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Neurology > Week 2 > Flashcards

Week 2 Flashcards

1
Q

The Facial Nerve {CN VII} passes through the _______ bone. This can be a site of constriction if the nerve becomes inflamed which may result in ______ ______.

A

Temporal; Bell’s Palsy

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2
Q

Tumours of the Parotid Gland may compress the _______ nerve, which passe through it.

A

CN VII; The Facial Nerve

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3
Q

CN VII {Facial} is responsible for?

A

Muscles of facial expression, taste and motor of the anterior 2/3 of the tongue, lacrimal glands, sublingual glands, submandibular glands. + Posterior belly of the digastric and the stylohyoid muscle.

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4
Q

CN V is responsible for?

A

Muscles of mastication, and facial sensation.

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5
Q

Bell’s Palsy is by definition?

A

Idiopathic.

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6
Q

Damage to which nerve will make sounds appear louder? Which condition is this often associated with and which CN is affected?

A
  • Nerve to Stapedius - Bell’s Palsy - CN VII
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7
Q

A problem drinking makes you think there is a ______ problem while a problem eating could be______.

A

Neurological; Neurological or Other causes {dry mouth, obstructions, ect.}.

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8
Q

Which nerve is responsible for sensation of the face, the muscles of mastication, and the lateral pterygoids?

A

CN V Trigeminal

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9
Q

What are the three branches of the trigeminal nerve {CN V}?

A

From Top to Bottom - Ophthalmic {V1} - Maxillary {V2} - Mandibular {V3}

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10
Q

Which CN is responsible for opening to eye? Which CN is responsible for sensation of the eye {cornea}? Which CN is responsible for closing the eye?

A

CN III CN V CN VII

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11
Q

Which CNs are responsible for the gag reflex?

A

CN IX {Afferent} & CN X {Efferent}

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12
Q

What is Dysarthria?

A

Dysarthria is a difficult or unclear articulation of speech; it may be caused by local pathologies of the mouth/tongue/throat, UMN/LMN/CN lesions, CNS issues, cerebellar ataxia, Parkinson’s disease…

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13
Q

What does Posterior Vitreous Detachment {PVD} present with? What might a PVD develop into?

A
  • A new floater. - Flashing lights. - Maybe decreased vision. - Only 10% have a tear. Should be seen within 1 - 2 days to look for a tear and treat before it turns into retinal detachment.
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14
Q

What does Retinal Detachment {RD} present with? How should RD be treated?

A
  • Decreased vision. - A RECENT floater. - A field defect. Should be seen ASAP if the macula is still attached. They will have good visual acuity but visual field defects. If the macula has already come off treat them within 1 - 2 days, there is no difference between a day and a week so no hurry.
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15
Q

What is Hyphema?

A

Blood in the anterior chamber of the eye {between the iris and the cornea}. It is most commonly caused by blunt trauma but may also occur following neovascularization.

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16
Q

What, besides just needing glasses, can cause an acute refractive error?

A

Hyperglycemia

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17
Q

Retinal detachment is more common in patients with _______ eyes.

A

Myopic {Nearsighted}

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18
Q

What are the two forms of age related macular degeneration and how are they treated?

A

Age-Related Macular Degeneration comes in 2 forms, Dry which results in a slow, chronic loss of vision over decade, and Neovascular {Wet} which can result in sudden, acute visual loss due to hemorrhage and leakage. Both are easy to treat! Dry: Vitamins A, E, b-carotene, Zn, and Cu. Wet: Vitamins + Anti-Vascular Endothelial Growth Factor {WEGF}Injections.

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19
Q

What forms can Retinal Vascular Occlusion of the eye take? What are all of these forms associated with?

A

Branch {BRVO}, Hemi, or Central {CRVO}. All are associated with HTN and vision loss via Vitreous Hemorrhage and Macular Edema.

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20
Q

How are BRVO and CRVO treated?

A

BRVO: Treat HTN, anti-VEGF, laser ablation of new vessels. CRVO: Avastin {anti-VEGF}

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21
Q

How are BRAO and CRAO treated?

A

There is no effective treatment.

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22
Q

What does Myasthenia Gravis present with?

A
  • Thymic Hyperplasia in Teens - 30’s - Thymoma in 55+
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23
Q

Polyneuropathy can be pure _______ or a mix of both sensory and motor. It is very rarely pure _______.

A

Sensory; Motor.

24
Q

And example of Acute Inflammatory Demyelinating Polyneuropathy would be?

A

Guillain-Barre Syndrome, in which patients will lose their reflexes very early.

25
Q

How is Guillain-Barre Syndrome diagnosed? How is GBS treated?

A
  • CSF analysis. There will be elevated protein with no elevation of WBC or Glucose. - Nerve Conduction Studies {NCS} can initially be normal. - You can treat GBS with IVIG or Plasma Exchange. Immunosuppression is NOT effective.
26
Q

Myopathies are characterized by _______ more than _______ weakness.

A

Proximal; Distal

27
Q

What is Myotonic Dystrophy and where does it have an especially high prevalence?

A

Myotonic Dystrophy {DM} is an autosomal dominant conditions and is prominent in Quebec. It is associated with gradual atrophy of the muscles. DM will slowly progress over many years, you need to watch for cardiac issues {arrhythmias} and respiratory issues {sleep apnea, restrictive lung disease}. There are no disease modifying therapies.

28
Q

What does Anterior Horn Disease present with and what is the most common anterior horn disease?

A
  • Weakness, Atrophy, and Fasciculations. - Amyotrophic Lateral Sclerosis {ALS}.
29
Q

What is the only effective drug for ALS? How long does it prolong life?

A

Riluzole, it prolongs life for a median of 3 months.

30
Q

What are the “5 D’s” of Neuromuscular Junction Conditions?

A
  • Diplopia - Lid Droop - Dysarthria - Dysphagia - Drooling
31
Q

What are the top 6 symptoms which are likely to present with a Transient Ischemic Attack {TIA}?

A
  1. Hemibody Weakness. 2. Speech disturbances for a defined period of time. 3. Monocular or Hemifield visual loss. 4. Double vision, crossed numbness or weakness, slurred speech, ataxia of gait. 5. Hemibody numbness. 6. Vertigo only if present with brainstem symptoms.
32
Q

What are the top 6 symptoms which are unlikely to present with a Transient Ischemic Attack {TIA}

A
  1. Positional and recurrent numbness of one limb or tingling of all 4 extremities. 2. Scintillating of flashing visual disturbances. 3. Symptoms of duration < 30 seconds. 4. Seizure of convulsions at least once. 5. Isolated syncope. 6. Postural dizziness alone.
33
Q

What is Lipohyalinosis?

A

A small vessel disease of the brain which is responsible for many of the small vessel ischemic strokes. Key risk factors are DM2 & HTN.

34
Q

What must blood pressure be under to administer TPA to a stroke patient?

A

< 220/120

35
Q

What is the ABCD2 Score used for and how is it calculated?

A

Determining the risk of a stroke occuring following a TIA.

36
Q

Define Transient Ischemic Attack.

A

A Transient Ischemic Attack {TIA} is defined as a focal neurological deficit lasting < 24 hours. It is better defined as a rapidly resolving episode of neurological symptoms {typically lasting < 1 hour}, with no evidence of infarction on MRI.

37
Q

What are considered high risk symptoms of TIA?

What are considered low risk symptoms of TIA?

A

High Risk: Speech Disturbances, Weakness of the Extremities, Weakness of the Face.

Low Risk: Monocular Vision Loss, Hemianopsia, Numbness.

38
Q

How should Hyperacute Ischemic Strokes be treated?

How should Acute Ischemic Strokes be treated?

A

Hyperacute: IV TPA {<4.5 Hours}, or Endovascular Therapies {put a shunt in, let the clot attach, remove it}.

Acute: ASA and Admission to the Stroke Unit.

39
Q

How does Tissue Plasmogen Activator {TPA} work?

A

TPA binds to fibrin in the thrombus and conerts entrapped plasminogen to plasmin which initiates fibrinolyis.

40
Q

What are the two main types of strokes? What are Cryptogenic Strokes and what is likely responsible for most of them?

A

Ischemic Strokes and Hemorrhagic Strokes.

Cryptogenic Strokes are essentially idiopathic, we don’t know what causes them, but a lot of them are probably due to atrial fibrillation that we just don’t look for carefully enough. They are a type of Ischemic Stroke.

41
Q

Ischemic Strokes may be due to small or large vessel occlusion. What is the mechanism for each size of vessel?

A

Large vessel occlusion is usually caused by emboli {often drom atrial fibirillation}.

Small vessel occlusion is usually NOT caused by emboli but by diseases of the vessels like atherosclerosis, degredation secondary to diabetes, of lipohyalinosis {which presents with small vessel wall thickening}.

42
Q

What are the two major causes for Hemorrhagic Stroke?

A

Hypertension and Amyloid.

43
Q

Where does a LAcunar Stroke occur and what does it affect?

A

A Lacunar Stroke is subcortical and involves the small vessels. This does not involve the cortex, but does affect where the sensory and motor fibres start to come together.

44
Q

What will Anterior Cerebral Artery, Middle Cerebral Artery, and Posterior Cerebral Artery Strokes cause?

A
  • An Anterior Cerebral Artery {ACA} stroke will affect the leg, usually sparing the arm and face.
  • A Middle Cerebral Artery {MCA} stroke will affect the face and the arm, usually sparing the leg.
  • A Posterior Cerebral Artery {PCA} stroke, will usually affect the occipital lobe and vision.
45
Q

Review the Clnical Findings of Myotinc Dystorphy (DM} Types I and II.

A
46
Q

Review the Symptoms of Myotonic Dystrophy.

A
47
Q

Review the 6 types of Diabetic Neuropathies.

A

First two are the most common.

48
Q

What is Penumbra?

A

Following a stroke there are two major zones of injury. The severely ischemic core is tissue which is no longer viable and will likely die {though some cells may make it through if repercussion occurs quickly}. The penumbra is tissue which is ischemic but still viable and will remain so for a couple hours. It will still die if repercussion never occurs.

49
Q

What is Nystagmus and what parts of the brain may be invovled with it?

A

Nystagmus is a condition of involuntary eye movement sometimes called “Dancing Eyes”. It may be congenital or acquired. When acquired it may be caused by certain drugs or medications including Phenytoin {Dilantin} which is an anti seizure medication. Alcohol and sedatives can also cause nystagmus.

It may be due to damage of the Labyrinth of the inner ear, the semicircular canals, the cerebellum, the medulla, the optic chiasm, or some other structures.

50
Q

Carbamasepine: What it is, what it is used for, and an interesting fact.

A

Interestingly can cause Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

Carbamazepine is an anticonvulsant which is primarily used to prevent seizures in epileptic patients. It is also used to treat trigeminal neuralgia and in extended release form to treat bipolar disorder. Occasionally used to treat mental illnesses: depression, PTSD. Occasionally used to treat drug and alcohol withdrawal, chronic pain, or diabetes insipidus.

51
Q

What are several symptoms of increased intracranial pressure?

A

Symptoms of Increased Intracranial Pressure Include:

- Behaviour Changes
- Decreased LOC
- Headache
- Lethargy
- Weakness, Numbness, Eye Movement Problems, Double Vision, + other neuro issues.
- Seizures
- Vomiting
52
Q

What is a concussion?

A

Also called “Mild Traumatic Brain Injury {TBI}. It is defined as a GCS of between 13 and 15 approximately 30 minutes after an injury. Also defined as a trauma induced alteration in mental status which may or may not have involved a loss of consciousness.

Concussions may result in minor cortical contusions due to coup and contrecoup injuries. Mild axon damage may also play a role, as well as release of excitatory neurotransmitters and the generation of free radicals.

53
Q

If you can’t use thrombolytic therpy on a stroke patient for any reason, what blood pressure should you make sure they are under?

A

If the blood pressure is <220/120 you should consider giving drugs to lower BP. Goal should be <185/110.

Don’t lower more than 15% in the first 24 hours.

54
Q

What are you blood pressure targets for stroke patieints receiving thrombolyic therapy?

A

Needs to be < 185/110 before starting therapy.

Should be kept at <180/105 for at least 24 horus following therapy.

55
Q

Should blood pressure be lowered in a patient with a hemorrhagic stroke?

A

It depends. You need to balance the benefits of decreasing blood loss through the hemorrhage by decreasing the blood pressure with the dangers of decreasing perfusion by lowering the blood pressure.

56
Q

The cornea is clear when _______ relative to other tissues and becomes opaque when _______.

A

Dry; Wet.

The cornea may become opaque due to increased fluid going into it or decreased fluid leaving it due to failure of the pumps on the endothelium to pump fluid out quickly enough.

57
Q

Infectious Bacterial Keratitis is an ocular emergency and presents with?

What are some major risk factors?

A
  • Decreased vision, white corneal infiltrate, epithelial defect with staining, and anterior chamber inflammation.
  • Contact lenses! Diabetes, Trauma.

Neurology (2 decks)

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