Neurology #2 Flashcards
What is normal pressure hydrocephalus?
Dilation of cerebral ventricles with normal opening pressures on LP
Triad of symptoms of normal pressure hydrocephalus?
- Dementia/Cognitive dysfunction
- Gait disturbance
- Urinary incontinence
Diagnostics for normal pressure hydrocephalus
- MRI > CT: enlarged ventricles in absence of sulcal dilation
- LP: CSF pressure normal
Treatment for normal pressure hydrocephalus
-Ventriculoperitoneal shunt
What abnormalities are usually the most improved with a ventriculoperitoneal shunt?
Gait abnormalities
MCC of aseptic (viral) meningitis?
Enteroviruses (Coxsackievirus and Echovirus)
Symptoms of aseptic meningitis
Classic symptoms but milder
-headache, stiff neck, photosensitivity, fever
How do you differentiate encephalitis and aseptic meningitis?
In aseptic meningitis, there are no focal deficits (AMS, changes in speech, personality, and movement)
What does an LP and CSF exam show if the meningitis is aseptic in nature?
- Normal pressure
- Clear appearance
- Normal protein
- Normal glucose
- Lymphocyte predominance
Treatment for aseptic meningitis?
Supportive: IVF, antipyretics, analgesics
Self-limited course without therapy most times
MCC of encephalitis
HSV-1
Symptoms of encephalitis
- headache
- neck stiffness
- photosensitivity
- Fever
- AMS changes: changes in personality, speech, and movement
Diagnostics for encephalitis
- CT scan of head must be performed to rule out space-occupying lesion
- LP performed after CT
- MRI preferred imaging
- PCR testing
What is the most accurate test for herpes encephalitis?
PCR testing of CSF fluid
What does an LP with CSF exam show in encephalitis?
- Normal glucose
- Increased lymphocytes
- Normal pressure
- Normal protein
Treatment for encephalitis
- IV Acyclovir started ASAP
- Supportive
Huntington Disease is an ________ neurodegenerative disorder
Autosomal dominant
What is the pathophysiology of Huntington Disease?
Inheritance of trinucleotide repeats (CAG/glutamine) on Huntingtin gene (Chromosome 14)
Symptoms of Huntington Disease
- Symptoms appear at 30-50 years old
- Mood, memory, movement
- -Behavioral and mood changes
- -Chorea
- -Dementia
What is shown on CT/MRI for Huntington Disease?
-Cerebral and striatal (caudate nucleus and putamen) atrophy
Management of a patient with Huntington Disease
No cure; usually fatal 15-20 years after presentation
No medication stops progression
Tetrabenazine for chorea or dyskinesia
What are the characteristics (exacerbating factors and improving factors) of an essential familiar tremor?
Intentional tremor: worsened with intentional movement, stress, and anxiety
Tremor improved with alcohol ingestion and slight improvement with rest
True or False: An essential tremor affects the head and the voice as well?
True
Treatment for essential tremor
- Treatment usually not needed
- Propanolol may help if severe
- Primidone (added to Propanolol or if no relief with Propanolol)
- Thalamotomy in refractory cases
Parkinson Disease is a movement disorder that is due to
idiopathic loss of dopaminergic neurons in the substantia nigra
Triad of symptoms for Parkinson’s Disease
Resting tremor: pill-rolling, worse at rest, improves with voluntary activity
Bradykinesia: slowness of voluntary movement
Rigidity: increased resistance to passive movement
Facial symptoms of Parkinson’s Disease
- Face involvement: immobile face (fixed facial expressions)
- Myerson’s Sign: tapping forehead causes blink
- Decreased blinking
- Seborrhea of skin common
Postural instability is a late finding in those with Parkinson’s Disease. What is one test you can do to test for this and what happens?
Pull test
-Stand behind patient and pulling the shoulders causes patient to fall or take steps backwards
On post-mortem histology what is seen in a patient with Parkinson’s?
Cytoplasmic inclusions (Lewy Bodies) and loss of pigment cells in substantia nigra
Most effective treatment for Parkinson’s Disease?
-Levodopa-Carbidopa
What are other medications that can be used as initial treatment in Parkinson’s?
Dopamine Agonists (Bromocriptine, Pramipexole)
How does Levodopa work?
Levodopa is converted to dopamine once it crosses the blood-brain barrier.
-Carbidopa reduces the amount of Levodopa needed and reduces the adverse effects of Levodopa
Dopamine agonists, such as Bromocriptine and Pramipexole, can be used as first-line agents for Parkinson’s in who
Patients younger than 65 to delay use of Levodopa
When should anticholinergics (Trihexyphenidyl, Benztropine) be used for treatment of Parkinson’s?
-Monotherapy in younger patients (<70) with tremor as the predominant symptom (without gait disturbance or bradykinesia)
Amyotrophic Lateral Sclerosis (ALS) is
Neurodegenerative disorder due to necrosis of BOTH upper and lower motor neurons, leading to progressive motor degeneration
MC presenting symptom of ALS
Asymmetric limb weakness
-Also difficulty chewing, aspiration
What motor functions are spared in ALS (there are 4)
- Sensation
- Voluntary eye movement
- Sphincter Function (bowel and bladder)
- Sexual function
Hallmark symptoms of ALS
- Mixed upper and lower motor neuron signs
- -Upper: spasticity, stiffness, weakness
- -Lower: muscle atrophy, hyporeflexia, weakness
diagnostic of choice for ALS
-Electromyography: elevated CPK levels
What is the only drug to impact ALS
Riluzole
How does Riluzole work?
Reduces glutamate buildup in neurons
What is the MCC of death in those with ALS?
Respiratory failure
First-line management for tourette syndrome
Habit reversal therapy (most don’t need medical management)
Tourette Disorder is thought to be due to
Excess dopamine + GABA deficiency in the caudate nucleus
If the patient does not see improvement with habit reversal therapy in tourette syndrome, what are some medical treatment options?
- Dopamine blocking agents: Tetrbenazine, Haloperidol
- Alpha-2-adrenergics: Clonidine or Guanfacine
Another name for Restless Leg Syndrome
Willis-Ekbom Disease
Common etiologies of Willis-Ekbom Disease
- CNS iron deficiency (MC)
- Pregnancy
- Peripheral neuropathy
- Chronic alcohol use
Symptoms of Willis-Ekbom Disease
- Uncomfortable or unpleasant sensation in legs that creates an urge to move the legs
- Symptoms improve with leg movement
- Worse at night and with prolonged periods of rest
Treatment for Willis-Ekbom Disease
- Dopamine Agonists: Pramipexole, Ropinirole (1st line)
- Iron supplementation
