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ICM II > Neuro > Flashcards

Neuro Flashcards

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1
Q

What is the difference between arousal and awareness? In what parts of the brain do they arise?

A
  • Arousal
    • vegetative function
    • brainstem and RAS (diencephalon)
  • Awareness
    • cognitive and affective function
    • cortex
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2
Q

What is included in a neuro exam for a possible coma patient?

A
  • C = level of consciousness
  • O = Ocular motility and pupils
  • M = Motor response
  • A = Airway and breathing
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3
Q

What does fruity breath signify in a possible coma patient?

A

Diabetic ketoacidosis

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4
Q

What does fishy breath signify in a possible coma patient?

A

Hepatic failure

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5
Q

What does musty breath signify in a possible coma patient?

A

Renal failure

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6
Q

If the patient has a hemispheric lesion, where will the eyes and head deviate?

A

Toward lesion

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7
Q

If the patient has a brainstem lesion, where will the eyes and head deviate?

A

Away from the lesion

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8
Q

If the patient’s pupils are in a mid-position and non-reactive, where is the lesion?

A

Midbrain

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9
Q

If the patient’s pupils are dilated on one side and non-reactive, where is the lesion?

A

CN III paralysis

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10
Q

If the patient’s pupils are small but reactive, where is the lesion?

A

Pontine

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11
Q

If the patient’s pupils are pinpoint but reactive, what is the cause?

A

Opiate intoxication

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12
Q

In the oculocephalic reflex, if the patients head is moved to one side, where should the eyes move?

A

To the opposite side (to stay focused on the same thing)

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13
Q

In the oculovestibular reflex, cold water in the ear should cause the eyes to move where? Warm water?

A

COWS: Cold water = Opposite; Warm water = Same

Cold water = nystagmus to opposite side

Warm water = nystagmus to same side

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14
Q

What part of the brain is responsible for inducible reflex lateral eye movements?

A

Pons and midbrain

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15
Q

If a patient lacks inducible reflex eye movements with the doll’s eye maneuver but has preserved pupillary reactivity, what is the likely diagnosis?

A

Drug intoxication

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16
Q

If patient presents with decerebrate rigidity (extended arms and legs), where is the lesion located?

A

upper brainstem (between red nucleus and vestibular nucleus)

Midbrain or pontine level

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17
Q

If the patient presents with decorticate rigidity (extended legs and flexed arms), where is the lesion located?

A
  • level of diencephalon or above
    • hemispheres
    • internal capsule
    • thalamus
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18
Q

Where is the lesion if an unconscious patient presents with small reactive pupills, full conjugate lateral eye movements, and an appropriate motor response?

A

Early diencephalic

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19
Q

Where is the lesion if an unconscious patient presents with small reactive pupills, full conjugate lateral eye movements, and decorticate rigidity?

A

Late diencephalic

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20
Q

Where is the lesion if an unconscious patient presents with midposition, fixed pupills, dysconjugate lateral eye movements, and decerebrate rigidity?

A

Midbrain

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21
Q

Where is the lesion if an unconscious patient presents with midposition, fixed pupills, absent lateral eye movements, and lack of a motor response?

A

Pons or Medulla

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22
Q

What are the possible causes of Cheyne-Stokes respiration?

A
  • Definition
    • Hyperpnea alternating with apnea
  • Causes:
    • Diffuse bilateral cerebral hemispheric dysfunction
    • Diencephalic dysfunction
    • CHF
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23
Q

What are the possible causes of central neurogenic hyperventilation?

A
  • Definition
    • sustained rapid and deep hyperpnea
  • Cause:
    • Lower midbrain or pons lesion
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24
Q

What is the cause of Apneustic breathing?

A
  • Definition:
    • end inspiratory pause alternating with end expiratory pause
  • Cause
    • Lwr pontine lesion
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25
What is the cause of Ataxic breathing?
* Definition * irregular breathing pattern * Cause: * Medullary lesion
26
What is invaded/ destroyed in a supratentorial lesion? What are some causes?
* Damage to diencephalon * Causes: * cerebral hemorrhage * tumor * Encephalitis
27
What is compressed in a subtentorial lesion? What are some causes?
* Compresses * midbrain-pontine reticular formation * Causes * Pontine or cerebellar hemorrhage * Infarction * Tumor
28
What size lesion does a CT detect? What type of lesion is best visualized? What is the advantage over an MRI?
* Size * \>5mm * Type of lesion * best for acute hemorrhage * Advantage * faster than MRI
29
What size lesion does an MRI detect? What can prevent a patient from being able to get an MRI?
* Lesion * 1-2 mm * Exclusion * people with metallic objects like pacemakers, aneurysm clip
30
What is the treatment for raised intracranial pressure from a brain tumor?
IV steroids
31
What is the treatment for diabetic ketoacidosis?
Insulin
32
What is the treatment for opiate overdose?
Naloxone
33
What is the treatment for benzodiazepine overdose?
Flumazenil
34
What is the treatment for ETOH abuse?
Thiamine
35
What is the treatment for hepatic encephalopathy?
Lactulose
36
What is a vegetative state?
* Arousal without awareness * Termed persistant after 4 weeks * Vegetative after: * 3 months (non-traumatic) * 12 months (traumatic)
37
What is a locked-in state?
* Patient is awake and aware * Reactive pupils * **Preserved voluntary vertical eye movements and blinking only** * Otherwise paralyzed
38
What is Brain Death?
* Irreversible damage that leaves the brain incapable of maintaining homeostasis of body * Unperceptie/Unresponsive to pain (Cortex) * Unreactive pupils (Midbrain) * Absent reflex eye movements (Pons) * Apnea (Medulla)
39
Patient reports severe headache with maximal intensity at onset ("thunderclap headache") and neck stiffness. What is the diagnosis? What is the cause?
* Diagnosis * Subarachnoid hemorrhage * Cause * Ruptured aneurysm (most common) * Ruptured AVM
40
What is the cause of subdural hematomas?
Tearing of bridging veins from trauma
41
Patient describes a headache following head trauma. They had a period of lucidity then deteriorating mental status. What is the diagnosis? What is the likely cause?
* Diagnosis: * Epideral Hematoma * Cause: * Damage to middle meningeal artery * Imaging * Convex (like a lens) * b/c expansion stops at skull sutures
42
What is shown?
Epidural Hematoma * Convex shape (like a lens) * b/c expansion stops at skull sutures
43
How can you tell the difference between an epidural hematoma and a subdural hematoma via imaging? Why does this occur?
* Epidural * Convex in shape (like a lens) * b/c expansion stops at skull sutures * Subdural * Concave in shape * expansion not limited by sutures
44
Patient describes a headache that is increasing in severity. What is the diagnosis? What are some possible causes?
* Diagnosis: * Intracerebral Hemorrhage * Causes: * HTN * anticoagulation
45
What is shown?
Acute Subdural hematoma * Hyperdense * Concave toward brain * Not limited by suture lines
46
What is shown?
Subarrachnoid hemorrhage Can see temporal horns from increased ICP
47
What is shown?
Chronic Subdural Hematoma * Dark color from CSF * Concave
48
What is shown?
Subarachnoid hemorrhage White fluffy stuff in sulci
49
What is shown?
Intracerebral Hemorrhage
50
Patient describes unilateral head pain preceded by bright zigzag lines. What is the diagnosis? How is it treated?
* Diagnosis * Classic migraine * Treatment * Triptans (only with acute!)
51
Patient describes unilateral headpain with hemiparesis and paresthesia. What is the diagnosis?
Complex migraine | (includes other neuro symptoms)
52
Why can triptans not be used with complex migraine?
It can cause a stroke
53
Patient describes headpain located more occipitally and neck pain. What is the diagnosis?
Tension headache
54
Patient describes a "pressure" in the head located more frontally. What is the diagnosis?
Sinus headache
55
Patient describes unilateral, sharp head pain that occurs multiple times a day. Other symptoms include ipsilateral corneal injection, tearing, and rhinorrhea. Symptoms normally last a few weeks and then disappear for a few months. What is the diagnosis?
Cluster headache
56
What medications can cause headache if used in excess?
* Triptans * NSAIDS * Tylenol
57
The vertebral a is a branch of which artery?
1st branch of the subclavian
58
The ophthalmic a is a branch of which artery?
Internal carotid | (clot here can cause vision problems)
59
Patient experiences episodes of focal neurological dysfunction. There is no brain tissue infarct. What is the diagnosis?
TIA
60
A patient experiences transient loss of vision in one eye. What is the disease? What is the cause?
* Disease * Amaurosis Fugax * Cause * extracranial carotid artery disease (internal CA) with retinal emboli
61
Patient presents with left-sided hemiparesis and sensory impairment that is more pronounced in the arms in addition to homonymous hemianopsia of the left fields. Eyes are deviated to the right. What is the diagnosis?
MCA Stroke on right side * Contralateral hemiparesis and sensory impairment * arms \> legs * Contralateral homonymous hemianopsia * Look toward the lesion (cortical)
62
What is the gaze preference in a cortical lesion? In a brainstem lesion?
* Cortical * eyes look toward lesion * Brainstem * eyes look away from lesion
63
Patient presents with left-right confusion, finger agnosia, acalculia and agraphia. What is the diagnosis?
Gerstmann's syndrome
64
Lesions in what area of the brain cause agraphia?
Angular and supramarginal gyri
65
Anosognosia (neglect) occurs in which hemisphere?
Non-Dominant
66
Patient presents with left-sided hemiparesis and sensory impairment that is more pronounced in the legs, abulia, personality change, and release signs. What is the diagnosis?
ACA stroke on right * Contralateral hemiparesis and sensory impairment * legs \> arms * Cognitive and personality effects * Frontal lobe release signs
67
Patient presents with left-sided arm and leg weakness and decreased proprioception and vibration sense. The tongue is deviated to the right. What is the diagnosis?
Medial Medullary Syndrome on Right \*Occlusion of Anterior Spinal artery\* * Contralateral weakness * CST and pyramids * Contralateral loss of proprioception and vibration * Medial lemniscus * Tongue deviation toward side of lesion * Hypoglossal nucleus
68
Patient presents with left-sided arm and leg numbness, right-sided facial numbness and ataxia, dysphagia, Horner's syndrome, and vertigo. What is the disease?
Lateral Medullary Syndrome on Right \*caused by occlusion of PICA (or VA)\* * Contralateral arm and leg numbness * STT * Ipsilateral facial numbness * Spinal trigeminal tract * Ipsilateral ataxia * ICP * Dysphagia * nu ambiguus * Horner's * descending sympathetics * Vertigo * Vestibular nuclei
69
Patient presents with hearing loss and facial weakness. What is the diagnosis?
AICA stroke
70
Patient presents with Diplopia, dysconjugate eye movements, gaze palsy with eyes looking to side of hemiplegia, and limb ataxia. What is the diagnosis?
Basilar artery stroke "Crossed findings are the hallmark of brain stem stroke" (does not elaborate)
71
Patient presents with homonymous hemianopsia with macular sparing and memory difficulties. No other focal symptoms are found. What is the diagnosis?
Posterior cerebral artery | (occipital and temporal lobes supplied)
72
What causes alexia without agraphia?
Lesion involving left occipital lobe and splenium of corpus callosum Disconnection syndrome (fyi: supplied by PCA)
73
What is the cause of Cortical blindness (aka Anton syndrome)?
Bilateral PCA stroke
74
What is lacunar syndrome?
Small, focused stroke located anywhere | (absence of large vessel symptoms)
75
What causes hemiballismus?
infarction of the subthalamic nucleus
76
What treatment is used for cardioembolic stroke?
Anticoagulants
77
What treatment is used for non-cardioembolic ischemic stroke prevention?
Antiplatelets (Aspirin)
78
When can tPA be used?
w/i 3 hours of stroke if caused by clot
79
Where is the most likely site of a bleed from HTN injury?
Putamen
80
What symptoms are associated with intracerebral hemorrhage?
Symptoms of increased ICP * Headache * vomiting * lethargy
81
Patient presents with headache, nausea, hemiplegia and homonymous hemianopsia. What is the diagnosis?
Intracranial hemorrhage in Putamen * Hemiplegia * from pressure on internal capsule * Hemianopsia * from pressure on optic radiations
82
Patient presents with headache, nausea, sensory and motor deficit, and limited eye movements. What is the diagnosis?
Intracranial hemorrhage in Thalamus
83
Patient had an acute headache, nausea and vomiting before losing consciousness. Patient currently has pinpoint pupils. What is the diagnosis?
Pontine hemorrhage
84
Patient presents with occipital headache, nausea, vertigo, and ataxia. What is the diagnosis?
Cerebellar hemorrhage \*\*\*needs rapid surgical treatment\*\*\*
85
What is commonly associated with subarachnoid hemorrhage?
1. **Polycystic kidney disease** (most important) * History of renal failure * Find cyst on scan 2. HTN 3. Smoking
86
What layer of tissue is missing in aneurysms?
Internal elastic lamina
87
Where are aneurysms most likely to rupture?
Posterior circulation
88
Patient presents with acute onset of the worst headache ever experienced then lost consciousness. What is the likely diagnosis?
Aneurysm rupture (subarachnoid hemorrhage) "thunderclap headache"
89
What is the definition of epilepsy?
2 or more unprovoked seizures
90
Which type of seizure is preceded by an aura? What are common auras?
* Seizure type: * Simple partial * Auras * Sense of fear * Rising sensation * Unusual odor
91
What is the typical EEG pattern of absence seizures?
3 Hz Spike and wave discharges
92
What are the risk factors for seizure?
* Family history * Febrile seizures * Head injury with significant loss of consciousness * Meningitis/Encephalitis
93
Patient presents with gait disturbance, bradykinesia, and progressive loss of eye movements with preservation of oculocephalic reflexes. No tremor is present, and symptomatic response to dopamine is poor. What is the diagnosis?
Supranuclear Palsy * Differences from Parkinson's * No tremor * loss of eye movements with preservation of oculocephalic reflexes * Symptomatic response to DA is poor * Neurofibrillary tangles form
94
Patient presents with ataxia, cerebellar dysmetria, and abnormal limb coordination and smooth pursuit eye movements. What is the disease? What cytoplasmic inclusions are found in brainstem nuclei?
* Disease * Olivopontocerebellar atrophy * Inclusions: * alpha-synuclein
95
Patient presents with bradykinesia, symmetric rigidity, and postural instability. There is no tremor and the patient is refractory to levadopa. What is the diagnosis?
Striatonigral degeneration
96
Patient presents with early autonomic dysfunction, bradykinesia, rigidity and postural instability. What is the diagnosis?
Shy-Drager syndrome
97
What does the suprachiasmatic nucleus control? How is it regulated?
* Controls sleep/wake cycle * Regulated by light
98
What stage of sleep is characterized by K complexes and sleep spindles on EEG?
Stage 2
99
Delta waves are present in the EEG of what sleep stages?
Stages 3 & 4
100
What is the sleep phase of a "night owl"?
Delayed Sleep phase * Tired all day except evening
101
What is the sleep phase of an "early bird"?
Advanced Sleep Phase * Wake early * Fatigue in late afternoon/ evening
102
What is the duration and number of respiratory cycles affected in sleep apnea?
* Duration: 10 seconds * Cycles: 2
103
What is the effect of the Chiari Malformation on sleep?
Central obstructive sleep apnea | (brain doesn't tell you to breathe)
104
What are the health effects of obstructive sleep apnea?
* Pulmonary HTN * CHF
105
What is the primary treatment of obstructive sleep apnea?
Continuous Positive Airway Pressure (CPAP)
106
What is REM Behavior Disorder?
Disappearance of muscle atonia in REM sleep causes people to act out their dream
107
What is the only required symptom to diagnose narcolepsy? What other symptoms are often present?
* Required: * excessive daytime sleepiness * Others: * Cataplexy (weak / paralyzed with emotion) * Hallucinations * Sleep paralysis * REM shows up very early in sleep Think of it as "bits of REM showing up in wakefulness"
108
What is the primary test used to diagnose sleep disorders?
Polysomnogram
109

ICM II (12 decks)

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