Neuro Flashcards by Rodrigo N

Involuntary spasms/movements and repetitive motions

Dyskinesia

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Sustained contraction, abnormal posturing

Dystonia

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Rapid involuntary jerky, uncontrolled, purposeless movements?

Chorea

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spinal cord tract that controls Voluntary motor activity: Terminates at anterior horn cell: ascends/descends same side

Costicospinal Tract

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senses vibration, position and light touch:

Ascends same side, decussates @ medulla

Dorsal Columns tract

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Senses pain and temperature and ascends at opposite sides crosses immediately

Spinothalamic Tract

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Motor efferent pathway (Away) of spinal cord

Anterior (Ventral Root) (Fast action front)

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Sensory Afferent pathway (Towards) of spinal cord

Posterior (Dorsal Root)

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Progressive motor degeneration 2T UMN/LMN necrosis: dysphagia, eventually respiratory: fatal 3-5 years

sensation, urinary sphincter, voluntary eye movement spared Tx:

Amyotrophic Lateral Sclerosis (ALS)

Tx: Riluzole

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Autosomal dominant nuero-degenerative disease: Chromosome 4 mutation/Abnormal CAG transcription:

behavioral (irritability), chorea, and dementia (<50):   Tx?
Caudate nucleus (Putamen) Atrophy: Fatal 15-20 years

Huntington Disease

Tx: Chorea (Tetrabenzine Antidopaminorgics)

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Idiopathic dopamine depletion–> failure to inhibit acetylcholine in the basal ganglia

(loss of pigment cells in substantia Nigra)

Parkinson’s Disease

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Resting Tremor (MC lessened with voluntary m.)
Bradykinesia (slow voluntary movement)
Rigidity
Flat Facis (Myerson’s nose tap=blink)
Instability w posture

Parkinson’s disease clinical manifestations X5?

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Parkinson’s Disease Tx?

Levodopa/Carbidopa- converted to dopamine (M.E Tx)
Bromocriptine (D. Agonists)
Benztropine (Anticholinergic)

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Demyelinating polyradiculopathy of the peripheral nerves. Ascending symmetric weakness/paresthesia

Assoc. w Campylobacter. Tx:

Guillian Barre Syndrome

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Autoimmune Inflammatory demyelinating degeneration of white matter. sensory pain/fatigue, cramping,

suspect w young and trigeminal neuralgia, optic neuritis episodic exacerbations; :Tx

Multiple Sclerosis

Tx: IVCS, plasmapheresis, Amantadine (Fatigue)
Glatiramer acetate (Reduces relapse severity)

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Autoimmune peripheral nerve disorder against Ach Receptors. Thymic hyperplasia/thymoma

General muscle weakness (Ocular, Resp., Bulbar): relieved w rest Tx:

Myasthenia Gravis

Tx: Pyridostigmine or Neostigmine 1st line
Plasmapheresis or IV Ig

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Restless leg syndrome treatment?

Pramipexole

- Ropinirole (Both domapine Agonists)

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CSF: High protein (>400) with a normal WBC (Albumin cytological dissociation)

Electrophysiologic decreased motor nerve conduction: Diagnosis studies for?

Guillain Barre Syndrome

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MRI with Gadollinium (TOC) confirms disorder showing white matter plaque hyper densities (Periventricular).

Multiple Sclerosis

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LP CSF shows increase IgG oligoclonal bands “Pleocytosis”

Multiple Sclerosis

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Blood test shows Acetylcholine receptor Antibodies (+) Muscle specific Tyrosine Kinase (Musk)

Myasthenia Gravis

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Myasthenia gravis Test that includes a rapid response to short acting IV_______?

Edrophonium

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Intentional tremor worse with emotional stress and intentional movement

Tx:

Essential Familial Tremor

Propranolol

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Tics associated with obsession-compulsion
Motor, phonetic, self-mutilating.

Tx:

Tourette syndrome

Tx: Risperidone (Clonidine or Haloperidol)

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CNS postural muscle tone abnormality 2T brain injury perinatal prenatal. spasticity is hallmark. Tx:

Cerebral Palsy Tx: Baclofen

RF with Post URI, DM, pregnancy. Ear pain, UL face paralysis, taste disturbance Tx:

Bell Palsy (CN VII) Tx: Prednisone (w/I 72 h of s/x), Artificial tears, Acyclovir

Constant daily Headache: not worse with activity: BL tight-band/vise-like no phono/photo phobia Tx: Prophylaxis and abortive

Tension Headache Tx: A-NSAID/APAP Amitriptyline P- BBs

Headache 4-72 hour in duration: pulsatile, lateralized, throbbing. NV, Phono/Photo phobia, worse w activity Tx: Abortive and Prophylaxis

Migraine Headache Tx: A- Triptans/Ergotamines (5HT-1) vasoconstrictions Metoclopramide, Promethazine, Prochlorperazine. (DBs) P- BBs/CCBs/TCAs

UL Headache: Temporal, periorbital, lancinating, < 2hoursseveral times a day/6-8 weeks. worse night/Etoh Horner's syndrome, UL congestion/lacrimation: Tx: A- P-

Cluster Headache Tx: A- 100% O2: Triptan/Ergotamines (Sumatriptan nasal) P- Verapamil

Brief episodic stabbing lancinating pain at eye, nostril and mouth. Worse with touch, wind, eating: Tx

Trigeminal Neuralgia (Tic Douloreoux) Tx: Carbamazepine (Anticonvulsant) Gabapentin

Headache worse with straining, NV, tinnitus, visual changes--> blindness, papilledema. CN6 Palsy, Obese W LP- Increased CSF pressure (Idiopathic) TX:

Idiopathic Intracranial HTN (Pseudomotor Cerebri) Tx: Acetazolomide

Concussion syndrome management?

- CT (SOC MRI Sx > 7-14 days) | - Cognitive/Physical rest

Acute abrupt transient confused state (medication or infection)

Delirium

Progressive, chronic, intellectual deterioration. Memory loss. RF > 60

Dementia

2nd MC type of dementia due to chronic ischemia or multiple lacunar infarcts. HTN most important RF

Vascular dementia

MC Dementia 2T amyloid deposition: Neurofibrillary tangles (Tau protein): cholinergic deficiency

Alzheimer Disease

Alzheimer Disease CT scan Dx? Tx?

Cerebral Cortex Atrophy Tx: Ach-esterase inh. (Donepezil, Rivastigmine, Tacrine) Memantine (NMDA reduce glutamate excitotoxicity)

Diffuse Lewy bodies (Protein Deposits) --> hallucinations and delusions.

Diffuse Lewy Body Disease

star shaped Tumor of the brain/spinal cord: primary CNS tumor in adults: Headaches + wakes patient up at night.

Astrocytoma

MC and aggressive primary CNS tumor in adults: Focal Deficits, headaches that wakes patient up at night. (+) Cushing's reflex

Glioblastoma

what is Cushing's reflex?

Hypertension, bradycardia, and irregular respirations.

Benign Tumor Associated with neurofibromatosis (NF-2)

Meningiomas

Atlas C1 Fracture (Ant/post arches): Increase in predental space > 3mm in adults; >5 mm in children

Jefferson fracture

C2 Axis/pedicle fracture --> spondylolisthesis (forward slipping) between C2-C3 (Unstable Fx) >5mm Operative

Hangman's Fracture

Fracture of Dens that is unstable

Dens fracture Type II ( MC @ base)

Extreme flexion fracture involving C1 and C2 associated with odontoid fracture

Atlanto-occipital dislocation

spinous process avulsion fracture: MC @ the lower cervical C-6 or C-7: Sx- only if non union or pain

Clay- Shoveler's fracture

Anterior displacement of wedge-shape g=fracture fragment. MC @ C2 Highly unstable that may cause anterior cervical cord syndrome.

Flexion Teardrop Fracture

is stable if all ligaments are intact and there is no posterior displacement of fractured segment

Burst Fractures

BP difference between arms 15mmHg 2T flow reversal at the expense of the basilar artery to arm. L Arm MC

Subclavian Steal Syndrome

Motor and sensory deficits in upper extremities in a "shawl distribution.

Central cord syndrome

Ipsilateral motor vibratory and proprioception deficits and contralateral pain and temperature deficits

Brown Sequard syndrome

Loss of temperature and pain in lower extremities. TEE-Pee

Anterior Cord Syndrome

TIA: Transient episode of neurological deficits las t less than ____ most resolving in __to___ MC due to ____?

<24 hours (resolve in 30-60 minutes) MCC Embolus

Damage Associated with voluminous meaningless effortless speech (Word Soup) with impaired comprehension of error

Wernicke's Aphasia

Damage Associated with partial loss or difficulty in ability to produce language: mild comprehension deficit

Broca's Aphasia

Ischemic strokes includes

- Hemiparesis (Cant' feel, move, see, talk) - sensory loss - Hemianopsia (half field blindness) - dysarthria - Aphasia

MC type of stroke and what vessel?

Ischemic (Middle cerebral Artery)

MC Arterial bleed: Between skull and Dura: involves medial meningeal artery: Lens shape (Convex)

Epidural Hematoma (Hemorrhage)

MC Venous bleed: Between dura and arachnoid: involves tearing of bridging veins: Blunt Trauma "elderly" Slow onset and crescent shape: "Midline shift"

Subdural Hematoma (Hemorrhage)

Bleed between arachnoid and pia: MC Berry Aneurysm rupture: Sudden thunderclap worse HA of life:

Subarachnoid Hemorrhage

Intraparenchymal hemorrhage: HTN, trauma or arteriovenous malformation: LP--> herniation

Intracerebral Hemorrhage

fever, chills, headache, photosensitivity, NV, AMS/seizures, nuchal rigidity Kernig's and Brudzinki's

Acute Bacterial Meningitis

MCC of bacterial meningitis 1 month- 18 yo

N. Meningitides

MCC of bacterial meningitis 18-50 yo? what about >50?

S. Pneumoniae (>50 Listeria)

MCC of bacterial meningitis < 1 month

Group B strep Agalactiae

CSF Glucose is decreased with increased lymphocytes, and increased protein.

Fungal or Tuberculosis Meningitis

CSF Glucose is normal with increased lymphocytes, and normal or decreased protein.

Viral Meningitis

CSF Glucose is decreased with increased Neutrophils PNMs, and increased protein .200.

Bacterial Meningitis

MCC is HSV1, Echo or coxsackie: profound lethargy with abnormal focal neurogocal deficits CN II, IV, VI, VII. CSF Lymphocitosis w normal Glucose Tx:

Encephalitis (Brain Parenchyma infx)

Viral Meningitis highlights

- Nuchal rigidity - mild meningeal symptoms - AMS with No focal deficits

what are the Type of seizures?

Partial (Focal)- Simple or complex | Generalized- Absence (Petit) or Tonic-clonic (Grand Mal)

Seizure that involve impaired consciousness with lip smacking, manual picking or patting/ coordinated m.

Complex Partial

Seizures where consciousness if fully maintained

Simple Partial seizure

Seizure involves brief lapse of consciousness stating w eyelid twitching

Absence (petit Mal)

status epilepticus are seizures without recovery for >___?

30 minutes

what is the 1st line Drug for Absence seizure

Ethosuximide

what is the 1st line drug for Status epilepticus?

Lorazepam/Diazepam --> Phenobarbital | Phenytoin LD infused >30 min.

Anticonvulsants include

- Valproate (Lavaca de Mili) - Lamotrigine - Carbamazepine - Benzos, Phenytoin, Phenobarbital

Foot drop suspect injury to what nerve?

Peroneal nerve

Tachycardia, Mydriasis, diarrhea/cramps, Agitation, tremor/twitching, hyperthermia, and hyperreflexia?

Serotonin syndrome

Neuro Flashcards

(81 cards)