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Flashcards in Neuro Deck (142)
1

Younger pt, asymmetric resting tremor, 4-5Hz

Early Parkinson --> trihexyphenidyl

2

Chorea, behavior disturbances, irritable, withdrawn disease and CT findings

Huntington = atrophy of caudate, large lateral ventricles

3

Broad-based gait, dysmetria, nystagmus, intention tremor, etOH abuse

cerebellar dysfunction/atrophy

4

Tremor when moving limb, goes away when relaxed

Essential tremor --> etOH, propanolol, primidone, gabapentin

5

Resting tremor, rigidity, bradykinesia, postural instability, asymmetric onset, inaudible speech

Parkinson

6

Tx Parkinson tremor

DA - levodopa

7

Tx Parkinson motor fluctuations, dyskinesia

Selegiline (MAOB), entacapone, tolcapone (COMT)

8

Tx Tourette syndrome

#1 = Clonidine --> guanfacine, pimozide, haldol, fluphenazine, trifluroperazine

9

Co-morbidity w/ Huntington

Depression --> suicide

10

Tx helpful for Huntington chorea

Tetrabenazine delplete DA

11

Sx Tx for Huntington

Haldol

12

Twisting, repetitive, abnormal posture

Dystonia - metaclopramide, prochlorperazine

13

Unilateral, violent arm movements

Hemiballismus - CL subthalamic nucleus

14

Broad-shuffling gait, memory loss, urinary incontinence, ventricular enlargement

NPH - dec CSF abs

15

Tremor in legs immediately when standing, gone with sitting, 14-18hz

Orthostatic tremor

16

Multiple, B/L periventricular plaques, heat sensitivity, new hemiplegia, incontinence tx?

MS exacerbation = steroids

17

Tx in relapsing-remitting or secondary MS

Glatiramer or beta-interferon

18

Inc IgG index, paraplegia, incontinence, dec vibratory and proprioception, spastic reflexes

MS - oligoclonal bands

19

Tx that Dec frequency, slow progression of RR form of MS

IF-beta; steroids if acute

20

Tx of progressive MS

Cyclosporine, MTX, Mitoxantrone

21

R UE, L LE weakness, ataxia, central vision defect, eye pain worse w/ movement

MS --> MRI w/ cerebral & cerebellar plaques

22

Fluctuating MS, visual hallicunations, spontaneous parkinsonism but dopa not helpful

Lewy body dementia (eosinophilic intracytoplasmic inclusions of alpha synuclein)

23

Memory loss, language difficulties, cortical atrophy

Alzheimer dementia

24

Euphoria, dis-inhibition, apathy, compulsive, hyperorality, poor memory

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