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Neuro Flashcards

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1
Q

Gower sign is?

A

Arises from floor by pulling on legs and body to get up

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2
Q

Pronator drift is?

A

Weaker hand - cups and supinates

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3
Q

Muscle fasciculations are?

A

Denervation from anterior horn cell or peripheral nerve disease.

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4
Q

LMN and Cerebellar lesions will affect tone how?

A

Hypotonia

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5
Q

UMN lesions will affect tone how?

A

Hypertonia - Spasticity

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6
Q

Extrapyramidal disease affects tone how?

A

Rigidity - resistance through ROM

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7
Q

Dysfx of cerebellar pathways will affect coordination how?

A

Ataxia, Intention tremor, Dysmetria (cant judge distance)

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8
Q

Cerebellar dysx affects gait how?

A

Broad-based, unsteady gait, that cant turn

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9
Q

Corticospinal tract dysfx affects gait how?

A

Stiff, scissoring gait and TOE walking

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10
Q

Extrapyramidal dysfx affects gait how?

A

Slow, Stiff, SHUFFLING gait w/ dystonic postures

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11
Q

LMN or neuromuscular d/o affects gait how?

A

Waddling gait w/ hip weakness.

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12
Q

LMN dz affects DTRs how?

A

Decreased DTRs

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13
Q

UMN dz affects DTRs how?

A

Increased DTRs

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14
Q

Corticospinal tract dysfx affects DTRs how?

A

Babinski response OR extensor plantar reflex

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15
Q

REDFLAGS of HAs?

A 
Worst HA of my life - SAH
AM HA - Tumor
Pain wakes child at night
Chronic progressive HA (Most ominous)
ABD/Focal neuro exam 
Changes w/ positioning - Pseudotumor cerebri
Recurrent vomiting
No family Hx
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16
Q

Worst HA of my life may indicate?

A

SAH

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17
Q

AM HA may indicate?

A

Tumor

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18
Q

Most ominous HA pattern?

A

Chronic progression

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19
Q

REDFLAGs of HA that overlap w/ migraines?

A

Changes w/ position

Recurrent vomiting

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20
Q

MC recurrent HA pattern?

A

Tension HA

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21
Q

Tension HA attributes?

A

Mild - lack S/S - Not disruptive
PAIN = global, squeezing/pressing
LASTS - Hrs to days
W/OUT - N/V, phonophobia/photophobia

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22
Q

Migraine HA attributes?

A 
Frontal, Bitemporal, Unilateral
PAIN - Mod/sev = Pounding/throbbing
LASTS - 1-72hr
Aggravated by activity and has AURA (15-30m)
W/ - N/V, Photo/Phono-phobia, pallor
Wants to seek dark quiet room to rest
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23
Q

Auras are experienced as?

A

Visual - Spots, flashes, flickering lines of light

Atypical - Perioral numbness, vertigo, unilateral weak

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24
Q

2ndy reasons for HAs?

A 
Head trauma
Viral illness
Sinusitis
Rx overuse
Serious causes (increased ICP)
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25
Causes of Increased ICP?
Masses, intrinsic increase of pressure
26
Increased ICP HAs attributes?
``` Worse HA w/ vomiting upon - lying down, 1st AM Wakens child at night Goes away standing up Worse w/ coughing/Valsalva/stooping Papilledema or Neuro deficits ```
27
What study checks for Intracranial bleeding?
Head CT
28
What study checks for posterior fossa lesions or subtle ABNLs concerning HAs?
MRI +- gadolinium contrast (SOC)
29
Basic HA TXT?
Lifestyle mods | NSAIDs/APAP
30
Migraine TXT?
1L - NSAIDS/APAP 2L - Triptans (Sumatriptan/Imitrex) Serotonin ag Antiemetics - Odansetron, Metoclopramide, Promethazine
31
CI to triptan therapy for migraines?
Focal neuro deficits w/ migraines | Basilar migraine signs > Syncope occurs = Stroke risk
32
Migraine prophylaxis considered if?
>1 disabling HA/wk
33
Migraine prophylaxis Rx?
``` BB - propranolol (CI - asthmatic/DM) TCA Anticonvulsants (Valproic acid/topiramate) CCB AH - Cyproheptadine SSRI - Fluoxetine ```
34
Types of seizures?
1. Generalized (begins diffusely) - (Tonic/clonic - Grand mal OR Absence - Petit mal) 2. Febrile seizure (type of generalized) 3. Partial (begins focally) - (Simple - no altered consciousness) - (Complex -Altered consciousness) 4. Status epilepticus (neuro emergency)
35
Simple partial seizure attributes?
Consciousness preserved | - Starts at specific anatomic focus +- spread
36
Simple partial seizure S/S?
Motor - Tonic/Clonic/myoclonic | Sensory, psychic, autonomic ABNLs
37
Complex partial seizure attributes?
Consciousness altered - Starts at specific anatomic focus +- spread Spread to whole brain = 2ndy generalized Spread - Face to arm to leg = Jacksonian March +- staring or automatisms
38
Types of generalized seizures?
Tonic-Clonic - Grand mal | Absence - Petit mal
39
Generalized - Tonic clonic seizure attributes?
Grand Mal seizure - Tonic - Brief cry, Fall, LOC - Clonic - Spastic, Rhythmic, symmetric shaking - Postictal - Gradual return of consciousness - EEG - NL when not seizing
40
Generalized Absence seizure - attributes?
Petit Mal - Begins 4-6yo - Short <15s blank stares and loss of awareness - +- lip smacking/eye fluttering - NO post-ictal state - EEG - 3hz spike and wave activity
41
TXT Generalized Absence seizure w/?
Petit Mal | - Ethosuximide or Valproic Acid
42
What is a neurological emergency w/ ongoing seizures?
Status Epilepticus
43
Status epilepticus is?
Ongoing seizure activity or repetitive seizures w/out return of LOC for >30m
44
TXT of status epilepticus?
ABC, EKG, O2/SO2 monitoring, IV Labs- CMP, CBC, GLU Anticonvulsant Rx, Toxicology Rx
45
Rx TXT of status epilepticus?
Diazepam or Lorazepam - Rapid/short | Midazolam - IV/Rectal
46
Seizure eval req?
Febrile - r/o meningitis, encephalitis, brain abscess Focal neuro S/S or Papilledema - CT before LP CT - acute/blood in brain MRI - subacute/brain lesions
47
Why CT before LP in a pt w/ seizures + focal neuro S/S or papilledema?
LP in a pt w/ ICP = herniation through foramen magnum
48
MRI is a study for what concerning neurology?
Brain lesions
49
What study is best for detecting brain bleeds?
CT
50
MC cause of seizures between 6mo-6yo?
Febrile seizures
51
Simple febrile seizure attributes?
Onset is generalized <15m occurring once/24h - good prognosis - no relative complications - No neuro Hx
52
Complex/atypical febrile seizure attributes?
Onset is focal >15m reoccurring w/in 24h OR Child has preexisting neuro Hx
53
Febrile seizure Mgmt?
Typically None - benign | +- rectal diazepam (prolonged or Hx of prolonged)
54
Sites where pathology for weakness/hypotonia occurs?
Anterior Horn cells Peripheral nerves NMJ Muscle tissue
55
Conditions causing weakness/hypotonia at the Anterior Horn cells?
Spinal Muscular atrophy | Polio
56
Conditions causing weakness/hypotonia at the Peripheral Nerves?
Guillain-Barre syndrome Charcot-Marie-tooth disease Tick paralysis
57
Conditions causing weakness/hypotonia at the NMJ?
Myasthenia Gravis | Botulism
58
Conditions causing weakness/hypotonia at the muscular tissue?
Muscular dystophies
59
UMN destruction causes?
Loss of voluntary control - BUT not loss of movement - Mild dysfx (slow/stiff motions) - Severe dysfx (Stiff/ABNL postures/spastic)
60
Severe UMN destruction pt posture will be in what position?
Forearm flexed at elbow, Wrist adduction to chest, Leg extension and adduction
61
LMN destruction causes?
Absence of movement/Complete paralysis + hypotonia
62
LMN is common pathway for?
Muscle activity - Destruction = paralysis
63
Does LMN have abnormal posturing?
NO - paralyzed - progressive weakness/hypotonia
64
UMN is ass/w what pathway?
Corticospinal tract
65
LMN is ass/w what pathway?
Neuromuscular junctions
66
UMN lesions tone/DTR/Babinski?
Tone - Increased DTR - Increased Babinski - Present
67
LMN lesions tone/DTR/Babinski?
Tone - Decreased DTR - Decreased Babinski - Absent
68
Spinal muscular atrophy (SMA) pathology is at what site?
Anterior horn cells (degeneration)
69
Types of Spinal muscular atrophy?
Types I - Wernig-Hoffman Dz II - Kugelberg-Welander syndrome III - Juvenile form
70
MC Spinal muscular atrophy type?
Type II - Kugelberg-Welander syndrome
71
Spinal muscular atrophy - Type I attributes?
Wernig-Hoffman Dz - Severe infantile form - die w/in 2y
72
Spinal muscular atrophy - Type II attributes?
Kugelberg-Welander syndrome - Late infantile - Slower than type I - Survive to adulthood
73
Spinal muscular atrophy - Type III attributes?
Juvenile - Chronic - NL life
74
Spinal muscular atrophy is?
Progressive anterior horn cell degeneration
75
Clinical features of Spinal muscular atrophy?
Tongue fasciculations - Esp. sleeping Proximal atrophy/weakness = progressive Floppiness - decreased movement Absent DTR
76
TXT of Spinal muscular atrophy?
None - PVT respiratory infection/support
77
Poliomyelitis pathology occurs at what site?
Anterior horn cells - destroyed in spinal cord
78
Poliomyelitis is due to?
A2M transmission of the poliovirus
79
Clinical features of Poliomyelitis?
Fever, Malaise, HA, URI s/s, N/V/D, myalgias Meningeal signs Prodrome > flaccid paralysis 3-8d after S/S
80
What is VAPP?
OPV - Vaccine associated paralytic poliomyelitis (No longer used) USA - IPV used only
81
Guillain-Barre Syndrome pathology affects what site?
Peripheral nerves
82
Guillain-Barre Syndrome is?
Acute inflammatory demyelinating polyradiculoneuropathy.
83
MC cause of acute flaccid paralysis is PEDs?
Guillain-Barre Syndrome
84
Guillain-Barre Syndrome is due to?
Post infectious autoimmune peripheral neuropathy | respiratory/GI infection - Mycoplasma pneumonia or Campylobacter Jejuni
85
Guillain-Barre Syndrome clinical features?
Absent Reflexes Symmetrical ASCENDING weakness (hrs-wks) Hand/feet paresthesia Bulbar/respiratory weakness - progressed
86
Mgmt of Guillain-Barre Syndrome?
Admit for observation +- respiratory support IVIG, Plasma exchange, Immunosuppressive Rx Resolution - 1yr
87
Charcot-Marie-Tooth Dz pathology is at what site?
Group of Peripheral nerve diseases
88
What pathway is affected 1st w/ Charcot-Marie-Tooth Dz?
Motor > sensation or autonomic
89
MC type of Charcot-Marie-Tooth Dz?
Type 1A
90
Clinical features of Charcot-Marie-Tooth Dz?
Ankle weakness/frequent tripping PES CAVUS deformity (high arched feet) Slow progression
91
Earliest nerves affected by Charcot-Marie-Tooth Dz?
Peroneal and tibial nerves
92
TXT of Charcot-Marie-Tooth Dz?
Support - foot bracing | PT
93
Tick paralysis is clinically similar to what neuro disease?
GBS
94
What does tick saliva do?
Blocks NM transmission causing acute motor neuron weakness
95
Clinical features of Tick paralysis?
Severe generalized flaccid weakness | - including ocular, papillary, bulbar paralysis
96
TXT of Tick paralysis?
Find/remove tick > motor fx returns
97
Myasthenia gravis is ass/w what pathologic site?
NMJ
98
Myasthenia gravis is?
Autoimmune - ABs block ACh Receptors at NMJ causing rapid muscle fatigue
99
Childhood types of Myasthenia gravis?
Juvenile Myasthenia gravis Transient neonatal Myasthenia gravis Congenital Myasthenia gravis
100
Transient neonatal Myasthenia gravis is due to?
Neonates born to mothers w/ Myasthenia gravis and have maternal anti-AChR
101
Congenital Myasthenia gravis is?
genetic mutations of NMJ (NO autoimmunity)
102
Myasthenia gravis presents as?
Ptosis, Diplopia, ophthalmoplegia | Extremity, Neck, face, jaw - weakness
103
Myasthenia gravis is dx how?
``` Tensilon test (Edrophonium) = ACh inhibitor - POS= temporary improvement in strength ```
104
TXT of Myasthenia gravis?
ACh inhibitors - Pyridostigmine Thymectomy - Reduce AB burden PO CCS or Immunosuppressive Severe - plasma exchange/respiratory support
105
Botulism is due to?
Clostridium botulinum - neurotoxin
106
PVT of infantile botulism?
No honey/canned food <1yo
107
Botulism presents as?
``` 1st signs - Constipation/poor suck/feed Hypotonia/weak Decreased Gag reflex, Eye movements, Pupil contract Ptosis Respiratory difficulty ```
108
Botulism pathology site?
NMJ
109
Types of muscular dystrophies?
Duchenne Muscular dystrophy | Becker Muscular dystrophy (milder than Duchenne)
110
What is Muscular dystrophy?
Lack of dystophin production - Genetic muscle diseases causing progressive myofiber degeneration and fibrotic tissue formation.
111
Duchenne Muscular dystrophy attributes?
X-linked Dystrophin gene mutation Asymptomatic in infancy Delayed motor milestones
112
Duchenne Muscular dystrophy presents as?
``` 2-3yo w/ awkward gait or cant run Gait is hyperlordotic/waddling Proximal leg weakness Clumsy, easily fatigued, weak muscles Pseudohypertrophy of calves Arm weakness by 6yo Wheelchair bound 12yo Ass/w Gower sign ```
113
Gower sign is ass/w what neuro condition?
Duchenne Muscular dystrophy
114
Why is Duchenne Muscular dystrophy ass/w Pseudohypertrohic calves?
Atrophy of thighs
115
Prader-willi syndrome is?
Severe neonatal hypotonia due to deletion of paternal Chromo 15q11q13
116
Prader-willi syndrome presents as?
Feeding problems > FTT Small hands/feet Boys - Small penis/testicles or cryptorchidism Early childhood - obesity/hyperphagia
117
Weakness eval req?
Muscle enzymes CSF Muscle Bx DNA blood test
118
What test is Dx for muscular dystrophy?
Muscle Bx
119
ABNL CSF results will point to what weakness d/o?
Polio or GBS
120
What muscle enzyme is elvated for muscular dystrophy?
CK elevated
121
MC symptom of concussion?
HA
122
Concussion is?
TBI resulting in rapid onset of short lived neuro impairment
123
Retrograde amnesia is?
Inability to recall events leading up to trauma
124
Anterograde amnesia is?
Cant form new memories after trauma
125
Second impact syndrome is?
Acute - sometimes fatal brain edema (increased ICP) when 2nd concussion occurs before 1st concussion heals fully.
126
RFs for concussion?
``` Artificial turf Football/Rugby Females playing - soccer/basketball BMI >27 Training <3hr/wk ```
127
RFs for recurrent concussion?
Hx of Concussion Longer playing time QB for football 1st 10d after a Concussion occured
128
Concussion SOC?
CT - Normal if a Concussion only (used to r/o)
129
Seizures ass/w Concussions are Benign or Pathologic?
If seizure occurs - at time of injury - Good prognosis - W/in 7d - Good prognosis - After 7d - glial scarring > lead to epilepsy
130
When can a Concussion lead to epilepsy?
After 7d s/p Concussion pt has seizures = glial scarring
131
A Concussion symptoms usually last how long?
<72h
132
Most Concussion resolve how long?
7-10d
133
Protocol for returning back to sports?
Stepwise Q/24h Day 1 - No activity - rest Day 2 - Light aerobic exercise - no resistance pt Day 3 - Sport specific exercise Day 4 - Noncontact drills - resistance training Day 5 - Full contact practice after medically cleared Day 6 - Gameplay
134
Epidural Hemorrhage attributes
ONSET - mins-hrs CT - Lens-shaped/football bleed compressing brain TXT - Surgical evac/monitor
135
Epidural Hemorrhage S/S?
Lucid interval w/ progressive neurologic deficits
136
Subdural Hemorrhage attributes?
ONSET - Hrs CT - Crescent shape bleed compressing brain TXT - surgical evac
137
Subdual Hemorrhage S/S?
Focal neuro deficits
138
Intraparenchymal Hemorrhage attributes?
Bleeding inside the brain tissue
139
Intraparenchymal Hemorrhage S/S?
Depressed consciousness Focal neurologic deficits +- multiple other contusions
140
TXT of Intraparenchymal hemorrhage?
Supportive only
141
Subarachnoid Hemorrhage S/S?
Stiff neck Worst HA of life Late hydrocephalus
142
TXT of Subarachnoid Hemorrhage?
Supportive
143
What brain Hemorrhages have best prognosis?
Epidural | Subdural
144
4 types of neurocutaneous d/o's?
Neurofibromatosis Tuberous sclerosis Sturge-Weber syndrome Arnold-Chiari Malformation
145
Types of Neurofibromatosis?
Type 1 - (Von Recklinghausen disease) | Type 2 - (Rarer)
146
What is the genetic etiology of Neurofibromatosis Type 1?
Autosomal dominate mutation on chromo 17 on NF1 gene (neurofibromin) - BUT can occur w/ spontaneous mutation
147
NF1 gene codes for?
Neurofibromin
148
Neurofibromas are?
Schwann cells that develop into dome shaped papules
149
Cardinal features of Neurofibromatosis Type 1?
Café au lait spots Axillary/inguinal freckles Cutaneous neurofibromas Lisch nodules (iris hamartomas)
150
Dx of Neurofibromatosis type 1 requires?
>1 of - Café au lait spots (>5 or >5mm size) - Axillary/inguinal freckles - 2+ Cutaneous neurofibromas - 2+ Lisch nodules (iris hamartomas) - Optic gliomas - Family Hx of Neurofibromatosis - Osseous lesions
151
What RAD is required of Neurofibromatosis?
Cranial imaging to r/o neoplasms
152
MC cause of death in pts w/ Neurofibromatosis?
Malignancy
153
Neurofibromatosis Type 2 genetic etiology?
AD mutation on Chromo 22 (NF2 gene- Merlin)
154
NF2 gene codes for what?
Merlin
155
Neurofibromatosis Type 2 is?
Intracranial/spinal tumors (schwannomas, meningimas, gliomas)
156
Neurofibromatosis type 2 presents as?
Posterior capsular or cortical cataracts | Skin lesions - plaque like, Sub-q nodules, cutaneous schwannomas
157
What is not found in Neurofibromatosis type 2?
Café au lait spots Lisch nodules axillary/inguinal freckling
158
Tuberous sclerosis genetic etiology?
AD - mutation of - - chromo 9 - TSC 1 gene - Hamartin - - chromo 21 - TSC 2 gene - Tuberin
159
Tuberous sclerosis is?
Hamartomas of brain, eyes, skin, kidneys, heart
160
What does TSC 1 gene code for?
Hamartin
161
What does TSC 2 gene code for?
Tuberin
162
Cardinal features of Tuberous sclerosis?
Facial angiofibromas (ADENOMA SEBACEUM) MR Epilepsy - Common cause for infantile spasms
163
Tuberous sclerosis CNS manifestation?
Cerebral cortex TUBERS (dysplasia areas) = MR/epilepsy
164
Tuberous sclerosis SKIN manifestation?
Adenoma sebaceum (sml red nodules - nose/cheek) Ash leaf spots - Hypomelanotic macules Shagreen patch - Raised, rough plaques (low back/ass)
165
Tuberous sclerosis RENAL manifestation?
Renal angiomyolipomas - malignant transformation
166
MC cause of death of adults w/ Tuberous sclerosis?
Renal angiomyolipomas
167
Dx of Tuberous sclerosis?
XR, CT/MRI | Skin lesion Bx
168
TXT of Tuberous sclerosis?
Support | Seizure Meds
169
Sturge-Weber syndrome is?
ABNL leptomeningeal blood vessels(ANGIOMAS) overlay cerebral cortex
170
Is Sturge-Weber syndrome inherited?
NO
171
What is Sturge-Weber syndrome ass/w?
- -Nevus flammeus - ipsilateral port-wine stain on face over ophthalmic division of trigeminal nerve - -Glaucoma
172
Sturge-Weber syndrome presents as?
Seizures - (MC) - hemiparesis - Stroke like episodes - HA - MR - Learning disabilities
173
TXT of Sturge-Weber syndrome?
Nevus Flammeus = laser surgery | Seizures = anticonvulsants
174
Arnold-Chiari Malformation types?
Types I - Cerenellar tonsils herniate through foramen magnum II - Type 1 + Lumbar meningomyelocele III - Type 1 + Occipital encephalocele
175
Arnold-Chiari Malformation may present as?
Early life - asymptomatic | Later life - Ataxia and vertigo, Hydrocephalus (obstruct)

Phase 2 PEDs (23 decks)

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