Neurology Flashcards
most common pituitary tumor? tx?
prolactinoma. dopamine agonists (bromocriptine) or transphenoid resection
55 yo pt presents w/ acute “broken speech.” what type of aphasia? what lobe and vascular distribution?
broca’s aphasia and frontal lobe, left MCA distribution
most common cause of SAH
trauma, the second most common is berry aneurysms
crescent-shaped hyperdensity on CT that does not cross the midline
subdural hematoma - 2/2 torn bridging veins
hx of initial AMS w/ an intervening lucid interval. Dx? most likely source? tx?
epidural hematoma. middle meningeal artery. neurosurgical evacuation
CSF findings w/ SAH
elevated ICP, RBCs, xanthochromia
albuminocytologic dissociation (increased protein in CSF w/o a significant increase in cell count)
guillain-barre syndrome
most common primary source of mets to the brain
lung, breasts, skin (melanoma), kidney, and GI
seizures seen in children who are accused of inattention in class; may be confused w/ ADHD
absence seizures
most frequent presentation of intracranial neoplasm
HA
most common cause of seizures in children (2-10 yo)
infection, febrile seizures, trauma, idiopathic
most common cause of seizures in young adults (18-35 yo)
trauma, alcohol withdrawal, brain tumors
first line med for status epilepticus
IV BZDs
confusion, confabulation, ophthalmoplegia, ataxia
wernicke’s encephalopathy due to def of thiamine
what % lesion is an indication for carotid endarterectomy
70% if the stenosis is symptomatic
most common causes of dementia
alzheimer’s and multi-infarct
combined UMN and LMN disorder
ALS
rigidity and stiffness w/ unilateral resting tremor and masked faces
parkinson’s dz
mainstay of parkinson’s dz therapy
levodopa/carbidopa
tx for guillain-barre syndrome
IVIG or plasmapheresis. avoid steroids
rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior
huntington’s dz
multiple cafe-au lait spots on skin
NF1
hyperphagia, hypersexuality, hyperorality, and hyperdocility
kluver-bucy syndrome (amygdala)
unilateral, severe, periorbital HA w/ tearing and conjunctival erythema
cluster HA
signs of UMN damage
hyperreflexia, hypertonia, + babinski
signs of LMN damage
hyporeflexia, hypotonia, atrophy, fasciculations
hallmarks of this neuro dz include a mask-like, immobile facial expression, bradykinesia, resting tremor, rigidity, and festinating gait (hypokinetic, shuffling gait - pt appears as if he was chasing his center of gravity). dx? cause? tx?
parkinson’s dz - caused by overactivity of cholinergic neurons and underactivity of dopaminergic neurons in the substantia nigra. tx include dopaminergic and/or anti-cholinergic drugs
HA triggered by darkness
closed-angle glaucoma (due to pupillary dilation)
HA triggered by light
migraine HA
differentiate between open angle and closed angle glaucoma
open angle = bilateral, gradual loss of peripheral vision w/ cupping (increased cup-to-disk ratio) of optic nerve head
vs
closed angle = unilateral, extremely painful, blurred vision, HA, N/V w/ hard, red eye, dilated pupil that is non-reactive to light
tx for closed angle glaucoma
medical emergency - consult + decreased IOP (eye drops - timolol, pilocarpine; systemic meds - oral or IV acetazolamide/mannitol; laser peripheral iridotomy)
pt presents w/ loss of visual acuity and difficulty w/ night vision. dx?
cataracts
pt presents w/ painles loss of central vision (distortion of straight lines is early sign). dx?
age-related macular degeneration
pt presents w/ sudden, painless, unilateral loss of vision. fundoscopic exam shows optic disk swelling, retinal hemorrhage, dilated veins, and cotton wool spots. dx?
central retinal vein occlusion
pt presents w/ sudden, painless, unilateral loss of vision. fundoscopic exam shows pallor of the optic disk, cherry red fovea, retinal swelling, boxcar segmentation of blood in retinal veins. dx?
central retinal artery occlusion
pt w/ throbbing HA (may be unilateral or bilateral) triggered by stress, food, light, etc that is associated w/ N/V, photophobia, +/- aura, and noise sensitive, usually relieved by sleep and darkness. dx? tx?
migraine HA. tx includes avoidance of known triggers, abortive therapy includes NSAIDs, triptans (5HT agonist), metoclopramide; prophylactic therapy includes anti-convulsants (topiramate), TCAs (amitriptyline), B-blockers (propranolol), and CCBs
pt w/ brief, excruciating, unilateral periorbital HA that may cause ipsilateral lacrimation of the eye, conjunctival injection, horner’s syndrome, and nasal stuffiness. dx? tx?
cluster HA. tx includes acute therapy - high flow O2, dihydroergotamine, octreotide, or sumatriptan and prophylactice therapy - CCB, lithium, valproic acid, topiramate
pt w/ HA at the end of the day that worsens w/ stress and improves w/ relaxation or massage, may describe as tight, bandlike pain. dx? tx?
tension-type HA. tx includes relaxation, avoidance of stressors, NSAIDs and acetaminophen
lewy body dementia vs pick's dz vs alzheimer's dz vs multi-infarct dementia
lewy body - fluctuating cognitive impairment, recurrent visual hallucinations, and motor features of parkinsonism
pick’s dz - personality changes, compulsive behaviors, and impaired memory w/ intact visual-spatial functions
alzheimer’s dz - subtle memory loss, language difficulties, apraxia, followed by impaired judgement and personality changes
multi-infarct dementia - step-wise decrease in cognitive function w/ motor and sensory neurological dysfunction
