Neurology IV highlights

Question 1

Seizures:
1) What is essential for diagnosis and classification?
2) What neuroimaging is preferred?

Answer 1

1) EEG
2) MRI preferred over CT

Question 2

A seizure is a transient occurrence of S/Sx due to abnormal excessive or synchronous neuronal activity in the brain and can be either _________ or ___________

Answer 2

focal or generalized

Question 3

Idiopathic seizures make up ~ ____% over all age groups

Answer 3

62%

Question 4

List 5 seizure meds

Answer 4

Valproic acid, phenytoin, topiramate, gabapentin, carbamazepine

Question 5

What type of seizures may be very brief? (seconds; ”miss a word or two when talking”)

Answer 5

Absence seizures (AKA petit mal)
[type of generalized nonmotor seizure]

Question 6

List the 5 different types of generalized motor seizures

Answer 6

1) Tonic
2) Clonic
3) Tonic-clonic [grand mal]
4) Myoclonic
5) Atonic

Question 7

What seizure type almost always starts in childhood, frequently ceases by age 20 y/o?

Answer 7

Absence/ petit mal

Question 8

Motor seizures [general]
1) Rigidity followed by LOC is characteristic of what kind?
2) Convulsions and LOC sound like what type?

Answer 8

1) Tonic
2) Clonic

Question 9

Motor seizures [general]
1) A pt has quick jerking without LOC. This sounds like which in this category?
2) A pt has rigidity with LOC, then convulsions and a postictal period. This describes which type?

Answer 9

1) Myoclonic
2) Tonic-clonic

Question 10

Sudden drop attack and LOC are characteristic of _________ general motor seizures (ddx: syncope)

Answer 10

atonic

Question 11

Abrupt onset __________, __________, and _______ are the signs of a tonic-clonic [grand-mal] seizure

Answer 11

rigidity, convulsions, and LOC

Question 12

List 6 meds that can be used to Tx generalized motor seizures

(not highlighted but seems important)

Answer 12

1) Carbamazepine (Carbatrol)
2) Phenytoin (Dilantin)
3) Valproic acid (Depakote)
4) Phenobarbital (Luminal)
5) Lamotrigine (Lamictal)
6) Gabapentin (GABA)

Question 13

What is the most important part of status epilepticus Tx?

Answer 13

Benzos: lorazepam 4 mg IV bolus

Question 14

What is a crucial element that defines the status epilepticus type of seizure?

Answer 14

No conscious recovery b/t seizures

Question 15

HTN is a risk factor for what condition that involves sudden onset neurological deficits?

Answer 15

Stroke (CVA)

Question 16

Epilepsy is a chronic condition characterized by what?

Answer 16

At least 2 unprovoked seizures at least 24 hours apart

Question 17

Unprovoked single seizure means the first what?

Answer 17

Single seizure not treated with anti-seizure Rx

Question 18

What is best indicator of driving safety with a seizure disorder?

Answer 18

Seizure free interval (6-month seizure free in TN to drive)

Question 19

True or false: State authorities make the ultimate decision about driving, not health care providers

Answer 19

True

Question 20

A TIA has focal neurologic symptoms of presumed ischemic origin with the absence of what?

Answer 20

Infarction on brain imaging (usually resolved in minutes)

Question 21

5-15% of patients with TIA will have stroke within ______ days esp older pts and pts with DM

Answer 21

90

Question 22

List the 4 features that increase risk of stroke after TIA.
What are the risks if none of these are present?

Answer 22

1) Age > 60
2) Diabetes
3) Speech or motor difficulties as part of presentation
4) Episode duration > 10 minutes
-None of above factors = minimal risk

Question 23

AHA/ASA recommends the ABCD2 score to calculate a patient’s __________ risk of developing a CVA

Answer 23

short-term

Question 24

Hospitalize patients with TIA if they present within 72 hours of the event and any of what criteria are present?

Answer 24

1) ABCD2 Score 4 or more (mod/high risk TIA)
2) ABCD2 score of 0-3 and uncertainty that diagnostic w/u can be completed within 2 days as an outpatient

Question 25

TIA urgent evaluation includes what? (4 main things, 3 sub-tests)

Answer 25

1) Non-contrast CT 2) MRI 3) Neurovascular imaging 4) Cardiovascular evaluation: a) ECG (enzymes as part of initial labs) b) Event monitor c) Echocardiogram

Question 26

When using neurovascular imaging to evaluate large artery disease during an urgent TIA eval., what would be a source of emboli?

Answer 26

Carotid artery disease (CAD)

Question 27

What are the two types of stroke (CVA)?

Answer 27

Ischemic + hemorrhagic

Question 28

What is the leading cause of disability? (US)

Answer 28

Stroke (CVA)

Question 29

What gives some improvement of disability at 90 days after an ischemic stroke? When must it be given?

Answer 29

IV thrombolytics (tPA-tissue plasminogen activator); must be given **within 3 hours**

Question 30

What is key for ischemic stroke Tx?

Answer 30

early rehab

Question 31

What is the most common exam finding of a stroke?

Answer 31

Unilateral weakness and speech disturbance

Question 32

____________, aka last known baseline state, is crucial for assessment and treatment options

Answer 32

Timing

Question 33

Stroke: 1) If speech is affected, what side is the stroke? 2) If the left side is paralyzed, what side is the stroke?

Answer 33

1) Left 2) Right

Question 34

NIH stroke scale (NIHSS): 1) How many items is it? 2) What is its chief utility?

Answer 34

1) 15 2) Stroke severity

Question 35

How do you interpret NIH Stroke Scale scores? **important**

Answer 35

8 or less = mild (no rtPA) 9-15 = moderate 16 + = severe

Question 36

Review: What are the maintenance recommendations for secondary prevention of ischemic stroke? (2 options)

Answer 36

1) ASA: 162-325 mg daily monotherapy OR 2) ASA 325 mg + Clopidogrel (Plavix) 75 mg daily monotherapy

Question 37

Carotid endarterectomy (CEA) is beneficial _________ stroke when ipsilateral extracranial internal carotid stenosis is ______% or greater.

Answer 37

after; 70%

Question 38

Endarterectomy is reasonable with ipsilateral stenosis of ____% to _____% in patients who are at lower surgical risk. (CAD stroke pts)

Answer 38

50% to 69%

Question 39

What is beneficial when ipsilateral extracranial internal carotid stenosis is 70% or greater?

Answer 39

Carotid endarterectomy (CEA)

Question 40

True or false: Most arteriovenous malformations (AVM)s bleed at some point

Answer 40

True

Question 41

What is a key part of Cerebral Aneurysm Rupture Tx?

Answer 41

Frequent neuro checks

Question 42

What is the goal of intracranial hemorrhage Tx?

Answer 42

prevent rebleed