Neurology #2 Precision and Pearls Flashcards
Encephalitis is infection of the brain parenchyma and causes include _____ (MCC), and others such as ______, ______, and ________
HSV-1 MCC
EBV, HIV, Rubella, Varicella
What are symptoms of encephalitis?
-Meningitis symptoms (nuchal rigidity, Brudzinski, Kernig), neck stiffness, fever, headache
-PLUS AMS, changes in speech, personality, and movement
-Focal neurologic deficits (palsies, sensory deficits)
Diagnostics done for encephalitis:
-What is done to rule out lesions
-What is preferred for encephalitis?
-What is the most accurate test for herpes?
-CT of the head to rule out lesions
-MRI preferred for encephalitis
-PCR most sensitives for herpes
If HSV is the cause of encephalitis, what is seen on MRI?
Temporal lobe involvement
Treatment for encephalitis (think about what the cause is)
IV Acyclovir
Normal pressure hydrocephalus is dilation of the ventricles with normal opening pressure on LP. What are some symptoms of this?
What is seen on MRI?
Dementia + Gait Disturbance + urinary incontinence
–Wet, wacky, wobbly
—wide based shuffling gait, urinary urgency
MRI: enlarged ventricles in absence of sulcal dilation
What is the treatment for normal pressure hydrocephalus?
Ventriculoperitoneal shunt
Although a cerebral abscess is rare, it has symptoms such as insidious onset of headache, fever, focal neuro findings and a history of what?
Recent sinus infection or ear infection: direct spread to the brain
An intracerebral hemorrhage, which is bleeding within the brain parenchyma that may compress the brain, ventricles, and sulci, has risk factors such as…..
Hypertension (MCC of ICH)
Cerebral amyloid angiopathy (MCC in old)
AVM (MCC in kids)
Symptoms of ICH
-Neuro symptoms increase in minutes to hours: headache, n/v, syncope, AMS, focal neurologic symptoms (hemiplegia, seizures, hemiparesis)
What diagnostic is done for ICH
CT scan!
How do you treat ICH?
How should you prevent ICP?
Supportive, gradually reduce BP
ICP: Raise head of the bed, no IVF, reduce BP
If the patient DOES have increased ICP, what should you give them?
IV Labetolol, Nicardipine, Hydralazine, Nitroprusside
An essential tremor is an autosomal dominant movement disorder that (explain what an essential tremor is)
-Intentional tremor: postural, bilateral action tremor that is worse with movement.
-MC affects upper extremities
-Worse with stress, anxiety, caffeine
What makes an essential tremor better?
Alcohol
Treatment for an essential tremor
-None needed
-Propanolol if situational
-Primidone if no relief with Propanolol
Explain the pathophysiology of Parkinson’s Disease
-Movement disorder due to loss of dopaminergic neurons in the substantia nigra –> failure of acetylcholine inhibition in the basal ganglia (acetylcholine is the excitatory neurotransmitter)
Symptoms of Parkinson’s Disease
-Resting tremor, bradykinesia, muscle rigidity
-Tremor: pill-rolling tremor, worse with rest, better with activity
-Slowness of movement, no arm swinging when walking
-Masked facies
-Myerson’s Sign (tapping forehead)
-Postural instability: pull test
-Dementia in 50%
-Cogwheel rigidity
What is the only way to make the definitive diagnosis for Parkinson’s Disease?
Post mortem histology: cytoplasmic inclusions (lewy bodies) and loss of pigment cells in the substantia nigra
Most effective pharm treatment for Parkinson’s Disease?
Levodopa-Carbidopa
What other drug class may be used in treating Parkinson’s?
Dopamine agonists (Bromocriptine, Pramipexole, Ropinorole)
Levodopa is converted to dopamine when…..
What are some adverse effects of this?
When it crosses the Blood-brain-barrier
Dyskinesia, wean off trouble, hallucinations
Dopamine agonists can be used in who?
< 65 years old to delay use of Levodopa
Huntington’s Disease is an autosomal dominant neurodegenerative disorder. Explain the patho of this.
What are some symptoms?
Inheritance of CAG/glutamine repeats on Huntingtin gene (chromosome 4)
-Symptoms appear in 30-50 year olds
-Mood, Movement, Memory
–Behavior/mood changes
–Chorea
–Dementia
–Gait abnormalities, ataxia, incontinence
What is seen on CT/MRI for Huntington’s Disease?
Cerebral and striatal (caudate nucleus and putamen) atrophy
Although Huntington’s is fatal in 15-20 years, what can be given for dyskinesia/chorea?
Tetrabenazine
NO MEDS STOP DISEASE PROGRESSION
Explain what delirium is
-Abrupt, acute, transient confused state due to an identifiable cause
-usually associated with fully recovery in 1 week
What is the MC type of dementia
-Alzheimer Dementia
What are the three hypothesized patho explanations for Alzheimer’s?
1) Amyloid-beta protein plaques in brain
2) neurofibrillary tau protein tangles
3) Acetylcholine deficiency
Symptoms of Alzheimer’s Dementia
-1st symptom: short term memory loss
-Progresses to long-term and cognitive deficits
Although Alzeheimer’s is a clinical diagnosis, what is seen on MRI and histology?
MRI: medial temporal lobe atrophy
Histology: plaques and tangles
Treatment for Alzheimer’s
-Acetylcholine inhibition: Donepezil, Tacrine, Rivastigmine, Galantamine
-NMDA Antagonist (Memantine): reduce glutamate cell death
Vascular dementia, which is due to chronic ischemia and lacunar infarcts, has a risk factor of __________. Explain the symptoms of this condition.
Hypertension
Sudden decline in functions with stepwise progression of symptoms: infarct –> stable –> infarct –> stable
How to prevent vascular dementia
BP control
Frontotemporal Dementia (Pick’s Disease) is degeneration of the frontotemporal lobes. Therefore, the symptoms include…
-Changes in social behavior, personality, and language (aphasia)
-Behavioral changes: socially inappropriate behaviors, hyperorality (changes in food likes), loss of sympathy/empathy
On histology, what is seen in Pick’s Disease?
Pick bodies: round aggregates of Tau Proteins on silver-staining
Diffuse Lewy Body Disease is progressive dementia characterized by presence of diffuse Lewy Bodies, which are….
How does this differ from Parkinson’s?
Abnormal neuronal protein deposits
In Parkinson’s, they are localized. In diffuse, they are everywhere!
Symptoms in Diffuse Lewy Body Disease
-Visual hallucinations, episodic delirium, rapid eye movement sleep disorder, autonomic dysfunction (ortho hypotension), and Parkinsonism.
Multiple Sclerosis is an autoimmune demyelinating disease of the CNS. What is happening here?
What is the MC type?
Axon degeneration of the white matter (brain and spinal cord)
Relapsing-Remitting (episodic)
Symptoms of Multiple Sclerosis
-Sensory disturbances followed by weakness and visual disturbances
–Diplopia, optic neuritis, trigeminal neuralgia, weakness, gait problems
What is Uhthoff’s Phenomenon (associated with MS)
Worsening of symptoms with heat
What are some other exam findings associated with MS (be specific)
-Upper motor neuron signs: spasticity, upward Babinski, hyperreflexia, rigidity
-Lhermitte’s Sign: neck flexion leads to lightning pain down the leg
-Marcus Gunn Pupil: pupils dilate with light
-Bowel, bladder, and sexual dysfunction
What is seen on MRI in Multiple Sclerosis?
MRI with gadolinium is the best test: hyper intense white matter plaques
How about LP in MS?
-Increased IgG and oligoclonal bands
For acute exacerbation of MS, what is the treatment
IV Glucocorticoids
For a prevention of a relapse, what is the treatment for MS?
Beta-interferon or Glatiramer
