Neurology Flashcards
Alzheimer disease Path: Pt: Dx: Tx:
Path:
MC type of dementia
Amyloid deposition (senile plaques) in brain
Neurofibrillary tangles
Pt:
Short term memory loss, progression to long-term memory loss, disorientation, behavioral and personality changes
Changes gradual in nature
Dx: CT scan: cerebral cortex atrophy
Tx:
Ach-esterase inhibitors: donepezil, tarcine, tivastigmine, galatamine
NMDA antagonist: memantine
Bell Palsy Path: Pt: Ramsay-Hunt syndrome, Bell phenomenon Dx: Tx:
Path:
Idiopathic; unilateral CN VII facial nerve palsy due to inflammation or compression (lower motor neuro lesion)
Strong associated with w/ HSV
Pt:
Ipsilateral facial weakness w/ forehead involvement, drooling, loss of taste, tongue numbness, ear/retro-auricular pain
Preserved ability to raise eyebrows suggests central process (forehead innervated bilaterally)
Ramsay-Hunt syndrome: Bell’s palsy + facial varicella zoster infection
Bell phenomenon: eye on affected side moves laterally & superiorly when eye closure is attempted
No other focal neurological deficits
Dx: DOE
Tx:
Self-limiting 1 months
Prednisone: start within first 72 hrs of onset for max benefit
Artificial tears- replace lacrimation, reduce vision problems +/- eye patch/taping eye shut to sleep if severe
Acyclovir: severe cases have been shown to improve symptoms/limiting of recovery
Ischemic cerebral vascular accident Path: Pt: Dx: Tx:
Path: thrombosis, embolism, hypoperfusion
risks: smoking, old age, male, DM, HTN, hyperlipidemia
Pt:
Anterior:
MCA (MC): contralateral sensory/motor loss: face (eyebrows normal), and arm
ACA: contralateral sensory/motor loss: leg and foot
Posterior
PCA: visual hallucinations, contralateral homonymous hemianopsia; ipsilateral CN deficits and contralateral muscle weakness
Basilar: cerebellar dysfunction-> CN palsies, dec vision, dec bilateral sensory
Vertebral: vertigo, nystagmus, N/V, diplopia, ipsilateral ataxia
Dx: Non-con CT- loss of grey-white interface, acute hypo density (maybe normal for 1st 6-24hrs)
Tx: Thrombolytics (rTPA, alteplase)- within 3hrs of onset (some cases 4.5hrs) if no evidence of hemorrhage
Antiplatelets: ASA, clopidogrel, dipyridamole
ASA- acute setting if after 3 hrs and thrombolytics aren’t given or >/= 24 hours after thrombolytics
+/- anticoagulation- if cardio-embolic
Indications to manage HTN:
Thrombolytics > 185/110
No thrombolytics if >220/120 or MAP >/= 130
Delirium
Path:
Pt:
Tx:
Path:
Acute, abrupt transient confused state 2/2 an identifiable cause (meds, infections, etc)
Pt:
Rapid onset associated w/ fluctuating mental status changes and marked deficit in short-term memory
Tx:
Full recovery within 1w in most cases
Dementia
Path:
Pt:
Progressive chronic intellectual deterioration of selective functions:
Memory loss and loss of impulse control, motor and cognitive functions (language dysfunction, disorientation, inability to perform complex motor actinides and inappropriate social interaction)
NOT due to delirium, meds, psychiatric illness
Risk factors: age (>60), vascular disease
Essential tremor
Path:
Pt:
Tx:
Path: MC movement disorder
Thought to be related to oscillating network of components of the cerebellothalamocortical circuit and neurodegeneration involving cerebellum and locus coeruleus
Genetic: autosomal dominant transmission
Pt:
Kinetic or postural
Bilateral and symmetric
Upper extremity, head, voice, jaw facial, lower extremity
Worsens with reaching for an item, stress, certain activities, over time
Improves w/ some voluntary control, ETOH
Tx:
Recommended w/ sx interfere w/ activities or quality of life
Initial (episodic): primidone or propranolol
Long-term: propranolol or topiramate
Refractory- deep or superficial brain stimulation, unilateral thalamotomy
Correlation w/ dementia
Tension Headaches
Path:
Pt:
Tx:
Path: Mental stress
Pt: Bilateral, tight, band-like
No N/V or focal neurologic symptoms
Tx:
NSAIDs, aspirin, Tylenol
TCAs in severe recurrent cases
PPX: beta blockers
Cluster headaches Path: Pt: Dx: Tx:
Path:
Not fully understood
M > F
Pt:
Serve unilateral periorbital/temporal HA lasting <2 hrs w/ spontaneous remission
Sharp suicide HA
Attacks recur 4-8w, 1-8/day at the same time each day
Associated autonomic features (1 confirms dx) Ipsilateral Horner’s: ptosis, anhidrosis Rhinorrhea Conjunctival injection Lacrimation Aural fullness
Dx: Clx
MRI/CT- presentation consistent w/ secondary HA-> Carotid dissection, aneurism, AVMs, tumors, giant cell arthritis
Tx:
Acute- oxygen, triptans, external vagus nerve stimulation, intranasal lidocaine
Transitional (terminate daily attacks while preventive therapy is started)-> corticosteroids, prednisone taper
Migraines
Dx:
Tx:
POUND pulsatile hOurs unilateral nauseating debilitating
Tx:
ID triggers:
Dietary, Avoid skipping meals, dehydration, stress, exhaustion menses, weather changes, lighting
Exercise is preventative; obesity linked to more severe migraines
Meds
Little to none: triptans (sx)
Moderate: triptans + antiemetics + prophylaxis (MgO, B2, coenzyme Q10, TCA/SSRI, anticonvulsants, antihypertensives)
Severe- triptans + antiemetics + prophylaxis (narcotics); refer to specialist
Parkinson disease
Path:
Pt:
Tx:
Path:
Idiopathic dopamine depletion
Lewy bodies, loss of pigment cells seen in the substantia nigra
Pt:
Tremor
Resting tremor (MC), lessened w/ volunteer activity, intentional movement
Bradykinesia: slowness of voluntary movement and dec automatic movements
Rigidity
Face involvement: fixed facial expressions
Postural instability
Tx:
Levodopa.Carbidopa
Dopamine agonists: bromocriptine, pramipexole, ropinirole
Transient ischemic attack Path: Pt: Dx: Tx:
Path:
Transient episode of neurological deficits without acute infarction; usually <24 hrs
MC due to embolus
Pt:
Internal carotid artery: amaurosis fugax-> monocular vision loss- temporary “lamp shade down on one eye”, weakness contralateral hand
Vertebrobasilar: gait, proprioception, dizziness, vertigo
Dx:
- CT scan of head: initial test of choice-> R/O ICH
- Carotid doppler: carotid endarterectomy recommended for >/=70% stenosis
- CT angiography, MR angiography: vasular occlusion
- ECHO: look for cardioembolic sources
Tx:
Aspirin + dipyridamole or clopidogrel
Thrombolytics CONTRAINDICATED!!!
Place in supine position to increase cerebral perfusion; avoid lowering BP (unless >220/120)
Reduce modifiable risk factor: DM, HTN, A-fib
Vertigo
Path:
Peripheral -> horizontal nystagmus
- Benign positional vertigo (BPV): episodic vertigo, no hearing loss
- Meniere: episodic vertigo + hearing loss
- Vestibular neuritis: continuous vertigo, no hearing loss
- Labyrinthitis: continuous vertigo + hearing loss
- Cholesteatoma
Central -> vertical nystagmus, + CNS signs, gradual onset
- Cerebellopontine tumors
- Migraine
- Cerebral vascular accident
- Multiple sclerosis
- Vestibular neuroma
Benign Paroxysmal Positional Vertigo Path: Pt: Dx: Tx:
Displaced otoliths
Pt:
Sudden, episodic peripheral vertigo provoked by changes of head position
Dx:
+ Dix-Hallpike test -> fatigable horizontal nystagmus
Tx:
Epley maneuver
Vestibular Neuritis and Labyrinthitis
Path:
Pt:
Tx:
Path:
Vestibular neuritis: inflammation of vestibular portion of CN 8 (MC after viral infection)
Labyrinthitis: vestibular neuritis + hearing loss/tinnitus (cochlear involvement)
Pt:
Vestibular sx: peripheral vertigo (continuous), dizziness, N/V
Cochlear sx (labyrinthitis): hearing loss
Tx:
Corticosteroids
sx: meclizine, benzos
Meniere's disease Path: Pt: Dx: Tx:
Path:
Idiopathic distention of end-lymphatic compartment of inner ear by excess fluid
Pt:
Episodic vertigo-> mins-hrs
Tinnitus
Ear fullness
Hearing loss
Dx:
Transtympanic electrocochleography most accurate test during active episode
Tx:
Sx: meclizine, benzos
Decompression if refractory to meds or severe
Prevent: diuretics (HCTZ), avoid salt, caffeine, chocolate, ETOH
