Neurology Flashcards
1
Q
retinal detachment
A
- separation of retina from pigmented ep layer, can occur spontaneously or 2ary to trauma or extreme myopia
- sxs: curtain of darkness with periph flashes, preceding post vitreous detachment (flashes of light, floaters, feeling of heaviness in eye, acute onset, painless vision loss (peripheral to central loss), blurred or blackened vision over several hours, partial or complete monocular blindness
- dx: detached retinal flapping in vitreous humor
- tx: emergent ophthal consult, remain supine w/ head turned to side of detachment, laser surg or cryosurg
- Prognosis: 80% recover w/ no recurrenc, 15% require retreatment, 5% will never reattach
2
Q
upper motor neuron lesion
A
- degeneration of frontal motor neurons located in the motor strip (Broadman area 4) and their axons traversing the corona radiata, internal capsule, cerebral peduncles, pontine base, medullary pyramids, and the lateral corticospinal tracts of the spinal cord
- sxs: weakness with slowness, incoordination stiffness, poor dexterity
- hyperreflexia (ankle clonus)
- spasticity (spastic gait with poor balance and leg flexor spasms)
3
Q
lower motor neuron lesion
A
- degeneration of lower motor neurons in the brainstem and spinal cord producing muscle denervation
- sxs: weakness (hand - diff manipulating small objects and writing; pros arm - difficulty bathing, dressing, grooming, eating; foot/ankle - tripping, slapping gait, falling; proximal leg - cannot arise from chair, climb stairs, or get up off floor; upper face - incomplete eye closure), atrophy, fasciculations, muscle cramps
4
Q
amyotrophic lateral sclerosis (Lou Gehrig’s dz) etiology and sxs
A
- amyotrophy with the pathological finding of lateral sclerosis, 65-70yo, M>F, peak 70-80s but can occur in 20s, sporadic, only 10% familial
- sxs: asymmetric limb weakness (80%) - upper extremity onset - hand weakness but may begin in shoulder girlde, lower extrem weakness of foot dorsiflexion (foot drop)
- bulbar sxs: dysarthria, dysphagia, coughing, choking, inc masseter tone and diff opening mouth (trismus), laryngospasm
- autonomic sxs: constipation, urgency without incontinence, excessive sweating, early satiety, bloating
- parkinsonism and supranuclear gaze palsy (facial masking, tremor, bradykinesia, postural instability), sensory tingling, resp muscle weakness, generalized weakness, wt loss
5
Q
amyotrophic lateral sclerosis (Lou Gehrig’s dz) dx and tx
A
- dx: upper and lower MN signs and sxs, progressive spread
- EMG: fibrillations, positive sharp waves
- electrodiagnostics: dec motor conduction velocity
- MRI (preferred) to ro other causes
- unilateral arm onset (MC) = contralateral arm → ipsilateral leg → contralateral leg → bulbar muscles
- unilateral leg → contralateral leg → ipsilateral arm → contralateral arm → bulbar muscles
- tx: riluzole 50mg BID
- AE: asthenia, dizziness, GI upset, elevated LFTs
- MCC death: progressive resp failure
- complications: aspiration
- median survival: 3-5y
6
Q
peroneal nerve palsy
A
- caused by lateral knee trauma (lateral collateral ligament) and injury of the common peroneal or superficial peroneal nerve, develops in 35% of PLC injuries
- sxs: paresthesias in the distribution of the peroneal nerve, prolonged foot drop
- signs: assess sensation and lower extremity strength (dorsiflexion, eversion), observe pts’s gait and look for foot drop
- dx: EMG/NCS - helps to differentiate from L5 root lesion (denervation in L5 mm outside of the peroneal territory) and peroneal nerve palsy (focal slowing in peroneal nerve at fibular head)
- tx: Ice, compression, analgesics x 48-72h
- health maintenance: ice should only be applied intermittently for treatment, generally for no longer than 15min q2h to prevent foot drop
7
Q
mononeuropathy, radiculopathy, hypoesthesia, anesthesia, hypoalgesia, analgesia
A
- mononeuropathy: individual peripheral nerve prob, dx clinically based on signs and sxs, aslo consider carpal tunnel syndrome
- radiculopathy: refers to pathology affecting nerve root which is expressed by signs and sxs in a corresponding dermatome
- hypoesthesia: dec ability to perceive pain, temperature, touch, vibration
- anesthesia: complete inability to perceive pain, temp, touch, or vibration
- hypoalgesia: dec sensitivity to painful stimuli
- analgesia: complete insensitivity to painful stimuli
8
Q
vascular disorders
A
- in most individuals, right common carotid originates from innominate (brachiocephalic0 artery, which is typically the first branch off the aortic arch, and the left CCA arises as the second branch off the arch
- the CCA bifurcates into the ICA and ECA at level of C4 to C5 intervertebral space
- ICA continues superiorly and gives rise to its first major branch, the ophthalmic artery in the subarachnoid space
- ICA then bifurcates into anterior and middle cerebral arteries, ICA divided into prepetrous, petrous, cavernous, and supraclinoid segments
9
Q
degrees of stenosis and helpful indications and definitions
A
- mild stenosis <50%, moderate stenosis = 50-69%, severe stenosis >70%
- carotid artery stenting (CAS) indications: sxatic pts at average or low risk of complications associated with endovascular intervention when diameter of lumen of ICA reduced by >70% by noninvasive imaging or >50% by catheter-based imaging with corroboration
- Carotid endarterectomy (CEA): sxatic pts with average or low risk and >5y life expectancy (perform within 2wks of ischemic event)
- routine long-term FU imaging of extracranial carotid circulation not recommended
- hyperperfusion syndrome is a potentially deadly complication from CAS or CEA
10
Q
carotid artery stenosis etiology and sxs
A
- extracran ICA stenosis >80% +/- sxs of ischemia
- asxatic refers to presence of narrowing of ICA in pts wo hx of recent ipsilat ischemic stroke or TIA
- sxatic refers to neuro sxs caused by TIA or ischemic stroke in carotid artery territory and ipsilat to sig carotid atherosclerotic pathology
- sxs: partial or complete blindness in one eye and absent pupillary light response, contralat homonymous hemianopsia, hemiparesis, hemisensory loss, aphasia (L hemisph), L visuospatial neglect (R hemisph), unilat limb shaking, trans loss of monocular vision w light, does NOT cause vert, lightheadedness, or syncope
- signs: carotid bruit, fund exam (arterial occlusion or ischemic damage to retina)
11
Q
carotid artery stenosis dx
A
- dx: cerebral angiography (gold standard) - permits use of entire carotid system, provides info about tandem atherosclerotic dz, plaque morph, collat circulation, identifies ppl who would benefit from endarterectomy (CEA)
- carotid duplex US (noninvasive, but hairline residual lumens can be missed and can overestimate degree of stenosis)
- MRI (less accurate for detecting moderate stenosis, more expensive, time consuming, pt must lie still, renal insuff can be an issue)
- CT angio (CTA) - impaire renal fn is relative contraind since contrast bolus must be given (DM/CHF)
12
Q
carotid stenosis tx
A
- asxatic bruits: start antiplatelet tx, statin, manage DM, tx HTN, healthy lifestyle, carotid endarterectomy (>80% stenosis), recurrent TIAs on med tx, duplex US, CAS only for high-risk pts
- sxatic bruits: manifested as recent TIA or ischemic stroke and ipsilateral CAS, anticoag (warfarin), CEA, CAS as alternative to CEA for sxatic pts at average or low risk of complications when lumen diameter of ICA is reduced by >70%
13
Q
acute epidural hematoma
A
- classic: talk and die
- collection of blood between dura and bones of the skull
- MCC: trauma
- MC affects temporoparietal region, 2/2 laceration of middle meningeal artery
- progressive sxs: hx of trauma with overlying skull fx, brief LOC, return to alterness (lucid interval), HA, V, lethargy, hemiparesis (coma 20%)
- signs: associated hematoma
- dx: noncon CT (lens shaped extraaxial collection of blood that doesnt cross suture lines)
- tx: urgent neurosurg consult, if evidence of herniation (pupil dilation or contralat hemiparesis) - burr hole ipsilateral to trauma, decrease ICP
- complications: herniation
14
Q
acute subdural hematoma
A
- MCC: trauma
- other RF: ETOHism, szs, coagulopathies
- Collection of blood between dura and arachnoid mater; source is bridging veins
- sxs: nonspecific nonlocalizing sxs or absent, stable, or rapidly progressive HA< confusion, dpressed LOC, +/- szs
- signs: hemiparesis - contralateral to lesion; ipsilateral pupillary dilation (75%)
- dx: CT scan - hyperdense crescent-shaped extraaxial collection of blood, rarely crosses falx or tentorium, subacute lesions (2-3wks) = isodense
- tx: immediate hosp, emergent neurosurg consult, unstable pts with rapidly worsening neurologic deficits - treat for increased ICP
15
Q
subarachnoid hemorrhage
A
- bleeding into the CSF; outside brian parenchyma
- RF: smoking, HTN, cocaine, ETOH use, 1st deg relative with SAH< F, AA, CT disorders
- sxs: thunderclap HA, sudden onset severe HA, sudden transient LOC, N/V, neck pain, nuchal rigidity, photophobia, visual changes, dec LOC, sz
- signs: HTN, retinal hemorrhage
- locations: saccular aneurysms at bifurcations of arteries of the circle of willis
- dx: fundoscopic exam, noncon CT, LP (CI in elevated ICP, thrombocytopenia, suspected epidural abscess, xanthochromia, elevated RBCs)
- blood in CSF, xanthochromia (yellow CSF) is gold standard for dx, CT angio
- tx: supportive care, admit, stool softeners (avoid straining), analgesia for HA, IV fluids, lower BP using CCB, vraniotomy and clippin (definitive), treat BP aggressivelyhigh mortality, most repleed occurs within first 3d after rupture
- complications: rerupture, vasospasm, hydrocephalus, SIADH, HTN
