Neurology #3 Precision and Pearls Flashcards
There are two types of focal (partial) seizure. Explain the difference between the two types
-Simple
-Complex
-Simple: consciousness maintained
-Complex: consciousness impaired
What diagnostic should be done for focal/partial seizures?
EEG
On an EEG, what is seen in a simple focal seizure?
Focal discharge at onset of seizure
On the other hand, what is seen with a complex focal seizure on an EEG?
-Interictal spikes at temporal or frontotemporal area
An absence (petit mal) seizure involves _________ and is MC seen in childhood. Explain the symptoms of this type.
Both hemispheres
-Pause/stare without loss of body tone
-Episodes last 5-10 seconds, eyelid twitching, lip smacking
-No postictal phase
What is seen on EEG in an absence seizure?
Bilateral symmetric 3 Hertz spike and wave activity
What is the first-line treatment for an absence seizure?
Ethosuximide
What two medications can exacerbate absence seizures?
Carbamazepine and Gabapentin
With generalized (grand mal) seizures, which are simultaneous neuronal discharge of both hemispheres, what are some symptoms?
Tonic Clonic (Grand Mal): sudden loss of consciousness with tonic activity (contraction and rigidity) followed by 1-2 minutes of clonic activity (repetitive movements) followed by postictal confusion phase.
-Cyanosis and urinary incontinence can occur
What two labs are elevated following seizures?
What is seen on EEG in a patient with a grand mal seizure?
Prolactin and lactic acid
High amplitude rapid spiking
What are some long-term treatment options for epilepsy?
Levetiracem, Phenytoin, Valproic Acid
What is status epilepticus?
Single, continuous seizure lasting 5 minutes or more, or more than 1 seizure in 5 minutes without recovery between
What is the first line treatment for status epilepticus
Benzodiazepines (Lorazepam)
Phenytoin has a MOA of _________ and some side effects include…..
Blocks voltage gated sodium channels
-P450 Inducer (Lupus Like Sx)
-Hyperplasia of gums and Hirsuitism
-Erythema Multiforme
-Osteopenia
-Nystagmus
On the other hand, Carbamazepine __________ and is the drug of choice for _________. Some other side effects of this medication are
-Blocks Na+ channels
-DOC in trigeminal neuralgia
-Hyponatremia (causes SIADH)
-SJS, Hepatotoxicity
-P450 Inducer (Lupus)
Ethosuximide is only used for what type of seizures?
What does this drug do?
Absence seizures
Blocks calcium channels, decreases neuronal firing
Another treatment option for seizures, topiramate, blocks Na+ channels and increases GABA, and is a glutamate receptor antagonist, has a side effect of…
Renal stones
Tourette Disorder, onset in childhood and MC in boys, has two diagnostic criteria. Name them.
Onset before age 18
Multiple motor and 1 or more vocal tic for > 1 year
What are some symptoms of Tourette Disorder?
-Motor tics: blinking, sniffling, etc.
-Verbal tics: obscene words, throat clearing, echolalia (repeat others)
-Self Mutilating tics: hair pulling, nail biting
What is the treatment for Tourette Disorder?
-Habit reversal therapy (1st line)
-Dopamine blockers (Tetrabenazine)
-Clonidine, Guanfacine are other options
MC etiology of TBI
Falls
What scoring system is used to quantify a TBI? What is the worst and what is the best? What are the components?
-Glascow Coma Scale
3 is worst, 15 is best
-Eye Response, Verbal, Motor
Treatment for a TBI
-ICU admission
-Endotracheal intubation
-Decrease ICP: elevate head of bead, Mannitol
What exactly is a concussion? What are some symptoms?
Mild TBI leading to AMS with or without LOC
-Headache, confusion, amnesia, blurry vision, emotional instability, vomiting, etc.
What diagnostics should be done for a concussion? When should an MRI be done
CT head without contract (DOC)
-MRI if symptoms > 7-14 days or worsening symptoms
Treatment for a concussion
-Cognitive and physical rest
-Observe for 24 hours
-Resume activity after all symptoms resolve
Post concussive syndrome is 3 symptoms for > 3 months after concussion. What is the MC symptom?
Headache
What are the symptoms of a lower motor neuron injury. Think FLABBY
-Fasiculations, Flaccid Paralysis
-Loss of muscle tone/strength
-Areflexia
-Babinski Downward
-Young
What are conditions that cause lower motor neuron injury (think B’s)
-Botulism
-Guillan Barre
-Bell Palsy
-Cauda Equina Syndrome
What are symptoms of an upper motor neuron injury. Think, muscles are SPASTIC
-Slight muscle loss
-Positive Babinski (toe up)
-Absence of Fasiculations
-Strong Tone
-Increased DTR’s
-Clonus
What conditions cause upper motor neuron injuries? Think of the S’s
-Stroke
-Multiple Sclerosis
-Spinal Cord or Brain Damage (TBI)
-Cerebral Palsy
What are symptoms of cerebral palsy
-Spasticity (hallmark)
-Motor deficits
-Intellectual or learning deficits
-Non progressive
-Limb length discrepancies
-Gross motor delay
-Asymmetric crawling
-Most onset before 3 years old
What diagnostic is done for cerebral palsy?
MRI
Treatment for cerebral palsy
-Pain management
-Baclofen or Diazepam for spasticity
Trigeminal neuralgia is……..
It is MC in who?
Compression of cranial nerve V
MC in middle-aged women
If trigeminal neuralgia occurs in someone YOUNG, think….
Multiple Sclerosis
Symptoms of Trigeminal neuralgia
-Brief episodic sharp pain on face
-Worse with touch, chewing, wind gusts
-Starts near mouth –> eye –> nose –> ear
Treatment for Trigeminal Neuralgia
-Carbamazepine (FIRST LINE)
-Oxcarbazepine
What is Amyotrophic Lateral Sclerosis (ALS)
Necrosis of both upper and lower motor neurons, leading to progression motor degeneration
Symptoms of ALS
-Asymmetric limb weakness (MC initial)
-Bulbar symptoms (chewing, aspiration)
-Mixed upper and lower motor neuron signs
-Sensation, eye movement, sphincter function, and sexual function spared
How do you diagnose ALS?
What lab is elevated
EMG
Elevated Creatine Phosphokinase
Treatment for ALS
-Riluzole: reduces glutamate buildup in neurons
-Fatal within 3-5 years because respiratory failure MCC of death
What is the MCC of death in those with ALS?
Respiratory failure in 3-5 years
