Neurology Flashcards
1
Q
What is the presentation of altered mental status?
A
- due to systemic infection or metabolic problems and vascular events (CVAs, bleeds)
- can lead to irreversible brain injury if they are not promptly identified and treated
- a systematic approach to the patient is important, diagnostic workup
- patients with altered mental status have a high mortality rate
2
Q
What can be both diagnostic and therapeutic?
A
naloxone when opiate overdose is suspected
-thiamine administration to cover for Wernicke encephalopathy
3
Q
What is dx and tx for altered mental status?
A
- ABCs, airway, breathing, and circulation, vital signs, blood glucose level
- administer thiamine and dextrose
- consider naloxone opiate overdose
- history and physical examination neurologic examination to rule out a focal deficit
- complete blood count, electrolyte panel, calcium, magnesium, and phosphorus
- liver and kidney function tests
- urine toxicology screen
- serum ammonia
- arterial blood gas
- blood cultures
- ECG and CXR
4
Q
What is the imaging for altered mental status?
A
- CT scan
- MRI with diffusion and gadolinium
- lumbar puncture
5
Q
What are the pearls of altered mental status?
A
AMS patients after ABCs, in the beginning, can all be given
- glucose (for low blood glucose levels)
- thiamine (Wernicke)
- Narcan (opiates)
6
Q
What is loss of consciousness?
A
syncope is an abrupt and transient loss of consciousness caused by cerebral hypo perfusion, accounts for 1 to 1.5% of emergency department visits need to be extensively worked up
7
Q
What are the causes of loss of consciousness?
A
- cardiovascular or structural heart disease
- arrhythmia
- cerebral hypo perfusion (CVS, hypovolemia, etc.)
- orthostatic hypotension syncope (supportive care)
- seizures
8
Q
What is the dx and tx for loss of consciousness?
A
- oxygen
- EKG
- CBC, CMP, troponin
- CT scan
- possible EEG
9
Q
What are the pearls of loss of consciousness?
A
- all patients with LOC need cardiac monitoring
- CT scan
- observation
10
Q
What is the glasgow coma scale?
A
Eye-opening -4 spontaneous -3 voice -2 pain -1 none Verbal -5 oriented -4 confused -3 inappropriate words -2 incomprehensible -1 none Motor -6 obeys commands -5 localizes pain -4 withdraws -3 abnormal flexion (decorticate) -2 abnormal extension (decerebrate) -1 none
less than 9 is coma
11
Q
What is the presentation for numbness/paresthesia?
A
- paresthesia an abnormal dermal sensation due to compromised nerve function
- commonly presents impaired sensations as prickling, tingling, itching, burning or cold, skin
12
Q
What are the causes of numbness/paresthesia?
A
symptoms usually arise from nerve damage or compromised due to injury blood flow toxins, numbness is often caused by damage, irritation, or compression of nerves
- diabetes (very common due to the destruction of the nerves due to the elevated glucose)
- nerve root pathology (impingement and compression of the nerves)
- central pathology (brain causes such as multiple sclerosis, CVAs, etc.)
13
Q
What are the pearls of numbness/paresthesia in the ER?
A
- brain (CVA, multiple sclerosis, seizures, etc.)
- spinal cord (impingement, compression, infection, etc.)
- or coming for the periphery (peripheral)
- Imaging (MRI/CT scan) of the brain and/or spinal cord is necessary for the workup
14
Q
What is a Bell palsy?
A
sudden onset unilateral facial nerve paralysis with no other focal neurologic or systemic findings
15
Q
What are the characteristics of Bell palsy?
A
- the symptoms peak in 48 hours
- 60% have a viral prodrome
- PE with show CN VII nerve palsy that does not spare the forehead
- most commonly caused by HSV
- Incomplete closure of eyelids = corneal exposure keratitis (lubricating eye drops needed/ patch at bedtime)
16
Q
What are the DDX of Bell palsy?
A
infectious, traumatic, and neoplastic etiologies
-the most common dx if idiopathic Bell’s palsy
17
Q
What is the tx for Bell palsy?
A
- treatment is prednisone, artifical tears, tape eyelid shut
- comments: Bilaterla: lyme disease, infectious mononucleosis
18
Q
What is encephalitis?
A
presents similar to meningitis: AMS, seizures, personality changes, exanthema = encephalitis is clinically differentiated from meningitis by altered brain functioning
19
Q
What are the characteristics of encephalitis?
A
- etiology: usually viral (HSV = MC, CMV in immunocompromised)
- Reye’s syndrome: rapidly progressive encephalopathy with hepatic dysfunction, usually post-flu/URI; Babinski positive and hyperreflexia noted = salicylate use (aspirin, Pepto); vomiting, confusion = seizure/coma
- DX: elevated liver enzymes, PTT, hyperammonemia, hypoglycemia, metabolic acidosi; tx = supportive
20
Q
What are the symptoms of encephalitis?
A
begins with flu-like illness
-fever, headaches, altered mental status, seizures, personality changes, exanthema
21
Q
How is encephalitis dx?
A
- lumbar puncture and MRI
- PCR for viruses
- Kernig’s and Brudzinski’s usually absent
22
Q
What is the tx for encephalitis?
A
supportive care and acyclovir 10- mg/kg IV q8hr started promptly
-empiric antibiotics are often given bacterial meningitis is excluded
23
Q
What is status epilepticus?
A
s/s: > or equal to 5 min continuous seizure activity or more than one seizure without recovery from the postictal state in between episodes
- always check finger stick blood =glucose, consider pyridoxine (B6) for INH toxicity
- MC caused by a change in medication regiment of someone with a seizure disorder
24
Q
What is the tx of status epilepticus?
A
- place in left lateral decubitus position (suppressed gag reflex = prone to aspiration of gastric contents)
- Pharm: 1. Benzo (lorazepam, diazepam, midazolam) 2. Phenytoin/fosphenytoin 3. phenobarbital and lacosamide
- IV route is preferred
- watchful waiting for auto-correction of acidosis once seizure activity is controlled
- untreated generalized seizures lasting > 60 min may result in permanent brain damage; longer-lasting seizures may be fatal
25
What is a partial focal seizure?
occur when this electrical acivity remains in a limited area of the brain
- the seziures can sometimes turn into generalized seziures, which affect the whole brain
- with retrained awareness (simple partial): no alteration in consciousness
- with loss of awareness (complex partial): automatisms (lip-smacking) - postictal state = confusion/memory loss
- tx - phenytoin, and carbamazepine are drugs of choice
26
What are generalized seizures?
occur when there is widespread seizure activity in the whole brain (left and right hemispheres)
27
What is absence seizure (petit mal)?
- brief mental status change; without motor activity - blank stare
- no aura, no post-octal state, no loss of postural tone
- MC in 5-10 yo
- EEG = brief 3-HZ spike and wave discharge
- Tx: ethosuimide
28
What is tonic-clonic?
convulsive (grand mal) - bilaterally symmetric and without focal onset, begins with LOC
-tonic phase: very stiff and rigid 10-60 seconds, clinic phase = convulsions, post-ictal phase = confused states
29
What is atonic?
drop attack = like syncope; loss of muscle tone
30
What is clonic?
loss of control of bodily function, jerking, may temporarily lose consciousness
31
What is tonic?
extreme rigidity then LOC
32
What is mycoclonic?
muscle jerking, no tonic phase, occurs in the morning
33
What is febrile?
temp >38, >6 mo, <5 years, absence of CNS infection/inflammation
34
What are infantile spasm?
type of epilepsy seizure
35
What is psychogenic non-epileptic seizure?
not due to epilepsy but look similar to an epileptic seizure
36
How do you dx seziures?
check electrolytes, glucose, pregnancy test, ECG, EEG, neuroimaging for adults with first seizure (CT/MRI)
37
What is the tx for seziures?
treat underlying cause = electrolytes, infection, toxic ingestion, trauma, azotemia, hypoxia, hypoglycemia, stroke/bleed
-meds for focal seizures: phenytoin, phenobarbitals, valproate, lamotrigine, gabapentin
38
What is an epidural hematoma?
- transient LOC from injury = LUCID = HA, unilateral contralateral weakness
- cause: traumatic intracranial hemorrhage after skull fracture = middle meningeal artery is MC involved = blood fills space between dura and skull
39
How is an epidural hematoma dx?
non-contrast head CT (lenticular, unilateral convexity - lens shape) usually in temporal region = "lemon"
40
What is the tx for epidrual hematoma?
surgical craniotomy/medical management of increased intracerebral pressure (mannitol, hyperventilate, steroids/ventricular shunt)
41
What is a subdural hematoma?
- head injury from fall, MVA, assault = sudden blow tears blood vessels; usually elderly pt with multiple falls presenting with neurological sx (AMS/neurologic signs) = usually in alcoholic or elders
- Injuries to bridging veins - acute = 48 hours; subacute 3-14 days, chronic: > 2 weeks (elderly)
- blood collects between dura and arachnoid mater
42
How is a subdural hematoma dx?
non-contrast CCT (credence-shaped, concave hyperdensity)
43
What is the tx of subdural hematoma?
depends on the severity
- small: obervation
- severe: surgery = burr hole trephination, craniotomy, craniectomy
44
What is a spinal cord injury?
damage to the spinal cord that results in a loss of function, such as mobility and/or feeling
-frequent causes of spinal cord injuries are trauma (car accident, gunshot, falls, etc.) or disease (polio, spina bifida, etc.)
45
What is anterior cord syndrome?
loss of pain/temperature below the level of the lesion preserved joint position/vibration
46
What is central cord syndrome?
loss of pain and temperature sensation at the level of the lesion, where spinothalamic fibers cross the cord with other modalities preserved (dissociated sensory loss)
47
What is complete cord transection?
rostral zone of spared sensory levels (reduced sensation caudally, no sensation in levels below injury); urinary retention and bladder distension
48
What is brown-sequard syndrome?
(hemisection of cord)
-loss of joint position and vibration sense on the same side as lesion and pain/temperature on the opposite side a few levels below the lesion
49
What is guillain-barre syndome?
ascending paralysis beginning in distal limbs: leg weakness = total paralysis of all 4 limbs, facial muscles, eyes, loss of reflexes
- often present after immunization
- post-infectious cause: campylobacter jejuni=MC, CMV, Epstein-Barr, HIV
50
How is guillain-barre syndrome dx?
based on lumbar puncture = elevated CSF protein with normal CSF WBC
51
What is the tx for guillain-barre syndrome?
plasma exchange (remove circulating antibodies) and IVIG
- monitor PFTs for paralysis of chest muscle/diaphragm (respiratory failure)
- good prognosis
52
What is status epilepticus?
a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without a person returning to normal between them
53
What are the two forms of status epilepticus?
convulsive and nonconvulsive
- convulsive status epilepticus presents with a regular pattern of contraction and extension of the arms and legs
- nonconvulsvie status epilepticus includes complex partial status epileptiucs and absence status epilepticus
54
What is the tx for status epilepticus?
benzodiazepines (lorazepam) are the preferred initial treatment after which typically phenytoin is given
55
What is a concussion?
involves transient, traumatic brain dysfunction; consciousness may be lost but sometimes patients manifest only confusion, memory loss, and gait or balance difficulties
- +/- brief LOC, amnesia = no structural abnormalities and no focal neurologic deficits
- negativ CT scan
56
What is a grade 1 concussion?
"mild" - GCS 13-15, no LOC, post-traumatic amnesia and other symptoms resolve < 30 min - can return to sports if asymptomatic for 1 week
57
What is a grade 2 concussion?
+LOC, 1 minute or post-traumatic amnesia that lasts > 30 min but < 1 week; may return to sports if asymptomatic at rest and exertion for at least 7 days
58
What is a grade 3 concussion?
+LOC, > 1 min or post-traumatic amnesia and other sx last > 1 week; may return in 1 month if asymptomatic at rest and exertion 7 days
59
How is a concussion dx?
usually clinical, sometimes head imaging
-get a CG if LOC, GCS < 15, suspected open skull/basilar skull fx, >2 episodes vomiting, > 65 y/o, amnesia > 30 min prior to impact, MVA with ejection, pedestrian struck by car, fall > 3 feet, underlying bleeding disorder/anticoagulant use, seizure activity, focal neurological deficit, ETOH involvement, persistently AMS, clinical deterioration
60
What is the tx for a concussion?
athletic activities resumed gradually
- single concussion: LOC lasting < 15 min - return to sports when asymptomatic for at least 1 week
- repeat: LOC/sx > 15 min = NOT to return to sports that season
61
What is a stroke?
can be ischemic or hemorrhagic
- risk factors: HTN, hypercholesterolemia, diabetes, afib, carotid artery disease, cigarette smoking, age, family history, male sex
- HTN = most significant and treatable
62
What is an ischemic stroke?
85% - 2/3 thrombotic, 1/3 embolic
- thrombotic caused by a blood clot that develops in the blood vessels inside the brain, usually preceded b y TIA
- embolic caused by a blood clot that develops somewhere else in the body usually from heart, aortic arch, large cerebral arteries = occur abruptly without warning
63
What is a hemorrhagic stroke?
usually secondary to HTN = intracerebral/subarachnoid
- a weekend vessel that ruptures and bleeds into surrounding brain compressing surrounding brain tissue = either aneurysms or AVMs; less predictable
- s/sx: hemiparesis, hemisensory deficit; must present on one side only and will be the side of body opposite stroke
- right-sided sx = left side stroke; left-sided sx = right sided stroke
64
What is anterior circulation?
(anterior cerebral/middle cerebral arteries) associated with hemispheric s/s (aphasia, apraxia, hemiparesis, hemisensory loss, visual field defect)
65
What is posterior circulation?
(vertebral/basilar arteries): coma, drop attack, vertigo, n/v, ataxia
66
What is carotid/ophthalmic?
amaurosis fugax
67
What is MCA?
aphasia, neglect, hemiparesis, gaze preference, homonymous hemianopsia
68
What is ACA?
leg paresis, hemiplegia, urinary incontinence
69
What is PCA?
homonymous hemianopsia
70
What is basilar?
coma, cranial nerve palsies, apnea, drop attack, vertigo
71
What is lacunar?
silent, pure motor or sensory
72
How is a stroke dx?
emergent brain imaging essential for ischemic stroke = noncontrast CT scanning
73
How is the tx for stroke?
thrombolyis, IV admin for rtPA for occulsive disease that with IV tPA within 3-4.5 hours onset
- admit to ICU or storke unit with neuro exams every 25 minutes during infusion, every 60 minutes for next 6 hours then 24 hours after tx/get serial blood pressures
- exclusions criteria for thrombolysis within 3 hours: SAH, head trauma/prior stroke within 3 mo, MI within 3 mo, GI/gastric ulcer within 3 weeks, major surgery in 14 days, hx of intracranial hemorrhage, elevated BP > 185 systolic/110 diastolic, active bleeding/acute trauma, INR > 1.7 with anticoagulation, glucose < 50, seizure with postical state, multilobal infarction on CT
- BP closely monitored in first 24 hours; hold antihypertensive until systolic > 220 or diastolic >120 with a goal to lower BP by 15% in first 24 hours if tx is indicated
- BP has to be <185/110 for thrombolytic = give labetalol 10-20 mg IV over 1-2 min
74
What is a cluster headache?
- always unilateral, but can change sides with new attack; pt is usually a man
- s/s: pain (excruciating unilateral pain, periorybital and temporal)
- autonomic sx: ptosis, mitosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion
- circadian periodicity: short-lived (15-180 min) cluster attacks; attacks occur daily in clusters followed by remission
- tx: 100% oxygen, sumatriptan (prophylaxis: CCBs)
75
What is a tension headache?
- MC type of headache
- bilateral, non-pulsating, bandlike pain occurring in frontal and occipital regions; with neck muscle tenderness
- MC causes by stress, or fatigue, glare, noise
- Tx: NSAIDs, smoking cessation
76
What is a migraine headache?
- F > M
- triggers: menstruation, pregnancy, contraceptives, food (chocolate, cheese, MSG, nitrites), alcohol
- gradual onset unilateral > bilateral, throbbing, pulsating headahce
- without aura = most common, N/V, photophobia, phonophobia
- aura: scotoma, flashing lights, sound
- Ha follows aura w/in 30 min; visual = MC
- dx: clinical
- tx:
- abortive: triptans, dihydreergotamine (DHE, antiemetics, NSAIDs)
- prophylaxis - beta-blockers, CCBs, TCAs
77
What is a subarachnoid hemorrhage?
- sudden, severe HA "worse HA of life", sudden LOC in 50% of patients, BP rises, may develop a fever
- Herald bleed occurs in 40% - less severe but atypical HA
- ruptured berry (saccular) aneurysm accounts for 75% non traumatic -r/f: smoking, HTN, hypercholesterolemia, heavy alcohol
78
How is a subarachnoid hemorrhage dx?
non-contrast heat CT, LP (elevated opening pressure/grossly bold fluid in all 4 tubes)
-cerebral angiography may be done, EEG may show site of hemorrhage/diffuse changes
79
What is the tx for subarachnoid hemorrhage?
prevention of elevated arterial/intracranial pressure - manage HTN
- surgical clipping/wrapping of aneurysm
- anticonvulsants for seizure prevention
80
What is an intracerebral hemorrhage?
- associated with high mortality; usually from HTN (sudden increase BP) = rupture small vessels deep in the brain parenchyma
- usually older pt, risk increase with age
- Ischemic stroke may = hemorrhagic stroke
- s/sx: abrupt onset of a focal neurologic deficit that worsens steadily over 30 to 90 minutes, altered LOC, stupor, coma, HA, vomiting and signs of increased ICP
81
How is intracerebral hemorrhage dx?
CT/MRI
82
What is the tx for intracerebral hemorrhage?
neurosurgery
83
What is a saccular aneurysms?
are almost always the result of hereditary weakness in blood vessels and typically occur within the arteries of the circle of Willis
84
How is an aneurysms dx?
magnetic resonance angiography (MRA) or CT angiography (CTA)
85
What is the tx for an aneurysms?
surgical clipping or end-endovascualr coil
86
What is the presentation of altered mental status?
- due to a systemic infection or metabolic problems and vascular events (CVAs, bleeds)
- can lead to irreversible brain injury if they are not promptly identified and treated
- a systemic approach to the patient is important, diagnostic workup
- patients with altered mental status have a high mortality rate
- naloxone can be both diagnostic and therapeutic when an opiate overdose is suspected, thiamine administration to cover for Wernicke encephalopathy
87
How is altered mental status dx and tx?
- ABCs, airwary, breathing, and circulation; vital signs, blood glucose level
- administer thiamine and dextrose
- consider naloxone opiate overdose
88
How is altered mental status dx?
history physical examination neurologic examination to rule out a focal deficit
- complete blood count, electrolyte panel, calcium, magnesium, and phosphorus
- liver and kidney function tests
- urine toxicology screen
- serum ammonia
- arterial blood gas
- blood cultures
- ECG and CXR
89
What is the imaging for altered mental status?
- CT scan
- MRI with diffusion and gadolinium
- lumbar puncture
90
What are the pearls of altered mental status?
- AMS patients after ABCs, in the beginning, can all be given glucose (for low blood glucose levels)
- thiamine (Wernicke)
- narcan (opiates)
91
What is syncope?
a brief LOC with loss of postural tone followed by spontaneous revival - motionless/limp and usually has cool extremities, weak pulse, shallow breathing
92
What are the characteristics of syncope?
- accounts fo 1 - 1.5% of emergency department visits and needs to be extensively worked up
- characterized by a rapid recovery of consciousness without resuscitation
- near syncope = lightheadedness/sense of impending faint without LOC
- seziure can caused sudden LOC but not considered syncope
- most result from insufficient cerebral blood flow = usually from decreased cardiac output or decreased venous return
- MC causes: vasovagal (apparent trigger/warning symptoms), idiopathic
- red flags: syncope during exertion, multiple recurrences in short time, heart murmur, old age, significant injury during syncope, family history sudeen unexpected death
93
What are the causes of syncope?
- cardiovascular or structural heart disease
- arrhythmia
- cerebral hypo perfusion (CVA, hypovolemia, etc.)
- orthostatic hypotension syncope (supportive care)
- seizures
94
How is syncope dx and tx?
treatment is aimed at identifying and fixing the underlying cause
- oxygen
- EKG
- CBC, CMP, troponin
- CT scan
- possible EEG
95
What are the pearls of syncope?
- all patients with LOC need cardiac monitoring
- CT scan
- Observation
96
What is the presentation of loss of coordination/ataxia?
cerebellar involvement
- question is what is affecting it??
- a detailed history and neurologic examination (finger-nose, and heel-shin testing)
- proper diagnostic tests
- may be chronic and slowly progressive (Parkinson's disease)
- acute due to infarction, edema, or hemorrhage
97
What is the dx and tx for loss of coordination/ataxia?
Imaging
- CT scan
- MRI with and without contrast
98
What are the pearls of loss of coordination/ataxia?
- can be due to drugs (ETOH) and toxins
- tumors
- CVAs
- genetics
99
What are the ddx of loss of coordination/ataxia?
hyper/hypovitaminosis (B12), inner ear issues, hallucinogen-related psych disorders, vertigo, encephalopathies, neoplasms, Huntington, MS, stroke, fibromyalgia, cerebral palsy, metabolic disorders, (hepatic encephalopathy)
100
What is a transient ischemic attack?
a transient epidote of neurologic dysfunction due to focal brain, retinal, or spinal cord ischemia without acute infarction
101
What are the characteristics of transient ischemia attack?
- blockage in blood flow does not last long enough to cause permanent infarction
- sudden onset of neurologic deficit, lasting minutes to <1 h (15-30 min on average), a reversal of symptoms within 24 h
- atherosclerotic plaque reduces blood flow in the internal carotid artery
- 10% of TIA patients will have a stroke within 90 days
102
How is a transient ischmic attack dx?
CT (without contrast), MRI more sensitive, carotid doppler ultrasound to look for stenosis, CT angiography, MR angiography of neck
-carotid endarterectomy if internal or common carotid artery stenosis is >70%
103
What is the tx of transient ischemic attack?
aspirin + dipyridamole or clopidogrel mono therapy (anti platelet therapy)
- ABCD2 score: predicts like likelihood of subsequent stroke with 2 days
- 30% of those with CVA had TIA; the risk is highest 24 hours after the initial event
104
What is loss of memory?
inability to remember events for a period of time, often due to brain injury, illness, or the effects of drugs and alcohol
105
What is dementia?
is a slow decline in memory, problem-solving ability, learning ability, and judgment that may occur over several weeks to several months, Alzheimer's disease is the most common after 65
106
What is delirium?
a sudden change in mental status such as withdrawal from alcohol or drugs or medicines, worsening of an infection or other health problem
107
What is amnesia?
memory loss that may be caused by head injury, stroke, substance abuse, or a severe emotional event, such as from combat or a motor vehicle accident, may be either temporary or permanent
108
What are the pearls of loss of memory?
It's either caused by
- dementia (alzheimer's)
- delirium (withdrawal or infection)
- amnesia (head injury, CVA, etc.)
109
What is delirium?
an acute syndrome caused by medical condition, substance, intoxication or withdrawal or medication side effect a AMS
- ex: sepsis, sundowning, ETOH withdrawal, opiate withdrawal, sunstroke
- rapid onset, short term, reversible
- criteria
- disturbed level of consciousness (decreased attention span/lack of environmental awareness)
- cognitive change - memory deficit, disorientation, language disturbance, visual/auditory hallucinations
- rapid onset within hours/days with a fluctuating course
- evidence of a causal physical condition
110
How is delirium dx?
history, CT/MRI, CBC, blood cultures, CXR, UA, BUN, electrolytes, glucose, urine toxicology to r/o infection
111
What is the tx of delirium?
treat underlying cause/supportive care; sedation when necessary
112
What is Alzheimer's disease?
- age-related progressive cognitive decline affects 5% of those aged 71-80 years, and near 40% of those aged over 90 years
- s/s: gradual, progressive memory loss, difficulty word-finding, concentration problems, emotional lability, personality changes, social withdrawal, difficulties with dressing, cooking, balancing the checkbook, and maintaining hygiene
- there are multiple types of dementia: Alzheimer disease, vascular dementia, and other less common dementias
113
How is Alzheimer's disease dx?
Folstein Mini-Mental State Examination (MMSE) or the memory impairment screen, the MMSE may be useful to provide a baseline for future comparison, controversy exists over the use of memantine and anticholinergic medications in the tx of dementia
- alzheimer disease = MC: 2/3 dementia cases; irreversible; early lanuage/visuospatial deects
- severe memory deficits; clue don't help memory retrieval
- r/f: advanced age, family hx
- vascular: 1/4 cases, r/f: HTN, dyslipidemia, DM, smoking, adv age
- lewy body: cognitive fluctuations, visual hallucinations, parkinsonism
- frontotemproal dementia: personality, and social behavior changes, non-fluent sppech
- neurodegenerative conditions: huntingon disease, metabolic abnormalities
114
What are the irreversible causes of dementia?
vascular dementia, Creutzfeldt-jakob
115
What are the reversible causes of dementia?
depression, B12 deficiency, syphilis, hypothyroidism, NPH, drug use, intracranial mass
116
What is the tx of dementia?
cholinesterase inhibitors (donepezil): NMDA antagonists (memantine) a don't cure, just slow progression
117
What is vertigo?
the sensation of movement in the absence of movement
118
What is peripheral vertigo?
inner ear = labyrinthitis, BPPV, meniere, vestibular neuritis, head injury = sudden onset, n/v, tinnitus, hearing loss, nystagmus (horizontal)
119
What is central vertigo?
brainsteam vascular disease, AVM, tumor, MS, vertebrobasilar migraine = more gradual onset/vertical nystagmus, no auditory symptoms
-vertigo+ syncope = vertebrobasilar insufficiency
120
What is BPPV?
positional, no hearing loss, tinnitus, ataxia
- dx: Dix-hallpike test
- tx: employ maneuvers, meclizine
121
What is vestibular neuritis?
not positional, no hearing loss/tinnitus
| -tx: meclizine
122
What is labyrinthitis?
acute, self-resolving episode; vertigo, hearing loss tinitus,
-tx: meclizine + steroids
123
What is Meniere's disease?
chronic, relapsing, remitting; vertigo + hearing loss + tinnitus
-tx: diuretics, salt restriction, CN VIII ablation for severe cases
124
What is perilymph fistula?
a history of trauma, vertigo from trauma
| -tx: fix damage surgically
125
What is an acoustic neuroma?
ataxia, neurofibromatosis type II
- MRI findings: vertigo, hearing loss, tinnitus, and ataxia
- tx: surgery
126
What is meningitis?
the classic triad of fever > 38 C, nuchal rigidity (stiff neck), headache
127
What are the characteristics of meningitis?
- unlike encephalitis no mental status changes
- physical exam: Kernig's sign (neck pain with knee extension), Brudzinski sign (leg raise with a bent neck)
- aseptic: usually viral; negative blood cultures
- bacterial: community-acquired, usually s. pneumonia (gram _ cocci)/n. meningitides (gram-diplococci) - likely if pt has a rash
- neonates = e.col/s.agalactiae
- >50-60 = listeria/cryptococcus neofromans
- hospital-acquired: staph/aerobic gram-negative
128
How is meningitis dx?
lumbar puncture = must first check for increased intracranial pressure (check for papilledema) = get a CT if unsure
- bacterial: increase protein, decrease glucose (bacteria love to eat glucose); markedly increased opening pressure
- viral: normal pressure, increased WBC (lymphocytes)
129
What is the tx for meningitis?
- aseptic: symptomatic or IV acyclovir for HSV
- bacterial: dexamethasone + empiric IV antibiotics (cephalosporin, Vanco, penicillins)
- household contacts: treat with rifampin, Cipro, Levaquin, azithromycin, ceftriaxone
130
What are the ddx for weakness/paralysis?
Epstein-Barr virus, human immunodeficiency virus, influenza, Lyme disease, meningitis (multiple agents), polio, rabies, syphills, toxoplasmosis, amyotrophic lateral sclerosis, cerebrovascular disease, stroke, subdural/epidural hematoma, Guillain-barre syndrome, multiple sclerosis, neoplasm, Lambert-eaton myasthenia syndrome, myasthenia gravid, organophosphate intoxication, cervical spondylosis, degenerative disc disease, spinal cord injury, spinal muscle atrophy, alcohol, adrenal insufficiency, glucocorticoid excess, hyperthyroid/hypothyroid, RA, polymyositis, dermatomyositis, RA, lupus, muscular dystrophy, PMR, etc.
