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Cheng-Ching > Systemic disease/general/pregnancy > Flashcards

Systemic disease/general/pregnancy Flashcards

1
Q

Autonomic dysreflexia

A

At or above T6 SC injury level

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2
Q

Development 5 primary vesicles of brain

A

Telencephalon- cortex
Diencephalon - thalamus, BG, hippocampus, amygdala
Mesencephalon - Midbrain
Metencephalon - pons and cerebellum
Myelencehalon - medulla, SC

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3
Q

Cavernous malformation

A

CCM1 - genetic mutation

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4
Q

Pilocytic vs anaplastic astrocytoma

A

Pilocytic - cystic mass in cerebellum, supratentorium

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5
Q

Lateral temporal vs medial temporal seizures

A

Lateral - shorter, auditory hallucinations, vertigo
Vs medial

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6
Q

Most susceptible to hypoxia

A

CA1 hippocampus (where you get Burnina bodies)

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7
Q

Ach

A

Preganglionic, parasympatheic postganglionic is ACh
Sympathetic sweat glands - ACh

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8
Q

Cystathione beta synthase deficiency

A

Homocystinuria
Clots

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9
Q

Aphemia
Amusia

A

Aphemia - Pure word mutisms, anarthria but comprehensive reading and writing intact

Amusia - nondom temporal - can’t process music

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10
Q

NF

A

NF 1 - cafe au lait, Lisce nodules, optic glioma

NF 2 - BL schwanommas/hearing loss; adulthood

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11
Q

Fatal familial insomnia

A

N2 loss sleep architecture
Inherited prion disease
Reduction in total sleep

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12
Q

Kluver busy

A

T2 hyperintensity BL anterior temp lobe HSV encephalitis association

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13
Q

osmotic demyelination

A

trident/snout sign

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14
Q

insomnia drugs MOA

A

Ramelteon - melatonin R agonist
Zolpidem - GABAergic
Trazodone - 5-HT2 antagonist

Suvorexant - inhibits Orexin R - suppresses wakefulness promoted by Orexin -

Orexin,( hypocretin)-narcolepsy type 1 + cataplexy- no orexin, low orexin in CSF (autoimmune attacking orexin neurons)

(Modafinil - blocks DA transport, neurostimulant)

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15
Q

infective endocarditis

A

ischemic stroke most common neuro complication

-mycotic aneurysms: distal arterial
-mechanical valves more complications vs bioprosthetic valves; equal complications with native valve
L sided endocarditis more neuro complications

-less common: secondary hemorrhagic, SAH, abscesses, meningoencephalitis

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16
Q

Sickle cell

A

Ischemic stroke more common than hemorrhagic; more common in kids than adults

17
Q

Plasma cell dyscrasias

A

-Waldenstrom
-MGUS - M monoclonal spike - myelin associated glycoprotein MAG - even if no MM-demyelinating neuropathy
-MM
-Plasmacytomas
-Amyloidosis

Can get POEMS syndrome
-encephalopathy -hypercalcemia, hyperviscosity (IG)
-infection
-paraneoplastic +
-infiltrative neuropathy (amyloid) -sensorimotor axonal neuropathy

-cryoglobulinemia - neuropathy, rare mononeuritis; cerebral vasculitis-stroke
type I - IgM - MM, Waldenstrom
type II-polyclonal IgM, IgG - lymphoproliferative, autoimmune, Hep C
type III - IgM, IgG, infections, autoimmune disorders

18
Q

ITP vs TTP vs DIC

A

Thrombotic thrombocytopenic purpura - seizure, microangiopathic hemolytic anemia, low plt, encephalopathy, renal dysfxn
-schistocytes, decreased plt NORMAL coags ;
Tx: plasma exchange

HUS - E coli, Shigella - ab pain, diarrhea in kids ->seizures, encephalopathy, CN palsy

DIC - fibrinogen reduced, D dimer elevated, abnormal PT/PTT

ITP - no neuro manifestations - no schistocytes

19
Q

hepatic encephalopathy

A

serum ammonia can be normal
-low protein diet, reduced ammonia
- from colon via lactulose
-TIPS increases risks
path: Alzheimer type II astrocyte

20
Q

Celiac disease/gluten sensitive enteropathy

A

neuro Sx can be only manifestations
-axonal peripheral neuropathy, inalmmatory myopathy
-cerebral calcifications risk seizures
-loss Purkinje cells cerebellum (not reversible)
-no increased malignancy

21
Q

Inflammatory bowel disease

A

venous, arterial thrombosis
cranial neuropathies - CN VII (Melkersson Rosenthal syndrome, tongue fissure+angioedema)
peripheral neuropathy - demyelinating + axonal
malabsorp vit E + B12

22
Q

electrolyte abnormalities

A

seizures - hyponatremia, hypoglycemia, hypomagnesemia

weakness - hypokalemia (spares bulbar) ; hypocalcemia-tetany, tingling in fingers; hypermagnesemia

encephalopathy - hypercalcemia

23
Q

thyroid disease

A

waxing waning encephalopathy - SREAT-autoimmune thyroiditis - check anti-microsomal Ab

hyperthyroidism - always tremor; can also get parkinsonism, dyskinesia, chorea

thyroid eye disease - restricted upgaze most common
-eyelid retraction - overactivation Muller muscle

hypothyroidism - pseudomyotonia (delay muscle relaxation after reflex)
-entrapment neuropathy
-axonal/demyelinating neuropathy

24
Q

diabetic neuropathy

A

CN - CN III + VI most common
- ipsilateral forehead pain 2/2 ischemia

diabetic amyotrophy -pain, sensory loss then weakness

neuropathy - accumulate sorbitol, fructose; oxidativestress
-early small fiber affected - tingling pain (small fiber neuropathy NCS NORMAL)

25
Q

osteopetrosis vs Paget’s vs achondroplasia vs polychondritis

A

increased bone mass 2/2 impaired bone resorption by osteoclasts - AD and AR
Sx: fracture + facial weakness, hearing/vision loss - CN 2/2 skull thickening - compress nerves - CN I, II, VII, VIII
-alk phos elevated

vs Paget’s disease - can compress nerves via skull enlargement
-Alk phos elevated

vs achondroplasia - short stature, developmental delay

vs relapsing polychondritis - Cartilage - inflammation, destruction of cartilage - ears, upper airway

26
Q

Sjogrens syndrome

A

sensory neuronopathy - can affect face/trunk before limbs
-Dx - Schirmer test (xerophthalmia), Ro/La

27
Q

systemic vasculitides - small and medium vessel

A

Necrotizing vasculitis ischemic neuropathy - vasa vasorum

-Polyarteritis nodosa - Hep B
-painful neuropathy, abdominal pain
- mesenteric aneurysms
-P-ANCA positive
-livedo reticularis, skin ulcerations, nodules

-Kawasaki disease - kids - fever, conjunctivitis, coronary artery aneurysms, aseptic meningitis

-Granulomatosis with polyangiitis (Wegener) - renal disease, sinusitis, pulm
-C-ANCA, proteinase-3 Ab

-Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)- asthma, eosinophilia, pulm, sinus Sx
-p-ANCA

Tx: steroids, cyclophosphamide

28
Q

large vessel vasculitis

A

Takayasu - subclavian, aorta, cerebral vessels
-constitutional Sx, peripheral claudication

Giant cell/temporal arteritis - HA, strokes rare

29
Q

Bechet’s disease

A

-uveitis, lesions, thrombophlebitis, can get cognitive effects late; increase ICP
-RARE peripheral nervous system involved

Diagnosis: skin pathergy test

30
Q

Hypercoagulability disorders

A

APLS - Risk CHOREA gravidarum, HA, seizures
(RLS-low iron)

factor V leiden, antithrombotic II deficiency, protein C/S deficiency, prothrombin polymorphism, hyperhomocysteinemia

31
Q

neurosarcoidosis

A

-aseptic meningitis with just HA
-CN VII most common N affected
-low glucose in CSF;
increase serum ACE
-diffuse leptomeningeal enhancement - base of brain or splenium corpus callosum
-intra/extramedullary spine lesions
-granulomatous infiltration hypothalamus - > central DI (no ADH)

32
Q

pheochromocytoma

A

can see in Sturge Weber, TSC, NF, VHL

Dx: plasma free metanephrines most sensitive

[vs carcinoid syndrome - episode flushing/HA - urinary 5-hydroxyindoleacetic acid]

33
Q

Pituitary

A

vascular supply: ICA (superior, inferior hypophyseal arteries) - capeillary plexus in hypothalamic median emenence

-hypophyseal portal vein ->infundibulum/stalk to anterior pituitary

anterior - adenohypophysis- Rathke pouch-oropharyngeal membrane
- PRL (DA), GH; TSH; FSH, LH; ACTH

hypothalamus : GHRH, TRH, gonadotropin release hormone, CRH

posterior pituitary - neurohypophysis - neuroectoderm of diencephalon
-hypothalamus supraoptic + paraventricular magnocellular neurons - make ADH, oxytocin ->secrete from post pituitary

34
Q

central DI

A

pituitary resection -> ADH deficiency
-hypernatremia -
polydipsia, polyuria

Dx: desmopressin (ADH analog) ->increase urine osmolality, decrease sodium (vs nephrogenic DI - urine osmolality does not increase in response to desmopressin - risk with lithium)

Tx: drinking water, giving desmopressin

35
Q

SIADH vs cerebral salt wasting

A

CSW - SAH
-hypovolemic on exam
-high urinary osmolality
Tx: fluids (isotonic vs hypertonic), salt supplement

SIADH - euvolemic; SAH, head trauma, paraneoplastic
-fluid restrict

36
Q

postpartum cerebral angiopathy

A

-similar to RCVS -> vasospasm
-HA
normal BP + kidneys
Dx: MRI, angio, Doppler US
Tx: CCB

Cheng-Ching (17 decks)

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