Neuro Flashcards
(142 cards)
1
Q
Younger pt, asymmetric resting tremor, 4-5Hz
A
Early Parkinson –> trihexyphenidyl
2
Q
Chorea, behavior disturbances, irritable, withdrawn disease and CT findings
A
Huntington = atrophy of caudate, large lateral ventricles
3
Q
Broad-based gait, dysmetria, nystagmus, intention tremor, etOH abuse
A
cerebellar dysfunction/atrophy
4
Q
Tremor when moving limb, goes away when relaxed
A
Essential tremor –> etOH, propanolol, primidone, gabapentin
5
Q
Resting tremor, rigidity, bradykinesia, postural instability, asymmetric onset, inaudible speech
A
Parkinson
6
Q
Tx Parkinson tremor
A
DA - levodopa
7
Q
Tx Parkinson motor fluctuations, dyskinesia
A
Selegiline (MAOB), entacapone, tolcapone (COMT)
8
Q
Tx Tourette syndrome
A
1 = Clonidine –> guanfacine, pimozide, haldol, fluphenazine, trifluroperazine
9
Q
Co-morbidity w/ Huntington
A
Depression –> suicide
10
Q
Tx helpful for Huntington chorea
A
Tetrabenazine delplete DA
11
Q
Sx Tx for Huntington
A
Haldol
12
Q
Twisting, repetitive, abnormal posture
A
Dystonia - metaclopramide, prochlorperazine
13
Q
Unilateral, violent arm movements
A
Hemiballismus - CL subthalamic nucleus
14
Q
Broad-shuffling gait, memory loss, urinary incontinence, ventricular enlargement
A
NPH - dec CSF abs
15
Q
Tremor in legs immediately when standing, gone with sitting, 14-18hz
A
Orthostatic tremor
16
Q
Multiple, B/L periventricular plaques, heat sensitivity, new hemiplegia, incontinence tx?
A
MS exacerbation = steroids
17
Q
Tx in relapsing-remitting or secondary MS
A
Glatiramer or beta-interferon
18
Q
Inc IgG index, paraplegia, incontinence, dec vibratory and proprioception, spastic reflexes
A
MS - oligoclonal bands
19
Q
Tx that Dec frequency, slow progression of RR form of MS
A
IF-beta; steroids if acute
20
Q
Tx of progressive MS
A
Cyclosporine, MTX, Mitoxantrone
21
Q
R UE, L LE weakness, ataxia, central vision defect, eye pain worse w/ movement
A
MS –> MRI w/ cerebral & cerebellar plaques
22
Q
Fluctuating MS, visual hallicunations, spontaneous parkinsonism but dopa not helpful
A
Lewy body dementia (eosinophilic intracytoplasmic inclusions of alpha synuclein)
23
Q
Memory loss, language difficulties, cortical atrophy
A
Alzheimer dementia
24
Q
Euphoria, dis-inhibition, apathy, compulsive, hyperorality, poor memory
A
Pick’s disease/Fronto-temporal dementia
25
Cognitive, motor, sensory dysfxn, step-wise worsening
Multi-infarct dementia
26
Dementia CT findings
Diffuse cortical, subcortical atrophy
27
Early Personality changes --> memory loss
Fronto-temporal dementia/atrophy
28
Pt complains of memory loss, sign of depression
Pseudodementia - assoc w/ depression
29
Risks and Tx for idiopathic intracranial HTN
Obese (female, tetracyclines, hyperVit A (isotretinoin) --> weight loss, acetazolamide
30
Young obese female w/ HA, normal MRI, papilledema
Benign IC HTN - causes: steroids, vit A, OCP --> blindness
31
HA - worse lying flat, pulsatile tinnitus, transient vision loss, papilledema, LP >250mmHg Dx?
Idiopathic Intracranial HTN
32
Trauma --> HA, old person, gradual LOC, crescent shape on CT
Subdural hematoma - bridging veins ---> craniotomy
33
Side of head, lucid interval --> coma, CT LENS shaped
Epidural hematoma --> middle meningeal ---> craniotomy
34
Blunt head trauma w/ hypotn --> HTN, brady, dec resp + IL hemiparesis, mydriasis, ptosis, coma
Epidural hematoma --> uncal herniation -->CN III, PCA, cerebral peduncle
35
"Thunder clap" HA = instant max intenstiy, worst HA ever, CT scan, ateriogram show bleed
Subarachnoid hemorrhage --> coil or clip w/in 48hrs OR after 6 weeks + CCBs, SBP <150
36
Instant severe HA, may return in 10days with same sx
SAH d/t aneurysm --> CT, spinal, ateriogram --> clipping or coil
37
Neuro deficit/stroke, HA, coma CT bleed in caudate, putamen
Intraparenchymal bleed --> dec SBP craniotomy & VP shunt ultimately
38
Acute HA worse when lying flat, vision changes, slit-like ventricles
Idiopathic Intracranial HTN
39
Holocranial HA, diplopia, pusatile tinnitus, young obese woman, empty sella, LR palsy
Idiopathic Intracranial HTN --> MRI --> LP + pressure
40
50, new HA, jaw claudication, scalp pain, polymyalgia rheumatica
Temporal arteritis --> High dose steroids --> Bx and ESR
41
Intense UL retroorbital pain, wakes up from sleep, ptosis, miosis
Cluster HA --> 100% O2
42
Prophylaxis for cluster HA
Verapamil, lithium, ergotamine
43
Progressive HA, worse in morning, blurred vision, vomiting --> bradycardia, HTN (Cushing reflex)
Brain tumor --> MRI + high dose steroids (decadron)
44
No growth in kids, sexual dyfxn in adult, bitemporal blindness, HA
Craniophrayngioma
45
#1 CNS lesion in AIDS
Toxo = sulfadiazine + pyrimethamine, TMP-SMX for prophylaxis only
46
Multiple ring enhancing lesions on CT
Toxo
47
Multiple hypodense, non-enhanced lesions in cortical white matter, focal neuro deficits, HIV +
PML - speech, gait, vision
48
Single periventricular ring weakly enhancing lesion, + EBV DNA
Primary CNS Lymphoma ---> + EBV DNA
49
Single ring-enhancing lesion in frontal lobe, neuro deficits, sinusitis, mastoiditis, lung abscess
Anaerobic bacteria (bacteroides)
50
Non-enhancing brain lesion
PML
51
Inappropriate behavior, optic nerve atrophy + papilledema on C/L side, anosmia
Frontal lobe tumor
52
Amenorrhea, galactorrhea, HA
Prolactinoma --> r/o pregnancy, hypothyroidism, prolactin level --> MRI --> bromocriptine
53
Solitary butterfly mass w/ central necrosis, vasogenic edema
Glioblastoma multiforme
54
Ataxia, truncal dystaxia, HA, nystagmus, papilledema
Medulloblastoma = VERMIS
55
Arm & leg dystaxia, IL falling/cerebellar signs
Astrocytoma = cerebellar hemisphere/parietal lobe
56
Paralysis of vertical gaze, retraction of eyelid, IC HTN, coarse face, axillary hair
Pinealoma
57
Short for age kid, HA, inc ICP, vomiting, visual defect, calcifications above sella, NDI
Craniopharyngioma
58
Concentric whorls, psamomma bodies
Meningioma
59
Waking up with HA, vomiting, sinusitis, mastoiditis, fever and sx developing over only 1-2wks
Brain abscess --> CT or MRI
60
Progressive U/L vision loss in 5 y/o, exopthalmos, café-au-lait spots
NF-1(optic glioma)
61
Pigmented spots on lips, B/L deafness, fam hx, Chr 22
NF-2 --> Frameshift or NON-sense mutation
62
cafe au lait + hearing loss
NF-2 --> MRI + Gadolinium
63
CSF high WBC, RBC, normal protein, glucose
Herpes encephalitis
64
Short term memory loss, amnestic, confabbulation
Korsakoff - thiamine deficiency
65
Nystagmus, ataxia, unable to move eyes, confusion
Wenicke's encephalopathy
66
Rapid dementia, sharp triphasic synchronous discharges/periodic sharp waves on EEG
Creutzfeld-Jacob disease (prion)
67
Benign IC HTN path
Impaired reabs of CSF --> weight reduction, acetazolamide
68
Burning smell, NO LOC, deja-vu feeling, pt remembers well
Simple partial seizure --> Phenytoin for Parital seizures
69
Burning smell, LOC, tonic-clonic activity, incontinence
Partial w/ secondary generalization
70
Burning smell, LOC or staring + chewing, swallowing, sucking, lip smacking
Complex partial
71
<7 y/o, MR + seizure, slow spike and wave on EEG
Lenox-Gaustaut
72
Hyperventilation during EEG --> 3Hz spike and wave
Absence, 2.5Hz = atypical
73
Daydreaming, staring, decline school performance, no memory of event
Absence --> Valproic or ethosuximide
74
Sudden LOC, hemiparesis, slow to come around, restored movement in 24hrs
Todd's (post-ictal) paralysis
75
Prolonged seizures ---> ?
Cortical necrosis/hyperintensity on MRI
76
Causes of cerebellar atrophy
Anti-epileptics like phenytoin, etOH
77
Tx for myoclonus
Clonazepam and Depakote (valproic acid)
78
Hemianesthesia w/ transient hemiparesis, athetosis
Thalamic stroke (VPL) / Dejerene-Roussy
79
Avoid these drugs in Lewy body dementia
Typical anti-psych
80
Vertigo - feeling of head movement/spinning
Labyrinth disorders
81
Head spinning when getting out of bead, laying down, turning, looking up
BPPV
82
Differences in blood pressure standing vs. laying down cause
Orthostasis - Loss of extracellular Na/dehydration
83
Lightheadedness, blurry vision, syncope
Global ischemia d/t AS, arrhthymia, TIA
84
High frequency (voices) hearing loss w/ age
Presbycusis
85
Types of conductive hearing loss
Impaction (#1), otitis externa, bony growth (swimmers, scuba), Perf, infection, otosclerosis
86
Types of sensorineural hearing loss
Presbycusis (#1), noise, infection, drugs, skull fx, TORCH, Menieres, neuroma, MS
87
U/L sensorineural loss, fullness/pressure, vertigo better w/ Na restriction
Meniere's disease
88
Conductive, Low frequency hearing loss d/t overgrowth
Otoslcerosis
89
Receptive aphasia lesion
Left temporal lobe
90
Unexplained xanthochromia on LP
SAH
91
>75 y/o, lobar cranial bleed
Amyloid angiopathy
92
CL hemiparesis, sensation, tongue deviates to lesion side
Medial medullary
93
Imparied sensory and motor of CN V and limb ataxia lesion
Lateral Pontine
94
Limb ataxia, CL eye deviation, paralysis of face arm, leg lesion
Medial pons
95
IL Horner's, face, CL pain and temp lesion
Lateral medulla
96
Ocular paresis, ataxia, CL hemiplegia
Central midbrain
97
Hemiplegia, hemi-sensory loss, gaze palsy, homnomynous hemianopsia
Putamen/ Basal ganglia
98
Hemiplegia, hemi-sensory loss, upgaze palsy, eyes toward lesions, non-rx mitotic pupils
Thalamus hemorrhage
99
Deep coma, paralysis w/in minutes, pinpoint pupils
Pons hemorrhage
100
UL upper and lower facial paralysis lesions location?
Peripheral CN VII - below pons
101
Areflexia and anesthesia over shoulders and arms
Syringomyelia (Cord cavitation)
102
Knife stabbing/"blot of lightning" pain in cheek that comes and go's, unshaven area
Trigeminal neuralgia = Carbamazapine --> CBC for aplstic anemia
103
Nonfluent speech, intact comprehension, R hemiparesis, impaired repetition
Broca's area - frontal lobe MCA
104
Fluent, meaningless words, no comprehension, R superior visual defect, impared repetition
Wernicke's area - temporal lobe MCA
105
Fluent w/ pheonmic erros, intact comprehension, very poor repetition, no other deficits
Arcuate fasiculus - Parietal lobe MCA
106
Hyperreflexia, bulbar reflexes dec, spacticity, fasiculations, muscle wasting, dysphagia
ALS - both upper and lower motor neuron --> Riluzole for tx (glutamate inhibitor)
107
1st step in first unprovoked seizure
CT w/o contrast
108
Confusion, fever, rigidity, diaphoresis, recently admitted for hallucinations
NMS - Haldol
109
Upward pronator drift, RAMs
Cerebellar dysfxn
110
Downward + supination of pronator drift
UMN lesion - often STROKE
111
Acute occipital HA, repeated vomiting, ataxia, fever
Cerebellar hemorrhage
112
Saddle anesthesia, asymmetric motor weakness, hypo/areflexia, late bowel-bladder loss
Cauda equina syndrome - spinal nerve roots
113
Perianal anesthesia, symmetric motor weakness, hyperreflexia, early bowel-bladder loss
Conus medullaris syndrome
114
Hemi-neglect lesion
Opposite PARIETAL lobe
115
Hemi-paresis, aphasia lesion
Frontal cortex
116
Adult onset distal muscle weakness, atrophy, dysphagia
Inclusion body myositis
117
Macrocytic anemia (folate), inc GGT, high TG, uric acid, dec thiamine, dec testosterone
etOH abuse
118
Warfarin + cerebral hemorrhage next step
FFP & avoid drops in BP
119
Isolated symmetric B/L LE weakness, loss of sensation, UMN injury 1st step?
MRI of spine - disk, abscess, malignancy
120
Rigidity, bradykinesia, postural hypotension, impotence, incontinence, dry mouth
Shy-Drager (multiple system atrophy)
121
DM neuropathy pain tx
TCAs (not in cystopathy or orthostasis) NSAIDs (not w/ renal dysfxn), gabapentin
122
Progressive ascending paralysis over hrs-days, no prodrome or autonomic dysfxn
Tick-borne paralysis
123
REM sleep dysreg, daytime sleepiness, loss of muscle tone w/ laughing, vivid awake hallucinations
Narcolepsy --> Ritalin, planned naps
124
Ascending paralysis over days-wks, tachy, urine retention
Guillan-Barre --> IV plasmaphoresis & immunoglobulin
125
Albumino-cytologic dissociation (CSF inc protein, normal WBC, RBC, glucose)
Guillan-Barre
126
Numbness In toes --> LE weakness, URI 4 wks ago, elevated CSF protein, 3 WBC, no DTRs
Guillan-Barre --> IV plasmaphoresis & immunoglobulin
127
Split sutures, bluging fontanelle, vomiting
Inc ICP
128
Earliest neuro/CNS injury sign
Fisting >3mo, stronger, more sustained primitive reflexes
129
#1 blindness
Trachoma
130
Night terrors
NON-REM stage 4, glass-eyed, NO memory, autonomic
131
Delayed growth rate + early morning emesis
CNS mass lesion
132
Pallor, cyanosis, hypoTN, seizures, apnea, tense fontanel, brady
IVH --> prevent pre-term labor, maternal steroids
133
Risk factors for IVH
#1 = pre-mature & LBW
134
Obsessive thoughts, intrusive images
OCD = CBT + SSRI --> clomipramine or anti-psych --> deep brain stim
135
Behavior changes, urinary incontinence, torticollis, vertigo, ataxia, babinski
AA instability from Down syndrome
136
Assoc w/ CP
IUGR, TORCH, apgar <3, IVH, trauma
137
Risk factors
PRE-ME, IUGR, infection, hemorrhage, etOH, tobacco use
138
Co-morbidities
Intellect, MR, strabismus, scoliosis
139
Diurnal enuresis tx
bladder stretch and timed void
140
No anal wink cause
SC compression
141
Secondary enuresis causes
Stressors - birth, divorce, moving --> counseling
142
Vasomotor instability, skin changes, dec ROM, patchy bone demineralization + severe pain, burning throbbing after trauma
Complex regional pain syndrome
| - NO paralysis
