objectives-1 Flashcards
for paralysis of face, does LMN and UMN affect ipsilateral or contralateral face?
LMN- ipsi
UMN- contra
bulbar palsy
weakness in chewing, speaking, or swallowing (aka bulbar functions)
UMN pseudobulbar vs LMN (CN 7, 9, 10, 12) bulbar palsy
UMN: hyperactive jaw jerk (masseter reflex)
LMN: atrophy and fasciculations of muscles of the face, jaws, palate or tongue
tabetic gait
foot slapping
from syphilis or severe polyneuropathy
pseudotumor cerebri presentation
throbbing HA, +/- N/V, diplopia.
Patients are often obese
papilledema on exam
LP will have normal CSF @ high opening pressure
what causes should you think when an older vs younger patient presents with trigeminal neuralgia?
younger: MS
older: Tortuous or kinked BV compressing trigeminal
treatment of trigmenial neuralgia
carbamazapine
bulbous neuroma
following aberrant re-growth of a damaged
nerve, often exquisitely painful.
where is lesion with Ataxic respiration (variable breaths at an irregular interval)?
medulla
where is lesion with large fixed pupils
tectal (dorsal) midbrain lesion involving the parasympathetic fibers there
where is lesion with UNILATERAL BLOWN PUPIL, unresponsive consensually or directly?
ipsilateral CN III compression from swollen temporal lobe (uncal herniation)
where is lesion with small fixed pupils
pontine lesion involving sympathetic fibers
Oculocephalic reflex:
eyes roll in opposite direction of head turn with intact brainstem.
Remain in fixed position despite rolling if brainstem not intact
Oculovestibular (cold caloric) reflex:
eyes should move slowly toward the cold (irrigated) ear
i. If not present, brainstem compromised
how is sleep apnea diagnosed?
sleep study
cataplexy
periodic loss of muscle tone often provoked by emotional triggers
narcolepsy features
REM naps suddenly
cataplexy
sleep paralysis (REM hypotonia)
hynapgogic/pompic hallucinations
diagnosing narcolepsy
via multiple sleep latency tests, where the abnormally early onset of REM is
recorded as the patient is allowed to fall asleep several times but not in a state of sleep deprivation
syncope symptoms
dimming vision, tachycardia, diaphoresis, and “light-headedfeeling”.
can recall after episode; return to baseline
seizure prodrome symptoms
nausea or dizziness,
but patient cannot remember events
+/- urinary incontinence, post-ictal confusion/lethargy/irritation
seizure signs
tongue bite mark, rapid RR, bowel/bladder incontinence. Can have elevated WBC
simple partial seizure of motor cortex
jerking, rhythmic movements
simple partial seizure of temporal lobe
deja vu, amnesia, dysphoric/euphoric feelings, abnormal taste/smell
simple partial seizure of parietal lobe
paresthesia, dysesthesia, numbness, vertigo
simple partial seizure of occipital lobe
visual hallucinations
complex partial seizures
LOC
Usually involves medial temporal lobe=staring into space, deja vu, emotional changes,
automatisms
generalized absence seizure
LOC several seconds of staring/freezing in place, post-ictal phase,
pediatric.
3 hz spike and wave, sux to have absence seizures
generalized tonic clonic contraction
seizure=LOC, first tonic contraction forcing air out (cry) and arching of back, then clonus with violent jerking, salivation/drooling, tongue biting, post-ictal phase
tremor causes
resting: parkinsons
postural: essential
kinetic: essential or cerebellar
dystonia causes - focal vs gen
Focal=localized (ie Torticollis)
Generalized=diffuse, disabling (seen in hereditary disorders)
dystonia description
continual, sustained, painful contractions leading to spasms, turning of limbs
myoclonus associations
toximetabolic encephalopathy, Cruetzfeldt-Jacob Dz, Wilson’s Dz
Asterixis description
flapping tremor that “looks like foot tapping”
asterixis cause if bilateral vs unilateral
bilateral: Hepatic/metabolic encephalopathy
uni: Structural or ischemic lesion
TIAs last how long
usually 15 min, within 24 hrs
where is path for amaurosis fugax
carotids via ophthalmic artery
MCA infarct characterized by what symptoms
transient hemiparesis, aphasias
PCA infarct characterized by what symptoms
transient homonymous hemianopsia
Basilar/SCA/AICA characterized by what symptoms
Dizziness, dysphagia, dysarthria, diplopia, cerebellar ataxia
Vertebral/PICA characterized by what symptoms
cerebellar ataxia, +/- medullary syndrome
workup for potential stroke
MRI/MRA brain, carotid doppler, TTE/TEE,
check glucose and BP control,
if no yield:
- vasculitis autoimmune serum panel
- LP for CSF analysis
treatment for atherosclerotic stroke
Start antiplatelet (ASA, or ASA+ clopidigrel common) and statin
- Surgical approach: carotid endartectomy, possibly ballooning/stenting
- Prevention: control DM, HTN, HLD, smoking cessation
treatment for embolic stroke
start anticoagulation (heparin, warfarin, Factor X inhibitors, etc)
pathophys mechanisms for intracranial hemorrhage
i. Deep hemorrhage-from small vessel, (lenticulostriate) rupture due to HTN (remember cocaine)
ii. Superficial hemorrhage-from head trauma, possibly CT disorders
iii. Both can be compounded if patient is on anticoagulation
workup of intracranial hemorrhage
CT non contrast looking for bright blood!!!,
others CTA, MRI/MRA, CBC/CMP, check INR
treatment for intracranial hemorrhage
Manage underlying bleeding disorder if any,
FFP and coag factors in some cases,
Neurosurg for coil/clip placement
