Neuro basics Flashcards
(206 cards)
1
Q
Cause of motor conduction defects w/o sensory symptoms
A
Lead
2
Q
Causes of sensory conduction defects w/o motor symptoms
A
Paraneoplastic
HIV
3
Q
Time required for denervation
A
10-21 days after injury
4
Q
Nerve conduction study results for neuropathy
A
Axonal - nml/mildly slow - toxic, metabolic, DM causes
Demyelinating - very slow - autoimmune, acquired, post-infectious (GBS)
5
Q
Repetitive nerve stimulation responses
A
Decremental - Myasthenia gravis
Incremental - Botulism, Lambert-Eaton
6
Q
Xanthochromia
A
Yellow CSF due to RBC breakdown 12h-14d after bleed
7
Q
Cytoalbumino-dissociation
A
CSF: High protein, low WBC
In demyelinating neuropathies (GBS)
8
Q
LP CIs
A
Raised ICP (somnolence, headache, imbalance, N/V, focal neuro deficit, new seizure, papilledema): Tumor, abscess Subarachnoid/intracerebral bleed Posterior fossa mass Low platelet count under 50k INR over 1.5 (warfarin)
9
Q
Do what before and after LP?
A
Review HCT/MRI to see:
No mass lesion + 4th ventricle, quadrigeminal cistern are open
Always check serum glucose as reference post-LP (CSF should have over 2/3 serum)
10
Q
RBCs in CSF means?
A
Traumatic tap if decreasing concentration with subsequent tubes (or rarely active bleed)
11
Q
Meningitis treatment
A
Treat empirically for likely bacteria/virus before LP: 10mg IV dexamethasone q6h for 4d Ceftriaxone/Cefotaxime Vancomycin Acyclovir ADD AMPICILLIN for those over 50y
12
Q
Reasons for EEG
A
Assess coma/consciousness
Seizure (vs pseudoseizure)
Creutzfeldt-Jacob disease
Periodic lateralizing epileptiform discharge (PLED) in herpes encephalitis
13
Q
Seizures
A
Abnormal, paroxysmal, excessive CNS neuron discharge
Eyes are open
Generalized - abnormal in all leads w/ spikes
14
Q
Head CT terms
A
Hyperdensity - white - bone, blood, Ca
Hypodensity - black - CSF, ischemia (abnormal after 6-24h), chronic subdural, edema, tumor
15
Q
Parts of brain that bleed w/ chronic HTN? Sx?
A
Aneurysms at branches of cerebral arteries
Lenticulostriate aa
Cerebellar aa
Intraventricular hemorrhage in premature infants;
Focal sx that progress to ICH signs (headache, N/V, AMS)
16
Q
Metastases to brain that commonly bleed?
A
Melanoma, RCC
17
Q
Subarachnoid hemorrhage management
A
Sedation/valium if conscious Give nimodipine, statin, MCA doppler, and consider angioplasty for vasospasm Keep BP higher to maintain perfusion Operate early on aneurysms Monitor for hydrocephalus
18
Q
MRI terms
A
Hypointensity - dark Hyperintensity - white T1, T2 Flair - MS Diffusion weighted imaging - detects ischemia
19
Q
Glasgow coma scale
A
Out of 15: Eye opening (4) - spontaneous, voice, pain, none Verbal response (5) - nml convo, disoriented, incoherent, sounds, none Motor response (6) - nml, localized to pain, withdraws from pain, decorticate (flexor), decerebrate (extensor), none 3-8 = Severe 9-12 = Moderate 13-15 = Mild
20
Q
MMSE
A
Out of 30: Orientation to time = 5 Orientation to place = 5 Registration = 3 (repeat named prompts) Attention/Calculation = 5 (serial 7s/'world' backwards) Recall = 3 (registration recall) Language = 2 (name pencil and watch) Repetition = 1 (Speak back a phrase) Complex commands = 6 (Varies. Draw figure shown.) Over 24 = Nml Over 19 = Mild cognitive impairment Over 10 = Mod Under 9 = Severe
21
Q
Seizure etiology
A
Etiology - Alcohol withdrawal, illicit drugs, meds; Brain tumor/trauma; Cerebrovascular disease (Subdural hematomas, HTN encephalopathy); Degenerative CNS disorders (AZD); Electrolytes (hyponatremia, uremia, liver failure, hypoglycemia); Idiopathic (60%)
22
Q
Stroke treatment, management, secondary prevention
A
Maintain elevated, but not very high BP
BMP (Cr for contrast), glucose, CBC, INR, Troponins, ECG, tox screen — Stat CT
If no hemorrhage, thrombolysis/thrombectomy
ECG for arrhythmia, Echo for endocarditis, Carotid U/S, Lipids, HbA1c, TSH, Homocysteine, ESR/CRP, Blood cx
ASA, dipyrimadole, clopidogrel; hold anticoag Carotid revascularization (CEA, stenting)
23
Q
How to test visual fields
A
Patient and examiner cover opposite eyes
Test one eye and one visual field at a time
24
Q
Testing aphasia
A
What did you have for breakfast?
Touch your L foot with your R hand.
Repeat: The brown dog ran down the muddy hill.
25
Diffuse petechiae/purpura in meningitis case?
Neisseria meningitidis
26
Leukonychia
Mees' lines on nails seen in arsenic (or other heavy metal) poisoning
27
Alopecia is common in what poisoning?
Thallium (non-standard pattern)
28
Dysphonia
Difficulty producing voice sounds (laryngeal issue)
29
Dysarthria
Difficulty articulating individual words (slurred speech)
30
Dysprosody
Difficulty with melody, rhythm of speech, inflection, intonation (Non-dom hemisphere stroke)
31
Aphasia
Language problem (Dom hemisphere stroke)
32
CN2 testing
Perform visual acuity and visual fields first
Perform fundoscopic exam and pupillary light reflex second
CN2 = afferent, CN3 = efferent
33
Conditions with anosmia
Head trauma
Frontal lobe mass/abscess
PD, AZD
34
Relative afferent pupillary defect occurs with what?
RAPD in CN2 injury
| Eye with defect dilates with swinging light to it
35
Argyll Robertson pupil
'Prostitute's' - accommodates, but doesn't react
| Neurosyphilis, maybe DM
36
Horner's syndrome
Ptosis, miosis, anhidrosis
| Dysfunction of SNS to orbit, face
37
Vertical gaze palsy
No up/down eye mvt
| Midbrain lesion
38
Horizontal gaze palsy
PPRF - brainstem lesion
| INO - MLF lesion
39
CN4 palsy
Head tilt toward unaffected side to compensate
40
Pupillary light reflex circuit
Light hits either retina, CN2 to pretectal nucleus, bilateral connections to E-W nuclei, PSNS pupillary constriction via CN3
41
CN3 palsy with blown pupil
Due to mass effect - emergent
| Uncal herniation or PcommA aneurysm
42
CN3 palsy with reactive pupil
DM
43
INO
Can look to affected side
| Affected eye cannot adduct while unaffected has concurrent nystagmus
44
CN7 lesions
Bell's palsy = LMN lesion affecting whole 1/2 of face
| Stroke = UMN lesion affecting only bottom of 1/2 of face
45
CN12 lesions
'Lick your wounds'
46
Resting tremor
While patient is relaxed
| PD specific
47
Postural tremor
When limb is being held up
48
Action tremor
When limb is moved
49
UMN lesion pattern
No initial atrophy
No fasciculations
Hyperreflexive with increased tone
50
LMN lesion pattern
Atrophy, fasciculations
| Decreased reflexes and tone
51
Tics
Intermittent, stereotyped - face or body
52
Chorea
Random movements - 'fidgets'
53
Dystonia
Sustained abnormal posture
54
Myoclonus
Lightening-like abrupt jerks
55
Duchenne muscular dystrophy
XR dystrophin mutations
Dilated cardiomyopathy, muscle pseudohypertrophy
Gower's sign
56
Myotonic dystrophy
AD
Myotonia - failure of spontaneous release from handshake
Pacemaker due to arrhythmia (conduction abnmlities)
Insulin resistance, cataracts
57
Pronator drift (down)
Indicates UMN lesion of contralateral pyramidal tract (or ipsilateral cerebellum if drifting upward)
Screen for mild weakness due to stroke
58
Cerebellar dysfxn signs
Dysmetria, Dysdiadochokinesis, Titubation, Dysarthria, Nystagmus, Intention tremor, Broad-based stance/gait
59
Dysmetria
Zig zag to target w/ finger
60
Dysdiadochokinesis
Impairment making smooth, rapid, alternating mvts
61
Titubation
Coarse tremor of the trunk
62
Dysarthria
Impairment of speech motor fxn - NOT language disorder
63
Cerebellar dysfxn indicates lesion of which side?
Ipsilateral
64
Heel-shin test performed in what position?
Supine
65
Romberg sign indicates?
Dorsal column dysfxn, NOT cerebellar
66
Graphesthesia
Identify number drawn on hand
67
Stereognosis
Identify object placed in hand
68
Dermatomal distribution of neuropathy indicates?
Radiculopathy (disk herniation), VZV, spinal cord lesion
69
REM sleep occurs?
Later at night.
70
For concussion ask about?
Cause, Loss of consciousness, Imaging, New sx
71
Peripheral neuropathies treated with?
TCAs, Pregabalin, Gabapentin, Duloxetine (SNRI)
72
Seizure types
Generalized: Tonic-clonic (grand mal), Absence, Myoclonic
Focal (partial): Simple (no AMS), Complex (AMS)
Focal may become generalized secondarily
73
Seizure treatments
Treat underlying cause first (metabolic, toxic)
Consider treatment withdrawal if seizure-free w/ nml EEG for 1y
Carbamazepine, Ethosuximide, Gabapentin, Lacosamide, Lamotrigine, Levetiracetam, Oxcarbazepine, Phenobarbital, Phenytoin, Topiramate, Valproate, Zonisamide
74
Seizure presentation
```
Aura (t = s-m)
Ictal period (s-m): Tonic and/or clonic mvts of body
Postictal (m-h): Slowly resolving confusion, disorientation, lethargy. May have focal neuro deficits (Todd's paralysis)
Status epilepticus
```
75
Status epilepticus
Cts tonic-clonic seizure at least 30m or repeated seizures w/o resolution of postictal encephalopathy.
Complications: neuronal death, rhabdo, lactic acidosis
76
Epilepsy
Recurrent unprovoked seizures
| 1% of pop
77
What immediately threatens brain tissue?
```
H's:
Hypoxia
Hyperthermia
Hypoglycemia
Herniation
```
78
PD questions
Tremor? Memory? Gait/falls? Dyskinesias/Freezing? Hallucination (from Dx or SE)?
79
Headache red flags
```
Thunderclap headache - SAH
Positional headache - CSF leak
Exertional headache - (HTN) usually migraine
New headache if over 50yo - mass
Substantial change in headache pattern
Constant headache in same location
Aura that is sudden, lasts over 1h, or doesn't resolve
Systemic sx - infxn
```
80
Transverse myelitis
```
Inflammation of spinal cord causing UMN signs
Due to:
Bacterial infxn (Mycoplasma, Borellia, Bartonella)
Viral infxn (HSV, VZV, EBV, CMV, HIV)
Rare vaccination rxn
MS
Paraneoplastic syndrome
Vascular etiology
```
81
Drugs lowering seizure threshold
```
Theophylline
Isoniazid, metronidazole, penicillins (give B6)
TCAs, bupropion, 5-HT agents
Steroids, insulin
Opiates, stimulants
Anticholinergics, AChEIs, antihistamines
Heavy metals, lithium
```
82
Non-Rx causes of lower seizure threshold
```
Sleep deprivation, stress
Fever
Rx withdrawal
Flashing lights
Menstruation
Metabolic - electrolyte abnmls, DM
```
83
Most common primary cancers metastasizing to brain in order of occurrence
Lung, breast, melanoma, colon
Multi met: Lung, melanoma
Single met: Breast, colon, RCC
Prostate CA rarely goes to brain
84
Sleep stages
```
Beta - awake
Alpha - eyes closed
Theta - N1
Sleep spindles - N2
Delta - N3 (night terrors, sleepwalking, bedwetting)
Beta - REM (flaccid paralysis)
```
85
Parkinsonism
Associated w/ Lewy bodies (a-synuclein) and loss of dopaminergic neurons of SNpc
May have hallucinations in addition to motor sx
Dementia presents late in PD
On spectrum w/ Lewy body dementia, but more motor involvement first
86
Huntington's
AD c4 CAG repeats
(CAG - Caudate loses ACh and GABA)
Neuronal death by glutamate tox
Chorea/Athetosis (writhing), personality changes, dementia
87
Hemiballismus
Sudden flailing of arm w/ or w/o ipsilat leg
| SubThNu stroke contralaterally (lacunar)
88
Myoclonus
Sudden brief uncontrolled muscle contraction
| Metabolic causes - liver, renal failure
89
Essential tremor
Associated w/ action, not present at rest
| May self-Rx w/ EtOH. Propranolol, primidone first line
90
Resting tremor
Present in Parkinsonism
| Pill-rolling, alleviated by intention
91
Intention tremor
Zig-zag of intentional mvt to target
| Cerebellar dysfxn
92
Homunculus organization
Head = lateral, inferior
| Lumbar, sacral = medial, superior
93
Broca's area
Anterior to cranial primary motor cortex in dominant (L) frontal cortex
Stroke = good comprehension, poor language formation
Broca's broken boca
94
Wernicke's area
Dominant (L) temporal lobe posterior to primary auditory cortex
Stroke = poor comprehension, can form language but it is incoherent
Wacky Wernicke
95
Amygdala lesion
Kluwer-Bucy syndrome: Hypersexuality, hyperorality, disinhibition
HSV-1 assoc
96
Frontal lobe lesion
Disinhibition, concentration deficits, poor judgment
| Primitive reflex reemergence
97
Gerstmann syndrome
L (dom) parietal-temporal cortex stroke
| Agraphia, acalcula, finger agnosia, L-R disorientation
98
R (non-dom) parietal-temporal cortex lesion
CL agnosia (hemispatial neglect)
99
Midbrain (reticular activating system) lesion
Reduced arousal
100
B/l mammillary body lesion
Wernicke-Korsakoff syndrome: Confusion, ataxia, ophthalmoplegia; memory loss, confabulation, personality change
EtOH assoc - always give B1 before glucose to suspected EtOH px to prevent this
101
Basal ganglia lesion
Resting tremor/chorea/athetosis
| PD
102
Cerebellar hemisphere lesion
Ipsilateral intention tremor, fall towards affected side
103
Cerebellar vermal lesion
Truncal ataxia, dysarthria
104
Peripheral neuropathy lab tests
B12, TSH, HbA1c, blood glucose, SPEP
105
B/l hippocampus lesion
Anterograde memory loss
106
PPRF lesion
Look away from lesion
107
FEF lesion
Look towards lesion
108
Cerebral pontine myelinosis
From low to high (Na), pons will die -- Locked-in syndrome
109
Global aphasia
Lesion of Broca + Wernicke areas
110
Conduction aphasia
Poor repetition, but fluent speech and intact comprehension
| Lesion of arcuate fasciculus
111
Cerebral perfusion controls
PCO2 increase causes increased cerebral blood flow
| Low PO2 only inceases cerebral flow once under 50
112
Charcot-Bouchard microaneurysms
Chronic HTN effect on lenticulostriate aa (thalamus, basal ganglia)
113
Post-stroke pain syndrome
Neuropathic pain due to thalamic lesion causing wk-mth of allodynia
114
Intraparenchymal hemorrhage
Due to HTN. Assoc w/ amyloidosis (AZD), neoplasm, vasculitis
| Typically into internal capsule. Can be lobar
115
Communicating hydrocephalus
Down CSF absorption -- up ICP, papilledema, herniation
| Post meningitis
116
Hydrocephalus ex vacuo
Appearance of up CSF space from brain atrophy
| No wet, wobbly, wacky sx
117
Werndig-Hoffmann and poliomyelitis lesions
LMN lesions only
| W-H = floppy baby
118
MS lesions
```
Random and asymmetric
Demyelination
Scanning speech, nystagmus, intention tremor
High CSF protein w/ oligoclonal bands
Periventricular plaques
```
119
ALS lesions
Combined UMN and LMN lesions w/o sensory or cortical loss
120
Presbycusis
Age-related gradual hearing loss
121
Friedreich ataxia
AR c9 GAA repeat causes multiple tract degen -- weakness, DTR loss, vibr loss, proprio loss
Presents in children w/ kyphoscoliosis, hypertrophic cardiomyopathy
122
Brown-Sequard syndrome
Cord hemisection
I/L UMN signs below lesion
I/L loss of FT, Pr, V 1-2 lv below lesion
C/L Pa, T, CT loss below lesion
I/L loss of all sensation at lesion level
I/L LMN signs at lesion
Horner's if lesion above T1 due to oculo-SNS path damage
123
Parinaud syndrome
Conjugate vertical gaze palsy due to superior colliculus lesion
124
Acute angle closure glaucoma presentation
Painful sudden vision loss, halos around lights, frontal headache
Don't give epinephrine b/c of mydriasis
125
Papilledema
Increased ICP: Bigger blind spot, elevated optic disc, blurred margins on fundoscopy
126
Pick disease
Frontotemporal dementia and atrophy
Personality changes, parkinsonism, dementia, aphasia
Spherical tau aggregates
127
Lewy body dementia
Initially dementia and visual hallucinations, followed by parkinsonism
On spectrum w/ PD, but dementia first
Due to a-synuclein defect
128
Creutzfeldt-Jakob
Rapidly progressive dementia w/ myoclonus
Specific 3Hz EEG
14-3-3 protein in CSF
129
GBS
```
Autoimmune Schwann cell destruction = LMN motor and sensory neuropathy
May have autonomic dysfxn - give steroids if SNS failure
Albuminocytologic dissociation (high CSF protein w/ nml cell count)
Treat w/ plasmapheresis, IVIG
***Steroids are not demonstrated to improve outcomes
```
130
PML
Oligodendrocyte (CNS) destruction due to reactivated JC virus
Seen in AIDS, natalizumab
Rapidly progressive and fatal
131
Postinfectious encephalomyelitis
Multifocal perivenular inflammation and demyelination
| Commonly after measles, VZV, rabies/smallpox vax
132
Metachromatic leukodystrophy
AR lysosomal storage disease
Arylsulfatase A deficiency -- Impaired myelin production
CNS + peripheral demyelination, ataxia, dementia
133
Charcot-Marie-Tooth disease
AKA Hereditary Motor and Sensory Neuropathy
Usually AD defective myelin protein production
Assoc scoliosis, foot arch deformities
134
Krabbe disease
AR lysosomal storage disease
Galactocerebrosidase deficiency
Peripheral neuropathy, dev delay, optic atrophy, globoid cells
135
Adrenoleukodystrophy
XR defect of very long chain FA metabolism -- buildup in nerves, adrenals, testes
Coma, adrenal gland crisis
136
Sturge-Weber
GNAQ acquired activation
| Port wine face stain, Ipsilateral leptomeningeal angioma, Seizures, Intellectual disability, Early onset glaucoma
137
Tuberous sclerosis
Hamartomas, Angiofibromas/renal Angiomyolipoma, MR, Ash-leaf spots/Shagreen patches, Rhabdomyoma, AD, Mental retardation, Seizures
138
NF1
AD c17 mutation
| Cafe-au-lait, Iris hamartomas, Neurofibromas, Optic gliomas, Pheochromocytomas
139
VHL
AD c3 VHL mutation -- angiogenesis
| Cavernous hemangiomas in skin, organs; B/l RCC; Hemangioblastomas of CNS (cerebellum); Pheochromocytomas
140
Partial seizures
1 brain area, most often medial temporal lobe w/ preceding aura
Simple partial - consciousness ok
Complex partial -- impaired consciousness
141
Generalized seizures
```
Diffuse brain involvement
Absence (staring) - 3Hz, no post-ictal
Myoclonic - quick repetitive jerks
Tonic - stiffening
Tonic-clonic - alternating stiffening/mvt
Atonic - drop to floor (not fainting)
```
142
Status epilepticus causes
All demos - fever (infxn), trauma, metabolic
Children - genetic/congenital
Adults - tumors, stroke
Elderly - stroke
143
MCA stroke
Upper limb + face
Motor + sensory cortex
Wernicke + Broca areas
Hemineglect if non-dom side, Aphasia if dom side
144
ACA stroke
Lower limb
| Motor + sensory cortex
145
Lenticulostriate aa stroke
Striatum + Internal capsule
C/l hemiparesis/hemiplegia
Common location of lacunar infarcts secondary to uncontrolled HTN
146
ASA stroke
Lat corticospinal tract + Medial lemniscus
CN XII if caudal medulla
C/l hemiparesis of upper + lower limbs, C/l down proprioception, I/l CN XII dysfxn
Medial medullary syndrome from ASA br infactions
147
PICA stroke
Lat MEDULLA (VesNu, Sp5Nu, NuAmb, LatSpThTr)
Vomiting, vertigo, nystagmus (VesNu); Down P/T/CT to I/l face (Sp5Nu) + C/l body (LatSpThTr); laryngeal dysfxn (NuAmb specific); Horner's syndrome.
Lateral medullary (Wallenberg) syndrome
Don't PICA ho[a]rse that can't [eat]
148
AICA stroke
Lat pons (CNNu, VesNu, 7Nu, Sp5Nu, CocNu)
Vomiting, vertigo, nystagmus (VesNu); Facial paralysis + gland dysfxn (CNNu); Deafness (CocNu)
Lateral pontine syndrome
FACIAL DROOP means AICA is pooped
149
PCA stroke
Occipital and visual cortex
| C/l hemianopia w/ macular sparing
150
Basilar a stroke
Medulla, pons, lower midbrain, CorSp, CorBulb, Ocular CNNu, PPRF lesions
Locked-in syndrome
Preserved consciousness and blinking w/ loss of all other mvt
151
ACom lesion
Usually aneurysm
| Visual field defects
152
PCom lesion
Usually aneurysm
| CN3 palsy with ptosis and pupil dilation
153
Akathisia
Restlessness, motion assoc w/ 1st gen antipsychotics and PD
| Seen in low dopaminergic state
154
NT changes in AZD
Low ACh
155
NT changes in anxiety
High NE
| Low GABA, 5-HT
156
NT changes in depression
Low NE, 5-HT, dopamine
157
NT changes in Huntington's
Low GABA, ACh
| High dopamine
158
NT changes in PD
Low dopamine
| High seratonin, ACh
159
NT changes in schizophrenia
High dopamine
160
NE synth site, changes in diseases
Locus ceruleus (pons) -- Stress, panic
High in anxiety
Low in depression
161
Dopamine synth site, changes in diseases
VTA, SNc -- Reward, pleasure
High in HD
Low in PD, depression
162
5-HT synth site, changes in diseases
Raphe nuclei
High in PD
Low in anxiety, depression
163
ACh synth site, changes in diseases
Basal nucleus of Meynert
High in PD
Low in AZD, Huntington's
164
GABA synth site, changes in diseases
Nucleus accumbens -- Reward, pleasure
| Low in anxiety, Huntington's
165
Delirium treatment
Address underlying cause -- infxn, metabolic, etc
Optimize brain condition w/ O2, hydration, pain control
Antipsychotics such as haloperidol
166
Neuroleptic malignant syndrome sx, treatment
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia due to dopamine antagonism
Treat w/ dantrolene, D2 agonists (e.g., bromocriptine)
FEVER: Fever, Encephalopathy, unstable Vitals, high Enzymes, Rigidity
167
Tardive dyskinesia, Rx, and development
Stereotypic oral-facial movements as a result of long-term antipsychotic use. Potentially irreversible.
Seen w/ high potency 1st gen antipsychotics especially: Trifluoperazine, Fluphenazine, Haloperidol
```
Evolution of EPS side effects:
4 hr acute dystonia (muscle spasm, stiffness,
oculogyric crisis)
4 day akathisia (restlessness)
4 wk bradykinesia (parkinsonism)
4 mo tardive dyskinesia
```
168
Tethered spinal cord
Urinary, bowel control issues
Low back pain
B/l muscle weakness, abnml gait
Foot, spine abnmlities
Assoc w/ spina bifida, Chiari malform
Once neuro sx develop, they may become irreversible
169
Bell's palsy
Idiopathic or as a complication in AIDS, Lyme, Sarcoid, Tumors, Diabetes
LMN lesion leads to paralysis of entire side of face
Treatment involves steroids
Most cases resolve spontaneously
170
Patients with Bell's usually experience:
Pain in ear preceding weakness
I/l numbness + weakness in face
Hearing unaffected
171
Normal pressure hydrocephalus presentation
Psychomotor slowing
Incontinence
Enlarged ventricles
172
Serial therapeutic agents order for status epilepticus
Glucose, lorazepam, fosphenytoin, phenobarbital
173
EMG results in carpal tunnel syndrome
Prolonged distal latency of median nerve conduction velocity across wrist
174
Immediate Rx for TMJ
High dose prednisone
175
Treatment of increased ICP due to head trauma
Steroids
176
BZD effects in elderly delirious patients
Increased SE risk, prolonged action, and may cause paradoxical agitation
Use haloperidol if absolutely necessary, but watch for NMS
177
Putamen hemorrhage sx
C/l hemiparesis, C/l hemiplegia, conjugate gaze deviation toward side of lesion
178
Obtain what in patients with neuropathy and borderline B12?
Serum methylmalonic acid (more sensitive for deficiency than B12 alone)
179
Diffuse axonal injury
Most significant cause of morbidity in TBI. CT shows numerous minute punctate hemorrhages w/ blurring of grey-white interface
180
Hypokalemia signs + ECG
Weakness, fatigue, cramps
Paralysis, arrhythmia if severe
ECG: Us, flat/broad Ts, PVCs
181
ICH sx, treatments
AKA pseudotumor cerebri
Presents as headache, (N/V, AMS), papilledema suggestive of mass in young obese female w/ nml CT and elevated CSF pressure.
Treat w/ weight loss, acetazolamide
Shunt or CN2 fenestration to prevent blindness w/o resolution
NO INCONTINENCE
182
Risks for CVA
HTN - strongest
Smoking, DM - strong
High cholesterol - marginal
EtOH - protective if mild/mod
183
Improvement of ptosis w/ ice suggests ...?
Myasthenia gravis: AChE inhibited at cold temps --> Better competition w/ autoAbs
184
Cluster headache sx, Rx
Acute, severe retroorbital pain that may awaken, be assoc w/ i/l eye erythema, secretions, Horner's
Acute: O2 (best), ergots, NSAIDs
Ppx: CCBs, steroids, ergots, NSAIDs
185
Cushing reflex sx? Suggests?
HTN, bradycardia, resp depression
| Suggests brainstem compression
186
Lumbar spinal stenosis sx
Assoc w/ degenerative joint disease
"Neuropathic claudication" - exacerbated w/ walking + relieved by spinal flexion (opens canal), worsened by extension (closes)
Found on MRI
187
Wilson's disease, sx, labs
Abnml copper deposits in tissue (liver, basal ganglia, cornea)
Pres w/ liver or psych disease
Rings on slit lamp exam, up urine Cu, down ceruloplasmin
188
Primary CNS lymphoma
Suspect w/ single periventricular weak ring lesion on MRI + HIV + EBV DNA in CSF
189
RLS labs, Rx MOA
```
Always check Fe
Dopamine agonists (rupinirole, pramipexole) or gabapentin
```
190
Posterior internal capsule CVA sx
U/l weakness w/o sensory loss or cortical sx
191
Cauda equina syndrome sx, management
Severe low back pain, unilateral radiculopathy, saddle anesthesia, hyporeflexia, asymmetric motor weakness, late onset incontinence/retention
Emergent MRI, steroids, neurosurg
192
Conus medullaris syndrome sx
Severe back pain, perianal anesthesia, hyperreflexia, mild bilateral motor weakness, early onset incontinence/retention
Emergent MRI, steroids, neurosurg
193
Spinal cord compression sx, management
Back pain, B/l LE weakness + sens loss, ataxia, late bowel/bladder
May acutely develop spinal shock, hyporeflexia, flaccid paraplegia
Emergent MRI, neurosurg, may add steroids
194
Riley-Day syndrome
AKA familial dysautonomia
AR, esp Jewish
Gross ANS dysfxn w/ severe orthostatic hypotension
195
Multiple system atrophy sx
Parkinsonism + orthostatic hypotension, impotence, incontinence, other ANS sx
196
Exertional heat stroke sx, management
Over 104F, CNS dysfxn
| Treat w/ rapid cooling, preferably ice water immersion
197
Tick-borne paralysis sx, management
Rapidly progressive ascending (asymmetric) paralysis w/o fever, sensory sx, or CSF findings
Remove tick for spontaneous improvement
198
Opioid OD sx
Pinpoint pupils, resp depression (usually under 12/m)
199
Cerebellar hemorrhage pres
HTN hx, AMS, focal occipital headache, w/ Xa inhibitor/anticoag use
200
MG sx, Rx, management
Anti-AChR autoAbs
Ptosis, fatigue, gen weakness. May have thymic mass--removal may improve sx
Treat w/ AChEIs, steroids for flares
Intubate + plasmapheresis/IVIG for acute crisis
201
Management of metastatic brain tumors
Solitary: Resect if good status and stable disease
Multiple: Whole brain radiation therapy
202
Sydenham's chorea
Rapid uncoordinated jerks of face, hands, feet w/o LoC after GABHS/ARF
203
AZD requirements for diagnosis
After eliminating other causes by H/P, must do head CT/MRI
204
Endolymphatic fistula sx
Vertigo associated w/ pressure changes to head/environment
205
Meniere's sx
Episodic vertigo w/ u/l tinnitus, hearing loss, ear fullness
206
HTN crisis treatment
Nitroprusside
| Not CCBs
