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Neuro Flashcards

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1
Q

Types of strokes (3)

A

Embolic (ischemic)
thrombotic (ischemic)
Hemorrhagic (SAH and IPH)

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2
Q

Seizure: causes

A 
Vascular (stroke)
Infection (meningitis/encephalitis)
Trauma (TBIs and brain bleeds)
Autoimmune (lupus cerebritis)
Metabolic (ca, Na, glucose)
Ingestion/withdrawal(benzos/EtoH)
Neoplasm
Psychiatric

VITAMINS

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3
Q

Status epilepticus: TX progression

A

Benzos (a lot of lorazepam) –> IV fosphenytoin and intubation –> midazolam and propofol –> phenobarbital

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4
Q

Broad spectrum anti-epileptics good for general epilepsy

A

valproate, lamotrigine, levetiracetam

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5
Q

Myoclonic: features and tx

A

no LOC and no loss of tone

valproate

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6
Q

Atonic: features and tx

A

No LOC, but loss of tone

valproate

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7
Q

Parkinsons disease: clinical features (4)

A

bradykinesia
cogwheel rigidity
resting tremor
gait/postural instability

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8
Q

Parkinsons disease: TX

A

NOTE: amantadine is wrong

COMT-inhibitors (-capones)
MOA-B inhibitors (selegeline)
Dopamine agonists (ropimerole, promipexole)
carbidopa/levodopa

If <70 and functional: start with dopamine agonist
If >70 or not functional: start with levodopa/carbidopa, then COMT and MOA-B inhibitors as dopaminergic neurons continue to degenerate in substantia niigra

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9
Q

Types of primary headaches (4)

A

Tension

Analgesic rebound

cluster

migraine

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10
Q

Tension HA: clinical features and TX

A

features: BL vice-like, with radiation down to neck

TX: NSAIDs, acetominenophen

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11
Q

Cluster HA: clinical features and TX

A

vascular pathology
asymptomatic for months, but then HA 8-10x/day with unilateral eye pain with a Horner syndrome-type presentation

TX: abortive–O2, then sumitriptan
ppx–ccbs (verapamil)

F/U with 1x brain imaging

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12
Q

Migraine HA: clinical features and TX

A

pathology is vascular

unilateral, pulsatile pain that is debilitating and lasts 4-72 houyrs w/o abortion

TX:
Abortive
mild–NSAIDs
mod-severe–triptans and ergots

PPX
propranolol
valproate
topiramate

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13
Q

Idiopathic intracranial HTN

A

female taking OCPs and/or acne meds with ICP (papilledema, FND, N/V, HA especially in morning)

negative CT
LP with high opening pressure (>25cmH20) and symptomatic relief

TX: acetazolamid, serial LPs, VP shunt

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14
Q

Reflexes to assess for brain stem function

A

corneal reflex (with Q-tip)
cold-water calorics (cold water causes opposite beating nystagmus in normal brainstem, and warm water same)
Dolls eye reflex (eyes should move when you turn head

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15
Q

Alzheimers: initial impairment

A

memory

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16
Q

Picks disease: initial impairment

A

personality (memory is retained)

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17
Q

Picks: CT finding

A

fronto-temporal atrophy

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18
Q

Lewy-Body dementia: features

A

parkinsonian type features albeit predominantly with dementia and also with visual hallucinations

Fluctuating cognition

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19
Q

Alzheimers: treatment

A

donepezil

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20
Q

Normal pressure hydrocephalus

A

Path: increased ICP
Wet, wacky, wobbly (ataxia early in disease)

DX: CT showing hydrocephalus and dilated ventricles
LP provides improvement

TX: VP shunt

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21
Q

CJD: DX

A

MRI

Clinically: behavioral change and myoclonus +/- seizures

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22
Q

Peripheral vertigo causes (3)

A

BPPV
labrynthitis/vestibular neuritis
Menieres

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23
Q

Menieres: clinical features and tx

A

Triad of hearing loss, vertigo, and tinnitus lasting <1hr but >30 minutes

Tx: salt restriction, thiazide duiretics, and meclizine

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24
Q

Labrynthitis/vestibular neuritis: clinical features and tx

A

4wks after a viral URI

vertigo with hearing loss, N/V lasting up to a week

TX: steroids and meclizine

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25
BPPV: path, clinical features, and Dx/TX
path from otolith in vestibular system recurrent, reproducible vertigo lasting <1 minute with positional changes Dx: dix-hallpike maneuver Tx: Epley maneuver
26
Multiple sclerosis: MRI findings
Periventricular white matter NOTE: get this for initial diagnosis of MS before committing to high dose steroids
27
Multiple sclerosis: chronic tx
IFN glatiraner fingolonod Bethanocol for urinary retention amitriptyline for urinary iconinence baclofen for spasms gabapentin for neuropathic pain
28
Ascending paralysis and hyporeflexia in s/o recent diarrheal illness
GBS NOTE: can also proceed URI and be accompanied by paresthesias and dysarthria
29
GBS: managment
NEVER steroids give IVIG or do plasmapharesis, or try one then the other
30
Myasthenia gravis: TX
Chronic: cholinesterase-inhibitor, give steroids, remove thymoma if diagnosed on CT Acute crisis: IVIG or plasmaphoresis
31
Eaton lambert disease: clinical features
Initial fatiguability, improvement with use Issues with proximal muscles EMG shows increased amplitude of impulses with more attempts CT can show small cell lung cancer (paraneoplastic syndrome)
32
Neuromuscular junction diseases
MG Lambert eaton syndrome organophosphate poisoning botulism
33
Muscle fibers
muscular dystrophies polymyositis and dermatomyositis hypothyroidism corticosteroids HIV myopathy
34
Peripheral nerve diseases (5)
hereditary primary motor sensory neuropathy GBS diabetic neuropathy amyloid neuropathy (MM) Lead poisoining
35
Anterior horn cell neuropathies (4)
Poliomyelitis spinal muscular atrophy ALS paraneoplastic syndromes
36
Upper motor neuron disorders
leukodystrophy vasculitis brain mass vit B12
37
Non eccymotic swelling in scalp on newborn that was not present at birth and involves one cranial bone
cephalohematoma | caput succedaneum is eccymotic and crosses suture lines
38
Serotonin syndrome vs neuroleptic malignant syndrome
Serotonin syndrome: triad of AMS, autonomic instability, and neuromuscular excitability (tremor, hyperreflexia, and myoclonus) Neuroleptic malignant syndrome: tetrad of AMS, autonomic instability, rigidity, and fever
39
Lithium toxicity
coarse tremors, ataxia, AMS, N/V, hypotension
40
Cholinesterase inhibitors used in alzheimers disease
donepezil, galantamine, and rivastigmine
41
Normal CSF values
Cells: O-3 glucose: 50-100 protein: 20-45 Pressure: 100-200
42
CSF values in viral/aseptic meningitis
Cells: >100 lymphocytes glucose: 50-100 protein: 20-45 Pressure: 100-200
43
CSF values in bacterial meningitis
Cells: >1000 PMNs glucose: <50 protein: 100 Pressure: >200
44
pseudotumor cerebri =
idiopathic intracranial HTN
45
peripheral nerve lesion: EMG findings
fasciculations/fibrilations at rest
46
Intrinsic muscle disease: EMG findings
no muscle activity at rest | Decreased amplitude of muscle contraction upon stimulation
47
Broca vs wernickes area: location
Broca: dominant frontal lobe Wernicke: dominant temporal lobe
48
Midbrain cranial nerves
3 and 4
49
Pons cranial nerves
5,6,7, &8
50
Medulla cranial nerves
9-12
51
Seizure with no post-ictal state
absence seizure
52
Normal age range for febrile seizure
6months old - 5 years old
53
25 year old with pmh of mr who has inability to relax grip =
``` myotonic dystrophy (autosomal dominant) Tx involves genetic counseling ```
54
Shy-Drager syndrome =
Parkinsoism predominantly with orthostasis
55
Medication used chronically in multiple sclerosis that can cause progressive multifocal leukoencephalopathy
Natalizumab
56
Paralysis of entire side of the face, involving forehard
bells palsy
57
Paralysis on one side of face, but can still wrinkle forehead =
stroke until proven otherwise
58
Bells palsy: TX
prednisone +/- acyclovir
59
Herpes simplex encephalitis: CSF findings and most accurate imaging
``` CSF Cells: >100 WBCs (90% lymphocytes) glucose: 50-100 protein: elevated (>100) Pressure: 100-200 RBCs present (from destruction of temporal lobe) ``` Imaging MRI most accurate (CT nl in 50% of cases)
60
Wernickes encephalopathy: clinical features
triad of sxs encephalopathy (confusion) oculomotor dysfunction (nystagmus) gait disturbance (broad based)
61
Spinal epidural abscess: TX
vancomycin and ceftriaxone (staph aureus most likely causative organism)
62
Contralateral hemiparesis and sensory loss due to ___
putaminal hemorrhage and involvement of adjacent internal capsule
63
Transient, focal neurologic deficit occurring after a seizure
Todd paralysis
64
Digoxin toxicity
N/V, diarrhea, vision changes, and arrythmias (percieved as palpitations)
65
Small-vessel lipohylanosis is caused by ____ and inturn causes___
atherosclerosis thrombotic small-vessel occlusions--> lacunar strokes and pure contralateral motor or pure sensory deficits

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