Uworld Neuro Flashcards
psychosis tx
-2nd generation antipsychotics
(preferred due to lower risk of extrapyramidal SE or tar dive dyskinesia)
- 1st gen. antipsychotics
- benzodiazepines (tx agitation)
2nd generation antipsychotics
- risperidone
- olanzapine
- quetiapine
- aripiprazole
- ziprasidone
- paliperidone
- clozapine
clozapine
- 2nd gen. antipsychotics
- gold standard tx-resistant schizophrenia
- SE: agranulocytosis
- used for pts who have failed 2 trials of antipsychotics
lithium
= mood stabilizer
- tx bipolar disorder
- monitor blood levels to prevent toxicity
febrile seizure px
- age: 6 months - 6 YO
- temp > 100.4F
- no hx of afebrile seizures, no CNS infection, no metabolic cause
-does NOT cause brain injury
febrile seizure tx
- reassurance
- abortive therapy only if seizure >5 minutes
neurofibromatosis type 1 px
cafe-au-lair spots + macrocephaly + feeding problems + short stature + learning disabilities
-fibromas, neurofibromas, tumors
neurofibromatosis type 2 px
bilateral acoustic neuromas + cataracts
- tearing bridging veins
- ruptured middle meningeal artery
- hypertensive hemorrhage
- ruptured aneurysm
- subdural hematoma (crescent)
- epidural hematoma (lens)
- intracerebral hemorrhage (putamen, thalamus)
- subarachnoid hemorrhage
thalamic stroke
Dejerine-Roussy syndrome
- VPL stroke
- contralateral sensory loss
- transient hemiparesis, athetosis
cavernous sinus thrombosis cause, px, tx
-cause: uncontrolled infection of skin/ sinuses/ orbit that spreads to cavernous sinus
-px: headache, intracranial HTN, periorbital edema, Cr III, IV, V, VI deficits
(travel thru cavernous sinus)
-tx: IV antibiotics (to prevent herniation)
primodone use, SE
- seizures, benign essential tremors
- acute intermittent porphyria –> abdominal pain, confusion, headaches, hallucinations, dizziness
effects of anti-dopinergic drugs on pathways:
- mesolimbic
- nigrostriatal
- tuberoinfundibular
- antipsychotic effects
- extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism)
- hyperprolactinemia –> amenorrhea, gynecomastia, dec libido
Cushing’s reflex
HTN + bradycardia + respiratory depression
-indicates elevated intracranial pressure
uncal herniation symptoms?
- ipsilateral hemiparesis (contralateral crus cerebri compression)
- ipsilateral Cr III palsy
- contralateral homonymous hemianopsia (ipsilateral PCA compression)
- coma (reticular formation compression)
anticholinergic excess symptoms? causes?
“red as beet, dry as bone, hot as a hare, blind as a bat, mad as a hatter, full as a flask”
- flushing
- anhidrosis/ dry mouth
- hyperthermia
- mydriasis/ vision changes
- delirium/ confusion
- urinary retention/ constipation
-excess benztropine, trihexyphenidyl
serotonin syndrome symptoms?
- agitation
- confusion
- tachycardia
- muscle rigidity
- seizures
-selegiline + SSRI or TCA
uses for propranolol
- benign essential tremor
- portal HTN
preeclampsia tx?
magnesium sulfate
Broca’s area
- posterior inferior frontal gyrus
- expressive aphasia
foot drop cause, px
- peripheral neuropathy
- common perineal nerve injury
- radiculopathy (L4-S2)
- inability to dorsiflex the foot
- patients overly flex the hip & knee to move foot forward
brain death definition
- irreversible cessation of brain activities
- absent cortical & brainstem functions
-spinal cord can still function –> DTR present
CT px of:
- progressive multifocal leukoencephalopathy
- cerebral toxoplasmosis
- CNS lymphoma
- non-enhancing lesions with no mass effect
- ring-enhancing mass lesion
- weakly ring-enhacing lesion; periventricular
positive drop arm test =
rotator cuff tear
botulism px
-descending flaccid paralysis
-constipation & drooling
(autonomic dysfunction)
-bilateral bulbar palsies: ptosis, sluggish pupillary reflex, poor suck & gag reflexes
botulism tx?
infant vs foodbourne
- human derived botulism Ig
- equine-derived botulism antitoxin
peripheral vs central facial palsy
-peripheral = Bell’s palsy = upper AND lower facial weakness
-below pons
(can’t raise eyebrows, close eyes, drooping mouth, loss of nasolabial fold)
-central –> forehead muscle sparing; intracranial lesions (ischemia or tumor)
glucocorticoid-induced myopathy px
- painless muscle weakness & atrophy
- normal ESR & CK
polymyalgia rheumatica px
- muscle pain & stiffness
- seen in 50% of temporal arteritis pts
- responds to glucocorticoids
- inc ESR, normal CK
inflammatory myopathies px
- muscle pain & tenderness
- proximal muscle weakness
- skin rash
- inc ESR & CK
statin-induced myopathy
- prominent muscle pain & tenderness
- rare rhabdo
- normal ESR, inc CK
hypothyroid myopathy
- muscle pain, cramps, weakness
- delayed DTRs
- rare rhabdo
- normal ESR, inc CK
Wernicke-Korsakoff syndrome cause, px
- thiamine (B1) deficiency
- ophthalmoplegia + dementia + ataxia
- irreversible amnesia, confabulation, apathy
cauda equina syndrome px
- unilateral, severe radiculopathy
- saddle anesthesia
- asymmetric motor weakness
- hyporeflexia
- late onset bowel/bladder dysfunction
conus medullaris syndrome px
- sunden onset severe back pain
- perianal anesthesia
- symmetric motor weakness
- hyperreflexia
- early onset bowel/bladder dysfunction
2 types of rigidity?
- uniform = lead pipe
- oscillating = cogwheel
Parkinson’s dx
- clinical dx
- 2 of 3 symptoms: resting tremor, rigidity, bradykinesia
-resting tremor may start in one hand and move to other
tx for agitation in elderly?
low dose haloperidol
-benzodiazepines are contraindicated in elderly due to risk of withdrawal, dependence, etc
intracranial HTN px
> 20 mmHG
- headache
- visual changes
- n/v, cr nerve deficits, confusion
- Cushing’s reflex = HTN + bradycardia
diabetic Cr III neuropathy cause, px
-ischemia
- ptosis
- “down and out” gaze
- normal light & accommodation reflex
-only somatic fibers are affected; parasympathetic fibers are spared
nerve compression of Cr III px
-somatic & parasympathetic fibers affected –> ptosis, “down & out” gaze, pupillary reflex deficit
basal ganglia hemorrhage px
- hemiplegia
- hemi-sensory loss
- homonymous hemianopsia
- stupor, coma
cerebellum hemorrhage px
- facial weakness
- nystagmus
- ataxia
- NO hemiparesis
- stupor/coma from brainstem herniation
thalamus hemorrhage px
- hemiparesis
- hemi-sensory loss
- upgaze palsy
- nonreactive miotic pupils
- eyes deviate AWAY from lesion
cerebral lobe hemorrhage px
- contralateral homonymous hemianopsia, paresis
- eyes deviate TOWARD lesion
pons hemorrhage px
- deep coma
- total paralysis within minutes of hemorrhage
- pinpoint reactive pupils
- decerebrate rigidity
status epileptics can lead to?
seizure >5 minutes
cortical laminar necrosis –> persistent neurological deficits & recurrent seizures
does hyperventilation stimulate complex partial seizures or absence seizures?
(during EEG)
absence
Lennox-Gastaut syndrome
- childhood onset epilepsy
- multiple types of seizures
- impaired cognitive function
typical vs atypical absence seizures?
atypical lasts longer & EEG frequency <2.5Hz
Todd’s paralysis
transient focal neurologic deficit following a seizure
disease onset of frontotemporal dementia vs Alzheimer’s?
40-60 YO
vs
>60 YO
hemi-neglect syndrome cause?
stroke to non-dominant parietal lobe
major risk factor for stroke?
HTN
-smoking, DB (lesser risk)
opiate overdose tx?
naloxone
= opiate antagonist; reverses respiratory suppression
benzodiazepine overdose tx?
flumazenil
tick-bourne paralysis px, cause, tx
-progressive ascending paralysis
-occurs over hours to
days
-sensation & autonomic function, CSF normal
- cause: neurotoxin release by tick
- tx: tick removal
acute glaucoma px, dx
- sudden onset eye pain/ photophobia/ mid-dilated pupil
- ocular tonometry
SE of SAH
-cerebral salt-wasting syndrome –> hypoNa
cerebral salt-wasting syndrome?
inc ADH –> inc ANP/BNP –> cerebral salt-wasting –> hypoNa
