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PANCE > Neurology - 7% > Flashcards

Neurology - 7% Flashcards

1
Q

Altered Level of Consciousness / Coma

A

D/t systemic infx or metabolic problems or vascular events

Systemic approach to properly ID etiology and treat appropriately to prevent further damage

History and PE - neurological exam to r/o focal deficit

Consider ABC - airway, braething, circulation

  • CBC, electrolyte panel, Ca. mg, phosphorus
  • urine tox
  • Serum ammonia
  • ABG
  • blood culture
  • EKG and CXR

Imaging - CT scan, MRI diffusion and contrast, LP

Tx:

  • Admin thiamine and dextrose
  • consider naloxone for opiate OD
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2
Q

Alzheimer Disease

Neurocognitive disorders

A

Progressive cognitive decline; MC > 65yo

Sxs

  • apathy
  • Loss of executive fx, visual-spatial skill
  • anomia - can’t remember regular name for things
  • Disorientation

Dx

  • abn clock drawing test
  • CT scan - cerebral cortex atrophy
  • beta amyloid (senile) plaques, neurofibrillary tangles (Tau protein)

Tx

  • Acetylholinesterase inhibitors
    • Donepezil/Aricept, Rivastigmine/Exelon, Galantamine, Tacrine
  • NMDA Antagonist
    • ​Memantine/Namenda
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3
Q

Arteriovenous Malformations

A

Abn connection btwn arteries and veins, bypassing capillary; risk of ICH & epilepsy;

MC is supratenorial

Sxs

  • Seizures
  • Headache
  • focal neuro deficits

Dx

  • Angiography - gold std

Tx

  • Surgery - endovascular embolization
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4
Q

Bell’s Palsy

A

CN VII swelling - compression of nerve => hemifacial weakness/paralysis

A/w Herpes Simplex; r/o Ramsay Hunt Syndrome from Herpes Zoster

Sxs:

  • URI preceding
  • Acute unilateral facial weakness/paralysis - Upper and lower
    • can’t raise eyebrows
  • Decreased tearing
  • Orbicularis m. - can’t close eyelids
  • Dysgeusia - taste impairment
  • Ageusia - taste loss

Dx:

  • Lyme ddx
  • EMG if paralysis > 10 days

Tx:

  • short course of prednisone 60-80mg & acyclovir
  • eye patch for corneal abrasions
  • Sx decompression for CN VII
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5
Q

Cerebral Palsy

Neuromuscular Disorders

A

CNS disorder a/w muscle tone and postural abnormalities d/t brain injury during perinatal or prenatal period

Sxs

  • Spasticity** - hall mark
  • Intellectual/learning disabilities and developmental abnromalities
  • PE - hyperreflexia, limb-length discrepancies, congenital decfects

Dx

  • MRI if early suspicion

Tx

  • Tx spasticity w/ Baclofen or diazepam
  • braces
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6
Q

Traumatic Brain Injury

Closed Head Injuries

A

Brain dysfunction d/t outside force via violent blow to head

Sxs

  • Immediate or delayed sx = change in LOC
  • Personablity change
  • amnesia
  • increased ICP
  • Diploia, posturing

Dx

  • GSC
    • mild - post traumatic amnesia <1 d
    • mod - PTA >1 & < 7
    • sev - > 7d

Tx

  • golden hour emergency tx
  • depends on recoveray stage of pts
  • most are mild
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7
Q

Cluster

Headaches

A

middle aged Males

Sxs:

  • unilateral, usually behind eye
  • periorbital lacrimation
  • Horner’s syndrome
    • anhydrosis
    • ptsosis
    • miosis
  • severe
  • not relieved by stress- usu pacing

Dx - Brain MRI r/o maladies

Tx:

  • 100% O2, 6-10L for 15 minutes
  • Subcut sumitriptan
  • Prophy w/ CCB - verapamil
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8
Q

Complex Regional Pain Syndrome

A

Sxs

  • Preceded by direct, minor physical trauma
  • Pain OOP
  • disturbances of color/temp - mottled purple
  • Decr ROM
  • Dystrophic skin and nails

Tx - NSAIDs, prednisone, PT, antidepressants

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9
Q

Concussion

dx, tx

A

Dx:

  • CT if
    • +LOC
    • GCS < 15
    • Suspected open skull/basilar skull f
    • >2 eps of vomiting
    • >65 yo
    • amnesia > 30 mins prior to contact
    • MVA w/ ejection, pedestrian struck by car
    • fall > 3 ft
    • seizure
    • underlying bleeding/anticoag use
    • ETOH involvement
    • clinical deterioration
    • persistently AMS

Tx

  • athletic activities resumed gradually -
  • single concusion
    • +LOC or sxs > 15 mins = return to sports if asymp for 1 week
  • repeat concussion
    • +LOC or sxs > 15 min = return next season
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10
Q

Concussion

eti, sxs/Grades

A

Transient, traumatic brain dysfunction; consciousness may be lost but patients manifest only confusion, memory loss, and gait or balance difficulties

Sxs:

  • +/- brief LOC, amnesia => no structural abnormalities and no neurologic deficits
  • Negative CT scan

Grade 1

  • No LOC,or Post-traumatic amnesia
  • other symptoms resolve < 30 mins - return to sports if asymptomatic for 1 wk
  • mild TBI, GCS 13-15

Grade 2

  • +LOC
  • 1 minute or post traumatic amnesia that lasts > 30 min but < 1 wk
  • Return to sports when asymp at rest and exertion for at least 7 days

Grade 3

  • +LOC > 1 min
  • post traumatic amnesia & other symp last > 1 wk
  • Return in 1 mo if asymp @ rest and exertion for at least 7 days
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11
Q

Delirium

Neurocognitive Disorders

A

acute syndrome d/t med conditions, substance, intox, med w/d or SE => temporarily AMS

Sxs

  • Sepsis, sundowning, ETOH or opiate w/d
  • rapid onset, short term and reversible
  • agitation

Dx

  • disturbed LOC - decr attention or lack of env awareness
  • cognitive change - memory def, language disturbance, visual illusion or hallucinations
  • rapid onset w.in hrs or days
  • labs, CT, or MRI

Tx - underlying cause, sedation if necessary

  • haloperidol
  • do not use benzo - worse in elderly
  • same structure rountine every day
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12
Q

Diabetic Peripheral Neuropathy

A

Hyperglycemia -> vascular insufficiency -> nerve infarct

Sxs

  • Stocking/glove distribution
  • tingling, burning
  • abn pain and temp sensation
  • Gait imbalance - walk on rope and glass, cant feel position of feet

Dx

  • N conduction study
  • r/o etoh, nutritional deficient, multi myeloma, vit b12

Tx

  • Anticonvuls - Pregabalin, Gabapentin, tramadol
  • Tightly control blood glucose
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13
Q

Encephalitis

A

Eti - usually viral (MCC HSV, CMV if IMC)

Reye’s Syndrome - rapidly progressing encephalopathy w/ hepatic dysfx, usual post-flu/URI

    • Babinski, hyperreflexia
  • Aspirin/salicylate use, vomiting, confusion => seizures/coma

Sxs:

  • Flu like illness
  • fever, headaches, AMS
  • Seizures
  • Personality changes
  • exanthema

Dx:

  • LP and MRI
  • PCR for viruses
  • Kernig’s absent
  • Brudzinski absent

Tx:

  • Supportive care
  • Acyclovir 10mg/kg IV q8hr started promptly
  • Empiric abx given until bacterial mengitis r/o
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14
Q

Epidural Hematoma

A

Transient LOC from injury => LUCID => HA, unilateral weakness

traumatic IC hemorrhage after skull fracture => MC Middle menigeal artery => blood fills space btwn dura and skill

Dx

  • non contrast CT - unilat convexity - lens usually temporal region => Lemon

Tx

  • small - observation
  • severe - surgery => burr hole, trephination, craniotomy, craniectomy
  • Surgical craniotomy
  • ICP management - mannitol, hyperventilate, steroids, or ventricular shunt
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15
Q

Essential Tremor

Movement Disorders

A

Bilateral tremor of hands, forearm or head; Autosomal Dominant

Sxs

  • worse w/ intention (hand and head)
  • better w/ alcohol
  • no resting tremor

Tx

  • Propanolol - if severe or situational
  • Primidone (barbituate) if no relief w/ propanolol
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16
Q

Frontotemporal Dementia (Pick’s disease)

Neurocognitive disorders

A

Localized brain degeneration of frontotemporal lobes

marked personality change before memory changes

apathy, disinhibition -impulsive

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17
Q

Glascow Coma Scale

A

Score < 8 = coma or severe brain injury

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18
Q

Guillain-Barré Syndrome

Peripheral Neuropathy

A

Often present after immunization; post infectious cause Campylobacter jejuni = MC, EBV, HIV

Sxs:

  • Ascending paralysis - begins In distal limbs
  • Leg weakness => total paralysis of all 4 limbs; facial m, eyes, loss of reflexes

Dx

  • LP = ele CSF protein, normal WBC

Tx

  • IVIG Plasma exchange - remove circ ab
    • monitor PFTs for paralysis of chest m, diaphragm (resp failure)
    • good prog
19
Q

Huntington Disease

Movement Disorders

A

Autosominal Dominant chromoson 4; incurable neurodegenerative disease; Onset 30-50yo

Sxs

  • Behavioral => chorea* => dementia
    • ​Behaviora - personality, cognitive, irritability
    • Chorea - rapid, involuntary or arrhythmic mvmt of face, neck, limbs
    • Dementia - before 50yo +psychosis

Dx

  • CT - cerebral and caudate nucleus atrophy

Tx

  • No cure - fatal w/in 15-20 years
  • Tetrabenazine for chorea
20
Q

Lewy Body Disease

Neurocognitive disorders

A

Gradual, progressive decline in cognitive abilities

Prominent visual hallucinations, delusions

+ Parkinsonian sxs

21
Q

Meningitis

A

Eti: bacterial - MC S. pneumo or N. meningitidis (G+ diplococci) - likely if pt has a rash

Neonates = E. Coli / S. agalatiae; >50-60 = Listeria/Cryptococcus neoformans

Aseptic - usu viral and negative blood cultures

Sxs:

  • no mental status changes - r/o encephalitis
  • Kernig’s sign - neck pain w/ knee extension
  • Brudzinski sign - leg raise w/ bent neck

Dx:

  • LP - check if ICP and papillaedema - get a CT if unsure
  • Bacteria
    • Incr Protein, decr glucose (bacteria likes glucose), increased OP
  • Viral
    • normal pressure, increased WBC

Tx:

  • Aseptic - symptomatic or IV acyclovir for HSV
  • Bacterial - dexamethasone + empiric IV antibiotics (cephalosporin, Vanco, pencillin)
  • Household contacts - Tx with Rifampin, Cipro, Levaquin, azithro, ceftriaxone
22
Q

Migraines

Headaches

A

MCC F > M, genetics, usu presents with aura but no auras are MC,

Vessel vasoconstriction => vasodilation, rush of blood returns causing pain = vasospasms

Sxs:

  • unilateral, pulsatile
  • preceded by aura 4 to 72 hours - sensory indication
    • floaters, vision - sensitivity to light
    • sound worsens
    • gustatory
  • worsens w/ activity - patients like dark, quiet rooms

Dx:

  • clinical - image when 1st head, change in severity

Tx:

  • Abortive therapy
    • Mild - Execedrin w/ caffeine, NSAIDs, aspirin, tylenol
    • Moderate - Triptans - Sumotriptan
      • ​CI - unctrl HTN, PVD, CAD
  • Preventative therapy
    • TCAs - Amtriptyline (less sedating)
    • Topiramate/Topamax
    • Valproic acid
23
Q

Multiple Sclerosis

Neuromuscular Disorders

A

Autoimmune - Demyelination of CNS, plaques

Sxs

  • motor weakness; impaired coordination
  • Sudden vision loss; optic neuritis - monocular - picture on top of each other and upside down
  • LHermitte’s sign
  • Heat sensitivity - Uhthoff’s Phenomenon

Dx

  • CSF - oligoclonal bands w/ IgG
  • T2 flairs on MRI w/ contrast
    • ​Dawson’s fingers
  • ​Visual evoked potential testing

Tx

  • Beta interferons or Glatiramer acetate
  • IV methylprednisolone 500mg/d x 5d for acute attacks
24
Q

Myasthenia Gravis

Neuromuscular Disorders

A

Autoimmune - antibodies against Acetylcholine and attacks muscle

a/w thymoma - block of NM transmission

Sxs

  • Muscle weakness that gets progressively worse throughout day
  • EOM fatigue*** Diploia; ptosis
  • Cogan’s lid twitch - close eye gently and look up rapidly - affected eye falls back into prev position

Dx

  • ice bag test for ptosis
  • +ACh receptor antibodies
  • +MuSK antibodies

Tx

  • Pyridostigmine
  • Steroids for acute exacerbations, IVIG
  • Thymectomy - only after puberty and before 60yo
25
Q

Neoplasms

A

MC CNS Tumor in children - Astrocytomas, Medulloblastomas, Ependymonas

MC CNS Tumors adults - Gliomas,

Meningiomas *MC benign, a/w Neurofibromatosis Type 2

Sxs

  • Triad
    • early morning occurence
    • N/V
    • very severe
  • Increased ICP
  • Irritability, lethargy, Changes in behavior, gait and balance

Dx

  • Head CT or contrast MRI

Tx

  • Complete surgical removal of tumor
  • CS to reduce edema
  • Anticonvulsants
26
Q

Parkinson Disease

Movement Disorders

A

Basal ganglia degeneration in substantia nigra (extrapyramidal system)

loss of Dopamine

Sxs

  • Tremor at rest - disappears w/ voluntary movement => pill rolling
  • Cogwheel (catching and releasing) Rigidity
  • Akinesia - difficulty initiating motion
  • masked facies, shuffling gait

Dx

  • clinical

Tx

  • < 65 yo - Dopamine agonists - used in younger patients to delay levodopa (less SE)
    • Bromocriptine/parlodel, pramipexole/Mirapex, ropinirole/requip
  • >65
    • Sinemet (levodopa/carbidopa)
27
Q

Postconcussion Syndrome

Closed Head Injuries

A

Cognitive or behavioral manifestations present for few days to weeks following concussion

Sxs

  • chronic HA
  • short term memory difficulty
  • difficulty sleeping
  • Irritability/mood swings
  • Sensitivity to light + noise

Dx - clinical

Tx - symptomatic - PRN analgesic, brain rest

28
Q

Focal Seizures

A

Focal - discrete region of brain (in one cerebral hemisphere); structural; MC in eldery

May be proceeded by aura; can progress to generalized

Simple vs Complex

Simple Partial

  • consciousness fully maintained
  • focal motor sxs or somatosensory sxs w/o loss of consciousness

Complex Partial

  • impaired consciousness that lasts > 30secs
  • loss of awareness and similar to absence sz
  • blank stares, automatism (lip smacking or eyelid fluttering)
  • post ictal state - confusion or loss of memory

Dx

  • ECG and EEG, CT or MRI in adults
  • Electrolytes Na, Ca, Mg
  • Glucose, Preg test

Tx

  • Tx underlying cause
  • Phenytoin
  • Phenobarbital
  • Valproate
  • Lamotrigine
  • Gabapentin
29
Q

Generalized Seizures

A

Starts midbrain/brainstem and spreads to both cortices

Absence Seizures (Petite Mal)

  • kids “blank stare” - brief impairment of consciousness < 15 seconds
  • EEG - 3 Hz spike and wave activity
  • no post ictal state, loss of body tone
  • Resolves by 2oyo, if not progress to Grand mal
  • tx ethosuximide

Tonic-Clonic (Grand Mal)

  • Tonic - very stiff and rigid 10-60 seconds
    • respiration is arrested, hypothermic
  • Clonic - generalized convulsion and limb jerking
  • Postictal phase - confused state - minutes to hours
  • Dx - glucose, CT, EEG (rapid spike)
  • tx - phenytoin/dilantin
30
Q

Status Epilepticus

A

Single epileptic seizure that lasts > 5 mins OR 2 or more seizures w/in 5 min period w/o person returning to normal btwn them

Two forms - convulsive and non convulsive

Convulsive

  • contration/extension of arms and legs

Nonconvulsive

  • complex partial status epilepticus and absence status epilepticus
  • prolong ep of mental status change

Dx

  • check blood sugars, antiepileptic drug levels

Tx

  • MED EMERGENCY
  • Lorazepam - initial 0.1mg/kg or 4 mg - repeat if still seizing
  • phenytoin 20mg/kg
31
Q

Intracerebral Hemorrhage

Stroke

A

Hemorrhagic Stroke (15%)

Bleeding into the brain parenchyma

Eti - MC d/t sudden increase in HTN,

  • Ischemic stroke converts to hemorrhagic stroke - reperfusion causes bleeding into dead tissues = hemorrhagic

Sxs:

  • Abrupt onset of focal neurological deficity - sxs depending on location of bleed
    • Anterior or MCA - numbness and muscle weakness
    • Broca’s Area - slurred speech
    • Wernicke’s area - difficulty undertanding speech
    • PCA - vision
  • Headache that becomes worse and worse until obtunded

Dx:

  • Non contrast CT or MRI
  • CT angio for specific location

Tx:

  • BP control with IV labetalol
  • Reduce ICP - Mannitol
  • Craniotomy - skill removed to drain blood and relieve pressure
32
Q

Stroke - Ischemic

A

Ischemic (85%) vs Hemorrhagic

Risk factors: HTN*, athersclerotic disease, hypercholesterolemia, DM, Afib, carotid artery disease, smoking, age, fam hx, M

2/3 are thrombic; 1/3 are embolic

  • Thrombic - clot that forms inside the brain vessel, usu follows a TIA
  • Embolic - clot that forms elsewhere and travels to the brain - acute presentation

Causes lack of blood flow to a specific brain area - surrounding that area is the penumbra (is still perfused by collateral vessles; can be saved if reperfused quickly)

20% are lacunar infarcts, 20% embolic (cardiac or atherothrombic)

Sxs:

  • Facial drooping
  • Arm weakness
  • Speech difficulties
  • Time - get reperfused ASAP

Dx:

  • Non-contrast Head CT - differentiates btwn hemorrhagic and ischemic
  • MRI - tissue changes
  • Carotid duplex scan - degree of stenosis
  • EKG - MI or A-Fib
  • MRA - level of stenosis in head

Tx:

  • t-PA therapy - within 4.5 hours of onset.
    • Do not initiate if
      • > 3 h
      • unctrl HTN <185/110
      • bleeding disorder or anticoagulated,
      • hx of recent trauma or surgery
    • Do not give Aspirin within 24 hrs if + t-PA
  • Aspirin - best If given w/in 24 hr of symptom onset
    • if within 3 h - give thrombolytics
    • if > 3 h = give aspirin, if allergic give Clopidergrel/Plavix
  • Supprotive tx - ABC, O2, IV fluids
  • Gradual BP control
    • IV labetalol 20mg
    • Do not give antihypertensives unless SBP >200, DBO > 120, MAP >130mmHg
  • Carotid endarterectomy - if > 70% stenosed
33
Q

Stroke - Ischemic

Treatment

A

t-PA therapy - within 4.5 hours of onset.Do not initiate if

  • > 3 h
  • unctrl HTN <185/110
  • bleeding disorder or anticoagulated,
  • hx of recent trauma or surgery
  • Do not give Aspirin within 24 hrs if + t-PA

Aspirin - best If given w/in 24 hr of symptom onset

  • if within 3 h - give thrombolytics
  • if > 3 h = give aspirin, if allergic give Clopidergrel/Plavix
  • Supportive tx - ABC, O2, IV fluids

Gradual BP control

  • IV labetalol 20mg
  • Do not give antihypertensives unless SBP >200, DBO > 120, MAP >130mmHg

Carotid endarterectomy - if > 70% stenosed

Maintenance

  • BP control
  • Antiplatelet - ASA and Plavix
  • Statin
  • Aticoag with Afib
  • Blood glucose
  • Stop smoking
34
Q

Subarachnoid Hemorrhage

Stroke

A

Bleeding into the CSF - outside brain parenchyma

Eti:

    1. Traumatic injury
  2. Aneurysms - MCC saccular cerebral aka berry aneurysms
    • most on anterior Half
    • marfan’s syndrome
    • Rupture with ICP
  3. Arteriovenous Malformation

Sxs:

  • Sudden onset severe headache - THUNDERCLAP headache
    • worse headache of life
  • Nuchal rigidity - blood irritating meniges
  • Seizures
  • N/V
  • Decr LOC

Dx

  • Non contrast CT
    • ​most are negative if < 2 hrs, most sensitive > 12 h
    • if negative - do CSF
  • CSF via LP
    • Xanthochromia - yellowish blood
    • Fresh Red blood
    • C/i if ele ICP (??)
  • Cerebral angiograph y - gold to id area

Tx:

  • emergency surgery
    • Clip artery - pressure
    • Catheter to insert coil to promote clot formation
  • BP control - CCBs to prevent vasospasms
35
Q

Transient Ischemic Attack

A

Transient ep of neurologic dysfunction d/t focal brain, retinal or cord ischemia = no acute Infarction

Sxs:

  • Sudden onset neurological deficit < 24 hrs
  • Lasts < 1-2 hr
  • Atherosclerotic plaques reducs BF in ICA
  • 10% of TIA will have a stroke in 30 days

Dx:

  • Non contrast CT
  • MRI more sensitive
  • Carotid doppler US

Tx:

  • ABCD2 Score - likelihood of stroke In 2 days
  • risk is highest 24 hrs after initial event
  • Carotid endarterectomy if ICA or CCA stenosis >70%
36
Q

Subdural Hematoma

A

Head injury from fall => Sudden blow tears blood vessels, usu eldery w/ multiple falls => presents w/ neurological sx (AMS/neuro signs) => etoh or elderly

Sxs:

  • injury to bridging veins - acute = 48 hrs
  • subacute 3- 14 days
  • chronic > 2 wks = elderly
  • Blood collects btwn dura and arachnoid* mater

Dx

  • non contrast CT - crescent shape concave hyper density

Tx

  • same as epidural
37
Q

Syncope - Cardiac

A

Life threatening cause of syncope

Strng fam hx - sudden cardiac death before 50 yo, heart dz, symptoms (CP, palps, SOB)

eti:

  • Arrhythmias - MCC of cardiac syncope
  • ischemia
  • Valvular abn
    • aortic stenosis
    • cardiac tamponade
    • pacemaker malfunction
38
Q

Syncope - Neurogenic, Orthostatic, Metabolic, Psychiatric

A

Loss of consciousness/postural tone 2/2 acute decrease in cerebral blood flow - rapid recovery in consciousness w/o resuscitation

Four main etiologies

Neurogenic Syncope

  • Carotid sinus hypersensitivity
  • Prodrome sxs before LOC - dizziness, warm/cold, N, pallor, visual disturbances, hearing abns
  • Normal PE, and normal EKG

Orthostatic Hypotension

  • drop in systlic BP > 20mmHg or
  • Reflex tachcyardia of > 20bpm
  • Failure of veins to constrict when patient is upright = reduce cardiac output
  • MCC deH2O, meds (CCB/BB, alpha Blockers, nitrates, diuretics, TCA)

Metabolic

  • hypoglycemia, hypoxia

Psychiatric

  • aniety and panic disorders
  • young, no cardiac dz, multiple eps
39
Q

Syncope Work Up/ Diagnosis

A

Conditions that can mimic syncope but not true syncope - Seizures, stroke, sleep disturbances, ad incjury

Dx:

  • PE and comprehensive Hx
    • Get the #, frequency, and duration of episodes
    • Onset, triggers, position & recent changes prior to syncopal eps
    • Most patient w/ prodromes - Neurocardiogenic or orthostatic hypotension
    • Medications
  • Vital signs
  • EKG
  • TTE - structural heart disease
  • CT Scan
40
Q

Tension

Headaches

A

MC type, younger in 30s, stress*

Sxs:

  • a/w with stress triggers
  • bilateral, band like
  • non pulsatile, squeezing
  • can last 30 mins to 7 days

Dx: clinical

  • episodic - <15 days/month
  • chronic - > 15 days / month

Tx:

  • NSAID
  • Aspirin
  • Acetaminophen
  • Head & muscle relaxants
41
Q

Tourette Disorder

Movement Disorder

A

Involuntary motor and vocal tics; sxs present for > 1yr and age onset < 18yo

Sxs

  • throat clearing, blinking, lip smacking
  • Echolalia - imitate what you’re saying
  • Echopraxia - do
  • Palilalia - do or say
  • Coprolalia - curse word

Dx

  • Tourette - both motor and vocal ticks > 1 year before 21yo
  • Persistent Chronic Tic disorder
    • sing or multiple motor or vocal tick > 1 year
  • Provisional tic disorder
    • single or multiple motor and/or vocal tics present < 1 year

Tx

  • Clonidine or antipsychotic
  • tics tend to lessen over time
  • Pimozide
  • Haldol
  • Tetrabenazine
42
Q

Vascular Dementia

Neurocognitive disorders

A

2nd MC type - brain disease d/t chronic ischemia and multiple infarctions (lacunar infarcts)

HTN - most important RF

Sxs

  • Cortical - forgetfulness, confusion, amnesia, executive diff, speech abn
  • Subcortical - motor def, gait abn, urinary diff, personality changes

Tx - control HTN

43
Q

Vertigo

A

Sensation of movement in the absence of actual movement

Peripheral

  • sudden onset - intermittent
  • tinnitus
  • hearing loss
  • nystagmus - horizontal w/ rotary component
  • Dx with Dix Hallpike

Central

  • eti MS, brain tumor, head injury
  • Gradual onset - continuous
  • N/V
  • Vertical nystagmus
  • No auditory symptoms
  • motor, sensory, cerebellar deficits
  • Romberg sign

Dx:

  • Dix Hallpike - for nonfatigable causes = central etiology
  • Audiometry
  • EMG
  • MRI

Tx:

  • Peripheral
    • Vestibular suppressants to help w/ auditory sxs
    • Diazepam, Meclizine
    • Epley manuveur
  • Central
    • Deep head hanging manuveur
    • tx source

PANCE (15 decks)

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