Neurology Flashcards
Bells Palsy etiology
idiopathic, U/L CN VII facial nerve palsy
Hemifacial weakness and paralysis
Strong association with HSV reactivation
Rsk Factors: DM, prego, post URI, dental nerve block
Bells Palsy manifestation
Ipsilateral ear pain for 24-48 hrs: Unilateral facial paralysis
Unable to life eyebrow
Bells Palsy Tx
None required
Prednisone decreases nerve inflamm if started within 1st 72 hours of sx
Artificial Tears, eye patch
Fxn returns within 2 weeks with significant improvements within 4 months
TIA sx
Monocular vision loss “lamp shade down one eye”
weakness, speech change, confusion
TIA Dx
CT initial TOC
W/O contrast to r/o hemorrhage
TIA tx
ASA and Plavix
Thrombolytics contraindicated
Place in supine position
Subclavian Steal Syndrome
Signs and sx from reversed blood flow down the ipsilateral vertebral artery to supply the affected due to occlusion or stenosis of subclavian artery
LEFT ARM MC
Subclavian Steal Syndrome manifestations
RISK: arthrosclerosis
Paresthesia, claudication, blood pressure difference in each arm, nystagmus, weakness, syncope
Subclavian Steal Syndrome Dx
Continuous wave doppler
Tx: revascularization or Percutaneous transluminal angioplasty
Acoustic Neuroma etiology
CN VII shwannoma: benign tumor of schwann cells which produce myelin sheath
Acoustic Neuroma sx
Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise, tinnitus, HA, facial numbness, vertigo
Acoustic Neuroma Dx
MRI
Acoustic Neuroma tx
Surgery or focused radiation therapy
Epidural hematoma etiology
Arterial Bleed MC between skull and dura
MC after temporal bone fx: middle meningial artery disruption
Epidural Hematoma Sx
Brief LOC, lucid interval, coma, HA, n/v, focal neuro sx, rhinorrhea d/t CSF fluid
Epidural hematoma dx
CT: Lemon bleed
Does NOT cross suture lines
Epidural hematoma tx
Herniate if not evacuated early; obs if small
If increased ICP: Mannitol, hyperventilation, head elevation (HOB 30 degrees), potentially a shunt
Subdural Hematoma etiology
Location: MC venous bleed, between dura and arachnoid d/t tearing of cortical bridging veins, MC in elderly
Mechanism: MC blunt trauma often causes bleeding on other side of injury
Subdural Hematoma sx
May have foval neuro sx
Subdural Hematoma dx
CT: concave, banana shape bleed
CAN CROSS SUTURES
Subdural Hematoma Management
Evacuation vs. supportive
Subarachnoid Hemorrhage etiology
Location: arterial bleed a/w arachnoid and pia
Mechanism: MC berry aneurysm rupture
Subarachnoid Hemorrhage Sx
Thunderclap headache: U/L, occipital area, meningeal symptoms: stiff neck, photophobia, AMS, no focal neuro deficits
Terson Hemorrhage: retinal hemorrhage
Subarachnoid Hemorrhage Dx
CT scan W/O contrast first
If negative: LP
4 vessel angiography after confirmed SAH
SAH Tx
Supportive: bed rest, stool softeners, lower ICP, surgical coiling
Lower BP gradually
Incracerebral Hemorrhage Etiology/dx/tx
Location: intraparenchymal
Mechanism: HTN, AVM, Trauma
Dx: CT scan, NO LP
Tx: decrease BP gradually IV mannitol
Cluster Headache sx
severe u/l periorbital/temporal pain, pouts lasting less than 2 hours with spontaneous remission
Triggers: worse at night, ETOH, stress
Cluster headache PE/tx
Ipsilateral horners syndrome: ptosis, miosis, anhidrosis
Tx: 100% O2 1st line, antimigraine meds Sumatriptan
PPX: verapamil 1st line
Complex Regional Pain Syndrome (CRPS) etiology
Formerly known as reflex sympathetic dystrophy
CRPS sx
MC: upper extremities
Stage I: pain out of proportion to injury
Stage II: waxy/pale skin, brittle nails, loss of hair
Stage III: joint atrophy, contractures
CPRS Tx
NSAIDS initial treatment
Vit C ppx after fx
GCS
Eye opening
Verbal response
Motor Response
Best: 15
Comatose <8
Unresponsive: 3
Concussion etiology
mild traumatic injury, alteration in mental status with or without LOC
Concussion sx
Confusion: confused or blank expression
Amnesia
HAs, dizziness
Signs of increased intracranial pressure: vomiting, increasing disorientation
Concussions Dx
CT scan: study of choice
MRI: study of choice IF prolonged sx >7-14 days
Concussion Tx
Cognitive and physical rest
Delirium
acute, abrupt, transient confused state d/t an identifiable cause (meds, hospital stay, infections.
Usually full recovery in 1 week
Dementia
Progressive, chronic intillectual deterioration of selective functions; memory loss and loss of impulse control, motor/cog fxns
Risk: >60 years old, vascular disease
Alzheimer’s Disease
MC type of dementia, amyloid deposits
Dx: CT scan shows cerebral cortex atrophy
Tx: Ach-esterase inhibitors: Donepezil
NMDA Antagonist: memantine
Vascular dementia
2nd MC type, chronic ischemic and multiple infarctions
HTN most important risk
Fronttemporal dementia
Localized brain degeneration of the FT lobes
MARKED PERSONALITY CHANGES
Lewy Body Disease
Abnl neuronal protein deposits
VISUAL HALLUCINATIONS, delusions, episodic delirium, dementia occurs later in disease
Viral (aseptic) meningitis
MC: enterovirus, then mumps/HSV
HA, fever, mild confusion, nuchal rigidity, photophobia
Viral meningitis dx
CSF analysis: MOST IMPORTANT TO DIFFERENTIATE
CT scan done 1st to rule out intracranial mass
Viral meningitis tx
supportive, antipyretics, IVF
usually self limited
Encephalitis etiology
MC cause: HSV-1 enterovirus
Infection of parenchyma
Encephalitis sx
HA, fever, lethargy, AMS, Abnl cerebral fxn
Encephalitis Dx
CSF analysis: lymphocytosis, normal glucose, increased protein
Encephalitis Tx
Supportive care, control edema, antipyretics, seizure ppx
Valcyclovit if HSV
Higher morbidity than viral meningitis
Acute bacterial meningitis
etiology/sx
hx of sinusitis or pneumonia prior to meningitis
sx: fevers, chills, meningeal sx
Acute bacterial meningitis dx
LP: neutrophils, decreased glucose, increased total protein, increased CSF pressure
CT: r/o mass before LP
Bacterial meningitis <1 month old
Organism: GBS
Tx: Ampicillin + cefotaxime
Bacterial meningitis 1m -18y
Organism: N meningitis
Tx: Ceftriaxone + Vanc
Bacterial Meningitis 18y-50y
Organism: S. Pneumo and N. Meningitis
Tx: Ceftriaxone + Vanc
Bacterial Meningitis >50yo
Organism: S. pneumo, listeria monocytogenes
Tx: Ampicillin, Ceftriaxone, and Vanc
