Neurology Flashcards
cerebrum
cortex functions in higher brain processes- controls voluntary.
frontal lobe: reasoning, problem solving, parts of speech, movement and emotion
parietal: perception, auditory stimuli, and speech
temporal : memory
occipital : visual
pons
regulates breathing
basal ganglia disorders
movement disorders - it helps with the coordination of movements (dyskinesia, dystonias, parkinson's, huntington;s) behavior control (tourette's and obsessive compusive)
parkinsonism
parkinson disease, dopamine antagonistic meds (haldol, metoclopramide),
Lewy body disease- loss of dopaminergic neurons.- recurrent hallucinations that are visual
TRIPTANS cannot be used with
Contraindications to their use include: ischemic heart disease (including coronary artery vasospasm [Prinzmetal angina], angina pectoris, myocardial infarction); stroke, transient ischemic attack, history of hemiplegic or basilar migraine; peripheral vascular disease (including ischemic bowel disease); uncontrolled hypertension; severe hepatic disease, `
rabies
negri body
Trigeminal neuralgia
common in MS
viral meningitis
most common cause is enterovirus
encephalitis
mc is herpes simplex
resting tremors
parkinson
postural tremor
occurs when holding position against gravity
lewy body disease
loss of dopaminergic aneurons- similar to parkinson symptoms - DEMENTIA (due to loss of anticholergic neurons), RECURRENT visual hallucination
huntington
caudate nucleus atrophy
-behavioral, chorea, dementia
cerebral and caudate nucleus atrophy
manage chorea- antidopaminergics. benzo for chorea and sleep
essential familial terror
BILATERAL!!!!- hands, forearms, head, neck and voice- worse with emotional stress and intentional movement
shortly relieved with ETOh
TX: PROPRANOL
parkinson’s
dopamine depletion- no inhibition of ACH in basal ganglia- LEW BODIES!!- loss of pigment cells seen in substantia nigra
RESTING TREMOR- pill roll- bradykinesia, rigityt, cogwhell, fixed facial expressions.
MYERSON: tap bridge of nose repetitively causes a sustained blink
INSTABILITY wth gait.
TX For parkinsons
levodopa/carbidopa: most effective!!! dopamine agonists: bromocriptine anticholinergics: (cuz parkinsons has too much ACH that are not inhibited- benztropine, trihexyphenidyl)- for the tremors Amantadine- increases dopamine release MA-B inhibits: selegline , rasagiline COMT inhibitors: entacapone, tolcapone
tourette syndrome
ASSOCIATED WITH Obsession compulsions
- too much dopamine also in basal ganglia
BLOCK THE DOPAMINE- haldol, risperdal
ALS lou gherig’s idsease
necrosis of both upper and lower motor neurons- eventual respiratory dysfunction
upper: spasticity, stiffness, hyperreflexia
lower motor neuron: bilateral fasciculations, muscle atrophy, hyporeflexia
SENSATION, URINARY sphincter, and volutnary eye movements ARE SPARED
cerebral palsy
injury during prenatal period= spasticity- UMN- development disability
BACLOFEN for the spasticty
REStless legs syndrome
sleep-related movement disorder
SECONDARY from CNS iron deficiency
- itching, burning, paresthesias in the leg that gives urge to move legs- worse at night- improves with movement
TX; DOPAMINE AGONISTS: pramipexole, ropinirole
GABAPNETINE
BENZO
opioids
GBS guillain barre syndrome
incidence with campylobacter jejuni- MC.
demyelinating polyradiculopathy of the peripheral nerves
SYMMETRIC weakness and paresthesias- immune response reacts with peripheral nerve components
ASCENDING WEAKNESS AND paresthesais - decreased DTR, breathing difficulty
TX:
plasmaphereissis!!!
IVIG!!!
DONT GIVE PREDNISONE
myasthenia gravis
autoimmune PERIPOHERAL nerve disroder
mc in young women
tymic ABNORMALITIES- hyperplasai or thymoma
AUTOIMMUNE ABX against ACETYLCHOLINE postsynaptic receptor at the NEUROMSUCULAR junction!- progressive weakness with repeated muscle use and recovery after periods of REST!
- ocular weakness, generalized ocular weakness- diplpia, eyelid weakness, PTOSIS!!!, generalized msucle weakness throughout the day- gets better with rest. BULGBAR weakess: with prolonged chewing
respiratory uscle wekness- myasthenic crissis!!
myasthenia dx and tx
dx: aceytlcholine receptor antibodies,
edrophonium test: rapid repsonse to short active edrophoium!!
CT SCAN - shows thymomA!!
tx:acetylcholinesterase inhibitors: pyridostigmine!!!!- incresaes acetylchonline!!!
PLASMAPHEREISIS OR IVIG!!- for myasthenic crisis!!
thymectomy
lambert-eaton
myastehnic syndrome- associate with sall cell lung cancer- weakness IMPROVES WITH REPEATED USE in LAMBERT~
MS
autoimmune- demylination of white amtter!!!
relapsing- remitting disease in the most common
TRIEGMINAL NEURALGIA!!!, worsening symptoms with heat, OPTIC NUERITIS!!!- unilateral eye pain worse with movements, diplolpia, central scotomas, vision loss (COLOR)- MARCUS-gunn pupil- pupils dilate in affected eye- during swinging flashing light
UPPER MOTOR NEURON- spasticitiy and positive babinski!!!
DX of Multiple SCLEROSIS
MRI- WHITE matter plaques!!!!!!!
lumbar puncture: iGG oligoclonal bands in CSF
ACUTE: IV corticosteroids and plasmapheriesis!!!
relapse-remitting: b interferron or glatiramere acetate
bells palsy
CNVII- facial nerve palsy- HEMIFACIAL weakness/paralysis due to infallmmmation and compression
LOWER MOTOR NEURON LESION
HERPES SIMPLEx VIRUS REACTIVATION
one side ear pain(hyperacusis), unilateral facial paralyasis, unable to lift affected eyebrow, wrinkle froward, smile on affecte side, drooping of the croenr of mouth, TASTE issues (anterior 2/3),
tx: prednisone
artificial TEAR!!!!
tension headaches
bilateral tight, band like vise like
no nausea, vomiting or focal neurologic symptoms
NSAIDS, Aspiprin, acetaminophen, ELAVIL
prophylaxis;: beta blockers
migraine headaches
migraine without aura
or migraien with aura( calssiC)
pulsatile/throbbing headache nausea, vomiting, photophobia, phonophobia- egoh, chocolate red wine makes it worse
aurus: visiual changes= light flashes, zig zag lines of light, scotomas, aphasia
auras usually last less than 60 minute!!! and then headache onset!!
tx for migraines
abortive: triptans or ergotamines: vasoconstriction- seratonin 5ht1 agonists!!- CI: CORONARY artery or peripheral vascular disease, unctrolled HTN!
dopamien blockers: METOCLOPRAMIDE!!!, promethazine
GIVEN WITH DIHYDRAMMINE TO PREVENT EPS, dystonic reactions
mild: nsaids
prophylactic: beta blockers, calcium channel blockers, TCA, anticonvulsants, NSAIDS
Trigeminal neuralgia
brief, episodic, stabbing/lancinated pain- worse with touch, eating, drafts of wind and movements- often UNLITERLA!
CARBAMAZEPINE!!!!!
cluster headache
unilateral periorobial/temporal pain- less than 2 hours!!!!!
several times a day over 6-8 weeks
ETOH, stress of ingestion of specific foods, WORSE AT NIGHT~
horner’s syndrome (ptosis, miosis, anhydrosis), nasal congestion/rhinorrhea, conjunctivitis and lacriatmation
TX: 100% oxygen, anti migraine meds- SQ sumatriptan!!!!,
VERAPAMIL - first line for propylaxis
pseudotuor cerebri
increased intracranial pressure- worse with strainging, visual changes- may lead to blindenss if not treated
MC I NOBESE children!
papilledema!!!
CT SCAN , then lumbar pucnture
TX: ACETAZolamidE!!!!!
normal pressure hydrocephalus
normal opening pressure on lumbar puncture- but dilation of the cerebral ventricles DEMENTIA GAIT DISTURBANCE URINARY INCONTINENCE!!!! ventriculoperitnieal shunt- tx
concussion
mild traumatic brain injury- alteration in mental status
confusion, amnesia
ehadache, dizzines,s visual, emotional instability, vomiting
ct scan
cognitive and physical rest: tx
delirium
transient confused state, rapid onset, fluncuating mental status change, SHORT TERM MEMORY !
dementia
chronic intellectual deterioration- memory loss and loss of impulse control!!! alzehimer's vascular frontotemporal diffuse lewy body
alzheimemrs
amyloid deposition= tau protein, cholinergic deficiency
1st- short term memroy loss, then long term, disorteintation, behavioral and personality changes
cerebral cortex atrophy on ct scan
DONEZEPIL, tACRINE, rivastigmie, galantamine
memantine- nmda antagonist!!!
vascular dementia
lacunar infarcts- htn - 2nd most common
front to temporal
picks disease- brain gdegenration- marked personality changes!!!!!
diffuse lewy body
visual hallucinations, delusions!!
astorcytoma
pilocytic astrocrytoma- grade I- most benign- mc in children and young adults
GRADE IV= glioblastoma-multiforme- mc primary cns tumors in ddauldts
glioblastoma multiforme
most caggressive of all the primary cns tumors in adults!!
cushings reflex: irregular respiratoions, htn, brady
meningiomas
usually BENIGN Tumors!!
associated with neurofibromatoisis NF 2
attached to the dura
spindle cells
atlast c1 burst fracture
jefferson!!!!
hangmans’
c2!!!! may lead to sponyloslisthesis between c2 and c3
cords
anterior cord : lower extremity more than upper
central cord: upper extremity more than lower- shawn distribution for sensory deficit
posterior cord: LOSS OF proprioception and vibratory sense only
brown sequard: ipsilateral motor, vibration and proprioception deficites (dorsal).Contralateral pain and temp deficients!!
non dominant side
usually right hemisphere: contralateral left hemiparesis, left neglect, apraxia: purposely movements can’t be done, flat affect, impaired judgement, impulsev
dominant side lesisons
usually the left hemisphere: right hemiparesis, right sensory loss, aphsia (can’t remember words), agraphia , decreased math compresnsions
TIA
due to embolus!!-internal caroitd artery
vertebrobrasilar: brain/Stem and cerebellar- gait, proprioception
Ct scan of head caroitd dopper - mroe than 70% of carotid steoniss - do a surgery ct angio echo to look for cardioembloci source
ASPIRIN, clopidogrel!!- no thrombolytics!!!!!!- supine increases cerebral perfusion!!! no blood pressure changes unless more than 220/120!!!
lacunar
small vessel disease- pure motor mc, dysarthria, HISTORY OF HTN!!!!
mmiddle cerebral artery (MOST COMMONLY AFFECTED BY ISCHEMIC STROKE)
MOST COMMON TYpE!!!
greater in face and arm than foot and leg
THROMBOlytICs within 3 hours!!! 4.5 hours in some cases!!!
alteplase!!!
antiplatelet therapy
anticoag if cardioembolic
185/110 or higher- lower for thromblytic otherwise don’t!
ischemic stroke
MOST COMMON Type is THROMBOTIC!!!!!
2nd is embolic
MOST COMMON FOR TIA is emoblic
anterior cerebral artery
greater in leg than upper extremity- personality changes, impaired judgement!
posterior cerebral artery
visual hallucinations
basillar artery
cerebellar dysfunction
vertebral artery
vertigo, nystagmus, n/v diplopia
ICH- intracranial
common by HTN!!!!- head elevation and IV mannitol, hyperventilation!!, lower only if 220/120
can be supportive or evacuation
SAH
sudden worst h ache of life- n/v/
nuchal rigidenty
mc due to berry aneurysm or AVM
xanthochromia, lumbar puncture- clipping or coiilng of aneurysm
epidural hemorrhage
ARTERIAL BLEED- between skull and DURA
MC after temporal bone fracture- middle meningeal artery!!!!
brief loc- lucid interval-coma, headache/n/v
CT: CONVEX (lens shaped)- does not cross - in temporal area!!!
hyper vent, mannitol, head elevation
subdural hematoma
VENOUS BLEED!!!!- between dura and arachnoid- mostly in ELDERLY
blunt TRAUMA!
COncave- CRESCENT SHAPED BLEED!
bleed can cross suiure liens
meningits
don’t wait for lumbar puncture to start empiric abx
glucose decreased, protein increased, pmn (in bacterial), increased CSF pressure
less than 1 month meningitis
group B strep- agalactiae, or listeria
Ampicillin to cover listeria and cefotaxime
1 month to 18 years
n. meninigits - s. pneumo-
ceftriaxone plus vanco
18-50 years
strep mostlyl, or n.meningitis-
ceftriaxone plus vanco
more than 50
s. pneumo, listeria
ampicillin, ceftriaxone and vanco
prophylaxis for meningits
cipro or rifampin
viral meningitis
most likely enterovirus - coxackie!!! or echovirus!!- no abonormal cerebral function
lymphocytosis, normal glucose
self limited
encephalitis
mc due to hsv1
supprtive care,
comes with cerebral function dysfunction- lethargy, ams, focal neuroogic deficits
valcyclovir
simple partial (Focla)
consiouss fully maintained-
complex partial (Focal)
consciousness impaired
generalized- absense
brief laspe of consciousness, staring episodes, eyelid twitching- NO POST ICTAL
achildhood
tx: ethosuximide
generlaized-tonic clonic
tonic: loss of conscioussness rigidt
clonic: repetitive, rhytmic jerking
postictal: flaccid coma/sleep
aka grand mall: tx: depakote, phenytoin, caramazepine, lamotriegine
generalized- myoclonus
sudden, brief, sporadic involuntary twitching, NO LOC- 1 muscl eor grup of muscles
atonic
drop attacks- sudde nloss of posture tone
- generalized
status epilepticus
seizure without recovery for more than 30 mins
ativan or valium , then phenytoin, and then last one would be phenobarbital!!!!
myoclonus
depakote, klonopin
febrile
phenobarbital
phenytoin
gingival hyperplasai, SJS,
depaktote se
pancreatitis, hepatotox
benzo overdose
flumezenil to reverse sedation
nerves
c5- biceps reflex
c6: brachioradialis reflex- wrist extension
c7: triceps jerk reflex
c8: finger flexion- motor
neuroleptic malignant syndrome
decreased dopamine activity like haldol, chlorpromazine, risperidone
hyper salivation, inconvintence, hyperthermia, muscle ridig, parkinson type syndrome, HYPO reflexia
rhambdo!!- due to muscle tremors and rigidity
discontinue drug, supportive care, dopamine agonists (like bromo)
serotonin syndrome
hyperthermia, tachy, agitated mood, HYPERREFLEXIA
dont mix seratonin with mao or st.john’s wort or promethazine!!
benzo for hyperthermia
seratonin antagonist: cryptohepadine
glutamate
excitatory neurotransmitter in CNS- too many in azlhermiers - which then causes ecll death
gaba
inhibitory trasnmistter in CNS- ETOH mimics GABA
decreased GABA in upper motor nueron lesiosn
benzo increases gaba
acetylcholine
in parkinson’s = it is increased- due to depletion of dopamine
in alzhemier’s- it is decreased
dopamine
inhbibitory cns transmittor- allows for corodinated movements
schizophrenia- increased dopamine!!!-
decreased in parkinson’s!
