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Flashcards in Neuro Deck (75):
1

Posterior cerebral artery supplies what? what is deficit do?

Visual cortex affected. 4 star
middle cerebral is brocas and stuff, and and the anterior supplies legs

2

AICA occlusion?

Facial paralysis, vertigo, nystagmus, deafness tinnitus. NO MOTOR OR LIGHT TOUCH DEFICIT

3

PICA occlusion?

Wallenberg. Contralateral body and ipsilateral loss of pain and temp on face. Ipsilateral cerebellar defects like ataxia and past pointing

4

Broca aphasia

Nonfluent aphasia. Can comprehend but can't speak.

5

Wernicke aphasia

Can produce words but can't understand

6

Conduction aphasia

Can't repeat. no ifs and or buts

7

Dorsal columns carry leg and arm sensation where?

What about in the corticospinal?

Arms outside, legs inside, just like a person. (arms are outside of legs)

Legs are lateral, so it is opposite.

8

What is not fed blood supply from anterior spinal artery?

The dorsal columns

9

Amyotrophic lateral sclerosis affects what tracks?

corticospinal (UMN symptoms: spastic paralysis EVERYTHING IS UP(per) so up spasticity and reflex)

Anterior horn: LMN symptoms
so flaccid paralsis as well (because synapsed before getting to anterior horn)

10

Poliomyelitis affects where?

Polio means gray, so it affects gray matter (anterior horn)

Flaccid paralysis

11

Tabes dorsalis affects where? Useful test for it

DORSALis affects dorsal, so impaired proprioception and gait/balance problems

Romberg test. Vision eliminated and patient has poor proprioception and they will tip over

12

*** B12 deficiency affects what?
WORK ON THAT

Dorsal columns and corticospinal tract.

So spastic bilateral and vibe sense loss

13

Brown squared is what?

ipsilateral loss of vibration and discrimination

Ipsilateral loss of vibe and discrimin
Ipsilatral spastic paralysis, ipsilateral flaccid paralysis
contralateral loss of pain and temp below the lesion

14

Argyll robertson pupil?

Tertiary syphilis. Accommodates but nonreactive to light.

Also have tabes dorsalis.

15

What brain lesion causes hemiballismus?

Subthal nucleus. It is flailing of the limbs.

16

*** What lesion causes agraphia?

Dominant parietal lobe

17

What lesion causes hemispatial neglect?

Nondom parietal lobe

18

Where does dorsal column decussate?

Medulla

19

Latreal corticospinal tract crosses wehre?

medullary pyramids

20

Meningitis and purpura?

Think neisseria

21

*** Meningitis with gram positive rods and coccobacilli is what bug?

Listeria list of shapes

22

Small pleomorphic gram negative coccobacilli in meningitis is what?

H influ

23

CSF is different in fungal/tb than it is in bacterial meningitis how?

WBCs are lymphocytes in fungal/tb where in bacterial it is neut

24

*** CT before lumbar puncture is when?

Seizure or focal defects or papilledema

25

*** What causes meningitis in less than a month old baby? What do you give?

E coli, GBS (always consider in sick kid) or listeria

Give amp with cefotaxime or gent

26

*** Over age of 60 meningitis? or debilitating disease

S pneumo is one, then listeria, then N meaning then gram negative

Treat empirically with
Ampicillin (listeria coverage), vanc, cefotaxime/ceftriaxone
GIVE IV DEXAMETHASONE

27

Longterm complicaitons of mening?

How do you help prevent them

Hearing loss, seizure disorder, intellectual disability, spastic paralysis (especially in kids)

DEXAMETHASONE

28

What causes viral meningitis?

enterovirus, so think echovirus, coxcaki, enterovirus.

Herpes can sometimes

29

Tx of viral meningitis?

Tylenol pain, IV fluids, bacterial meningitis excluded, ACYCLOVIR if suspicion of HSV or focal findings

30

Encephalitis HP?

Malaise headache neck pain vomit (just like meningitis)

BUT ALTERED Consciousness, or or change mental status or focal defects

31

What causes temporal lobe encephalitis?

Herpes

32

*** West nile can cause severe symptoms which include what?

How do you dx?
How do you treat?

Flaccid paralysis by anterior horn involvement. Alterations in consciousness (encephalitis) and possible death

Dx serology for IgM
Tx supportive

33

Reye sydnrome affects what?

H and P?

Encephalitis brain and liver. Significant hypoglycemia

Rash, vomit, elevated LFTs headache and lethargy

From aspirin after viral illness

34

Brain abscess is caused by what?

They are ring enhancing lesions on MRI! b/c cavitation

think about history. IF ear infection, s pneumo. If in hospital with neuro surg think staph

35

Treatment of abscess if from oral spread?

metronidazole with 3rd gen cep
corticosteroids
drainage

36

If from hematogenous spread or near procedure in brain abscess give what?abscess?

Give cef and vanc
corticosteroids
drainage

37

Poliomyelitis cause what symptoms?

Dx?

Muscle weakness and flaccid paralysis b/c motor neurons (MAKES SENSE B/c remember atrophied leg) anterior horns

Dx b/c antibody
LP for viral meningitis
Viral culture

38

Reye syndrome does what three things?

Hypoglycemia, liver and brain issues

39

*** Toxoplamosis is suspected if? Dx?

Tx?

Encephalitis in HIV with CD4 less than 100. Positive Toxo IgG antibody

Multiple ring enhancing lesions

Tx with sulfadiazine, pyrimethamine

40

Tx of headaches

Tension headache:

Cluster

Migraine

tension: NSAIDs usually, maybe triptans

Cluster: 100% oxygen

Migrain: triptan, ergots (they are both constrictors, be careful with symptoms and pregnancy!!! can't vasospasm preggers!

41

***Migraine prophylaxis

CCBs (verapamil)
Beta blockers
TCAs
NSAIDs
Antiseizure meedslike valproate

CONSIDER comorbiditis

42

***Tx of psuedotumor cerebra?

Confirm with LP and rule out others with CT/MRI

D/c vitamine A, TCAs
Weight loss
ACETAZOLAMIDE
Invasive option: serial lumbar punction, shunting

43

**** Headache with extra ocular muscle palsy?

Cavernous sinus thrombosis, REMEMBER THE NERVES RUN THROUGH IT

44

Bilateral trigeminal neuralgia?

How do you treat if not due to the pathology?

MS

tx anticonvulsants
FIRST LINE is carbamazapine

45

Lacunar TIA?

occlusion of small arteries from middle cerebral to deep part of the brain

46

TIA prompts what tests?

CT (faster for bleeding) or MRI (better for infarct), US of carotid, Echo for embolus eval, MRI or CT angiogram

Patent foramen or heart aneurysm

47

Tx of TIA?

Antiplatelet, antilipid, anti htns

Antiplatelet: Clop or aspirin and dypyridamole
Antilpid: high statin in all patients
BP if over 140/90
Embolic: warfarin (Need bridge as following) and HEPARIN or dabigatran, rivaroxaban or apixaban

48

What is dabigatran?

one of the embolic therapies to bridge with warfarin

49

Carotid endarterectomy indications?

Symptomatic patients with narrowing of 70-99%, no need if 100% b/c compensated

Symptomatic men 50-70%

Asymptomatic if 80 or more and surgeon is experienced and life is expected 5+ years

50

*** basilar artery occlusions cause what symptoms?

contralateral weakness.

If complete occlusion, you get hemiparesis and vertigo

51

Lacunar arteries lesions

Variety of symptoms, focal or motor sensory deficits.

They are affecting just one side of the body.

ABSENT CORTICAL SIGNS

52

Stroke contraindications for alteplase?

More than 4.5 hours old. Recent hemorrhage or surgery, hypertensive urgency

53

What length of time is required for thrombolytics?

4.5 for systemic, if you can do it localized, you have up to 6 hours but need a specialist

54

Other meds for strokes? Acute vs long term?

Read last line of this

Aspirin ASAP unless thrombolytis, then you wait 24 hours
Long term prevention of clop or aspirin and dyspyrdamole
High statins in all patients
Don't treat hypertension acutely unless 220/120 or if have CAD

55

Hemorrhagic brain bleeds keep BP at what? What else do you do?

less than 200
Mannitol
Hyperventilation: PaCO2 of 25
Surgical decompression if necessary
Elevate bed

56

First line treatment for trigeminal neuralgia?

Carbamazapine

57

Two syndromes associated with berry aneurysms?

Ehler danlos and ADPKD

58

Subarachnoid dx?

CT scan and if negative, getLumbar Puncture. Blood or yellow!

Cell count of first and last in lumbar puncture to make sure it is not from traumatic puncture!

59

*** Meds to lower BP in subarachnoid? What is bp goal?

Goal is below 150 if cognitive function intact.

Labetalol is used, no nitros b/c they increase ICP
Nimodipine can be used
Tx is surgical clipping or coil

60

Do you give phenytoin if subarachnoid hemorrhage?

no!

61

Parenchymal hemorrhage is hemorrhagic stroke. BUT NOT SUBARACHNOID HEMORRHAGE! What is CT finding?

Focal motor or sensory deficits, headache, seizures, LOOK FOR CT for BRIGHT COLOR

62

Adult with new seizure? What caused it?

Idiopathic, metabolic like hyponatremia or hypoglycemia, drugs, drug withdrawal, trauma, neoplasm

63

*** Famous adult infections causing seizures?

Toxoplasmosis, neurocysticercosis, HSV

64

What do you give to patients getting isoniazid?

B6 b/c it gets absorbed and could get seizures!

65

Big time drugs causing med induced seizure?

Theophyline, Bupropion, narcotics, Psychostim, phenycyclidine (PCP), antipsych, antibiotics,

66

*** Partial seizure is what?

What part of brain affected?

Only in part of the brain. Preceded by aura like burning tires

Temporal affected

67

Simple partial vs complex?

Simple does not lose consciousness, but have purposeless movements or parenthesis

Complex partial: hallucinations POST ICTAL STATE! temporal lobe

68

Petite mal EEG finding?

Aka absence seizures Three cycle per second spike wave pattern. no post octal state

69

Tx for status epilepticus

How do you prevent recurrence in acute setting?

ABCs
IV/IM benzo
IV barb if no working
Phenytoin to prevent recurrance

70

*** Phenytoin side effects

Phenytoin Has Given MDs Frustration

Peripheral neropathy
Hirsutism
GINGIVAL HYPERPLASIa
metabolic anemia from folate absorption issue
Drug induced Lupus
Steven Johnson
Fetal hydantoin

71

fetal hydantoin syndrom is what?

Cleft lip, palate, congee heart disease, developmental delay

72

*** Stephens johnson drugs?

Seizure drugs including lamotrigine, SULFAs and PENICILLINS and ALLOPURINOL

73

Drugs that cause agranulocytosis?

C drugs
Carbamazepine
Clozapine
Colchicine
PTU and methimazole

74

What are two big side effects to remember for valproic aid and carbamazepine?

Hepatotoxic and spina bifida

75

Cyp p450 inducers?

Coronas Guiness and PBRs induce chronic alcoholism

Carbamazepine
Griseofulvan
Phenytoin
Barbiturates
Rifampin
St. Johns Wart