Neurology IV highlights Flashcards
Seizures:
1) What is essential for diagnosis and classification?
2) What neuroimaging is preferred?
1) EEG
2) MRI preferred over CT
A seizure is a transient occurrence of signs or symptoms
due to abnormal excessive or synchronous neuronal activity in the brain and can be either _________ or ___________
focal or generalized
Idiopathic seizures make up ~ ____% over all age groups
62%
List 5 seizure meds
Valproic acid, phenytoin, topiramate, gabapentin, carbamazepine
What type of seizures may be very brief? (seconds; ”miss a word or two when talking”)
Absence seizures (AKA petit mal)
[type of generalized nonmotor seizure]
List the 5 different types of generalized motor seizures
1) Tonic
2) Clonic
3) Tonic-clonic [grand mal]
4) Myoclonic
5) Atonic
What seizure type almost always starts in childhood, frequently ceases by age 20 y/o?
Absence/ petit mal
Motor seizures [general]
1) Rigidity followed by LOC is characteristic of what kind?
2) Convulsions and LOC sound like what type?
1) Tonic
2) Clonic
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?
1) Myoclonic
2) Tonic-clonic
Sudden drop attack and LOC are characteristic of _________ general motor seizures (ddx: syncope)
atonic
Abrupt onset __________, __________, and _______ are the signs of a tonic-clonic [grand-mal] seizure
rigidity, convulsions, and LOC
List 6 meds that can be used to Tx generalized motor seizures
(not highlighted but seems important)
1) Carbamazepine (Carbatrol)
2) Phenytoin (Dilantin)
3) Valproic acid (Depakote)
4) Phenobarbital (Luminal)
5) Lamotrigine (Lamictal)
6) Gabapentin (GABA)
What is the most important part of status epilepticus Tx?
Benzos: lorazepam 4 mg IV bolus
What is a crucial element that defines the status epilepticus type of seizure?
No conscious recovery b/t seizures
HTN is a risk factor for what condition that involves sudden onset neurological deficits?
Stroke (CVA)
Epilepsy is a chronic condition characterized by what?
At least 2 unprovoked seizures at least 24 hours apart
Unprovoked single seizure means the first what?
Single seizure not treated with anti-seizure Rx
What is best indicator of driving safety with a seizure disorder?
Seizure free interval (6-month seizure free in TN to drive)
True or false: State authorities make the ultimate decision about driving, not health care providers
True
A TIA has focal neurologic symptoms of presumed ischemic origin with the absence of what?
Infarction on brain imaging (usually resolved in minutes)
5-15% of patients with TIA will have stroke within ______ days esp older pts and pts with DM
90
List the 4 features that increase risk of stroke after TIA.
What are the risks if none of these are present?
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
AHA/ASA recommends the ABCD2 score to calculate a patient’s __________ risk of developing a CVA
short-term
Hospitalize patients with TIA if they present within 72 hours of the event and any of what criteria are present?
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
TIA urgent evaluation includes what? (4 main things, 3 sub-tests)
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
When using neurovascular imaging to evaluate large artery disease during an urgent TIA eval., what would be a source of emboli?
Carotid artery disease (CAD)
What are the two types of stroke (CVA)?
Ischemic + hemorrhagic
What is the leading cause of disability? (US)
Stroke (CVA)
What gives some improvement of disability at 90 days after an ischemic stroke? When must it be given?
IV thrombolytics (tPA-tissue plasminogen activator); must be given within 3 hours
What is key for ischemic stroke Tx?
early rehab
What is the most common exam finding of a stroke?
Unilateral weakness and speech disturbance
____________, aka last known baseline state, is crucial for assessment and treatment options
Timing
Stroke:
1) If speech is affected, what side is the stroke?
2) If the left side is paralyzed, what side is the stroke?
1) Left
2) Right
NIH stroke scale (NIHSS):
1) How many items is it?
2) What is its chief utility?
1) 15
2) Stroke severity
How do you interpret NIH Stroke Scale scores?
important
8 or less = mild (no rtPA)
9-15 = moderate
16 + = severe
Review: What are the maintenance recommendations for secondary prevention of ischemic stroke? (2 options)
1) ASA: 162-325 mg daily monotherapy
OR
2) ASA 325 mg + Clopidogrel (Plavix) 75 mg daily monotherapy
Carotid endarterectomy (CEA) is beneficial _________ stroke when ipsilateral extracranial internal carotid stenosis is ______% or greater.
after; 70%
Endarterectomy is reasonable with ipsilateral stenosis of ____% to _____% in patients who are at lower surgical risk. (CAD stroke pts)
50% to 69%
What is beneficial when ipsilateral extracranial internal carotid stenosis is 70% or greater?
Carotid endarterectomy (CEA)
True or false: Most arteriovenous malformations (AVM)s bleed at some point
True
What is a key part of Cerebral Aneurysm Rupture Tx?
Frequent neuro checks
What is the goal of intracranial hemorrhage Tx?
prevent rebleed
