Notes 5 Flashcards
Infective endocarditis tx?
Antibx, AP and AC is contraindicated as it can cause hemorrhage.
SAH from aneurysm ruptures are usually/not usually assoc with vasospasm
Not usually
Sickle cell: ICH or ischemic is more common
ischemic
In children with sickle cell + concern for stroke, whats special about management?
TCDs periodically, when inc velocities are detected, blood transfusions have been shown to reduce risk of stroke.
Antibody assoc with Miller Fischer variant of GBS?
Anti-GQ1b
DIC vs TTP
PLTS
schistocytes
D-dimer
fibrinogen
clotting time
DEC DEC
PRESENT PRESENT
ELEVATED NORMAL
REDUCED NORMAL
INCREASED NORMAL
uremic encephalopathy can cause myoclonus due to?
alterations in cerebral phosphate metabolism
Dialysis dysequilibrium syndrome
can range from mild encephalopathy to fatal cerebral edema.
Results from shifts of water into the brain due to changes in osmotic gradient.
Polyarteritis nodosa: Neuro manifestations
Seizures
mononeuritis multiplex
Cranial neuropathies
peripheral neuropathies
Churg Strauss Syndrome
Asthma, eosinophilia, sinua and pulmonary involvement
Wegener granulomatosis
What is it and how to dx
sinus, pulmonary involvement + glomeruonephritis
Dx: granulomas on biopsy, c-ANCA+ and proteinase-3 Ab +
Kawasaki Disease
fever, conjunctivitis, mucositis, rash, lymphadenopathy
- inc risk of coronary artery disease
- neuro manifestation of aspeptic meningitis
Pituitary blood supply?
Superior/Inferior hypophyseal arteries which arise from ICA
Diabetes insipidus (central)
deficiency of ADH (responds to ADH/desmopressin trial)
Diabetes insipidus (peripheral)
due to inadequate renal response to ADH
does not respond to desmopressin trial
Urine osmolality in diabetes insipidus
low (not absorbing any water so you are peeing it all out)
Cerebral salt wasting
what is it and tx
from excessive renal losses of sodium
seen in patients with CNS injuries
(pathology unclear, thought to be from inc atrial natriuretic peptide released from cardiac atria)
tx with salt supplementation or iso/hypertonic IV fluids
SIADH: tx?
fluid restrict and correct underlying cause (medication induced, head trauma, paraneoplastic ADH production_
postpartum cerebral angiopathy
what is it and tx
on the spectrum of RCVS due to multifocal vasospasms
p/w HA, seizures, focal deficits
Tx with CCBs +/- steroids
pre/eclampsia
what is it, sx and tx
HTN + proteinuria and often edema in the face/feet
Eclampsia = pre-eclampsia + seizures
Sx: headache, visual changes, seizures, PRES
Tx: delivery, IV mag, IV anti-hypertensives
Patient’s with antiphospholipid syndrome + acute onset chorea
chorea gravidarum
MOA of amphetamine
causes immediate release of dopamine and NE and inhibits their reuptake.
MOA of cocaine
inhibits reuptake or dopamine and NE (no direct release)
Both cocaine and amphetamine act on the reward centers:
- ventral segmental area
- nucleus accumbens
to produce a euphoria feeling
classic MRI finding in Wernicke’s encephalopathy
petechial hemorrhages in mamillary bodies, hypothalamus, medial thalami, periaqueductal grey matter
MOA of alcohol
stimulates GABA receptors (similar to benzos)
MOA of nicotine
nicotinic Ach receptor agonist inc release of dopamine)
MOA of caffeine
adenosine receptor inhibitor = less inhibition on excitatory NTs -> more cortical excitability
MOA of PCP/ketamine
glutamate NMDA receptor antagonist (can cause hallucinations, seizures)
excess zinc can lead to
a copper deficiency which presents as a myelopathy similar to SCD seen in B12 def.
sensorimotor peripheral neuropathy with axonal loss, spastic paresis and posterior column dysfunction
Vitamin E deficiency
Caused by
sx
caused by chronic diarrhea and subsequent malabsorption of fat soluble food
can resemble friedrich’s ataxia: ataxia, dysarthria, areflexia, large fiber sensory loss
B1 thiamine deficiency?
2 types
Dry beriberi: axonal sensory loss
Wet beriberi: cardiac involvement (CHF, arrhythmias, cardiomegaly), peripheral edema
Arsenic poisoning presents with
garlic odor on the breath, encephalopathy, seizures
cyanide poisoning p/w
bitter almond odor, rapidly lethal
mercury toxicity p/w
previously known as mad hatter’s disease as hatters used to work with mercury when making hats.
p/w cerebellar signs, tender gums, excessive salivation, psych changes
lead intoxication p/w? path?
abdominal pain, constipation, wrist/ankle drop
basophillic stippling of RBCs
manganese toxicity
seen in patients w/
sx?
MRI?
chronic liver disease, those receiving TPN, and weilding/steel industry
parkinsons sx, personality changes, hallucinations, psychosis
high T1 signal in globus pallidus
methanol toxicity is assoc with what neuro finding?
optic nerve necrosis
vincristine and cisplatin assoc with
peripheral neuropathy
methotrexate is assoc with
leukoencephalopathy and aseptic meningitis
cytarabine is assoc with
aseptic meningitis, cerebellar syndrome
5-fluorouracial is assoc with
cerebellar syndrome
bevacizumab is assoc with
hemorrhagic stroke and ICH
Rituximab is assoc with
PML!!
Wernicke’s is due to
thiamine def
Wernicke encephalopathy tried
Confusion
ataxia
nystagmus/ophthalmoplegia
Wernicke MRI finding
hemorrhagic mamillary bodies
Garlic breath
arsenic
almond odor
cyanide
alopecia + painful neuropathy: what exposure causes this
thallium
Cherry red skin from exposure?
CO, cyanide
wirst/foot drop in a patient with encephalopathy
lead poisoning
globus pallidus necrosis
CO
putamen necrosis
methanol
Which brain organs do not have a blood brain barrier?
area postrema, subfornical organ, organum vasculosum, neurohypophysis, median eminence, pineal gland, subcommisural organ
Post-transplant acute limbic encephalitis is usually caused by
HHV6, requires antiviral tx
best predictor of poor outcome after anoxic injury
absence of pupil/corneal reflex after 3 days
innervation of the dura?
supratentorial dura innervated by CN V while infratentorial is innervated by CN 10, 9, first 3 cervical nerves.
CPP formula
MAP-ICP
transtentorial (uncal) herniation
herniation of the medial temporal lobe -> compresses CN3 = blown pupils and corticospinal tract = contralateral hemiplegia
Central herniation
downward displacement of the brainstem -> traction on CN6 = lateral rectus palsy and if more severe can cause BL uncal herniation
subfalcine herniation
parenchyma (usually cingulate gyrus) herniates under the falx cerebri = usually asx but can cause ACA infarcts
Most common location of saccular aneurysms (berry)
- Acomm
- Pcomm
- MCA
cerebral vasospasm 2/2 ruptured aneurysm can be treated by
triple H therapy
HTN
hypervolemia
hemodilution
located in deep vessels, the usual cause of deep BP related ICH?
Charcot Bouchard aneurysms
spinal cord blood supply?
throughout it is supplied by posterior (from vertbral/PICA) or anterior spinal arteries. however, the T spine is supplied by a branch of the Aorta, making the T spine the most sensitive to ischemia
Artery of adamkiewicz
arteries coming from the aorta to supply lumbosacral spinal cord
somatotropic organization of the internal capsule?
anterior-> face
posterior->legs
corticospinal pathway?
cortex -> corona radiata ->internal capsule -> cerebral peduncle (basis pedunculi) -> pons (basis pontis) -> medullary pyramids (85% decussate and 15% do not)
somatotropic organization of the lateral corticospinal tract
leg laterally and hand medially
sympathetic vs parasympathetic pathway for pre and post ganglionic tracts
Symp: short pre and long post
Para: long pre and short post
NT in preganglionic neurons in both para and symp?
Ach
NT in post ganglionic neurons in both para and symp?
Para: Ach
Symp: NE
Cuneate carries info from trunk at what levels?
Above T6
VPL of the thalamus
body sensation
VPM of the thalamus
face sensation
lateral geniculate of the thalamus
relay for vision
medial geniculate nucleus of the thalamus
relay for hearing
ventral lateral nucleus of the thalamus
receives projections from cerebellum and BG
List the episodic ataxia syndromes
Episodic Ataxias
1: facial twitching, KCN1A mutation, responds to CBZ
2: brainstem sx: CACNA1A4, responds to diamox
3: vertigo/tinnitus
4: ocular motion abnormalities
