Neurology from PANCE Pearls Flashcards
What is Parkinsonism
A disorder associated with tremor, bradykinesia, rigidity, and postural instability
It includes Parkinson’s Disease, Medications, Lewy Body Dementia and trauma
What is an essential tremor
Autosomal dominant inherited disorder of unknown etiology
Sx of Essential Tremor
Postural, bilateral action tremor of hands, forearms, head, neck or voice
Worsened with emotional stress and intentional movement
Tremor is shortly relieved with alcohol
No abnormal neurologic findings
Tx of Essential Tremor
None needed
Propranolol if severe
What is Parkinson’s Disease
Idiopathic dopamine depletion
Failure to inhibit acetylcholine in basal ganglia
See Lewy bodies and loss of pigment cells in substantia nigra
Sx of Parkinson’s Disease
Tremor: Resting tremor, pill rolling tremor
Bradykinesia: Slowness of voluntary movement and decrease of automatic movements, lack of swining of arms while walking/shuffling gait
Rigidity: Flexed posture
Instability: Postural instability
Face involvement: Imobibe face (fixed faces), widened palpebral fissures, seborrhea of skin, decreased blinking
Myerson’s Sign: Tapping the bridge of the nose repetitively causes a sustained blink
Tx of Parkinson’s Disease
Levodopa/Carbidopa (Levodopa is coverted to Dopamine)
Dopamine Agonists: Bromocriptine, Pramiprxole, Ropinirole (used in young patients to delay use of Levodopa/Carbidopa)
Anticholingergis: Block excitatory cholinergic effects (used in patients
What is Huntington’s Disease
Autosomal dominant neurodegenerative disease
Sx of Huntington’s
Sx usually start around 30yrs
Initially behavioral changes (personality, cognitive, intellectual, psych)
Chorea
Dementia
Dx of Huntington’s
CT shows cerebral and caudate nucleus atrophy
Tx of Huntington’s
No Cure
Control Chorea: Antidopamineric agents and Benzodiazepines
What is Guillain Barre Syndrome
Acute/Subacute inflammatory demyelination polyradiculopathy with symmetric Lower to Upper extremity WEAKNESS
ASCENDING WEAKNESS
What leads to Guillain-Barre Syndrome
Campylobacter or other antecedent respiratory or GI infeciton (CMV, EBV)
Demyleination and axonal degenation slows impulses which leads to symmetric weakness and parasthesias
Sx of Guillain Barre Syndrome
Symmetric weakness and parasthesias
Decreased DTR
Tachycardia, hypotension or HTN, breathing difficulties
Dx of Guillain Barre Syndrome
CSF: HIgh protein with normal WBC
Tx of Guillain Barre Syndrome
Plasmapheresis removes antibodies causing demyelination
IVIG suppresses harmful inflammation
What is Myasthenia Gravis
Autoimmune disorder of peripheral nerves
Common in young women
What causes Myasthenia Gravis
Autoimmune antibodies against acetylcholine post-synaptic receptor at neuromuscular junction leads to progressive weakness with repeated muscle use and recovery after periods of rest
Sx of Myasthenia Gravis
Ocular: Extraocular muscle weakness, Diplopia, Ptosis
Generalized muscle weakness, worse with repeated muscle use, relieved with rest, weakness with prolonged chewing, dysphagia
What makes this deadly is respiratory weakness leads to respiratory failure = Myasthenia Crisis
Dx of Myasthenia Gravis
Tensilon Test (Edrophonium): Rapid response to short acting IV edrophonium
Positive Ach-receptor Antibodies
Ice Pack Test
Tx of Myasthenia Gravis
Acetylcholinesterase Inhibitors: Pyridostigmine, Neostigmine
Immnosuppression with corticosteroids, Cyclosporine
Thymectomy if Thymoma present
What is Multiple Sclerosis
Autoimmune inflammatory demyelinating disease of CNS, axon degeneration of white matter of brain, optic nerves, and spinal cord
What are the different forms of Multiple Sclerosis
Relapsing-Remitting
Progressive
Secondary Progressive (relapse remitting pattern that becomes progressive)
Sx of Multiple Sclerosis (3 major categories)
Optic Neuritis
Sensory Deficits
Spinal Cord Sx
Sx of Multiple Sclerosis (detailed)
Optic Nueritis: Unilateral eye pain worse with eye movements, diplopia, scotoma/vision loss, blurry vision
Sensory deficits: Weakness, parasthesias, fatigue
Spinal Cord sx: Bladder, bowel or sexual dysfunction
Charcot’s Neurologic Triad: Nystagmus, Stacatto speech and Intentional tremor
Tx of Multiple Sclerosis
Acute Exacerbations: Steroids
Relapse-Remitting/Progressive: Beta-Interferon, Amantadine for fatigue
What is a Subarachnoid Hemorrhage
Arterial bleed between the arachnoid and pia
What leads to a SAH
Berry Aneurysm rupture
AVM
Sx of SAH
Thunderclap: Worse headache of my life, Unilateral, occipital
Meningeal sx: stiff neck, photophobia, delirium
Dx of SAH
CT
If Negative do LP, look for RBC (Xanthochromia), increased CSF pressure, no focal neuro sx
Tx of SAH
Supportive
Bed rest, stool softeners, anti-anxiety meds
What is an Epidural Hematoma
Arterial beed between the skull and dura
What causes an Epidural Hematoma
Which artery is most commonly affected
Skull fracture
Middle Meningeal Artery
Sx of Epidural Hematoma
Brief LOC, Lucid Interval, Coma, Headache, N/V, Focal neuro sx, Rhinorrhea
Dx of Epidural Hematoma
CT (Convex/sens shape, does NOT cross suture lines)
Tx of Epidural Hematoma
Observation if small
What is a Subdural Hematoma
Venous bleed between the dura and arachnoid due to tearing of BRIDGING veins
What causes a Subdural Hematoma
Blunt trauma
Bleeding usually happens on side opposite of where trauma occurred
Sx of Subdural Hematoma
May have neurologic sx
Dx of Subdural Hematoma
CT (Concave/Crescent shape, can cross suture lines)
Tx of Subdural Hematoma
Hematoma evacuation vs. supportive
If midline shift, must evacuate
What is Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s Disease)
Necrosis of both upper and lower motor neurons
Progressive motor degeneration with normal sensory function
Sx of ALS
Loss of ability to initiate and control motor movements with mixed UMN and LMN signs
Progressive bilateral fasciculations
Muscle Atrophy
Eventually, Respiratory dyxfunction
Tx of ALS
Riluzole
What is Delirium
An acute, abrupt confused state
Transient global disorder of attention
What is Dementia
Progressive, Chronic Deterioration
Memory Loss and loss of impulse control, motor and cognitive functions that are not due to delirium, meds, or psych illnesses
What is Alzheimer’s Disease
Loss of brain cells, amyloid deposition (senile plaques) in the brain, neurofibrillary tangles (tau protein)
Tx of Alzheimer’s Disease
Ach-esterase inhibitors (Donepezil, Rivatigmine, Galantamine) NMDA Antagonists (Memantine)
What is Pick’s Disease
Localized brain degeneration of the fonrtotemporal area which may progress globally
See marked personality changes
What is Diffuse Lewy Body Disease
Abnormal protein deposits in nerve cells
Sx of Diffuse Lew Body Disease
Visual Hallucinations, Delusions, Parkinsonism
What is the most common artery affected by an Ischemic Stroke
Middle Cerebral Artery
Sx with Middle Cerebral Artery Stroke
Contralateral sensory/motor loss/hemiparesis
Greater in face and arm
Gaza preference towards side of lesion
Dx of Ischemic Stroke
Noncontrast CT to rule out hemorrhage
CT may be normal in first 6-24 hours
Tx of Ischemic Stroke
Thrombolytic therapy within 3 hours of onset of cases of ischemic stroke (rTPA Alteplase
Antiplatelet therapy: ASA, Clopidogrel Dipyridamole
