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Flashcards in Neuro Deck (211):
1

RF stroke

HTN
DM
Hyperlipidemia
Smoking

2

Causes of stroke

Ischemic - 85%
Hemorrhagic - 15%

3

Embolic origins of stroke

#1 Heart - AF (MC), valvular disease, paradoxical DVT
#2 Carotid stenosis

4

MC artery occluded in stroke

Middle cerebral

5

Sx in MCA stroke

Weakness and sensory loss on opposite side
Homonymous hemianopsia (eyes look at lesion)
Aphasia

6

Sx in ACA stroke

Personality/cognitive defects (confusion)
Urinary incontinence
Leg more than arm weakness

7

Sx PCA stroke

LOC
Ipsilateral sensory loss in face and CN IX, X
Contralateral sensory loss of limbs
Limb ataxia

8

Best initial test for any stroke

CT head w/o contrast

9

Most accurate test for stroke

MRI

10

Why is CT done before MRI in stroke

R/O bleeding

11

Best initial therapy for stroke

3hrs - Aspirin
Hemorrhagic - Nothing

12

Patient on aspirin has stroke

Add dipyridamole
OR
Switch to clopidogrel

13

When is a Penumbra catheter indicated (clot retrieval)

Within 90min then thrombolytics if unsuccessful

14

Rx if damage valves caused stroke

Surgery

15

Rx if thrombi caused stroke

Heparin then warfarin to INR 2-3

16

How to determine heart source of stroke

Echo

17

Rx for AF on EKG which caused stroke

Warfarin to INR 2-3

18

EKG normal but suspected heart etiology of stroke

24-48hr Holter monitoring

19

Sx cerebrovascular disease w/ >70% stenosis

Surgical correction

20

No CEA

21

100% carotid stenosis

No CEA (that side is "protected")

22

Control DM to prevent stroke

HbA1c

23

Control HTN to prevent stroke

140-160

24

Control LDL to prevent stroke

25

Control BP in Hemorrhagic stroke

Target - 140-160
>170 give Nicardipine, Enalaprat, Labetalol

26

MC headache

Tension

27

Light causing photophobia

Bright
Natural

28

Inducing factors in Migraines

Visual disturbance
Photophobia
Aura
Menses
Food (men)
Emotions (women)

29

Features of Cluster headaches

Frequent
Short duration
High intensity
M 10x > W

30

Features giant cell arteritis

Visual disturbance
Systemic sx
Jaw claudication

31

Association with pseudotumor cerebri

Obesity
Venous sinus thrombosis
OCPs (taken off market)
Vit A tox

32

Physical findings in migraines

Rarely aphasia/numbness/dysarthria/weakness
- Looks like stroke

33

PE results on cluster HA

Red tearing eye with rhinorrhea (ipsi)
Occasional Horner's

34

What must be evaulated for HA w/ red eye

Glaucoma

35

PE results for giant cell arteritis

Visual loss
Tenderness in temporal region (ipsi)

36

PE results for pseudotumor cerebri

Papilledema with diplopia from CN VI palsy

37

Dx test in 1st time migrain/cluster/pseudotumor cerebri presentation

Head CT to exclude masses

38

Features of tension HA

B/L
Lasts 4-6hrs
Temple/occipital pressure relieves

39

Dx sequence for pseudotumor cerebri

Head CT
LP for increased pressure

40

First step in management of giant cell arteritis

Steroids before Bx
Bx is most accurate test

41

NSAIDS AE

Aseptic meningitis
↑LTs → Bronchoconstriction and ↑Mucous
Gastric ulcers
Interstitial nephritis
Papillary necrosis

42

Rx tension HA

NSAIDs and other analgesics

43

Rx Migraine

Triptans or ergotamine as abortive therapy
Proclorperazine for monotherapy w/ vomitting

44

Rx cluster HA

Triptans or ergotamine first
100% O2
Li

45

Rx temporal arteritis

Prednisone

46

Rx Pseudotumor cerebri

Weight loss
Acetazolamide
Steroids
Repeated LP to lower pressure
VP shunt
Cut into optic nerve

47

Cluster HA PPx

Verapamil
Li
Prednisone

48

When to give PPx for migraines

3-14 per month

49

Best PPx for migraines

Propranolol

50

Other PPx for migraines

CCBs
TCAs (not in elderly)
SSRIs (only with concurrent anxiety/depression)
Topiramate
Botox (good for breakthrough)

51

What is trigeminal neuralgia

Idiopathic CN V disorder
Overwhelming facial pain

52

Precipitants of trigeminal neuralgia attacks

Chewing
Touching face
Pronouncing certain words

53

Dx test in trigeminal neuralgia

None

54

Best Rx trigeminal neuralgia

Oxcarbazepine
Carbemazepine

55

Other Rx trigeminal neuralgia

Baclofen
Lamotrigine

56

Rx trigeminal neuralgia if meds fail

Gamma knife surgery

57

What is postherpetic neuralgia

Zoster reactivation along CN V

58

Is their pain with resolution of zoster vesicles in postherpetic neuralgia

15%

59

Rx postherpetic neuralgia

Antiherpes meds
- Acyclovir

60

Pain reduction in postherpetic neuralgia

TCAs
Gabapentin
Pregablin
Carbamazepine
Phenytoin
Topical capsaicin

61

Prevention of zoster

Zoster vaccine

62

Types of seizures

Partial → focal
Absence
Generalized
Status epilepticus

63

Causes of generalized tonic/clonic seizures

↓/↑ Na
↓ Glucose
↓ Ca
↓ Mg
Hypoxia
CNS infection/anatomic abnormality
Uremia
Hepatic failure
EtOH/barb/benzo withdrawal
Cocaine tox

64

When to do EEG for seizures

NL CT/MRI/metabolic panel

65

Confusion is to coma ans seizure as

Angina is to MI

66

What is epilepsy

Seizures of unclear origin

67

Best initial therapy for status epilepticus

Benzos

68

Subsequent status epilepticus meds if condition persists

Phenytoin
Barbs
NM blockage
Generalized anaesthesia
Intubate

69

AE IV Phenytoin

Hypotension
AV block

70

When to start Rx for 1st time seizure

Status epilepticus
Abnormal EEG
FHx seizures

71

Rx absence seizures

Ethosuximide

72

Alternative seizure meds

Gabapentin
Topiramate
Lamotrigine
Oxcarbazepine
Levetiracetam

73

When to discontinue seizure meds

Seizure-free for 2yrs

74

Best way to tell if there is possibility of seizure recurrence

Sleep deprivation EEG

75

Where are most aneurysms causing SAH

ACA in circle of willis

76

Most frequent conditions with brain aneurysms

PCKD
Tobacco smoking
HTN
Hyperlipidemia
Alcoholics

77

MC presentation of SAH

Severe HA with meningeal irritation
- Stiff neck, photophobia, fever
LOC in 50%
Focal complications in 30%

78

Differences in SAH from meningitis

Very sudden
LOC

79

Best initial test for SAH

Head CT w/o contrast

80

Most accurate test for SAH

LP with blood

81

What is Xanthochromia

Yellowish discoloration of CSF 2/2 RBC breakdown

82

Normal WBC:RBC in CSF

1:500-1000

83

What does an elevated WBC:RBC in CSF indicate

Meningitis

84

How to locate aneurysm site

CT angiography

85

Rx SAH

Nimodipine - Prevent subsequent
Embolization - Prevent repeat
VP shunt - Only if there is hydrocephalus
Seizure PPx - Phenytoin only if there is seizure

86

Why is preventing rebleading in SAH so important

50-70% who rebleed will die

87

Who gets ASA

MVA
High velocity trauma

88

Sx in ASA

No pain and temp
Position and vibration intact
Flaccid paralysis below infarct
Loss of DTRs

89

Causes of subacute degeneration of the spinal cord

B12 def
Neurosyphilis

90

Sx in subacute degeneration of the spinal cord

Position and vibration lost

91

Features of spinal trauma

Acute limb weakness +/- sensory loss below lesion
Sphincter function impaired
Loss of DTRs at level
Hyperreflexia below lesion

92

Rx spinal trauma

Steroids

93

Brown-Sequard features

Ipsi motor, position, vibration lost
Contra pain, temp lost

94

What is syringomyelia

Fluid-filled dilated central canal

95

Causes of syringomyelia

Tumor
Severe trauma
Congenital

96

Sx of syringomyelia

Loss of pain and temp cape-like
Loss of reflexes and muscle atrophy

97

Most accurate test for syringomyelia

MRI

98

Best rx syringomyelia

Removal of tumor
Drainage of fluid

99

Where do brain abscesses spread contiguously from

Sinuses
Mastoid air cells
Otitis media

100

Extracranial causes of brain absceses

PN or endocarditis leading to bacteremia

101

Sx of brain abscesses

HA
N/V
Fever
Seizures
Focal neuro deficits

102

Can CA give fever

Yes

103

Best initial test for brain abscess

CT or MRI
w/ and w/o contrast

104

Most accurate test for brain abscess

Brain bx

105

Rx duration of brain abscesses

6-8wks IV then 2-3mos oral

106

Empiric Rx brain abscesses

PCN + metro + ceftriaxone/cefepime

107

High risk organism causing brain abscess after neurosurgery

Staph epi and MRSA
Give vanco instead of PCN

108

Neuro abnormalities in tuberous sclerosis

Slowly progressing mental deterioration
Seizures

109

Skin abnormalities in tuberous sclerosis

Ash leaf patches
Adenoma sebaceum
Shagreen patches

110

Rx tuberous sclerosis

Control seizures

111

Features of Neurofibromatosis

Neurofibromas
CN VIII tumors
Cutaneous hyperpigmented lesions (Cafe-au-lait spots)
Meningiomas and gliomas

112

Rx Neuro abnormalities in tuberous sclerosis

None
CN VIII decompression

113

Sturge-Weber presentation

Port-wine stain of face
Seizures
Homonymous hemianopsia
Hemiparesis
Mental subnormality

114

Skull XR in sturge-weber

Calcification of angiomas

115

Rx in sturge-weber

Control seizures

116

What is an essential tremor

Present at both rest and intention

117

What is the best therapy for essential tremor

Propranolol

118

What improves essential tremor

Alcohol

119

What makes essential tremor worse

Caffeine

120

What is parkinsonism

Loss of dopaniergic cells in the substantia nigra

121

Common etiologies of parkinsonism

Repeat head trauma (boxing)
Antipsychotic meds
Encephalitis
Reserpine
Metoclopromide

122

MCC parkinsonism

Idiopathic

123

Presentation of parkinsonism

50-60
Tremor
Cogwheel rigidity
Bradykinesia
Shuffling gait
Hypomimia
Micrographia
Postural instability
Orthostasis

124

Rx mild parkinsonism

Anticholinergics (benztropine, trihexyphenidyl)
Amantadine - release DA from substantia nigra

125

Who is most likely to get amantadine for parkinsonism

> 60 who is intolerant to anticholinergics

126

Anticholinergics AE

Dry mouth
Worsening BPH
Constipation

Worse in older pts

127

What does severe parkinsonism mean

Can't take care of themselves

128

Best initial therapy in severe parkinsonism

DA agonists
- Pramimexole
- Ropinirole

129

Most effective med for severe parkinsonism

Levodopa/carbidopa

130

What is on/off phenomenon

Bradykinesia - not enough DA
Dyskinesia - too much DA

Seen in Levodopa/carbidopa

131

Rx on/off phenomenon in parkinsonism

COMT inhibitors

132

What do COMT inhibitors do

Extend Levodopa/carbidopa duration

133

What are the COMT inhibitors

Tolcapone
Entacapone

134

What do MAOIs do

Block DA metabolism

135

What are the MAOIs

Rasagiline
Selegiline

Use as single agent or adjuvant to Levodopa/carbidopa

136

What med class can slow the progression of parkinsonism

MAOIs

137

What causes psychosis in parkinsonism

Parkinsonism meds

138

Rx psychosis in parkinsonism

Antipsychotic like clozapine
Don't stop parkinsonism meds

139

What is Lewy-body dementia

Parkinsonism + Dementia

140

What is Shy-Drager syndrome

Parkinsonism with orthostasis

141

Rx spasticity

Baclofen
Dantrolene
Tizanadine

142

What should you always check in a pt with RLS

Ferritin (usually low)

143

Huntington's Triad

Memory
Mood
Movement

144

Defect in huntington's

CAG repeat on chromosome 4

145

Features of huntington's

Choreaform movement
Dementia
Behavioral changes
30-50 w/ FHx

146

Dx huntington's

Genetic test

147

Rx huntingtons's

Dyskinesia - Tetrabenazine
Psychosis - Haloperidol, Quetiapine

148

Features of Tourettes

Vocal tics, grunts, coprolalia
Motor tics
Obsessive compulsive behavior

149

Cause of Tourettes

Idiopathic

150

Rx Tourettes

fluphenazine
Clonazepam
Pimozide
Methylphenidate
ADHD rx

151

What is MS

Idiopathic demyelinating CNS disorder

152

Most common presentation of MS

Focal sensory sx w/ gait and balance problems

153

Other common MS presentations

Blurry vision from optic neuritis
Fatigue
Spasticity and hyperreflexia
Cerebellar deficits

154

What is internuclear ophthalmopegia

Inability to adduct one eye w/ nystagmus in the other eye
Characteristic of MS

155

Dx test for MS

MRI - Best initial and Most accurate

156

What does LP show in MS

Mild protein elevation

157

When to do LP in MS

MRI is equivocal

158

Best initial therapy for acute exacerbations of MS

High dose steroids

159

Other Rx MS to prevent relapse and progression

Fingolimod
Natalizumab
Mitoxantrone
Azathioprine
Cyclophosphamide

160

Which MS med can cause worsening of neuro deficits with an MRI showing new white matter hypodense lesions

Natalizumab

161

What has Natalizumab associated with

PML

162

First choice Rx MS to prevent relapse and progression

Glatiramer
Beta-IFN

163

What is ALS

Idiopathic loss of upper and lower motor neurons

164

What to look for in ALS

20s-40s
Weakness of unclear etiology
Difficulty chewing and swallowing
Decrease in gag reflex - pooling of saliva and aspiration

165

What is poor prognosis in ALS

Weak cough
Loss of swallowing

166

Electromyography results in ALS

Loss of innervation in muscle groups

167

Lab results in ALS

↓NIF
↑CPK

168

Role of Riluzole in ALS

Reduce glutamate buildup

169

Role of Baclofen in ALS

Treat spasticity

170

Role of BIPAP/CPAP in ALS

Help with resp difficulties 2/2 muscle weakness

171

MCC death ALS

Respiratory failure

172

Management at end stage ALS

Tracheostomy and ventilator

173

Features of Charcot-Marie-Tooth disease

Distal weakness and sensory loss
Wasting in the legs
Decreased DTRs
Tremor

174

Lower extremity appearance in CMT

Foot deformity with high arch
Legs look like inverted champagne bottles

175

Most accurate test for CMT

Electromyography

176

MCC peripheral neuropathy

DM

177

Other causes of peripheral neuropathy

Uremia
Alcoholism
Paraproteinemias (MGUS)

178

Best initial therapy for peripheral neuropathy

Gabapentin or Pregablin
TCAs
Seizure meds

179

Biker, pressure on palms, trauma to medial elbow

Ulnar
Wasting of hypothenar eminence
Pain in 4th and 5th digit

180

Pressure of inner, upper arm
Saturday night palsy
Pressure in axilla (crutches)

Radial
Wrist drop

181

Nerve damage in obesity, pregnancy, sitting cross legged

Lateral cutaneous nerve of the thigh
Pain/numbness of outer aspect of one thigh

182

Nerve damage that worsens w/ walking

Tarsal tunnel (tibial nerve)
Pain/numbness in ankle and sole of foot

183

Nerve damage in high boots, pressure on back of knee

Peroneal
Weak foot with decreased dorsiflexion and eversion

184

Nerve damage in typists, carpenters, working with hands

Median
Thenar wasting
Pain/numbness in first 3 fingers

185

Identifiable causes of CN VII palsy

Lyme
Sarcoidosis
Zoster
Tumors

186

Differentiate Bell Palsy with Stroke

Stroke - Can wrinkle forehead
CN VII - Cannot wrinkle forehead

187

2 specific features of Bell palsy

Hyperacusis - Stapedius can't deaden sound
Taste disturbances - Anterior 2/3 tongue

188

Most accurate test for Bell palsy

Electromyography and nerve conduction studies
Rare needed

189

Rx Bell palsy

Steroids - Best initial therapy
60% resolve spontaneously

190

Why does corneal ulceration happen in CN VII palsy

Eye has difficulty closing leading to dryness and ulceration

191

What is GBS

Autoimmune demyelination of peripheral nerves

192

What is GBS associated with

Campylobacter jejuni

193

Features of GBS

Ascending weakness
Loss of DTRs

194

What is the danger of GBS

Hitting the diaphragm - resp muscle weakness
Autonomic dysfunction - hypo/hypertension, tachy

195

Most specific Dx test in GBS

Electromyography and nerve conduction studies

196

CSF in GBS

Increased protein
NL cell count

197

What values tell who may die from GBS

PFTs
- Peak inspiratory pressure
- FVC

198

Rx GBS

IVIG
Plasmapheresis

199

MCC death from GBS

Dysautonomia and Resp failure

200

What is myasthenia gravis

Muscle weakness 2/2 autoAbs to acetylcholine receptors in NMJ

201

Features of MG

Double vision
Difficulty chewing
Dysphonia - weakness of muscles at end of day

202

PE findings of MG

Ptosis
Weakness in sustained activity
NL pupillary response

203

Best initial test for MG

Acetylcholine receptor Abs

204

Best test for MG pts w/o Abs

Anti-MUSK Abs

205

Most accurate test for MG

Electromyography

206

What imaging should be done in MG

Chest CT - Thymoma

207

Best initial treatment for MG

Neostigmine or Pyridostigmine

208

Most appropriate next step in MG if meds fail

60 - Prednisone

209

Presentation of acute myasthenic crisis

Profound weakness or respiratory involvement

210

Rx Acute MG crisis

IVIG or plasmapheresis

211

What to give to MG pts to ween off steroids

Azathioprine
Cyclophosphamide
Mycophenolate