Neurology Flashcards
What is Bells palsy? Symptoms? tx?
Unilateral facial weakness with no evidence of other neurological dz. Involves CN VII (facial nerve)
Sxs: Paralysis of the forehead and lower face; cannot close eye, raise brow, or smile on the affected side
Pain on the ipsilateral ear; Loss of taste of the anterior 2/3 of the tongue
tx: oral prednisone
How does Guillian barre syndrome present? RF?
idiopathic polyneuropathy following minor infections, immunizations, and surgical procedures
Sxs: Symmetrical weakeness that begins distally; may have some sensory abnormalities; May begin with ataxia, pin and needles sensation in the feet
What reduces recovery time and neurological deficits in Guillian barre syndrome?
Plasmapheresis
Acute crisis: IV immunoglobulin
What is the pathophysiology of myasthenia Gravis?
Acquired autoimmune disorder that causes a decrease in Acetylcholine receptors
What are the s/s of Myasthenia gravis?
- Sxs: muscle weakness and fatigability that improves with rest (trouble combing hair, climbing stairs, or lifting objects
- Early stages: Affects eye muscles–>Ptosis and diplopia
How do you dx Myasthenia Gravis?
- Tensilon Test: confirmed if marked clnical improvment with short-acting anticholinesterase
- IV edrophonium or IM neostigmine results in improved strength within seconds to minutes
- Check for elevated levels of circulating ach receptor antibodies (80-90%)
- Do not forget CXR to r/o Thymoma!!
How do you treat Myasthenia gravis? what medication should be avoided?
Cholinesterase Inhibitor (Pyridostigmine)–improves strength
IgG plasmapharesis
Steroids, immunosuppressive drugs, IV immunoglobulins, –if refractory disease
Thymectomy if needed!
Aminoglycosides should be avoided!!
What is Lambert-Eaton Syndrome? Sxs? Tx?
- Similar to Myasthenia Gravis, but associated with lung cancer (Small cell carcinoma) AND IMPROVES WITH ACTIVITY!
- PROXIMAL muscle weakness
- Defective release of ach in response to nerve impulse
- may have dry mouth
Confirmed electrophysiologically
Tx: Plasmapheresis and immunosuppressive therapy
HOw do you treat Cluster headaches?
Prevention: Oral corticosteroids started immediately will often force a cluster cycle into remission and prevent future HA
Abortive Tx:
- 100% oxygen
- Ergotamine tartate (dihydroergotamine) and Sumatriptan
What is the most common viral cause of encephalitis?
Herpes simplex
HOw do you dx viral encephalitis/Meningitis?
- Assess increased intracranial pressure first
- LP and CSF analysis ASAP
- Increased lymphocytes or monocytes
What are the S/S of bacterial meningits?
Rapidly progressive, can be fatal
Acute sxs of fever, HA, vomiting, stiff neck, Petechial rash (N. meningitidis)
PE: + kernig, + Bruzenski’s signs
CN abnormalities III, IV, VI, and VII
How do you diagnose Bacterial meningitis?
- Dx: first CT
- LP with CSF
- May be turbid/purulent, elevated WBC (neutrophil predominant), decrased glucose, high protein
- Gram stain/culture of CSF
Treatment of bacterial meningitis; What is the prophylaxis for close contacts?
- Begin antibiotics immediately if CSF not clear and colorless
- Vanocomycin plus ceftriaxone
- neonates: Ampicillin pluse Cefotaxime
- Immunocompromised/>50 y/o: Cefotaxime PLUS vancomycin PLUS Ampicillin
- Hospital acquired: Ampicillin PLUS ceftazidime PLUS vancomycin
Prophlyaxis for close contacts: oral Rifampin
RPT LP and CSF after 24 hours of tx
What is Huntington Disease? what are the sxs?
Inherited autosomal dominant disorder (Chromosome 4)
- Sxs: Presents with insidious onset of clumsiness and random, brief fidgety movements; behavioral changes (irritability, emotional liability) progressing to dementia
- Choreic movements: worse with voluntary movement, dissapears with sleep
- Choreiform movements: irregular gait and dance-like movements
When is the onset of Huntington disease? How is it treated?
Onset: 30-50 y/o
No cure or medical interventions (just symptomatic tx)
What is the pathophys of Parkinson disease? What is the clinical presentation?
Loss of dopaminergic neurons in the substantia nigra–>Imbalance of dopamine and acetylcholine
Clinical presentation:
Hallmark: resting tremor (“pill rolling”)
bradykinesia: slowing of movements; lack of facial expression (masked fascies), monotone speech
slow shuffling gait
Cogwheel rigidity
How do you treat Parkinson disease?
-
Anticholinergic drugs: more helpful with tremor and rigidity
- Amantadine
-
Levodopa: converted to dopamine in the body
- improves all s/s
- Add carbidopa-Stops breakdown of Levodopa
- If refractory to Levodopa therapy–>Dopamine agonist
What is the most common cause of nontraumatic subarachnoid hemorrhage?
Ruptured berry aneurysm
What is the initial diagnostic study for subarachonid hemorrhage? definitive dx?
Initial: CT scan
Definitive dx: Cerebral angiography: identifies source of the bleed
What is the definition of epidural hematoma? what artery is involved?
Defn: Accumulation of blood in the potential space btwn the dura and bone; usually results from a temporal bone fracture
Middle meningeal artery
What is the clnical presentation of Epidural hematoma? Dx? Tx?
Caused by head injury or skul fracture
Brief period of unconsciousness follwed by a lucid interval
PE: spinal fluid rhinorrhea; Dizziness; Enlarged pupil in one eye; HA, vomiting
DX: CT shows hyperdense lenticular-shaped
Tx: emergent craniotomy
What is the definition of subdural hematoma?
Accumulation of blood below the inner layer of the dura; Involves **bridging veins; **
Present more than 20 days after the trauma
What is the clinical presentation of Subdural hematoma? how is it dx? tx?
Sign and symptoms develop later; Confusion, hemiparesis, HA, seizures, visual disturbances
dx:CT scan: Crescent shaped clot
Tx: Burr holes
What is Cerebral palsy
Disorder of movement and posture
Impairement of muscle tone, strength, coordination, and movement that results from insult to or anomaly of the immature central nervous system (during prenatal period)
NOT progressive
Commonly associated with seizures
define Apraxia
Impaired ability to carry out motor activities despite intact motor function
define Agnosia
Failure to recognize or identify objects despite sensory function
What is the pathophys of Alzheimers? What is seen microscopically?
Unknown etiology but a protein called beta-amyloid deposits in neuritic plaques and aterial walls damages brain cells
MIcroscopically: Progressive loss of cortical neurons; Formation of amyloid plaques and intraneuronal neurofibrillary tangles
HOw does the clinical presentation of vascular dementia differ from Alzheimers?
Vascular dementia involves Forgetfullness in the absence of depression and innattentiveness
WHat is Frontotemporal dementa?
Formally called Picks diseaes
Presents as progressive change in personality or social behavior, progressive aphasia, limb apraxia
Lewy body symptoms, How do you treat Lewy body dementia?
Sxs: fluctuating cognitive impairment, visual hallucinations, REM sleep disorder, Parkinsonism
Tx:
Acetylcholinesterase Inhibitors: Psychological function
Levodopa: motor function
What is Creutzfield-Jakob disease? sxs? Dx?
caused by spontaneous transformation of normal prion proteins into abnormal proteins
Sxs: Initially flu like sxs, fatigue, cognitive impairment
Rapid cognitive dysfunction, pyramidal tract signs (weakness), cerebellar signs (clumsiness), myoclonic jerks
Labs: 14-3-3 protein in CSF
Histology: spongiosis and neuronal loss
Rapid onset and deterioration (weeks to months)
What is Multiple sclerosis? Who does it affect? cliical presentation?
- Chronic autoimmune demyelinating disease of the CNS
- F>M, 18-45 y/o
- Relapsing and remitting sxs of weakness, numbness, tingling, spastic paraparesis, neuritis, diplopia, urinary sphincter dysfunction, ataxia
- sxs may last a few weeks and disapear
- Upper Ext> lower ext
- Positive Lhermittes sign: Sensation of electricity down back with passive neck flexion
- Optic neuritis-blurry vision
HOw do you diagnose MS?
MRI of brain and spinal cord show demylinating plaques in white matter
**2 or more regions of white matter lesions must be present for diagnosis**
How do you treat MS?
- Decrease frequency of relapses
- Interferon B–TOC!
- Glatiramer Acetate (mild)
- High dose steroids for optic neuritis
- Secondary progressive type:
- Cyclophopamide or Azathioprine
What is a tonic clonic seizure and how is it tx?
AKA Grand Mal
LOC, follwed by tonic (stiffening) then clonic (rhtymic jerking phases)
Urinary incontinence follwed by postictal period (altered state of consciousness post seizure)
Tx: First line: Carbamezapine
What is an Absence seizure and how is it tx?
Petite mal
Brief abrupt and self limiting LOC (Pts appear awake)
Staring spells—>can have rapid eye blinking x 3-5 seconds
Tx: Only 2 drugs have FDA approval: Ethosuximide or Valproic Acid
What is a myoclonic seziure? How is it treated?
short periods of muscle contraction that may reoccur x several minutes
NO LOC
Tx: Valproic acid
What is a simple partial seizure and how is it tx?
Abnormal activity of a single limb; no loc
May be followed by a transient neurologic deficit (Todd’s paralysis)
TX: first line: Carbamezapine
What is a Complex partial seizure and how is it tx?
Usually preceded by some type of sensory aura, followed by impaired consciousness (but not total LOC), along with an involuntary motor activity
Resolves in about 30 minutes and followed by postictal confusion
Ex. “Episod begins by upset stomach, appears confused, turns head to left, and raises Left arm in the ear–lasts 30 to 60 seconds-followed by fatigue x 1 hour”
Tx: first line: Carbamezapine
What is the first line tx for Tourette syndrome?
- Alpha 2 adrenergic receptor agonist
- Clonidine
- Guanfacine
What are the most common organisms that cause bacterial meningitis in neonates? greater than 2 months?
- Neonates: Group B strep, E. coli, listeria
- Greater than 2 months: Strep pneumonia, N. Meningitides
What is the gold standard diagnostic study for Guillian barre syndrome?
Nerve conduction studies or muscle biopsy
WHat is the first line tx for Status Epilepticus?
Long acting benzodiazepines:
Lorazepam or diazepam
What is central cord syndrome
- Involves loss of motor function that is more severe in the upper extremities than in the lower extremities; and more severe in the hands
- Usually hyperesthesia over the shoulders adn arms
What is anterior cord syndrome?
Presents with paraplegia or quadriplegia, loss of lateral spinothalamic function with preservation of posterior column function.
Absence of the knee jerk reflex suggests compression of what nerve roots?
L3-L4
Absence of the Achilles (ankle jerk) reflex suggests compression of what nerve root?
S1,S2
Absence of the Triceps reflex suggests compression of what nerve root?
C7, C8
Abscence of the brachioradialis reflex suggests compression of what nerve roots?
C5, C6
The presence of HA associated with papilledema raises concern for a brain tumor, but if MRI excludes this what is next on the differential?
Pseudotumor cerebri (AKA benign intracranial HTN)
May cause visual loss
Frequent in obese, adolescent girls and young women
May be associated with OCPs, vitamin A, or tetracycline
Tx: weight loss, diuretics, and steroids
What is Horner’s syndrome?
unilateral, small pupil with mild ptosis in which pupillary response to light and accommodation is preserved.
may be ass. with ipsilateral anhydrosis
classic triad: Constricted pupil (Miosis), Partial ptosis, and loss of hemfacial sweating
what is an Adie pupil?
Unilateral dilated pupil that is sluggish to direct light stimuli
After extended near focusing (or accomodation) the involved pupil may actually become tonic (remain constricted long after discontinuing accomodative effort).
Idiopathic
What is an Argyll Robertson Pupil?
Usually affects both eyes; is irregular in shape, and poorly reactive to light, but can still constrict when pt focuses on a near object.
(Accomodate, but are not reactive)
Highly specific sign of neurosyphillis
What are some causes of Horner’s syndrome?
- Pancoast tumor (lung ca) or lung infxn
- Dissecting carotid aneurysms
- migraine
- brachial plexus trauma
What is the ACUTE treatment of choice for aborting a migraine HA?
5-HT receptor Agonists–Rizatriptan
What is used as a preventative measure for Migraine HA?
Propanolol
If c/I due to Asthma, then Amitriptyline
What diagnoses Narcolepsy?
Multiple sleep latency test
What is a potential finding of a lower motor neuron process? Of an upper motor neuron process?
Lower motor neuron: Muscle weakness
Upper motor neuron: Hyperreflexia
“when the parents are away, the kids are at play”
