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PANCE/EOC > Neurology #2 > Flashcards

Neurology #2 Flashcards

1
Q

What is normal pressure hydrocephalus?

A

Dilation of cerebral ventricles with normal opening pressures on LP

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2
Q

Triad of symptoms of normal pressure hydrocephalus?

A
  • Dementia/Cognitive dysfunction
  • Gait disturbance
  • Urinary incontinence
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3
Q

Diagnostics for normal pressure hydrocephalus

A
  • MRI > CT: enlarged ventricles in absence of sulcal dilation
  • LP: CSF pressure normal
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4
Q

Treatment for normal pressure hydrocephalus

A

-Ventriculoperitoneal shunt

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5
Q

What abnormalities are usually the most improved with a ventriculoperitoneal shunt?

A

Gait abnormalities

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6
Q

MCC of aseptic (viral) meningitis?

A

Enteroviruses (Coxsackievirus and Echovirus)

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7
Q

Symptoms of aseptic meningitis

A

Classic symptoms but milder

-headache, stiff neck, photosensitivity, fever

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8
Q

How do you differentiate encephalitis and aseptic meningitis?

A

In aseptic meningitis, there are no focal deficits (AMS, changes in speech, personality, and movement)

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9
Q

What does an LP and CSF exam show if the meningitis is aseptic in nature?

A
  • Normal pressure
  • Clear appearance
  • Normal protein
  • Normal glucose
  • Lymphocyte predominance
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10
Q

Treatment for aseptic meningitis?

A

Supportive: IVF, antipyretics, analgesics

Self-limited course without therapy most times

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11
Q

MCC of encephalitis

A

HSV-1

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12
Q

Symptoms of encephalitis

A
  • headache
  • neck stiffness
  • photosensitivity
  • Fever
  • AMS changes: changes in personality, speech, and movement
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13
Q

Diagnostics for encephalitis

A
  • CT scan of head must be performed to rule out space-occupying lesion
  • LP performed after CT
  • MRI preferred imaging
  • PCR testing
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14
Q

What is the most accurate test for herpes encephalitis?

A

PCR testing of CSF fluid

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15
Q

What does an LP with CSF exam show in encephalitis?

A
  • Normal glucose
  • Increased lymphocytes
  • Normal pressure
  • Normal protein
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16
Q

Treatment for encephalitis

A
  • IV Acyclovir started ASAP

- Supportive

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17
Q

Huntington Disease is an ________ neurodegenerative disorder

A

Autosomal dominant

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18
Q

What is the pathophysiology of Huntington Disease?

A

Inheritance of trinucleotide repeats (CAG/glutamine) on Huntingtin gene (Chromosome 14)

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19
Q

Symptoms of Huntington Disease

A
  • Symptoms appear at 30-50 years old
  • Mood, memory, movement
  • -Behavioral and mood changes
  • -Chorea
  • -Dementia
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20
Q

What is shown on CT/MRI for Huntington Disease?

A

-Cerebral and striatal (caudate nucleus and putamen) atrophy

21
Q

Management of a patient with Huntington Disease

A

No cure; usually fatal 15-20 years after presentation
No medication stops progression
Tetrabenazine for chorea or dyskinesia

22
Q

What are the characteristics (exacerbating factors and improving factors) of an essential familiar tremor?

A

Intentional tremor: worsened with intentional movement, stress, and anxiety
Tremor improved with alcohol ingestion and slight improvement with rest

23
Q

True or False: An essential tremor affects the head and the voice as well?

A

True

24
Q

Treatment for essential tremor

A
  • Treatment usually not needed
  • Propanolol may help if severe
  • Primidone (added to Propanolol or if no relief with Propanolol)
  • Thalamotomy in refractory cases
25
Q

Parkinson Disease is a movement disorder that is due to

A

idiopathic loss of dopaminergic neurons in the substantia nigra

26
Q

Triad of symptoms for Parkinson’s Disease

A

Resting tremor: pill-rolling, worse at rest, improves with voluntary activity
Bradykinesia: slowness of voluntary movement
Rigidity: increased resistance to passive movement

27
Q

Facial symptoms of Parkinson’s Disease

A
  • Face involvement: immobile face (fixed facial expressions)
  • Myerson’s Sign: tapping forehead causes blink
  • Decreased blinking
  • Seborrhea of skin common
28
Q

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?

A

Pull test

-Stand behind patient and pulling the shoulders causes patient to fall or take steps backwards

29
Q

On post-mortem histology what is seen in a patient with Parkinson’s?

A

Cytoplasmic inclusions (Lewy Bodies) and loss of pigment cells in substantia nigra

30
Q

Most effective treatment for Parkinson’s Disease?

A

-Levodopa-Carbidopa

31
Q

What are other medications that can be used as initial treatment in Parkinson’s?

A

Dopamine Agonists (Bromocriptine, Pramipexole)

32
Q

How does Levodopa work?

A

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

33
Q

Dopamine agonists, such as Bromocriptine and Pramipexole, can be used as first-line agents for Parkinson’s in who

A

Patients younger than 65 to delay use of Levodopa

34
Q

When should anticholinergics (Trihexyphenidyl, Benztropine) be used for treatment of Parkinson’s?

A

-Monotherapy in younger patients (<70) with tremor as the predominant symptom (without gait disturbance or bradykinesia)

35
Q

Amyotrophic Lateral Sclerosis (ALS) is

A

Neurodegenerative disorder due to necrosis of BOTH upper and lower motor neurons, leading to progressive motor degeneration

36
Q

MC presenting symptom of ALS

A

Asymmetric limb weakness

-Also difficulty chewing, aspiration

37
Q

What motor functions are spared in ALS (there are 4)

A
  • Sensation
  • Voluntary eye movement
  • Sphincter Function (bowel and bladder)
  • Sexual function
38
Q

Hallmark symptoms of ALS

A
  • Mixed upper and lower motor neuron signs
  • -Upper: spasticity, stiffness, weakness
  • -Lower: muscle atrophy, hyporeflexia, weakness
39
Q

diagnostic of choice for ALS

A

-Electromyography: elevated CPK levels

40
Q

What is the only drug to impact ALS

A

Riluzole

41
Q

How does Riluzole work?

A

Reduces glutamate buildup in neurons

42
Q

What is the MCC of death in those with ALS?

A

Respiratory failure

43
Q

First-line management for tourette syndrome

A

Habit reversal therapy (most don’t need medical management)

44
Q

Tourette Disorder is thought to be due to

A

Excess dopamine + GABA deficiency in the caudate nucleus

45
Q

If the patient does not see improvement with habit reversal therapy in tourette syndrome, what are some medical treatment options?

A
  • Dopamine blocking agents: Tetrbenazine, Haloperidol

- Alpha-2-adrenergics: Clonidine or Guanfacine

46
Q

Another name for Restless Leg Syndrome

A

Willis-Ekbom Disease

47
Q

Common etiologies of Willis-Ekbom Disease

A
  • CNS iron deficiency (MC)
  • Pregnancy
  • Peripheral neuropathy
  • Chronic alcohol use
48
Q

Symptoms of Willis-Ekbom Disease

A
  • 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
49
Q

Treatment for Willis-Ekbom Disease

A
  • Dopamine Agonists: Pramipexole, Ropinirole (1st line)

- Iron supplementation

PANCE/EOC (63 decks)

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