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Flashcards in Neuro Lecture 3 Deck (176):
1

what will an EEG tell you?

What type of epilepsy you have

2

List the 3 main types of intracranial aneurysms

saccular aneurysm
fusiform aneurysm
Microaneurysms (Charcot-Bouchard)

3

what type of aneurysms is almost always a result of an inherited weakness?

Saccular aneurysm

4

What are some conditions that cause saccular aneurysms?

Polycystic kidney disease
Marfan syndrome
Neurofibromatosis type I
Tuberous sclerosis complex
Connective tissue diseases

5

What's an important questions to ask if someone has a saccular aneurysms?

Has anyone else in your family had an aneurysm?

6

What are some risks for a saccular aneurysm?

Cocaine/ amphetamine use
heavy ETOH use
tobacco use
HTN
obesity

7

Are saccular aneurysms more common in males or females?

females

8

are saccular aneurysms common in children?

No, they are rare

9

Where do saccular aneurysms usually occur?

Circle of Willis

10

Is it common for patients with saccular aneurysms to have more than one?

Yes, 1/4 will have more than one

11

What are some signs of "warning leaks" of a saccular aneurysm?

Headaches
dizziness
eye pain and visual deficits

12

When blood hits the gray matter of the brain what can happen?

Seizures

13

what type hemorrhage usually happens with the rupture of saccular aneurysms?

Subarachnoid hemorrhage

14

What occurs when a saccular aneurysm ruptures?

Thunderclap headache
mental status, visual changes
N/V/ stiff neck, photophobia

15

If the rupture of a saccular aneurysm fatal?

Yes, 60% of people die

16

What are fusiform aneurysms usually associated with?

HTN and atherosclerosis

17

Where is the most common location of a fusiform aneurysm?

Basilar artery
second- internal carotid artery

18

Which rupture more often, fusiform or saccular aneurysms?

Saccular

19

what can happen with fusiform aneurysms usually by trauma?

Dissection

20

What is aneurysms of small blood vessels. Usually occur in basal ganglia and grey/white matter junction of the brain

Micro aneurysms

21

What parts of the eye are parts of the CNS?

Retina, optic nerves

22

who get microaneursyms?

chronic HTN
coccaine
diabetics

23

When intracranial aneurysms rupture, what happens?

Focal intraparnechymal hemorrhage
get a focal neurologic deficit

24

how are most aneurysms found?

Incidentally usually

25

On a CSF sample, what will you get in the sample with an aneurysm.

Protein will be elevated, will have blood in the sample

26

How do you test if it was a "dirty tap" or blood in the CSF?

collect 3 samples, if the first has most in it then it was a dirty tap

27

what do you do for the emergency treatment of a aneurysm rupture?

Breathing support
Reduction of ICP

28

What are three ways to treat an intracranial aneurysm?

Clipping
Coiling
Stenting

29

list the four types of intracranial hemorrhages?

Epidural
Subdural
Subarahnoid
Intracerebral

30

what 2 intracranial hemorrhages are called stroke?

subarachnoid
intracerebral

31

Bleeding between the dura mater and the skull?
Often due to trauma, frequently fracture

Epidural hemorrhage

32

what type of hemorrhage may have a lucid period followed by rapid onset of symptoms.

Epidural hemorrhage

33

What are some signs of an epidural hemorrhage?

Ipsilateral fixed and dilated pupil (CN III)
contralateral weakness, hemianopsia

34

There is a risk of what type of herniation with epidural hemorrhage?

uncal herniation

35

What shape will an epidural hemorrhage look like on a CT/ MRI?

Lens shaped

36

How do you treat epidural hemorrhages?

Burr hole
craniotomy
trepanning

37

Is prognosis good or bad for a epidural hemorrhage when the patient has a Glasgow Coma Score of 3?

Good prognosis

38

What is bruised brain tissue?

Concussion

39

Bleeding between the dura mater and the arachnoid mater

Subdural hemorrhage

40

what is more fatal, subdural hemorrhage or epidural?

subdural

41

what does a subdural hemorrhage look like on a CT/ MRI?

crescent-shaped

42

list the three types of subdural hemorrhage?

acute
subactue
chronic

43

List some possible symptoms of SDH?

LOC at event, lucid period
sedation
headache
N/V
ipsilateral weakness
speech difficulties
seizure (blood on grey matter)

44

who is more likely to have a subdural hemorrhage?

Men> women
50 years of age (increases w/ age)
anticoagulation therapy or coagulopathy
intra-cranial hypotension (ex-Post LP)

45

What are some risk factors of subdural hemorrhage?

Chronic ETOH use (cerebral atrophy + coagulopathy)
DM
HTN
Arteriosclerosis

46

What type hemorrhage is a common finding with "shaken" baby syndrome?

subdural hemorrhage

47

How do you treat subdural hemorrhage?

watchful waiting
trepanning (bedside) or craniotomy
Rebhabilitation

48

What can you do to the skull when taking it out to keep it perfused?

Put it in the ommentum

49

Bleeding between the arachnoid mater and the pia mater

subarachnoid hemorrhage

50

is subarahnoid hemorrhage fatal?

Yes, 40-50% fatal

51

where does subarahnoid hemorrhage usually occur?

Circle of Willis

52

What is a good way to visualize a subarachnoid hemorrhage?

CT (hyperdense in the middle)

53

If the CT is negative and you suspect subarachnoid hemorrhage?

LP with 3 tubes

54

What is the most common cause of subarachnoid hemorrhage?

rupture of a saccular intracranial aneurysm

55

How do you treat a subarachnoid hemorrhage?

Stabilize patient
address the aneurysm
CSF drain if needed for increased ICP
calcium channel blocker (vasospasm)
Hypertension/hypervolæmia/hæmodilution
seizure prophylaxis
rehabilitation

56

If someone has a rupture saccular aneurysm what do you look for?

Look for more saccular aneurysm

57

How do you keep someone Hypertension/hypervolæmia/hæmodilution?

Pump them up with saline

58

Bleeding within the brain tissue itself

Intracerebral hemorrhage

59

2 sub types of intracerebral hemorrhage?

Intraparenchymal (inside brain tissue)
Intraventricular (inside ventricles)

60

Symptoms of an intracerebralhemorrhage?

Severe headache
Vomiting
Focal neurologic signs
Seizure

61

What does an intracerebral hemorrhage look like on CT?

A ball

62

List some risk factors of intracerebral hemorrhage

HTN
DM
menopause
tobacco use
ETOH
AV malformation
rupture aneurysm
coagulopathies
African American

63

How do you treat intracerebral hemorrhage?

Stabilize patient/ address underlying problem
Surgical removal
CSF drain if needed for increase ICP
treat inflammation with steroids
seizure prophylaxis
rehabilitation

64

What type hemorrhage do you use calcium channel blockers?

subarachnoid hemorrhage

65

What is permanent CNS damage cause by thrombus, embolus, venous thrombus, systemic hypoperfusion, SAH or ICH?

stroke

66

What are some stroke symptoms?

imagine not having what different areas of the brain do
headache (hemorrhage stroke)

67

How do you treat a stroke?

Confirm last known well
Keep O2 >94%, IV isotonic saline is SBP <120
ECG (look for a-fib)
CBC platelets, BMP, INR/PT/aPTT, troponins
Neuro exam
STAT head CT w/o contrast

68

What do troponins do?

Give a good prognosis, how likely will we get this person rehabed?

69

If a patient has HTN what should it be brought down to?

<110

70

If a patient has hypotension what should it be brought up to?

>120/>80

71

What is the only FDA-approved pharmacologic therapy for acute ischemic stroke?

Recombinant tissue plasminogen activator (rtPA)

72

What criteria is used to determine eligibility for rtPA?

NIHSS- National Institutes of Health Stroke Scale

73

How long within the last known well period can you treat with rtPA?

less than 4.5 hours since LKW
best results within 1.5 hours of LKW

74

What are some alternatives to rtPA?

thrombectomy
anti-platelet (aspirin) and anticoagulation therapy (heparin/ warfarin)
hemicraniectomy (for ICP)

75

What is the sequale of stroke?

Disability
mood disorders (depression, anxiety, panic)
sleep disturbances
seizures

76

What are "mini-strokes" where symptoms resolve w/i 24 hours?

transient ischemic attack

77

What is the area of at risk tissue around the dead tissue that is damaged but savable?

Peneumbra

78

If you have a stroke, what are you are you more at risk for?

another stroke

79

what does the brain tissue look like with a TIA

all penumbra, little necrosis

80

What are ways to prevent TIAs?

Smoking cessation
nutrition (more fruits and veggies, less fat, sodium)
moderation of ETOH use
regular exercise
controlling BP and weight

81

What can you do for TIA prophylaxis?

Antiplatelet/ anticoagulant meds
talk about preparedness

82

What is the FAST algorithm?

Face
Arm
Speech
Time

83

What can you do to look at what is causing a TIA?

carotid duplex- carotid stenosis
EKG (a-fib)
Echo (thrombus in heart)

84

does blood show in MRI?

Yes, but bone doesn't show as well

85

inability to initiate movements?

akinesia

86

slow movements

bradykinesia

87

dystonia

involuntary sustained contractions

88

feeling stuck in a particular position or blocked from moving for a few seconds?

freezing

89

increased muscle tone

rigidity

90

inability to sit still

akathesia

91

lack of muscle coordination

ataxia

92

slow, writhing movements

athetosis

93

large involuntary movements

ballismus

94

small, rapid movements flowing unpredictably from one body part to another

chorea

95

difficulty with speech articulation

dysarthria

96

unintentional bilateralization

mirror movements

97

sudden, brief movement of muscle group

myoclonus

98

compulsion/ repeated (same word over and over)

tic/ sterotypy

99

rhythmic alternating movement of flexor/extensor, pronator/supinator, etc.

tremor

100

what makes a physiologic tremor worse?

stress
fatigue
caffeine
"enhanced physiologic tremor"

101

what part of the brain is involved in ataxia?

cerebellum

102

how many people have a physiologic tremor?

all of us

103

tremor that appears during voluntary movements (kinetic tremor/action tremor)

essential tremor

104

What makes a essential tremor worse?

physical or emotional stress/ fatigue

105

when does a essential tremor get more prominent?

with age

106

Essential tremors follow what genetic pattern?

Autosomal dominant pattern

107

If you have essential tremor you are more likely to get what?

Parkinson Disease

108

What causes an essential tremor

abnormality of Purkinje cell synapses in the cerebellum, and/or of cerebello-thalamo-cortical circuits.
(similar problem caused by ETOH)

109

If it is a real essential tremor, what will make it better?

drinking a bit of ETOH

110

What makes an essential tremor temporarily worse?

Caffeine

111

How do you medically treat essential tremor?

Beta blockers (propranolol, nadolol)- gets rid of adrenaline
anticonvulsants (PRM, GBP, TPM)

112

Who is propranolol contraindicated in?

allergic rxn who have an epi-pen

113

For severe cases of essential tremor what can you do?

Depp brain stimulation (DBS)
Thalamotomy

114

What is a degenerative neurologic and psychiatric disorder that leads to progressive death of the dopamine-generating cells of substantia nigra in the midbrain?

Parkinson's Disease

115

What are the main motor symptoms of Parkinsonism?

Resting tremor
Cogwheel (or lead-pipe) rigidity
Bradykinesia
other motor symptoms

116

Is parkinson's disease present in sleep?

No

117

What is very common symptom of Parkinson's Disease?

Pill-rolling and voice changes

118

What is cogwheel rigidity a combination of?

Tremor and rigidity

119

What is lead pip-rigidity?

Arm feels like a lead pipe
Patients without tremor
asymmetric, descending

120

If bradykinesia for parkinson's disease equal for tasks?

No, it is unequal
Ex- can ride a bike but unable to walk
may be able to walk backward not forward

121

what is difficulty initiating and executing movement?

Bradykinesia

122

what is rapid shuffling common in PD?

festination

123

What is typical posture with PD?

Flexed posture (elbows, wrists, knees, hips, spine)

124

What are some PD symptoms?

festination
flexed posture
dysarthria
masked facies
micrographia (write very small)
dysequilibrium/falls

125

What are some neuropsychiatric symptoms of PD?

Cognitive disturbances (executive, attn., memory)
Mood disturbances (anxiety, depression, apathy)
Impulse control (hypersexuality, gambling…)
Dementia (2-6× risk)
Psychosis (usually iatrogenic)

126

Is brain imaging helpful with PD?

Usually unremarkable early on

127

What are some PD+ disorders?

Progressive supranuclear palsy
Multiple system atrophy
Corticobasal degeneration
Pick Disease
(Alzheimer Disease)

128

Do people with PD+ have a irregular resting tremor at onset?

No, not usually but have additional symptoms and typically poor response to dopaminergic meds

129

Treatment for PD

Levodopa
only 5-10% crosses BBB

130

What can peripheral dopamine cause?

Dyskinesias
naseau
stiffness

131

What are some drugs you can do with levo-dopa to reduce the peripheral metabolization of levodopa. Don't cross the BBB

Carbidopa
Benaserazide

132

What is a drug that reduces the metabolization of dopamine that is used w/ carbidopa/ benaserazide.

Entacapone

133

WHat can levodopa cause?

Dopamine dysregualtion syndrome

134

What is dopamine dysregulation s yndrome

Compulsive use of the medication
"Punding"- compulsive fascination w/ assembling/disassembling, sorting collection

135

what can happen with long term use of levodopa

Get "on-off" states not related to dosing/ formulation
delay use of levodopa as much as possible and keep doses low to help prevent this from happening

136

what causes iatrogenic dyskinesias?

Levo-dopa
it is constant movement

137

what are some psychiatric effects of dopamine (from levodopa)?

confusion, agitation, hallucinations, , irritability, panic, paranoid delusions, mental depression, dementia, mania, and psychosis

138

What can dose reduction or withdrawal of levodopa lead to?

neuroleptic malignant-like syndrome

139

What is an alternative to levodopa? Consists of selegiline and rasagiline. Makes it so receptors don't break down dopamine.

Monoamine oxidase B (MAO-B) inhibitors

140

What are 2 other PD treatments that are more invasive?

Deep Brain Stimulation (DBS)- stimulate places that tend to release dopamien (thalamus, globus pallsidus or subthalamic nucleus)

Pallidotomy- surgical destruction of the globus pallidus to control dyskinesias

141

how does PD progress

gets worse as it goes along but doesn't necessarily kill you

142

when is the most common onset of PD?

60 years
higher risk with pesticide/insecticide exposure
(well water, grow up on farm, exposure to agent orange)

143

What can help prevent Parkinson's DIsease.

Caffeine intake
NSAID use
Tobacco use

144

Disease that involves Initially restlessness, small unintentional movements, poor coordination, saccadic eye movements. Dominant inheritance pattern.

Huntington's Chorea

145

what are some main symptoms of HD?

ataxia
dysarthria
dysphagia
unstable gait

146

what are some psychiatric syndromes of HD?

mood
disorders
cognition (executive function)
Obsessions and compulsions
psychosis
dementia

147

where is huntington protein highly concentrated?

nerves and testes

148

What are some physical symptoms of HD?

testicular atrophy
muscle atrophy, osteoprossis, weight loss
impaired glucose tolerance
cardiac failure

149

What is the typical onset of HD?

35-44 years
onset earlier with successive generations

150

CAG is a CAt who's a _______ for ______ with a really long tail.

Glutton
glutamine

151

Huntington's disease is a ____ repeat sequence?

CAG on chromosome 4

152

What type of HD has chorea briefly, it at all. rigidity is the dominant symptom and seizures are common.

Juvenile HD

153

What does a MRI of HD show?

atrophy of caudate nuclei or may be unremarkable

154

What drug can be given for chorea?

Tetrabenazine
neuroleptics and benzos may be helpful

155

Lifespan of HD is usually ____ years post diagnosis.

20 years

156

An acute cognitive impaired with onset w/i a matter of hours / days. Usually fluctuates in intesity and will have attentional deficits. Confusion and decreased awareness/ orientation.

Delirium

157

What will you find in delirium but not dementia?

Onset within a matter of days/ hours
Usually fluctuates
Attentional deficitis

158

what are some causes of delirium

Dehydration
Hypothyroidism
Hypercalcemia
Chronic liver and kidney disease
Hypoglycemia
pernicious anemia
folate/ thiamine deficiency

159

what infections can cause delirium?

UTI
pneumonia
skin and abdominal infections
HIV, chronic meningitis, syphillis

160

what are some toxic causes of delirium?

ETOH/ drug abuse
ETOH/ drug withdrawal

161

How do you manage delirium?

Identify the causing factors (there may be more than 1)

162

What is a chronic cognitive impairment. Commonly becomes slowly and steadily progressive. Typically an insidious onset. Hallmarks include memory loss and language dysfunction.

Dementia

163

Onset before ___ years is considered early onset dementia?

65 years

164

are awareness and attention typically normal in early stages of dementia?

Yes

165

What can you do to test for dementia?

MMSE
trailmaking test (connect 1 to 2 to 3 etc)
clock drawing test
questionnaires
full neuropsychometric testing (takes 10 hrs)

166

what are some useful imagings for dementia?

SPECT and PET are more useful than head CT and MRI

167

What scan is good at predicting the development of AD within the next 2 years?

PET scan

168

Progressive dementia associated with tangles and plaques in the gray matter of the brain

Alzheimer Disease

169

What are the tangles in AD?

aggregates of intraneuronal τ protein

170

What are plaques in AD?

extracellular deposits of β amyloid

171

what is often an early sign of AD?

difficultly remembering recent events

172

Is there currently a treatment for AD?

No- currently no cure, or symptomatic treatment to affect the progression of the disease qWhat can be

173

What can be helpful for AD?

Acetylcholinesterase inhibitors (mild to moderate disease)

174

What drug can be helpful in moderate to severe AD?

Memantine (NMDA receptor agonist)

175

What is the main treatment for AD?

Caregiving

176

What needs to be provided for the caregiver of someone with AD?

Psychosocial support and cognitive behavioral therapy for the caregiver need to be provided.