Neuro- Diagnostic methods Flashcards
(221 cards)
1
Q
Common signs of upper motor neuron lesion
A
weakness/ paralysis
increased muscle tone
increased reflex strength & + Babinkski sign
muscle mass maintained
2
Q
Possible cause of upper motor neuron lesions?
A
Stroke (contralateral symptoms), cord section
3
Q
where is the lesion in an upper motor neuron
A
above the anterior horn cell in the spinal cord or above the nuclei of the cranial nerve
4
Q
what happens to tone in an upper motor neuron lesion?
A
increased (spasticity) +/- clonus
5
Q
what happens with muscle weakness in upper motor neurons?
A
all muscle groups of the lower limb- more marked in the flexor muscles. in the upper limb, weakness is more marked in the extensors
6
Q
fasciculations in the upper motor neuron lesions?
A
absent
7
Q
wasting? what happens in a upper motor neuron lesion?
A
appears late, mainly because of disuse
8
Q
damage to several discrete nerves (not contiguous)
A
multiple mononeuropathy
9
Q
damage to multiple diffused nerves
A
polyneuropathy
10
Q
damage to a nerve root?
A
radiculopathy
11
Q
damage to motor nerves can show up as?
A
weakness, but also cramps, fasciculations, muscle wasting
12
Q
damage to large sensory fibers can show up as?
A
damage to the ability to feel vibrations and touch- especially in the hands and feet
* leads to stocking glove distribution of numbness, loss of reflexes, loss of position sense (makes it hard to coordinate complex movements)
13
Q
damage to small fibers without myelin sheaths interferes with the ability to? what else can happen with this type of damage?
A
interferes with the ability to feel pain/temp
it can causes neuropathic pain
14
Q
damage to autonomic nerves can cause?
A
excess sweating, heat intolerance, blood pressure fluctuations, and GI symptoms
15
Q
most neuropathies affect?
A
motor, sensory and autonomic systems
16
Q
what two nerve types are predominantly effected with neuropathy?
A
motor and sensory
17
Q
most neuropathies are?
A
length dependent meaning the farthest nerve endings in the feet are where symptoms develop first or are worse
18
Q
most common cause of single nerve injury?
A
physical injury (trauma)
19
Q
leading cause of polyneuropathy in the US?
A
Diabetes
20
Q
what is the major difference between PNS disorders vs stroke
A
Time frame is important
* PNS disorders slowly progressive compared to stoke
21
Q
Herniation at the L3-L4 disc; L4 nerve root would have pain where? Numbness? weakness? atrophy? what reflex would be diminished?
A
Pain: lower back, hip, posterolateral thigh, anterior leg
numbness: Anteromedial thigh and knee
weakness: quadriceps
atrophy quadriceps
reflexes: knee jerk diminished
22
Q
Herniation at the L4-L5 disc; L5 nerve root would have pain where? Numbness? weakness? atrophy? what reflex would be diminished?
A
Pain: Above sacroiliac joint, hip, lateral thigh and leg
numbness: lateral leg, first three toes
weakness: dorsiflexion of great toe and foot; difficulty walking on heels; foot drop (may occur)
atrophy: minor or nonspecific
reflexes: changes uncommon in knee and ankle- posterior tibial reflex diminished or absent
23
Q
Herniation at the L5-S1 disc; S1 nerve root would have pain where? Numbness? weakness? atrophy? what reflex would be diminished?
A
pain: over sacroiliac joint, hip, posterolateral, thigh and leg to heel
numbness: back to calf, lateral heel, foot and toes
weakness: plantar flexion of foot and great toe may be affected; difficulty walking on toes
atrophy: Gastrocnemius and soleus
reflexes: Ankle jerk diminished or absent
24
Q
when do people with back pain need an MRI?
A
if they have a history of cancer
if they have back pain and fever or concern for infection
objective extremity weakness
loss of bowel or bladder control
25
weakness of the legs, saddle anesthesia, urinary retention, loss of reflexes, loss of rectal tone +/- low back pain?
Cauda Equina syndrome
26
What type of diagnostic imaging should you get for Cauda Equina syndrome?
MRI
27
Rare condition in which a person's immune system attacks the peripheral nerves
gullain-Barre syndrome
28
what is key to diagnosis of Gullain-Barre syndrome?
Absent reflexes
29
what methods can you use to DIAGNOSE Guillan-Barre?
Electrophysiological studies (Nerve conduction studies)
- CSF analysis
30
Management of Guillan-Barre? what is first line?
Plasmapheresis or IVIG
31
temporary weakness or facial paralysis on one side of the face resulting from dysfunction of cranial nerve VII- most common cause of facial paralysis
Bells palsy
32
bells palsy vs stroke? how can you tell the difference?
the key is the forehead! is there wrinkling when you ask patient to raise eyebrow?
if wrinkles are present, think stroke
if no wrinkles- it is likely Bells
33
how do you treat bells palsy?
no treatment is really required
however you can give steroids (prednisone) to reduce inflammation are associated with good facial functional recovery
34
Autoimmune disease affecting skeletal muscles leading to fluctuating weakness and fatigue?
myasthenia gravis
35
what is the pathophysiology of Myasthenia gravis?
antibodies block acetylcholine receptors at post-synaptic neuromuscular junction.
since acetylcholine can't bind, it is more quickly broken down by acetylcholinesterase
36
what is considered a mild form of myasthenia gravis?
limited to eye muscles
37
what is considered a severe form of myasthenia gravis?
it affects many muscles (including breathing in severe forms)
38
what types of diagnostic testing can be done to diagnose myasthenia gravis
fatigue test
ice test or sleep test
tensilon
serologic screening
Electrophysiologic testing
thyroid panel, thoracic imaging
39
treatments for myasthenia gravis?
acetylcholinesterase inhibitors
immunosuppressants
thymectomy
40
what is considered acts of daily living during stroke recovery?
transfers, bathing, positioning, dressing, feeding, toileting, grooming
41
What is considered instrumental activities of daily living during stroke recovery?
shopping, meal prep, use phone, drive, money management, emergency aid, use of safety precautions
42
What is the peak of neurologic recovery during a stroke?
the first 3 months of stroke
43
what is considered secondary prevention for stroke?
CHD (anti-platelet therapy) hypertension control, lipid lowering therapy, exercise, smoking cessation
44
what is on the stroke risk assessment?
pain assessment
bowel and bladder functional assessment (LOOK FOR DYSURIA)
mobility and need for assistance
risk of DVT
hx of anti-platelet or anticoagulation tx
psychosocial assessment (holistic assessment by social worker)
emotional support
45
what should you start once a stroke patient is medically stable?
rehab therapy (mobilize the patient)
46
what does mobilizing a stroke patient reduce the risk of?
DVT/ pulmonary embolism,
47
what is standardized evaluation tool that can be used for stroke evaluation? when should you do the evaluation? What does that evaluate?
NIHSS
Assess within the first 24 hours of stroke
this helps asses probability of outcome (recovery) determine appropriate level of care and develop optimal interventions
48
a score of <6 on the NIHSS signifies what? A score >16 signifies what
<6= good recovery
>16= death or severe disability
49
what is the standardized tool to asses for function after a stroke?
FIM
50
what does the functional assessment of stroke rehabilitation include?
arousal, attention, cognition
balance
circulation (particularly w/ position change)
gait
pain
ROM
muscle performance
motor function
51
difference between inpatient and outpatient rehab?
inpatient rehab is more aggressive- pt. must meet criteria for aggressive therapy
52
what is the pathophysiology behind Multiple Sclerosis?
Destruction of myelin sheath slows then stops the conduction of nerve impulses- this happens progressively
53
What symptoms of MS contribute to the patients perception of overall health?
Pain
unsteady gait
fatigue(most common and chronic disabling symptom)
54
what is the current- McDonald Diagnostic Criteria?
At least 2 attacks with objective clinical evidence of at least 1 lesion, plus dissemination in space shown on MRI, or two or more MRI lesions consistent with MS, plus positive CSF finding or second clinical attack
55
What is the preferred method to evaluate MS non-invasively? What characteristic is preferred to make a diagnosis?
MRI (gadolinium enhanced)
three characteristic lesions (white patches) are preferred to make diagnosis
56
what is another method of diagnosing MS? What would you expect to see?
cerebrospinal fluid (CSF)
increased IgG & oligoclonal bands
* oligoclonal immunoglobulin bands positive in CSF, negative in serum
57
1st clinical episode consistent w/ a demyelinating etiology, suggestive of MS
Clinically Isolated Syndrome
58
incidental brain or spinal cord MRI findings suggestive of MS, in an asymptomatic patient lacking history, symptoms or signs of MS
Radiologically Isolated syndrome (RIS)
59
characterized by partial or total recovery after attacks
it is the most common and treatable form of MS. This is characterized by exacerbations where new symptoms can appear and old ones resurface or worsen
relapsing-remitting MS
60
A relapsing-remitting course which become steadily worse. Attacks and partial recoveries continue to occur. in the early phases the person may still experience a few relapses but after a will they merge into a general progression
secondary- progressive MS
61
progressive from onset; symptoms generally do not remit. Onset is typically in the late thirties or early forties and men are likely as women to develop this form and the initial disease activity is in the spinal cord, not the brain
primary-progressive MS
62
This form of MS follows a progressive course from onset, punctuated by relapses. There is a significant recovery immediately following a relapse but between relapses there is gradual worsening of symptoms
Progressive Relapsing MS
63
what are the most important factors for predicting worse clinical outcome in MS?
poor relapse recovery
high burden of disease on MRI
New T2 lesions on MRI
Spinal cord lesions
64
What therapy should be started early in the course of MS?
Disease modifying therapy
65
what is the benefit of disease modifying therapy?
Decrease the relapse rate
reduce disability progression
slow the accumulation of lesions on MRI
66
how is diet implicated in MS?
patients that maintained a low fat-vegetable based diet were much more likely to be free of MS relapses
omega 3 fatty acids are also associated with significant reductions in the frequency & severity of relapses
67
what are some uses of CT?
useful for certain types of brain injuries
lesions due to cancer
identify brain swelling or bleeding (hemorrhage)
show structural brain changes from diseases such as Alzheimers or schizophrenia
ventricles
intracranial masses
calcification
68
why choose CT over MRI?
no magnet, so safer for people with implanted hardware
not as much detail as MRI- but much faster study. Useful for identifying stroke or other acute conditions
69
what does bone show up as on a CT scan?
white
70
what does Air show up as on a CT scan?
black
71
what does the brain show up as on a CT scan?
gray
72
what does blood show up as on a CT scan?
white
73
what are advantages to CT?
can change slice thickness and angulation
fast
inexpensive
widely available
74
what are disadvantages to CT?
radiation
contrast dye
75
what is a CT angiogram useful for?
Helpful for visualizing blocked blood vessels (accounts for 90% of strokes)
aneurysms (ballooning {thinning} of vessel walls)
trauma to vessels
vasculitis
pre-op planning
76
what should you consider before ordering a CT angiogram?
Consideration for patient's renal function since dye is processed through the kidneys
Need IV access
77
if you want to rule out a hemorrhagic stroke (brain bleed in about 10% of strokes) what might you consider ordering?
Non-contrast CT
78
What does a non-contrast CT have good have sensitivity for?
bone, blood and air
79
if you get someone with stroke-like symptoms that started less than 4 hours ago, and you get a negative non-contrast CT (no hemorrhagic stroke) what drug can you give that would be lifesaving?
tPA (tissue plasminogen activator
80
what happens to a patient who has a hemorrhagic stroke if given tPA?
you will cause them to die quickly
81
what is often the gold standard for evaluating stroke, brain tumors and other brain/spinal cord pathology?
MRI
82
what are some advantages to MRI?
soft tissue contrast resolution superior to CT
smaller lesions missed on CT can be picked up w/ MRI
multiplanar views
more info on blood flow w/out use of contrast
no radiation
less artifact
83
what are some disadvantages to MRI?
Length of time
claustrophobia
84
what imaging modality should you consider for a head injury when evaluating for foreign body?
radiography
85
what are the uses for radiography? what do certain parts of the body show up as?
useful for the Skull, neck, sinuses
bones=white
soft tissue= black/gray
86
what are some advantages to radiography? what is a disadvantage?
readily available
foreign bodies, some fractures
Disadvantage= low sensitivity
87
what are some uses for ultrasound?
carotid artery patency
newborn screening
88
what are some advantages of ultrasound?
portable
no radiation
portable
89
what are some disadvantages to ultrasound?
operator dependent
can's use for brain after fontanelles have been closed
90
what imaging modality is a dynamic X-ray?
You inject contrast material into subarachnoid space and then monitor real-time flow to see if abnormalities appear
usually paired with a CT to better evaluate?
myelography
91
what are some advantages of myelography?
-used for disk herniations and to rule out spinal cord compressions
- useful if patient can't get an MRI
92
disadvantages of myelography?
invasive procedure
radiation exposure
93
Functional studies evaluate which two systems?
CNS & PNS
94
what functional studies evaluate the CNS?
EEG, MEG, fMRI, PET
95
what functional studies evaluate the PNS?
PET, EMG, NCS
96
What imaging modality measures brain waves (electrical activity of neurons)
frequency from different brain areas provide data as to what is occurring?
Electroencephalography (EEG)
97
EEG can detect issues such as?
seizure disorders
sleep disorders
changes to electrical activity from brain tumors, infection. brain damage, dementia (only electrical activity, often not diagnostic)
98
what imaging modality measures the magnetic field from neuron electrical activity?
MEG
99
what is the difference between the MEG and EEG?
in EEG the electrodes are placed on the scalp while he MEG uses a dewar that has multiple sensor coils (do not touch patients head
100
benefit of MEG?
can identify the precise locations where seizures arise
101
what are some uses of MEG?
used for pre-operative planning and in epilepsy surgery has shown promise in identifying autistic children by studying auditory processing
identifying cognitive defects in alzheimers, psychiatric disorders and head injury
102
disadvantages of MEG?
much more expensive (thousands of dollars) than EEG (hundred of dollars) or fMRI (fewer thousands than MEG)
103
which imaging modality can detect changes in blood flow and oxygen levels that arise from brain activity?
it also uses the magnetic field of the scanner to affect the magnetic nuclei of hydrogen atoms, so they can be measured and converted into images?
fMRI
104
What is a key difference between the MRI and the fMRI?
MRIs display anatomic structure and fMRIs measure metabolic function
105
what are the calculations for fMRI aimed at determining?
how the amount of oxygenated blood flow changes (more oxygenated blood in one part of the brain = more activity)
106
what are some benefits and uses of fMRI?
no radiation
useful for assessing: brain activity
finding brain abnormalities
creating pre-surgical brain maps
107
which imaging modality uses a small amount of radioactive tracer (similar to glucose) that is injected into a vein and the scanner take a picture of where glucose is being used in the brain?
Position emission tomography (PET)
108
when is a PET imaging modality useful?
useful primarily for cancer evaluation- tracer accumulates within the malignant cells because of their high rate of glucose metabolism
also:
to detect and highlight tumors and diseased tissue
measure cellular and or tissue metabolism
show blood flow
evaluate patients who have seizure disorders that don't respond to therapy
patients with certain memory disorders,
determine brain changes following injury, or drug abuse
109
which imaging modality measures muscle response or electrical activity in response to a nerve's stimulation of the muscle?
it also measures the electrical activity of muscle during rest, slight contraction and forceful contraction
Electromyography (EMG)
110
when is EMG useful?
used to help detect location of neuromuscular abnormalities
-numbness, weakness, inflammation, etc)
helps find where the lesion is
111
what imaging modality is a measurement of the amount of speed of conduction of an electrical impulse through a nerve? this modality can determine nerve damage and destruction, and often performed at the same time as EMG
Nerve Conduction Study
112
progressive neurodegenerative conditon that causes death of the upper motor neuron and lower motor neuron
Amyotrophic Lateral Sclerosis (ALS)
113
Classically presents as asymmetric progressive weakness in one limb that progresses over time to involve other limbs?
ALS
114
What LMN deficit would be seen in ALS?
muscle atrophy, fasciculations- tongue fasciculations are classic
115
What UMN deficit would be seen in ALS?
brisk reflexes, clonus, upgoing toes (babinski) jaw jerk, spastic speech, Hoffman's sign
116
what are the four regions of the body that could be affected in ALS?
bulbar, cervical, thoracic, lumbar
117
what would provide a probable diagnosis of ALS?
UMN or LMN in 2 of 4 regions of the body
LMN may be determined by EMG only
118
what is the prognosis of ALS after diagnosis
2-3 years
119
what could cause a myasthenia crisis?
physiologic stress, surgery or medication
120
X-linked disorder in dystrophin leads to nearby absence of protein?
Duechenne Muscular dystrophy
121
What are some signs of of DMD?
Signs: Proximal leg weakness causing falls and walking problems
waddling gait
calf pseudohypertrophy (fat replaces muscle)
gower's sign (inability to rise from seat on the ground without hands)
122
what is the benefit of steroids in DMD?
mobility improves cardiac and respiratory function
123
what are considered primary headache disorders?
tension type-headache
migraine headache
trigmeminal autonomic cephalgias
124
what is the most prevalent type of primary headache?
tension-type
125
what is the true range of glucose?
there is not true normal range of glucose
126
what is the gold standard for diagnosing Bacterial meningitis?
Culture
127
if getting a result and it is a gram-negative cocci in pairs what should you think of?
Neisseria meningitidis
128
if getting a result and it is a gram-positive cocci in pairs what should you think of?
strep pneumo
129
symptoms of bacterial meningitis
fever
headache
photophobia
irritability
vomiting
altered mental status
seizures
130
what is the classic triad for bacterial meningitis?
fever, neck stiffness, headache
131
Recurrent episodes of headache associated with other symptoms?
Nausea+/- vomiting
photophobia or phonophobia and or osmosphobia (scent hypersensitivity)
GI symptoms (delayed digestion, diarrhea, constipation)
neck pain
132
inherited disorder of sensory processing- currently though to be a disorder or the central nervous system (and not to be a vascular disorder)
migraine
133
to diagnose a migraine with aura, the patient must have one of the following symptoms
visual
sensory
speech and/or language
motor-motor symptoms may last up to 72 hours
brainstem
retinal
134
what is the most common trigeminal autonomic cephalgias?
Cluster headache
135
what is known as the suicide headache?
cluster
136
shorter lasting attacks
unilateral
intense pain in the trigeminal distribution- most often in the ophthalmic branch
ipsilateral cranial autonomic symtpms
trigeminal autonomic cephalgias
137
with a migraine headaches need to last? what are some criteria for a migraine without aura
4-72 hours
unilateral location
pulsating quality
moderate to sever pain
aggravation by or causing routine physical activity
nausea and or/vomiting
photophobia and phonophobia
138
attacks tend to surround typical times of the day- often soon after sleep onset, midmorning, midafternoon
attacks tend to be seasonal- often spring and fall
cluster
139
which headaches are unilateral? bilateral?
Cluster is always unilateral
tension type is bilateral
migraines can be unilateral, usually bilateral in children and adolescents
140
what is the typical duration of each headache?
migraine- 4-72 hours
tension type- 30 minutes to 7 days
cluster 15 minutes-3 hours
141
what imaging modality is the imaging of choice (if not contraindicated) to rule out secondary causes of headache?
MRI
142
What headache type is most common primary headache disorder associated with medication overuse headache?
migraine
143
what is the most common cause for spontaneous sudden acute headache?
Subarachnoid hemorrhage
144
urge to move legs, most often after a period of inactivity; "creepy crawly sensation" "bugs all over me" "electrical sensation" gets better when they move around
causes sleep disturbance
Restless leg syndrome
145
what are some of the pathogenesis of RLS?
Iron deficiency
Dopaminergic deficiency
thalamic issue
peripheral pathology
146
what should you check in suspected RLS?
always check Iron levels
review medications- first gen. antihistamines, antipsychotics, antidepressants
147
what are some protective factors in parkinson's?
smoking, caffeine, exercise/ aerobic
148
Depletion of dopamine in the substansia nigra results in disruption of communication from the basal ganglia to the motor cortex
Parkinson's disease
149
what are cardinal motor features in parkinson's
tremor: resting, asymmetric, pill rolling
Rigidity: lead pipe, cogwheeling
bradykinesia (akinesia)
postural instability
150
in order to make a diagnosis of parkinson's the patient must have?
bradykinesia on exam plus tremor and/or rigidity
151
what imaging can be done in the evaluation of parkinson's? what does it show?
DAT scan- shows density of health dopamine neurons
152
how do you get a definitive diagnosis of parkinson's?
Autopsy
153
what are some non-motor symptoms of parkinson's
olfactory dysfunction
sleep disturbances
Fatigue
cognitive changes/ dementia
mood disorders
autonomic symptoms: orthostatic hypotension, constipation, urinary syptoms, sexual dysfunction
154
degenerative changes in caudate, putamen, globus pallidus, temporal and frontal lobes
Huntington's disease
155
when can a diagnosis for huntington's disease be made?
when chorea (dance like movements) are seen
156
high number of CAG repeats leads to instability during replication, so the next generation, likely to have a high number of CAG repeats, which can lead to more severe diseases or earlier onset
Huntingtons diease
157
what are some indications for lumbar puncture?
subarachnoid hemorrhage
CNS infection/ meningitis (most common)
many disorders affecting the nervous system (Guillan-Barre, MS)
Certain types of cancer
excess CSF in the brain
158
how is the diagnosis of a subarachnoid hemorrage usually made?
diagnosis is usually made by CT scan or blood in CSF
159
when is a lumbar puncture contraindicated?
in the presence of infection in the tissues near the puncture site
in the presence of pailledema (increased cranial pressure)
in coagulopathy or decreased platelet count
160
what positions can you place the patient for lumbar puncture?
Lateral recumbent position (lying on their side)
Sitting position (if difficult entry, start seated then move to lateral recumbent position)
161
which position for a lumbar puncture has an increased risk of post lumbar puncture headache?
Sitting position
162
tuffier's line is located?
superior iliac crest intersection (L4)
163
where should the needle be inserted during a lumbar puncture? What about in children
L3/L4 or L4/L5
in children the spinal cord ends at L3, insertion L4/L5 or L5/S1
164
what should you get if you cannot find the right place to insert the needle during a lumbar puncture?
Fluoroscopy
165
what are some lumbar puncture complication?
post lumbar puncture headache (#1 complication)
back pain
traumatic tap
dry tap
referred LE pain
cerebral herniation
infection
166
what is the cause of a lumbar puncture headache? what is it related to?
it is due to the leakage of CSF through the dural puncture site, leaking faster than CSF reproduced
-directly related to the size of the needle
167
what causes macroscopic blood in CSF? secondary to improper needle placement?
traumatic tap
168
how do you compare a traumatic tap vs. subarachnoid hemorrhage?
Clot formation in one of the tube favors traumatic tap
169
what is considered abnormal lab results for CSF analysis?
>250mmH20
170
what should you begin to think about in patients with WBC > 1000
bacterial meningitis
171
what should you think about in patients with <100 WBC's/ mm3`
Viral meningitis
172
what would a traumatic do the the white blood cell count?
cause an artificial rise
173
if RBCs decrease in subsequent tubes, think?
traumatic tap
174
if RBCs constant in subsequent tubes, think?
intracranial bleed
175
elevated protein level (100-1000mg/dl) without an accompanying decreased cell count
Guillain-Barre syndrome
176
increased immunoglobulin levels and oligoclonal bands (increased number of antibodies)
Multiple sclerosis
177
lymphocytosis in CSF can be seen in?
viral, fungal and tuberculosis CNS infections
178
what would you see in glucose levels for bacterial infections? Viral infections?
Lowered CSF glucose in bacterial
normal glucose levels in virus
179
90% of the cause of bacterial meningitis is?
streptococcus pneumoniae
Neisseria meningitis
180
the most common cause of acute septic (viral) meningitis is?
enteroviruses
181
what is the most rapid and accurate test for the presumptive diagnosis of acute bacterial meningitis?
gram stain
182
key complication of bacterial meningitis
hearing loss
183
the culture done from lumbar puncture is usually accomplished from tube #?
4
184
Aphasia (receptive, expressive)
right sided weakness
right side sensory distubance
Left MCA
185
Left side weakness
neglect
left side sensory disturbance
Right MCA
186
paralysis/ sensory loss of the leg/foot
urinary incontinence
paresis of the proximal arm
abulia
flat affect
akinetic mutism
ACA stroke
187
peripheral (cortical)
homonymous/ hemianopsia
memory deficits
Central (penetrating)
sensory loss (thalamus)
CN III palsy with contralateral hemiplegia
PCA stroke
188
the dizzy paitent--> vertigo
"drunk" oscillopsia
lightheaded/ fainting---> cardiovascular
key signs/symptoms
Cerebellar/Vestibular Strokes
(PICA, AICA, SCA)
189
What is the workup for ischemic stroke/ TIA
Imaging of vasculature (MRA) and carotid (US)
cardiac telemetry and echo
blood pressure control
cholesterol: LDL and HDL
etc.
190
difference between absence and complex partial seizure?
look at the timing, complex partial seizures tend to last longer
191
what is the 1st, 2nd and 3rd line agent for acute seizures (but pt is not currently seizing)
lorazepam
192
what can be first line in kids with complex seizures?
carbamazepine
193
proximal muscles affected should hint to?
muscular disorders
194
when to image for headaches?
new onset headaches in older people or significant worsening or change in pattern
-thunderclap headache
-continuous headache
-pulsatile tinnitus
-associated neurologic symptoms
-jaw claudication
-positional headache
-older onset
195
Aphasia
apraxia
agnosia
problems with memory
cortical signs
196
movement disorders
changes in posture or tone
gait abnormalities
tremors
Sub-cortical signs
197
motor, sensory, temperature and pain lost; vibration/position intact
anterior cord syndrome
198
motor impairment of upper more than lower extremities
central cord syndrome
199
loss of fine, vibratory and position sensation; preserved motor function
posterior cord syndrome
200
ipsilateral paralysis, loss of proprioception, touch, and vibration; contralateral loss of pain and temp
brown-sequard (hemicord) syndrome
201
a reflexic bladder, bowel and lower extremities; sacral reflexes can be preserved; reduced rectal tone and perirectal sensation
conus medullaris syndrome
202
sensory loss, with flaccid weakness; sacral reflexes abnormal or absent
cauda equina syndrome
203
what happens to GABA and acetylcholine levels in Huntington's disease?
The levels decrease
204
What area of the brain is responsible for movement of the body as a whole?
The primary motor cortex
205
A tumor or destruction of the this area would result in widespread paralysis
the primary motor cortex
206
what area of the brain coordinates movements of the hands?
the premotor area (anterior to the primary motor cortex)
207
A tumor or other destructive agent in this area leads to uncoordinated movement and non-purposeful hand movement called motor apraxia. It may also affect the complex activities related to speech, voluntary eye movement and head rotation.
Anterior to the primary motor cortex (premotor area)
208
what is immediately posterior to the primary motor cortex?
the primary sensory cortex
209
Destruction to the primary motor cortex would result in?
loss of sensation
210
what is immediately superior to Broca's area?
regions for personality and memory storage
211
Middle cerebral artery lesions are associated with?
contralateral motor and sensory deficits of the face, arms and legs (face and arm deficits are more pronounced than the leg)
212
anterior cerebral lesions are associated?
Leg weakness greater than arm weakness, mild contralateral cortical sensory deficits and dyspraxia
213
internal carotid occlusion causes symptoms similar to? what else may it include?
Middle Cerebral artery
may also include ipsilateral ocular symptoms
214
branch occlusion of the vertebrobasilar system can cause? what symptoms could that include?
cerebellar, sensory and cranial nerve symptoms
findings may include dizziness, vertigo, diplopia, ataxia, cranial nerve palsies and limb weakness
215
A positive Babinski reflex is an indication that?
the corticospinal tract has been transected
216
Where does the corticospinal tract originate? where does it terminate? what does it control?
originates in the frontal love and terminates in the ventral horn of the spinal cord
controls the contralateral side of the body with the majority of fibers crossing the medulla
217
damage to this nerve root may cause tingling primarily on the medial surface of the arm, into the lateral hand into the fourth and fifth digits. may also cause dysfunction of the hand
C8
218
damage to this nerve root may cause neck and upper shoulder numbness and pain
C4
219
damage to this nerve root may cause deltoid and shoulder numbness and pain, biceps tendon reflex may be diminished
C5
220
damage to this nerve root can cause numbness and tingling down the arm into the thumb, with weakness in the bicep muscle and diminished brachioradialis tendon reflex
C6
221
damage causes numbness and pain down the affected arm but into the middle finger, triceps reflex may also be diminished
C7
