Neurology Flashcards
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
Cerebral Aneurysm Path: Pt: Dx: Tx: Complication:
Path: Weakness in blood vessel in brain that balloons and fills w/ blood
Pt: Asx
HA, N/V, bleeding, dizziness, light sensitivity, stiff neck, thunderclap HA
Dx: MRI, MRA, CT, CTA
Tx: Supportive Embolization, endovascular coiling/clipping Antihypertensives, anticoagulants Endovascular aneurysm repair
Complications: Subarachnoid hemorrhage
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
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
Glasgow coma scale (GCS)
Eye opening 'Spontaneous- 4 'Response to verbal commands- 3 'Response to pain- 2 'No eye opening- 1
Best verbal response 'Oriented- 5 'Confused- 4 'Inappropriate words- 3 'Unintelligible sounds- 2 'No verbal response- 1
Best motor response 'Obeys commands- 6 'Localizing response to pain- 5 'Withdrawal response to pain- 4 'Flexion to pain- 3 'Extension to pain- 2 'No motor response- 1
Mild brain injury >/=13
Moderate 9-12
Severe = 8
Myasthenia-Gravis Path: Pt: Dx: Tx:
Path: antibodies to acetylcholine receptors at the neuromuscular junction
Pt: ptosis, diplopia, dysphagia, dysarthria, and proximal muscle weakness
Dx:
+ tensilon test
+acetylcholine receptor binding abs
CT chest-> thymic mass
Tx: Pyridostigmine, neostigmine
steroids >60, thymectomy <60
Crisis: Plasmapheresis, IVIG
Guillain-Barre Path: Pt: Dx: Tx:
Path: Autoimmune peripheral demyelinating
Pt: Ascending paralysis following diarrhea or vaccination
Dx: intubation (if needed)
LP-> lots of protein, few cells
Best-> nerve conduction test
Tx: IVIG = plasmapheresis
NEVER give steroids!!!!
Multiple-Sclerosis Path: Pt: Dx: Tx:
Path: autoimmune central NS demyelinating
Pt: neuro sxs separated in both time and space
optic neuritis=blurry vision
Dx: MRI-> periventricular white lesions, demyelinated plaques
Tx:
acute: methylprednisolone x5 days
Chronic: interferon + glatiramer
Grand Mal Seizure Path: Pt: Dx: Tx:
Path: generalized, complex
Pt:
Convulsions = tonic clonic jerking
Loss of consciousness
Dx: EEG
Tx:Benzodiazepines
Myoclonic Seizure Path: Pt: Dx: Tx:
Path: simple, partial
Pt:
Spastic contractions
NO loss of consciousness
Dx: EEG
Tx: Valproate
Absence Seizure Path: Pt: Dx: Tx:
Path: partial, complex
Pt:
Maintains tone
Loses consciousness- 100s of times per day
Children, you think they are ADD
Dx: EEG
Tx:
Ethosuximide
Valproate
Atonic Seizure Path: Pt: Dx: Tx:
Path: Partial, simple
Pt:
Loses tone
Maintains consciousness
Dx: EEG
Tx: Valproate, helmets
Tension Headache
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 Headache
Pt:
Dx:
Tx:
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
ppx: verapamil, lithium, valproate
Migraines
Pt:
Tx:
Pt: pulsing, unilateral, nausea, disabling, aggravated by physical activity, typically associated w/ photophobia
Tx: triptans
ppx: MgO, B2, coenzyme Q10, TCA/SSRI
Giant Cell Arteritis Path: Pt: Dx: Tx:
Path: Systemic arteritis of medium sized arteries, incidence increases w/ age >60 yrs
Pt: variable
Non-specific HA +/- tender, thrombosed temporal artery, jaw claudication, scalp tenderness, scalp necrosis, tongue ischemia
Associated w/ Polymyalgia rheumatica
sx: fatigue, malaise, weight loss, depression, myalgia, arthralgias
Visual sx: amaurosis fugax (transient vision loss), diplopia, may cause rapid and permanent blindness
Dx:
Temporal artery bx
ESR, CBC w/ plt count (anemia, thrombocytosis), CRP
Tx:
Prednisone & tocilzumab (emergent to prevent blindness)
Meningitis Path: Pt: Dx: Tx: Other paths and txs
Path:
<1m: S. Agalactiae, E. Coli, listeria, klebsiella
1-23m: S. agalactiae, e coli, s. Pneumonia, nisseria meningitidis, h. Influenzae
2-50yrs: s. Pneumoniae, nisseria meningitis
>50yrs: s. pneumoniae, nisseria meningitids, listeria, aerobic gram-negative bacilli
Pt: fever, HA, stiff neck
Dx: LP-> many neutrophils
Tx: ceftriaxone, vancomycin, steroids
immunocomp: ampicillin
Syphilis: VDRL, RPR in CSF-> IV PCN
Lyme: lyme ab in CSF-> ceftriaxone
Cryptococcus-> cryptococcus antigen -> amphotericin
RMSF: RMSF ab-> ceftriaxone
Meningitis LP or abx?
FAILS focal neuro deficit AMS immunocompromised lesions over the site of LP seizures
IF FAILS…. ABX first, then CT, then LP
If NOT fails… LP first, then abx
Encephalitis Path: Pt: Dx: Tx:
Path: viral
Pt: fever, HA, AMS
Dx: CT scan w/ antibodies
Best-> LP: lymphocytes.. get HSV PCR
Tx: herpes w/ acyclovir
flaccid paralysis: west nile
temporal lobe: herpes encephalities
