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Flashcards in Neuro Deck (34)
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1

a left MCA stroke results in what visual field deficit?

Right homonymous hemianopsia: loss of right visual fields in both eyes
eyes deviate to the left since they cannot see right
"look towards the side of lesion"

2

speech is on what side of brain

dominant: typically LEFT in Right handed individuals

3

ACA stroke

Leg more than arm weakness
Personality/cognitive defs
Urinary incontinence

4

PCA stroke

SAME side face sensory loss + CN 9/10
OPPOSITE limb sensory loss
limb ataxia

5

best treatment for nonhemmorhagic stroke

less than 3 hrs: tPa
more than 3 hrs: ASA, if already on, add dipyridamole OR switch to clopidogrel
NOT ASA and clopidogrel together
everybody gets a statin

6

treatment if cardiac thrombi

heparin followed by warfarin for INR 2-3
alternatives: rivaroxaban, dabigatran

7

more than 70% but not 100% carotid stenosis?

endarterectomy > carotid angioplasty

8

unique HA findings
red, tearing eye with rhinorrhea, Horners?
papilledema with diplopia from 6th CN palsy?

Cluster HA
pseudotumor cerebri

9

How to abort migraine and cluster headaches

Both: ergot or triptans
Only cluster: 100% oxygen, prednisone, lithium, prophylaxis with verapamil

10

Best migraine prevention

Propranolol, then CCBs, TCAs, SSRI, topiramate, Botox injections, Sodium valproate

11

When can patients discontinue seizure medication

Seizure free for two years

12

Severe headache, stiff neck, photophobia, fever

SAH, may present with fever due to blood irritating the meninges
Very similar to meningitis, but more sudden in onset and LOC in 50%

13

CSF wbc: rbc ratio
How is this different between SAH and meningitis

Normal: 1 WBC : 500 RBC
SAH: both increased but normal ratio
Meningitis: elevated (more WBCs)

14

EKG findings in ICH

Large or inverted T waves suggestive of myocardial ischemia

15

Cape like distribution of loss of pain and temp bilaterally across upper back and arms

Syringomyelia

16

Differentiating between cancer and abscess with imaging
How to treat if abscess

Both are ring enhancing, need biopsy
Empiric: penicillin plus metronidazole plus ceftriaxone/cefepime, vancomycin if risk of MRSA
Switched more specific regimen when culture results get back

17

Tuberous sclerosis

Neuro abnormalities
Adenoma sebaceum – red facial nodules
Shagreen patches – leathery on trunk
Ash leaf spots
Retinal lesions
Cardiac rhabdomyomas

18

Neurofibromatosis

Neurofibromas
Eighth cranial nerve tumors
Café au lait spots
Meningioma and gliomas

19

Sturgeon – Weber

Port wine stain on face, seizures, Visual changes, hemiparesis, mental delays, calcification of angiomas on skull x-ray

20

Treatment for mild Parkinson's

Anti-cholinergic: benztropine, trihexyphenidyl
Amantadine

21

Treatment for severe Parkinson's

Dopamine agonist: pramipexole and ropinirile
Levodopa/carbidopa: most effective
COMT inhibitors: Tolcapone, entaCapone
MAO inhibitors: selegiline, may slow progression
Deep brain stimulation: highly effective for tremors and rigidity

22

What to do if Parkinson's patient and levodopa/carbidopa presents with psychosis

Start clozapine or other antipsychotics with few EPS side effects, do not stop Parkinson's meds the patient will become locked in with severe bradykinesia

23

Parkinsonism with orthostasis

Shy – Drager syndrome

24

Treatment for Huntington's disease

Tetrabenazine for dyskinesia
Psychosis: haldol, seraquel, other antipsychotics

25

Tourette disorder treatment

Antipsychotics:Fluphenazine, clonazepam
Also methylphenidate and other ADHD treatments

26

Most common presentation of MS

Focal sensory symptoms with gait and balance problems, no longer visual disturbances

27

MS patient develops worsening neuro deficits with new, multiple white matter hypodense lesion is think what medication is causing this?

Natalizumab, has been associated with development of PML

28

ALS, most worrisome presentation? What is not lost?

Most serious: difficulty and chewing and swallowing and decreased gag reflex
No sensory loss in sphincters are spared
EMG for diagnosis, elevated CPK

29

Distal weakness and sensory loss, wasting in legs, decreased DTRs, hi foot arch, abnormal leg contour, think?

Charcot – Marie – tooth disease diagnosed with EMG, no treatment

30

Additional features in bell palsy

Since it is seventh cranial nerve palsy, may see hyperacusis, and taste disturbances as it supplies taste of the anterior 2/3 of the tongue
Also, difficulty with closing the eye, so corneal ulcerration may occur, tape shut at night