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Casey: Neurology > Riesert Lectures > Flashcards

Riesert Lectures Flashcards

1
Q

“Having disturbed ambulation”

A

Dizziness

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2
Q

Change in BP and cerebral blood flow d/t transient low BP; alteration in normal response to standing; may occur w/ aging d/t LOSS OF VASOCONSTRICTION (w/ standing, blood falls to feet, and you get dizzy/pass out)

A

Orthostasis

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3
Q

Lie for 10 min, stand for at least 2 min; Fall in systolic BP>20mmHg; Fall in diastolic BP>10mmHg; increase in HR 10-25 BPM; symptoms of cerebral hypoperfusion

A

Orthostasis

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4
Q

Drug used to tx Orthostasis=

A

Fludricortisone (mineralcorticoid)

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5
Q

Loss of buffers to remain conscious; what comes before syncope referred to as ‘prodrome’

A

Fainting

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6
Q

May be d/t arrhythmia/dysrhythmia; Heart block; aortic stenosis; medications (orthostasis)

A

Syncope-cardiac causes

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7
Q

Best tx to true cardiac syncope=

A

implantable cardiac defibrillator

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8
Q

Impaired vestibular system; may be d/t disturbance of inner ear; altered head position in space, via alteration of CN VIII (vestibulocochlear)

A

Vertigo

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9
Q

MC cause of orthostatic hypotension=

A

Dehydration

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10
Q

Dx of orthostatic hypotension=

A

Tilt-Table test*

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11
Q

Visual input, somatosensory input (skin, joints, muscles, spinal cord), Cerebellum, Cerebrum all involved with=

A

normal BALANCE maintenance

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12
Q

Alteration of eye movement; oscillation to lateral gaze; normal 2-3 beats, if more, consider abnormal

A

Nystagmus

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13
Q

Abnormal input to stabilize (ie Car sickness); unfamiliar head position (i.e. sea sickness); unusual head position (i.e. painting a ceiling); spinning

A

Vertigo-physiologic

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14
Q

Disturbance of vision, somatosensory system, vestibular system; CNS tries to correct (homeostasis is disrupted)-abnormal head sensation; worse w/ rapid head movement; nausea and ataxia

A

Vertigo-Pathological

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15
Q

MC cause of vertigo; includes acute labyrinthitis and vestibular neuritis

A

Idiopathic

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16
Q

Cochlear disease affecting ear mechanism; progressive hearing loss to low frequency; Tinnitus, dizziness; unknown etiology

A

Meniere’s disease

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17
Q

Tx for Meniere’s=

A

Diuretics (HCTZ); low salt restriction (

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18
Q

Involved w/ sound and balance; Acoustic neuroma pushes on this (unilateral hearing loss, tinnitus, schwannoma or meningioma); MRI is diagnostic test***

A

Cranial nerve VIII (vestibuluocochlear nerve)

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19
Q

D/t changes in head position; no clear known cause; may last months; Epley maneuver to tx!

A

Benign Positional Vertigo (BPV)

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20
Q

Tests to include for cardiac testing for syncope=

A

EKG, Echocardiogram, Holter monitor & Event monitor, exercise stress test, electrophysiologic study (EP study), Tilt table test

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21
Q

Meclizine, Dimenhydrinate, Promethazine=

A

Vestibular suppressants

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22
Q

Diazepam=

A

Benzodiazepines

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23
Q

Alteration is when the vestibular sense, visual sense, and somatosensory sense are NOT CONGRUENT; principal symptom is N/V

A

Sea sickness/motion sickness

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24
Q

” A paroxysmal event d/t abnormal CNS d/c with resultant manifestations depending on area involved”

A

Seizure disorder

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25
Q

Defines a pt with recurrent seizures=

A

Epilepsy

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26
Q

Type of seizure; deranges area of cerebral cortex often d/t a structural anomaly-consciousness is preserved

A

Partial seizure

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27
Q

Type of seizure; diffuse region of brain firing simultaneously; often d/t a widespread problem (cellular d/o, biochemical disruption, structural issue)

A

Generalized Seizure

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28
Q

Type of seizure; may be motor, sensory, autonomic, psychic but WITHOUT loss of consciousness; often clonic with repetitive flexion/extension; EEG shows abnormal impulses in focal area of brain

A

Simple Partial Seizures

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29
Q

Simple partial seizure; motor activity begins DISTALLY, like fingers, and spreads to whole extremity; EEG shows spike waves

A

Jacksonian March

30
Q

Simple partial seizure; local paresis lasting minutes to hours

A

Todd’s paralysis

31
Q

Simple partial seizure; continues hours to DAYS

A

Epilepsia partialis continua

32
Q

Changes in somatic sensations (paresthesisas), change in vision (flashing light, hallucinations), changes in equilibrium (falling, vertigo), autonomic changes (flushing, sweating)

A

Symptoms of simple partial seizures

33
Q

Focal activity progresses to loss of contact with environment (ictal stage)-STARE, AMNESIA; often begins with an aura stereotypical for the pt “feel funny”;

A

Complex partial seizures

34
Q

Electrical d/c spread and both hemispheres become involved; results in tonic-clonic seizure; common when partial seizures in frontal lobe

A

Partial seizures with secondary generalization

35
Q

Arise in both cerebral hemispheres simultaneously; look like focal seizure that secondarily generalized though not associated with a specific focal onset event ; includes absence seizures and tonic-clonic seizures

A

Generalized seizures

36
Q

Brief LOC without postural control; few seconds; No post ictal confusion; eye blinking, chewing, clonic movement of hands; childhood onset

A

Absence seizures (Petit mal)

37
Q

MC type when seizures are d/t metabolic derangement; sudden onset

A

Generalized Tonic-Clonic Seizures (Grand Mal)

38
Q

T-C seizure variation; 1-2sec lose motor tone; brief LOC; no post-ictal confusion; risk after head injury

A

Atonic seizures

39
Q

T-C seizure variation; brief contraction or jerk (when you fall asleep & twitch); seen in brain injuries

A

Myoclonic seizures

40
Q

Type of epilepsy seen in children; Multiple different types of seizures, particularly tonic (stiffening) and atonic (drop) seizures; associated with CNS disease (developmental delay, trauma, infection, neural injuries)

A

Lennox Gastuat Syndrome

41
Q

MRI shows hippocampal sclerosis=

A

Mesial temporal lobe epilepsy

42
Q

Shifts in balance of excitations and inhibition in the CNS

A

Seizures

43
Q

Burst of electrical activity; influx of extracellular calcium & sodium; spike d/c; inhibitory neurons overwhelmed by calcium and potassium; channel problems

A

Seizures

44
Q

May occur from infection (otitis media, respiratory infection, gastroenteritis); can be simple (one event) or complex (repeated activity); NOT EPILEPSY

A

Febrile Seizures

45
Q

Key to diagnosing seizure disorders=

A

EEG*

46
Q

Non-epileptiform behaviors that resemble seizures; can be seen with stress/conversion reaction

A

psychogenic seizures

47
Q

Common first line meds for seizures=

A

Phenytoin, Valproic acid, carbamazepine

48
Q

Goal of pharmacotherapy is to block activity of ion channels or neurotransmitters in treating____

A

seizures

49
Q

Blacks voltage dependent calcium channels, modulating excitatory NT release; binds alpha 2 delta subunit of calcium channels reducing NT release producing anti-nociceptive and anti seizure effects

A

Gabapentin & pregabalin

50
Q

Continuous seizure; may range from T-C seizure to more subtle; Medical emergency (CV implications, hyperthermia, metabolic derangements, CNS injury);

A

Status epilepticus

51
Q

Temporal lobectomy, Focal lesion removal, Corpus callosotomy=

A

surgical tx of seizures

52
Q

Play a bipolar electrode in left vagus nerve; generator delivers a pulse ; may increase seizure threshold

A

vagal nerve stimulator

53
Q

An acute confusional state with decreased attention

A

delirium

54
Q

AKA confusion, encephalopathy, acute brain failure, acute confusional state=

A

delirium

55
Q

Decrease attention key; change in sleep awake cycles, hallucinations, delusions, ANS changes s/a HR or BP problems, hypo or hyperactive status

A

delirium

56
Q

Usually d/t diffuse cerebral dysfunction; low Ach levels? may mimic Alzheimer’s, Lewy body dementia; high dopamine levels possible too

A

Delirium

57
Q

Elderly w/ delirium that gets worse at night

A

sundowning

58
Q

Acute alcohol withdrawal syndrome; agitation, tremor, hallucinations, ANS instability (incr BP, pulse, resp), seizures

A

Delirium tremens

59
Q

Tx with Benzodiazepines, Phenobarbital, Antipsychotics

A

Delirium Tremens

60
Q

Continuum of diseases with memory loss, speech and language difficulties, impaired judgement, mood issues

A

Dementia

61
Q

Changes in cerebral circuits; nerve loss; changes in NT (Ach, Serotonin, Glutamine)

A

Dementia

62
Q

Memory loss subtle; progressive over years; Neuritic plaques (“senile plaques”), amyloid deposition in arterial walls of neurons, neurofibrillary tangles in the cytoplasm of the neurons

A

Alzheimers type dementia

63
Q

Multi-infarct dementia (classically hypertensive pts); diffuse white matter disease (Binswanger’s dz or leukoaraiosis); lg or sm infarcts, lacunar infarcts; more sudden onset; Looks like AD, may have amyloid, with incr risk of hemorrhage

A

Vascular dementias

64
Q

Includes Huntington’s chorea (dementia), Pick’s disease, progressive supra nuclear palsy; memory loss later is dz; aphasias seen

A

Frontotemporal dementias

65
Q

Autosomal dominant inheritance (chromosome 4, fam hx); results in writhing movements (chorea, dancing); symptoms include motor and cognitive problems

A

Huntington’s chorea

66
Q

Involuntary movements; look like jerks or tics, but can’t control; mood changes, cerebral atrophy; after 10yrs+, looks like parkinson-bradykinesias, rigidity, dystonia

A

Huntington’s chorea

67
Q

Anterior frontal and temporal cerebral cortex; intracellular inclusions stain with silver stain*

A

Pick’s disease

68
Q

Parkinson like; falls; gaze paralysis (can’t look down); rigidity; dementia; death in 5-10 years

A

Progressive supra nuclear palsy

69
Q

Intraneuronal cytoplasmic inclusions that stain with PAS staining

A

Lewy bodies

70
Q

Gate ataxia; dementia; urinary incontinence; imaging shows large ventricles; shunting is tx

A

Normal pressure hydrocephalus (NPH)

71
Q

Can’t recall recent memory despite immediate memory retention

A

Korsakoff’s syndrome

72
Q

Not a dementia; awake and fine, then later forget a moment of time

A

Transient global amnesia

Casey: Neurology (7 decks)

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