Neuro Flashcards
(440 cards)
1
Q
Normal pressure hydrocephalus (NPH) pathophys
A
CSF accumulation causing enlarged ventricle size with little to no increase in intracranial pressure.
2
Q
Causes of NPH
A
Idiopathic
HTN
Decreased CSF absorption
Secondary: intracventricular hemorrhage, subarachnoid hemorrhage, trauma, meningitis, infalmmatory disease, cancer, Paget’s disease of skull base, achondroplasia (dwarf)
3
Q
NPH clinical presentation
A
Glue-footed gait is first sign
Urinary incontinence
Falling
4
Q
NPH physical exam
A
Brisk DRTs
Grasp reflex
Mental status deficits and critcal thinking decreased
Slower in timed tasks
Performs poorly on tests of devided attention
Difficulty with fluency tests and poor learning
5
Q
NPH diagnosis
A
Ventriculomegaly without verebral atrophy on MRI
Stretching/thinning of corpus callosum
Lumbar puncture remove 50 mL of CSF and document pt gait before and after lumbar. Normal to high opening pressure
6
Q
NPH treatment
A
Shunt from lateral ventricle to peritoneum or atrium
7
Q
Idiopathic intracranial hypertension symptoms
A
Headache, papilledema, vision loss
Elevated intracreanial pressure with normal CSF composition
8
Q
Idiopathic intracranial hypertension risk factors
A
Females of childbearing age
Overweight
Obesity
9
Q
Idiopathic intracranial HTN diagnosis
A
Modified Dandy Criteria
Papilloedema
Normal neurologic exam
Normal neuroimgaing
Normal CSF constituents
Elevated lumbar puncture presssure >25cm CSF
10
Q
Neuroimaging findings suggestive of raised inrracranial pressure
A
Empty sella
Flattening of posterior aspect of the globe and tortuous optic nerve
Transverse venous stenosis
11
Q
Headache in idiopathic intracranial HTN
A
Worse in morning or with valsalva maneuver
Worsen with posture change
Retrobulbar pain
Pain with eye movement
12
Q
Idiopathic intracranial HTN physical exam
A
Papilledema
Loss of visual field and acuity
Sixth nerve palsy
13
Q
Idiopathic intracranial HTN diagnosis
A
Lumbar puncture with elevated opening pressure.
Above 20-25cm H2O
Normal cell counts
MRI with venography to rule out central venous thrombosis
14
Q
Opening pressure normal value
A
6-25cm H20
18cm H2O is average
15
Q
Idiopathic intracranial HTN treatment
A
CARBONIC ANHYDRASE INHIBITORS (ACETAZOLAMIDE)
Can add furosemide if symptoms don’t subside
Optic nerve sheath fenestration or CSF shunting
Discontinue whatever might have caused it
Weight loss
Low Na diet
16
Q
Brain tumor headache
A
Worse in the morning bc CSF can’t drain downward like it should when you stand up
17
Q
Brain tumor physical exam to check
A
Speech
Sight
Strength
Sensation
Stability
Fundoscopic exam to look for papiledema from increased intracranial pressure
18
Q
Upper motor neuron syndrome
A
After acute injury
Tendon jerks, spasms
Babinski sign
19
Q
Brain tumor imaging
A
MRI is preferred
20
Q
Brain tumor treatment
A
Surgery, radiotherapy, chemotherapy
Glucocorticoids help with edema improving neurologic funciton (dexmethasone)
21
Q
Astrocytomas
A
Derived from gliomas (most common type of malignant primary brain tumor
22
Q
Pilocytic astrocytoma
A
Grade 1 astrocytoma.
One of the most common tumors in. children
In cerebellum and optic nerves at brainstem.
Well demarcated
Giant cells usually found in ventricular wall of pts with tuberous sclerosis
23
Q
Grade 2 astrocytoma
A
Often in young adults with seizures
Very invasive
Most often it will become malignant astrocytoma decreasing pt survival time to 5-10 years
24
Q
Grade 3 astrocytomas
A
Typically in 30-50 yo pts
Surgery following chemo and radiation is best
Temozolmide usually used for chemo
25
Grade 4 astrocytoma (Glioblastoma)
Most common high grade astrocytoma.
Present in pts 50s-60s
Ring enhancing masses with centralized necrosis and surrounding edema.
Chemo lasts 6-12 months
Median survival rate is 14-18 months
VEGF (bevacizumab) also being used
26
Oligodendroglioma
Perinuclear clearing and reticular pattern of blood growth (fried egg)
Surgery then radiation and chemotherapy
27
Ependymomas
RUmors from ependymal cells on ventricular surface
Adults usually have them on filum terminale of spinal cord
28
Meduloblastomas
Most common malignant brain tumor of childhood
Highly cellular tumors with abundance of dark stainging
75% live long term after treatment
29
Meningiomas
Most common primary brain tumor
Arise from dura mater and made of meningothelial cells
Dural tail often seen (light bulb appearance)
More common in females
30
Schwannomas
Generally benign
Acoustic neuromas (vestibular schwannomas) most common
Related to NF2 gene
hearing loss, dizziness, tinnitus.
MRI
31
Where do tumors metastatic to brain develop
Most develop at gray-white matter junction
32
What cancer has the highest odds of metastasizing to brian
Melanoma
33
Most common organ source of brain metastases
Lung and breast carcinomas
34
What layers of meninges most commonly infected
Leptomeninges (arachnoid and pia mater)
35
What layer of meninges is most effected by inflammation
Pachymeninges (dura mater)
36
What type of infection is most common cause of meningitis
Viral
37
Meningitis early symptoms
Fever
Headache
Stiff neck
No apetite
N/V
Muscle aches
38
Cryptococcal meningitis pathogen
Cryptococcus gattii
Fungal (yeast)
Found in pigeon droppings
Crosses BBB
Has antiphagocytic capsule
39
Cryptococcal meningitis presentation
Mostly just in immunocompromised (AIDS)
Present with symptoms of pneumonia
Musculum contagiosum skin lesions
40
What virus group is most common cause of meningitis
Enteroviruses
Also can be caused by herpes, and arboviruses
41
Aseptic meningitis
Viral meningitis
42
Enteroviruses examples
Poliovirus
Rhinovirus
Coxsackie A&B
Echovirus
43
Viral meningitis symptom
Headache
Neck stiffness
N/V
Malaise
Rash
NO AMS
44
Viral (aseptic)Meningitis physical exam
Nuchal (neck stiffness)
Positive brudzinski (neck flexion produces knee and/or hip flexion)
Positive Kernig sign (Inability to straighten knee with hip flexion)
45
Viral meningitis diagnostics
Rule out bacterial
Lumbar puncture best test
46
Viral meningitis lab findings
Lymphocytosis (>5 usually 25-2000)
Normal or low glucose
High protein (>50)
SLightly elevate opening pressure (usually 70mm-180mm)
NEGATIVE GRAM STAIN
47
Viral meningitis treatment
Fever control with antipyretics
Hydration
Anti-emetics
Acyclovir if caused by herpes, epstein barr, varicella zoster
48
Purulent meningitis
Bacterial meningitis
Usually history of otitis or sinusitis
49
Bacterial meningitis pathology
Usually hematogenous spread to brain
Adjacent spread (from sinus, skull, orbits)
Acute bacterial infections (nasopharyngial conlonization to blood stream to meninges causing inflammation)
Could come from lyme disease
50
Strep pneumoniae bacterial meningitis
Most common cause in adults and children >3yo
51
Neisseria meningitides bacterial meningitis
Most common in oder children (10-19yo)
Second most common in adults
RASH
52
Group B strep (Strep agalactiae) bacterial meningitis
Most common cuase in neonates <1month from vaginal flora and infants <3months
53
Listeria monocytogenes bacterial meningitis
Increased incidence in neonates, >50yo, and immunocompromised
54
Strep pneumonia meningitis risk factors
Alcohol
URTI
DM
Skull fracture
Pneumococcal pneumonia
55
Listeria monocytogenes meningitis risk factors
Immunocompromised
Age <1month and >60yo
Pregnant
Ingesting contaminated food
56
Bacterial meningitis clinical findings
AMS
Headache
Neck stiffness
N/V
Fever
57
Bacterial meningitis late symptoms
Increased intracranial pressure
Papilledema
Poor pupil reactivity
Cushing's reflex (bradycardia, HTN, irregular respirations)
Coma
58
Bacterial meningitis physical exam findings
Nuchal rigidity
Positive Bruzinski
Postive Kernig sign
Focal neurologic findings
59
Best test for bacterial meningitis
Lumbar puncture
60
Bacterial meningitis CSF findings
high neutrophils (200-20,000)
Low glucose (<45)
High protein (>50)
Markedly elevated opening pressure (>180mm)
61
Bacterial meningitis imaging
Head CT if need to rule out mass effect of lesion, papilledema, seizures, confusion, focal neuro findings
62
When is lumbar puncture contraindicated
Increased intracranial pressure
63
Bacterial meningitis treatme
IV empiric abx with good CSF penetration, bacterialcidal, start ASAP after LP
Vanc and ceftriaxone for 1month-50yrs
Vanc + ceftriaxone + ampicillin (for listeria) for >50yrs
Ampicillin + Gentamicin and/or cefotaxime for <1 month
IV steroids (dexmethasone IV)
64
Prophylaxis care against N. meningitidis
Ciprofloxacin PO or Rifampin PO
65
Head trauma or post neurosurgical procedure meningitis trreatment
Vanc + ceftazidime or cefepime
66
Chronic meningitis pathogens
M. tuberculosis
Lyme disease
Syphillis
Herpes
Epstein barr
C. neoformans
H.capsulatum
Candida
67
Chronic meningitis symptoms
4 weeks to several months
Headache
Neck and back apin
AMS
Weakness
Vision changes
Hearing loss
Urinary disfunction
Ataxia
68
Encephelitis symptoms
AMS
Change in personality, speech, movement
HA
Neck stiffness
photosensitivity
Fever
Chills
N/V
69
Encephalitis physical exam
Hemiparesis
Sensory deficits
Cranial nerve palsy
70
Encephalitis diagnosis
CT scan of head FIRST to rule out lesions
Lumbar puncture
MRI
PCR test CSF (trying to find herpes)
71
Encephalitis risk factors
Age
Condition
Glasgow coma scale (GCS < 8, intubate)
72
Most common pathogen of encephalitis
HSV-1
73
Encephalitis treatment
Acyclovir
Ganciclovir
74
Primary amoebic meningoencephalitis
Naegleria fowleri amoeba.
Brain eating amoeba
Get it from lake
Death within 5 days of symptom onset
75
Brain abscess
Localized collection of pus in brain parenchyma
Usually bacterial (polymicrobial)
76
Brain abscess symptoms
HA
Drowziness
N/C
Confusion
Focal neural deficits
77
Brain abscess imaging
CT first line.
If positive, don't need lumbar puncture
78
Brain abscess treatment
Drain
Abx
Maybe steroids
MRI every two weeks and at deterioration
Dexmethasone must be tapered
79
Spinal epidural abscess risk factors
Immune deficiency
IV drug use
Soft tissue infection
Previous spinal surgery
80
Spinal epidural abscess pathogen
Staph aureus (including MRSA)
Gram negative bacilli
Streptococcus
Anaerobes
Fungi
81
Spinal epidural abscess early clinical findings
Neck/back pain on midline
Fecer
Headache
Malaise
Neurological deficit
82
Spinal epidural abscess late clinical findgins
Sensory disturbances in legs.
urinary and fecal retension
Tenderness along midline back and neck
83
Spinal epidural abscess physical exam
Gait disturbance
Radiculopathy (compression of nerve root)
Myelopathy (entire spinal cord compression)
84
Spinal epidural abscess diagnosis
MRI
WBC<22000
ESR>20
CRP>1.0
85
Spinal epidural abscess treatment for non-operative
Van or nafcillin + Ceftriaxone and metronisdazole
Thoracolumbar stabilizing orthotic to help with pain
86
Primary headache
Biologic disorder of brain
Most common
No structural abnormality
87
Secondary headache
Has identifiable cause on CT/MRI, serum labs, and/or CSF labs
88
Head pain red flags
HEAD PAIN
History of exposure to CO, alcohol, or drugs
Exertional
Acute onset
Disturbance to vision
Pregnant
Age>40
Immunocompromised (HIV, cancer)
Neurologic abnormalities
89
Pt comes in with worst headache ever. PE is normal. What shoudl you order?
GOLD: CT without contrast of head to rule out bleed in emergency
MRI better if not emergency
ESR and CRP if suspect giant cell arteritis
Lumbar puncture if suspect infection
90
Major primary headache categories
Tension (band around head)
Migraine (whole half of head)
Cluster (small area)
91
Tension headache pathophys
May involve heightened sensitivity of CNS, espeicially in trigeminal system and muscle contraction in head and neck region
92
Tension headache presentation
Mild to moderate bilateral pain (dull, nonpulsatile)
Ocasional to daily, worse at end of day
Without associated nausea or vomiting
Pericranial muscle tenderness
Poor concentration
Normal neurologic exam
93
Tension headache trigger
Stress
Fatigue
Noise
Glare
Poor posture
94
Tension headache subtypes by frequency
Infrequent episodic: < 1 day/month
Frequent episodic: 1-14 days/month
Chronic: >15 days/month
95
Tension headache treatment
OTC analgesics (NSAIDs, acetaminophin, aspirin, caffeine) < 15 days/month
Excedrin (aspirin + acetaminophen + caffeine) < 10 days/month
96
Tension headache prevention
Avoid triggers
Amitriptyline (start low and go slow)
97
Migraine pathophys
Trigeminal activation
Cortical spreading: wave of neuronal depolarization spreads across cortex causes aura of migraine, alters BBB permeability, Activate trigeminal nerve afferents
Trigeminovascular system comunicate pain signals to thalamus
Neurons become more sensitive
CGRP released in trigeminal ganglia
98
Migraine without aura
>5 attacks lasting 4-72hrs without treatment
Unilateral location
Pulsating
Moderate or severe pain
Aggravation
N/V or photophobia and phonophobia
99
Migraine with aura
>1 attack
Reversible aura symptoms on visual, sensory, speech/language, motor, brainstem, retinal
>2 of the following
>1 aura symptom over >5 mins
> 1 symptom occur in succession
Each aura symptom is 5-60 mi s
At least one aura symptom is unilateral
At lest one aura symptom is positive
Aura accompanied or followed within 60 mins by headache
100
Aura
Unusual sensation or feeling that warns of impeding migraine or seizure. Gradual over 5 mins
Negative featues are reversible
101
Positive aura featues
Bright lines, shapes, objects
Tinnitus, noises, music
Burning, pain, paresthesia
Jerking or repetitive movement
102
Negative aura features
Reversible
Loss of vision, hearing, feeling, ability to move part of body
103
Scotoma
Visual aura
Blind spot
104
Photopsia
Luminous visual hallucinations like stars, sparks, light flashes
105
Scintillating scotomas
Geometric patterns or zigzags of light
106
Menstrual migraine
Migraine occurs 2/3 or more of menstrual cycles
Occurs within -2 to +3 days of menstration and no other time during cycle
107
Opthalmoplegic migraine
Rare
Diagnosis of exclusion
CN II and CN VI palsy
Lateralized pain around the eye
N/V and diplopia due to transient external opthtalmoplegia
Temporary blindness
Twinkling lights
Only in one eye
108
Migraine triggers
Stress
Female hormones
Lack or excess of sleep
Missed meals
Specific
Menstration
Weather changes
109
Migraine treatment
Analgesics (NSAIDs, acetaminophen, Excedrin)
CGRP antagonist (-pant)
5-HT1F receptor agonist (lasmiditan)
Serotonin agonist (-triptan)
Opiods (risk of abuse)
110
Chronic migraine therapy
Migraine with duration >72hrs
IV dopamine
IV diphenhydramine
Hydration
111
Cluster headaches (trigeminal autonomic cephalagias) presentation
Severe unilateral pain localized in periorbital areas lasdting 15mins-3hrs
Ipsilateral autonomic symptoms
Occur at same time of day
AKA peroxysmal hemicrania/hemicrania continua
Ipsilateral nasal congestion
Rhinorrhea
Lacrimation
Redness of eye
Horner syndrome
112
Horner syndrome
Common symptom of cluster headache
Produced by lesion anywhere along sympathetic pathway
Miosis
Anhidrosis
Ptosis
113
Cluster headache trigger
Stress
Alcohol
Smoking
Bright light
Foods
Seasonal changes
114
Chronic cluster headache
No remission
Horner syndrome may persist between attakcs
115
Cluster headache treatment
Sumatriptan
100% O2 12-15L in nonrebreather mask
116
Cluster headache prevention
Oral prednisone
Corticosteroid injection
Verapamil (CCB)
Topiramate (antipileptic)
Lithium carbonate
117
Intracranial hemorrhage
Spontanious bleeding within tissue of brain
10-15% of all strokes
High risk of death and disability
118
Intracranial hemorrhage pathophys
Primary injury happens within minutes of bleeding
Secondary injury occurs hours to days after injury from presence of intraparenchymal blood (we're trying to miniimize this)
119
Intracranial hemorrhage causes
HTN
Cerebral amyloid angiopathy
Cerebral arteriovenous malformations
Trauma
120
Intracranial hemorrhage symptoms
Sudden onset
Focal neuro symptoms relating to location
HA
N/V
Decreased consciousness
121
Intracranial hemorrhage imaging
CT with intra-axial hyperdense region
Want one 6 hours later after first one to see max size (24 hrs for pts with untreated coagulopathy)
122
Spot sign
Shows contrast leaking into hemorrhage actively (shows not well controlled)
123
Initial prehospital resuscitation for suspicion of intracerebral hemorrhage
Airway (watch for vomiting)
Breathing goal PCO2 35-45 SPO2 >92
Circulation: MAP>65 SBP<160
DIsability: GCS, pupil exam, neck exam for meningismus
124
Intracerebral hemorrhage initial treatment
CT non-contrast and CT angio of head
Figure out if on anticoagulants
Get SBP<160
Give vitamin K to pts on warfarin to get INR<1.4
125
Hydrocephalus
Pressure inside brain gets high
Put in drain to relieve pressure
ICP goal <22
CPP goal >60
126
Normal intracranial pressure (ICP)
5-15 mmHg
127
Normal cerebral perfusion pressure (CPP)
60-70 mmHg
128
What happen if ICP raises above compensation efforts
Cushings triad (high SBP, low DBP, Bradycardia, Irregular inspirations)
129
Arteriovenous malformations
Congenital
Abnormal arteriorvenous shunting between cerebral arteries and veins
130
Arteriovenous malformation treatment
Monitor
Surgical resection
Risk of seizure after resection
131
Subarachnoid hemorrhage symptoms
Abrupt onset thundrclap headache (worst ive ever had)
Loss of consciousness
Neck pain
N/V
132
Modified Fischer scale
Predicts the risk of vasospasm in subarachnoid hemorrhage
0: no risk
1:24% - No SAH no IVH
2:33% - Thin SAH no IVH
3:33% - Thin SAH and IVH
4:40% - THick SAH and IVH
133
Subarachnoid hemorrhage imaging
Noncontrast CT with star pattern of blood pooling in basilar cisterns
CT head and neck with contrast to locate aneurism
Cerebral angiogram/DSA for cerebral vasculature
134
What confirms subarahnoid hemorrhage diagnosis in CSF
Xanthochromia found on stain
This is not necessary if CT is diagnostic
135
Subarachnoid hemorrhage treatment
Send to neuro to drain
Reversal of coagulopathy (vitamin K for warfarin. protamine for heparin, FEIBA for DOAC)
Treat pain and anxiety
Keep SBP<160
Avoid nitroprusside
136
Subarachnoid hemorrhage complications
RRebleeding
Hyponatremia
Hypovolemia
Vasospasm
137
Neurocardiogenic cardiomyopathy
Tako Tsubo
Catecholamine mediated
138
Ischemic stroke
Most common stroke
Blood flow to part of brain is reduced resulting in tissue damage.
Results from clot
139
Infarct core
Brain tissue that relies on one artery for blood that is blocked
140
Penumbra
Surrounds infarct core
Maintains some blood supply through colateral circulation
Faster the treatment the less effected the penumbra is affected
141
Large arteries of brain
internal corotid
Middle cerebral
Anterior cerebral
Basilar
Posterior cerebral
142
Cardioembolic stroke
Embolus forms somewhere else and travesl to vessel causing ischemia in brain.
Heart is common source (Afib)
143
Cryptogenic (unusual) ischemic stroke etiology
Arterial dissection
Fibromuscular dysplasia
Vasculitis
Sickle cell disease
144
Cerebral autoregulation
Brain's blood flow is maintained at constant level despite moderate variations in perfusions pressure
145
What perfusion pressure distinguishes ischemia vs infarct
>30% = ischemia
<30% = infarct
146
Genetic diseases that carry higher risk of stroke
Sickle cell
Marfan's
Ehlers danlose
147
Stroke Risk factors
HTN
Smoking
Diabetes
Carotid/coronary artery disease
High blood cholesterol
Sedentary lifestyle
Obesity
Age
Male
Fam hx
Hx of stroke
148
Stroke symptoms
BE FAST
Balance
Eye (loss of vision usually in one eye)
Facial drooping
Arm or leg weakness
Speech (diff speaking, slured, trouble understanding)
Time to call
149
NIHSS scoring system
0 - No score
1-4 - Minor stroke
5-15 - Moderate stroke
16-20 - Moderate to severe stroke
21-42 - Severe stroke
150
Level of consciousness stroke NIHSS PE scoring
0 - Alert
1 - Not alert but arousable by minor stimuli
2 - Not alaert and requires repeated stimulation
3 - Responds to only reflex motor or unresponsive
151
Level of consciousness questions NIHSS PE scoring
Ask month and his/her age
0 - answers both correctly
1 - answers one correctly
3 - answers neither correctly
152
Level of consciousness commands NIHSS PE scoring
Open and close eyes
Grip and squeeze hand
0 - Performs both correctly
1 - Performs one correctly
2 - Performs neither correctly
153
Gaze assesssment NIHSS PE scoring
Tell pt to look at object and turn their head
0 - normal
1 - partial gaze palsy
2 - Froced deviation or total gaze paresis
154
Visual fields NIHSS PE scoring
0 - No visual loss
1 - partial heianopia
2 - complete hemianopia
3 - Bilateral hemianopia
155
Facial palsy NIHSS PE scoring
0 - normal
1 - minor paralysis
2 - parital paralysis
3 - complete paralysis of one or both sides
156
Arm motor NIHSS PE scoring
0 - no drift
1 - Drift within 10 seconds
2 - Some effort against gravity but can't stay up
3 - No effort against gravity, limb falls
4 - No movement
157
Leg motor NIHSS PE scoring
0 - Leg holds pposition for full five seconds
1 - Leg drifts but does not hit bed
2 - Leg drifts and hits bed or some effort against gravity
3 - No effort against gravity, leg falls to bed immediately
4 - No movement
158
Imaging studies for suspected ischemic stroke
Noncontrast brain CT FIRST to rule out bleed/tumor
then MRI and CT angiography of head and neck and ECG
159
Ischemic stroke treatment
1. Stabilaize airway, breathing, circulation
2. Fluids
3. Treat and maintain BP that is >185/110
4. IV thrombolytic therapy (-plase)
5. Antiplatelet therapy with aspirin/clopidogrel
6. Start or continue high intensity statin asap for long term
Thrombectomy for large vssel ischemic stroke unable to be treated within 24 hrs of onset
160
Who should be given tPA after stroke
Ischemic stroke with known time of onset
Measureable deficit on NIGSS
No evidence of intracranial bleeding on CT
BP <185/110
Glucose >150
>18yo
3 hours of onset
161
Who should not be given tPA after stroke
CT shows hemorrhage
BP>185/110
Bleeding disorder
Heparin in last 48 hrs
Use of direct factor Xa inhibitors
Trauma
INR> 1.7 or PT> 15 sec
162
Ateplase
Thrombolytic tPA with short half life so give bolus and continuous infusion
163
Tenecteplace
More selective thrombolitic tPA that has longer half live given as singlle bolus
Less bleeding complications
164
What artery is the most common for stroke
Middle cerebral
Usually causes contralateral hemianopsia
165
Lacunar stroke
Strongly associated with HTN
CT has small punched out hypodense areas
166
PCA stroke
Visual changes
167
Anteriorcerebral artery stroke
Worse in legs and feet
Urinary incontinence
168
Cerebellar strokes
Appendicular or trunical ataxia
Dizziness
Gait instability
N/V
169
Transient ischemic attack
Neurologic emergency
Focal ischemic cerebral neurologic deficits that lasts for less than 24 hrs (usually less than 1-2 hours)
Should fix itself
170
Transient ischemic attack diagnostic studies
MRI (symptoms have subsided)
171
Transient ischemic attack treatment
Supine position
Avoid lowering BP unless >220/120
ABCD score < 4 start aspirin
ABCD score > 4 start DAP
Endarterectomy if internal caroted artery stenosis
Long term high intensity statin
172
What order to treat traumatic brain injury
Threats to life, then limb, then eyesight
Put in C collar and spine motion precautions
173
Glascow coma scale scoring
14-15: mild brain injury
9-13: moderate brain injury
<8: severe brain injury
174
Coup injury
Occurs at site of injury (where object hits head)
175
Contrecoup injury
Opposite to site of impact (where brain ricochets to other side of skull after being struck
176
Diffuse axonal injury
Shearing of axons when brain shifts/rotates in skull
Result from traumatic acceleration or rotational injuries
Freq cause of vefetative state
177
Vault fracture
Involves one or more of frontal, parietal, squamous of temporal, sphenoid, or interparietal bone
178
Linear fracture
Break in cranial bone resembling thin line without splintering, depression, or distortion of bone
179
Stellate fracture
Bone fracture lines beak and radiate from point usually from site of injury
180
Depressed fracture
When degree of depression is greater than thickness of skull
181
Basilar skull fracture
VSF otorrhea/rhinorhrhea
Bruising on mastoid process
Raccoon eyes
CSF leak shows halo sign (imediate neuro consult)
CN VII
182
Intra-axial hematoma
Intraparenchymal/intracerebral hemorrhage
183
Extra-axial hematoma
SUbdural hematoma
Subarachnoid hemorrhage
Epidural hematoma
184
Subdural hematoma
Venous bleeding
Crescent-shaped on non-contrast CT
185
Subdural hematoma symptoms
HA
DIzziness
Focal neurological symptoms
N/V
AMS
186
Subdural (and epidural) hematoma management
Keep O2 over 90%
Keep EtCO2 35-40
SBP > 100
INR < 1.4
Consult for decompression
levetiracetam for seizure prophylaxis
187
Seizure prophylaxis for subdural hematoma
Levetiracetam FIRST CHOICE
Phenytoin second choice
188
Should you give steroids to pt with traumatic brain injury
No
189
Epidural hematoma
Arterial bleed
Biconvex shape
Doesn't cross suture lines
Fast growing
190
Epidural hematoma symptoms
Initial unconsciousness then they're fine, then quickly go downhill and die.
HA
N/V
Focal neurological symptoms
Glascow coma scale
191
When to refer epidural hematoma to surgery
Hemorrhage volume>30cm, >15mm thickness, >5mm midline shift, or GCS<8
192
Decorticate posture
Flexed (arms curled up over chest, internally rotated legs and feet)
often only efffects one side of the body
Better survival rates of epidural hematoma
3 points on GCS
193
Decerebrate posture
Extended
Damage to deeper structures
More commonly seen in epidural hematoma
2 points on GCS
194
Ways to monitor intracranial pressure
Extraventricular drain
Bolt
195
Normal Intracranial pressure
5-15mmHg
196
Cushing's triad
Sign of increased intracranial pressure
Increased SBP (widened pulse pressure)
Bradycardic
Low RR
197
Elevated intracranial pressure treatment
Fix underlying cuase (blood clot evacuation, tumor resection, CSF diversion)
Med emergency: support O2 and BP
Isotonic fluids
Sedation to decrease metabolic demand
198
Concussion
Mild TBI that results in temporary loss of brain function
GCS of 14-15
Grade 1: Ringing, HA, mem loss
Grade2: Loss of consciousness for less thanfive minutes or amnesia greater than 30 mins
Grade 3: loss of consciousness for greater than 5 mins or amnesia greater than 24 hrs
199
Concussion symptoms
Confusion
HA
Memory loss
Sensitivity to light
Ears ringing
Trouble sleeping
Abnormal speech
200
Concussion imaging
Non-contrast CT to rule out other injuries
MRI if greater than 7 days
201
Post-concussion syndrome
Symptoms lasting longer than 14 days
Persistent continues longer than 3 months
Headache/migraines
Insomnia
Dizziness/lightheadedness/vertigo
Personality change
202
Chronic traumatic encephalopathy (CTE)
Degenerative disease effecting people who have repeated concussions/TBIs
203
CTE symptoms
Aggression
Poor impulse control
Suicidality
Personality change
204
CN II dysfunction most common cause
Optic neuritis in young adults
Ischemic disease in older aldults
205
Muscles acted on by CN III
Medial rectus
Superior rectus
Inferior rectus
Inferior oblique
206
Cranial nerve III palsy clinical features
Ptosis
Mydriases
Eye looking down and out
207
CN III palsy management
MRI to find underlying cause
208
CN IV palsy clinical features
Diplopia
Head tilt
209
CN IV palsy management
MRI to find underlying cause
210
Trigeminal neuralgia pathophysiology
Compression of CN V root
Common in MS
211
Trigeminal neuralgia clinical features
Shocking pain in the 2nd or 3rd division of trigeminal nerve
212
Trigeminal neuralgia diagnostics
Tender to palpation over V2 or V3
Consider MRI
213
Trigeminal neuralgia management
Carbamazepine or oxcarbazepine
214
CN VI muscles
Lateral rectus (abducts the eye)
215
CN VI palsy causes
Tumors
Vascular disease
Trauma
216
CN VI palsy clinical features
Horizontal binocular diplopia.
Eyes can't abduct (look laterally)
217
CN VI diagnostics
MRI
218
Bells palsy
CN VII palsy
Spontaneous facial nerve paralysis caused by inflammation, ischemia, or compression of CN VII (usually herpes simplex)
219
Bells palsy clinical features
Unilateral facial weakness/paralysis
Taste disturbance on anterior 2/3 of tongue
Decreased tearing of effected eye
220
How to differentiate stroke vs bells palsy
Stroke spares forehead (they can raise eyebrows)
Stroke also has slurred speech, numbness
221
Bells palsy treatment
Resolves itself in a month
If symptoms started <72 hours gibe prednisone to speed recovery
222
CN IX dysfunction clinical features
Dysphagia
Lack of gag reflex
Impaired taste over posterior 1/3 of tongue
Uvula deviation to opposite side
No carotid sinus reflex
223
CN X motor function
Palatoglossus
Superior laryngial nerves to cricothyroid muscle
Pharyngeal branches supply levator veli palatini salpingopharyngeus, palatopharyngeus, and uvula
224
CN X sensory function
Taste from supraglottic region
Chemo and baroreceptors at aortic arch
225
Main parasympathetic nerve of body
CN X (vagus)
226
CN XII function
Genioglossus, styloglossus, hyoglossus for movement of tongue
227
CN XII lesion
Tongue deviates to same side of lesion
228
Seizure
Transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge in brain
229
Epilepsy
Recurrent seizures.
At least two unprovoked seizures occuring >24 hours apart
230
Status epilepticus
Seizure that lasts longer than 5 mins.
More than one seizure withing 5 mins without return to baseline
231
Prodrome in seizure
Nonspecific changes that preced impending seizure by hours
232
Aura in seizures
Symptoms that precede seizure by few seconds or minutes
233
Ictus
Another word for seizure
234
Ictal phase of seizure
Phase of seizure where seizure actually occurs
235
Postictal phase of seizure
Immediately following seizure
236
Interictal phase of seizure
Time between seizures
237
Seizure pathophys
Too much glutamate and not enough GABA causes overexcitation of neurons
238
Primary causes of seizure
Trauma
Tumor
Ifectoin
Stroke
Degenerative disease
Metbolic disease
Genetic
239
Secondary causes of seizure
Hypoglycemia
Hyponatremia
Intoxicant/withdrawal
Fever1
240
Epilepsy risk factors
Febrile seizures
Fam history
Past meningitis/encephilitis
Brain lesion history
Head trauma
Preterm birth
Stroke
Neuro development delay
Brain surgery
Intellectual disability
241
Focal onset seizure.
Only oin one cerebral hemisphere
What happens in ictal phase depends on position
May have neuro deficit for up to 24 hours
Motor symptoms usually contralateral to lesion
Can develop into bilateral tonic-clonic seizure
242
Most common lobe for seizure in people over 20yo
Temporal
243
Frontal lobe seizure sympoms
Movements contalateral to seizure focus
Personality changes
Movements of face, hands, toes
244
Jacksonian motor seizure
Frontal lobe
Motor seizure.
Usually no impaired awareness
245
Temporal lobe seizures
most common adult-onset focal epilepsy
Aura could be auditory, olfactory, or gustatory hallucinations
Lip smacking, chewing, screaming, grunting
Ictal aphasia
Patililalia
246
Palilalia
Repitition of words
247
Parietal lobe seizure
Uncommon
Tingling, numbness, or pain on one side of body
248
Occipital lobe seizure
Visual changes
Easily confused with prodroem or aura
Often spreads to temporal or frontal lobes and progresses from focal to bilateral tonic-clonic
249
Focal seizure treatment
Also for focal that progresses to bilateral
Lamotrigine
Levetiacetam
Oxcarbazepine
250
Tonic
Muscles are stiff
EEG shows fast rhythmic spikes
251
Clonic
Rhythmic jerking
EEG shows bursts of spikes and slow waves
252
Myoclonus
Quick involuntary muscle jerk
253
Atonic
Loss of postural tone
254
Generalized tonic-clonic seizure
Most common motor seizure
Has tonic phase, clonic phase, and post-ictal phase
255
Generalized tonic-clonic seizure prodrome phase
Hours before seizure
Mood change
Headache
GI pain
256
Generalized tonic-clonic seizure tonic phase
10-20 secs
Opening of mouth
Upward deviation of eyes
Flexion of trunk
Extension of arms and legs
Pronation of hands
Piercing cry
Suspended breathing with cyanosis
Dilated pupils
Bladder incontinence
257
Generalized tonic-clonic seizure clonic phase
30-60 secs
Mild tremor starts 8/sec then 4/sec
Flexor spasms
Elevated BP
Swseating
Salivation
Apnea
Dilated pupils
258
Generalized tonic-clonic seizure post-ictal phase
Several minutes
Motionless/limp
Confusion, agitation
Drowsiness
Pulsatile headache
Pupils constrict
259
Lab changes post generalized tonic-clonic seizure
Lactic acidosis
High CO2
Elevated creatine kinase
Elevated prolactin
Elevated ammonia
260
Atonic seizure
Onset of 2-6 years old, persists into adulthood
AKA Lennox-Gaustaut
Falls is first symptom (unexplained injuries)
261
Atonic seizure treatment
Felbamate
"I fell mate"
262
Myoclonic seizure
Brief muscular contraction (myoclonic jerks)
Usually very short
Juvenile myoclonic epilepsy "college seizures"
teens or early 20s
Makes you drop stuff
263
Myoclonic seizure treatment
Valproic acid
264
Generalized nonmotor (abscence seizures)
Brief loss of cnsciousness but appear to be daydreaming
3/sec doublet with spike and wave pattern lasting 10 seconds
No auras
No post-ictal periods
Can be precipitated by hyperventilation
265
Generallized seizure treatment
Ethosucimide (absence only)
Lamotrigine (may worsen myoclonic)
Levetiracetam
Valproate
266
What med can make a myoclonic seizure worse
Lamotrigine
267
Febrile seizures
Specific children 6 months - 5 years
Usually inherited
Single, generalized motor seizure
HHV-6
No EEG or MRI abnormalities
Rash
No indication to treat
268
Seizure physical exam findings
Injuries from seizure (bitten tongue)
skipping numbers when counting
Could have babinsky
Depression and anxiety
269
What labs to order for seizure
Creatininine kinase
Prolactin
Lactic acid
Ammonia
CBC
CMP
Ca
Mg
UA
Folate
Vitamin D
Bone density
270
Seizure diagnostic studies
ECG shows long QT
EEG (maybe use flashing lights and hyperventilation to induce)
MRI to see structure (indicated with focal neuro symptoms in pts >20yo
271
When is treatment of seizures indicated
Two unprovoked seizures
One unprovokd seizure with EEG or MRI abnormalities
Seizure onset while asleep
272
What meds decrease seizure threshold (increase risk of having seizure)
Carbapenem and fluoroqunolone abx
Bupropion
Methylpheniate, amphetamine, dextroamphetamine
Fluorquinolones, penicillin, cephlasporins, metronidazole
Tramadol, opiods
Cyclobenzaprine
Diphenhydramine
273
What med to give someone trying to get pregnant with epiliepsy
Levetiracetam
274
Diet changes to make for children with seizure
Put them on Keto
80-90% fat
Induces ketosis in hospital
Need vitamin D
275
AMS life threats
Hypoxia
Hypoglycemia
Hypoventilation
Hypoperfusion
Elevated intracranial pressure
276
Treatment for life threatening AMS
Thiamine (B1)
Dextrose
Naloxone (narcan)
277
Causes of AMS
AEIOU TIPS
Alcohol, acidosis, ammonia, arrhythmia
Electrolytes, endocrine, epilepsy
Infection
Overdose, oxygen, opiates
Uremia
Temp, trauma, thiamine (B1)
Insulin
Psychiatric, poisoning
Stroke, seizure, syncope, space occupying lesions, shunt, SAH
278
What does a unilateral absence of response to painful stimuli indicate
Corticospinal lesion
279
What does bilateral absence of response to painful stimuli indicate
Implies brainstem involvement
280
AMS pupil exam
Could be slight ly smaller than normal but responsive to light.
Could be fixed or dilated following overdose
Dysconjugate gaze (eyes don't line up)
Eyes don't move when turning head
281
What does an eye not rotating when turning head indicate
Brain stem dysfunction/lesion
282
Oculovestibular reflex
Poor cold water into ear.
Normal reaction is jerk nystagmus for 2-3 mins
Unconcieous with intact brainstem causes eyes to tonically deviate toward irrigated ear for 2-3 mins without fast nystagmus
283
Cheyne-stokes respirations
Deep breathing alternate with periods of apnea.
May occur with bihemispheric or diencephalic disease or in metabolic disorders
284
Central neurogenic hyperventilation
Excessively rapid and deep breathinng occuring with lesions of brainstem tegmentum
285
Apneustic breathing
Prominent end-inspiratory pauses.
Suggests damage at pontine level due to basilary artery occlusion
286
Ataxic breathing
Completely irreagular.
Deep and shalllow breaths at random
Associated with lesions of lower pontine tegmentum and medulla
287
AMS imaging
Noncontrast head CT looking for lesion
288
Stupor
Unresponsive except to repeated, vigorous stimuli and will briefly arouse until left undisturbed
289
Coma
Unarousable and unable to respond to external events or internal needs
290
Pupil reactivity and coma and stupor
Normal
291
Locked-in syndrome (pseudocoma)
Pt conscious and aware of surroundings but can not move or communicate verbally
292
When is it considered a persitent vegetative state
When it lasts over 4 weeks
293
Whenis it considered a chronic vegetative state
When it lasts over 12 months
294
Brain death diagnostic imaging
EEG shows no activity
295
Wernicke encephalopathy
Acute condition requiring emergent treatment
Vitamin B1 (thiamine) deficiency
296
Korsakoff encephalopathy
Chronic amnesic syndrome
297
Wernicke-Korsakoff encephalopathy cause
Alcoholism
AIDS
Bariatric surgery
298
Wernicke-korsakoff encephalopathy clinical features
Confusion
Ataxia
Gaze palsies
Nystagmus
Peripheral neuropathy
Confabulation
299
Wernicke-Korsakoff encephalopathy treatment
Thiamine (B1)
Don't delay while waiting for labs
300
Confabulation
You say something made up is there and the pt believes you
301
Spongiform encephalopathy (Creutzfeldt-Jakob)
Makes brain spongy from abnormal prions.
Normal prion proteins mutate.
Mad cow disease
302
Hashimoto encephalopathy
Steroid-responsive
Autoimmune
Elevated antithyroid peroxidase antibody or antithyroglobulin antibody
303
Hashimototreatment
Corticosteroids
304
Hepatic encephalopathy
Results from chronic liver disease
Can be triggered by infection or dehydration
305
Hepatic encephalopathy symptoms
Asterixis (arms and legs look like trying to push on something)
Slurred speech
Memory loss
Sweet or musty breath
306
Hepatic encephalopathy treatment
Lactulose
Withhold oral protein
307
Chronic traumatic encephalopathy cause
Snowball effect of TBIs
308
Chronic traumatic encephalopathy symptoms
Mood and cognitive changes, agression, suicidality, depression, erratic behavior
309
Chronic traumatic encephalopathy diagnosis
Exclusion
310
Chronic traumatic encephalopathy treatment
None
311
Complex regional pain syndrome risk factors
Pre-operative anxiety
Higher pain levels in early trauma
Prolonged immobilization
Depression
Genetics
312
Complex regional pain syndrome clinical findings
Continuous pain and paresthesia out of proportion to inciting event days to months after.
Burning or shocking
Localized sweating and changes in blood flow
Usually effects hands and feet (not all at once)
313
Type 1 complex regional pain syndrome
Regional pain after illness or injury not related to specific nerve damage
314
Type 2 complex regional pain syndrome
Confirmed injury to specific nerve
315
Complex regional pain syndrome diagnosis
Exclusion
Budapest criteria (pic in camera roll)
316
Complex regional pain syndrome diagnostic imaging
Nerve conduction studies (blocking nerve to see if pain stops)
Bone scan showing increased bloodflow (inflammation)
317
Complex regional pain syndrome treatment
Pain meds (NSAIDS)
Cognitive behavioral therapy
318
Diabetic neuropathy clinical findings
Dying abck pattern
Lose sensoryin toes and works its way up, also fingers and arms
Pins and needles
Burning, aching pain
Abnormal sweating
Dysfnctional thermoregulation
Dry eyes and mouth
Gastroparesis
319
Diabetic neuropaty physical exam
Foot exam
Monofilament
Vibratory sense
Propriocetion
Pedal pulses
Ankle-brachial inde
320
Diabetic neuropathy complications
Charcot arthropathy from inflammation and repetitive trauma
Collapsed arch of midfoot.
Warmth, erythema
Pes planus deformity
Amputatoin needed sometimes
321
Diabetic neuropathy management
Prevent by having better glucose control
Duloxetine, venlafaxine (SNRI)
Amitriptyline, nortriptyline, desipramine (TCA)
Pregabalin, gabapentin
DIabetic shoes
322
Charcot-marie-tooth
Most common hereditary neuropathy
Autosomal dominant
323
Charcot-marie-tooth clinical findings
Distal muscle wasing
Pes cavus foot deformity (foot curving inward)
Claw toes
324
Charcot-marie-tooth treatmnt
Ankle brace preventing supination and improving stability
325
Drugs that cause peripheral neuropathy
Isoniazid
Metformin
326
Vitamin B12 deficiency Clinical findings
Hand paresthesias appears before lower extremity
Preference of large fiber sesnsory loss
Loss of proprioception and vibratory sense
Ataxia
327
What people usually have vitamin B1deficiency
People who eat lots of rice
Alcoholics
Weight loss surgery
Total parental nutrition
328
Cause of acute seizure
Metabolic disturbance (low Na)
Infectoin/fever
Stroke
Trauma
Drug toxicity
Antiseizure med non compliance
Hypoxemia
Cardiac arrest
Hypoglycemia
329
Cause of chronic seizures
Pre-existing epilepsy
Anticonvulsant withdrawal
Chronic EtOH abuse
CNS tumors
Organ failure
Illicit drug use
330
Seizure emergent treatment
Benzos (lorazepam, medazolam, diazepam)
DO NOT underdose
331
Seizure urgent control treatment (after emergency benzo is given)
levetiracetam (Keppra)
Sodium valproate
Phenytoin
Fosphenytoin
332
Long term maintenance post-seizure meds
Antivonvulsant (levetiracetam)
333
Super refractory status epilepticus
Seizure occuring within 24 hrs of weaning anesthitic drips
334
Super refractory status epilepticus treatment
Therapeutic hypothermia
Ketogenic diet
Neurosteroid (ganaxolone)
335
How to avoid post-op problems in neurosurgery
Mobilize ASAP
336
Radiculopathy
Pain, numbness, weakness from compresson of nerve
PNS problem
337
Essential tremor clinical presentation
Bilateral hands, head, or both
Speech maybe effected (can't hold steady note)
Activated by voluntary movement (trying to take finger to something) or arms out forward
Usually absent at rest
Normal gait
Normal behavior
No neuro deficits
338
Common cause of essential tremor
Stress, anxiety, excitement, muscle fatigue, hypoglycemia, meds
339
Essential tremor treatment
Propranolol when predictable
Primidone when no propranolol
Deep brain stimulation
Transcranial ultrasound thalamotomy
Stereotactic radiosurgery for unilateral
340
Huntington disease pathophys
CAG trinucleotide in huntington disease at 4p16.3
341
Huntington disease clinical presentation
Motor: choreiform (dance-like)
Memory: dementia
Mood: psychiatric impairment
Gets worse over time
342
Huntington disease imaging
CT or MRI shows cerebral atrophy and atrophh of caudate nucleus
343
Huntington disease diagnosis
CAG trinucleotide expansion of >36 repeats in huntington gene
344
Huntingrton disease treatment
No cure
Treat chorrea symptoms with VMAT2 inhibitor (-benazine) or amantadine
Clozapine for behavioral symptoms (need close monitoring bc of bone marrrow suppression)
Deep brain stimulation
345
Tourette syndrome onset
usually 2-15
Usually simple tics (squinting/sniffing)
346
What type of tics are usually seen first in tourette syndrome patients
Motor ticks,
Usually eventually get a combination of motor and phonic tics
347
Coprolalia
Obscene speech tic
348
Echolallia
Repetition of speech of others tic
349
Echopraxia
Imitation of others' movements tic
350
Palilalia
Repetition of words or phrases usually with increasing rapidity tic
351
Touret syndrome complications
Kids have social problems bc get in trouble for tics
352
Touret syndrome clinical presentation
Tics with no other neuro deficits
353
Touret syndrome treatment
No cure
habit reversal therapy
Clonidine or guanfacine
2nd: haloperidol, aripiprazole, pimozide
Deep brain stimulation for refractory
354
Parkinsonism
any combo of tremor, rigidity, bradykinesia, and progressive postural instability.
Progressive
355
Parkinsons pathophys
Gradual loss of dopamine producing neurons in substantia nigra.
Low dopamine and high acetylcholine
356
Parkinsons clinical presentation
Tremor
Rigidity
Bradykinesia (slow movements)
Postural instability (later symptom)
357
Parkinson tremor
Noticable at rest
Less severe during voluntary activity
Made worse in stress
Usally unilateral at first for months or years then progresses to bilateral
Pill-rolling
358
Parkinsons rigidity
Resistance to passive movement causing flexed posture
Cogwheel
Lead pipe
359
Cogwheel rigidity
Parkinsons
Pattern of resistance and relaxation when examiner is moving pt limb.
360
Lead-pipe rigidity
Parkinsons
Resistance constant throughout entire range of passive movement
361
Parkinsons gait
Slow
Freezing
Festination (very short steps especially when turning)
Loss of arm swing
362
Parkinsons treatment
No cure
Amantadine
Dopamine agonist
Levodopa + carbidopa (take at night)
363
Levodopa adverse effects
Dyskinesias (fixed by amantadine)
Confusion
364
Carbidopa
Parkinson med
Inhibits decarboxylase so dopamine stays high
365
Inhaled levadopa
Used to reverse akinesia in off period of parkinsons pt treatment
366
Amantadine in parkinsons
Use in mild symptoms and no disability.
Improves parkinson symptoms and levodopa induced dyskinesias
367
Gross motor function classification System
Cerebral palsy grading
1: Walks without limitation
2: Walks with limitation (balance or endurance
3: Walks using a hand-held mobility devise (cain, crutches, etc.)
4. Self mobility is limited. May use walker for short distances but mostly wheelchair.
5. Only wheelchair
368
Multiple sclerosis pathophys
Autoimmune demyelinating disease of CNS
BBB is compromised
369
MS presentation
Weakness, numbness, tingling, or unsteadiness of limb.
Spasit paraparesis
Retrobulbar optic neuritis
Diplopia
Dysequilibrium
Urinary incontinence
Electric sensation down back of legs
Visual disturbance with elevated core body temp
370
Optic neuritis symptoms
Monocular vision loss
Decreased color perception
Pain worsens with EOM
371
MS diagnois
MRI
Two or more different regions of central white matter effected at two different times
CSF with increased protein and IgG
372
Relapsing MS
Attacks over days/weeks
Initial attack has complete recover over weeks/months then continued attacks with decreased recovery (not getting back to baseline)
373
Secondary progressive MS
Starts as relapsing then goes to progressive deterioration with worsening of dysfunction
374
Primary progressive MS
Steady decline in function from disease onset with no relapse or remissions with quick onset of disabilty
375
MS treatment
corticosteroids
Plasmapheresis
376
ALS (Lou Gherig) pathophys
Prions cause cell dammage and inflammation leading to damage to nerves.
Can be UMN, LMN, or both
Astrocytes have impaired glutamate uptake
377
ALS symptoms
Starts distally
Muscle weakness/cramps/stiffness
Twitching
Speech
Trouble swallowing
Drooling
disturbed gait
Sensory and cognitibe function is preserved
378
ALS treatment
Riluzole
Rehab
379
Guillan-Barre syndrome pathophys
AKA acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
Autoimmune response against schwann cells or myelin sheath of peripheral nerves
Recovery is possible
Bad reaction to infection or vaccination
380
Guillan-Barre syndrome clinical presentation
Illness 1-3 weeks prior
Weakness starting with numbness and tingling in fingers iand toes.
Decreased balance
Abscent thermal discrimination, proprioception, vibratory sensation, and pinprick
Loss of deep tendon reflex in lower extremity
381
Guillan-Barre syndrome diagnosis
CSF with elevated protein, WBC<50
Prolonged or absent F waves and absentH reflexes
INcreased distal latencies in conduction blocks
Slowing or absence response on nerve conduction
EMG of week muscles show reduced recruitment or denervation
382
Guillan-Barre syndrome treatment
Admit to hospital
IV immunoglobulin
Plasmapheresis
VTE prophylaxis
Send to ICU if unstable
383
Myasthenia gravis pathophys
Acetylcholine receptors at postsynaptic membrane are destroyed
384
Myasthenia gravis clinical presentation
Diplopia, ptosis (improved with ice pack), pupilary light reflex is spared.
Dysphagia, dysarthria
Risk of aspiration [neumonia
Fatigue with chewing
Myasthenic sneer
385
Myasthenia Gravis diagnosis
SERUM ASSAY with ACh receptor antibodies
Decremental muscle response rom repetitive nerve stimulation
CR of chest shows thyoma
386
Myasthenia Gravis treatment
Cholinesterase inhibitors (gimine)
CCS
Eculizumab
Thymectomy (younger than 65 unless pain)
387
Lambert-Eaton Myasthenia syndrome (LEMS) pathophys
Associated with small cell lung cancer
Autoantibodies to voltage-gated calcium channels
Decreased ACh release at NMJ
388
LEMS clinical presentation
Symetrical proximal weakness
Weakness improves with repetitive stimulation (exercise)
Autonomic dysfunction (sluggish pupillary light reflex, erectile dysfunction, dry mouth, blurred vision, constipation)
389
LEMS diagnosis
Serum assay
Repetitive nerve stimulation
CT of chest, abdomen, and pelvis
390
LEMS treatment
Plasmapheresis
IV imunoglobulins
Prednisone
Azathioprine
391
Spinal cord injury pathophys
Gray matter irreversibly damaged within hour of injury.
White matter may be spared but irreversible after 72 hrs due to hemorrhage, ixchemia, excitotoxicity, cellular dysfunction, apoptosis
392
Where are the spinal nerves of C1-C7
Superior to same numbered vertebra with nerve C8 under vertebra C7
393
Where are the spinal nerves of T1-S5
Inferior to the same numbered vertebra
394
What does C3-C5 innervate
Diaphragm
395
What does C4-C7 innervate
Shoulder and arm
396
What does C6-C8 innervate
Forearm extensors and flexors
397
What does C8-T1 innervate
Hand musculature
398
What does L2-L3 innervate
Hip flexion
399
What does L3-L4 innervate
Knee extension
400
What does L4-L5 innervate
ankle dorsiflexion and hip extension
401
What does L5-S1 innervate
Knee flexion
402
What does S1-S2 innervate
Ankle plantar flexion
403
What to do for spinal cord physical exam
Inspect and palpate
Check motor, sensory, and reflexes
Log roll
Rectal exam (if sensation then not full spinal cord injury)
404
Dermatome
Area of skin mainly supplied by afferent nerve fiber from dorsal root of single spinal nerve
405
Reflex scoring
0 - absent
1+ hyporeflexic
2+ normal
3+ hyperreflexic
4+/CL asociated with clonus
406
Tetraplegia
Injury to 5th cervical segments or above
407
Parapalegia
Injury to thoracic cord
408
Spinal shock
Loss of motor function at time of injury
Temporary loss of autonomic function
Neurogenic shock (bradycardia and hypotension)
After weeks reflexes become very strong
After several months withdrawal reflexes exagerated
409
Anterior (ventral) cord syndrome
Pain, temp sensation and motor deficit below level of spinal cord injury from direct compression of anterior spinal cord or injury to anterior spinal artery
410
Anterior (ventral) cord syndrome causes
Post surgery HTN
Cross clamping of aorta
Increased spinal canal pressure
Sickle cell or other hypercoagulable diseases
Trauma
411
Anterior (ventral) cord syndrome pathophys
Direct compression of anterior spinal cord
412
Anterior (ventral) cord syndrome PE findings
Loss of active ROM
Tender
Passive ROM intact
Loss of pain sensation
Loss of temp sensation
413
Anterior (ventral) cord syndrome diagnosis
MRI
Abnormal T2 signal witin regions of anterior horn
Thin hyperinensities across several spainal levels
Get LP and blood work to rule out infection
414
Anterior (ventral) cord syndrome treatment
Underlying cause (surgery for aortic dissection or immunosuppression for vasculitis)
Supportive management
415
Posterior (dorsal) cord syndrome
Bilateral involvement of dorsal columns
Corticospinal tracts and descending central autonomic tracts to bladder control centers in sacral cord
416
Posterior (dorsal) cord syndrome clinical findings
Loss of proprioception and vibration
Ataxic gate (wide and inconsistent)
Hypotonia
No tendon reflexes
417
Posterior (dorsal) cord syndrome diagnosis
Radiograph
MRI without contrast looking for demyelination of spinal cord
LP
Check for vitamin deficiency
418
Posterior (dorsal) cord syndrome treatment
Underlying cause
Surgical laminectomy for spinal decompression if trauma related
Therapy
419
Brown Sequard syndrome
Hemisection of spinal cord affecting dorsal column, corticospinal tract, and spinothalamic tract of one side
420
Brown Sequard syndrome cause
Trauma MCC
Vertebral disc herniation
Tumors
MS
421
Brown Sequard syndrome clinical findings
Loss of vibration, motor, and proprioception to one side
Loss of pain and temp on opposite side of lesion
422
Brown Sequard syndrome diagnosis
Radiograph then CT if traumatic
MRI
Unilateral hemisection of spinal cord damaged
Rule out infection
423
Brown Sequard syndrome treatment
Decompression osurgury for trauma or turner
Spine immobiliazation
Physical therapy
Abx
Analgesics
Antispasmotics
Laxatives
424
Central cord syndrome
Most common complete cord injury
Loss of motor function more in upper limbs
Effects spinthalamic and medial aspect of corticospinal tracts
425
Central cord syndrome causes
Blunt trauma
Infarct from dissection of vertebral artery
Expanding hematoma or edema in central spinal cord
426
Central cord syndrome pathophys
Spinal cord compression and central cord edema with destructiono f lateral corticospinal tract white matter.
427
Central cord syndrome clinical findings
Weakness with hand dexterity most affected
Hyperpathia
Burning in distal upper extremity
Pain and temp sensation absent in some spaces
Preserved vibration and position sensation
Loss of deep tendon reflexes at level of injury
Possible urinary retention
428
Central cord syndrome diagnosis
Radiograph with vertebral fractures, spinal subluxation
Possible CT scan for trauma or fall
MRI most specific
429
Central cord syndrome treatment
Surgery if significant compression
Immobilization with cervical collar
Therapy
Fluids to prevent hypotension
430
Complete spinal cord injury
Nerves completely severed
No nerve communication below injury site
Sensory and motor function below injury lost
431
Most common cause of complete spinal cord injury
Motor vehicle accident (50%)
432
Complete spinal cord injury clinical findings
Flaccid paralysis below level of injury
No reflexes below injury
No sensation, sweating, sphincter tone
433
Complete spinal cord injury diagnosis
Radiograph
CT
MRI
434
Complete spinal cord injury treatment
Surgery
Stabilize spine
Rehab
435
Herniated nucleus pulposus
Prolapse of intervertebral disc through through tear in surrounding annulus fibrosus
436
Cauda Equina syndrome
Simultaneous compression of multiple lumboscral nerve roots below L2 (conus medularus)
Causes compromise to bladder and bowel
437
Cauda equina syndrome PE findings
Low back pain, leg pain and weakness
Urinary retention
Bilateral lower extremity weakness
Bilateral or unilateral lower extremity sensory probs
Decreased lower extremity reflexes
438
Cauda equina syndrome diagnosis
MRI
Bladder ultrasound
439
Cauda equina syndrome treatment
Emergent surgical decompression within 24 hrs (48 hrs acceptable)
Microdisectomy (laminotomy)
Laminectomy
440
