Neurology Flashcards
A patient presents with sudden onset of weakness on one side of their body and face (sparing upper 1/3 from eyes up), aphasia and partial/total loss of vision. What is the most likely diagnosis?
Stroke or Transient Ischemic Attack (TIA)
What is the difference between stroke and transient ischemic attack (TIA)?
Stroke lasts for 24 hours or longer (associated with permanent residual neuro deficits)
TIAs last less than 24 hours (symptoms resolve)
What is amaurosis fugax?
transient loss of vision in one eye
occurs in TIAs
What is the best initial step for a patient presenting with symptoms suggesting stroke?
Head CT without contrast
rule out hemorrhage before thrombolytics
What cerebral arterial lesion results in profound lower extremity weakness, mild upper extremity weakness, personality changes/ psychiatric disturbances, and urinary incontinence?
Anterior cerebral artery
What cerebral arterial lesion results in profound upper extremity weakness, aphasia, apraxia/ neglect, eyes deviating towards lesion, and contralateral homonymous hemianopsia with macular sparing?
Middle cerebral artery
What cerebral arterial lesion results in prosopagnosia (inability to recognize faces)?
Posterior cerebral artery
What cerebral arterial lesion results in vertigo, N/V, “drop attack” (loss of consciousness), vertical nystagmus, dysarthria, dystonia, sensory changes in face & scalp, and ataxia?
Vertebrobasilar artery
What cerebral arterial lesion results in ipsilateral face symptoms, contralateral body symptoms, vertigo and Horner’s syndrome?
Posterior inferior cerebellar artery
What cerebral arterial lesion results in ataxia, parkinsonian signs, sensory deficits, hemiparesis (mostly in face), and bulbar signs without cortical deficits?
Lacunar artery
What cerebral arterial lesion results in amaurosis fugax (transient loss of vision in one eye)?
Ophthalmic artery
What is the best initial diagnostic test for suspected stroke/ TIA?
Head CT without contrast
What is the most accurate diagnostic test for suspected stroke/ TIA?
Magnetic resonance angiogram (MRA)
What is the best initial treatment for a patient with a non-hemorrhagic stroke/ TIA?
- Thrombolytics (TPA) if within 3 hours of onset
2. aspirin if after 3 hours of onset
What are the two alternate treatments for patient who develop a non-hemorrhagic stroke/ TIA while on aspirin?
- switch to clopidogrel
2. add dipyridamole with aspirin
Other than an anti-platelet (aspirin, clopidogrel, dipyridamole), what other treatment should be initiated for a patient with a non-hemorrhagic stroke/ TIA?
Statin (to control hyperlipidemia)
What are the contraindications to thrombolytic (TPA) treatment? (8)
- hx of hemorrhagic stroke
- presence of intracranial neoplasm/mass
- active bleeding/ surgery within 6 weeks
- bleeding disorder
- traumatic CPR within 3 weeks
- suspected aortic dissection
- stroke within 1 year
- cerebral trauma/ brain surgery within 6 months
What are the diagnostic tests that should be performed in a stroke patient after head CT, thrombolytics and aspirin are given? (3)
- Echocardiogram (assess for clots/ valve vegetation)
- Carotid Dopplers/ duplex (assess for stenosis)
- EKG and Holter monitor (assess for a-fib)
What are additional diagnostic tests for young patients (
- ESR (sedimentation rate)
- VDRL/ RPR (assess for syphillis)
- ANA, double-stranded DNA (assess for lupus)
- protein C
- protein S
- Factor V Leiden mutation
- antiphospholipid syndrome
(rule out vasculitis or hypercoaguable state)
What is the blood pressure goal for patients who had a stroke?
What is the LDL goal for patients who had a stroke?
What is the treatment for paradoxical emboli through a patent foramen?
closure with catheter device
What is the treatment protocol for status epilepticus?
- Benzo (lorazepam)
- Fosphenytoin (after 10-20 mins)
- Phenobarbital (after 10-20 mins)
- general anesthesia (after 10-20 mins; pentobarbital, thiopental, midazolam, propofol)
What are the diagnostic tests that should be performed initially for a patient having a seizure? (4)
- electrolytes (sodium, calcium, glucose, oxygen, creatinine & magnesium level)
- urgent head CT
- urine toxin screen
- liver & renal function test
What should be done for a patient having a seizure after initial diagnostic testing is negative? (2)
- EEG
2. neuro consult
What are the four indications for chronic anti-epileptic drug therapy after a single seizure?
- strong family history of seizures
- abnormal EEG
- status epilepticus
- non-correctable precipitating cause (brain tumor)
What is the best initial treatment for absence (petit mal) seizures?
Ethosuximide
What anti-epileptic medication is associated with Stevenes-Johnson syndrome?
lamotrigine
What is the most likely diagnosis for a tremulous patient with a slow, abnormal festinating gait and orthostasis?
Parkinson’s Disease
What are 6 physical findings associated with Parkinson’s disease?
- cogwheel rigidity
- resting tremor
- hypomimia (masklike, under-reactive face)
- micrographia (small writing)
- orthostasis
- intact cognition and memory
What is the best treatment for a younger patient (
anticholinergics (benzotropine, hydroxyzine)
What is the best treatment for an older patient (>60) with mild symptoms of Parkinson’s disease?
Amantadine
anticholinergics worsen memory and increase side effects in elderly
What is the first line treatment for patient with severe symptoms (inability to perform activities of daily living) of Parkinson’s disease? (2)
- Carbidopa-levodopa
2. dopamine agonist (pramipexole, ropinirole, cabergoline)
What are the 3 second line treatments for patient with severe symptoms (inability to perform activities of daily living) of Parkinson’s disease)?
- COMT inhibitors (tolcapone, entacapone w/ dopamine drugs)
- MAO inhibitors (selegiline, rasagiline)
- deep brain stimulation
What treatment can be added when levodopa causes psychosis in a Parkinson’s patient?
Quetiapine
What is the most likely diagnosis for a patient with a tremor at rest and with intention (action)?
Essential tremor
What is the best treatment for a patient with essential tremor?
Propranolol
can also use alcohol if only option
A patient presenting with multiple neurological deficits developing at different times (months to years apart) most likely suffers from …
Multiple sclerosis
What is the most common abnormality associated with multiple sclerosis?
optic neuritis
What is the best initial diagnostic test for a patient with suspected multiple sclerosis?
MRI
What is the most accurate diagnostic test for a patient with suspected multiple sclerosis?
MRI
What is the next best diagnostic tool for a patient with suspected multiple sclerosis if an MRI is nondiagnostic?
CSF (lumbar tap showing oligoclonal bands)
What is the best initial therapy for multiple sclerosis?
steroids (for acute exacerbation)
What is the best therapy for fatigue associated with multiple sclerosis?
amantadine
What is the best therapy for spasticity associated with multiple sclerosis? (2)
- baclofen
2. tizanidine
What is long term treatment for multiple sclerosis?
disease modifying therapy (beta interferon, glatiramer, mitoxantrone, natalizumab, fingolimod, dalfampridine)
What adverse side effect is associated with the use of natalizumab?
PML
What diagnostic tests should be performed in a patient presenting with memory loss? (4)
- head CT
- vitamin B12 level
- thyroid function testing (TSH, T4)
- RPR/ VDRL
What is the only abnormal test result in a patient with Alzheimer’s disease?
head CT showing diffuse, symmetrical atrophy
What is the best initial treatment for a patient with Alzheimer’s disease?
anticholinesterase (donepezil, rivastigmine, galantamine)
A patient presenting with personality and behavioral changes followed by memory loss most likely suffers from …
Frontotemporal dementia
(focal atropy of frontal and temporal lobes)
(treat like Alzheimer’s)
A patient presenting with rapidly progressive dementia and myoclonus most likely suffers from ..
Creutzfledt-Jakob Disease (CJD)
What is the CSF finding associated with Creutzfeldt-Jakob disease?
14-3-3 protein
What diagnostic tests should be performed in a patient with suspected Creutzfeldt Jakob disease? (3)
- EEG
- MRI (no abnormality)
- CSF (14-3-3 protein)
(however brain biopsy is most accurate)
A patient presenting with resting tremor, cogwheel rigidity, wide based gait, vivid & detailed hallucinations, and dementia most likely suffers from …
Lewy Body Disease
A patient presenting with urinary incontinence, dementia, and wide-based gait/ ataxia most likely suffers from …
Normal Pressure Hydrocephalus
wet, wacky, wobbly
What is the best treatment for normal pressure hydrocephalus?
shunt placement
What diagnostic test should be performed in a patient with suspected normal pressure hydrocephalus? (2)
- head CT
2. lumbar puncture
A young patient presenting with dementia, psychiatric disturbances, personality changes, dance-like movements and a family history of similar symptoms most likely suffers from…
Huntington’s disease
What is the best diagnostic test for suspected Huntington’s disease?
specific genetic testing
What is the best treatment for the movement disorder associated with Huntington’s disease?
tetrabenazine
What are 4 common triggers of migraine headaches?
- cheese
- caffeine
- mensruation
- oral contraception
A pt presents with a unilateral/bilateral headache associated with abnormal smells, aura, flashing lights, photophobia and visual changes most likely suffers from ..
migraine
When should a head CT or MRI be performed for a patient presenting with a headache? (3)
- sudden or severe
- onset after age 40
- associated with focal neurological findings
What is the best initial abortive therapy for migraines?
Triptans or ergotamine