Neurology Flashcards
What do you see on autopsy of pt with Alzheimers disease?
Neurofibriallary tangles and senile plaques
Treating Alzheimers symptomatically, what 2 behavioral problems proab need treating?
Delusions: Risperidone, olanzapine or quetiapine. Avoid Haloperidol
Agitation: Trazodone, divalproex or carbamazepine: avoid anticholinergics
What class of drug can help improve cognition, AODL and apathy with Alzheimers?
Aceytlcholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine. SE: N/V/Diarrhea and muscle cramps
Most common movement disorder of children?
Cerebral palsy
CP
A non-progresive disorder of movement and posture that results from a lesion of the immature brain
4 types of Pyramidal (Spastic) with CP?
Diplegia: Bil LE extreme spasticity
Quadriplegia: All limbs severely involvd, LE >UE
Hemiplegia: UE > Lower
Bilateral hemiplegia: all limbs involved
Extrapyramidal with CP.
Variable tone +/- hyperreflexia
1) Ataxic: diff coordinating purp. movements
2) Dystonic: Uncontrollable jerking, writhing and posture movements
Unilateral facial weakness of unkonown etiology
Bell’s Palsy
Bell’s Palsy S/S
Usu. facial paralysis in am and appears to come on overnight
- Diff closing eye on affected side
- Paralysis may be preceeded by pain by ear
- Taste loss ant two thirds of tongue
Herpetic lesion noted in ext aud canal?
Ramsay Hunt Syndrome
Tx Bell’s?
Many resolve on their own, try Acyclovir/Corticosteroids
Most common neurologic syndrome in DM pts?
Sensorimotor Polyneuropathy
-Stocking glove pattern of numbness/tingling, loss of 2 point discrimination
Gullain-Barre syndrome?
Acute or subacute polyradiculoneuropathy 2 to an immune-mediated mechanism. Lymphatic infiltration and macrophage-mediated Dymyelination and axonal degenaration.
Ascending weakness, ataxia starting in feet–>legs then loss of deep tendon reflexes……following some type of infection
Think Gullain-Barre syndrome. Ground to Brain
What do you have to watch for with GB?
Resp failure, may need ventilator
TX for GB?
Get EMG, check spinal fluid
TX: Plasmapheresis and high doses of human immunoglobin
Myasthenia Gravis?
Think Mind to Ground—>Autoimm. disorder casues a decrease in Ach receptors at the motor endplate.
Females 20 and males in 50-60s
S/S MG?
affects eye muscles, causein ptosis and dipoplia. Other facial muscles affected. Increased and abnormal fatigue. Normal DTR
DX of MG?
- Anticholinesterase chalenge test (Edrophonium or neostigmine) shows increased muscle strenght for a few seconds-minutes.
- EMG
- Serology testing
Reccurent episodes of freq headaches seperated by periods of beng headache free. More common in females by 6:1, Unilateral, Temporal with lacrimation. nasal congestion, ptosis?
Cluster headache
Tx Cluster headache?
- High flow 02
- Ergotamine tartate
- Sumatriptan, lithium carbonate Can try Verapamil for ongoing.
Migraine SXMS?
May be brought on by triggers May have prodrome \+/- Aura Unilateral and throbbing Photophobia, phonophobia, vomitting Review tx for Migraines, dep on severity NSAIDS< Caffeine, Sumatriptin, Ergotamine, Meperidine, Vascoconstictors (5 HT agonists) BB, TCAs, CCB, Anticonvulsants
Most common type of primary headache disorder?
Tension headache
Tension headache S/S?
Recurrent attacks of diffuse, tight, bandlike, bil. pain
Tx with NSAIDS APAP
Infxn of brain parenchyma 2 to mosquitos or ticks?
Viral encephalitis
Dx of Viral enchephalitis?
- CT head
- CSF analysis
CSF in viral encephalitis?
Negative Gram Stain for bacteria WBC greater than 50/mm with mononuclear leukocytes Normal or decreased Glucose Protien > 100 mg/dL Normal C react protein
SS Viral encephalitis
- meningeal irritation
- headache
- photophobia
- stiff neck
- Seizures
- Decreased LOC
TX of viral encephalitis?
Acetominophen DOC fever and headache
Acyclovir
Bacterial Meningitis?
Inflammation of arachnoid, pia matter and CSF
**Medical emergency
can also be Pneumococcal and Staph aureus
S/S Bacterial Meningitis?
Fever, headache, vomitting, stiff neck
-Petichial rash
Kernig’s sign?
pt supine, hip knee flexed to 90 degrees, further extension casue pain in NECK or hamstring
Brudinski’s sign?
Flexion of neck with pt supine results in flexion of the hip and KNEE is positive.
CSF in Bacterial Meningitis?
Rapid antigen test for HIB, strep PNA, Group B strep, N Meningitidis, and E coli
- WBC .>100
- -Glucose < 40
- Protein > 100
- Elevated lactic acid
- Elevated C reactive protein
Typical organisms in Neonate Bact Meniningitis?
Strep B, E coli, Listeria monocytogenes
Children < 15 year old Bact Meningitis
Strep Pna, N Meningitidis, HIB
Adults >15
Staph aureus, Gram neg Bacilli, N Meningitidis
ALS?
Upper and lower motor neuron disorder of unknown cause with progressive muscle weakness
ALS sxms
muscle weakness hands, faciculations, spasticity, dysarthria and dysphagia. Sensory system weakness
ALS dx
history, EMG, Treat symptomatic
Riluzole may help for a few months FATAL in 3-5 years
Essential Tremor?
Inhereted, autosomal dominant. Tx with Beta Blockers
30-50 y.o.Pt presents with insidious onset of clumsiness and random, brief, fidgety movements?
Think Hunnington’s Disease
Hunnington’s disease is….?
A genetic disorder characterized by choreiform movements, mental status decline, and personality changes. No cure, CT shows Cerebral atrophy.
Brisk reflexes, can’t maintain tongue protrusion.
Chorea?
Chorea is characterized by brief, semi-directed, irregular movements that are not repetitive or rhythmic, but appear to flow from one muscle to the next
Progressive, degenerative disease resulting from loss of Dopaminergic neurons in the Substancia Nigra?
Parkinson’s
Classic Triad of Tremor, Cogwheel rigidity, Bradykinesia?
Parkinson’s
Also Masked facies, shuffling gait, dementia
Tx for Parkinson’s?
Levodopa plus Carbidopa
Dopamine agonists (Bromocriptine, Pramipexole, Ropinirole)
Anticholinergics:
Amantadine, Selegiline
Surger stereotactic thalamotomy for disabling tremor
Immune-initiated inflammatory Demyelination and axonal injury, greater in females 20-50 y.o.
Multiple Sclerosis
Multiple sclerosis S/S?
weakness, numbness, tingling, unsteadiness in a limb. Spasticity with positive Lhermitte’s sign
Sensation of electricity down the back with passive flexion of neck?
Lhermitte’s Sign for MS
oligoclonal bands, CSF protein normal, CSF cell count less than 50, increased levels of myelin basic protein
Think CF for CSF testing
Tx for MS?
Baclofen, diazepam for spasticity
Immunomodulatory therapy
Inteferon B-ib (Betaseron)
Partial seizures: 2 types
Simple
Complex
A 35 year old patient comes to your office because
his wife made him. He has been increasingly
irritable and moody. She has also noticed that he
is very restless. You order a CT scan which showes
cerebral atrophy as well as atrophy of the caudate
nucleus. What is the most likely diagnosis?
Hunnington’s
An EEG showing generalized spikes and associated
slow waves should make you think of what
diagnosis?
Generalized or absence
What is the most common primary intracranial neoplasm?
Glioma
Brief, abrupt and self limiting loss of consciousness, staring followed by rapid eye blinking for 3-5 seconds–No post-Ictal period
Absence seizure
Loss of consciousness followed by tonic (stiffening) then clonic (rhythmic jerking), urin incontinence…then post ictal period
Tonic-Clonic seizure
Seizure of tonic-clonic with high fever in a 6 month old to 4 years of age?
Febrile siezure
Most important diagnostic in seizure?
EEG can get MRI
Tx for status epilepticus?
Thiamine and glucose, Diazapem TOC (also Lorazapam)
Start Phenytoing immedietly. Greater than 30 min, intubate then start Phenobarbital, etc….
Most common intracranial aneurysm?
Saccular ( BERRY) Usu located in Circle of Willis
Fusiform aneurysm develops where?
basilar artery
Dilation of cerebral ventricles 2 to prior CNS insult?
Normal pressure Hydrocephalus
Phenytoin?
Stablizes neuronal cells by decreasing flux of sodium ions
Nystagmus, Ataxia, N/V, Gingival hyperplasia
TETROGENIC***
Valporic Acid?
Enhances GABA action at the inhibitory synapses, reducing abnormal discharge in the brain.
Usual stuff but monitor for Liver toxicity
A middle age male presents with unilateral
periorbital headaches occurring daily for several
weeks. These headaches are extremely painful.
Which type of headache is the most likely cause?
Cluster headache
What percentage of strokes are ischemic? What
percentage are hemorrhagic?
80%, 20%
There is an MRI result of multiple foci of
demyelination in the white matter. What is the
most likely diagnosis?
Multiple Sclerosis
Most common stroke?
Ischemic
NPH?
Apraxia (wide shuffling gait), dementia, urin incontence, weakness, malaise, lethargy
NPH?
High Pressure Lumbar Puncture
Enlarged ventiicles
Removal of CSF provides temp relief, Venticulo shunt is TOC
TOC for Status Epilepiticus?
Ativan—Lorazepam
If stroke less than 24 hours?
TIA
Stroke work up
EKG, Carotid Doppler, CT scan—non-contrast is the initial first study.
MRI is most sensitive
Thrombolytic therapy is the only effective method for acute tx for?
Ischemic Stroke
Must be started within 3 hours after onset, get CT to r/o hemorrhage.
BP must be less then 180/110
Contraindications to thrombolytic therapy?
Major surgery or trauma in last 2 weeks
Evid of GI bleeding
Tx of Hemmorhagic stroke?
Mannitol, hyperventilation, head elevation, Heparin if indicated. Need lower ICP
Subarachnoid Hemmorrhage
Rupture of vessels on or near the surface of the brain or ventricles
Most common cause of SAH?
Trauma
Worst Headache of my life!
Think SAH Also stiff neck with delirium possible
Fundoscopic exam of SAH?
Well circumscribed, bright red, preretinal hemorrhages
SAH imaging?
If CT negative, get lumbar puncture with high susp. Red blood cells in tube.
Definitive imaging SAH?
Cerebral angiography definitive test of choice
A patient presents to your office complaining of
a tremor in his right hand. He states after a beer
it goes away completely. What is the most likely
diagnosis?
Benign essential tremor or familial tremor
What is the most common cause of subarachnoid
hemorrhage aside from trauma?
Ruptured cerebral aneurysm
Which nerve root is responsible for the knee jerk
reflex?
L3-L4
A patient complains of muscle weakness and
fatigability that improves with rest. What is the proab dx?
Mysathenia gravis
A patient has an intracranial neoplasm causing
auditory illusions, olfactory hallucinations and
emotional changes. What lobe is the lesion likely?
Temporal lobe
patient presents with inability to speak and right
sided weakness. He seems to understand speech
and follows commands well. What type of aphasia
Broca’s aphasia
