Neurology -Panre Flashcards
No LOC, post traumatic amnesia and other symptoms resolve in < 30 minute when can the athletes return?
7 days
+ LOC , 1 minute or post-traumatic amnesia and other symptoms last > 30 minutes but < 1 week, when can athlete return to sport?
2 weeks if asymptomatic at rest and exertion for at least 7 days
MC cranial neuropathy (facial) nerve palsy associated with lyme dz?
Bell’s Palsy
Bells’s Palsy differentiates from TIA/STroke ?
If upper face is okay(able to wrinkle both sides of forehead ) its NOT bell palsy
How does bell palsy presents?
Sudden onset of ipsilateral hyperacusis 24-48 hours later =unilateral facial paralysis and taste disturbance 2/3
Weakness paralysis only affect’s face?
bell’s palsy
Is treatment need for Bell’s palsy ?
No, will resolve within 1month; but prednisone, artificial tears and acyclovir are used
When is prednisone used with Bell’s palsy
1st 72 hour onset
Idiopathic unilateral CNVII /facial nerve palsy ?
Bell
Bell’s + Zoster
Ramsey Hunt ; same side facial palsy, vertigo, some side hearing loss
Brain injury during perinatal or prenatal period
Cerebral palsy
Muscle tone & postural abnormalities?
Cerebral palsy
What are the 3 types of cerebral palsy?
spastic, syskinetic, ataxia (difficult with movt/speech
Tx for cerebral palsy?
pt, ot, antispasmotic benzondiapenzies, baclofen, cantrolene
Protrusions in the intracranial arteries due to thin or
absent tunica media or internal elastic membrane results in what of type of cerebral aneurysm?
Berry aneurysm, circle of willis
MC type of aneurysm?
Berry aneurysm, circle of willis
Enlargement of entire circumference of vessel results in type of aneurysm?
Fusiform:
Mycotic aneurysm is?
Due to infected emboli from endocarditis
What is Delirium (Level 1)
abrute transient confused state due to identifiable cause
Delirium (Level 1) is common in ?
high suspicion in elderly population,
What is Encephalitis (Level 1)
infection of brain (parenchyma)
Encephalitis (Level 1) Common culprits are?
1 HSV, arboviruses (West Nile, Zika, St Louis); also CMV,
toxoplasmosis, VZV, Borrelia , Rickettsia
Encephalitis (Level 1) s/s?
Altered mental status, fever, HA, seizure, confusion, lethargy, focal neuro
deficits (CN deficits, ↑ DTR)
Dx of encephalitis?
CSF evaluation by LP, CT/MRI may show mass effect
↑lymphocytes, ↑ protein and normal glucose in LP for encephalitis?
viral
Presence of RBC without trauma in LP for encephalitis?
suggesting HSV
tx of encephalitis
HSV encephalitis has ↑ morbidity (70% in untreated), start IV acyclovir at 1st
whiff of suspicion
○ Supportive care: Fluids, pain meds, seizure prophylaxis, airway management
Essential tremor is what type of inherited dz?
autosomal dominant, no genes have been identify
What is the onset age of Essential tremor
> 60
Essential tremor s/s
Postural bilateral tremor common to upper extremities and head
○ Worse with intentional movement and stress
■ Eg, finger to nose testing → tremor ↑ when approaching finger
Temporarily relieved by alcohol
○ No other PE/neuro findings
What is disorder is temporarily relived by alcohol?
essential tremor
Essential disorder presents with other PE/neuro finding true or false?
false
What is Guillain-Barré syndrome (Level 1)
Acquired inflammatory demyelinating polyradiculopathy of peripheral nerves
○ Nerve degeneration slows impulses causing weakness and paresthesias; inflammatory demyelination of many nerve roots in peripheral nerves which was obtained after infection/immunzation etc
What is the #1 cause Guillain-Barré syndrome (Level 1)
Campylobacter jejuni
How does Guillain-Barré syndrome (Level 1) presents?
CM: minimal weakness of legs to total paralysis of all 4 limbs, facial muscles and legs Ascending symmetric weakness/paresthesias
■ May involve muscles of breathing; with loss of reflexes
One critical complication of Guillain-Barré syndrome (Level 1) is?
Paralysis of chest muscles/diaphragm =respiratory failure
How is guillan-barre treated
Plasmapheresis, IVIG, respiratory support as needed
● Prognosis: Full recovery in 1 year ~ 60%
What Myasthenia graves?
Autoimmune peripheral nerve dz, 75% have thymic abnormality (hyperplasia or thyoma) or other autoimmune dz. May occur postpartum
Presents with muscle weakness that improve with rest and antibodies are directed against acetycholine receptors
Myasthenia graves
- Ocular weakness (1st presenting symptom) (dipolpia, ptosis, pupils are spared). 2. Follow with generalized muscle weakness and respiratory muscle weakness (may lead to respiratory failure?
Myasthenia graves; muscle weakness least in the am worsen with repeat muscl e use throughout they day, normal sensation/deep tendon reflexes
How to dx Myasthenia graves?
Acetylcholine receptor abx and + MuSK (muscle specific tyrosine kinase ) abx ; Edrophonium (tenilson test)
How to treated Myasthenia graves in non acute settings? in acute settings?
1st line management =Pyriodstigmine or Neostigmine. Plasmapheresis or IVIG for rapid response; Thymectomy if thyme
MOA of Pyridstigmine or Neostigmine?
Increases acetylcholine by decreasing acetylcholine breakdown
s/e of Pyridstigmine or Neostigmine?
abdominal cramps/diarrhea ; cholinergic crisis?
what is cholinergic crisis?
excess acetycholine due to ach-esterase inhibition=weakness, n, v, pallow, sweating, salivation, diarrea, miosis , bradycaria, respiratory failure
To distinguish between cholinergic crisis or myasthenia crisis what test is done?
Tensilon-if flaccid paraylsis improves with test=myasthenic crisis; if worsen with test=cholinergic crisis
What medications need to avoid during myasthenia crisis?
fluoroquinolone and ahminoglycosides
what is Lambert-eaton? How does it differ from MG?
Myasthenic syndrome, MC associated with small cell lung cancer, abs against presynaptic voltage-gated calcium channels prevents acetylcholine release. Difference between MG, weakness IMPROVES WITH REPEATED USE
What is #1 type of dementia?
Alzheimer Disease
Rf of alzheimer dz?
Age, FH, female gender, Down syndrome
Pathology of alzheimer dz?
Neuritic plaques with amyloid deposition and neurofibrillary tangles (tau protein)
What is alzheimer
Loss of brain cells, amyloid deposition (senile plaques) in the brain; Cholinergic deficiency causes memory, language changes, visuospatial changes. Normal reflexes
s/s of alzheimer dz?
1st symptom is memory loss of newly acquired information, progressive along
with disorientation, behavioral and personality changes
what is the 1st symptoms of alzheimer
memory loss
alzheimer is dx?
Clinical features of cognitive decline with no motor impairme. CT-scan: cerebral cortex, atrophy on CT scan
Tx of alzheimer includes?
ACh-esterase inhibitors: Donepezil-reverses cholinergic deficiency and symptoms (does not slow progression); Memantine may slow progression (add in mod-to severe). Anti psychosis for agitation
Memantine#
NMDA antagonist; blocks nmda receptor, slowing ca influx & nerve damage. Glutamate is an excitatory neurotransmitter of the NDMA receptor. Excitotoxicity causes cell death. NMDA antagonists reduces glutamate excitotoxicity. May be adjunctive
2 type of overall dementia after Alzheimer Disease
Vascular
What are the causes of #2 vascular dementia? Rf?
Chronic ischemia and multiple lacunar infarcts; age, HTN, DM2, h/o CVA
s/s of vascular dementia (2 types)
Cortical symptoms: Confusion, amnesia, speech and executive difficulties
○ Subcortical symptoms: Motor deficits, gait difficulties, personality changes
dx of vascular dementia?
Presence of dementia along with focal neurologic signs and symptom onset
either abrupt, stepwise or related to CVA; imaging may show evidence of old infarcts
tx of vascular dementia?
ACh-esterase inhibitors along with Memantine may be helpful
○ Risk factor management
What is Frontotemporal dementia
FTD; has been known as Pick’s disease; Group of neurodegenerative disorders characterized by changes in behavior,
personality, speech along with atrophy of frontal and temporal lobes
MC variant of Frontotemporal dementia
Behavioral variant FTD
s/s of Frontotemporal dementia
Disinhibition, significant behavioral and personality changes
early in disease, lack of empathy, apathy (PRESERVES VISUOSPATIAL)
DX & TX Frontotemporal dementia? RISKS?
Dx: Clinical, MRI/CT showing atrophy
● Tx: Symptomatic
FAMILY HX
What IS A common cause of early onset dementia onset 50-60’s ?
Pick’s dz