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