Neurology Flashcards by Taylor Batson

Transient loss of vision in one eye in setting of TIA =

amaurosis fugax

How well did you know this?

Not at all

Perfectly

The first branch of the internal carotid artery is the

opthalmic artery (why amaurosis fugax happens in TIA)

How well did you know this?

Not at all

Perfectly

TIAs are NEVER caused by

hemorrhage; always by emboli or thrombosis

How well did you know this?

Not at all

Perfectly

Anterior cerebral artery lesion symptoms =

contra lower extremity weakness
personality changes
urinary incontinence

mild UE weakness

How well did you know this?

Not at all

Perfectly

Middle cerebral artery lesion symptoms=

Profound contra upper extremity weakness
Aphasia
Apraxia/neglect
Eyes deviate TOWARD the lesion side
Contra hemonymous hemianopsia w/ macular sparing

How well did you know this?

Not at all

Perfectly

Posterior cerebral artery lesion symptoms =

Prosopagnosia (inability to recognize faces)

How well did you know this?

Not at all

Perfectly

Vertebrobasilar artery lesion symptoms =

Vertigo
Nausea/vomiting
Loss of consciousness (drop attack)
Vertical nystagmus
Dysarthria and dystonia
Sensory changes in face/scalp
Ataxia
BILATERAL FINDINGS

How well did you know this?

Not at all

Perfectly

Posterior inferior cerebellar artery lesion symptoms =

Ipsilateral face
Contralateral Body
Vertigo and Horner’s syndromes

How well did you know this?

Not at all

Perfectly

Lacunar infarct symptoms =

ABSENCE of cortical deficits
Ataxia
Parkinsonian signs
Sensory probs
Hemiparesis (mostly face)
Possible bulbar signs

How well did you know this?

Not at all

Perfectly

Which test can be positive for stroke within an hour?

MRA

How well did you know this?

Not at all

Perfectly

Always do what before treating a stroke?

NON CON HEAD CT

How well did you know this?

Not at all

Perfectly

An intracranial neoplasm or mass is an absolute contraindication to

thrombolytic therapy for stroke

How well did you know this?

Not at all

Perfectly

CPR within 3 weeks that was traumatic is an absolute contraindication for

thrombolytic therapy for stroke

How well did you know this?

Not at all

Perfectly

Up to 6-8 hours after a stroke, what can be done?

Catheter retrieval of the clot (removes it like a corkscrew

How well did you know this?

Not at all

Perfectly

Best initial therapy for those arriving late for stroke care?

Aspirin!

How well did you know this?

Not at all

Perfectly

Which antiplatelet agent is ALWAYS the wrong answer?

Ticlopidine! No added benefit and it can cause TTP and neutropenia

How well did you know this?

Not at all

Perfectly

Manage __ stroke and __ stroke the same way

Anterior and middle cerebral artery strokes are managed the same way

How well did you know this?

Not at all

Perfectly

What needs to be done after initial stroke treatment?

Echo to look for clot origin
Carotid dopplers
EKG and holter monitor if EKG is normal
If a-fib is present, start warfarin, dabigatran, or rivaroxaban

How well did you know this?

Not at all

Perfectly

Young patients w/ no PMH who present with stroke should also have which tests?

ESR
VDRL or RPR for syphilis
ANA, double stranded DNA
Protein C, S, Factor V Leiden mutation, Antiphospholipid syndromes

How well did you know this?

Not at all

Perfectly

The younger the patient, the more likely the stroke is caused by

Vasculitis or hypercoagulable state

How well did you know this?

Not at all

Perfectly

Are thrombolytics indicated for TIA?

How well did you know this?

Not at all

Perfectly

Therapy for status epilepticus =

Benzos
Fosphenytoin if persists after 10-20 min
Phenobarb after another 10-20 min
General anesthesia after yet another 10-20 min

How well did you know this?

Not at all

Perfectly

Which blood tests need to be done on seizing patient?

Sodium
Calcium
Glucose
Creatinine
Magnesium
Liver and renal function

How well did you know this?

Not at all

Perfectly

Which non-blood tests need to be done for seizing patient?

Urine toxicology screen

Head CT urgently

How well did you know this?

Not at all

Perfectly

When should a first seizure patient be started on chronic antiepileptics?

Strong family hx of seizures Abnormal EEG Status epilepticus requiring benzos Brain tumor

First line antiepileptics =

valproic acid carbamazepine phenytoin leviteracetam

What is an AE of lamictal (lamotrigine)?

Stevens Johnson syndrome and severe skin reactions

Absence or petit mal seizures should be treated with

Ethosuximide

Treat mild parkinson's disease under age 60 with

anticholinergic agents such as Benztropine or Hydroxyzine

Treat mild parkinson's over age 60 with

Amantadine due to danger of anticholinergics in the elderly

First line tx for severe parkinson's includes

Levodopa/Carbidopa and dopamine agonists (pramipexole, ropinirole, cabergoline)

Additional meds for parkinson's if first line failes include

COMT inhibitors (tolcapone, entacapone) MAOi's Deep brain stimulation last resort

COMT inhibitors block dopamine metabolism and work best with

Dopamine based medications

The most common abnormality in multiple sclerosis is

optic neuritis

Best initial dx test AND most accurate test for MS is

MRI

Is there any reason to order a CT for MS?

What will you find on CSF of multiple sclerosis?

Oligoclonal bands ONLY if MRI is nondiagnostic

Disease modifying therapies for MS include

beta interferon, glatiramer, mitoxantrone, natalizumab, fingolimod, or dalfampridine

An anti-CD52 drug that inhibits lymphocytes and deters progression of MS is

Alemtuzumab

What is an adverse effect of natalizumab?

PML

For ALL patients with memory loss, order

Head CT B12 level Thyroid function testing RPR or VDRL

Head CT showing diffuse, symmetrical atrophy =

Alzheimer's disease MAYBE (dx of exclusion)

Standard of care for Alzheimer's =

Anticholinesterase inhibitors such as donepezil, rivastigmine, and galantamine

Pick's disease, aka frontotemporal dementia, will show __ on head CT or MRI

focal atrophy of the frontal and temporal lobes. Treat the same as Alzheimers!

Rapidly progressive dementia and presence of myoclonus =

Creutzfeldt-Jacob Disease. Patients way younger than Alzheimers

CSF shows ___ in CJD

14-3-3 protein (spares the patient a brain biopsy

Parkinson's disease + dementia =

Lewy Body dementia, VERY VERY VIVID hallucinations

Wet, Wobbly, Wacky =

Normal pressure hydrocephalus. Treat w/ shunt

Dx NPH with

LP plus clinical picture (normal pressure duh)

Diagnose Huntington's Disease/ Chorea with

specific genetic testing, inheritance is autosomal dominant

Give ___ for huntingtons movement disorder

tetrabenazine

Best initial abortive therapy for migraine is

sumatriptan or ergotamine

4 or more migraines per month, ppx with

beta blockers

Best initial therapy for cluster headache is

triptans or 100% oxygen

Ppx for cluster headaches =

calcium channel blockers such as verapamil

Dx test for temporal arteritis =

ESR is best initial test, but temporal artery biopsy is most accurate!

Delay in steroid treatment for temporal arteritis can result in

permanent vision loss

Obese young woman with headache and double vision =

pseudotumor cerebri Vitamin A use can cause!

LP in pseudotumor cerebri will show

markedly elevated pressure

Treat pseudotumor cerebri with

weight loss Acetazolamide Surgery if those fail

Generally all patients with vertigo should have what test?

MRI of the internal auditory canal

Vertigo alone with no hearing loss, no tinnitus, and no ataxia =

Benign positional vertigo

Idiopathic inflammation of the vestibular portion of the 8th cranial nerve

Vestibular neuritis

Is there hearing loss or tinnitus in vestibular neuritis?

Treat vestibular neuritis with

meclizine

Labyrinthitis is inflammation of

the cochlear portion of the inner ear

What are symptoms of labyrinthitis?

Hearing loss and tinnitis; self-limited

Treat Meniere's with

salt restriction and diuretics

Ataxia + hearing loss + tinnitus + vertigo =

Acoustic neuroma (8th cranial nerve tumor, related to Von Recklinghausen's)

Treat Wenicke-Korsakoff syndrome with

Thiamine first, then glucose

When a CNS infection is suspected, some patients will require you to

Do a head CT BEFORE an LP if there is a history of CNS disease, FND, papilledema, seizures, altered consciousness, or significant delay in the time to perform the LP

Gram negative pleomorphic occobacillary organisms on CSF =

Haemophilus

A normal protein level in CSF essentially excludes

bacterial meningitis

Glucose levels below 60 percent of serum levels are consistent with

bacterial meningitis

Best initial therapy for cryptococcus is

amphotericin and 5-flucytosine, followed by oral fluconazole

Treat lyme disease with

IV ceftriaxone or penicillin

Treat Rocky Mountain spotted fever with

doxycycline

The single most accurate test in TB of CSF is

PCR!

How to treat amoebic meningitis

Miltefosine and maybe amphotericine; steroids may help

Fever + AMS+ photophobia + stiff neck =

encephalitis

Almost all encephalitis in the US is caused by

Herpes

How to dx encephalitis?

PCR, NOT brain biopsy Treat with acyclovir

Ring-enhancing brain lesion basically means either __ or __

cancer or infection

Brain lesions of progressive multifocal leukoencephalopathy are not associated with

ring-enhancement or mass effect

Patient from Mexico with a seizure =

neurocysticercosis

Multiple 1cm cystic lesions on head CT =

neurocysticercosis; treat with albendazole

Neuro symptoms in the setting of hypertensive crisis, preeclampsia, or cytotoxic meds like cyclosporine =

Posterior Reversible Encephalopathy Syndrome

What is the goal pCO2 when trying to constrict cerebral blood pressures in increased ICP?

pCO2 of 28-32 (hyperventilation)

Do steroids help intracranial hemorrhage?

Head trauma, burns, and ET intubation with mechanical ventilation can have what adverse effect?

Stress ulcers; treat with PPIs

Subarachnoid hemorrhage is associated with what EKG finding?

T-wave inversion

To be sure an increased WBC is a sign of infection, check the

ratio of WBCs to RBCs (normal is 1:500)

Diagnose syringomyelia with

MRI

ALS is treated with

Riluzole

How does Riluzole work?

Blocks accumulation of glutamate in ALS

Wasting, fasciculations, and weakness are ___ motor neuron signs

Lower

Radial nerve palsy results in __

wrist drop

High boots pressing at the back of the knee can lead to

peroneal nerve palsy; self limiting

Treat bell's palsy with

steroids

Chronic regional pain syndrome, AKA reflex sympathetic dystrophy, can be treated with

NSAIDs, gabapentin, and occasionally nerve block. Surgical sympathectomy may be necessary

The most urgent step in suspected Guillain Barre is

peak inspiratory pressure due to impending diaphragm weakness

Best initial test for myasthenia gravis =

Anti-acetylcholine receptor antibodies

If pyridostigmine or neostigmine do not work for myasthenia gravis, last resort is

thymectomy for <60 yo