Neuro Flashcards by Birwe Leon

What is the risk of stroke in the first 3 months following a transient ischemic attack?

10-15%,with most events occurring in the first 2 days

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Most common site for hypertensive hemorrhage is

PUTAMEN

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Gold standard for evaluating the precise anatomy of the AVM

Conventional X-ray angiography

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Largest lesion of avm is located at

POSTERIOR HALF OF HEMISPHERE

(Wedge shaped lesion extending to the ventricles),

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Angiograpgic features of AVM that predicts higher bleeding risks

Smaller lesionS
Deep vein drainage
Vein outflow stenosis
Intranidal aneurysm

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Results from multiple small vessel infarcts within the subcortical white matter likely from chronic hypertension and may lead to subcortical dementia syndrome

Leukoaraiosis

Aka periventricular white matter disease

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The most common cause of viral meningitis

ENTEROVIRUS

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What is the recommended chemrophylaxis for individuals exposed to meningococcal meningitis?

RIFAMPIN 600mg q12 for

2 days

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What is the antibiotic of choice for meningococcal meningitis for susceptible strains?

PENICILLIN G

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What is the antibiotic of choice for meningococcal meningitis with CSF ISOLATES N. Meningitidis that is resistant to penicillin and ampicillin ?

CEFOTAXIME
OR
CEFTRIAXONE

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What is the ALTERNATIVE chemrophylaxis for individuals exposed to meningococcal meningitis?

Azithromycin

Ceftriaxone

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Px with HIV and meningitis symptoms and CSF abnormalities.
India ink staining of CSF: (+)FUNGI
Diagnosis?
WHAT IS THE TREATMENT?

Diagnosis: CRYPTOCOCCAL MENINGITIS

TX
Amphotericin B + FLUCYTOSINE X al least 2 weeks
Followed by FLUCONAZOLE X at least 8weeks

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a patient suspected of HERPES SIMPLEX VIRUS encephalitis but with CSF PCR analysis that is negative. What is the next course of action?

Continue Acyclovir and REPEAT LUMBAR PUNCTURE

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What is the standard criterion for treatment success in syphilitic meningitis?

NORMAL CSF count within 12 months and
decrease in VDRL titer by TWO dilutions or
REVERT to NON REACTIVE within 2 years of complete therapy

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What condition presents with recurrent meningoencephalitis with uveitis, retinal detachment, alopecia, lightening or eyebrows and lashes, cataracts and glaucoma

VHK

VOGT KOYANAGI HARADA SYNDROME

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What virus causes tropical spastic paraparesis

Human T cell lymphocytic virus 1

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What is the management for status epilepticus

Anticonvulsant: Give IV BENZODIAZEPINE
(Lorazepam, midazolam,clonazepam)
followed by antiepileptic drugs: Levetiracetam 20mg/kg
(Phenytoin, valproate acid)

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Most common syndrome associated with focal seizures with impairment of consciousness and has distinctive clinical, EEG and pathological feature

Mesial temporal lobe epilepsy syndrome

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Highly selective loss of specific cell populations within hippocampus in most cases

Mesial temporal lobe epilepsy syndrome

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Most common seizure type resulting from metabolic derangement

Generalized tonic clinic seizure

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First line antiepileptic drug for focal seizure that acts in the modulation of the release of synaptic vesicles

levetiracetam

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When cerebral blood flow remains poor for a longer duration leading to infarction in the border zones between the major cerebral artery distributions with WIDESPREAD BRAIN NECROSIS

Global hypoxia Ischemia

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Resulting cognitive sequele to Global hypoxia Ischemia

HIE

HYPOXIC ISCHEMIC ENCEPHALOPATHY

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Magnitude of flow reduction is a a function of collateral blood flow:
Bloodflow of zero

Brain tissue death within 4-10mins

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Magnitude of flow reduction is a a function of collateral blood flow: Bloodflow of <16-18ml/100g tissue/min

INFARCTION WITHIN AN HOUR

Magnitude of flow reduction is a a function of collateral blood flow: Bloodflow of <20ml/100g tissue/min

Ischemia without infarction

Medical support in stroke: maintain glucose of

60-180mg/dL using an insulin infusion

Peak of cerebral edema

2nd to 3rd day and can last for 10days

Management of cerebral edema

1. Water restriction, IV mannitol 2. Avoid hypovolemia 3. Hemicraniectomy

What is the prophylactic surgery for prevention of brainstem compression

SUBOCCIPITAL DECOMPRESSION OF LARGE CEREBELLAR INFARCTS

The only antiplatelet agent proven safe and effective for the acute treatment of ischemic stroke

Aspirin

Most common site of infarction via cardioembolism

Intracranial internal carotid artery ICA MCA middle cerebral artery PCA posterior cerebral artery

Most common cause of cardioembolic stroke

NONVALVULAR OF NONRHEUMATIC AF | Annual average is 5%

Most common source of artery to artery embolus

CAROTID BIFURCATION

Most frequent site in the carotid for artery to artery embolism stroke

Common carotid bifurcation | Proximal internal carotid artery PICA

Location of infarction in a patient who | Presents with PURE MOTOR HEMIPARESIS ONLY

Posterior limb of internal capsule Or PONS

Location of infarction in a patient who | Presents with PURE SENSORY ONLY

Ventral THALAMUS

Location of infarction in a patient who | Presents with ATAXIC HEMIPARESIS ONLY

VENTRAL PONS OR INTERNAL CAPSULE

Location of infarction in a patient who | Presents with DYSARTHRIA AND CLUMSY HANDS OR ARMS ONLY

Ventral pons | Genu of internal capsule

Cause of stroke that affects cervical arteries mainly in women, presence of multiple rings or segmental narrowing alternating with dilation in carotid or vertebral arteries.

FIBROMUSCULAR DYSPLASIA

Most significant risk factor in stroke and TIA

Hypertension BP goal <140-150/90 (Recommendation of vascular neuro <130/80) Elderly: lower SPP DRUGS: ACEI AND THIAZIDES DIURETIC

What DM drug lowers risk of recurrent stroke, MI and vascular death

PIOGLITAZONE

Anticoagulation goal INR in chronic NONVALVULAR AF that prevents cerebral embolism and is safe

INR 2-3

For primary prevention or for patients who have experienced stroke or TIA, what drugs reduces the risk by about 67%

Vitamin k antagonist (warfarin,dicumarol)

Oral thrombin inhibitor that is non-inferior to VKA in preventing second stroke or systemic embolization

DABIGATRAN

Higher dose of dabigatran that makes it superior to VKA

150mg/d

Lower dose of dabigatran that makes it have lower rate of major bleeding compared to VKA

110mg/d

Oral Factor Xa inhibitor that is non-inferior and EVEN SUPERIOR to VKA, with LOWER RISK of bleeding

APIXABAN

Oral anti-Xa anticoagulants that are non inferior to VKA

Rivaroxaban and ENDOXABAN

anticoagulant therapy for untreated rheumatic heart disease

Long term warfarin (untreated RHD)

3 month anticoagulation course in Acute MI REDUCES risk of embolism in:

Acute myocardial infarction with: ``` Anterior q wave infarction Substantial LV dysfunction CHF MURAL THROMBOSIS AF ```

Most serious complication of prosthetic heart valve implantation

STROKE sec to thromboembolism

True or false | AVOID ANTITHROMBOTIC AGENTS FOT INFECTIVE ENDOCARDITIS

True | May cause pericardial hemorrhage

What is the recommended antithrombotics for non bacterial thrombotic endocarditis

Full dose unfractionated HEPARIN or SC LMWH

MCA forms collateral formation via

LEPTOMENINGEAL VESSELS

Parts supplied by the lenticulostriate arteries from the proximal MCA

Outer Globus pallidus Posterior limb of internal capsule Adjacent corona radiata Caudate nucleus

Manifestation of MCA syndrome

``` Contralateral hemiplegia Hemianesthesia Homonymous hemianopia Ipsilateral preferential gaze (1-2 days) Dysarthria due to facial weakness ```

Manifestation of MCA syndrome with dominant hemisphere involved

GLOBAL APHASIA

Manifestation of MCA syndrome with non-dominant hemisphere involved

ANOSOGNOSIA CONSTRUCTIONAL APRAXIA NEGLECT

Anti-epileptic drug that modulates release of synaptic vesicles

Levetiracetam | Brivaracetam

Antiepileptic drug that inhibits T type ca channels in the thalamus neurons

ETHOSUXIMIDE | VALPROIC ACID

HLA allele that caries high risk for developing serious skin reaction from carbamazepine, phenytoin, oxcabazepine and lamotrigine

HLA B 1502

HLA Allele that is associated with carbamazepine induced hypersensitivity reaction in patients of European or Japanese ancestry

HLA A 31:01

Patient profile with the greatest chance of remaining seizure free after drug withdrawal

1. Complete medical control of seizures for 1-5 years 2. Single seizure type, with generalized seizures having a better prognosis than focal seizures 3. Normal neuro examination including intelligence 4. No family history of epilepsy 5. Normal EEG

After reasonable attempt to withdraw antiepileptic drugs after 2 years, most recurrences occurs when?

First 3 months

Marked increase in seizure frequency around the time of menses

CATAMENIAL EPILEPSY

Pregnant women should take how many mg of folate

1-4mg/day

What is the most common primary headache syndrome

Tension type headache

Prophylaxis or Preventive treatment for headache

TOPIRAMATE PROPANOLOL AMITRIPTYLINE VALPROATE

What is the mechanism of action of sumatriptan

5HT 1B/1D RECEPTOR AGONIST

What is the only proven treatment for CHRONIC tension type headache

AMITRIPTYLINE

Drugs that can be used to treat acute tension type headache

Acetaminophen Aspirin NSAIDS

True or false TRIPTANS can only be effective in MIXED TTH with +MIGRAINE

True

Best treatment option for cluster headache

100% oxygen at 10-12L for 15-20mins

What is the treatment of choice for a Unilateral, severe short lasting episodes of headache, with very frequency attacks (5-40x per day) , has a rapid course and a marked autonomic features ipsilateral to the pain

Diagnosis: PAROXYSMAL HEMACRANIA TOC: Indomethacin

Presents with EXCRUCIATING PAROXYSMS of lancinating pain involving her right cheek and jaw. (Lancinating : it give u fever or flu sa kasaki) Speaking, chewing or brushing her teeth can trigger an attack. After pain occurs there is a period of time where she can speak, eat or brush without pain hence paroxysm.

TRIGEMINAL NEURALGIA

What is the most important risk factor for Alzheimer’s disease

Age > 70 years and a POSITIVE family history

Risk factors for Alzheimer’s disease:

Diabetes History of head trauma with concussion Women who carries a single APO E4 allele

There widespread neurotic PLAQUES, neurofibrillary tangles [NFTs] and AB accumulation in blood vessels wall In the Cortex And Leptomeninges

Alzheimer’s disease

Medication for Alzheimer’s that is no longer used due to hepatoxicity

TACRINE

Medications used for Alzheimer’s

DONEZEPIL RIVASTIGMINE Galantamine Memantine

Most common source of brain metastases

Lung and breath CA

What malignancy has the greatest propensity to metastasize to the brain

MELANOMA (same embryonic source)

malignancies that will cause hemorrhagic metastases to the brain 🧠

Renal cell ca Choriocarcinoma Melanoma Papillary thyroid carcinoma

Which brain malignancy is characterized by Codeletion of 1p/19q and usually have IDH mutation

Oligodendroglioma

What virus plays an important role in the pathogenesis of primary CNS lymphoma

Epstein Barr virus

In a patient who presents with facial paralysis of wrinkle his forehand or close his eye) , (+)pain behind ear may precede the paralysis for a day or two, (+)decrease taste (+)hyperacusis

Bell’s palsy - MCC of facial paralysis Normal NE except for facial nerve

Best treatment for Bell’s palsy

Prednisone 60-80mg daily during the first 5 days then tapered over the next 5days

True or false Antiviral agents (acyclovir or valacyclovir) combination with glucocorticoid maybe marginally better than prednisone alone in severe Bell’s palsy

True

What is the most favorable prognostic sign in Bell’s palsy

Presence of Incomplete paralysis in the first week

In Bell’s palsy, evidence of denervation after 10days on EMG indicates

AXONAL degeneration

In a patient recurrent episodes of vertigo lasting for 30 minutes associated with TINNITUS and a feeling of fullness in his right ear. + Decreased hearing in the right ear. Normal MRI and neurological exam . What should be the procedure done?

Ménière’s disease Procedure : audiometry

Patient complains of vertigo lasting for 30mins with movement lasting for 3 weeks, with relief when he lies down. NO HEARING LOSS and with normal NE. (-) DIX HALLPIKE MANEUVER DIAGNOSIS AND TX?

BPPV | TX: CANALITH repositioning procedure

True or false: | A negative DIX HALLPIKE maneuver does not rule out BPPV

True

What is the most common Antibody target for miller fisher syndrome

Anti-Gq1b IgG found in >90%

May have an acute onset that Mimics GBS but symptoms deteriorate after 9 weeks and relapses at least 3x

Chronic inflammatory demyelination polyneuropathy CIPD

What is the gold standard for the diagnosis of small fiber neuropathy

Skin biopsy

Systemic malignancy that commonly associated with subacute sensory neuropathy due to antibodies and cytotoxic T cells that cross react with the HU proteins of the dorsal root ganglion neurons resulting in immune mediated neuronal destruction

Small cell LUNG cancer

May present with visual symptoms that are generally monocular and are preceded by periorbital pain aggravated by eye movements

Multiple sclerosis

Chronic use of natalizumab for chronic Multiple sclerosis may cause infection by the John Cunningham virus seen on CSF by PCR

Progressive multi focal leukoencephalopathy

Is an oral sphingosine - 1 phosphate inhibitor that reduces the attack rate and improves all measures of disease severity in multiple sclerosis thru the sequestration of lymphocytes in The periphery thus inhibiting their trafficking to the CNS

FINGOLIMOD (oral) -S1P inhibitor 0.5mg PO OD

Disease modifying therapies for relapsing MS

1. FINGOLIMOD 2. Dimethyl fumarate 3. teriflunomide

Disease modifying therapies for relapsing MS which is a Krediet cycle metabolite with anti-inflammatory effects Inhibits the ubiquitylation and degradation of nuclear factor E2 related factor

Dimethyl fumarate

Disease modifying therapies for relapsing MS which is a dihydro-orotate dehydrogenase inhibitor, exerts anti inflammatory effects by limiting the proliferation of rapidly dividing T and B cells (CYTOSTATIC)

TERIFLUNOMIDE

Variant of MultiPle sclerosis may present acutely as solitary lesion, often mistaken as brain tumor, and follows a fulminant course typically with no remissions

Marburg’s variant

Diagnostic procedure for myasthenia gravis

(+) anti-Achr radioimmunoassay | Acetylcholine

Negative anti-achr radioimmunoassay does not rule out myasthenia gravis and 40% will have positive

Anti-Musk antibodies

A zero positive MG px was admitted at ICU with respiratory failure, severe weakness and dysphasia. What is the best treatment option:

A course Of 5 five plasma exchanges over a 10 days period

Steroid therapy for myasthenia crisis

Start high dose prednisone 60mg/day given in a single dose

Ina patient diagnosed with MG taking “pyridostigmine 180 mg q hours” complains of excessive drooling, diarrhea, slurring Of speech and worsening of weakness. What is the common side effect?

Acetylcholine inhibitor overdose Patient shows cholinergic symptoms

What is the most common sign/symptom accompanying severe migraine attacks?

Nausea

52/F, presents with a unilateral, throbbing frontal headache of moderate in intensity and aggravated by movement, associated with nausea and vomiting. The headache is being felt repeatedly and lasting for almost the entire day. PE: normal. What is the most likely diagnosis?

Migraine

Neuro Flashcards

(112 cards)