Neurology Flashcards
cauda equina syndrome vs conus medullaris syndrome
CES: spinal roots, more radicular pain, late onset fecal and urinary incontinence, arreflexia
CMS: early onset fecal/urinary incontinency, hyperreflexia- mix of LMN and UMN
heat stroke symptoms
temp over 104
CNS dysfunction
rhabdo, renal failure, resp failure, DIC
non traumatic SAH is most commonly due to
ruptured berry aneurysm
most common cause of IC hemorrhage in children
cerebral AV malformation
another word for vasovagal syncope
neurocardiogenic syncope
what is hypertensive vasculopathy
charcot bouchard aneurysm due to high BPs can cause deep intracerebral hemorrhage like putaminal or lenticular hemorrhage
bilateral trigeminal neuralgia caused by
MS
what the thresholf for hyperglycemic hyperketotic state
blood sugar >600
more commonly >1000
sphenoid bone fracture will cause what kind of brain bleed
acute EPIdural hematoma
Spinal Epidural Abscess
- signs: back pain, fever, neurological symptoms (you may see distended bladder)
spreads hematologically from staph infection.
need MRI of spine to diagnose
spinal cord compression symptoms
focal back pain
early: hyporeflexia of LE, symmetric LE weakness
late: hyper-reflexia, Babinski, paralysis
Uhthoff syndrome?
worsening MS in warm temp
acute headache, nausea, blurry vision, sluggish and dilated pupil
angle closure glaucoma
what meds cause acute angle closure glaucoma
decongestants, antiemetics, anticholinergics
essential tremor
tremor with intention motion
migraine medical treatment
acute: sumitriptan and NSAIDs
prophylactic: Amitryptiline, B blocker, topimirate
dopamine pathways
- nigrostriatal- movement disorders
- mesolimbic- psychotic disorders like hallucinations or euphoria
- tuberoinfundibular- prolactin
HSV encephalitis CSF findings
- lymphocytic pleocytosis
- RBC due to temporal lobe hemorrhage
- normal opening pressure, normal glucose
CSF OP > 250 but otherwise normal CSF
pseudotumor cerebri aka idiopathic intracranial htt
IIH/pseudotumor cerebri medication causes
Growth Hormone, tetracyclines, hypervitamin A (isoretinoin)
ischemic CN III palsy vs compression CN III palsy
inner somatic n
superficial parasympathetic
ischemic will affect inner n’s first and spare the pupils
whereas compression will affect both EOM and pupils
what is paradoxical agitation?
benzodiazepines can cause agression and agitation in the elderly (1%)
whats the mechanism by which low CO2 can cause decreased ICP
low CO2 causes cerebral vasoconstriction which decreases CBF
what are headache warning signs that would req early imaging
- new characteristics, is this diff from previous headaches
- onset >40 yo
- onset trauma
- present at awakening
- neurologic findings/defecits
what is the Wernicke Encephalopathy triad
gait ataxia, ocular dysfunction, and encephalopathy
what are amitrityline side effects?
anticholinergic - dry mouth
histamine- sleepiness
alpha agonist- ortho static hypotension
EBV DNA in CSF is specific for ?
primary CNS lymphoma
how do you treat severe cancer pain
short acting opioid
what are the treatment options for schitzophrenia suspected?
if pt is agreeable, do oral not IV or IM longacting!
there is no different btw the antipsychotics except for clozapine, which has severe agranulocytosis and should be saved for pts unreponsive to 1st line tx
fasciculations are 1. upper? 2. lower? motor neuron findings?
fasciculations indicate LMN damage
where is Broca’s area
Dominant Frontal Lobe
what is wallenberg syndrome
it is a lateral medullary infarct
can cause ipsilateral face and contralateral body loss of pain and temp
ipsilateral Horner’s and bulbar symptoms
vestibulocerebellar impairment.
what is subclavian steal?
when the subclavian A is stenosed and steals reverse blood flow from vertebral A.
symptoms include asymettrical BPs in UE, dizziness with exercise of UEs, and parasthesia in UE
how to manage acute MS flare
GC, 2nd line plasmapheresis
where is the lesion causing hemineglect
R (non dom) parietal lobe
for what kind of stroke would you order a contrast vs noncontrast CT?
hemorrhagic- non contrast
ischemic- contrast
cavernous sinus thrombosis
infection from face affects cavernous sinus and causes ICH. CN III , IV, and VI are affected.
most common cause of spontaneous (non traumatic) lobar hemorrhage in >60 yo
amyloid angiopathy
most likely AE of status epilepticus
cortical necrosis
drop arm test- what is it? whats it sensitive for?
passively raise pt’s arm over head, and have them bring it back down. if they suddenly drop the arm and are unable to lower it in a controlled fashion it is indicative of a supraspinatous injury.
GBS treatment
supportive care
IVIG
plasmapheresis
what would hypokalemia present as in clinic?
what about on EKG?
in clinic: muscle weakness, cramping, and decreased DTR
U waves, flattening of T wave, PVCs,
syringomyelia clinical findings?
muscle wasting, motor weakness, loss of pain and temperature in arms and hands/ or capelike distribution
-dorsal columns spared
who would benefit from carotid endartectomy?
- symptomatic- has had TIA
- WITH carotid occlusion of 70-99%
without both of these pts can do anti-platelets and statin therapy
steppage gait is caused by?
L5 radiculopathy or common peroneal neuropathy
following a subarachnoid hemorrhage whats a risk in the first day? whats a risk after 3 days?
- rebleed within 24 hr
- cerebral vasospasm
alcoholic cerebellar degeneration
> 10 yrs alcoholism causes toxic injury to purkinje cells in cerebellar vermis, leading to problems with gait/falls in the setting of a normal sensory exam.
Pick’s disease
behavioral variant of Frontaltemporal dementia. 1. behavior changes 2. hoarding/compulsivity 3. executive function/memory
how to treat delirium?
Haloperidol
SCC vs cauda equina vs conus medullaris
a sensory level excludres CES
conus has back pain, urinary incontinence but is less likely to have sensory involvement or weakness
SCC has a clear sensory level with sensory loss and incontinence and weakness
asymmetric ascending paralysis over the course of hours
tick toxin release
MRI of Alzheimer’s
temporal and parietal atrophy
expecially hippocampi
what is the theory for NPH pathophysiology?
decrease of CSF absorption or some form of obstruction causes a a transient increase in pressure, but the ventricles increase in size and pressure normalizes
central cord syndrome vs anterior cord syndrome
central- usually following whiplash, causes decreased sensory and motor in arms and spares the legs
anterior- trauma injury to ASA, loss of motor and sensory of pain/temp
CT showing minute punctate hemorrhages and blurring of grey and white interface
diffuse axonal injury
Riluzole
glutamate inhibitor approved for ALS. can prolong life span and time to trach
intracranial hypertension
headache worse at night, nausea/vom, focal changes ex- vision
lumbar spinal stenosis prov/palliation
prov- extension ex: standing or walking downhill
pall- flexsion, ex- sitting or walking uphill
acute dementia and sharp triphasic on EEG is?
CJD
thalamic pain syndrome
paroxysmal burning pain esp sensitive to light touch
cluster headache treatment? prophylaxis?
tx- 100% O2, IM Sumitriptan
ppx- Lithium, Ca ch blocker
botulinum treatment
equine antitoxin therapy
TPA window
3-4.5 hr
Livedo Reticularis
a mottled skin appearance
an AE of amantidine
anterior shoulder dislocation
causes injury to axillary n
happens when force applied to ex rot, abducted shoulder.
Parkinsonian gait
narrow based, shuffling, fenistrating, hypokinetic, no movement of arms
Brown Sequard symptoms
ipsilateral hemiparesis, loss of proprioception and light touch at LEVEL of injury and below
contralat loss of pain and temp 1-2 BELOW LEVEL of injury
what does MRI of brain mets look like?
multiple circumscribed lesion at gray and white matter junction with surround edema
treating a Myasthenia Crisis
HOLD the pyridostigmine
give plasmapheresis, or IVIG, with corticosteroid
central cord syndrome
UE weakness that spares the lower extremities
caused by hyperextension in a pt with osteoarthritis
whats the treatment for idiopathic intracranial hypertension?
acetalzolamide +/- furosemide
how to work up amaurosis fugaux?
carotid doppler
2 most common causes of brain abscess
- strep viridans
- staph aureus
IIH most serious consequence?
blindness
extra axial well circumscribed meningeal mass?
meningioma
how can you tell apart ACA from MCA infarct
ACA: LE> UE affected
MCA: face/UE> LE affected.
pronator drift is sensitive for
pyramidal/corticospinal tract lesion
Neuroleptic Malignant syndrome
- fever
- rigidity
- autonomic dysfunction
- mental status change
Lewy Body Dementia
cognitive disturbance
Parkinsonism
visual hallucination
Multiple Systems Atrophy (shy drager syndrome)
Parkinsonism, orthostatic hypotension, autonomic dysfunction
corneal vesicles and dendritic ulcers
HSV keratitis
how to manage sunconjunctival hemorrhage?
- just observe for 48 hr, it should self resolve
usually benign and due to simple trauma
how to manage conjunctivitis?
simple viral- use cold compress
bacterial superinfection- give antibiotics, this will be more purulent
“curtain coming down over my eye” with preceding floaters
retinal detachment will show gray retina with tears
closed angle vs open angle glaucoma
closed angle is acutely painful eye, headache, and mid-dilated NR pupil
open angle is slower with a gradual loss of vision, seen in AA esp with diabetes and glaucoma hx.
acute angle glaucoma diagnosis
goniometry is ophtho available
tonometry in emergency
sudden loss of vision, floaters, can’t visualize fundus, red glow
vitreous hemorrhage most often due to diabetic retinopathy
dacrocystitis
infection of lacrimal duct. redness and pain over medial canthal region. purulent discharge sometimes
contact lens wearer gets corneal ulceration and injection of sclera, painful.
contact keratitis usually caused by pseudomonas or serratia
CMV retinitis vs HIV retinitis vs toxo chorioretinitis
CMV- yellow and fluffy with hemorrhages around vasculature
HIV- cotton wool, without hemorrhage, around vasculature
toxo- not around vasc
whats sympathetic ophthalmia
it is the “spared eye injury”. when one eye is injured and loses sight the other eye experiences disturbances due to an immune mediated reaction from the exposure of “hidden agents”
anterior uveitis
red painful eye, decreased visual acuity, hazy aqueous humor, pupillary constriction
assn with IBD, Sarcoid etc.
vertical lines in visual grid test seen as wavy and blurred is found in
macular degeneration
sudden painless loss of vision is most likely? treatment?
CRAO
give ocular massage to dislodge thrombus into a more distant branch of eye, and high flow O2.
what does CRVO look like on fundoscopy
blood and thunder
hemorrhage, dilated tortous veins, cotton wool spots
what does the visual fields of macular degeneration look like
central vision lost, with peripheral and navigational vision intact
retinal necrosis in HIV+ pt is caused by
HSV
what are the fetal hydrantoin features
- caused by use of AEDs in pregnancy
- midfacial hypoplasia, microcephaly, cleft palate/lip, hirsutism, developmental delay, hirsutism
homocystinuria
fair and marfanoid with hyperelasticity, thrombosis is common so watch out for stroke
give B6, folate, and antiplatelet agents
heat stroke complications
DIC (bleeding)
rhabdo
ARDS
renal failure
cherry red spot seen in blindness?
CRAO
how to reverse warfarin
vit K (can take a day)
prothrombin complex
FFP ( not preferred bc it takes time to prepare and infuse)
glactosemia
a def in galactose 1P uridyl transferase
cataracts, vomitting, jaundice, MR etc.
how is galactosemia diff from a galactokinase def or a UDP galactose 4 epimerase def
galactokinase- purely cataracts
UDP galactose 4 epimerase def- all of galactosemia + HYPOTONIA and sensorineural DEAFNESS
most common cause of spontaneous lobar hemorrhage in >60 yo
amyloid angiopathy, causes weakening of the vessels make a rupture and bleed out more likely. Esp common in alzheimers
CONUS vs CAUDA
CONUS- peri anal numbness, hyper-reflexia, early onset incontinence
CAUDA- saddle anesthesia, hyporeflexia , late onset incontinence
how to differentiate vascular dementia and alzheimer’s
alzheimer’s has early onset memory loss, but vasc has early onset executive function losses.
commando crawl baby with equinovarus deformity of lower extremities has what?
CP
shy drager syndrome
parkisonism + autonomic instability (post hypo, ED) + neuro signs
Myotonic Dystrophy genetics
AD
Myotonic Dystrophy features
myotonia (slow to release grip) dysphagia weak face catarcts frontal balding small testis cardiac conduction
glucocorticoid induced myopathy has what lab findings?
normal ESR and CK
carotid endartectomy indication
> 70% stenosis with symptoms
NPH caused by ?
decreased CSF absorption
