Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RCE 2021 > General Neurology > Flashcards

General Neurology Flashcards

1
Q

Lateral Medullary Syndrome/Wallenberg

A 
Vessel: PICA or vertebral
Ipsilateral ataxia
Ipsilateral dysphagia
Ipsilateral face/contralateral body dec pain/temp
Ipsilateral Horner's
Vertigo/nystagmus
Hiccups
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Findings in lateral medullary syndrome

A

Vitals - ?AF, BP maybe up
CN - Horner’s (ptosis, miosis, anhydrosis), face pain/temp, dec corneal reflex, dec gag reflex, nystagmus (fast AWAY from lesion), hoarse voice
Motor - normal strength/reflexes
Sensory - contralateral pain/temp
Coordination - ipsilateral dysmetria and dysdiachokinesia
Gait - ataxic
Other - hiccups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medial Medullary Syndrome

A

Vessel = anterior spinal artery
Ipsilateral tongue weakness
Contralateral arm/leg weakness
Contralateral body vibration/proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Midbrain lesion/Weber’s

A 
Vessel = PCA
Ipsilateral CN3 palsy (ptosis, mydriasis, diplopia)
Eye down and out
Contralateral hemiplegia (face, arm, leg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ACA

A

Contralateral leg weak and numb

Contralateral grasp reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Left MCA stroke - superior branch

A
  • Broca’s aphasia (expressive, non fluent)
  • R weakness face and arm > leg
  • Gaze deviation to the left
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Left MCA stroke - inferior branch

A

Wernicke’s aphasia - receptive/fluent
R cortical sensory loss
Right pie in the sky visual loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Left MCA - main branch M1

A
  • Global aphasia
  • Right weakness face and arm >leg
  • Right cortical sensory loss
  • Right pie in the sky
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

R MCA superior branch

A

Left weakness face and arm >leg

Gaze deviation to Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

R MCA inferior branch

A

Left cortical sensory loss
Left hemineglect
Left pie in the sky

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

R MCA main branch

A

Inferior and superior mix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PCA stroke

A

Contralateral homonymous hemianopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pure motor stroke

A

Localizations: posterior limb internal capsule, corona radiata, midbrain cerebral peduncle, pons
Artery: ant choroidal, small MCA/PCA branch, basilar
Symptoms
- Contralateral face, arm and leg weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pure sensory stroke

A

Localization: thalamus
Artery: thalamoperforators from PCA/MCA
Sx
Contralateral face, arm, leg sensory symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outpatient Management of TIA/non disabling stroke

A
  • Presenting after 24 hours
  • CT head or MRI head (ideally CTA/MRA arch to vertex)
  • BW: INR/PTT, glucose, lipid, A1c
  • ECG
  • Holter 24 hr plus - if think cardioembolic = 2 weeks
  • TTE if mechanism unknown
  • Start single antiplatelet
  • If already on anti platelet could switch to another
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acute Stroke in ER Management

A
  • Symptoms <24 hour
  • Eval for TPA or EVT
  • ABC, NIHSS, Evaluate/treat seizures
    Sx <4.5 hour = CT head ?tpa
    Sx <6 hour = CT, CTA arch to vertex ?EVT
    Sx 6-24 hr = CT, CTA, CTP if eligible for late window EVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

TPA for Acute Stroke

A 
Inclusion
- Ischemic stroke, DISABLING deficit (NIHSS6+, aphasia, hemianopia, visual/sensory extinction, weak against gravity), >18 yo
- Time from last known well <4.5 hr
Exclusion
- Any source of active hemorrhage
- Hemorrhage on bring imaging
- DOAC use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

EVT for Acute Stroke

A
  • Can be in addition to TPA or for those not eligible
    Inclusion
  • > 18 yo, disabling sx, func independent, life expectancy >3 m
  • <6 hr from last known well
  • CT head small-mod ischemic core
  • CTA occlusion in anterior circulation of proximal large vessel (not in posterior circulation, consider basilar)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute Stroke BP Management

A
  • TPA = <180/105 x 24 hr
  • TPA and EVT = <180/105 x 24 hr
  • No TPA <220/120
  • EVT only - no targets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Acute Stroke Antiplatelets immediate

A

ASA 160 mg (sometimes DAPT)
IF not on anti platelet, no TPA and no bleed on CT

IF TPA - wait 24 hr before starting ASA (no DAPT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

High risk TIA/Minor stroke antiplatelets

A
  • If non cardioembolic
  • Plavix and ASA 21-30 d then mono therapy
  • Minimal loading dose Plavix 300-600 and 160 ASA
  • Ideally within 12 hours as soon as brain imaging done
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Antiplatelets severe intracranial atherosclerosis

A

TIA/stroke in last 30 days PLUS
70-99% stenosis in major intracranial vessel
Consider DAPT x 3 mos then single

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Stroke while on antiplatelets

A

On ASA –> Plavix

On Plavix –> ASA/dipyridamole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Stroke and Carotid Stenosis

A

TIA/non disabling + ipsilateral 50-99%

  • Get CTA
  • Stroke expert ASAP

TIA/non disabling + ipsilateral 70-99%

  • CEA either within 48 hr or 2 weeks
  • CEA > CAS if >70 yo

Symptoms <50%
- Max medical management

Asymptomatic/remote >6 m + 60-99%

  • If life expectancy >5 yr = evaluate by stroke expert
  • Maybe CEA/CAS
  • Max medical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Stroke and AF Med choice

A
  • DOAC >warfarin
  • Bridge with anti platelet (not heparin)
  • Mechanical valve OR mod-sev MS = warfarin only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Stroke and AF Timing

A

TIA <1 d
Mild/small <8 - 3 days
Mod 8-15 - 6 days
Severe/large 16+ - 12 days
Delay if: hemorrhagic transformation, mod-large infarct, high NIHSS, uncontrolled HTN, coagulopathy
Early if: mechanical heart valve, intracardiac thrombus, hypercoagluable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Stroke Secondary Prevention

A 
BP
- Past stroke/TIA BP<140/90
Lipids
- Check level, start statin, LDL<2/50% drop
DM
- Test, A1c 7% or less
Diet
- High fruit/veg, low fat dairy/fibre, plant protein
- Na <2 g/day
- Exercise mod 4-7 d/week
- Stop smoking, alcohol F<10, M<15
- Weight BMI 18.5-25
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Stroke PFO

A

If stroke due to PFO, closure with anti platelet recommended if:

  • 18-60 yo
  • Stroke non lacunar
  • Specialist thinks PFO most likely cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Post stroke depression

A
  • 1st year highest risk
  • screen patients
  • if more than mild tx CBT, IPT, SSRI (tx min 6-12 mos)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Patient comes in with major stroke >24 hr after symptoms started

A

Single anti platelet only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Dissection causing stroke

A
  • If EXTRAcranial carotid or vertebral dissection = anti platelet or anticoagulant
  • Heparin or warfarin - can choose either
  • Usually x3-6 mos (repeat CTA to see if resolved)
  • No evidence for DOACs, duration
  • No evidence for anticoagulation with INTRAcranial dissection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Symptomatic extra cranial dissection

A

IV heparin –> LMWH/warfarin x 3-6 mos
Repeat CTA to see if resolved
Can use anti platelet instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Asymptomatic extra cranial dissection

A

Antiplatelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Any extra cranial dissection and floating thrombus on CTA

A

Heparin
Then warfarin 3-6 mos
Repeat CTA for resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Intracranial dissection

A

Antiplatelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Embolic stroke undetermined source

A

No good evidence for riva or dabi and inc bleed compared to ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Stroke in <55 yo

A

Risk factors still HTN, DLD, smoking

Most commonly - cardioembolic and dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Intracranial Hemorrhage Investigation

A

CTA - rule out underlying lesion, better than MRA for vascular lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

ICH BP Management

A
  • Assess q15 min x 24 hr
  • SBP <140-160 for first 24 hr
  • Prefer 140 if <6 hr ago, on anticoagulant, signs of expansion, presenting SBP <220

Long term target <130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

ICH on anticoagulant

A
  • Reverse anti Xa with PCC
  • Reverse dabi with idaracizumab
  • LMWH within 12 hr - protamine
  • IV UFH - protamine
  • TXA may reduce volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

ICH Neurosurgery

A

Always call for assessment
EVD if dec LOC and hydrocephalus
No surgery if stable and no signs herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ICH Work up

A

Consider MRI to look for mass/AVM/AVF/amyloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

ICH DVTp

A

IPC then LMWH 48 h after hematoma stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ICH Seizure

A

If in first 24 hours no need for AED longterm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

ICH Steroids

A

HARMFUL, don’t use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Rest tremor

A

Idiopathic PD

Other parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Action tremors

A

Postural

  • Enhanced physiologic
  • Essential
  • Dystonic

Kinetic/intention

  • Cerebellar disease
  • Li
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

PD tremor

A 
Low frequency
Asymmetrical
At rest
Respond to levodopa
Minimal impairment
micrographia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Essential tremor

A 
Higher frequency
Symmetrical
Action/posture
Fam hx common
Good response to alcohol, no to levodopa
Significant impairment
Writing messy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Enhanced physiologic tremor

A 
High frequency
Small amplitude
Symmetrical
Postural
Enhanced by caffeine, anxiety, stress, TSH, drugs, withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Dystonic tremor

A 
Dystonia patients when they fight their posture
Head and hands
Asymmetrical
Irregular
Postural, not at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Cerebellar tremor

A

Intention or postural
Can also have ataxia, dysdiachokinesia
Young –> think MS, Wilson’s
Stroke -> sudden onset, older, asymmetric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Psychogenic tremor

A 
Rest/posture/intention mix
Irregular
Variable freq and amplitude
Distractible
Entrainable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Parkinsonism Symptoms

A
  1. Tremor - rest, low amp, thumb
  2. Rigidity
  3. Akinesia/bradykinesia - slow, fatigue and decrement
  4. Postural - hesitant gait (short shuffling, reduce arm swing), freezing
55
Q

Parkinsonism DDx

A
  1. Idiopathic PD
  2. Park plus - LBD, PSP, MSA, CBD
  3. Vascular - stroke
  4. Drug induced - antipsychotics, metoclopramide
  5. Genetic - Wilson’s
  6. Toxins - manganese
56
Q

Idiopathic PD Dx

A
  1. Parkinsonism - akinesia + one of rigidity or tremor
  2. Two supportive
  3. Absence absolute exclusion
  4. No red flags
57
Q

IPD Absolute Exclusion

A
  1. Cerebellar abnormal - MSA
  2. Downward vertical gaze palsy/slow vertical saccades - PSP
  3. Dx FTD
  4. Exclusive lower extremity Parkinsonism x 3 yrs - vascular
  5. Tx dopamine receptor blocker - drug induced
  6. No response to L dopa
  7. Cortical sensory loss, apraxia, aphasia (CBD)
  8. Normal functional neuroimaging of dopaminergic system
  9. Alternative dx documented
58
Q

IPD Supportive Criteria

A
  1. Response to L dopa
  2. L dopa induced dyskinesia
  3. Rest tremor of limb
  4. Documented olfactory loss/cardiac sympathetic denervation on MIBG scintigraphy
59
Q

Red flags IPD

A
  1. Rapid gait impairment - wheelchair within 5 years onset
  2. No progression of motor sx
  3. Early bulbar dysfunction
  4. Stridor
  5. Sev autonomic failure in first 5 yrs
  6. Recurrent falls within 3 years onset
  7. Anterocollis
  8. Absence common non motor sx despite 5 yrs disease
  9. Pyramidal signs
  10. Bilateral symmetric
60
Q

Typical PD Disease Course

A 
Preceding
- Anosmia
- REM sleep behaviour disorder
- Constipation
Early
- Asymmetric tremor, bradykinesia and rigidity
Late
- Postural instability/falls
- Dementia
- Visual hallucinations
- Autonomic
61
Q

Levodopa/Carbidopa

A
  • PD motor sx
  • Convert to dopamine in CNS
    SFx
  • N/V, ortho HOTN, sedation, confusion, hallucinations
  • Dyskinesia
  • Dopa dysregulation (Addiction)
62
Q

Pramipexole

A 
PD Motor sx
- Dopamine agonist
SFx
- Ortho HOTN
- Sleep attacks
- Halluncations
- ICD - gamble, sex, shop, eat
- Leg swelling
63
Q

Trihexyphenidyl

A 
Tremor
ANTIcholinergic
SFx
- Dry eyes, blurry vision, dry mouth, constipation, retention
- Memory issues
64
Q

Selegiline

A

PD motor sx
MAOi inh
- HTN crisis tyramine foods
- Serotonin syndrome

65
Q

Entacapone

A

Prolong L dopa
COMT inhibitor
Orange urine

66
Q

Amantadine

A

Dyskinesias

  • Anticholinergic
  • Insomnia
  • Levido reticularis
  • CI if seizures
67
Q

Domperidone

A

Ortho HOTN
Dopamine agonist in gut
QT prolong

68
Q

PD Guidelines

A
  • no CT/MRI routine
  • Ldopa most effective
  • Regular exercise program
  • deep brain stimulation
  • Botulinum for drooling
  • Ortho HOTN - midodrone, fludrocortisone, domperidone
  • REM SBD before dx
69
Q

Drug induced parkinsonism

A
  • Symmetric Parkinsonism
  • Tremor postural
  • Weeks/mos of onset of drug
    Think metoclopramide, antipsychotic
70
Q

Vascular parkinsonism

A

Risk factors, multiple small strokes

  • Symmetric
  • Lower body parkinsonism
  • Falls, pyramidal
  • Dementia, incontinence
  • Tremor not common
  • Poor response to Ldopa
71
Q

MSA

A
  • Symmetrical parkinsonism
  • No tremor
  • Early falls, ataxia
  • Dysautonomia - ortho, ED, incontinent
  • Pyramidal signs
  • Stridor
  • Distal myoclonus
  • No response to levodopa (orofacial dyskinesia)
72
Q

PSP

A
  • Symmetric parkinsonism
  • Axial rigid
  • No tremor
  • Early falls
  • Verticular supranuclear gaze paresis
  • Hyperfrontalis
  • Sev dysarthria
  • Mild dementia
  • Poor response LD
73
Q

CBD

A 
Very asymmetric parkinsonism
Dystonia
Myoclonus
Apraxia
Aphasia
Cortical sensory loss
Alien limb
No response to LD
74
Q

LBD

A
  • Symmetric parkinsonism
  • Tremor
  • Early dementia
  • Fluctuating attention
  • Visual hallucinations
  • Hypersensitive to antipsychotics
  • some response to LD
  • REM SBD
75
Q

CRAO

A

Vasculopathy
Sudden complete PAINLESS unilateral vision loss
Cherry red spot

76
Q

Papilledema

A

Bilateral disc edema

think intracranial HTN

77
Q

Acute optic neuritis

A

Young F
Unilateral eye pain
Vision loss
Pale disc = prior optic neuritis

78
Q

Glaucoma

A 
Older
Poor peripheral vision
No pain
Eye pressure elevated
Large cup to disc ratio
Pale disc
79
Q

Diabetic Retinopathy

A 
Cotton wool spots
Microaneurysms
Hard exudates
Neovascularization
Flame hemorrhages
80
Q

Hypertensive Retinopathy

A 
Cotton wool spots
Hard exudates
Flame hemorrhages
AV nicking
Copper Wiring
Disc Edema
81
Q

Infective endocarditis eye

A

Roth Spot

82
Q

Approach to Diplopia nerves involved

A
  1. CN6 = LR
  2. CN4 = SO
  3. CN3 = the rest, eyelid, constrict
  4. Sympathetics = dilation
83
Q

Cavernous Sinus contains

A

CN 3,4, V1, V2, 6 and sympathetics

84
Q

Monocular diplopia

A

Psych or Ophtho

85
Q

Binocular diplopia

A

Neurology problem

86
Q

Horizontal images

A

CN 6 palsy

87
Q

Vertical images

A

CN 4 palsy

88
Q

Oblique images

A

CN 3 palsy

89
Q

Diplopia worse near

A

CN 3/4

90
Q

Diplopia worse far

A

CN 6

91
Q

Diplopia worse looking L/R

A

CN 6

92
Q

Diplopia worse looking up/down

A

CN 3/4

93
Q

CN3 Palsy vs Horner’s

A 
Ptosis
- Both
Pupil
- Horner = miosis
- CN3 = mydriasis
Anisocoria
- Horner worse in dark
- CN3 worse in light
Diplopia
- CN3 down and out
Rule Out
- Horner - carotid dissection in neck
- CN3 PCOMM aneurysm
94
Q

Binocular Diplopia

A
  • EOM - thyroid
  • NMJ - MG
  • Cavernous sinus
  • Brainstem internuclear - stroke, MS INO
95
Q

CN3 Palsy ischemic vs compressive

A
  • Both have ptosis and down and out
  • Ischemic pupil spared, comp mydriasis
  • Ischemic no pain, comp pain
  • Ischemic in DM/DM/HTN
  • Comp in aneurysm
96
Q

CTA for CN3

A
  1. Complete CN3 and pupil spared = no CTA
  2. Partial CN3 and pupil spared = CTA
  3. Pupil involved = CTA
97
Q

Horner’s syndrome

A
  1. Ptosis
  2. Miosis
  3. Anhidrosis
    Ddx
  4. First order neuron - stroke, demyelinating, tumour - MRI brain
  5. Second order - T1 radic, pan coast tumor - MRI C spine/CT chest
  6. 3rd order - carotid dissection/aneurysm - CTA neck/brain
98
Q

CN6 Palsy

A
  • Binocular diplopia, horizontal images, worse far, worse looking to same side as palsy
    Inv
  • CT/CTA if cavernous sinus
  • MRI brain with GAD - tumor, inflame, infection
  • MRI brain with MRV/CTV (for VST) then LP (IIH)
99
Q

Complete Cord Syndrome

A
  • Bilateral sensation below
  • Bilateral weakness (LMN at level, UMN below)
  • Bowel and bladder problems
  • Above C3=respiration
  • Above T6=auto dysreflexia
  • If sudden injury may initially be flaccid and absent reflexes

Etiology

  • Trauma
  • Large disc
  • Hemorrhage
  • Abscess
  • Transverse myelitis
100
Q

Central Cord

A
  • Suspended sensory loss pain/temp
  • No weakness
  • No loss vib/prop

Etiology

  1. Syringomyelia (fluid filled cyst in spinal cord)
  2. Intramedullary tumor
101
Q

Anterior Cord Syndrome

A
  1. Bilateral loss pain and temp
  2. Bilateral weak
  3. Bowel and bladder
  4. Normal prop/vib

Etiology

  1. Spinal cord infarction (ant spinal artery)
  2. Disc herniation
102
Q

Posterior Cord Syndrome

A
  1. Bilateral loss prop/vib
  2. +/- weakness
  3. Pain/temp fine

Etiology

  1. Syphilis - tabes dorsalis
  2. B12 - subacute combined degeneration
103
Q

B12 Def - SCD

A
  1. Anemia, atrophic glossitis
  2. Dementia
  3. Normal pupils, dec visual acuity
  4. UMN weakness - brisk knee reflexes, upping toes
  5. LMN weakness - loss of ankle reflexes
  6. Loss of vib/prop
  7. Can have loss of pain/temp/vib/propr distal
  8. Sensory ataxia
  9. Positive Romberg
104
Q

Syphilis tabes dorsalis

A
  1. Gummas, LN, aortitis
  2. Dementia
  3. Argyll Robertson pupils
  4. Normal strength
  5. Loss reflexes
  6. Loss vib/prop
  7. Sensory ataxia
  8. Positive Romberg
105
Q

Hemi Cord/Brown Sequard

A
  1. Ipsilateral weakness
  2. Ipsilateral loss vib/prop
  3. Contralat loss pain/temp

Etiology

  1. Trauma
  2. Demyelination - MS
106
Q

Pure Motor Spinal Cord

A

Asymmetric weakness - UMN only(HTLV) or LMN only (ALS) or both (West Nile/polio)

107
Q

L5 vs Peroneal Neuropathy

A

Ankle inversion and hip ABduction strong in peroneal, weak in L5

108
Q

C7 vs radial neuropathy

A

Radial lesion

  • Strong pronator teres, triceps
  • weak BR

C7 Lesion

  • Strong BR
  • Weak pronator teres, triceps
109
Q

C8/T1 vs Ulnar

A

Ulnar
- FPL (flex thumb), APB (abduct thumb), EIP strong

C8/T1
- FPL, APB, EIP weak

110
Q

White on CT

A
  1. Calcium/bone
  2. Contrast
  3. Blood - acute, hrs to days
  4. Melanoma, lymphoma
111
Q

Blood on CT

A

Hyperdense - hrs to days
Isodense - 1-2 weeks
Hypodense - 3-4 weeks

112
Q

Rule out SAH with CT head if

A

Within 12 hrs from onset and read by neuroradiologist

Otherwise need LP

113
Q

T2 and FLAIR MRI

A

Hyperintense = any pathology

Stroke, tumor, blood, demyelination

114
Q

DWI and ADC

A

Acute stroke <14 d will be white on DWI and dark on aDC

115
Q

GRE or SWI

A

Blood of any age or calcium

116
Q

T1 with gad

A

enhancement = tumor, new demyelinating lesion, infection

117
Q

ALS

A

Selective loss of pyramidal neurons and motor neurons
Die from respiratory failure
Bulbar - dysphagia, dysarthria, dyspnea, brisk jaw jerk
LMN at level of lesion
UMN below lesion

118
Q

UMN findings

A

Spasticity
Hyper reflexia
Upgoing toes

119
Q

LMN findings

A

Atrophy
Fasciculations
Weakness

120
Q

ALS Dx

A

MRI C spine

NCS/EMG

121
Q

ALS Tx

A

Multidisciplinary clinic
Riluzole - inc survival 3 mos
Edaravone - dec functional decline

Sialorrhea - anticholinergic, suction, botox
Spasticity - PT, baclofen, botox
Cramps - tonic water, gabapentin, baclofen

122
Q

ALS Respiratory Care

A 
- FVC baseline and q 3 months
Home NIV
- Symptoms - orthopnea
- SNIP <40, MIP <40
- Upright FVC <65%
- FVC sit/supine <80% symptoms
- Daytime PCO2>45
- Abnormal nocturnal oximetry/sleep disordered breathing
123
Q

Pseudobulbar Palsy

A 
UMN lesion in the corticobulbar pathway (medulla and CS tract)
Sx
1. Dysphagia
2. Dysarthria
3. UMN findings
4. Pseudobulbar affect
Etiology
1. ALS
2. MSA
3. PSP
124
Q

Outpatient stroke last 48 hours very high risk features and tx

A 
Features: unilateral weakness, language/speech
Tx
1. Send to ED stroke centre
2. Imaging within 24 hours
3. ECG
Tx DAPT 2-3 wks
125
Q

Outpatient stroke 48 hrs-2 weeks high risk

A

Unilateral weakness, language/speech disturbance
See stroke neurologist within 24 hrs
Tx DAPT 2-3 wks

126
Q

Outpatient stroke 48 hrs-2 weeks medium risk

A

No weakness, language/speech change
Stroke expert within 2 weeks
Tx DAPT 2-3 wks

127
Q

Outpatient stroke >2 weeks

A

See stroke expert in 1 month

Tx DAPT 2-3 wks

128
Q

Amaurosis Fugax

A 
Painless
Sudden transient blindness
Usually embolic from ipsilateral carotid
Monocular
Last <5-10 mins
129
Q

Bell’s palsy Tx

A
  1. Prednisone

2. +/- acyclovir

130
Q

Motor grading

A 
0 = paralysis
1 = flicker
2 = can't move against gravity
3 = can move against gravity
4 = move against some resistance
5 = complete strength
131
Q

LEMS

A

Anti Ca channel Ab
Associated with small cell carcinoma
Proximal muscle weakness = incremental response
Hyporeflexia or absent

132
Q

Pontine lesion

A

Pupils small and fixed

133
Q

Triptan and ergot CI

A

CAD

134
Q

Cauda Equina

A

Acute

  • Weakness/paraparesis
  • Reduced DTRs at knees/ankles
  • Bilateral sensory loss
  • urinary retention +/- fecal incontinence
  • LBP to legs (sciatica)
  • NO babinski

RCE 2021 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions