Neurology Flashcards
Amaurosis fugax
Monocular vision loss- temporary “lamp shade down one eye”. Seen in TIA from internal carotid artery
Pathophysiology of Huntington dz
Autosomal dominant neurodegenerative d/o of cerebral/caudate nucleus atrophy
Clinical symptoms of Huntington dz
1) dementia
2) chorea: rapid involuntary movements
3) behavioral changes
Pathophysiology of Parkinson’s dz
Idiopathic dopamine depletion with unspooled acetylcholine
What part of the brain does Parkinson’s effect
Basal ganglia
Clinical manifestations of Parkinson’s
1) tremor: resting
2) bradykinesia
3) rigidity
4) instability
5) fixes facial expression
Parkinson’s treatment
Levodopa /carvadopa (levodopa is converted to dopamine )
- dopamine agonist
- anticholinergics ( decrease acetylcholine)
- MAOI ( selegiline)
Pathophysiology of Guillain Barre Syndrome
Demyelination of peripheral nerves following a URI
MC bacteria predisposing a patient to Guillian Barre
Campylobacter jejuni
Diagnosis of Guillain barre syndrome
CSF!!!!!
*high protein with normal WBC, “albuminocytological dissociation”
Treatment of Guillain Barre
1) plasmaphoresis
2) IVIG
* PREDNISONE CONTRAINDICATED
Pathophysiology of myasthenia Gravis
Autoantibodies against acetylcholine receptors, inhibiting skeletal muscle firing
What other d/o is highly associated with myasthenia Gravis? (75%)
Thymine abnormality: hyperplasia or thymoma
Management of myasthenia Gravis
Pyridostigmine: acetycholinesterase inhibitors
Pathophysiology of multiple sclerosis
Autoimmune inflammatory demyelination of the CNS
3 types of multiple sclerosis
1) relapsing remitting (MC)
2) Progressive: constant decline without exacerbations
3) secondary progressive: relapsing-remitting that becomes progressive
Clinical manifestations of MS
1) SENSORY: trigeminal neuralgia, worse with heat (uhthoff phenomonon) , Lhermitte sign (neck flexion sends pain down leg)
2) OPTIC: optic neuritis , Marcus-Gunn pupil (dilates on swinging light test)
3) UPPER MOTOR NEURON: spasticity with babinski
4) BLADDER: incontinence
5) CHARCOT’s NEURO TRIAD: 1) nystagmus 2) tremor 3) staccato speech
MS diagnosis
1) MRI with gadolinium : at least 2 white matter plaques
2) LP: IgG oligoclonal bands
Acute MS exacerbation to
1) steroids
2) plasmapheresis
Relapsing remitting / progressive multiple sclerosis TX
Beta-interferon
Medications that can precipitate actor angle closure glaucoma
sympathomimetics, anticholinergics
Patient complaints when experiencing actor glaucoma
unioccular pain, HALOS around lights, peripheral vision loss, tunnel vision
physical exam in acute angle closure glaucoma
steamy cornea, fixed-non reactive pupil
Management of glaucoma
- acetazolamide (decreases aqueous humor production)
2. timolol drops (decreased intra ocular pressure.
Treatment of choice for absence seizures
ethosuxamide
treatment of status epilecticus
lorezapam (increases GABA)
phenytoin (blocks Na channels)
phenobarbital (binds to GABA to increase it)
In what nerve distribution is Bell’s palsy and what disease does it have a strong association with?
Cranial nerve VII
associated with HSV reactivation
Is there eyebrow involvement in bell’s palsy?
YES, there must be complete paralysis of that side of face
Bell’s palsy treatment
prednisone
Abortive drugs for migraine headaches
*the goal is to increase serotonin and decrease dopamine which will cause vasoconstriction. **do not use these drugs if any CAD or PVD present.
1) Triptans and Ergotamines (increase serotonin)
2) Metachlopromide (decrease dopamine) **give with benadryl to prevent tariff dyskinesias
Prophylactic drugs for migraine headaches
HTN meds such as BB, CCB, TCA, AED
Essential tremor:
aggravating and alleviating factors and treatment
ACTION tremor, relieved with alcohol
treat with propranolol
Actute and prophylactic treatment of cluster headaches
actute=100% oxygen, 6-10 L
prophylactic=VERAPAMIL
How is the brain effected in a patient with alzheimers ?
amyloid deposition, neurofibrillary tangles (tau proteins), as well as cerebral cortex atrophy **causes a cholinergic deficiency
Alzheimers treatment
1) ach-esterase inhibitors; Donepezil (aricept)
2) NMDA antagonist ; memantine
4 types of dementia and their ahllmarks
1) alzheimers; memory first
2) Vascular; from many lacunar infarcts
3) Frontotemporal dementia; picks dz, PERSONALITY changes
4) Lewy Body Dementia; hallucinations, delusions, parkinsonism
What is the MC primary CNS tumor in adults
glioblastoma multiforme aka grade IV astrocytoma
What is a cushion’s reflex?
irregular respirations, hypertension, bradycardia in the presence of severe glioblastoma multiform
Glioblastoma multiforme presentation on CT or MRI
mass with hypodense center, a variable ring of enhancement surrounded by edema
Meningioma hallmarks
usually benign, arise from DURA
-on bx you may see spindle cells, whorled pattern, or psammoma bodies (calcifications)
CNS lymphoma hallmarks
- epstein barr virus is a risk factor
- ring enhancing lesions on imaging
- methotrexate is the most effective chemo
Hallmarks of hemangiomas
- MC from the brainstem and cerebellum
- foam cells with high vascularity on bx
most common pathogen and tx for meningitis in a child
group B. strep, listeria
tx with ampicillin
most common pathogen and tx for meningitis in 1mon-18 year old
nisseria meningitis , s. pneumo
tx with ceftriaxone and vancomycin
most common pathogen and tx for meningitis in 18-50 y/o
S. pneumo, N. meningitis
tx with ceftriaxone and vancomycin
most common pathogen and tx for meningitis in adult >50
S. pneumo, listeria
tx with ceftriaxone and ampicillin maybe vancomycin
in what age ranges are you concerned about listeria meningitis
less than one month
greater than 50 years
What causative organism of meningitis is highly associated with the petechial rash
N. meningitis
LP findings consistent with bacterial meningitis
LOW glucose
high protein
neutrophils
LP findings consistent with viral meningitis
NORMAL glucose
lymphocytes
normal protein
MC cause of encephalitis
HSV, you can treat with valcyclovir
Treatment for restless leg syndrome?
Pramipexole, Ropinirole
-These are dopamine agonists
What is Broca’s Aphasia?
Frontal lobe nonfluency, comprehension preserved with sparse output (you can understand what is being said to you, but you can’t formulate a response)
What is Wernicke’s aphasia?
Fluent aphasia (voluminous, meaningless) with markedly impaired comprehension
(you are speaking a lot of nonsense, but can’t comprehend what is being said to you)
Treatment of a TIA
ASA and plavix
Workup of a TIA
- CT head
- Carotid u/s
- CT or MR angiography
- Blood glucose
- Echo
What are the 4 presentations of a lacunar infart?
- Pure motor (MC)
- Ataxic hemiparesis worse in leg than arm
- Dysarthria clumbsy hand syndrome
- Pure sensory loss
An infarct in the middle cerebral artery would present how?
- UPPER EXTREMITY involvement
- Facial droop opposite lesion
- gaze towards the side of the lesion
An infarct in the anterior cerebral artery would present how?
- LOWER EXTREMITY
- face spared
- personality changes, flat affect
- urinary incontinence
An infarct in the posterior cerebral artery would present how?
Visual hallucinations, contralateral homonymous hemianopsia, drop attacks
What is xanthocromia?
Yellowing of the CSF due to subarachnoid hemmorhage
Side effects of dilantin/phenytoin
gingival hyperplasia, rash, hypotension, arrythmia
Order of treatment in status epilepticus
- Benzo-lorazepmam is most effective because it has the shortest 1/2 life
- Phenytoin-stabilizes neuronal membranes without causing CNS depression
- Phenobarbitol-binds to GABA receptor to potentiate GABA mediated CNS inhibition
