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Neuro shelf > Panda neuro 1 > Flashcards

Panda neuro 1 Flashcards

1
Q

MCC SAH

A

Trauma

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2
Q

MCC Nontraumatic SAH (give locations!)

A

Ruptured Aneurysm (ACOMM > PCOMM > MCA > BA)

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3
Q

Risk Factors for SAH

A

HTN, Smoking, Cocaine, Vascular Disease (Marfans, ED), Fibromuscular Dysplasia, Aortic Coarctation

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4
Q

How do you work up a SAH?*

A
  1. CT without contrast —> if negative do LP for xanthochromia
  2. When either are positive, next step is cerebral angiogram for possible aneurysm
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5
Q

Complications of SAH (4)

A

Rebleed = Hemorrhage/Edema
Hydrocephalus
Vasospasm 4-14 days
Hyponatremia secondary to increase ANF/SIADH

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6
Q

How do you manage the 4 major complications of SAH?

A

Rebleed = Coil/Clipp
Hydrocephalus = EVD
Vasospasm 4-14 days = Nimodipine
Hyponatremia = monitor labs

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7
Q

How does a patient with SAH present?

A

Worst headache of their life with initially focal and rapidly spreading neurologic deficits. Don’t forget subhyaloid (preretinal hemorrhage) from acute increases in ICP.

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8
Q

“False Localizing Sign”

A

CN 6 dysfunction as a result of increased ICP

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9
Q

What is BP with elevated ICP?

A

Usually high (Cushing’s Reflex)

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10
Q

Basilar Bain Fracture

  • 4 Signs
  • Consequence
A

Signs:

  1. Raccoon
  2. Battle
  3. CSF Rhinorrhea
  4. CSF Otorrhea

Consequence - increased risk for Bacterial Meningitis

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11
Q

Alert vs. Lethargic vs. Stupor vs. Coma

A
  1. Alert= normal
  2. Lethargic= drowsy, sleeping but easily aroused
  3. Stuporous = hard to arouse, but doable
  4. Coma = unarousable
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12
Q

Which is better for acute bleed - CT or MRI? What about subacute bleed?

A

Acute = CT, Subacute = MRI

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13
Q

What does the following look like on CT? without contrast?

  • Epidural Hematoma
  • Recent Subdural Hematoma
  • Chronic Subdural Hematoma
A
  • Epidural Hematoma = acute bleed = hyperdense = bone
  • Recent Subdural Hematoma: recent bleed = isodence = brain
  • Chronic Subdural Hematoma: old bleed = hypodense = CSF
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14
Q

Patient on warfarin has epidural hematoma, going for NSx. What do you need to do before and after surgery?

A
  1. Before = FFP to reverse warfarin immediately

2. AFter = ASA until safe to use warfarin

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15
Q

Why are subdural hematomas more common in elderly?

A

Dura mater is fixed to the skull, more common for subdural > epidural.

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16
Q

Classic Script for Epidural Hematoma?

A

Closed head injury —> Lucid Period (1-2 hours) —> rapid deterioration in a cranio-caudal manner

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17
Q

4 Signs of increased ICP?

A

Cushing Reflex
CN 3 Problems/CN6 (False localizing signs) Problems
Change in Consciousness
Papilledema

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18
Q

DDx Primary Headache?

A

Tension, Cluster and Migraine

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19
Q

DDx Secondary Headache? (4)

A
  1. Intracranial HTN = Mass Effect, PTC, Dural vein thrombosis
  2. > 50 = Temporal Arteritis
  3. Meningeal Component = SAH / Meningitis
  4. Rx Overuse = Analgesic Withdrawal
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20
Q

MCC Daily Chronic HA?

A

Medication Overuse/Analgesic Withdrawal

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21
Q

Classic Components for Migraine Presentation?

A

Prodrome (no focal neuro) —> +/- Aura (focal Neuro) —> Migraine —> +/- Associated Symptoms (N/V/Photo-phonophobia).

Migraine = unilateral throbbing headache

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22
Q

Abortive Treatment for Migraine?

Prophylaxis?

A 
Abortive = take at HA onset = Triptan, Ergot, Midrin
Prophylactic = Propranolol, TCA, Topomax
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23
Q

Common signs of proximal muscle weakness?

Where does this localize the lesion?

A

Proximal Muscle Weakness = Arms heavy, can’t get out of chair, can’t reach for something in cabinet, trouble combing hair

HAIR CHAIR STAIR

Localize = Muscle + NMJ

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24
Q

Shortness of breath towards the end of the day that gets better with sitting up rather than laying down in a 24 yr old woman. Diagnosis?

A

MG

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25
Q

What should every patient with suspected MG be checked for at some point?

A

Thymic pathology

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26
Q

If a patient with MG by clinical eval has -antibodies and normal CXR, what is the next step?

A

Serology for anti-musk antibodies

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27
Q

Other than Antibodies and thymus evaluation, how else can you evaluate for MG?

A

Tensilon (Edrophonium) test

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28
Q

What determines Myasthenia crisis?

A

Respiratory distress

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29
Q

After stabilizing patient in Myasthenic Crisis, what do you monitor bedside?

A

FVC

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30
Q

3 CNS Lesions in HIV Patients

A
  1. Toxoplasmosis: multiple ring enhancing lesions
  2. Primary CNS Lymphoma: SINGLE ring enhancing lesions with EBV DNA in the CSF
  3. PML: non-ring enhancing lesion
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31
Q

DDx for Stroke in young patient (3)

A 
Carotid Dissection (Horner's)
Vascular Malformation (AVM)
Cryptogenic (PFO)
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32
Q

Describe Vascular Malformations and the most severe form

A

Vascular malformations (AV) are high flow high pressure AV connections with lots of A-V shunting. Severe form = moyamoya.

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33
Q

Management of carotid artery stenosis:

  • Asx
  • Sx
A

Asx: CAE if 60-99% occlusion

Sx: CAE if 70-99%
if Long Term ASA

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34
Q

What PD Rx are used mainly for the tremor?

A

Anti-AcH = Triphenhexidyl and Benztropine

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35
Q

Diffuse Atrophy —-
Atrophy of Caudate —
Atrophy of Lentiform —

A 
Diffuse = AD
Caudate = Huntington's
Lentiform = Wilson's
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36
Q

Progressive HA + decreased consciousness suggests…

A

Elevated ICP

  • HA = localizes to meninges, periosteum, vessels, etc.
  • Decreased Consciousness = bicerebrum vs. RAS
  • Combine the two = elevated ICP
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37
Q

Double vision that corrects with one eye covered up is _________ and is usually secondary to ______.

A

Binocular Diplopia

CN 3/6 weakness (if problems with seeing nearby = CN3, far = CN6)

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38
Q

TVO

A

Transient visual obscurations = b/l vision loss lasting seconds that are associated with increased ICP (transmitted along the optic nerve).

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39
Q

DecerEbrate vs. Decorticate position

A 
Decerebrate = Extension predominates
Decorticate = Flexion predominates
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40
Q

4 Types of Herniations

A
  1. Subfalacine (Cingulate): when medial anterior lobe is pushed under Falx Cerebri
  2. Central (Transtentorial): when structures above the midbrain compress down upon the midbraine, usually pushing down upon the brainstem
  3. Uncal: medial temporal lobe compressing midbrain ipsilaterally
  4. Cerebellum: supra-cerebelllar structures push tonsils through foramen magnum
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41
Q

Consequences of Uncal Herniation

A

Ips CN 3 Compression = Ips CN 3 Palsy
Ips PCA Compression = C/L Homohemianopasia
Contralateral Crus Compression = Ips Hemiapresis

42
Q

Consequences of Cerebellar Herniation

A

When it hits medulla - cardiopulmonary arrest

43
Q

Most common benign brain tumor?

A

Meningioma

44
Q

Patient with elevated ICP needs to be managed. What is the eventual step and what 4 things to do before that?

A

Eventually: Decompressive Craniectomy

  1. Elevate Bed 30
  2. Intubate + Hyperventilate (hypoxic vasoconstriction decreases blood volume component of iCP)
  3. Mannitol
  4. Dexamethasone + Anticonvulsant
45
Q

Adult onset seizures is secondary to _______&raquo_space;> ______ until proven otherwise.

A

Tumor&raquo_space;» Stroke

46
Q

What is the management for any new adult seizure?

A

B-E-M: Blood, EEG, MRI

47
Q

Do you start anticonvulsant medications after 1st seizure?

A

No, unless there is abnormality on B-E-M above or neuro exam that predisposes to more seizures (anti-convulsants)

48
Q

Know This:

  • Common Rx for Partial (3)
  • Common Rx for Generalized (5)
A

Partial: Gabapentin, Phenytoin, Carbamazapine

Generalized: Valproate, Leviteracetam (keppra), Lamotrigine, Zonisamide, Topomax

49
Q

Describe Complex Partial Seizure

A
  • Focal Neurologic Signs
  • Impaired Consciousness
  • Before: aura
  • During: automatism
  • After: Post-ictal
50
Q

How can you test for absence seizure bedside?

A

Hyperventilate

51
Q

Patient loses consciousness and then has some myoclonic activity — Dx?

Patient starts having myoclonus of right hand and then loses consciousness —- Dx?

A

Syncope

Seizure

52
Q

Cardiogenic Syncope is decreased CBF secondary to (2)

A
  1. Decreased CO

2. Arrythmia

53
Q

DDx CO and Arrhythmia

A

Decreased CO: Aortic Stenosis + Valsalva/Micturation

Arrythmia: Sick Sinus, WPW, age, electrolyte imbalance

54
Q

Vasovagal Syncope Paph

A

Emotional experience —> abnormal increased in vagal tone —> decreased HR/BP —> syncope

55
Q

DDx Orthostatic Hypotension:

A

Old: dehydration + increased venous pooling
Young: prolonged standing
Other: ANS dysfunction (diabetes, amyloid) = withdrawal of PaNS tone with abnormal increases in SNS tone = low catecholamines = syncope

56
Q

Pseudoseizure Definition

A

Psychiatric mechanism (conscious or not) to cope with emotional/physical stress = Conversion Disorder

57
Q

How do you recognize pseudoseizure?

A

other than odd seizure, the degree of neurologic signs will not correlate to the degree of consciousness

58
Q

How do you manage/diagnose pseudoseizure?

A

Admit to inpatient service and get EEG + Video Camera

59
Q

Symptomatic Seizure Definition (vs. idiopathic)

A

Secondary to underlying pathology (stroke, temporal lobe); therefore the seizure is a symptom of the underlying pathology

Idiopathic = hereditary disorer

60
Q 
Describe the following pediatric seizure disorders:
1. JME
2. West Syndrome
3. Lennox Gestaut
(Benign Rolandic discussed separately)
A
  1. JME: related to sleep, consciousness unimpaired, multiple types of seizures
  2. West: infantile spasms, hypsarrhythmia, developmental regression
  3. Lennox: Slow 1.5-2 Hz, multiple seizures, developmental delay
61
Q

(T/F) All pediatric idiopathic disorders resolve spontaneously.

A

False, all do except JME

62
Q

Do you perform an LP on a 17 month old with febrile seizure?

A

Yes, all patients 18 months, only perform LP if +meningeal signs.

63
Q

What is the MC idiopathic seizure disorder?

A

Benign Rolandic

64
Q

BRE Of Childhood:

  • Paph
  • Classic Presentation
  • Management
A

Paph: complex partial seizure around central sulcus
Presentation: nocturnal seizure of face/saliva with loss of conscoiusness in a patient with +FHMx
Management: resolves, Rx only if 3+

65
Q

GSE Definition

A

Tonic CLonic Seizure >30 min

2+ TC seizures without return to baseline in between

66
Q

Management for GSE?

A

Ativan —> Phosphenytoin —> Intubate —> phenobarb/propofol —> burst suppression

Once Stable: BEM
Blood/urine: any imbalances, drugs
EEG
MRI: recall in adult new onset seizure is tumor until proven otherwise

67
Q

3 Etiologies of Dizziness?

A
  1. Vertigo: disease of vestibular system (inner ear, vestibular nerve, nuclei)
  2. Ataxia: instability; disorder of cerebellum (if constant) or dorsal columns (if worse in the dark)
  3. Lightheadedness: syncope; disorder of low blood flow
68
Q

Menier’s Disease

  • Pathophysiology
  • Presentation
  • Treatment
A
  • Paph: Idiopathic Endolymph Hydrops = too much endolymph
  • Presentation: gradual vertigo, hearing loss (sensorineural) and aural fullness. The hearing loss is specific for loss of low frequency sounds (finger rub, but not watch tic-toc)
  • Treatment: Acetazolamide, salt wasting diet, shunt
69
Q

Vestibular Neuronitis vs. Labyrinthitis

A

Neuronitis: vertigo without hearing loss
Labyrinthitis: vertigo with hearing loss

70
Q

(T/F) Central vertigo is more severe than peripheral vertigo.

A

False, central vertigo is more constant and low level, peripheral is more intermittent and severe.

71
Q

5 Characteristics of Vertigo and Nystagmus seen in BPPPV

A 
Episodic/Transient
Position Dependent
Latency - takes a second to start
Habituation
Fatigued
72
Q

You do the Dix Hallpike to diagnose BPPV, how do you manage the patietn?

A

Epley Maneuver

Teach Brandt Daroff Exercises for them to do at home

73
Q

Best imaging for stroke?

Best imaging for tumor?

A

MRI without contrast = stroke

MRI with contrast = tumor (so it will enhance)

74
Q

Two diseases that present with infranuclear facial weakness, sensorineural hearing loss and vertigo?

A

CPA Tumor

Ramsy Hunt

75
Q

How to distinguish between CPA Tumor

and Ramsy Hunt on exam?

A

CPA Tumor has +CN5 findings +cerebellar finding

76
Q

Alcoholic Cerebellar Degeneration

  • Localize Lesion
  • Findings
A

Superior Cerebellar Vermis Lesion

Truncal Instability (Titubation)

77
Q

Diffuse Cerebellar Signs + Dysphagia over several years in 50 year old woman.

A

PNP cerebellar degeneration from breast, lung, ovarian, lymphoma cancer

78
Q

Disk herniation can result in compression of what two structures? And how can we tell the difference between the two clinically?

A
  1. Spinal Cord = myelopathy
  2. Nerve Root = radiculopathy

When pain is involvement, the nerve root is more likely to be involved.

79
Q

What is a simple test you can do to tell whether or not the disc is herniating onto the cord or root, if the patient is not presenting in pain?

A

Bear down (valsalva) to increase intraabdominal pressure —> increase pressure on nerve root —> increase pain. If no increased pain, then disc is on the vertebral column

80
Q

What are the following segments:

  • Patellar
  • Medial lower leg
  • Lateral lower leg
  • Medial foot
  • Lateral Foot
A
  • Patellar: L3
  • Medial lower leg: L4
  • Lateral lower leg: L5
  • Medial foot: L5
  • Lateral Foot: S1
81
Q

MCC Radiculopathy and MC Locations

A

Herniated Disks:

  • L4-5
  • L5-S1
82
Q 
Give the actions of the following roots:
L3
L4
L5
S1
A

L3: knee = extension of lower leg
L4: dorsiflexion of ankle
L5: eversion
S1: inversion

83
Q

Sciatic N Compression vs. L5-S1 disc hernation?

A

No back pain with sciatic nerve compression

84
Q

Cauda Equina Syndrome

  • Paph
  • Presentation (4)
A

Paph: damage to CE (LMN = ROOTS, not spinal cord) before exiting the spinal canal

Classic Presentation:

  1. Back pain
  2. Saddle Anesthesia
  3. LMN Signs = low rectal tone
  4. Bowel/Bladder Dysfunction
85
Q

Difference between lateral and posterior herniation of nucleus pulposus?

A

Lateral Herniation = compress nerve roots (LMN + PAIN = radiculopathy)

Posterior Herniation = compress cord/CES

86
Q

Neurogenic vs. Vascular Claudication?

A

Neurogenic: occurs secondary to spinal canal stenosis associated with STANDING STILL b/c venous pooling in epidural venous plexus

Vascular: occurs secondary to muscle ischemia associated with INCREASED ACTIVITY

87
Q

Causes of Hypothyroidism (5)

A
  1. Repetitive Movements
  2. Hypothyroidism
  3. Diabetes
  4. Pregnancy
  5. Idiopathic
88
Q

Diagnostic Test for CTS vs. Cervical Radiculopathy

A

CTS = EMG?NCS

Cervical Rad = Imaging for Spien

89
Q

5 Steps in Working Up Someone with ED Signs of Meningitis?

A
  1. ABC
  2. Blood Studies (CBC, INR, BCx, CMP)
  3. IV Amp, Cef, Vanc, Acyclovir, Dexamethasone
  4. Image
  5. LP
90
Q

Chronic Meningitis Causes

A

Think about bugs that kill slowly / other chronic disease:

Fungal, TB, Lyme, Sarcoidosis, Carcinomatous (h/o canceR)

91
Q

Aseptic Meningitis Definition/Causes

A

Meningitis not caused by pyogenic organism (viral, NSAID, etc)

92
Q

NL CSF Findings

  • Opening Pressure
  • Protein
  • WBC/RBC
  • Glucose
A
  • Opening Pressure
93
Q

3 Non-ID consequences of meningitis?

A
  1. Hyponatremia = SIADH from inflammation of hypothalamus
  2. Seizure = bicerebral inflammation
  3. Elevated ICP
94
Q

Stroke: if a patient has head turned to the right, what could cause this?

A

L sided Neglect

R sided gaze preference

95
Q

In cortical/spinal cord, where are arms/face vs. legs?

A

Arms and face are lateral, legs are medial

96
Q

(T/F) Hypoglycemia can produce focal neurologic symptoms/

A

True

97
Q

How does toxic metabolic insult cause stroke like symptoms?

A

Usually cause decompensation of previous stroke/injury

98
Q

MCC TIA?

A

Embolic from atherosclerotic plaques in the carotid/vertebrobasilar systems

99
Q

Patient in eval had a TIA and is now completely resolved, what is the next best step?

A

Admit ASAP for evaluation of etiology

100
Q

MC Locations for Hemorrhagic Stroke

A

Basal Ganglia (PUTAMEN)&raquo_space;» Thalamus, Cerebellum and Pons

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