Week 3 Neuro Flashcards
Infantile spasms Sxs
Sudden flexion and adduction of arms, few seconds many times daily
Absence seizures Sxs
Typical: Ages 4-12 yrs, no falling or convulsions, many times daily with eyelid fluttering, neuro and cognitive exams normal
Atypical: under 4 yrs, assoc w Lennox Gastaut, LOC complete, hx of damage to nervous sys, seizures into adulthood
Tonic clonic seizures
Outcry->LOC/falling–> tonic contraction with clonic motions, tongue biting, frothing, 1-2 min
Atonic seizures
Children (assoc w Lennox-Gastaut), LOC, fall to ground
Myoclonic seizures
Brief, lightening like jerks of a limb, bilateral or unilateral
Partial seizures
Excess neuronal discharge from one cerebral cortex, usu from structural abnormalities
Simple or complex
Simple partial seizure
Motor and sensory seizures= structural brain disease… Work up!!
Motor: contralateral face, trunk, limbs with clonic movement and Jacksonian March
Sensory: parasthesias or tingling in extremity/face assoc with distortion of body image
Complex partial seizure
Originate in temporal lobe, aura prodrome
Postictal state
After a generalized seizure: deep sleep, headache, confusion, muscle soreness
History questions for seizure dx
Sxs, prior head trauma or CNS infection, drug use or withdrawal, family hx
Brain abscess
Due to sinusitis, mastoiditis, head wound, sepsis
Sxs: headache, nausea, vomiting, lethargy, fever, seizures
Encephalitis
Inflammation of brain parenchyma, due to virus (rarely helminthic)
Sxs: fever, headache, seizures, neuro deficits
Dx: MRI and CSF testing
(Eg rabies: hydrophobia with ascending paralysis)
Subdural empyema
Due to sinusitis, ear infection, cranial trauma, bacteremia (rare)
Sxs: fever, lethargy, focal neuro deficit, seizure
Creutzfeldt-Jakob Dz
Prion dz, variant from meat with bovine spongiform encephalopathy (Mad Cow)
Suspect in elderly pts with rapidly progressing dementia esp with ataxia or myoclonus
Bacterial meningitis
Rapidly progressing, N. Meningitidis or Strep pneumoniae
Sxs: severe! Malaise, fever, irritability, vomiting, fever, headache, seizures in 40% children
Viral meningitis
Due to enterovirus or HSV
Sxs: fever, myalgia, GI or resp sxs, headache, fever, nuchal rigidity
Essential tremor
FHx in 50%, with voluntary movement, bilateral, alcohol alleviates
Tremor red flags
Abrupt onset, under 50yrs with no family hx, neuro deficits, tachycardia and agitation
Generalized seizures
Electrical discharge involves cortex of both hemispheres, often due to metabolic disturbances
Infantile spasms, absent seizures (petit Mal), tonic-clonic (grand Mal), atonic, myoclonic
Huntington Dz
Neuronal loss in basal ganglia –> dementia then chorea, tics, myoclonal disturbances, facial grimacing
Parkinson Dz
Bradykinesia, resting tremor, cogwheel rigidity, postural reflex impairment, coarse tremor
Due to Lewy bodies
Multiple Sclerosis
20-40 yrs, paresthesias in 1+ extremities, weakness or clumsiness of leg or hand, stiffness, gait disturbances
PE: Opthalmoplegia, central scotoma, wide gait, hyper reflexive DTRs
Myasthenia Gravis
Age 20-40yrs (F), Episodic muscle weakness, fatigabilify, ptosis, diplopia
Dx: serum anti-AchR Abs and EMG
Guillain Barre syndrome
Sxs: paresthesias of feet then hands, rapid severe muscle weakness (symmetric), respiratory paralysis
PE: sinus tachycardia, urinary retention, no DTRs
Amyotrophic Lateral Sclerosis
Lou Gehrig’s Dz.
Sxs: random, asymmetric cramps, weakness, muscle atrophy. Fasiculations, hoarseness, dysphagia
PE: hyper reactive DTRs, + Babinski
Dx: clinically
Gliomas
Primary tumors in brain parenchyma
