Neurology Flashcards
what are reversible causes of dementia?
hypothyroisidm depression pernicious anemia bismuth poisoning normal pressure hydrocephalus
is dementia more or less likely in parkinsons
more likely
what headache is bilateral, non-throbbing, band-like
tension headache
treatment for tension headache?
- NSAID (ibuprofen, ketoralac if severe)
- caffeine containing agents
- avoid opiates
prevention for tension headaches?
TCA (amitriptyline)
prevention for tension headaches?
TCA (amitriptyline)
What headache is unilateral, throbbing, pulsatile, has n/v, photophobia, photophobia, often preceded by aura?
migraine headache
treatment for migraine headache?
triptan (sumatriptan)
prophylaxis for migrane headaches?
propranolol
prophylaxis for basilar migraine (bickerstaff syndrome)?
verapamil
what headache is severe, unilateral, orbital/supraorbital, ipsilateral symptoms = lacrimation, eye injection, rhinorrhea, increased sweating and cutaneous blood flow, affects me?
cluster headache
cluster headache treatment and prophylaxis ?
triptan + 02
prophylaxis = verapamil
Describe Horner syndrom?
unilateral ptosis
miosis
anhydrosis
Describe Horner syndrome?
unilateral ptosis
miosis
anhydrosis
Describe Horner syndrome?
unilateral ptosis
miosis
anhydrosis
What is non-dermatomal limb pain following soft tissue injury of fracture?
complex regional pain syndrome (reflex sympathetic dystrophy)
What are the symptoms of complex regional pain syndrome?
local = limb pain, swelling, reduced ROM, skin changes
autonomic = cyanosis, mottling, increased sweating, cold
Urologic = incontinence or urinary retention
Treatment for stages 1/2/3 for complex regional pain syndrome?
Stage 1: neuron tin, alluvial and alendronate (bisphosphonate)
Stage 2: add steroid
stage 3: include pain management specialist
most common type of peripheral neuropathy?
diabetic neuropathy
What are the 3 types of peripheral neuropathy?
- Axonal -sensory
Slow onset: DM, uremia “stocking glove pattern.” Rapid onset = drugs - myelinating - motor; ascending = guillain barre
- hereditary - charcot-marie-tooth: peroneal nerve disease
Diagnosis for peripheral neuropathy/
electromyography/nerve conduction study
Treatment for pain with peripheral neuropathy?
gabapentin, pregabalin, amitriptyline
spontaneous leg movement while at rest, unpleasant paresthesias,?
restless leg syndrome
What is restless leg syndrome associated with (4)?
- peripheral neuropathy (DM)
- uremia (endstage renal disease)
- pregnancy
- iron deficiency
Treatment for restless leg syndrome?
- dopamine agonists (pramipexole, ropinirole)
- iron therapy
symptoms of Bell’s Palsy (6)?
- unilateral facial paralysis
- inability to wrinkle forehead
- inability to close eye, decreased tearing
- loss ot taste sensation
- pain around ear precede facial weakness
- mouth drawn to the unaffected side
Cause of Bell’s Palsy?
herpes simplex virus
Herpes zoster + Bell’s Palsy = _____?
Ramsay Hunt syndrome
herpes zoster of face complicated by same side facial palsy and vertigo
Treatment of Bell’s Palsy?
- oral steroids (prednisone) = begin soon (mainstay)
- supportive care = lubricating eye drops, protective glasses or goggles, patches
Describe a TIA?
- brief episode of neurologic dysfunction due to focal, temporary cerebral ischemia without cerebral infarction
- no longer than 24 hours
What are the 2 types of TIA?
- large artery (low flow) = short/minutes = stenosis
- embolic (longer- hours)
When do you treat carotid stenosis with surgery?
when stenosis >70%
Workup for TIA?
- CT w/o contrast
- US of carotids
- echo with doppler
- ekg/labs
Treatment for TIA?
- admit
- aggrenox or aspirin
- if CAD + TIA = plavix
- if TIA due to fib = warfarin
What is CHADS2 score?
indication for warfarin therapy if >2
- CHF
- HTN
- Age >75
- DM
- S2 prior stroke
What symptoms do you expect with a TIA in the carotid circulation?
- contralateral hand-arm weakness with sensory loss
- ipsilateral visual symptoms or aphasia
- amaruosis fugax
- carotid bruit may be present
What symptoms do you expect with a vertebrovascular TIA?
-diplopia, ataxia, vertigo, dysarthria, CN palsy, LE weakness, dimness or blurring of vision, premolar numbness, drop attacks
Ischemic stroke 2 types?
- thrombotic
- embolic
What arteries are affected in the anterior circulation stroke/TIA?
- carotids to frontal
- middle cerebral arteries
homonymous hemianopia?
ischemic stroke - anterior circulation
signs of anterior circulation stroke?
aphasia, apraxia, hemiparesis, hemisensory loss, visual field defects
(middle cerebral arteries)
Exclusion criteria for tPA for ischemic CVA?
labs and CT result
CT without contrast = intracranial hemorrhage, multi lobar infarct involving >33% of cerebral hemisphere
labs: platelet 1.7; elevated PTT
Exclusion criteria for tPA for CVA based on history (10)?
- CVA or head trauma in last 3 months
- hx of intracranial hemorrhage
- major surgery in last 14 days
- GI or urinary bleeding in last 21 days
- MI in last 3 months
- arterial puncture of a non-compressible site for last 7 days
- use of dabigatran in last 48 hours
- stroke symptoms
- BP >185/110
- active bleeding or acute trauma/fracture
S/S for posterior circulation TIA?
VANISH’D
- vertigo
- ataxia
- nystagmus
- intention tremor
- slurred speech
- heel-shin test
- dysdiadochokinesia
- broad based gait
What arteries are affected in posterior circulation TIA?
vertebral and basilar
What is the most significant and treatable risk factor for stroke?
HTN
What is the best test to differentiate ischemic from hemorrhagic stroke?
CT w/o contrast
What are the 4 types of cerebral aneurysms?
- saccular - thin walled
- fusiform - dilation of entire circumference of vessel
- berry/saccular - circle of willis
- mycotic - infected emboli
when do aneurysms become symptomatic?
when they rupture (bleeding into subarachnoid space)
risk factors for cerebral aneurysm?
- HTN, smoking, hypercholesterolemia, heavy etoh
- polycystic kidney disease
- coarctation of the aorta
first study to get if suspect cerebral aneurysm or SAH? and 2nd study?
CT/MRI
-lumbar puncture (bloody)
Treatment of cerebral aneurysm?
- supportive (prevent elevated intracranial pressure) = bed rest, stool softener
- manage HTN
- surgery = clipping or coiling
worst headache of my life? and other symptoms?
subarachnoid hemorrhage
- sudden onset, severe
- n/v, seizure, altered LOC
- agitated pacing
workup for subarachnoid hemorrhage?
CT
then lumbar puncture (bloody)
What are hemorrhagic strokes usually due to?
HTN
What is the most common source of intracranial metastasis?
carcinoma of the breast (#1), lung, GI, kidney
symptoms for brain tumor in frontal lobe?
personality or intellectual change
symptoms for brain tumor in temporal lobe?
olfactory or gustoatory hallucination, licking or smacking of lips
symptoms for brain tumor in parietal lobe?
sensory seizure or sensory loss (impaired stereognosis)
symptoms for brain tumor in occipital lobe?
visual defect or visual hallucination
symptoms for tumor on brain stem?
CN palsy, ataxia (nystagumus)
symptoms for tumor on pituitary?
visual loss, endocrine symptoms
What is the most common type of primary intracranial neoplasm?
-gliomas
the rest are meningiomas, pituitary adenoma, neurofibromas, etc
Patient presents with initial transient loss of consciousness from injury, then lucid period, then increased drowsiness/HA, then weakness….what do you suspect? what artery might be affected? treatment?
suspect epidural hematoma
- artery = middle meningeal artery
- CT = biconvex lens-shaped appearance
- treatment = small (observe); large = surgery
lens shaped appearance on CT?
epidural hematoma
major head trauma,, CT shows crescent-shaped lesion
subdural hematoma
Treatment =
- small = observe
- large = burr holes, craniotomy, antiepilepitc drug for seizure prevention, watch for intracranial pressure
What can spontaneous subdural hemorrhages occur with?
blood thinners, etoh, cerebral atrophy
Most common source of brain injury in the young? the elderly?
young = MVA elderly = falls
What are the 3 types of subdural hemorrhage?
acute = hours-2day subacute = 3-14 day chronic = 15+ days
What is the difference between generalized or partial seizures?
- Generalized = affects entire brain {convulsive vs non convulsive}
- partial = affects one side (often temporal lobe) {simple vs complex}
describe generalized absence seizures?
start around age 3 - conscious but unaware
- staring
- last
Describe simple partial seizures?
- consciousness is not impaired
- symptoms aura-like, smells, sights
- focal rhythmic discharge
Describe complex partial seizure?
- consciousness is impaired
- last >30 seconds
- may have unilateral limb twitching
- temporal lobe
- interictal spikes
Children born with _____ have increased incidence with seizures?
sturge-weber syndrome (port wine stain)
What is a Jacksonian seizure?
type of simple partial seizure
- originates in the motor cortex
- small jerking movements occur at the hand and then spread to other motor areas
Describe tonic-clonic seizures (grand mal)
body very stiff and rigid, 10-60 sec, often bite tongue, incontinence of urine or feces
-EEG = spike
What is status epileptics? and treatment?
single nonstop seizure longer than 5-10 minutes, no return to baseline
medical emergency
IV lorazepam
2nd line = phenytoin
what is neurogenic syncope?
vasovagal syncope
- transient LOC due to reflex response of vasodilatation and/or bradycardia causing hypotension and cerebral hypo perfusion
- triggered by stress (venipuncture, painful stimuli, fear, prolonged standing, heat)
Glasgow Coma Scale scores
3 = min points 15 = max points
13 = minor brain injury
