Step Up- CNS and PNS Flashcards
Symptoms of a vertebrobasillar stroke
dizzyness
double vision
numbness of ipsilateral face and contralateral body
dysarthria
Most common predisposing condition in people with lacunar infarcts
HTN
Most common location of origin of embolic strokes
Heart
Lacunar infarcts are either pure ______ or pure ______.
Either pure motor or pure sensory
What determines if a lacunar infarct is purely motor or sensory?
Pure motor– lesion involves internal capsule
Pure sensory– lesion involved the thalamus
Describe the blood flow in subclavian steal syndrome
Narrowed subclavian proximal to the vertebral artery
Retrograde flow results in the vertebral artery to supply the subclavian distal to the stenosis
Leads to vertebrobasillar insufficiency
A lack of blood flow to the area supplied by the anterior cerebral artery would result in deficits to these locations
Contralateral lower extremity and face
A patient <50 with a stroke should be evaluated for
hypercoagulable states:
Protein C
Protein S
antiphospholipid
Factor V leiden
VDRL/RPR, lyme, ANA, ESR
Two common treatments to lower ICP
Hyperventilation and mannitol
Order of preferred antithrobotics in stroke (pre-3hr, post etc)
If within 3 hours– give t-PA if not contraindicated
If after 3 hours– give aspirin
If allegic to aspirin give clopidogrel–if not possible give ticlopidine
Treatment of patient with asymtomatic carotid stenosis <60%
Aspirin and risk reduction
This test is the gold standard to Dx SAH…why?
Xanthochromia
yellow color of CSF caused by the breakdown of blood products. Will only be present in patients whom have a bleed.
most common cause of a hemorrhagic stroke
HTN or a sudden increase in BP
Shy-drager syndrome
parkinsonian symptoms with autonomic insufficiency
Difference between pregressive supranuclear palsy and parkinson
PSP does not cause tremors
PSP does cause opthalmoplegia
Use of bromocriptine or pramipexole in parkinson
used to decrease the “freezing” that occurs before initiating a movement
Start as soon as diagnosis is establised
Transmission pattern of huntington dz
Autosomal dominant
Mutated chromosome and repeat present in huntington
Chromosome 4
CAG
Hunting 4 prey using a CAGe
There is a lack of this neurotransmittier in huntington disease
GABA in the striatum
MRI finding in huntington disease
Atrophy of the caudate
Thiamine deficiency in alcoholics can lead tot his kind of dimentia
Korsakoff dimentia
This kind of medication should always be avoided in alzheimer patientes
Anticholinergics
Visual disturbances in MS
Optic neuritis and intranuclear opthamoplegia
- monocular vision loss
- pain on movement of eyes
- central scotoma
- decreased pupillary reation
Which two immunomodulating drugs can be used to treat MS? Major side effect?
Interferon B-1a and B-1b
Persistent flu-like symptoms
Inflammatory demyelinating polyneuropathy
Guillian-Barre
Common infections that preceed gullian barre
C. jejuni
CMV
Hepatitis
HIV
Lupus
Hodgkin disease
Should steroids be given in guillian barre?
NO they are harmful in GBS
Ab against this exist in mysthenia gravis
Post-synaptic nicotine acytylcholine receptors
Imaging study to be performed in myasthenia gravis
Chest CT for Thymoma
This procedure leads to resolution of symptoms in many patients with mysthenia
Thymectomy– even with no known thymoma
Steroid recommendations for duchenne muscular dystrophy
Boys over the age of 5 with motor deficits should be on steroids
Lesions noted in NF1
Cafe au lait spots
neurofibromas
CNS tumors
freckling
iris hamartoma (lisch nodules)
bony lesions
Pheochromocytoma
Port wine stain with epilepsy and mental retardation
Sturge-Weber syndrome
Cavernous hemangioma of the brain, renal angiomas and cysts
Von hippel-lindau disease
Renal lesions associated with VHL
Renal cell carcinoma
pheochromocytoma
Cape-like distribution of sensory loss
syringomyelia
Describe brown sequard lesion
contralateral loss of pain and temp sensation
Ipsilateral loss of vibratory and proprioception
ipsilateral hemiparesis
Difference between central and peripheral vertigo
Central: gradual in onset with other neurologic findings
Peripheral: Rapid and severe onset, dependant upon head positioning
Triad of meniere disease
Vertigo
tinitus
hearing loss
Drug of choice for generalized tonic-clonic seizures
phenytoin and carbamzepine
Drug of choice for absent seizures
ethosuxamide or vaproic acid
Upper and lower motor neuron signs in a 60 year old patient
ALS until proven otherwise
Four types od aphasia
Wernike
Broca
Conduction
Global
Wernike aphasia is characterized by these findings
Fluent aphasia
Inpaired comprehension of written or spoken language
Fluent and articulate but words are nonsense becuase patient doesn’t understand what he or she is saying
Broca aphasia is characterized by these findings
nonfluent
slow speech
meaningful content with broken words
normal comprehension
often associated with right hemiparesis and hemisensory loss
Conduction aphasia is characteried by the inability to…
repeat phrases, words, sentences
Steroids should be used to treat bell palsy except…
When Lyme disease is suspected!
Name the deficits seen in an MCA stroke
Contralteral weakness
Contralateral hanonomys hemianopsia (eyes will deviate towards the lesion)
Aphasia (if dominant hemisphere involved)
Name the deficits in an ACA stroke
Personality and cognitive deficits
Leg more than arm weakness
Urinary incontinence
Deficits in PCA stroke
Ipsilateral sensory loss on the face (9th and 10th CN as well)
Contralateral sensory loss on limbs
Limb ataxia
What is the treatment for a patient with an ischemic stroke who is already on aspirin?
Add dipyrimidole
or
Add clopidogrel
Target LDL for a patient with carotid stenosis
<100
Physical exam findings in pseudotumor cerebri
Papilledmea with doplopia from CNVI (abducens) deficit
Treatment for pseuotumor cerebri
Acetazoleamide to decrease CSF production
Prophylaxis and treatment for cluster headaches
Prophylaxis: verapamil
Treatment: 100% O2 is abortive, also prednisone and lithium
Prophylactic therapy for recurrent migranes
Propanolol
Tx for trigeminal neuralgia
oxcarbazepine
or
carbamazepine
Treatment for pain of posterherpetic neuralgia
TCA
Gabapentin
pregabalin
carbamazepine
phenytoin
indications for zoster vaccine
all persons over the age of 60
Treatment for status epillepticus
Benzo
or phenytoin or fosphenytoin
Side effect of phenytoin? Why?
AV block and hypotension
because it is a class1b antiarrythmic
What is the last line agent to stop seizing?
Neuromuscular blockage with vecuronium or succinylcholine and then general anesthsia
Order of treatment in status epillepticus
- benzo
- fosphenytoin
- phenobarb
- Neuromuscular blockade
