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3rd year_Neurology > Neurology 2 > Flashcards

Neurology 2 Flashcards

1
Q

What types of stroke have no Tx to reverse them?

A

Hemorrhagic stroke

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2
Q

Surgical drainage will NOT help where?

A

outside of the Posterior Fossa

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3
Q

If patient is already on Aspirin at the time of stroke, after 3 hours what would you give for Tx?

A
  • Add Dipyridamole
    or
  • Switch to Clopidogrel
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4
Q

Most common type of headache?

A

Tension headache

though it is a dx of exclusion

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5
Q

Type of Headache?

Visual disturbance, systemic symptoms such as muscle pain, fatigue, & weakness

A

Giant Cell Arteritis

- also includes Jaw Claudication

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6
Q

Type of Headache?

Ass’d w/ obesity, venous sinus thrombosis, oral contraceptives, & vitamin A toxicity

A

Pseudotumor Cerebri

- Mimics a brain tumor w/ nausea vomiting, & visual disturbance

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7
Q

Type of Headache?

Mimics a brain tumor w/ nausea vomiting, & visual disturbance

A

Pseudotumor Cerebri

- Ass’d w/ obesity, venous sinus thrombosis, oral contraceptives, & vitamin A toxicity

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8
Q

PE findings in Tension headaches?

A

None

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9
Q

PE findings in Migraine?

A

Usually none, but rare cases have aphasia, numbness, dyarthria, or weakness

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10
Q

PE findings in Cluster headache?

A
  • Red, tearing eye w/ rhinorrhea

- Horner syndrome occasionally

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11
Q

PE findings in Giant Cell Arteritis?

A
  • Visual loss

- Tenderness of the Temporal area

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12
Q

PE findings in Pseudotumor Cerebri?

A
  • Papilledema w/ diplopia from 6th cranial nerve (abducens) palsy
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13
Q

What does Pseudotumor Cerebri show on LP?

A

Increased pressure only.

CSF itself is normal

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14
Q

Most accurate Dx test for Giant Cell Arteritis?

A

Biopsy.

Also ass’d w/ markedly elevated ESR

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15
Q

Tx?

Tension headaches

A

NSAIDS & other analgesics

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16
Q

Tx?

Migraine

A

Triptans or Ergotamine as abortive therapy

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17
Q

Tx?

Cluster headaches

A

Triptans, Ergotamine, or 100% Oxygen as abortive therapy

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18
Q 
Tx? 
Giant Cell (Temporal) Arteritis
A

Prednisone

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19
Q

Tx?

Pseudotumor Cerebri

A

Weight loss

  • Acetazolamide - to dec CSF prod
  • Steroids help
  • Repeated LP rapidly lowers ICP
  • Place V-P shunt or fenestrate (cut into) the Optic Nerve if medical therapy doesn’t control
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20
Q

Prophylaxis Tx for Cluster headaches?

A

Verapamil

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21
Q

Prophylaxis Tx for Migraines? When do you give proph Tx?

A
  • Propranolol
  • Give this if having 3 or more migraines per month

others include CC-blockers, TCAs, SSRIs, Topiramate, Botulinum toxin injections

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22
Q

Trigeminal Neuralgia Tx?

A

Oxcarbazepine or Carbamazepine

  • Baclofen & Lamotrigine also have been effective
  • Gamma knife surgery if meds ineffective
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23
Q

Postherpetic Neuralgia Tx?

A

TCAs, Gabapentin, Pregabalin, Carbamazepine, or Phenytoin

  • Topical Capsaicin helpful
  • Most antiepileptic meds are effective, but none of them in more than 50-70% of patients
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24
Q

Indication for Zoster vaccine?

A

All persons >60 yrs.

25
Q

Status Epilepticus Tx?

A

1st = Benzodiazepine

  • if persists, give Fosphenytoin or Phenytoin
  • if still persists, give Phenobarbitol
  • if still, give neuromuscular blocking agent such as Succinylcholine, Vecuronium, or Pancuronium to allow intubation & anesthesia such as Midazolam or Propofol
26
Q

IV Phenytoin adverse effects?

A

Hypotension & AV block (Class 1b anti-arrhythmic)

Fosphenytoin has fewer SEs & same efficacy

27
Q

Can neuromuscular blocking agents stop seizure?

A

No, they just stop muscular contraction or the external manifestation of the seizure

28
Q

What is a partial seizure?

A

Seizure focal to one part of the body

Can be simple (intact consciousness) or complex (loss or alteration of consciousness)

29
Q

Opioids used for diarrhea?

A

Loperamide & Diphenoxylate

30
Q

Opioid used for cough suppression?

A

Dextromethorphan

31
Q

Tramadol MOA?

A
  • Very weak opioid agonist
  • Also inhibits 5HT & NE reuptake

“Tram-it-all”

32
Q

Initial Tx for MS?

A
  • Steroids during exacerbations

- B-interferons or glatiramer Acetate (Copaxone) for proph

33
Q

How long should a patient be seizure-free for you to D/C antiepileptics?

A

2 years

34
Q

Dx?

Sudden onset severe headache w/ meningeal irritation (stiff neck, photophobia), & fever

A

Subarachnoid Hemorrhage
(ruptured aneurysm of ant. circle of Willis)
- LOC in 50% due to inc’d ICP

35
Q

How does SAH differ from meningitis?

A

SAH is very sudden in onset & is ass’d w/ LOC

36
Q

SAH: best initial test?

A

CT w/out contrast (95% sensitive)

37
Q

SAH: most accurate test?

A

Lumbar Puncture showing bleed

38
Q

Normal WBC:RBC ratio in CSF?

A

WBC:RBC = 1:500 - 1:1000

39
Q

In general, when do you use contrast on CT?

A

When looking for mass lesions like cancer or abscess.

Do NOT use contrast when looking for blood!

40
Q

After SAH dx, how do you determine which vessel ruptured?

A

CT angiography, standard angiography w/ catheter, or MRA

41
Q

Best initial Tx for bacterial meningitis?

A

Vancomycin, Metronidazole, & Ceftriaxone

42
Q

Pseudotumor Cerebri: ass’d w/ what 4 things?

A
  • Obesity
  • Venous Sinus Thrombosis
  • Oral Contraceptives
  • Vitamin A toxicity
43
Q

4 primary presenting symptoms of meningitis?

A
  • Fever
  • Headache
  • Neck stiffness (nuchal rigidity)
  • Photophobia
44
Q

Meningitis: best initial test?

A

LP

45
Q

Meningitis: most accurate test?

A

LP

46
Q

Suspected Meningitis:

When would a head CT be necessary prior to LP?

A

Only if there is a possibility of a space-occupying lesion. I.e. if there is:

  • Papilledema
  • Seizures
  • Focal neurological abnormalities
  • Confusion interfering w/ neuro exam
47
Q

Papilledema - what’s it look like on fundoscopic exam?

A

Blurred, fuzzy disc margin

from increased ICP

48
Q

When do you give ABX prior to LP in suspected meningitis?

A

If there is a c/i to IMMEDIATE LP, then give ABX as first step

49
Q

What test is indicated if patient has received ABX prior to LP in suspected meningitis?

A

Bacterial Antigen Detection (Latex Agglutination Test)
– necessary b/c of ABX, culture may be falsely negative

    • extremely specific
    • not sensitive enough to exclude if negative
50
Q

Decorticate posturing consists of what?

A

Upper-extremity adduction and flexion at the elbows, wrists, and fingers, together with lower-extremity extension, which includes extension and adduction at the hip, extension at the knee, and plantar flexion and inversion at the ankle

51
Q

Decerebrate posturing consists of what?

A

Upper-extremity extension, adduction, and pronation together with lower-extremity extension

52
Q

Decorticate posturing means what?

A

This occurs with dysfunction at the cerebral cortical level or below and may reflect a “release” of other spinal pathways

53
Q

Decerebrate posturing means what?

A

Traditionally implies dysfunction below the red nucleus, allowing the vestibulospinal tract to predominate

54
Q

Which response to pain has better prognosis – decorticate or decerebrate?

A

Decorticate

55
Q

Major cause of morbidity in the first 24 hrs after SAH?

A

Rebleeding

56
Q

Major cause of morbidity 3-10 days after SAH?

A

Vasospasm
(likely caused by arterial narrowing @ base of brain due to degradation of blood & its metabolites leading to cerebral infarction)

57
Q

How to prevent vasospasm following SAH?

A

Initiate tx w/ Nimodipine

58
Q

How to detect vasospasm following SAH?

A

CT angiography

3rd year_Neurology (8 decks)

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