Neurology Flashcards
What does TIPSS stand for?
T- tumor I- injury P- psychological disorders S- stroke S- sepsis
What does AEIOU stand for?
A- alcohol E- epilepsy I- insulin O- opium U- uremia
What are some concerning symptoms of the nervous system?
- Headache - Dizziness or vertigo - Generalized, proximal, or distal weakness - Numbness or paresthesias - Abnormal or loss of sensations (vision, hearing, speech) - Loss of consciousness, syncope, or near-syncope - Seizures - Tremors or involuntary movements - Changes in mood - Changes in sleep - Alcohol/ drug use
What are the 3 fundamental questions you should know about your patient’s stroke?
- What area of the brain? 2. Ischemic or hemorrhagic? 3. If ischemic, thrombus or emboli?
What are the warning signs of a stroke?
SUDDEN = Stroke - Sudden numbness/ weakness - Sudden confusion, trouble speaking or understanding - Sudden trouble seeing - Sudden trouble walking, dizziness, or loss of balance/ coordination - Sudden severe headache
Syncope
- what were the doing before syncope? - standing or sitting? - any warning signs? - could you hear voices? - how long did it last? - was the onset/offset, fast or slow? - any palpitations before? - any hx of heart disease? - who witnessed it? - did you loose continence? - did you get hurt during the episode?
Name the types of syncope
Vasovagal Hypovolemia Valsalva Reduced cardiac output Hypoxia Pulmonary emboli Anemia Hypoglycemia TIA Anxiety
Name the types of seizures
- Simple/Partial Focal Seizure 2. Complex Focal Seizure 3. Partial Generalized Seizure 4. Tonic-Clonic or Grand Mal Seizure 5. Absence Seizure 6. Myoclonic Seizure 7. Myoclonic Atonic Seizure (drop attack) 8. Pseudo-seizure
Simple/Partial Seizure
Focal or unilateral seizure without loss of consciousness Types: - Jacksonian - Sensory - Autonomic - Psychiatric
What is a Jacksonian (simple/partial seizure)?
- unilateral, no loss of consciousness - tonic, then clonic - unilateral, starts in one part of body, then moves to another part on the same side
What is a Sensory (simple seizure)?
- unilateral, no loss of consciousness - numbness or tingling - simple visual, auditory or olfactory hallucinations such as flashing lights, buzzing or odors
What is autonomic (simple seizure)?
- unilateral, no loss of consciousness - funny feeling feeling in epigastrium, - nausea - pallor, flushing - lightheadedness
What is a psychiatric simple seizure?
- unilateral, no loss of consciousness - anxiety or fear - feeling of familiarity or unreality - dreamy states
Complex Partial Seizure
- unilateral seizure - impairment of consciousness - temporary confusion and HA - may remember aura but rest is amnesic - may or may not start with autonomic or psychic symptoms (if do, called aura) - Automatisms may develop (smacking lips, chewing, walking about)
Partial Generalized Seizure
- focal seizure that becomes generalized - Resemble tonic-clonic - Has an aura - Unilateral neurologic deficit
Tonic Clonic or Grand Mal Seizure
- Bilateral - Lose consciousness suddenly, stiffen into tonic extensor rigidity. - Breathing stops, cyanosis - Clonic phase follow (rhythmic muscular contractions) - Breathing resumes with excessive salivation - Injury: tongue biting and incontinence may occur - Postictal- confusion, drowsiness, HA, fatigue and temporary focal deficits - No remembrance of aura or seizure
Absence or Petite Mal Seizure
- Bilateral - Sudden brief lapse of consciousness, with momentary blinking, staring or movements of lips and hands but no falling - Petit mal 10 sec and some postictal confusion) - No aura recalled
Myoclonus Seizure
- Bilateral - Sudden brief rapid jerks involving trunk or limbs - Variable postictal state
Atonic Seizure (drop-attack)
- Bilateral - Sudden LOC with falling but no movements - Either prompt return to normal or brief/ mild confusion
Pseudo-seizure
- Bilateral - No neuroanatomic pattern - Variable postictal
What is the most common type of seizure for ages 12-20?
Idiopathic Trauma Drug and Alcohol withdrawal
What is the most common type of seizure for ages 20-35?
Trauma Alcoholism Brain Tumor
What is the most common type of seizure for ages 35+?
- Brain tumor - Cerebrovascular disease - Metabolic disorders: Hyponatremia, Hypoglycemia, Hepatic failure, Uremia - Alcoholism
What is a likely diagnosis for: Transient monocular blindness, lasting a few days to weeks
retro-bulbar neuritis
What is the likely diagnosis for: New onset of blurred vision or unexplained change in normal acuity
Diabetes
What is the likely diagnosis for: Tinnitus and vertigo
Meniere’s disease
Nystagmus- definition
rhythmic oscillation of the eye (like a tremor of the eye) - Horizontal (occurs when looking to the side) - Vertical (occurs when looking down) - Rotary (turns in a circle when looking straight)
Nystagmus- causes
- Impairment of vision early in life - Disorders of labyrinth and cerebellar system - Drug toxicity
Aphonia
loss of voice from disease affecting larynx or nerve supply
Dysphonia
- Difficulty speaking because of impaired function. - Secondary to impaired function of the vocal cords or respiratory disease (CN X)
Dysarthria
- Difficulty in articulating words. - Impaired movement of the palate, tongue or lips - usually due to CNS lesions - Difficulty pronouncing “t” “m” “l” “g” (Parkinosnism)
Aphasia
- Loss of production or comprehension of spoken and/or written language - cerebral hemisphere damage usually left side - Two types: fluent (Wernicke’s) and non-fluent (Broca’s)
Wernicke’s v. Broca’s Aphasia
Wernicke’s- fluent- can hear the voice or read the print, but doesn’t understand the meaning. Can’t get message out Broca’s- non-fluent- can’t produce language (spoken or written) Leave out words or really slow speech
What are possible causes of numbness and paresthesias?
- Nerve root compression due to herniated disc - Anemia (pernicious) B-12 deficiency - Peripheral neuropathies - Metabolic: hypocalcemia, hypomagnesium - Hyperventilation syndrome - Medications (i.e. digoxin, heavy metal poisoning)
What are possible causes of intermittent weaknesses or paralysis?
- Think of myasthenia gravis - Hypokalemia - TIA
What are possible causes of persistent weakness or paralysis?
- Sequela of stroke - Peripheral neuropathies - Diabetic neuropathy - Demyelinating disease such as MS - Connective tissue disorder such as polymyositis - Muscular dystrophies
What can altered mood be attributed to?
- Alcohol and/or drugs - Depression - Dementia related to alcoholism, HIV, AIDS, or syphilis
Lethargic Patient
- appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep.
Obtunded Patient
- opens the eyes and looks at you, but responds slowly and is somewhat confused. - Alertness and interest in the environment are decreased.
Stuporous Patient
- arouses from sleep only after painful stimuli. - Verbal responses are slow or even absent. - lapses into an unresponsive state when the stimulus ceases. - minimal awareness of self or the environment.
Comatose Patient
- remains unarousable with eyes closed. - no evident response to inner need or external stimuli
Circumstantiality speech
- indirect and delayed speech - excessive use of detailsthat have no connection to the point
Derailment speech
- shifts topics with no apparent relation between the topics
Flight of ideas speech
- accelerated change of topics in a very fast but generally coherent manner
Incoherent speech
- incomprehensible speech - illogical
Confabulation speech
- fabrication of facts to hide memory impairment
Delusions
- false, fixed beliefs that are not shared by other members of the person’s culture
Illusions
- misinterpretations of real stimuli
Hallucinations
- subjective external stimuli the patient hears or sees that others don’t hear or see - auditory (schizophrenia) - visual (drug withdrawal, fever) - olfactory - gustatory, taste - tactile
Affect
The observable mood of a person expressed through their facial expression, body movements and voice - flat affect: lack of facial movement - does their affect reflect their mood?
What to asses in the patient’s speech?
- Quantity of speech: silent, excessive? - Rate: fast, slow? - Loud: loud, soft? - Articulation: speaking clearly? - Fluency: involves the rate, flow and melody of speech
When are speech hesitancy seen?
aphasia from strokes
When are monotone inflections seen?
schizophrenia or severe depression
What is circumlocution?
when words or phrases are substituted for the work a person can’t remember ex. “what you write with” for “pen”
Paraphasias
when words are malformed “I write with a den”, wrong “I write with a branch” or invented “I write with a dar”
How to test for CN I?
CN I: Olfactory Occlude each nostril and test different smells
How to test for CN II?
CN II: Optic Snellen eye chart or hand-held card; inspect fundi; screen visual fields by confrontation
How to test for CN II & III?
CN III: Oculomotor; CN II: Optic Inspect size and shape of pupils; test reactions to light and near response
How to test for CN III, IV & VI?
CN III: Oculomotor CN IV: Trochlear CN VI: Abducens Test extraocular movements in 6 cardinal directions of gaze; lid elevation; check convergence
How to test for CN V?
CN V: Trigeminal Palpate temporal and masseter muscles while patient clenches teeth; test forehead, each cheek, and jaw on each side for sharp or dull sensation; test corneal reflex
How to test for CN VII?
CN VII: Facial Assess face for asymmetry, tics, abnormal movements. Ask patient to raise eyebrows, frown, close eyes tightly, show teeth (grimace), smile, puff both cheeks