Neurology Flashcards
What is the definitive diagnosis of Alzheimer’s disease?
Brain autopsy
MC type of dementia?
Alzheimer disease
What changes in the brain are seen in Alzheimers?
amyloid deposits (senile plaques) and neurofibrillary tangles (tau protein)
What is the mechanism of Alzheimer?
cholinergic deficiency
Treat of Alzheimer?
Cholinesterase inhibitors: Donepezil, Rivastigmine, and Galantamine
What drugs should be avoided in Alzheimer?
anti-cholinergics drugs (cough meds too)
What NMDA antagonist is used for mod-severe Alzheimer?
Memantine
What symptoms are seen in Alzheimer?
Short term memory loss (1st), long term, disorientation, behavioral and personality changes
Diagnosis for Alzheimer?
non-contrast CT or MRI
What is the mechanism of ach-esterase inhibitors?
prevent the breakdown of acetylcholine
What 4 medications are FDA approved for Alzheimers?
Tacrine
Donepezil (Aricept®, Aricept ODT)
Rivastigmine (Exelon®, Exelon patch)
Galantamine (Razadyne®, Razadyne ER)
What is the first symptom seen in Alzheimers?
anterograde amnesia
Treatment for delirium?
treat the cause
Whom is delirium mostly seen in?
hospitalized elderly pts
What type of hallucinations are the most common type experienced by patients with delirium?
Visual hallucinations
What is a typical antipsychotic commonly used for the treatment of delirium?
Haloperidol
What is the most common cause of delirium?
alcohol abuse
What is the treatment of choice for delirium tremens in alcohol withdrawal?
Benzodiazepines
“blind as a bat, hot as Hades, red as a beet, dry as a bone, mad as a hatter
Anticholinergic overdose
How does bell palsy look?
unilateral facial weakness/paralysis
both upper and lower parts of the face
What does Bell palsy forehead look like?
unable to lift affected eyebrow (wrinkle forehead)
Treatment for Bell palsy?
Txt is not required- most cases resolve 1mo
Prednisone- 1st 72hr of sx onset
Artificial tears
Acyclovir
MC side for Bell palsy?
right (60%)
Bell palsy has strong association with?
Herpes simplex virus reactivation
What nerve is affected in Bell palsy?
CN VII (7)
What is the pathogenesis of bell palsy?
inflammation or compression of CN VII
Bell palsy usually follows what?
a URI
What should Bell palsy pt wear at night to prevent corneal abrasion?
eye patch
A CVA blockage is ?
ischemic stroke
A CVA rupture of blood vessel is?
hemorrhagic stroke
Right sided symptoms=
left sided stroke
Left sided symptoms=
Right sided stroke
Dx for CVA?
CT without contrast
Txt for CVA?
IV tPA within 3-4.5 hrs of symptom onset
Txt for CVA after 4.5 hours?
Intra-arterial thrombolysis up to 6hrs
What is the most common artery affected in a ischemic stroke?
middle cerebral artery (anterior circulation)
Most important modifiable risk factor of stroke?
HTN
Primarily affects frontal lobe function, with legs>arms
Anterior cerebral artery occlusion
Risk factors for Lacunar stroke?
diabetes and hypertension
What is the mc cause of chronic severe disability?
stroke
What should the blood pressure be maintained at for tPA?
<185/105
Exclusion criteria for tPA use in strokes?
suggest SAH Head trauma or prior stroke within 3mo MI within 3mo GI or gastric ulcer hemorrhage within 21 days Major surgery within 14days Elevated BP >185/ 110 Active bleeding Taking anticoagulants
Extended exclusion criteria for tPA?
Age >80yrs All pts taking oral antigcoagulants regardless of INR Stroke scale > 25 Hx of stroke and diabetes Oral aspirin
What causes a essential tremor?
autosomal dominant inheritance
Presentation of a essential tremor?
shaking with task, handwriting, or shaving, tremors with outstretched arms or performing movement WITHOUT resting component
What makes essential tremors better?
alcohol
What is the first line txt for essential tremor?
Propranolol or atenolol
2nd and 3rd line txt for essential tremor?
Primidone (barbiturate)
Alprazolam (benzodiazepine)
What makes essential tremors worse?
anxiety, fatigue, caffeine, or stimulants, drugs for asthma and emphysema
Three cardinal features of Parkinson?
Rest (pill rolling), tremor, cogwheel rigidity, bradykinesia, shuffling gait
Gold standard for Parkinson dx?
neuropathologic exam
Txt for Parkinson < 65yr?
bromocriptine, pramipexole, ropinirole (dopamine agonist)
Txt for Parkinson > 65yr?
Levodopa/carbidopa (Sinemet)
What are sde of L-dopa?
GI upset w/ n/v, vivd dreams or nightmares, psychosis, and dyskinesias
Mechanism of Parkinson?
idiopathic dopamine depletion, failure to inhibit Ach in the basal ganglia
What is seen in brains of Parkinson pts?
lewy bodies, loss of pigment cells seen in substantia nigra
T/F Parkinson tremor is present at rest?
True
T/F essential tremor is absent at rest?
True
What is a positive Myerson’s sign?
tapping the bridge of the nose causes sustained blink
What is the most effective txt for Parkinson?
Levodopa/Carbidopa (Sinemet)
Side effect of dopamine agonist?
orthostatic hypotension
What are two additional treatment classes that can me used for Parkinson?
Monoamine oxidase type B inhibitors
Catechol-O-Methyltransferase COMT inhibitors
What are focal seizures?
no alteration in consciousness
What are complex partial seizures?
focal seizures with altered consciousness
Abnormal movements or sensations?
Focal seizures (simple partial)
Lip smacking, confusion and loss of memory
complex partial
Treatment for focal seizures?
Phenytoin and carbamazepine
What are absence (petit mal) seizures?
brief impairment of consciousness , most miss them
What are tonic clonic seizures (grand mal)?
classic seizures with postictal phase: confused
What are atonic seizures?
drop attacks, looks like syncope with loss of muscle tone
Treatment for Absence Petit Mal seziures?
Ethosuximide
Treatment for Status Epilepticus?
Lorazepam or Diazepam-> Phenytoin (Dilantin)-> Phenobarbital
Treatment for Myoclonus seizures?
Valproic acid, Clonazepam
What are sde of Phenytoin?
gingival hyperplasia, SJS, hirsutism
What is the diagnosis of seizures?
EEG
What are the sde of Valproic acid?
pancreatitis, heptotoxicity
What are the sde of benzo?
sedation
MC cause of syncope?
Vasovagal syncope
