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Flashcards in Neuro Deck (43):
1

complex regional pain syndrome

follows an injury to extremity

pain, swelling, color/temp changes. Pain is burning, exacerbated by light tough

severe tenderness to light touch

tx: early intervention is best
saids, steroids, PT/OT, pain management, gabapentin
regional nerve block

2

peripheral neuropathy

caused by anything
motor, sensory, autonomic
acute: infectious, GB
Motor: weakness, distally and ascent proximal
lower ext: dorosflexion of foot, foot drop
sensory sx; stocking glove distribution, numbness/ pain
Muscle atrophy
PE: diminished DTR
Dx: EMG and nerve conduction
Nerve/ skin bx: for vasculitis
labs; glucose, BUN/Cr, CBC, vitamin b6 /b12 RPR

3

diabetic neuro

distal symmetric polyneuropahty
autonomic: erectile dysfunction
no tx
control sugars
tx: gabapentin, TCA, lyrics, cymbals, lidoderm patch

4

charcot-marie tooth dz

complain of motor sxs
foot drop
no tx: use ankle foot orthrosese, genetic counseling

5

trigeminal

shooting pain in the corner the mouth and goes to mandible

worse with chewing

tx: gabapentin

6

post herceptic neuralgia

tx: acyclovir and steroids

7

Bell's Palsy

no clear etiology
follow a stress to body ( dm, pregnancy, infection)
ipsilateral ear pain
loss of motor control of mouth
pt recover all the way

start steroids in 5 days

the worst it looks the better it is ( bells palsy vs. stroke)

8

cluster headaches

men in 40's
retroorbital, red, tearing of eye, ptosis, myosis

at night and clusters

triggers: similar to migraines

tx: abortive: oxygen, SC triptans, steroids

prophylactic: verapamil
topirmate, lithium

9

migraine

nervous dysfunction
women ( teen to 30s)
fix

unit, throbbing, n/v, motion worse, photophobia, photophobia
auras( zigzags, flashes of lights)

triggers: stress, foods, smells, bright lights, menstruation

imaging: not warranted

tx: avoid triggers, dark/quite room

abortive: NSAIDs, ASA, APAP

ergotamine with caffeine
triptans

preventing: antileptitus
antihypertensives

10

tension HA

generalized, constant
gripping, vice-like

triggers: stress, fatigue

tx: reduce stress, improve sleep, ASA, APAP, NSAiDs
caffeine, butabial

amitriptyline for prophylaxis

11

encephalitis

infection of brain tissue

viral causes
happens with meningitis

herpes simples
west nile

If immunocompromised: HIV, Varicella/ zoster

fever, malaise, n/v, rash,
headache, seizures

lumbar puncture: elevated opening pressure, elevated ptn, and lymphocytes, normal glucose
CT head first if risk for cerebral herniation

MRI, EEG

Tx: acyclovir
supportive: ICU, seizure monitor, hydrate, fever
anti-emetics
west nile: ribavirin
weeks to months for recovery

12

meningitis

infection of arhachoid membrane, pia matter, and css

bacterial and viral

incidence is lower with vaccine

h. flu- children
strep pneuma- adults
neisserira- dorms, barracks, jails

listeria:

presentation: stiff neck, fever, headache,
Kerning/ Brudzinksi signs
petechiae/ ecchyotic rash
seizure, hydrocephalus, CN abxn

lumbar puncture: elevated opening pressure, CSF w/ decreased glucose, grain stain, cx

tx: IV abx and dex
Vanco and 3rd gen cephaosporin

continue to examine-give mannitol for elevated ICP

viral: enterovirus, coxsackie
fever, ha, stiff neck, don't look as sick

csf: normal glucose, normal protein, run PCP,

tx: supportive tx, fluids,
treated as outpatient

13

essential tremor

postural tremor of hands, head, and voice
fix
may be being at any age
ETOH relieves sx

no disabling

tx: propanalol
primidone

14

huntington dz

autosomal dominance
gradual:chorea, dementia, and behavior changes

30- 50 y/o, fatal

no diagnostic tools

genetic test available

tx: sxs:
tetrabenzaine for dyskinesias

15

parkinson dx

second most common neuro-degenerative

45-65

cardinal: pill rolling tremor, rigidity ( cogwheel), bradykinesia( hard to stand up)
masked faces, reduced to blink
no muscle weakness or reflex changes

tx: levodopa-coveted to dopamine
combine with levodopa

other meds: amantadine, anticholinergics, dopamine agents,
deep brain stimulation

16

cerebral aneurysm

berry aneurism
anterior circle of willis
asymptomatic until they rupture

RF:

diagnosis : CT or MRA,
angiography ( gold standard)

monitor :

17

stroke

ischemic- 85%

RF: AA/Hispanic, men, HTN, DM/ smoking , carotid stenosis, A.fib

ishchemic: plaque
emboli-
lacunar: smaller arterioles

TIA 24 hours, brain infarction

Need an accurate timeline

usually painless

exam: focal neuro déficit

MCA- middle cerebral artery( contralateral hemiparesis, arm/face, sensory loss, expressive aphasia)

dx: CT brain
investigate etiology of stroke
cardiac investigation

ABC:
correct glucose

thrombolytic therapy:
3-4 hours-- too late

ASA effective for acute ischemia stroke

tPA contraindication:
BP 180/ 110, major surgery or trauma w/in 2 weeks, active GI, recent anti coagulated, evidence of CH,

prevention: ASA, plavix, control lipids, control BP, smoking cessation, anti-coags for a. fib, OT/PT therapy

18

ischemic stroke diagnosis

CT head

check for coagulopathy, autoimmune disorders, cardiac evaluation

19

subdural hematoma

crescent saved collection on CT brain

tx: wath/watch, evacuate with burr hole, tx for seizure

20

epidural hematoma
what is it?

blood accumulates below the skull but above dural
-looks convex on CT

evolve faster than SDH
may have a lucid vessel but not common in real world

tx: rapid surgical cautery and ligation of damaged vessel

tx skull fx

21

Altered mental status

4 conditions
stupor= transient arousal by vigorous stimuli
comatose= arousable, not response to ext events-
vegetative state: wakefulness is retained but awareness of self

results from: seizure, hypothermia, drugs, metabolic disorders


22

exam of ALC

exam: response to painful stimuli, pupil reactions, ice water caloric

ox sat
EKG
serum glucose, calcium, LFT's, BUN/Cr, toxicology
EEG, brain imaging ( CT/MRI), lumbar puncture

23

glasgow coma scale
memorize

severe head injury- 8 or less
moderate : 9-12
mild 13-15
testing eye opening, verbal response, and motor response

24

how to approach ALC

depends on disorder

stabilize c-spine
control seizures

coma cocktail:
dextrose, naloxone, thiazmie

25

concussion

transient trauma-induced change in mental status

watch carefully to detect hematoma or edema

s/sx: ha, n/v, disoriented, lethargic, amnesia, glascow coma scale

ct scan

Grade 1- transient confusion, sxs last 15, no loss consciousness

grade 3- severe- ER evaluation, consider admission

26

concussion of sports

grade 1: remove from consent
grade 2; remove for 1 weeks
grade 3- to ed, CT/MRI daily exams

27

post concussion syndrome

lasts weeks to > 1 yr

ha- primary sxs
neuro psycho sxs
tx: NSAIDS, acetaminophen, triptans
vestibular maneuvers for dizziness
increased risk for Alzheimer, Parkinson, CTE

28

cerebral palsy

trauma during birth ( hypoxia,

chronic and static impairment of mm tone

high risk for premature

exam: spasticity in common
ataxia, chorea, seizure disorder, mental retardation

exam: hyperreflexia

MRI brain

tx: maximize physical function- PT/OT

baclofen

px depends on how bad it is

29

dementia

progressive decline in intellecutal/ cognitive function
not due to psychiatric illness

typically 60 y/o

reversible dementia- low thyroid, b12 deficient, thiamine

vascular demential
lewy body dementia

30

alzheimer d

anterograde amnesia first and most intense sx
short term memory loss

language difficulty- word findings

executive dysfunction

apathy

exam: reversible causes
Mini mental state exam

Neuro psych exam

screen for depression

no genetic

consent to death -some years to a couple of years

at risk for delirium

cease driving

31

alzheimer dx

exercise

aricept, exelon
named
trazadone for sleep
agitation
r/o delirium
last resort: low dose atypical antipsychotic

32

other types of dementia

vascular- multiple strokes

lewy body dementia: parkinsonism

frontotemporal lobar- disorder of behavior
rude, sexually explicit, impulsive, binging

33

delirium

acute state of confusion

check for some systemic problem

rapid onset
sundownig- pm onset of delirium in demented pt

RF: age, dementia, sleep deprivation, immobilization, psychiatric meds, impaired vision

causes; correct alcohol withwrar, infection,

anterograde and retrograde- impaired short-term memory and recall

34

delirium evaluation

history
PE
labs
EKG

identify and tx disorder
prevention

avoid anticholingerics

35

Guillain-Barre syndrome

acute onset of weakness being in the legs following viral infection

seen with C. jejune

start in the legs and move upwards

dx; clinical,

tx: plasmapheresis , IVIG, steroids not that effective, breathing support

recovery over months

36

MS

young women of western- europe

autoimmune- white matter dz

s/sx: weakness, double vision, migrate from limb to limb

exam: hyperreflexia, nystagmus, pregnancy will help
relapsing remitting- period of remission after into episodes

secondary progressive- initially have relapsing- reciting an then persistent

primary progressive- steady decline

have to have 2 or more sxs lasting > 24 hours and appear in a different site and then happen again

has to be dissemination in time and space

MRI brain- dawson's fingers

lumbar puncture- oligoclonal bands, myeline basic pix
EMG

tx: acute attacks with coritocsterods
beta interferon
immune modulators

37

Myasthenia graves

weakness of voluntary mm

sxs: double vison, ptosis,

dx: weakness on exam, receptive nerve stimulation
dx: serum acetylcholine receptor
tx: pyridostigme,neostigmine
avoid aminoglycosides

thymectomy if pt

38

seizure

epilepsy- recurrent unprovoked seizure

etiology: genetic

focal or general
complex partial
simple partial
switching or jerking in one limb

Jacksonian March

39

generalized seizure

absence seizure- brief impairment of consciousness - childhood

grand mal- tonic clonic , shaking, jerking, up going toes ( post-ictal) state, tongue biting

produce

dx: brain imaging, EEG, labs, lumbar puncture

meds: ETOH withdrawal
classics: valproic acid
keppra-dont' have to measure
phenytoin

pregnancy: make sure to check contra indications

40

status epilepticus

medical emergency!

repeated seizures w/o recovery > 30 minutes

maintain airway

50% dextrose
benzodiazepines
( phenytoin, fosphenytoin)

respiratory depression and hypotension possible
may need to intubate

41

syncope

no blood flow to brain

causes: carotid stenosis, orthro static hypotension, vasovagal
s/sx: faints

dm common cause

42

vassal syncope

fear, emotion/ anxiety

pt get faint,light headed

avoid triggers

work up: head injury, cardiac work up, carotid imaging

evaluation: vasoconstrictor, treat cardiac abn

43

tourette syndrome

frequent motor/ phobic tics

motor tics most common

tx: CBT
clonidine
haloperidol