Neurology 3 Flashcards
pituitary apoplexy clinical features + cause
- HA + bitemporal visual field defects + CN III palsy
- panhypopituitarism, so have features of adrenal insufficiency (hypotension)
- typically due to hemorrhage into a pituitary adenoma (from preexisting adenoma that bleeds)
Treatment of pituitary apoplexy
- high dose steroids (often complicated by acute secondary adrenal insufficiency), then NSGY consult
early symptoms of parkinsons
- REM sleep behavior disorder
- excessive daytime somnolence
- mood disturbance
- anosmia (impaired sense of smell)
- constipation
- non-motor symptoms can be seen years before the onset of motor symptoms
management of dystonia in Parkinson’s patients in the morning (eg painful muscle contractions)
- switch to longer-acting carbidopa-levodopa at night to maintain steady levels of dopamine
Transverse myelitis clinical features
- acute onset of weakness + sensory low below a segmental spinal level
- paresthesias + bowel, bladder dysfunction
Workup of suspected transverse myelitis
MRI with contrast
Typical cause of cauda equina syndrome
- herniated disk or tumor
cauda equina syndrome clinical features
- severe unilateral pain in saddle region
- pain radiating down to the legs
- asymmetrical lower extremity weakness
- bowel, bladder, sphincter symptoms
Formal criteria for brain death diagnosis
- apnea testing is first step (confirms brainstem failure of patient cannot generate spontaneous breaths or trigger the ventilator in response to elevated PaCO2 levels ten minutes after disabling control mode)
- 2 clinical brain death exams
Presentation of embolic vs thrombotic stroke
- embolic = maximal symptoms at onset
- thrombotic = fluctuating symptoms with periodic improvement + stuttering progression (symptoms improve, then worsen again)
acute subdural hematoma cause + presentation
- typically trauma
- “lucid interval” before progression to coma
First step in differentiating ischemic CVA
thrombotic vs embolic
Differentiating third nerve palsy + next step
IF pupil involvement – aneurysmal compression (STAT MR or CT-A) (parasympathetics are compressed by the aneurysm)
IF no pupil involvement – DM2 (occurs in center of nerve and spares the parasympathetic fibers that run on the outside) (supportive care)
additional management of viral encephalitis
- NS infusion during acyclovir administration with goal UOP of 75 ml/hr
HSV encephalitis clinical features
- focal neuro deficits (hemiparesis, ataxia) (localization)
* seizures
