Random Neuro ClinMed (Hon) Flashcards
Who is Cryptococcal fungal meningitis most common in? (2)
immunocompromised or diabetic patients
What are the 3 first-line drugs used to treat bacterial meningitis?
- Vancomycin
- Ceftriaxone (3rd Gen cephalosporin)
- Steroids (Dexamethasone) –> prevent complications
- do ASAP via IV –> do NOT delay treatment of patient
What are 5 common Infectious Encephalitis organisms commonly seen in adults?
HSV 1 and 2 HIV West Nile Varicella Zoster Treponema pallidum (Syphilis)
majority of pathogens causing encephalitis are viruses
Herpes Simplex 1 Encephalitis
Where is it located, what Abs are associated with it, and what is used to treat it?
- focal abnormalities in TEMPORAL LOBE
- headache, fever, impaired consciousness, seizures
Abs: NMDA autoantibodies –> secondary immune encephalitis
Tx: acyclovir
Autoimmune Encephalitis
What are they associated with, when does it commonly arise, and what are 4 treatment methods (I/P/R/C)?
- associated with SEIZURE and intractable epilepsy
- seen in pts. w/rapid (< 6wk) encephalopathy/psychiatric disturbances
Tx: IVIg, plasma exchange, RITUXIMAB, cyclophosphamide
NMDA Encephalitis
Who is it seen in, what are two labs that help diagnose it, and what presence is it associated with?
- seen in young/middle-aged women
Labs: abnormal EEG with EXTREME DELTA BRUSH and NMDA receptor Abs (also pleocytosis/oligoclonal bands)
- associated with the presence of a TERATOMA
LGI1 Encephalitis
Who is it seen in, how does it present, and what is required for treatment?
- seen in men commonly
Sx: Faciobrachial Dystonic Seizures
- same side face AND arm brief seizures
- sleep disturbances, short-term memory issues
Tx: do NOT respond to antiepileptics; require IMMUNOTHERAPY
- 1/3 of pts RELAPSE
Which gender and from where is at inc. risk of MS?
What is seen on Lumbar Puncture?
Men > Women
Temperate Zones > Tropical Zone
- father from equator = inc. risk of MS
LP: oligoclonal bands and /or inc. IgG index/synthesis
What is seen on MS MRI?
MRI = ovoid lesions on T2W1 in periventricular WM and SC
- acute lesions get brighter with 2nd imaging
What 5 things are used in maintenance of MS (M/I/F/F/GA)
What is the only drug approved for Primary Progressive AND Relapsing/Remitting MS?
- mAbs, interferons, fingolinmod, fumarates, Glatirimer Acetate
- OCREVUS only drug for BOTH PP and RR MS
What two medications are used to treat ACUTE EXACCERBATIONS of MS?
- Methylprednisolone
2. ACTH (Acthar gel) or IVIg
Clinically Isolated Syndrome (CIS)
What is the difference between Monofocal and Multifocal?
What is another name for Multifocal Episode?
Monofocal: single neurological sign or symptom from a SINGLE lesion
- only happens ONCE
Multifocal: more than 1 neurological sign or symptom from lesions in MORE than 1 place
- only happens ONCE
Multifocal = Acute Disseminated Encephalomyelitis
Propranolol, primidone, clonazepam can be used to treat what in MS?
Intention Tremor
Devic’s Disease (Neuromyelitis Optica)
What is it, what are two labs that can help diagnose it, and how is it treated (R/S/PE)?
- inflammation of demyelination of optic nerves/spinal cords
- numbness/tingling/weakness/spasticity w/VISUAL issues
Labs: NMO (aquaphorin 4) and MOG Abs in blood/CSF
Tx: Rituximab, steroids, plasma exchange (ACUTELY)
- also azothiaprine/mycophenolate
What is Epilepsy?
- 2 or more unprovoked seizures
Dx: made after 2 unprovoked seizures
Which epilepsy variant can be determined almost entirely on a SINGLE EEG?
Petit mal (w/HV) –> 90% positivity
% positive for ALL TYPES of epilepsy with 3 sleep-deprived EEFs = 85%
What is the single most important piece of information for diagnosis of epilepsy?
HISTORY of the events, preferably from an eye-witness
normal EEG does NOT exclude epilepsy presence
What is the difference between Myoclonic, Tonic, Clonic, and Atonic?
Myoclonic - brief jerks of extremities/trunk
Tonic - arms out front and extended
Clonic - jerking w/arms FLEXED
Atonic - go limp and fall down
What is the difference between these seizures:
- Simple Partial
- Complex Partial
- Secondary Generalized
- focal with no LOC; lasts seconds; NO post-ictal state
- nonresponsive staring w/possible aura preceding
- 1-3 min; post-ictal state
- BILATERAL tonic-clonic activity; LOC; 1-3 min
- post-ictal state
What is the difference between these Generalized seizures:
- Absence
- Tonic-Clonic
- Atonic
- Myoclonic
- nonresponsive staring, rapid blinks, chewing, LOC
- 10-30 seconds, NO post-ictal state
- BILATERAL extension w/symmetrical extremity jerking
- LOC; 1-3 min; post-ictal state
- sudden muscle tone loss, head drop, pt. collapse
- LOC; post-ictal state
- brief, rapid symmetrical extremity/torso jerking
- LOC; < few minutes; MINIMAL post-ictal state
What AED should NOT be given to pregnant women to treat seizures?
VALPROIC ACID
- strongest Generalized seizure drug; VERY TERATOGENIC
synergistic with LAMOTRIGINE
What two AEDs are commonly used to treat seizures?
Leviteracetam and Lamotrigine
What is the only drug that is used for Absence Seizures?
Ethosuxamide
What is Status Epilepticus and what two drugs are commonly used to treat it?
If still seizuring after treatment with drugs, what should be done?
SE: prolonged seizure (> 10 min) or repeated seizures WITHOUT recovery in between
Tx: Benzodiazepine –> Leviteracetam (IV)
- if unsuccessful –> midazolam/propofol IV (intubate pt before treatment)
What is a major consideration of treating women of child-bearing age for seizures?
- should be on multivitamin with 1 mg. Folic Acid, as many of the AEDs are FOLATE-DEPLETING
Tx: drug that pt. responds the MOST to
What is Transient Global Amnesia?
- sudden, temporary, isolated episode of memory loss with NO OTHER neurologic symptoms/signs
- patient knows self/family/close friends, but may not recognize others
- last hours then resolves (asks some question multiple times till out of seizure)
Why should Acute HTN in Ischemic Stroke NOT be treated?
- area of infarction may have lost autoregulatory function, so that ‘normal’ BP may be relatively HYPOtensive in the brain
- lowering BP may inc. risk of damage to area around CORE of stroke
What do all stroke patients require and what should NOT be given to them?
- all stroke patients require IV access and IV fluids should NOT contain GLUCOSE (hyperglycemia = WORSE outcome)
- get two IV access sites if tPa is considered
When should tPa be administered and is heparin useful for stroke patients?
- tPa should be started within at least 3-4 1/2 hours in acute ischemic stroke patients
- heparin is NOT useful for acute ischemic stroke patients
What are two major scenarios where patients would need long-term anticoagulation therapy?
Atrial Fibrillation and Prosthetic Valves
- also MI, ASD, hypercoagulable state
- use WARFARIN, Dabigatran, Riveroxaban, Apixaban
What treatment of stroke has been shown to have improved outcomes compared to standard therapy?
Intra-arterial thrombolysis with clot reversal
What is the major difference in presentation between these Akinetic Rigid Syndromes:
- Progressive Supranuclear Palsy
- Multiple System Atrophy
- Cortical Basal Degeneration
- loss of VOLUNTARY control of eye movements
- especially vertical gaze
- PRONOUNCED autonomic dysfunction
- EARLY vs Parkinsons Dz (late involvement)
- sensory loss, apraxia, myoclonus, aphasia
- CORTICAL involvement
see Lewy Bodies, bradykinesia, rigidity
Syndenham’s Chorea
Who is it seen in, what does it cause, and how can it be treated?
- seen in children w/previous Group A Strep infection
- causes UNILATERAL choreiform movements and behavioral changes
Tx: bedrest and antibodies
What is the treatment Idiopathic Torsion Dystonia and Focal Torsion Dystonia?
ITD = low dose levodopa
FTD = Botulinum Toxin injections
- good use for Writer’s Cramp
What is the definition of Gilles De La Tourette’s Syndrome?
Chronic multiple motor and vocal tics with onset before the age of 21 yo
What is Essential Tremor?
- postural or kinetic tremor of both hands; can involve head or voice
- not seen till later in life
- alcohol and decrease tremor temporarily
What are the criteria for clinical diagnosis of Alzheimers Dz?
- deficits in 2+ areas of cognition with worsening memory and NO disturbance in consciousness
- onset around 40-90 yo (usually after 65 yo)
What 2 categories of drugs are commonly used to slow Alzheimers Dz?
- Acetylcholinesterase Inhibitors - DONEPIZIL
2. NMDA Receptor Antagonist - MEMANTINE
What is the Tetrad of (Diffuse) Lewy Body Dz?
- Dementia
- Parkinsonism (NO TREMOR)
- visual hallucinations/illusions (small animals/kids)
- EXTREME antipsychotic sensitivity
psychotic symptoms are much more common and occur earlier than Alzheimers Dz
How should Lewy Body Dz be treated?
- use newer antipsychotics, like quetiapine or olanzapine
CADASIL’s Dz
What age range does it affect, what is it caused by, and how does it present?
age range: 40-50 yo
cause: hereditary stroke disorder from blood vessel smooth muscle degeneration
- MRI = multiple areas of ischemia
Sx: “migraine” headaches and TIAs/stroke
- seen years prior to symptom onset
How do Visual, Labyrinthine, and Proprioceptive systems tell us about balance and body position?
Visual - distance
Labyrinthine - acceleration/position change
Proprioceptive - posture
What does the Romberg Test tell us about?
PROPRIOCEPTION
What is Benign Positional Vertigo?
- idiopathic; spontaneous recovery occurs frequently
- brief recurrent episodes of vertigo triggered by changes in HEAD POSITION
- debris floating in endolymph of any of the semicircular canals (POSTERIOR is most common)
What is the diagnosis of Benign Positional Vertigo confirmed by?
What can help treat this issue?
Dix-Hallpike position testing
- usually resolves spontaneously but positional exercise is helpful
What is Vestibular Neuronitis?
- spontaneous vertigo w/NO hearing loss and is NOT positional; acute N/V
- peaks at 24 hrs and lasts days –> weeks
- resolves spontaneously; steroids can help
What is Meniere’s Dz?
- onset in 20-50 yo WOMEN due to inc. in volume of labyrinthine endolymph (POOR ABSORPTION)
- recurrent spontaneous vertigo lasting > 20 min/< 24 hrs
- LOW FREQUENCY hearing loss, tinnitus, aural fullness
What are two useful treatments for Meniere’s Dz?
- Sodium Restriction
2. Diuretics: thiazides, furosemide
What is Mal de Debarquement?
illusion of movement as an after effect of travel, like sea
- rocking/swaying feeling almost immediately after cessation of event
What are 5 common causes of Peripheral Drug Induced Disequilibrium? (A/Q/Abx/D/C)
- alcohol, Quinine compounds, Antibiotics, diuretics, chemotherapeutics
What is Friedrich’s Ataxia?
- onset occurs before 20 yo with gait ataxia eventually of all 4 limbs; also muscle weakness and absent tendon reflexes
- pts also have scoliosis, pes cavus, extensor plantar responses (UMN), and CARDIOMYOPATHY
NO TREATMENT AVAILABLE
What is Ataxia-Telangiectasia?
- progressive limb/trunk ataxia ( < 4 yo) with oculocutaneous telangiectasia, and recurrent sinopulmonary infection/pneumonia (immune def.)
- nystagmus/dysarthria also present
- telangiectasia appear in teen years; immune def. due to dec. IgA and IgE antibodies
What two things does coma require?
only needs one of these two, if not both
- bilateral hemispheric dysfunction
- brainstem dysfunction (ARAS failure)
What two things are required for consciousness?
- Arousal - alertness; interact with environment
2. Awareness - know what’s going on
What are the 3 ‘P’s’ of pinpoint pupils?
Pontine lesion
oPiates
Pilocarpine
By rule of thumb, what does an enlarged pupil on ONE side of a patients face usually indicate?
What is the difference between Conjugate and Dysconjugate Roving eye movements?
parasympathetic dysfunction due to CN VIII issues
- herniation can cause this
Conjugate = brainstem INTACT Dysconjugate = brainstem LESION
What eye movement is seen with Cold water irrigation to the ear with intact brainstem function?
Unilateral Ear –> eyes deviate to IRRIGATED side
Bilateral Ears –> eyes deviate DOWNWARD
What is the difference between Decorticate and Decerebrate positioning of Coma patients?
Decorticate - arms flexed, legs extended
- HEMISPHERIC
Decerebrate - all extremities extended
- BRAINSTEM
- more ‘e’s’ = EXTENDED
What herniation leads to ipsilateral dilated pupils (compressed CN VIII), ptosis, and eventually contral lateral brainstem compression causing ipsilateral hemiparesis?
Uncal Transtentorial Herniation
What two things are associated with Cessation of Brain Function?
- Unresponsiveness - no response to ALL sensory input, including pain/speech
- Absent Brainstem Reflexes
- use apnea test
only heartbeat remains
What is the Apena Test?
- used to help determine Brain Death (GOLD STANDARD)
- pt. is given 100% oxygen; pts. pCO2 lvls are allowed to rise to 60 mmHg
- if respiratory responses are absent at 8-10 min, they are brain dead
get ABG before AND after test
