USMLE Neuro Flashcards
Critical illness myopathy
Critical illness myopathy is characterized by an elevated serum creatine kinase (CK) level. Predisposing factors include the patient’s prolonged ICU stay, use of corticosteroids and neuromuscular junction–blocking agents, and hyperglycemia.
Meningitis
Age 2-50
Age > 50
Neurosurgery shunt
Immunocompromised
Penetrating trauma
- Age 2-50 Vanc + Ceftraisone
- Age > 50 Vanc + ceftriaxone
- Neurosurgery shunt : Vanc + cefepime
- Immunocompromised : Vanc + cefepime + ampicillin
- Penetrating trauma: Vanc + Cefepime
Cefepime alternative : ceftazidime or meropenem
ampicillin alternative: Bactrim for listeria
Asian patients Siezure meds
In an Asian patient with the HLA-B*1502 allele, the risk of Stevens-Johnson syndrome is increased with exposure to carbamazepine, lamotrigine, oxcarbazepine, and phenytoin but not with exposure to levetiracetam.
Bell’s palsy
Acute perpheral BP is due to HSV
Start patient on Steriods and Valacyclovir
Brain stem level of medulla oblongata
Brainstem at the level of midbrian
Posterior limb of internal capsule
numbness of ipsilateral face / cotralateral body, horners syndrom , gag and cough refles, nystagmus, ipsilateral ataxiawithout any motor symptoms
CNIII nerve palsey, horners, tongue intact, left sided hemiplegia left facial droop
Posterior limb of internal capsule / contralateral weakness numbness with or without facial weakness.
Capgras syndrome
delusional misidentification syndrome associated with lesions of the right hemisphere, have the delusion of imposters, believing that important and familiar persons in their lives have been replaced by fraudulent doubles.
Reduplicative paramnesia, in many ways the opposite of Capgras syndrome, is a delusion of familiarity in which a patient in a hospital bed insists that he or she is at home.
Clinical Uses of Amantadine
- Sever Tramatic brain injury
- Fatigue related to MS
- Parkinson Dz
Celebral Amyloid Angiopathy
- Second most common cause of Intercrainial bleed in > 75 yrs and older\
- in the cortical or subcortical areas usually
- patient get symptoms of stroke and siezures after that
Corticosteroid myopathy
presents with predominantly proximal weakness, preserved reflexes, a normal serum CK level, and normal or only mildly myopathic findings on electromyography (EMG).
Cryptogenic Stroke / TIA
Causes?
Up to 40 % of the ischemic strokes
- Foramen Ovale
- Paroxysmal A-Fib
- Aortic Arch Atheroma
- Vasculitis
- Lacunar infarct
- Complex migraine
Essential Tremor
Tremor with action or posture can happen to voice head, chin, legs
Tx
propranalol or primidone
features of glioblastoma multiforme seen on MRI
MRIs, glioblastoma multiforme typically has a ring-enhancing lesion with areas of central necrosis and hemorrhage.
Giant Cell arthritis
Fever / Fatigue / weight loss
Unilateral HA
JAw /arm claudication
Visual symptoms
Polymailgia rheumatica PMR
non productive cough
Aortic aneurism or dissection
Dont worry about Berney Start on Steriods then do the bx if negative then do a second Bx biatch ..
Hereditary hemorrhagic telangiectasia
or Osler Weber Rendu
- Freq epitaxis
- Multiple mucocutaneous telangiectasias
- Organ involvement (AVMs)
- First Degree relative with HHT
- Siezures
How can one reduce neurological injury in post cardiac arrest
therapeutic hypothermia induction with in 6 hrs post event and 12-24 hr maintanance
How to treat symptomatic treatments of multiple sclerosis–related fatigue.
related to muscle spasm/stiff ness
Overacitve bladder
Amantadine and modafinil are used as symptomatic treatments of multiple sclerosis–related fatigue.
Baclofen (oral or intrathecal pump), tizanidine, cyclobenzaprine, benzodiazepines, carisoprodol, botulinum toxin
Oxybutynin
HSV Encephalitis
- REpeate PCR for HSV fi first negative
- MRI most sensitive and specific
- IV acyclovir 10 mg/kg Q8H
Idiopathic intercrainial pressure (psuedotumor Cerebri)
- Sx
- Physical E
- Dx
- HA / Transient vision loss / pulsatile tinnitis
- Papilledema / prepheral vision defects / CN VI palsey
- Normal brain imaging / open pressure > 250 mmHg
Manage an unruptured cerebral aneurysm.
In the anterior cerebral circulation, the risk of rupture over 5 years is negligible until an aneurysm reaches 12 mm in diameter; in the posterior circulation, the risk of rupture increases as aneurysms become greater than 7 mm.
Cerebral vasoconstriction syndrome
Cerebrovascular imaging is used to document reversible cerebral vasoconstriction syndrome, which comprises a group of disorders characterized by recurrent thunderclap headache occurring over a few days or weeks and is associated with transient segmental cerebral vasoconstriction.
Migrain criteria
Without Aura
A. At least five attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
C. Headache with at least two of the following four characteristics:
- Unilateral location
- Pulsating quality
- Moderate or severe pain intensity that inhibits or prohibits daily activities
- Aggravation by walking on stairs or similar routine physical activity
D. During headache, occurrence of at least one of following symptoms:
- Nausea/vomiting
- Photophobia/phonophobia
E. Exclusion of secondary headaches
With Aura
A. At least two attacks fulfilling criteria B and C
B. Headache with at least three of the following four characteristics:
- One or more fully reversible aura symptoms indicating focal cerebral cortical and/or brainstem dysfunction
- At least one aura symptom that develops gradually over more than 4 minutes, or two or more symptoms that occur in succession
- Duration
- Headache after aura with an intervening free interval
C. Exclusion of secondary headaches