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Pance Re-Up > Neurology #2 Precision and Pearls > Flashcards

Neurology #2 Precision and Pearls Flashcards

1
Q

Encephalitis is infection of the brain parenchyma and causes include _____ (MCC), and others such as ______, ______, and ________

A

HSV-1 MCC

EBV, HIV, Rubella, Varicella

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2
Q

What are symptoms of encephalitis?

A

-Meningitis symptoms (nuchal rigidity, Brudzinski, Kernig), neck stiffness, fever, headache
-PLUS AMS, changes in speech, personality, and movement
-Focal neurologic deficits (palsies, sensory deficits)

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3
Q

Diagnostics done for encephalitis:
-What is done to rule out lesions
-What is preferred for encephalitis?
-What is the most accurate test for herpes?

A

-CT of the head to rule out lesions
-MRI preferred for encephalitis
-PCR most sensitives for herpes

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4
Q

If HSV is the cause of encephalitis, what is seen on MRI?

A

Temporal lobe involvement

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5
Q

Treatment for encephalitis (think about what the cause is)

A

IV Acyclovir

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6
Q

Normal pressure hydrocephalus is dilation of the ventricles with normal opening pressure on LP. What are some symptoms of this?

What is seen on MRI?

A

Dementia + Gait Disturbance + urinary incontinence
–Wet, wacky, wobbly
—wide based shuffling gait, urinary urgency

MRI: enlarged ventricles in absence of sulcal dilation

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7
Q

What is the treatment for normal pressure hydrocephalus?

A

Ventriculoperitoneal shunt

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8
Q

Although a cerebral abscess is rare, it has symptoms such as insidious onset of headache, fever, focal neuro findings and a history of what?

A

Recent sinus infection or ear infection: direct spread to the brain

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9
Q

An intracerebral hemorrhage, which is bleeding within the brain parenchyma that may compress the brain, ventricles, and sulci, has risk factors such as…..

A

Hypertension (MCC of ICH)

Cerebral amyloid angiopathy (MCC in old)

AVM (MCC in kids)

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10
Q

Symptoms of ICH

A

-Neuro symptoms increase in minutes to hours: headache, n/v, syncope, AMS, focal neurologic symptoms (hemiplegia, seizures, hemiparesis)

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11
Q

What diagnostic is done for ICH

A

CT scan!

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12
Q

How do you treat ICH?

How should you prevent ICP?

A

Supportive, gradually reduce BP

ICP: Raise head of the bed, no IVF, reduce BP

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13
Q

If the patient DOES have increased ICP, what should you give them?

A

IV Labetolol, Nicardipine, Hydralazine, Nitroprusside

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14
Q

An essential tremor is an autosomal dominant movement disorder that (explain what an essential tremor is)

A

-Intentional tremor: postural, bilateral action tremor that is worse with movement.
-MC affects upper extremities
-Worse with stress, anxiety, caffeine

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15
Q

What makes an essential tremor better?

A

Alcohol

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16
Q

Treatment for an essential tremor

A

-None needed
-Propanolol if situational
-Primidone if no relief with Propanolol

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17
Q

Explain the pathophysiology of Parkinson’s Disease

A

-Movement disorder due to loss of dopaminergic neurons in the substantia nigra –> failure of acetylcholine inhibition in the basal ganglia (acetylcholine is the excitatory neurotransmitter)

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18
Q

Symptoms of Parkinson’s Disease

A

-Resting tremor, bradykinesia, muscle rigidity
-Tremor: pill-rolling tremor, worse with rest, better with activity
-Slowness of movement, no arm swinging when walking
-Masked facies
-Myerson’s Sign (tapping forehead)
-Postural instability: pull test
-Dementia in 50%
-Cogwheel rigidity

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19
Q

What is the only way to make the definitive diagnosis for Parkinson’s Disease?

A

Post mortem histology: cytoplasmic inclusions (lewy bodies) and loss of pigment cells in the substantia nigra

20
Q

Most effective pharm treatment for Parkinson’s Disease?

A

Levodopa-Carbidopa

21
Q

What other drug class may be used in treating Parkinson’s?

A

Dopamine agonists (Bromocriptine, Pramipexole, Ropinorole)

22
Q

Levodopa is converted to dopamine when…..

What are some adverse effects of this?

A

When it crosses the Blood-brain-barrier

Dyskinesia, wean off trouble, hallucinations

23
Q

Dopamine agonists can be used in who?

A

< 65 years old to delay use of Levodopa

24
Q

Huntington’s Disease is an autosomal dominant neurodegenerative disorder. Explain the patho of this.

What are some symptoms?

A

Inheritance of CAG/glutamine repeats on Huntingtin gene (chromosome 4)

-Symptoms appear in 30-50 year olds
-Mood, Movement, Memory
–Behavior/mood changes
–Chorea
–Dementia
–Gait abnormalities, ataxia, incontinence

25
Q

What is seen on CT/MRI for Huntington’s Disease?

A

Cerebral and striatal (caudate nucleus and putamen) atrophy

26
Q

Although Huntington’s is fatal in 15-20 years, what can be given for dyskinesia/chorea?

A

Tetrabenazine

NO MEDS STOP DISEASE PROGRESSION

27
Q

Explain what delirium is

A

-Abrupt, acute, transient confused state due to an identifiable cause

-usually associated with fully recovery in 1 week

28
Q

What is the MC type of dementia

A

-Alzheimer Dementia

29
Q

What are the three hypothesized patho explanations for Alzheimer’s?

A

1) Amyloid-beta protein plaques in brain
2) neurofibrillary tau protein tangles
3) Acetylcholine deficiency

30
Q

Symptoms of Alzheimer’s Dementia

A

-1st symptom: short term memory loss
-Progresses to long-term and cognitive deficits

31
Q

Although Alzeheimer’s is a clinical diagnosis, what is seen on MRI and histology?

A

MRI: medial temporal lobe atrophy
Histology: plaques and tangles

32
Q

Treatment for Alzheimer’s

A

-Acetylcholine inhibition: Donepezil, Tacrine, Rivastigmine, Galantamine

-NMDA Antagonist (Memantine): reduce glutamate cell death

33
Q

Vascular dementia, which is due to chronic ischemia and lacunar infarcts, has a risk factor of __________. Explain the symptoms of this condition.

A

Hypertension

Sudden decline in functions with stepwise progression of symptoms: infarct –> stable –> infarct –> stable

34
Q

How to prevent vascular dementia

A

BP control

35
Q

Frontotemporal Dementia (Pick’s Disease) is degeneration of the frontotemporal lobes. Therefore, the symptoms include…

A

-Changes in social behavior, personality, and language (aphasia)
-Behavioral changes: socially inappropriate behaviors, hyperorality (changes in food likes), loss of sympathy/empathy

36
Q

On histology, what is seen in Pick’s Disease?

A

Pick bodies: round aggregates of Tau Proteins on silver-staining

37
Q

Diffuse Lewy Body Disease is progressive dementia characterized by presence of diffuse Lewy Bodies, which are….

How does this differ from Parkinson’s?

A

Abnormal neuronal protein deposits

In Parkinson’s, they are localized. In diffuse, they are everywhere!

38
Q

Symptoms in Diffuse Lewy Body Disease

A

-Visual hallucinations, episodic delirium, rapid eye movement sleep disorder, autonomic dysfunction (ortho hypotension), and Parkinsonism.

39
Q

Multiple Sclerosis is an autoimmune demyelinating disease of the CNS. What is happening here?

What is the MC type?

A

Axon degeneration of the white matter (brain and spinal cord)

Relapsing-Remitting (episodic)

40
Q

Symptoms of Multiple Sclerosis

A

-Sensory disturbances followed by weakness and visual disturbances
–Diplopia, optic neuritis, trigeminal neuralgia, weakness, gait problems

41
Q

What is Uhthoff’s Phenomenon (associated with MS)

A

Worsening of symptoms with heat

42
Q

What are some other exam findings associated with MS (be specific)

A

-Upper motor neuron signs: spasticity, upward Babinski, hyperreflexia, rigidity
-Lhermitte’s Sign: neck flexion leads to lightning pain down the leg
-Marcus Gunn Pupil: pupils dilate with light
-Bowel, bladder, and sexual dysfunction

43
Q

What is seen on MRI in Multiple Sclerosis?

A

MRI with gadolinium is the best test: hyper intense white matter plaques

44
Q

How about LP in MS?

A

-Increased IgG and oligoclonal bands

45
Q

For acute exacerbation of MS, what is the treatment

A

IV Glucocorticoids

46
Q

For a prevention of a relapse, what is the treatment for MS?

A

Beta-interferon or Glatiramer

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