NEUROLOGY Flashcards
diagnosis:
weakness in LEs, flaccid paralysis and loss of pain + urinary retention following descending throacic aortic aneurysm surgery
spinal shock due to anterior spinal cord infarction
a potential complication of thoracic aortic aneurysm repair
MS treatment
IV methylprednisolone
plasma exchange if unresponsive
tx for pseudotumor cerebri
acetazolamide
amaurosis fugax
painless rapid and transient (<10min) monocular vision loss = like a curtain
d/t emboli from atherosclerosis in carotid artery
evaluate with duplex u/s of the carotid
open angle glaucoma
vs
acute closure glaucoma
open angle = insidious onset with gradual peripheral vision loss = tunnel vision; cupping of optic disc and increased itnraocular pressure
acute closure = acute onset with severe eye pain and blurred vision, nausea and vomiting (tx iv acetazolamide)
wide based gait after years of heavy alcohol use but cognition intact?
resolution possible?
alcoholic cerebellar degeneration
(degeneration of purkinje cells in cerebellar vermis) = alcohol neurotoxicity
alc cessation will prevent progression but not return to normal fxn
recurrent acute severe periorbital pain at night with autonomics (ipsilateral miosis, lacrimation) but not vision changes
dx?
tx?
cluster headaches
abortive tx is 100% oxygen
why is it important to assess symmetry in forehead innervation in bells palsy?
if forehead muscles are spared, this suggests intracranial lesion (central palsy)
vs a peripheral palsy where you lose ipsilateral forehead innervation
folic acid supplementation will correct anemia, however if it is given alone….
neuologic deficits will progress due to vitamin B12 deficiency
must give B12 WITH folic acid!
differences in how a stroke in the following places presents
1 MCA (mid cerebral artery)
2 ACA
3 PCA
1 MCA –> contralateral weakness/sensory loss, homonymous hemianopsia (loss of the opposite field so deviate toward lesion), and aphasia
2 ACA –> personality change/confusion, urinary incontinence, leg > arm weakness
3 PCA –> ipsilateral sensory loss of face, contralateral sensory loss of limbs, limb ataxia
tx of nonhemorrhagic and hemorrhagic stroke
<3 hrs since onset = thrombolytics
> 3 hrs = aspirin or add dipyridamole or switch to clopidogrel
hemorrhagic = nothing
every stroke patient should be started on ____ regardless of LDL
statin
when to operate on carotid stenosis?
> 70% stenosis
do not operate with 50% or under
HA that is more common in men?
cluster
HA with jaw pain and visual change
giant cell temporal arteritis
HA with diplopia (CNVI palsy) and obesity
pseudotumor cerebri
HA with tearing/rhinorhea
cluster HA
what do you do FIRST if you suspect giant cell arteritis?
start steroids without waiting for the biopsy results!!
migraine tx
ppx?
triptans + ergotamine as abortive tx
ppx propanolal
tx for cluster ha
prophylaxis?
triptans, ergotamine, or 100% oxygen
ppx verapamil
tx for pseudotumor cerebri
weightloss and acetazolamide (decrease csf) +/- ventriculoperitoneal shunt if needed
bandlike ha?
tx?
tension ha
tx with nsaids and acetaminophen
knifelike pain in face?
tx?
trigeminal neuralgia
carbamazepine or oxcarbazepine
zoster vaccine is indicated in…
all people 60+ to prevent shingles(herpes zoster)
status epilepticus
def?
best tx?
persistent seizure
benzodiazepine (IV lorazepam or diazepam)
if it persists, then give phenytoin or fosphenytoin(less s/e)
after that, next step would be phenobarbital
side effects of phenytoin
hypotension
AV block
when do you start antiepileptic drugs after a SINGLE seizure
usually you dont
you DO when: was status epilepticus or had focal neurologic signs abnormal eeg or lesion on ct or family hx of seizures
tx for absence seizures
ethosuximide
contrast vs no contrast on head ct/mri
use contrast when youre looking for lesions
dont use contrast if youre looking for bleeding!!
anterior spinal artery infarction
posterior column intact (position and vibration)
flaccid paralysis below level of lesion and loss of DTRs
loss of pain and T
2 main causes of loss of position and vibration sense (posterior cord)
B12 def and neurosyphilis = both lead to subacute degeneration of the cord
brown sequard syndrome
unilateral hemisection
loss of pain and T on contrlateral side and lose motor and positon/vibration on ipsilateral side
syringomyelia
def?
dx?
tx?
fluid filled dilated spinal canal leading to loss of pain and T bilaterally across upper back and arms = capelike distribution of atrophy
MRI
surgical intervention + drainage
tuberous sclerosis versus neurofibromatosis
TS = neuro abnormalities + skin nodules (adenoma sebaceum or ash leaf) + retinal lesions or cardiac rhabdomyomas
NF= neurofibromas (fleshy lesions on peripheral nerves) + CNVIII tumors + afe au lait spots + meningioma/glioma
sturge weber syndrome
port wine stain on face
seizures
and
CNS effects ( homonymous hemianopsia, hemiparesis, mR)
calcified angiomas on xray
essential tremor
presentation?
tx?
occurs at both rest and intention
caffeine makes it worse, alcohol makes it better
propanolol
parkinsons
mech?
presentation?
dx?
loss of substantia nigra (dopamine down)
tremor, cogwheel rigitdity, gait, bradykinesia
clinical dx, no test
what are the only drugs that can slow the progression of parkinsons?
MAO inhibitors (rasageline, selegiline)
single most effective med for parkinsons?
duration can be exxtended by?
levodopa-carbidopa
comt inhibitors (tolcapone, entacapone) to block dopamine metabolism
tx for restless leg syndrome
dopamine agonists like pramipexole
huntington disease
presentation?
dx?
tx?
choreoform movements + dementia + behavior change
genetic test, CAG repeats, caudate nucleus invovlement
cannot be reversed; tetrabenzine for dyskinesia and haloperidol or quetiapine for psychosis
Multiple sclerosis
presentation?
dx?
tx?
multiple neruo deficits often with visual effects like internuclear ophthalmoplegia (inability to adduct one eye with nystagmus in other), fatigue, cerebellar issues, hyperreflexia
MRI shows white plaques in the white matter of brain (central) +/- oligoclonal bands in csf
tx for acute attack = high dose steroids
prevention = Beta interferon
ALS presentation dx tx mc cause of death?
loss of upper and lower motor neurons, NO sensory loss
weakness starting in 20-40yo
dx electromyography shows loss of innervation in multiple muscle groups
tx: riluzole (prevent progression) and baclofen for spasticity
respiratory failure
charcot marie tooth disease
presentation
dx
tx
loss of motor and sensory –> wasting of legs, loss of distal sensory and DTRs, tremor
*look for foot deformity with HIGH ARCH (pes cavus)
dx electromyography
NO tx
nerve deficits = name the nerve
1 hypothenar wasting + 4th/5th finger pain
2 wrist drop/crutch use
3 pain/numbness on outerside of 1 thigh
4 pain numbness in ankle and sole that is worse with walking
5 decreased foot dorsiflexion and eversion
6 thenar wasting, first 3 fingers pain
1 ulnar 2 radial 3 lateral cutaneous nerve 4 tarsal tunnel (tibial nerve) 5 peroneal 6 median
paralyzed side of face
1) can wrinkle forehead on affected side?
2) cant wrinkle affected side?
1 stroke
2 bell palsy
gullain barre syndrome
autoimmune damage of multiple peripheral nerves (myelin sheaths)
NO CNS involvement
associated with campylobacter jejuni
ascending weakness and loss of reflexes
tx IVIG OR plasmapheresis (not both, no steroids)
myasthenia gravis
ab against ach receptors in nmj
double vision, chewing weakness, normal pupillary responses
weakness with sustained activity
dx ach receptor antibodies or electropmyography, or edrophonium test
tx neostigmine or pyridostigmine
tx for myasthenia crisis (severe overwhelming weakness in M patient)
IVIG or plasmapheresis
alzheimers
frontotemporal type?
tx
mc cause of dementia
see symmetric atrophy on mri
frontotemporal = emotional/social appropriateness/behavior is first sign, memory is later
donezepil, rivastigmine, or galantamine (all increase ach)
acute rapid dementia with myoclonic jerks, normal ct
csf with 14-3-3 protein
creutzfeldt jakob disease
