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neuro Flashcards

1
Q

how to use the VAN tool to identify LVOs

A

Pt must have extremity weakness + at least 1 of the V/A/N to be VAN positive

  • visual disturbance: field cut, diplopia, blindness
  • aphasia: expressive or receptive
  • neglect: inability to track, extinction, hemineglect
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2
Q

tonic gaze deviation toward lesion (2 options)

A

internal carotid or MCA

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3
Q

contralateral lower extremity motor/sensory deficits (spares hands/face), urinary incontinence
WITH
- mute, transcortical motor aphasia (understand and can repeat but can’t speak well)

A

L ACA

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4
Q

LLE motor/sensory deficits (spares hands/face), urinary incontinence
WITH
hemimotor neglect

A

R ACA

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5
Q

hemiparesis, facial plegia, contralateral sensory loss
- usually face/upper extremity > lower extremity
- gaze toward lesion
WITH
- aphasia

A

L MCA

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6
Q

hemiparesis, facial plegia, contralateral sensory loss
- usually face/upper extremity > lower extremity
- gaze toward lesion
WITH
- dysarthria w/o aphasia, contralateral neglect

A

R MCA

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7
Q

posterior circulation stroke: 5 Ds

A

dizziness, dysarthria, dystaxia, diplopia, dysphagia

- must have multiple simultaneous complaints

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8
Q

crossed neuro deficits should make you think of

A

a posterior circulation stroke

- example: ipsilateral CN deficit, contralateral motor deficit

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9
Q

quadriplegic stroke

A

basilar artery

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10
Q

unilateral headache w/visual agnosia (can’t recognize objects)

A

PCA

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11
Q

pure contralateral motor deficits

A

posterior limb of internal capsule

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12
Q

pure contralateral sensory deficits

A

thalamus

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13
Q

contralateral motor + sensory deficits

A

internal capsule + thalamus

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14
Q

how to age a stroke on MRI

A

I be iddy biddy baby doodoo

T1/T2 when compared to brain: I = isointense, B = bright, D = dark

hyperacute: IB
acute: ID
early subacute: BD
late subacute: BB
chronic: DD

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15
Q

bright areas on DWI: DDx

A
  • ischemic brain: if also dark on ADC (if ADC is also bright, it’s shine-through)
  • cerebral abscess: if also dark on ADC
  • active MS plaque (old plaques aren’t bright)
  • some tumors
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16
Q

7 dangerous causes of dizziness

A 
posterior fossa stroke
posterior fossa tumor
dysrhythmia
hypoglycemia
ACS
anemia
drug toxicity
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17
Q

length of a typical post-ictal period

A

20-30m

18
Q

immediate action post-sz

A

CTH (unless you have a clear explanation otherwise by hx)

19
Q

Fentanyl dose for neurointubation

A

2-5 mcg/kg

20
Q

Keppra dosing in neuroemergencies

- exception

A

60 mg/kg

- exception: 30 mg/kg for HD pts

21
Q

avoid benzos in

A

cirrhotics

elderly

22
Q

ischemic stroke BP thresholds

A

< 220/120

after tPA < 185/110

23
Q

hemorrhagic stroke SBP threshold

A

< 140

24
Q

Explain the HINTS exam.

A

all 3 must suggest a peripheral cause to r/o central cause

  1. head impulse: saccade = peripheral
  2. nystagmus: unilateral/nonrotary = peripheral
  3. test of skew: no deviation to realign eyes = peripheral
25
Q

CN IV palsy and compensatory head position

A

eye drifts superomedially > vertical diplopia > head tilts contralaterally and down

26
Q

diabetic CN III palsy

A

down and out w/pupillary sparing

27
Q

expected nystagmus during caloric testing

A

COWS (if the pt follows these rules, it’s peripheral)

if not, consider vestibular dysfunction

28
Q

sudden hearing loss

A

develops over 3d or less

  1. conducteive: OM, cerumen
  2. sensorineural: infx, autoimmune, neoplasm, CVA, ototoxic meds

tx: prednisone

29
Q

Meniere disease

A

vertigo, tinnitus, hearing loss

30
Q

Alport syndrome

A

hearing loss, glomerulonephritis

31
Q

cavernous sinus thrombosis

A

S. aureus > fever, periorbital edea, chemosis, CN VI palsy

32
Q

GCS

A 
E
4 = normal
3 = to speech
2 = to pain
1 = nothing
V
5 = normal
4 = confused
3 = inappropriate
2 = incomprehensible
1 = nothing
M
6 = normal
5 = to pain
4 = withdraws
3 = decorticate
2 = decerebrate
1 = nothing
33
Q

pulsatile tinnitus

A

idiopathic intracranial hypertension

34
Q

mechanism of central cord syndrome

A

forced hyperextension makes the ligamentum flavum buckle into the spinal cod, causing contusion or hemorrhage in the central portion of the cord

35
Q

Guillain-Barre: tx

A

IVIG

36
Q

most common secondary condition to hypoK periodic paralysis

A

hyperthyroidism (and ultimately, thyrotoxicosis)

37
Q

VP shunt failure

A

usually proximal 2/2 choroid plexus or CSF protein in catheter

distal is usually 2/2 thrombus

sx: bulging fontanelle, sundown eyes, HA, nausea

38
Q

most common focal encephalitis in AIDS

A

toxoplasmosis

- prefers the basal ganglia

39
Q

toxo tx

A

pyrimethamine, sulfadiazine, folinic acid

40
Q

presentation of primary CNS lymphoma

A

progressive altered mental status

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