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PANCE/EOC > Neurology #4 > Flashcards

Neurology #4 Flashcards

1
Q

What is the difference between a simple and a complex focal (partial) seizure?

A

Simple: with retained awareness
Complex: with impaired awareness

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2
Q

Automatisms are _____ and what type of seizure can they accompany?

A 
Repetitive behaviors (lip smacking, facial grimacing, chewing, etc.) 
-Complex partial seizures
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3
Q

What is seen on an electroencephalogram with a absence (petit mal) seizure

A

Bilateral symmetric 3 Hertz spike and wave activity (2.5-5 Hz)

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4
Q

Explain the symptoms of an absence seizure

A
  • MC in childhood
  • Sudden, marked impairment of consciousness without loss of body tone
  • Staring episodes with pauses (behavioral arrest)
  • Last between 5-10 seconds
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5
Q

First line treatment for absence seizures

A

-Ethosuximide

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6
Q

What two medications can exacerbate absence seizures?

A

Carbamezapine and Gabapentin

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7
Q

Explain what a tonic-clonic (Grand Mal) seizure is

A
  • Sudden loss of consciousness with tonic activity (contraction and rigidity) that may be associated with respiratory arrest
  • Followed by 1-2 minutes of clonic activity (repetitive, symmetric jerking)
  • Followed by post-ictal confusion phase. Cyanosis and urinary incontinence can occur
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8
Q

What labs occur immediately after seizures can rule out pseudo-seizures?

A

Increased prolactin and lactic acid

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9
Q

What seizure medications are safest in pregnancy?

A

-Levetiracetam & Lamotrigine

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10
Q

What is status epilepticus?

A
  • A single, continuous epileptic seizure lasting 5 minutes or more, or more than 1 seizure within a 5 minute period without recovery in between episodes
  • Considered a neurologic emergency
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11
Q

What are the preferred initial agents in management of status epilepticus?

A

Benzodiazepines (Lorazepam)

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12
Q

However, if no response to Benzodiazepines, what can be given?

A

Phenytoin or Fosphenytoin

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13
Q

How does Phenytoin work?

A

Stabilizes neuronal membranes by blocking voltage-gated sodium channels

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14
Q

Name some side effects of Phenytoin

A

-P: P450 inducer and induces Lupus-like syndrome
-H: Hyperplasia of gums and Hirsuitism
-E: Erythema Multiforme
-T: Teratogenic
O: Osteopenia
I: Inhibits folic acid absorption
N: Nystagmus

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15
Q

Ethosuximide, the drug of choice for ______, has side effects such as _____

A

Absence (Petit Mal) seizures

-Rash (SJS), GI upset, drowsiness

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16
Q

MOA for Ethosuximide

A

Blocks calcium channels

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17
Q

What is a lacunar infarct?

A

Small vessel disease of the penetrating branches of the cerebral arteries in hte pons and basal ganglia

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18
Q

Risk factors for a lacunar infarct

A

Hypertension (MC)

DM

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19
Q

5 Classic Presentations of a lacunar infarct

A
  • Pure motor (MC): hemiparesis or hemiplegia
  • Ataxic hemiparesis: ipsilateral weakness and clumsiness in the leg > arm
  • Pure sensory deficits: numbness and paresthesias on one side of body
  • Sensorimotor
  • Dysarthria (Clumsy hand)
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20
Q

Diagnostic for lacunar infarct

A

-CT scan: small punched out hypodense areas usually in central and non cortical areas

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21
Q

Management of lacunar infarct

A
  • Aspirin

- Control risk factors: Hypertension and DM

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22
Q

What is a transient ischemic attack?

A

Transient episode of neurologic deficits without acute infarction

23
Q

Symptoms of a TIA

A
  • Neurologic deficits lasting < 24 hours, depending on artery involved
  • Most last for a few minutes
  • Amaurosis Fugax: transient monocular vision loss (temporary shade down on one eye)
24
Q

What may be heard on physical examination of a patient with a TIA

A

Carotid bruits

25
Q

Diagnostics done for a TIA (3 steps)

A

Neuroimaging + Neurovascular imaging + rule out cardioembolic source

1) CT scan performed but MRI more sensitive
2) CT or MR angiography, carotid Doppler. Angiography is definitive
3) Ancillary testing: ECG, telemetry, echocardiogram

26
Q

How to manage a patient with a TIA

A
  • Place patient in supine position
  • Avoid lowering BP unless > 220/120
  • DO NOT GIVE THROMBOLYTICS
27
Q

If the TIA is noncardiogenic in nature, what is the treatment?

A
  • Antiplatelet therapy: aspirin, Clopidogrel, Aspirin + Dipyridamole
  • Carotid endarterectomy if stenosis 50-99%
28
Q

If the TIA is cardiogenic in nature, as if it is from A-fib, what is the treatment?

A

Oral anticoagulation

29
Q

The risk of a stroke after a TIA is significantly increased. The ABCD2 score is used to determine the risk of stroke 3-90 days after a TIA. Explain.

A

A: Age > 60
B: BP > 140/90
C: Clinical symptoms (slurred speech = 1 points, unilateral weakness = 2 pts)
D: Duration ( > 10 minutes = 1 point, > 60 minutes = 2 pts)
D: Diabetes

0-3 pts: 3.1%
4-5 pts: 9.8%
6-7 pts: 17.8%

30
Q

MC type of ischemic stroke?

A

Thrombotic

31
Q

Risk factors for ischemic strokes

A
  • Hypertension
  • Dyslipidemia
  • DM
  • A-fib
  • Cigarette Smoking
  • Males, age, ethnicity, family history
32
Q

Which artery is most commonly involved in an ischemic stroke?

A

Middle cerebral artery

33
Q

Symptoms of an MCA ischemic stroke

A
  • Contralateral sensory and motor deficits greater in face and arm > leg > foot
  • Only involves lower half of face (still can raise forehead)
  • Gaze preference toward side of the lesion
34
Q

With an MCA ischemic stroke, if the lesion is on the dominant side, what are the symptoms?

A

Aphasia, math deficits

35
Q

With an anterior cerebral artery stroke, what are the symptoms?

A
  • Contralateral sensory and motor deficits greater in the leg, foot > arm
  • Face is usually spared
  • Urinary incontinence
  • Gażę toward side of lesion
  • Personality/cognitive deficits (impaired judgment)
36
Q

With a posterior cerebral artery stroke, what are the symptoms?

A

-Vertigo (with nystagmus), vomiting, visual changes (diplopia)

37
Q

Diagnostics for an ischemic stroke

A
  • CT head without contrast: best initial test (MRI most accurate though)
  • Ancillary testing: ECG, carotid Doppler US, echo
  • Conventional angiography rarely needed
38
Q

Immediate management of an ischemic stroke

A
  • Within 3 hours of symptom onset: Alteplase if no contraindications (BP > 185/110, recent bleeding, bleeding disorder, recent trauma)
  • Mechanical thrombolectomy within 24 hours of symptom onset
  • Aspirin and long-term management within 3-4.5 hours
39
Q

What should be started in a patient for long-term management?

A

Statin therapy, regardless of LDL level

40
Q

True or False: Aspirin therapy should not be initiated until 24 hours after the time of thrombolytic therapy

A

True. If the patient was already on Aspirin prior to stroke, add Dipyridamole or switch to Clopidogrel.

41
Q

An epidural hematoma is bleeding in

A

the space between the skull and the dura

42
Q

MC etiology of an epidural hematoma

A

-Rupture of the middle meningeal artery, often associated with a temporal bone fracture

43
Q

3 classic phases of an epidural hematoma

A

-Brief loss of consciousness followed by a lucid interval followed by neurologic deterioration

44
Q

With an epidural hematoma, an uncal herniation is present. What does this mean?

A

Cranial nerve III palsy–fixed dilated blown pupil on the ipsilateral side of the injury

45
Q

What is the initial test of choice for an epidural hematoma and what is seen?

A

Head CT without contrast

-Biconvex (lens-shaped) hyperdensity in the temporal area that does NOT cross suture lines

46
Q

Treatment for an epidural hematoma

A
  • Hematoma evacuation or craniotomy

- May be observed closely if the patient is in good condition, with serial imaging

47
Q

If the patient has an epidural hematoma and increased intracranial pressure, what should you do?

A 
head elevation
short-term hyperventilation
hyperosmolar therapy (IV Mannitol)
48
Q

A subdural hematoma is

A

bleeding between the dura and arachnoid membranes

49
Q

MC etiology of a subdural hematoma

A

Rupture of cortical bridging veins after blunt trauma

50
Q

Who is most at risk for a subdural hematoma

A

Elderly and alcoholics
Anticoagulant use
Shaken baby syndrome, child abuse

51
Q

Symptoms of a subdural hematoma

A

-Gradual increase in generalized neurologic symptoms

52
Q

What is seen on a head CT without contrast in a subdural hematoma?

A

Concave (crescent-shaped) bleed that can cross the suture lines

53
Q

Management for a subdural hematoma (both nonoperative and operative)

A

Nonoperative: if clinically stable, or small ( < 5 mm), observe
Operative: surgical evacuation if > 5 mm or greater midline shift (burr hole trephination, craniotomy, decompressive craniectomy)

PANCE/EOC (63 decks)

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