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Surg > Pestana11 Neuro > Flashcards

Pestana11 Neuro Flashcards

1
Q

Transient ischemic attack (HA +/-)

A

Without headache

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2
Q

TIA (workup, mgmt)

A
  • Duplex studies (sono+Doppler)

- CEA, Angioplasty+stent (need filter first)

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3
Q

TIA (mc etiology)

A
  • High grade stenosis (>70%) of internal carotid

- Ulcerated plaque at the carotid bifurcation

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4
Q

TIA (clinical significance)

A

Predictors of stroke

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5
Q

TIA vs Ischemic stroke (onset, sequela)

A
  • Suddent for both

- No sequela w/ TIA, permanent sequela w/ stroke

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6
Q

Ischemic stroke (complication)

A

Hemorrhagic stroke

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7
Q

Ischemic stroke (initial step)

A

CT scan to r/o extensive infarcts or presence of hemorrhage

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8
Q

Ischemic stroke (mgmt)

A
  • tPA w/in 4hr

- Rehabilitation

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9
Q

Ischemic stroke (workup after initial evaluation)

A

Vascular workup to identify lesions that may cause recurrence

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10
Q

Hemorrhagic stroke (dem, presentation)

A
  • Uncontrolled hypertensives

- Very severe HA of sudden onset

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11
Q

Hemorrhagic stroke (dx, mgmt)

A
  • CT scan
  • Control HTN
  • Rehabilitation
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12
Q

Subarachnoid hemorrhage (presentation)

A
  • Worst HA of sudden onset
  • May not have any neurological deficits (in subarachnoid space, ergo no mass effect); may have signs of meningeal irritation
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13
Q

Subarachnoid hemorrhage (etiology)

A

Ruptured aneurysm in the Circle of Willis

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14
Q

Subarachnoid hemorrhage (dx, mgmt)

A
  • CT scan (also bloody spinal tap, but not first line) followed by arteriogram to locate the aneurysm
  • Clipping (surgical)
  • Endovascular coiling (radiological alternative)
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15
Q

Brain tumors (presentation)

A
  • HA (worse in morning, progressive over mos)

- ICP (blurred vision, papilledema, projectile vomiting; Cushing reflex: bradycardia+HTN)

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16
Q

Brain tumors (dx)

A

MRI

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17
Q

Brain tumors (sxs mgmt)

A

High-dose steroids (dexamethasone: Decadron)

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18
Q

Tumors at the base of the frontal lobe (presentation 4)

A

Foster-Kennedy syndrome:

  • Inappropriate behavior
  • Ipsilateral optic nerve atrophy
  • Contralateral papilledema
  • Anosmia
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19
Q

Craniopharyngioma (features 3)

A
  • Short stature
  • Bitemporal hemianopsia
  • Calcified lesions above sella (xray)
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20
Q

Prolactinomas (presentation)

A

Amenorrhea and galactorrhea in young woman

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21
Q

Prolactinoma (work up 4)

A
  • Pregnancy test (r/o pregnancy)
  • TSH (r/o hypothyroidism)
  • Serum PRL
  • MRI of sella
22
Q

Prolactinoma (mgmt)

A
  • Bromocriptine (or analog)

- Transnasal, trans-sphenoidal removal (fertility; resistance to bromocriptine)

23
Q

Acromegaly (clinical features)

A
  • Huge hands, feet, tongue and jaw

- HTN, DM, sweaty hands, HA, rings/hats no longer fit

24
Q

Acromegaly (workup)

A
  • Somatomedin C (IGF-1) levels

- MRI of pituitary

25
Q

Acromegaly (tx)

A
  • Surgical removal

- Radiation (alternative)

26
Q

Pituitary apoplexy (definition)

A

Bleeding into a pituitary tumor

27
Q

Pituitary apoplexy (phases)

A
  • Indolent phase

- Acute phase

28
Q

Pituitary apoplexy (indolent phase sxs 3)

A

Pituitary tumor sxs:

  • HA
  • Vision loss
  • Endocrine problems
29
Q

Pituitary apoplexy (acute phase sxs 3)

A
  • Severe HA
  • Compression of nearby strxs (deterioration of remaining vision, b/l optic nerve pallor)
  • Destruction of pituitary (stupor, hypotension)
30
Q

Pituitary apoplexy (dx)

A

CT/MRI

31
Q

Pituitary apoplexy (initial mgmt)

A

-Steroid and hormone replacement

32
Q

Tumors of the pineal gland (features 2)

A
  • Loss of upper gaze

- “Sunset eyes” (Perinaud syndrome)

33
Q

Brain tumors in children (location)

A

Posterior fossa

34
Q

Brain tumors in children (sxs)

A
  • Cerebellar sxs

- Children often assume knee-chest position to relieve HA

35
Q

Brain abscess vs brain tumor

A
  • Similar manifestation d/t space-occupation

- Abscess has a shorter timetable (1-2wks)

36
Q

Brain abscess (features)

A
  • Fever (not always)

- Obvious source of infection (eg, otitis media, mastoiditis, dental caries)

37
Q

Brain abscess (dx)

A

CT w/ contrast

38
Q

Tumors affecting the spinal cord (origin)

A

Metastatic/extradural

39
Q

Tumors affecting the spinal cord (dx)

A

MRI

40
Q

Tumors affecting the spinal cord (tx)

A

Decompression

41
Q

Neurogenic claudication (clinical features)

A
  • Exacerbated by walking
  • Relieved by rest
  • But both are position-dependent (hip flexion relieves; extension exacerbates)
42
Q

Neurogenic claudication (etiology)

A

Spinal stenosis

43
Q

Neurogenic claudication (dx)

A

MRI

44
Q

Neurogenic claudication (mgmt)

A

Block affected nerves

45
Q

Trigeminal neuralgia, aka tic douloureux (presentation)

A

Extremely severe, sharp, shooting pain in face triggered by touch (60s)

46
Q

Trigeminal neuralgia, aka tic douloureux (workup)

A

MRI to r/o organic lesions

47
Q

Trigeminal neuralgia, aka tic douloureux (mgmt)

A
  • Anticonvulsants (first line)

- Radiofrequency ablation

48
Q

Reflex sympathetic dystrophy, aka causalgia (onset)

A

Several months after crushing injury

49
Q

Reflex sympathetic dystrophy, aka causalgia (features)

A
  • Constant, burning, agonizing pain refractive to usual analgesics
  • Slightest stimulation aggravates pain
50
Q

Reflex sympathetic dystrophy, aka causalgia (extremity appearance)

A
  • Cold
  • Cyanotic
  • Moist
51
Q

Reflex sympathetic dystrophy, aka causalgia (dx)

A

Sympathetic block

52
Q

Reflex sympathetic dystrophy, aka causalgia (tx)

A

Sympathectomy

Surg (7 decks)

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