Random Neuro facts Flashcards
Treatment for absence seizures
Ethosuximide and if that fails valproic acid
What type of seizures is phenytoin indicated for?
Partial and generalized tonic clonic seizures
Gerstmann’s syndrome
- usually involves the left parietal lobe damage
- tetrad of acalculia, agraphia wihtout alexia, right left confusion, finger agnosia
- left angular gyrus
What type of lesions is alexia without agraphia seen?
Splenium of the corpus callosum
What is the treatment for trigeminal neuralgia?
carbamazepine and oxcarbazepine
- other treatments: gabapentin, TCAs, tiagabine, opioids, NSAIDS, lidocaine patches, benzos, stereotatic gamma knife
Giant cell arteritis
Medium sized vessels, women affected more than men
- new onset or change in headache with fever, fatigue, myalgia, night sweat, weight loss, jaw claudication. 25% of pts have polymyalgia rheumatica. The temporal artery can demonstrate tenderness with induration and diminished or absent pulse. Can have irreversible and sudden vision loss as a result of central retinal artery occlusion.
Test of choice is ESR, then gold standard temporal artery biopsy.
Treatment is prednisone.
cluster headaches
attaches generally nocturnal
alcohol consumption is a common trigger
Abortive therapies: oxygen, sumatriptan subcutaneous injection, ergotamine
Prophylactic therapies: prednisone, verapamil, depakote, methysergide and lithium
What are causes of acquired peripheral neuropathy?
Vincristine and isoniazid, excess B6 therapy, inhalant abuse (toluene, NFO), heavy metal poisoning, hydrocarbon exposure, vitamin B12 deficiency, niacin deficiency, complications of mono, lupus
dermatomyositis
autoimmune disease that affects skin and muscle, purplish rash on face and eyelids(can also appear on neck, elbows, and knees which are often red and indurated), and muscle weakness
- CPK levels often elevated
- EMG shows myopathy and muscle irritability
- Biopsy shows perifascicular atrophy and “ghost fibers”
- Strong relationship between dermatomyositis and occult neoplasm in up to 50% usually carcinoma
What is the most significant genetic risk factor for Familial Alzheimer’s dementia?
homozygosity for the inheritance of E4 allele of apolipoprotein E (apo E). Apo E4 has been associated with chromosome 19.
What is Saturday night palsy?
Radial nerve entrapment- prolonged armpit compression when the arm is draped over the edge of a chair or on crutches
- weakness in the extensor muscles of the wrist, fingers, tricept weakness, and supinator weakness.
usually resolves after 1-2 months
Ulnar nerve entrapment
- occurs at elbow or wrist (elbow trauma w/ entrapment in cubital tunnel or with compression during surgery)
- weakness in the flexor carpi ulnaris, intrinsic hand muscles, and fourth and fifth deep flexor weakness
Musculocutaneous nerve injury
Injury to brachial plexus such as shoulder dislocation, shoulder compression
- weakness of biceps and brachialis
Median nerve entrapment
Carpal tunnel
tenosynovitis of the transverse carpal ligament places pressure on the median nerve in the tunnel
- causes nocturnal hand paresthesias of thumb and index and middle fingers
- may be sensory loss, thenar atrophy and positive tinels test
- diagnostic test is needle EMG and nerve conduction studies which show delayed sensory latency across the wrist
Suprascapular nerve entrapment
can occur after repetitive forward traction of the shoulder. diffuse aching of posterior shoulder. EMG shows denervation of the infraspinatus and supraspinatus muscles
The most common cause of intracerebral hemorrhage is hypertension, how does this happen?
Chronic hypertension probably causes lipohyalinosis of the small intraparenchymal arteries and charcot bouchard microaneurysms that rupture owing to increased vascular pressure
Where is the most common area of predilection for ICH
putamen followed by the thalamus
Screening test for sarcoidosis
serum ace level
Cryptococcal meningitis
yeast, AIDS w/ CD4 count generally less than 200. opening pressure usually elevated, csf colorless and clear, leukocytosis of 50 to 1000 cells with lymphocytic predominance, elevated protein.
Indian ink - capsule and budding yeast (can also do cryptococcal antigen assay-more sensitive)
Treatment: amphotericin B (but this does have high rate of renal toxicity)
What protein makes up amyloid plaques found in alzheimers disease?
APP, found on chromosome 21
Creutzfeldt-Jakob disease
Prodromal period of vegetative symptoms such as weakness, sleep and appetite disturbances
Then, rapidly progressive dementia with deficits in memory and concentration, depression, self neglect and personality changes.
Then, global dementia and death typically 2-7 months after onset of symptoms
Diagnostic tests: lumbar puncture CSF assay of 14-3-3 and tau proteins
Internuclear ophthalmoplegia
Seen in MS
lesion localizes to the medial longitudinal fasiculus of the brain stem
- abnormal horizontal ocular movements with absence or delayed adduction of the eye ipsilateral to MLF lesion and course horizontal nystagmus in the abducting eye. Convergence is preserved
Lesion is ipsilateral to the eye that does not adduct
anosognosia
inability to recognize a neurological deficit that is occurring to oneself
MS
the most common inflammatory demyelinating disease
Onset: 15-50 years old
2/3 have relapsing-remitting at onset
- only 20% of patients have primary progressive disease at onset
- heat sensitivity-increases in core body temp can bring on or worsen already existing symptoms (uhthoff’s phenomenon)- conduction block as body temperature rises