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

- Anticholinesterase chalenge test (Edrophonium or neostigmine) shows increased muscle strenght for a few seconds-minutes. - EMG - Serology testing

- High flow 02 - Ergotamine tartate - Sumatriptan, lithium carbonate Can try Verapamil for ongoing.

Neurology Flashcards by Iain Black

What do you see on autopsy of pt with Alzheimers disease?

Neurofibriallary tangles and senile plaques

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Treating Alzheimers symptomatically, what 2 behavioral problems proab need treating?

Delusions: Risperidone, olanzapine or quetiapine. Avoid Haloperidol
Agitation: Trazodone, divalproex or carbamazepine: avoid anticholinergics

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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

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Most common movement disorder of children?

Cerebral palsy

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A non-progresive disorder of movement and posture that results from a lesion of the immature brain

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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

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Extrapyramidal with CP.

Variable tone +/- hyperreflexia

1) Ataxic: diff coordinating purp. movements
2) Dystonic: Uncontrollable jerking, writhing and posture movements

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Unilateral facial weakness of unkonown etiology

Bell’s Palsy

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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

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Herpetic lesion noted in ext aud canal?

Ramsay Hunt Syndrome

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Tx Bell’s?

Many resolve on their own, try Acyclovir/Corticosteroids

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Most common neurologic syndrome in DM pts?

Sensorimotor Polyneuropathy

-Stocking glove pattern of numbness/tingling, loss of 2 point discrimination

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Gullain-Barre syndrome?

Acute or subacute polyradiculoneuropathy 2 to an immune-mediated mechanism. Lymphatic infiltration and macrophage-mediated Dymyelination and axonal degenaration.

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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

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What do you have to watch for with GB?

Resp failure, may need ventilator

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TX for GB?

Get EMG, check spinal fluid

TX: Plasmapheresis and high doses of human immunoglobin

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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

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S/S MG?

affects eye muscles, causein ptosis and dipoplia. Other facial muscles affected. Increased and abnormal fatigue. Normal DTR

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DX of MG?

Anticholinesterase chalenge test (Edrophonium or neostigmine) shows increased muscle strenght for a few seconds-minutes.
EMG
Serology testing

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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

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Tx Cluster headache?

High flow 02
Ergotamine tartate
Sumatriptan, lithium carbonate Can try Verapamil for ongoing.

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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

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Most common type of primary headache disorder?

Tension headache

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Tension headache S/S?

Recurrent attacks of diffuse, tight, bandlike, bil. pain

Tx with NSAIDS APAP

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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