Exam 2 - week 6 Flashcards
(183 cards)
1
Q
new back pain in age < 18 y/o concerning for
A
congenital abnormality
2
Q
new back pain in age >50 concerning for
A
compression fracture, malignancy
3
Q
new back pain with anticoagulant use concerning for
A
spinal hematoma with nerve root compression
4
Q
new back pain with fever concerning for
A
infection, malignancy
5
Q
classic triad of spinal epidural abscess
A
fever, back pain, neuro deficit (only present in 10% of pts)
6
Q
new back pain with bowel/bladder dysfunction, sexual dysfunction concerning for
A
cauda equina syndrome
7
Q
new back pain with IV drug abuse concerning for
A
infection (epidural abscess or spondylodiscitis secondary to hematogenous seeding from bacteremia)
8
Q
new or different back pain in patients with recent surgery or spinal injection concerning for
A
infection, hematoma
9
Q
new back pain with trauma concerning for
A
fracture, spinal hematoma
10
Q
new back pain with new reduced anal sphincter tone concerning for
A
cauda equina syndrome
11
Q
back pain with hyperreflexia concerning for
A
acute cord compression
12
Q
back pain with hyporeflexia or areflexia concerning for
A
cauda equina syndrome
13
Q
back pain with lower extremity muscle weakness concerning for
A
acute cord compression or cauda equina syndrome
14
Q
epidural spinal cord compression is associated with what malignancies
A
prostate, breast, lung
15
Q
ssx associated with back pain due to malignancy
A
progressive back pain over several months that may worsen with valsalva, weight loss, night pain
16
Q
red flag physical exam findings with back pain
A
progressive neuro deficits, weakness, reduced anal sphincter tone, alteration in gait, absence of sensation to light touch and pinprick, saddle anesthesia, abnormal reflexes
17
Q
origin of anterior supply of brain
A
internal carotid
18
Q
origin of posterior supply of brain
A
vertebral arteries/basilar artery
19
Q
what does middle cerebral artery supply
A
lateral convexity of cerebral cortex
20
Q
what does anterior cerebral artery supply
A
medial frontal and medial parietal regions
21
Q
what does posterior cerebral artery supply
A
occipital lobe and inferior surface of temporal lobe
22
Q
cerebellum and brainstem are supplied by
A
basilar, PICA, AICA, SCA
23
Q
what does PCA supply
A
midbrain
24
Q
what does AICA supply
A
lateral pons
25
what does basilar artery supply
medial pons
26
what does PICA supply
lateral medulla
27
what does ASA supply
medial medulla, anterior 2/3 of spinal cord
28
ASA stroke at level of spinal cord ssx
loss of all but posterior columns (paralysis below lesion, only vibration/proprioception intact)
29
AICA infarction ssx
facial droop, hearing loss
30
PICA infarction ssx
dysphagia, hoarseness
31
ASA infarction at level of brainstem
contralateral motor loss, tongue deviation
32
transtentorial herniation aka
uncal herniation
33
what is an uncal herniation
shift of brain from the middle to the posterior fossa through the tentorial incisura
34
uncal hernation effects
compression of CN III, duret hemoprrhages in midline rostral brainstem, compression of contralateral cerebral peduncle, compression of posterior cerebral artery with infarction of medial occipital lobe
35
uncal herniation clinical triad
fixed and dilated pupil, hemiplegia, decreased LOC/coma
36
what does posturing indicate
lesion of brainstem causing loss of consciousness
37
decorticate posturing lesion
spares red nucleus, upper midbrain, intact rubrospinal tract
38
decerebrate posturing lesion
includes red nucleus, upper pons
39
what is red nucleus
part of midbrain reticular formation that plays major role in consciousness
40
what is horner's syndrome
compression or disruption of sympathetic ganglia
41
causes of Horner's syndrome
lesion of spinal cord above T1/cervical transection, carotid dissection, cavernous sinus tumor, hypothalamus-descending efferent pathway
42
Horner's syndrome triad
ptosis, miosis, anhidrosis
43
pathophys of concussive injury
massive efflux of potassium ions and influx of calcium ions, with release of glutamate and nonspecific depolarization leading to increased energy requirements, decreased cerebral blood flow
44
duration of postconcussion physiologic cascade
up to 10 days
45
incidence of post-concussion syndrome
10-15%
46
postconcussion syndrome definition
continued symptoms after 10 days post-injury
47
components of sideline eval for concussion
orientation, memory, mental status, balance
48
sideline concussion eval tool
SCAT 2
49
indications for postconcussive brain imaging
complex or prolonged symptoms
50
duration of rest after concussion
at least 24-48 hours
51
postconcussion syndrome treatment
vestibular therapy, visual rehab, learning strategy education
52
headache red flag ssx
focal neuro signs, papilledema, neck stiffness, immunocompromise, thunderclap, personality changes, post-traumatic HA, HA that worsens with exercise
53
most common type of headache
tension-type
54
tension-type headache ssx
bilateral mild-moderate pressure without associated ssx
55
likely source of tension headache
nociceptors in pericranial myofascial tissues
56
ssx of migraine mnemonic
POUND
57
POUND
pulsatile, duration of 4-72 hours (how is that O?), unilateral, N/V, disabling intensity
58
tension headache duration
30 minutes - 7 days
59
aura definition
visual, sensory, or speech ssx that appear gradually, last no longer than 60 minutes, and are completely reversible
60
cluster HA duration
15-180 minutes
61
cluster HA age of onset
70% <30
62
cluster HA ssx
sharp, pulsating, or pressure-like pain that is severe and usually unilateral and retro-orbital with ipsilateral autonomic ssx (eyelid edema, nasal congestion, sweating, lacrimation)
63
duration of a period of cluster HA
6-12 weeks followed by up to 12 months of remission
64
cluster HA risk factors
family history, depression, sleep apnea, restless legs, asthma
65
first or worst HA of patient's life is red flag for
CNS infection, intracranial hemorrhage
66
HA with focal signs that are not typical of migraine aura are concerning for
AV malformation, collagen vascular disease, intracranial mass lesion
67
HA triggered by cough, exertion, sexual intercourse concerning for
mass lesion, SAH
68
HA with change in mental status, personality concerning for
CNS infection, intracerebral bleed, mass lesion
69
new onset HA in pregnancy or postpartum concerning for
cortical vein/cranial sinus thrombosis, carotid artery dissection
70
HA with worsening pattern concerning for
medication overuse, mass lesion, subdural hematoma
71
temporal arteritis is associated with
polymyalgia rheumatica
72
HA in age>50 concerning for
mass lesion, temporal arteritis
73
temporal arteritis lab test
ESR
74
HA with papilledema concerning for
encephalitis, mass lesion, meningitis, pseudotumor
75
HA with rapid onset with strenuous exercise concerning for
carotid artery dissection, intracranial bleed
76
ssx of CNS infection
headache, fever, papilledema, severe HTN
77
when to get MRI for HA with and w/o contrast
immunocompromised, suspected temporal arteritis, suspect carotid artery dissection
78
when to get CT or MRI w/o contrast for HA
suspect meningitis, severe HA in pregnancy, thunderclap
79
leading cause of epidural hematoma
accidental falls leading to temporal bone fracture leading to laceration of middle meningeal artery/vein
80
what is true of pediatric epidural hematoma
not necessarily associated with skull fracture and they are more likely to have a lucid interval
81
what determines length of lucid interval in epidural hematoma
whether it is arterial or venous
82
what proportion of epidural hematomas have a lucid interval
1/3
83
epidural hematoma location
between skull and dura mater
84
most common etiology of subdural hematoma
bridging vein laceration due to trauma
85
subdural hematoma location
between dura and arachnoid mater
86
uncal herniation triad
dilated pupil, down and out pupil. contralateral weakness. Massive herniation may result in ipsilateral weakness
87
what is diffuse axonal injury
damage to white matter tracts of brain and brainstem with microscopic axonal spheroids
88
diffuse axonal injury ssx
immediate loss of consciousness
89
causes of diffuse axonal injury
high velocity accidents or "shaken baby syndrome" causing rotational acceleration/deceleration injuries
90
cause of chronic traumatic encephalopathy
repeated blows to the head
91
describe coup-contrecoup injuries
acceleration and deceleration producing shearing forces on septum pellucidum
92
what form of coup-contrecoup injury is most severe
lateral
93
concussion ssx
HA, pressure feeling in head, temporary LOC, confusion, brain fog, amnesia, dizziness, seeing stars, tinnitus, N/V, slurred speech, fatigue, delayed response to questions
94
head injury red flag ssx
anisocoria, diminished level of consciousness, unrelenting/progressive HA, focal/cerebellar signs, N/V, seizures, altered mental status, loss of consciousness
95
concussion tx
observe for 24 hours (can be at home), physical/mental rest for 48 hours, gradual return to activities, take APAP for headache (avoid ibuprofen)
96
seizure definition
clinical manifestation of abnormal and excessive activity of cortical neurons
97
epilepsy definition
enduring predisposition to generative epileptic seizures not due to acute provoking factors
98
bimodal age distribution for seizures
at birth, >70 y.o
99
"provoked" seizures are due to
electrolyte or metabolic derangement, meds, other medical conditions, recreational drugs/toxins, CNS lesions
100
types of generalized seizures
absence, myoclonic, tonic, clonic, tonic-clonic, atonic
101
what is a generalized seizure
starts in deep structures and propagates to cortex via bilateral distributed networks
102
generalized seizure provoking factors
head trauma, brain surgery, CNS infection, tumor, stroke, hypoxia/ischemia
103
metabolic/electrolyte imbalances provoking seizures
sodium, calcium, magnesium, glucose, urea nitrogen
104
other medical conditions provoking seizures
hypertensive encephalopathy/posterior reversible encephalopathy syndrome, liver failure, hypothyroidism, etc
105
what is a myoclonic seizure
brief shock-like jerks of muscle lasting 1-2 seconds, patient is alert and oriented, can be single or multiple
106
what are tonic seizures
sudden stiffening of muscles lasting seconds to minutes associated with loss of consciousness
107
what are atonic seizures
sudden loss of tone of all muscles without myoclonus lasting less than 2 seconds
108
what is an absence seizure
brief stare and loss of awareness lasting less than 10 seconds that may be accompanied by automatisms (blinking, chewing, gestures)
109
absence seizures EEG findings
3 Hz spike-wave discharge
110
what is juvenile myoclonic epilepsy
common generalized epilepsy syndrome that emerges in mid to late childhood
111
what is the first seizure in JME and when does it occur
usually absence, seen between 5-16 y/o
112
what types of seizures are associated with JME
myoclonic seizures, absence, generalized tonic-clonic
113
when do myoclonic seizures emerge in JME
1-9 years after first seizure followed by generalized tonic clonic seizures in 1/3 of patients
114
triggers of status epilepticus
epilepsy, cerebral damage, brain tumors, electrolyte abnormalities, drug ETOH OD/withdrawal, encephalitis
115
1st line tx for status epilepticus
diazepam or lorazepam
116
focal seizures without impairment of consciousness aka
simple partial seizure
117
focal seizures without impairment of consciousness types
motor, autonomic, sensory, psychic phenomena
118
focal seizures with impairment of consciousness aka
complex partial seizures
119
focal motor signs associated with focal seizures without impairment of awareness
isolated muscle rhythmic jerking, jacksonian march
120
motor signs associated with focal seizures without impairment of awareness
focal motor signs, version (extreme head turn/eye deviation), postural (tonic)
121
location of seizure onset in focal seizures without impairment of awareness
contralateral frontal lobe
122
focal seizure without impairment of awareness temporal lobe sensory ssx
auditory hallucinations, noxious smell, metallic taste
123
focal seizure without impairment of awareness parietal lobe onset sensory ssx
unusual somatosensory sensations, vertiginous
124
focal seizure without impairment of awareness occipital lobe onset sensory ssx
visual ssx (lights, darkness, lines), visual hallucinations if from parietal-temporal-occipital junction
125
focal seizure without impairment of awareness autonomic signs location of onset
insula (temporal lobe)
126
focal seizure without impairment of awareness insula onset ssx
nausea, pallor, sweating, flushing, piloerection
127
focal seizure without impairment of awareness psychic symptoms temporal or frontal lobe onset
broca/wernicke aphasia
128
focal seizure without impairment of awareness psychic ssx temporal lobe onset
deja vu, derealization, feeling of impending doom
129
focal seizure without impairment of awareness psychic ssx amygdala onset
dreamy, time distortions, fear/anger, illusions
130
major modifiable risk factors for stroke
HTN, a fib, smoking, carotid artery disease, sickle cell
131
most common historical feature of an ischemic stroke
awakening with or acute onset of ssx
132
ssx of SAH
thunderclap HA (+/-sentinel episode), vomiting, photophobia, seizures, meningismus, decreased LOC, +/- focal signs
133
common stroke mimics
seizure, conversion disorder, migraine, hypoglycemia
134
initial CVA workup
noncontrast brain CT or MRI, BGL, O2 sat, CMP, CBC, troponin, coags, ECG
135
who needs an MRI instead of a CT for stroke eval
patients with acute vestibular syndrome or suspected posterior infarction
136
4 types of herniation
subfalcine, uncal, central, tonsillar
137
subfalcine herniation
cingulate gyrus goes under falx cerebri causing ACA compression and contralateral leg paresis
138
central herniation
diencephalon herniates against midbrain
139
tonsillar herniation
cerebellar tonsils herniate through foramen magnum, usually due to posterior fossa mass lesion. Usually fatal due to cardiorespiratory failure
140
transtentorial herniation (central)
thalamus, hypothalamus, and medial temporal lobes are forced through tentorium cerebelli leading to somnolence, small or nonreactive pupils, posturing
141
what is the dominant hemisphere
the hemisphere that contains the centers for language production and comprehension
142
types of aphasia with impaired repetition
broca, wernicke, conduction, global
143
broca aphasia characteristics
repetition impaired, nonfluent, intact comprehension
144
broca aphasia area affected
inferior frontal gyrus
145
wernicke aphasia characteristics
repetition impaired, fluent, impaired comprehension
146
wernicke aphasia area affected
superior temporal gyrus
147
conduction aphasia characteristics
repetition impaired, fluent, intact comprehension
148
conduction aphasia area affected
arcuate fasciculus
149
global aphasia characteristics
repetition impaired, nonfluent, impaired comprehension
150
types of aphasia with intact repetition
transcortical motor, transcortical sensory, transcortical mixed
151
transcortical motor aphasia characteristics
repetition intact, nonfluent, intact comprehension
152
transcortical motor aphasia area affected
frontal lobe surrounding broca, which is spared
153
transcortical sensory aphasia characteristics
repetition intact, fluent, impaired comprehension
154
transcortical sensory area affected
temporal lobe around wernicke, which is spared
155
transcortical mixed aphasia characteristics
repetition intact, nonfluent, impaired comprehension
156
area affected in transcortical mixed aphasia
watershed areas surrounding broca, wernicke, and arcuate fasiculus (all spared)
157
left hemisphere damage leads to ____, while right hemisphere damage leads to _____
aphasias, neglect/agnosia
158
right PCA stroke is associated with _____
visual agnosia
159
right ACA stroke is associated with _______
mild left hemineglect
160
right MCA stroke is associated with ____
neglect, either mild (superior division) or profound (inferior division)
161
what is cortical sensory loss
relatively spared sensation with tactile agnosia and graphesthesia
162
what causes cortical sensory loss
damage to territory or somatosensory cortex (left or right ACA or MCA)
163
which cranial nerves have midline motor nuclei
ones that divide into 12 (III, IV, VI, XII)
164
which cranial nerves have lateral nuclei
V, VII, IX, XI
165
what is the anterior choroidal artery
arises from internal carotid artery and supplies portions of globus pallidus, putamen, thalamus, posterior limb of internal capsule
166
what is conduction aphasia
damage to the white matter tracts connecting brocas and wernickes areas
167
left ACA stroke syndrome ssx
right leg paresis, right leg cortical sensory loss, frontal lobe deficits, right face and arm weakness (if anterior limb of internal capsule affected), transcortical motor or transcortical mixed aphasia (repetition intact)
168
what is cortical sensory loss
relatively spared sensation with decreased stereognosis and graphesthesia
169
right ACA stroke syndrome ssx
left leg paresis, left cortical sensory loss, frontal lobe deficits, left face and arm weakness (if anterior limb of internal capsule), left hemineglect (if posteriolateral parietal or corpus callosum lobe affected)
170
left PCA stroke syndrome ssx
right homonymous hemianopia, memory impairment (if temporal lobe), alexia without agraphia (can't read, but can write), right hemisensory loss/right hemiparesis (if thalamus/internal capsule), transcortical sensory aphasia
171
right PCA stroke syndrome ssx
same as left PCA but with visual agnosia (can't name objects), no aphasia and on the opposite side
172
left MCA superior division stroke ssx
right face and arm paresis, broca's aphasia, may have right face and arm cortical sensory loss
173
left MCA inferior division stroke syndrome ssx
wernicke's aphasia, right face and arm cortical sensory loss, right visual field deficit, disorientation/confusion, absent motor symptoms
174
left MCA deep territory stroke syndrome ssx
right pure motor hemiparesis, cortical deficits (if large infarct)
175
left MCA stem stroke syndrome ssx
right hemiplegia, right hemianesthesia, right homonymous hemianopsia, global aphasia, left gaze preference
176
right MCA superior division stroke syndrome ssx
left face and arm paresis, left hemineglect, may have left face and arm cortical sensory loss
177
right MCA inferior division stroke ssx
profound left hemineglect, left motor neglect (decreased voluntary or spontaneous movement), mild left sided weakness, left visual field deficits, right gaze preference
178
right MCA deep territory stroke syndrome
left pure motor hemiparesis, cortical deficits such as neglect (if large infarct)
179
right MCA stem stroke ssx
left hemiplegia, left hemianesthesia, left homonymous hemianopia, profound left hemineglect, right faze preference
180
levetiracetam MOA
SV2A receptor antagonist
181
which antiepileptics are sodium channel blockers
lamotrigine, valproate, topiramate, lacosamide, phenytoin, carbamazepine
182
narrow-spectrum drug for absence seizures
ethosuximide
183
broad-spectrum antiepileptics
levetiracetam, lamotrigine, valproate, topiramate
