NEUROLOGY Flashcards
5 main lacunar syndromes
Pure motor hemiparesis, pure sensory, ataxic hemiparesis, sensorimotor, dysarthria clumsy hand syndrome.
SAH blood pressure goal
<150
BP meds to avoid in SAH
Nitroprusside, nitroglycerine
BP rx preferred to lower BP in SAH
labetalol
Name some medications or med withdrawals known for causing seizures
Buproprion, Buspirone, Enflurane, Benzos/barbs/ethanol, anti-epileptics. Theophylline OD. B6 deficiency.
Myoclonic seizures DOC
Valproic acid
Top 3 meds to treat partial seizures
Lamotrigine, Carbamazapine, Phenytoin
What neurologic defects seen with an infarction of anterior cerebral artery
contralateral loss of sensory/motor in legs ,feet, trunk
Target BP in patient with ischemic stroke
BP<220
If getting tPA, <185/110.
Name some medications or med withdrawals known for causing seizures
Buproprion, Buspirone, Enflurane, Benzos/barbs/ethanol, anti-epileptics. Theophylline OD. B6 deficiency.
Myoclonic seizures DOC
Valproic acid
What neurologic defects seen with basilar artery infarction
CN abnormalities Contralateral full body weakness Altered RAS Visual
Herniation of a cervical disc affects which nerve root?
Nerve root above. aka C5-C6 herniation more likely affects C5.
Herniation of a lumbar disc affects which nerve root?
Nerve root below. aka L2-L3 herniation affects L3 nerve root.
Sx of spinal artery syndrome
bilateral loss of pain and temp (one level below lesion) Bilateral spastic paresis (below lesion) Bilateral flaccid paralysis (level of lesion)
Sx of brown sequard
Ipsilateral loss of vibration and discrimination (below lesion) Ipsilateral spastic paresis (below lesion) Ipsilateral flaccid paralysis (level of lesion) Contralateral loss of pain and temperature (below lesion)
Contraindications to tPA
Stroke/significant head trauma in past 3 months
Arterial puncture in non-compressible site in past
INR>1.7
BP>185/110
Platelets < 50
Best initial test for guillain barre
LP/CSF analysis
Most accurate test for guillain barre
EMG/nerve conduction studies
Most important measure to monitor in guillain barre
Pulmonary function tests (Vital capacity). Impending respiratory failure is predicted by:
Forced vital capacity <20
Max inspiratory pressure <30
Max expiratory pressure <40
What direction of nystagmus in central vertigo
Up-down, tends to be more visible with focused gaze.
What direction of nystagmus in peripheral vertigo
Side-to-side, tends to lessen with focused gaze.
Adults: brain cancer #1-3
GBM Meningioma Schwannoma
COMT inhibitors
Entacapone, tolcapone These are used to reduce fluctuations and adverse effects in PD, they DO NOT help any Parkinsons sx themselves.
When the pt with PD’s response to dopaminergic begins to decline, what med class can be added?
MAO-B inhibitors. Selegiline, rasagiline.
MCC of complication/death after SAH (a pt that initially survives that rupture of an aneurysm)
Cerebral vasospasm
Most common cause of SAH
Trauma
Pts with parkinsons under the age of 60 with good management of ADL and minimal postural instability
Anti-cholinergic, such as trihexyphenyldyl or benztropine
Pts with parkinson over the age of 60 with good management of ADL and minimal postural instability
Amantadine. We want to avoid anticholinergics in the elderly population.
For increased effect in treatment of PD with carbidopa/levodopa, adjunctive therapy with what meds may be added?
DA agonists Pramipexole Ropinirole
How is the nausea of anti-PD medications managed?
Domperidone.
DOC in parkinson’s psychosis
Atypical antipsychotics, particularly QUETIAPINE or risperidone.
Major diff between Parkinsons and Lewy body dementia
In PD, dementia comes AFTER movement d/o. In levy body, dementia comes before or along w/movement d/o.
1st and 2nd line for benign essential tremor
Propranolol Primidone
Best initial test in Wilsons
Slit-lamp exam
Ceruloplasmin in Wilsons
Low levels.
Gold standard test for Wilsons
Liver bx
Tx of Wilsons
Chelation with D-penicillamine
1st synapse for spinothalamic tract and decussation
First synapse at spinal cord (1-2 levels removed from entrance) 2nd neuron decussates at spinal cord and travels up.
Lateral spinothalamic tract
Pain and temperature
Anterior spinothalamic tract
Crude touch and pressure
Injury to DCML, spinal
IPSILATERAL loss of touch and vibration below injury
Injury to DCML in sensory cortex
Contralateral loss of fine touch and vibration
Lateral corticospinal tract
Extremity muscles
Anterior corticospinal tract
Axial muscles
How does a stroke to the MCA affect the face?
CONTRALATERAL lower facial paralysis. Additionally, CN III to ipsilateral eye is affected, therefore the eyes tend to deviate TOWARDS the side of the lesion. Thats just bc if one eye moves laterally (due to the lesion), the other (normal) eye wants to do the same by reflex.
Why kind of stroke might cause urinary incontinence due to weakness in pelvic floor musculature?
ACA
Weber syndrome
Pyramidal tracts (gives us CST) –>contralateral hemiplegia. CN III –> ipsilateral. Penetrating branch of PCA
Benedikt’s syndrome
Weber syndrome + affect of red nucleus and substantial nigra. CN III –> ipsilateral Pyramidal tracts (gives us CST) – > contralateral hemiplegia Red nucleus and substantia nigra – > severe gait disturbances.
Wallenberg syndrome
PICA ! Facial sensory loss (ipsilateral .. CN VII) Body sensory loss (contralateral .. spinothalamic tract) Also, since we are losing VIII, dizziness and ataxia. Horner’s syndrome. Dysarthria as tracts of CN V are also affected.
Generally, hearing loss &/or tinnitus accompanying your vertigo points to ..
Peripheral cause (e.g., vestibular neuritis). Problem in inner ear or cochlear nerve.
Which vertigo tends to last longer?
Central.
Anti-emetics prescribed for peripheral vertigo
Diphenydramine Metoclopramide Phenergan
Vestibulosuppressants/anti cholinergics prescribed for peripheral vertigo
Meclizine Scopolamine
Pathophys of Menieres disease
Unilateral, intermittent increases in perilymphatic volume, resulting in unequal vestibular function. This is why pts often c/o “feeling of fullness”
Tx of Meniere’s disease
Mostly supportive but diuretics can also help
Acute onset of vertigo preceded by “pop” sensation in ear.
Perilymphatic fistula, due to rupture of bony capsule in inner ear, resulting in leakage of perilymphatic fluid into the middle ear.
Dix hallpike maneuver should elicit nystagmus with a fast phase toward .. ?
AFFECTED ear.
Disease association with ependymomas
Neurofibromatosis type I
Disease association with meningiomas
Neurofibromatosis type I
2 brain tumors associated with Li Fraumeni
Medulloblastoma Astrocytomas
Von hippel lindau is associated with which brain tumor?
Hemangioblastoma, generally in the cerebellum.
Which drugs are known for inducing cP450 system?
BCG-PQRS. Barbs Carbamazepine Griseofulvin Phenytoin Quinidine Rifampin St. Johns Wort
Downward displacement of cerebellar tonsils and medulla through foramen magnum
Arnold-Chiari
Most common pre-disposing condition for an intracranial hemorrhage
HTN
Rescue therapy for sudden akinetic episodes in PD
Apomorphine, subQ.
What is pseudo bulbar affect?
Inappropriate laughing or crying Yawning
In Huntingtons, what happens to acetylcholine levels?
They decrease.
Tx for chorea
Tetrabenazine, a DA antagonist.
Most common autonomic dysfunction seen in guillain barre
Tachycardia
What is Pickwickian syndrome?
Obesity hypoventilation syndrome characterized by hypersomonlence, dyspnea, hypoxemia (causing cyanosis, polycythemia, and plethora) and pulmonary hypertension leading to right sided heart failure and peripheral edema.
First line for narcolepsy
Modafinil
Tx of cataplexy
Venlafaxine Fluoxetine Atomoxetine
2 insomnia tx that act at benzo receptor
Zolpidem Zalepton
What makes Esziopiclone unique?
May be used long term (its lunesta)
What is Remelteon’s MOA?
Works at melatonin receptors therefore its nonaddictive. Avoid if hepatic insufficiency!!!
Why is thiamine given in a glucose infusion to alcoholics with hypoglycemia?
Glucose administration in the absence of thiamine can theoretically exacerbate damage to the mamillary bodies and worsen Wernicke’s encephalopathy.
What is the MOA of the preferred medication in the treatment of RLS?
DA agonist
EEG wave forms in stage 1
theta
EEG wave forms in stage 3 and 4
Delta, low freq and high amp
EEG wave forms in REM
Beta, high freq low amp
MCC of blindness in pts over age 55
Macular degeneration
MCC of blindness in pts under 55
DM
MCC of blindness in blacks at any age
Glaucoma
Potential serious complication of corneal ulceration
HSV keratitis
Colored halos indicate?
Acute angle closure glaucoma (also SE of digoxin)
“Shallow anterior chamber”
Acute angle closure glaucoma
MCC of conjunctivitis appearing in the first 24 hours of life
Chemical conjunctivitis 2/2 abx prophylaxis.
Tx of orbital cellulitis
Immediate IV vanco and IV cefotaxime or ceftriaxone until afebrile and clinically improved. Then PO abx for 2-3 weeks.
Inflammation of internal melbomian sebaceous glands
Chalazion
Infection of external sebaceous glands of Zeiss or Moi (tender red swelling at LID MARGIN)
Hordeolum/stye
Infection of eyelids and lashes secondary to seborrhea
Anterior blepharitis
Painless, progressive decrease in vision manifested with difficulty driving at night ,reading road signs, or reading fine print
Cataracts
Near-sightedness is often an early mx of ?
Cataracts
Initial tx for acute angle closure
0.5% timolol, 1% apracolinidine, and 2% pilocarpine. 2 tabs of Acetazolamide, 250 mgs.
If refractory to initial tx in acute angle closure
Mannitol
BITOTS SPOTS
Areas of abnormal squamous cell proliferation and keratinization of the conjunctiva, seen in Vitamin A deficiency.
SAH
Dx and tx
Bullous myringitis, note hte large reddish vesicles on the TM. Mycoplasma is common casue so treat iwth oral macrolides.
Risk factors for devo of cataracts
Prolonged sun exposure
Trauma esp caustic
DM
Age
Low education
White
What is the difference between Arnold Chiari and Dandy walker
Arnold Chiari is when a narrow cranio spinal junction and a small posterior cranial fossa causes displacement of the cerebellum and medulla downward, leading to compression of CSF passage at the level of foarmen magnum (non cummunicating hydro cephalus). Type II is symptomatic and commonly associated with meningomyelocele and syringomyelia.
Dandy Walker is also around the 4th ventricle but this time it is a small cerebellar vermis that gives room to the fourth ventricle and expands in a cyst like structure, also could lead to hydro cephalus. Unlike Arnnold, THE POSTERIOR FOSSA IS LARGE.
3 essential features of dandy walker
Agenesis of the vermis
Cystic dilation of the 4th ventricle
Enlargement of the posterior fossa
