Neurology Flashcards
Essential Familial Tremor
Autosomal dominant inherited disorder
Sx: Intentional tremor (postural, bilateral action tremor of hands, forearms, head, neck or voice)
Worse with emotional stress and intenitonal movement
Alcohol relieves sx
Tx: None needed but Propranolol if severe
Parkinson’s Disease
Dopamine depletion, failture to inhibit acetylcholine in basal ganglia
Sx: Tremor worse with rest or emtoional stress, Pill-rolling tremor (resting)
Bradykinesia: slowness of voluntary movement, lack of swining arms while walking, shufflint gait
Rigidity: Increased resistance to passive movement (flexed posture)
Fixed facial expressions, seborrhea of skin
Tx: Levodopa/Carbidopa - MOST EFFECTIVE
Dopamine Agonists (Bromocriptin, Pramiprexole), used in young patients to hold off on use of Levodopa/Carbidopa
Anticholingergics: Block excitatory cholingergic effects, used in elderly with tremor as primary sx (Benztropine, Trihexyphenidyl)
Amantaidein
Selective MAO-BE Inhibitors (Selegiline, Rasagiline)
Huntington’s Disease
Autosomal dominant neurodegenerative disorder
Sx: Initially behavioral changes (personality, cognitive, intellecutal, psych), Chorea and Dementia
Restlessness, fragility
Dx: CT shows cerebral and Caudate Nucelus atrophy
Tx: No cure, Antidopaminergic agents for chorea
Guillain Barre Syndrome
Acute/Subacute inflammatory demyelinating polyradiculpathy with SYMMETRIC LOWER TO UPPER EXTREMITY WEAKNESS (ASCENDING WEAKNESS)
Seen with Camyplobacter, CMV, EBV
Sx: Decreased DTR, weakness and parastehsias
Tachycardia, hypotension/HTN
Dx: CSF shows high protein with normal WBC
Tx: Plasmaphersis to remove harmful autoantibodies
IVIG to suppress inflammation
Myasthenia Gravis
Autoimmune disorder of peripheral nerves, against acetylcholine post synaptic receptor at neuromuscular joints
PROGRESSIVE WEAKNESS WITH REPEATED MUSCLE USE AND RECOVERY WITH PERIODS OF REST
Sx: Ocular weakness: Diplopia, Ptosis (eyelid weakness more prominent with upward gaze)
Generalized muscle weakness: least in morning, worse with repeated use through day, weakness with prolonged chewing, dysphagia, respiratory muscle weakness that can lead to respiratory failure
Dx: Tensilon Test (Edrophonium): rapid response to short acting IV edrophonium
Positive Ach-receptor antibodies, ice-pack test
Tx: Ach-ase inhibotors (Pyridostigmine, Neostigmine)
Immunosuppression with corticosteroids, Azathioprine, cyclosporine
Multiple Sclerosis
Autoimmune inflammatory demyelinating disease of CNS
Degeneration of white matter of brain, optic nerve and spinal cord
Relapsing-remitting
Progresisve disease
SEcondary Progressive (relapse remitting pattern that becomes progressive)
Sx: Optic Neuritis (unilateral eye pain worse with eye movements, diplopia, scotoma/vision loss, blurry vision)
Sensory Deficits: Weakness, parastehsias, fatigue, some sx worsen with heat (hot tubs, fever, exercise), Neck pain may cause shocking pain radiating from spine down to leg when neck is flexed
Spinal Cord: Bladder or bowel dysfunction, Nystagmus, stacatto speech, intentional tremor, Babinski reflex
Dx: MRI with Gandolinium (see white matter plaques)
CSF: High IgG in CSF
Tx: Steroids for acute
Beta0Interferon for relapse-remitting/progressive
Amantadine for fatigue
Alzheimer’s Disease
Loss of brain cells, amyloid deposition in brain, neurofibrillary tangles
Cerebral cortex atrophy noted on CT
Tx: Ach-esterase inhibitors (Donepezil, Rivastigmine, Galantamine)
MNDA antagonists: Memantine
Cluster Headaches
Unilateral periorbital/temporal sharp lancinating pain lasting less than 2 hours
Horner’s Syndrome: potsis, miosis, anhydrosis, nasal congestion/rhinorrhea, conjunctivitis
Tx: Oxygen, SQ Sumatriptan during attack
Verapamil 1st line prophylaxis, steroids
Migraine Headaches
Common: Without Aura
Classic: With Aura
Lateralized mulsatile/throbbing headache associated with N/V, photophobia, phonophobia that lasts from 4-72 hours
Tx: Abortive tx is Triptans, IV Dihydroergotamine
Dopamine blockers for N/V
Beta-blocker or CCB for Prophylaxic, TCA
Tension Headache
Bilateral tight band-like, vise-like constant daily headachse worse with stress, fatigue, noise or glare
Tx: Like Migraines, NSAIDS, TCA, Beta blockers
Trigeminal Neuralgia
Compression of Trigeminal Nerve root by superior cerebellar artery or vein
Sx: Brief, episodic, stabbing, lancinating pain in the 2nd/3rd division of Trigeminal Nerve, WORSE WITH TOUCH, EATING, DRAFTS OF WIND AND MOVEMENTS, Usually unilateral
Tx: Carbamazepine is 1st line
Gabapentin in young people or MS
Ischemic Stroke
Middle Cerebral Artery is most common type
-Contralateral sensory/motor loss/hemiparesis, greater in face/arms than leg/foot
-Gaze preference towards side of lesion
-L side dominant will have aphasia
-R side dominant will have spatial deficits, dysarthria, L-side neglect
Dx: Non-Contrast CT
Tx: Thrombolytic therapy if within 3 hours of onsent of sx (rTPA Alteplase)
Antiplatelet Therapy: ASA, Clopidogrel, Dipyridamole
Subarachnoid Hemorrhage
Sudden worse headache of my life, thunderclap
Usually due to rupture of berry aneurysm
Brief LOC, N/V, meningeal irritation
Dx: CT
Tx: bedrest, avoid training, anti-axiety meds
Epidural Hematoma
Arterial Bleed between skull and dura
Usually to due skull fracture disrupting Middle Meningeal Artery
Sx: Brief LOC, coma, headache, N/V
Dx: CT shows convex (lens shape), does NOT cross suture lines
Subdural Hematoma
Venous bleed between dura and arachnoid
Usually due to tearing of briding veins
Due to blunt trauma
Dx: CT shows concave (crescent-shaped), can cross suture lines
TIA
Transient episode of neurological deficits without acute infarction
Usually due to Embolus
Sx: Internal Carotid Artery monocular vision loss, lamp shade down on one eye, weakness contralateral hand
ICA/MCA/ACA: Speech changes, confusion
Vertebrobasila: Brainstem/cerebella sx like gain and proprioception
Dx: CT scan to rule out hemorrhage
CVA risk assessment (age, blood pressure, Clinical features, duration, DM
Carotid Doppler to look for stenosis
CT Angiography
Tx: ASA, Clopidogrel (Plavix), THROMBOLYTICS ARE CONTRAINDICATED
Place supine, avoid lowering BP
Bell’s Palsy
Idiopathic unilateral CN 7 (facial nerve) palsy
Usualy due to HSV, VZV, Lyme Disease
FAcial weakness from inflammation or compression
Sudden onset, unilateral facial paralsyis
UNABLE TO LIFT AFFECTED EYEBROW OR WRINKLE FOREHEAD, can’t smile, loss of nasolabial fold, drooping of corner of mouth, taste disturbance
Dx of exclusion
Tx: Prednisone, should be started within 72 hours of sx
Artificial Tears
Acylovir
Bacterial Meningitis
STREP PNEUMO IS MOST COMMON CAUSE but depends on age
Sx: Fevers, chills, meningeal sx (headache, nuchal rigidity), photosensitivty, N/V, seizures
Kernig’s Sign: INability to straighten knee with hip flexion
Brudzinski Sign: Neck Flexion produces knee/hip flexion
Dx: Lumbar Puncture CSF
-High PMN, Low Glucose, High Protein, High CSF Pressure
<1 month old: Group B Strep, Lysteria, E.Coli, S. Pneumo, Tx with Ampicillin + Cefotaxime
1 month-18 years: N. Meningitidis, Strep. Pneumo, H. INfluenza, Tx with Vancomycin + Ceftriaxone
18yrs-50yrs: Strep.Pneumo, N. Meningitidis, H. Influenza, Listeria, Tx with Vancomycin + Ceftriaxone
Elderly: Strep. Pneumo, Listeria, Gram Negative Rods, Tx with Ampicillin + Ceftriaxone
Post-Exposure Prophylaxis: Cipro or Rifampin
Simple Partial Seizure
Consciousness maintained
May have focal sensory, autonomic motor sx
Complex Partial Seizure
Consciousness Impaired
Auras, lip smacking, manual picking, patting
Absence seiazures
Brief impariment of consciousness, patient usually unaware of attacks
Brief staring episode, eyelid twitching
Tx: Ethosuximide, Valproic Acid
Tonic-Clonic Seizure (Grand Mal)
Loss of consciousness
Rigidity and arrest of respiration, repetitive rhythmic jerking followed by flaccid phase of coma/sleep
Auras may occur
Tx: Valproic Acid, Phenytoin, Carbamazepine, Lamotrigine
Myoclonus Seizure
Sudden, brief, sporadic involuntary twithcin
No loss of consciousness
Tx: Valproic Acid, Clonazepine
Atonic Seizures
Drop Attacks, sudden loss of postural tone
Amyotrophic Lateral Sclerosis
Necrosis of both upper and lower motor nuerons
Progressive motor degeneration with normal sensory function
Sx: Loss of ability to initate and control motor movements with mixed UMN and LMN signs
Progessive bilateral fasciculations, msucle atrophy, spasticity, hyperreflexia
Tx: Riluzole
