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neurology STEP 2 > spinal Disorders, brain abscess > Flashcards

spinal Disorders, brain abscess Flashcards

1
Q

causes of brain abscess / organisms?

A
  1. spread from contguous infection in the sinuses, mastoid air cells or otitis media
  2. bacteremia (esp pneumonia and endocaditis)
    organisms: staph, strep, gram (-) bacillim anaerobes (frequently mixed)
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2
Q

how to distinguish brain cancer from abscess

A 
no way (not even on imaging study) --> only with biopsy
(cancer can give fever) --> also to determine the precise organism and its sensitivity
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3
Q

brain abscess - best initial test / most accurate

A
  • best initial: CT or MRI: ring or contrast enhancing lesions that will likely have surrounding edema and mass effect
  • most accurate: brain biopsy
  • LP: useless and contraindicated
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4
Q

brain abscess - treatment

A
  • empiric therapy with penicillin + metronidazole + ceftriaxone (or cefepime) is acceptable while waiting for results
  • if recent neurosurgery and risk risk of staph: vancomycin
  • avoid prolonged empiric therapy
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5
Q

anterior spinal artery infraction - manifestation + treatment

A
  1. loss of al function except the posterior column (position + vibration intact)
  2. flaccid paralysis below infraction
  3. loss of DTR at the level of the infraction
  4. loss of pain and Q
  5. extensor plantar response
  6. evolves plastic paraplegia several wks later
    - no specific treatment
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6
Q

sabacute combined degeneration of the Cord - causes and manifestation

A
  • from b12 def or neurosyphilis

- position and vibratory sensation are lost

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7
Q

vitamin B12 deficiency - spinal cord lesions

A

sabacute combined degeneration –> demyelination of dorsal column, lateral corticospinal tracts, and spinocerebellar tracts

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8
Q

vitamin B12 deficiency - symptoms because of spinal cord lesions

A
  1. ataxic gaits
  2. paresthesia
  3. impaired progression and vibration sense
  4. weakness
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9
Q

tabes dorsasis - spinal cord lesion?

A

degeneration (DEMYELINATION) of dorsal columns and roots

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10
Q

spinal trauma - treatment

A

glucocorticoids

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11
Q

spinal trauma - manifestation

A

acute onset of limb weakness and/or ensory disturbance below the level of the injury with the severity in proportion to the degree of injury.

  • Sphincter function impaired
  • loss of DTRs at the level of injury and hyperreflecia below
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12
Q

Brown-Sequard syndrome - manifestation

A
  1. ispilateral UMN signs below the level of lesion
  2. ipsilateral loss of tactile, proprioception, vibration below the level of lesion
  3. contralateral pain and temperature loss below the level of lesion
  4. Ipsilateral loss of all sensation AT LEVEL OF LESION
  5. ispilateral UMN sign at the level of lesion
  6. Horner syndrome (if lesion above T1)
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13
Q

syringomyelia ?

A

fluid filled, dilated central canal in pinal cord –> widening bubble or cavitation first damages neural fibers passing near the center of the spine (bytumore or trauma or congenital) –> loss of pain and Q bilaterally across the upper back and both arms (capelike distribution –> ALSO LOSS OF REFLEXES + MUSCLE ATROPHY IN THE SAME BILATERAL DISTRIBUTION

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14
Q

Tourrete Disorder - diagnostic tests / treatment

A
  • no specific diagnostic tests
  • fluphenazine, clonazepam, pimozide or other neuroleptic. Methylphenidate and ADHD treatment are intrinsic to Tourrete management
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15
Q

Huntington disease - chromosome of trinucleotide / trinucleotide repeat / age

A

ch 4
CAG
30-50

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16
Q

Huntington disease - symptoms

A
  1. choreiform movements (dyskinesia)
  2. aggression
  3. depression
  4. dementia
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17
Q

Huntington disease - movement disorder

A

starts with fidgetiness or restlessness progressing to dystonic posturing, rigidity and akinesia
- movement disorder may be troubling, but it is far worse to progress to no movement (rigidity)
(also athetosis and chorea)

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18
Q

Huntington disease - diagnostic test

A

specific genetic test (99% sensitive) –> CAG trinucleotide repeat sequences are found on genetic analysis –> symptom triad (movement/memory/mood) is confirmed with the test

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19
Q

Huntington disease - treatment

A

no treatment reveres HD

  • dyskenesia is treated with tetrabenazine, reseprine
  • psychosis is treated with Haloperidol, quatiapine
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20
Q

Huntington disease - MRI

A

Atrophy of caudate and putamen nuclei with hydrocephalus ex vacuo

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21
Q

Huntington disease - a common cause of death / is sometimes mistaken for

A
  • suicide

- substance abuse

22
Q

Restless Leg syndrome - presentation

A

patient reports an uncomfortable sensation in the leg that is creepy and crawly at night –> discomfort is worsened by caffeine and relieved by moving the legs.

23
Q

Restless Leg syndrome - treatment

A

dopamine agonists such as pramipexole

24
Q

Movement disorders - types

A
  1. athetosis 2. chorea 3, Dystonia 4. Essential tremor
  2. Hmiballismus 6. intention tremor 7. Myoclonus
  3. Resting tremor
25
Q

Athetosis - presentation / characteristic lesion

A

slow, writhing (snake-like) movements, especially seen in fingers
Huntington (basal ganglia)

26
Q

Chorea - presentation / characteristic lesion

A

sudden, jerky purposeless movements

Huntington (basal ganglia)

27
Q

dystonia - presentation and example

A

sustained involuntary muscle contraction
ex: Writer’s cramp
blepharospam (sustained eyelid twitch)

28
Q

hemiballismus - presentation / lesion

A

sudden, wild flailing of 1 arm +/- ispilateral leg

- contralateral subthalamic nucleus (eg. lacunar stroke)

29
Q

intention tremor - presentation / lesion

A

slow, zigzag motion when pointing extending toward a target

- cerebellar dysfunction

30
Q

Myoclonus - presentation / causes

A

sudden brief uncontrolled muscle contraction

  • hiccups are common
  • metabolic abnormalities such as liver or renal failure
31
Q

Resting tremor - presentation / seen in

A

uncontrolled movement of distal appendages (most noticeable in hands) (pill rolling tremor)
tremor alleviated by intentional movement
- seen in parkinson

32
Q

Essential tremor occurs

A
  • at both rest and with intention
  • greatest in the hands but can affect the head as well
  • it may affect manual skills such as handwritting or the use of a computer keyboard
33
Q

essential trempr

A

the best therapy is propranolol

- improved with alcohol

34
Q

Parkinsonism - definition

A

loss of cells in the substatia nigra resulting in a decrease in dopamine –> significant movement disorder presenting with tremor, gait disturbance and rigidity

35
Q

MCC of parkinsonism / other causes of parkinsonism

A

MCC of parkinsonism: idiopathic
other:
1. encephalitis
2. drugs: a. metroclopramide b. reserpine c. antipsychotics

36
Q

Parkinson disease - histology

A
  1. Lewy bodies (composed of a-synuclein - intracellilar eosnophilic inclusions)
  2. loss of dopaminergic neurons of substantia nigra pars compacta (de-pigmentation)
37
Q

Parkinson disease - symptoms

A

MNEMONIC: TRAP

  1. Tremor (pill-rolling tremor at rest)
  2. Rigidity (cogwheel) –> slowing on passive flexion or extension
  3. Akinesia (or bradykinesia)
  4. Postural instability (orthostatic hypotenstion
  5. Shuffling gait
  6. FACIAL expression is limited (hypomimia and writing is small (micrographia)
38
Q

Parkinson disease - age

A

50-60

39
Q

all Parkinson drugs and mechanism of action (shortly)

A
  1. Bromocriptine (dopamine agonist)
  2. Pramipexole (dopamine agonist)
  3. ropinirole (dopamine agonist)
  4. amantadine (incr dopamine release and inh reuptake)
  5. Levodopa (increases dopamine levels in CNS)
  6. carbidopa (DOPA decarboxylase inhibitor)
  7. entacapone(peripheral COMT inhibitor)
  8. tolcapone (central and peripheral COMT inhibitor)
  9. selegiline (MAO-B inhibitor) (and rasagilini)
  10. benzotropine and trihexyphenidyl (antimuscarinic)
40
Q

Parkinson disease - anticholinergic medications

A

benzotropine and trihexyphenidyl –> releive tremor and rigfitidy
SE: dry mouth, worsening prostate hypertrophy, constipation

41
Q

Parkinson disease - medication for patients above 60 with anticholinergic medications intolerance

A

amantadine

42
Q

which medications are for mild parkinson disease

A

anticholinergic and amantadine (all the other are for severe - inability to care for themselves)

43
Q

best initial therapy for severe parkinson

A

dopamine agonists: pramipexole, ropirinole

44
Q

most effective medication for parkinson

A

Levodopa/carbidopa (ON/OFF episodes)

45
Q

COMPT inhibitors - drugs / role

A
  • tolcapone, entacapone
  • extend the duration of levodopa/carbidopa by bloccking the metabolism of dopamine
  • use when there are on/of, or when the response is inadequate
46
Q

Parkinson treatment - electrical stimulation

A

highly effective for tremors and rigidity in some patients

47
Q

MAO inhibitors - role / drugs / be careful

A
  • resagiline, selegiline
  • adjunct to levodopa/carbidopa
  • block metabolism of dopamine
    avoid tyramine containing food –> hypertension
48
Q

medications of Parkinson that slow progression of the disease

A

ONLY MAOi

49
Q

antiprakinsonism medication complicated withpsychosis and confusion - next step

A

start antipsychotic with the fewest extrapyramidal effects (eg. clozapine)
you cannot stop medications because lock in with severe bradykinesia

50
Q

Shy-Drager syndrome

A

parkisnosnims predominantly with orthostasis

51
Q

spasticity - definition, associated with

A
  • painful, contracted muscles from damage of CNS

- associated with MS

52
Q

spasticity - treatment

A
  • no single treatment is universally effective

- baclofen, dantrolene and central acting α-agonists tizanadine

neurology STEP 2 (8 decks)

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