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PANRE > Neurology 6% > Flashcards

Neurology 6% Flashcards

1
Q

Complex regional pain syndrome, presentation

A

Non-dermatomal limb pain usually following a trauma or surgery.
Upper or lower limb pain, swelling, reduced range of motion, skin changes, and bone demineralization.
Pain is disproportionate to the injury with continuing pain that is disproportionate to any inciting event.

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2
Q

Complex regional pain syndrome, symptoms; signs

A

Sensory: hyperalgesia and/or allodynia.
Vasomotor: skin, temperature, color asymmetry.
Pseudomotor/edema: edema, sweating changes, or sweating asymmetry.
Motor/trophic: decreased range of motion or motor dysfunction and/or trophic changes (hair, nail, skin).

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3
Q

Peripheral neuropathies

A

Symmetric distal sensory loss along with burning pain or weakness.

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4
Q

Peripheral neuropathies, slow onset in stocking glove (hands and feet) pattern; fast onset; ascending

A

Diabetes mellitus, uremia.
Drugs.
Guillain-Barre Syndrome.

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5
Q

Cluster headache

A

Severe, unilateral, periorbital pain, lacrimation, and nasal congestion.
More common in men (4:1).
Treatment: 100% oxygen.

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6
Q

Migraine

A

Unilateral (70%), throbbing, disabling pain, nausea, vomiting, photophobia.
Classic: Aura.
Common: No aura (80% of migraines).

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7
Q

Migraine, treatment

A

Abortive: Triptans (do not use in ischemic heart disease), ergotamine (do not use in pregnant women).

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8
Q

Tension headache

A

Bilateral, non-throbbing, band-like or “vice like” pain.
A tension-type headache is typically described as bilateral, mild to moderate, dull pain, whereas a migraine is typically pulsating, unilateral, and associated with nausea, vomiting, and photophobia or phonophobia.

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9
Q

Tension headache, treatment

A

NSAIDs, Excedrin, muscle relaxer.

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10
Q

Encephalitis

A

May present similar to meningitis but will see altered mental status, seizures, personality changes, exanthema.
Encephalitis is clinically differentiated from meningitis by altered brain functioning.

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11
Q

Encephalitis, etiology

A

Usually viral: Most common species: HSV or Immunocompromised: CMV.

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12
Q

Meningitis, symptoms; signs

A

Classic Triad: Fever, headache, stiff neck, petechiae (especially N. meningitidis).
Kernig’s sign: knee extension causes pain in neck (Remember K = Kernig’s and K = Knee).
Brudzinski’s sign: leg raise when bend neck.

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13
Q

Meningitis, CSF findings: bacterial; viral

A

↑ Protein, ↓ Glucose (bacteria love to eat glucose) there is a markedly increased opening pressure.
Normal pressure, increased WBC (lymphocytes).

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14
Q

Essential tremor

A

Bilateral intention tremor of the hands, forearm, and/or head without resting component.
Family history in 50-70% of patients, autosomal dominant inheritance.
Elderly patients.
Worse on intention. Hands and head.
Better with alcohol.
Less likely to be unilateral.

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15
Q

Huntington Disease

A

Inherited autosomal dominant neurodegenerative disease characterized by progressive motor and psychiatric dysfunction, dementia, and chorea (nonrepeating, complex, involuntary rhythmic movements that may appear purposeful).
Genetic testing: 40+ CAG repeats.

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16
Q

Parkinson disease

A

Resting/pill rolling tremor, masked facies, cogwheel (catching and releasing), bradykinesia, and shuffling gait.
Decreased dopamine in substantia nigra.
Lewy bodies.

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17
Q

Cerebral aneurysm

A

Weak, bulging spot on the wall of a brain artery very much like a thin balloon or weak spot on an inner tube.
Usually found either incidentally or when a patient presents with subarachnoid hemorrhage.

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18
Q

Cerebral aneurysm, symptoms

A

Before a larger aneurysm ruptures, the individual may experience such symptoms as a sudden and unusually severe headache, nausea, vision impairment, vomiting, and loss of consciousness.
A key symptom of a ruptured aneurysm is a sudden, severe headache (the worst headache of my life).

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19
Q

Cerebral aneurysm, types

A 
Saccular (Berry), Fusiform, dissecting, Mycotic, and Traumatic.
Ruptured saccular (berry) aneurysm accounts for approximately 75% of nontraumatic cases of SAH and has a mortality rate of 50%.
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20
Q

Cerebral aneurysm, diagnosis

A 
Noncontrast head CT is the initial investigational modality for suspected SAH.
Lumbar Puncture (LP) with evaluation of CSF reveals markedly elevated opening pressures and RBC in CSF. Xanthochromia (CSF protein > 150 mg/dL or serum bilirubin > 6 mg/dL) - if the blood has been in the CSF for over 2 hours.
Cerebral angiography (Gold Standard) should be done to evaluate the entire vasculature.
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21
Q

Cerebral aneurysm, treatment

A

Surgical clipping or endovascular coiling is usually performed within the first 24 hours.

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22
Q

Intracranial hemorrhage, epidural hematoma:

A

Transient loss of consciousness from an injury, period of lucency, then neurologic deterioration.
CT: lens-shaped, biconvex.

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23
Q

Intracranial hemorrhage, subdural hematoma

A

Elderly patient with a history of multiple falls who is now presenting with neurological symptom. May be chronic, taking days to weeks to develop symptoms.
CT scan: Crescent shaped density in the brain.

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24
Q

Intracranial hemorrhage, subarachnoid hemorrhage

A

“Explosive thunderclap” headache described as “the worst headache ever.” Aneurysm or AVM rupture.

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25
Q

Stroke

A

Acute onset of focal neurologic deficits resulting from - diminished blood flow (ischemic stroke) or hemorrhage (hemorrhagic stroke).
Contralateral paralysis, motor function. Right-sided symptoms = left side stroke, Left-sided symptoms = right side stroke.

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26
Q

Stroke, Carotid/Ophthalmic

A

Amaurosis fugax (monocular blind).

27
Q

Stroke, MCA

A

Aphasia, neglect, hemiparesis, gaze preference, homonymous hemianopsia.

28
Q

Stroke, ACA

A

Leg paresis, hemiplegia, urinary incontinence.

29
Q

Stroke, PCA

A

Homonymous hemianopsia.

30
Q

Stroke, Basilar Artery

A

Coma, cranial nerve palsies, apnea, drop attach, vertigo.

31
Q

Stroke, Lacunar infarcts

A

Occur in areas supplied by small perforating vessels and result from atherosclerosis, hypertension, and diabetes (silent, pure motor or sensory stroke, “Dysarthria-Clumsy hand syndrome”, ataxic hemiparesis).

32
Q

Stroke, diagnosis; treatment

A

CT without contrast for acute presentation - important to diagnose as ischemic or hemorrhagic.
For occlusive disease treat with IV tPA if within 3-4.5 hours of symptom onset.
Can consider intra-arterial thrombolysis in select patients (major MCA occlusion) up to 6 hours after onset of symptoms.
For embolic disease and hypercoagulable states give warfarin/aspirin once the hemorrhagic stroke has been ruled out.
Endarterectomy if carotid > 70% occluded.

33
Q

Transient ischemic attack

A

An episode of neurologic dysfunction due to focal brain, retinal, or spinal cord ischemia without acute infarction.

34
Q

Transient ischemic attack, large artery low flow TIA (stenosis

A

Likely carotid stenosis causing short live (minutes) decrease in flow to the brain.

35
Q

Transient ischemic attack, embolic TIA

A

Emboli often form in the heart (afib, septic emboli from endocarditis).

36
Q

Transient ischemic attack, clinical manifestations, internal carotid artery

A

Amaurosis Fugax (monocular vision loss - temporary “lampshade down on one eye”) weakness in the contralateral hand.

37
Q

Transient ischemic attack, clinical manifestations, ICA/MCA/ACA

A

Cerebral hemisphere dysfunction. Sudden headache, speech changes, confusion.

38
Q

Transient ischemic attack, clinical manifestations, PCA

A

Somatosensory deficit.

39
Q

Transient ischemic attack, clinical manifestations, vertebrobasilar

A

Brainstem/cerbral symptoms (gait and proprioception).

40
Q

Transient ischemic attack, diagnosis

A

CT (without contrast), MRI more sensitive, carotid doppler to look for stenosis, CT angiography, MR angiography.

41
Q

Transient ischemic attack, treatment

A

Carotid endarterectomy if internal or common carotid artery stenosis is > 70%.
Aspirin within 24 hours. Antiplatelet therapy (e.g., aspirin or clopidogrel or aspirin-dipyridamole) should be then initiated.

42
Q

Level of consciousness

A 
A. Eye opening:
4- spontaneous
3- voice
2-pain
1-none
B. Verbal:
5-oriented
4-confused
3-inappropriate words
2-incomprehensible
1-none
C. Motor:
6-obeys commands
5-localizes pain
4-withdraws
3-abnormal flexion (decorticate)
2-abnormal extension (decerebrate)
1-none

Scoring
Maximum score is 15 which has the best prognosis
Minimum score is 3 which has the worst prognosis
Less than 9 is a coma

43
Q

Cerebral palsy

A

Prenatal injury perinatal hypoxia or ischemia, preterm baby.

Hyperreflexia, rigidity, intellectual impairment, seizures.

44
Q

Concussion, Grade 1

A

No LOC, post traumatic amnesia and other symptoms resolve in < 30 minutes.
Athlete may return to sports if asymptomatic for one week.

45
Q

Concussion, Grade 2

A

+ LOC , 1 minute or post-traumatic amnesia and other symptoms last > 30 minutes but < 1 week.
Athlete may return to sports in 2 weeks if asymptomatic at rest and exertion for at least 7 days.

46
Q

Concussion, Grade 3

A

+ LOC > 1 minute or post-traumatic amnesia and other symptoms last > 1 week.
Athlete may return to sports in 1 month if asymptomatic at rest and exertion for 7 days.

47
Q

Concussion, repeat concussions

A

If associated with either loss of consciousness or symptoms for more than 15 minutes NOT to return to play sports for that season.

48
Q

Dementias, Alzheimer’s disease

A

Most common.
Definitive diagnosis on autopsy - beta amyloid plaques and neurofibrillary tangles.
Abnormal clock drawing test.
Treat with Anticholinesterase drugs (Tacrine, Donepezil).

49
Q

Dementias, vascular dementia

A

2nd most common type.
Correlated with a cerebrovascular event and/or cerebrovascular disease.
Stepwise deterioration with periods of clinical plateaus.

50
Q

Dementias, Lewy body dementia

A

Fluctuating cognition associated with parkinsonism, hallucinations and delusions, gait difficulties, and falls.

51
Q

Dementias, frontotemporal dementia

A

Personality changes precede memory changes.

52
Q

Delirium

A

Acute, fluctuating mental status change caused by a medical condition.
Delirium is rapid in onset, short term and reversible.

53
Q

Delirium, underlying organic causes; treatment

A

UTI, pneumonia, metabolic changes, CVA, MI, TBI, medications (anticholinergics, benzodiazepines, opioids). Treat underlying cause.

54
Q

Guillain-Barré syndrome

A

Symmetrical ascending paralysis beginning in distal limbs, following Campylobacter jejuni infection, will often present after immunization.
Weakness begins in lower extremities; respiratory paralysis if no treatment.
Treatment: admit, plasmapheresis or IVIG.
Good prognosis.

55
Q

Multiple sclerosis

A

Autoimmune - antibodies against myelin sheath.

56
Q

Multiple sclerosis, symptoms

A

Often first finding: retrobulbar optic neuritis.

Other symptoms: numbness, tingling, balance disturbance, diplopia.

57
Q

Multiple sclerosis, diagnosis

A

MRI: Dawson fingers (white matter lesions).
CSF: Elevated IgG, oligoclonal bands.

58
Q

Multiple sclerosis, relapsing remitting

A

Most common, 85% (symptoms come and go).

59
Q

Multiple sclerosis, secondary progressive

A

Relapsing remitting progresses to steady decline.

60
Q

Multiple sclerosis, primary progressive

A

No remission, steady decline from onset.

61
Q

Multiple sclerosis, progressive relapsing

A

Combination. Worse overtime with acute relapses. Most rare.

62
Q

Myasthenia gravis

A

Autoimmune attack of acetylcholine receptors at the neuromuscular junction results in motor problems.

63
Q

Myasthenia gravis, presentation

A

Young women, older men. Weakness in everyday activities like brushing hair.
Proximal to distal weakness: eyes: ptosis usually first.

64
Q

Myasthenia gravis, diagnosis

A

Diagnose with acetylcholine receptor antibodies.

Tensilon test/edrophonium test- short acting anticholinesterase.

PANRE (9 decks)

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