zone of spared sensory levels (reduced sensation cuadally, no sensation in levels below injury); urinary retention and bladder distention
what is Brown-sequard syndrome
semisection of cord
loss of joint position and vibration sense on the same side as the lesion and pain/temp on opposite side as a few levels below the lesion
what presents as ascending paralysis beginning in distal limbs
guillain-Barre syndrome
how is guillain-barre syndrome diagnosed
lumbar puncture - elevated CSF protein with normal CSF WBC
what is the treatment of GBS
plasma exchange (remove circulating antibodies) and IVIG
what is the diagnostic test for stoke evaluation
emergent brain imaging essentail for ischemic stroke - non-contrast CT scanning
transcranial doppler US, echo for ischemic stroke
what is the treatment of stroke
thromolysis, IV admin for rtPA for occlusive disease treat with IV tPA within 3-4.5 hours onset
what is the diagnostic test for subaarachnoid hemorrhage
non-contrast head CT, LP (elevated opening pressure / grossly blod fluid in all 4 tubes)
Cerebral angiogrpahy may be done
EEG may show the site of hemorrhage/diffuse changes
what is the treatment of subarachnoid hemorrhage
prevention of elevated arterial/intracranial pressure - manage HTN
surgial clipping/wrapping of aneurysm
how are TIA diagnosed?
CT (without contrast)
MRI more sensitive
carotid doppler US
CT angiography
MR angiography
what is the treament for TIA
aspirin + dipryidmole or clopidogreal monotherapy (antiplatelet therapy )
how is alzheimers disease diagnosed
Folstein Mini-Mental state examination (NMSE) or memory impairment screen
what are treatment options for alzheimers disease
cholinesterase inhibitors (donepazil)
NMDA antagonist (memantine)
what is the classic triad of meningitis
fever > 38C, nucal rigidity (stiff neck) and headache
(no mental status change)
what is Kernig sign
neck pain with knee extension
what is brudzinski sign
leg raise with a bent neck
how is meningitis diagnosed
lumbar puncture - first check for increased ICP (papiledema)
CT if unsure
what is seen on LP with bacterial meningitis
increase protein
decreased glucose
marked increase in opening pressure
