Neuro Review Flashcards

Question

central herniation

Answer 1

diencephalon (thal/hypothal) through notch in tentorium, due to general edema, effacement of the perimesencephalic cisterns and loss of gray- white matter differentiation decreasing consciousness, cheyne-stokes breathing, small pupils but dilate later LOC, decorticate =>decerebrate, w/ fixed midsize pupils and extensor posture

Answer 2

respiratory and cardiac dysfunction

Answer 3

basilar artery thrombosis = unresponsive, ocular bobbing, pinpoint reactive pupils, no VO reflex, quadriplege worse than locked in! yikes

Answer 4

Need established cause of COMA late recoveries of minimally conscious state is usually traumatic (not hypox/ischemic) Decerebrate posturing means you havve brain stem function (not allowed), but triple flexion/DTRs are from spinal cord and are possible w/ brain death

Answer 5

Uidentified bright objects

Answer 6

``` glioblastoma = intra-axial ring enhancing, heterog, necrotic center meningioma = homog enhancing, durally based, full of calcium (in subgrontal can mess up taste, and give h/a) ```

Answer 7

hx of worsening bioccipital headaches when running/coughing/sneeze/bend/lifting Unsteady on romburg Associated w/ syrinx (cough headache is bad!- need decompression of p.fossa)

Answer 8

don't wait for dx, give tx: dex 10 mg q6X4 days, abx 15 min later, CT, and LP within 4 hours of abx (cipro or rifamp for meningo coverage) Hypoglycorrachia = cancer Low sugar + lymphocytic pleocytosis s. aureus = worst bacterial endocarditis Tuberculus meningitis treated w/ roids early, thick basilar exudates can => cranial neuropathies. EWWW ampicillin for listeria (babies and oldies), vanc if staph/drug resistanct, aminoglycos for GNR

Answer 9

give IV acylcovir!

Answer 10

``` cholinergic = soman/OP antichol = TCA, urologic, benztropine EPS = metaclopromide (reglan), anti-em, antipsych, VALPROATE Seritonin s = sweaty, flush, myoclonus NMS = rigid NMJ = botulism, M gravis, lambert eaton ```

Answer 11

``` PRES!!! periph nerve = vincristine, taxane, plat, thalidomide cerebellar = 5 FU, cytarabine Mening = intrathecal methotrex, ara-c Encephalopathy = ifosfamid Leukoenceph = methotrex ```

Answer 12

Bilat occiptal abnoramlities, cortically blind, recovery in 24 hours Bevacizumab (Avastatin) = VEGF inhibitor! NLP OU (normal pupils!)

Answer 13

Diplopia, dysphagia, dysphonia, unsteady gait, flaccid motor paralysis DESCENDING! normal sensory! (from soman gas!)

Answer 14

Longer half life (except lorazepam), after one week see agitation and seizure Vs. alcohol withdrawal in 24 hours

Answer 15

Temp 104, rigid, CK 1500, myoglobinuria, b/c of not enough dopamine! increased risk of sudden cardiac death, problonged QR interval!

Answer 16

Nasty tremor, cerebellar toxicity (tx w/ hemodialysis) Also tremors in neuroleptics, antiemetics, reserpine, SSRI beta ag, theophylline, cafein, roids, thyroid, tracro, cyclo, amphetamines EPS w/ haloperidol, VALPROATE Topiramate to quell action tremor

Answer 17

Neuropathic pain med might cause urinary retention in diabetic male

Answer 18

After 1 seizure, 20-30% risk of recurrence! normal EEG tells you nothing! Oh n o! Cocaine association

Answer 19

CMZ = potent P450 inducer, increases metabolism of OCP Oxcz and topamax do it too! OCP => decreased lamictal levels!

Answer 20

Bad = no pregos, no PCOS, maybe infert, anov, teratogenesis Broad spectrum drug if unclear epilepsy syndrome (also topamax and lamictal), but only valpro can be IV loaded rapidly! Don't use keppra unless clear epilepsy syndrome?

Answer 21

Stroke, both remote/acute hemorrahge/ischemic = 60% of all status, less common causes = enceph, metabolic derange (hyponat/hypogly)

Answer 22

Activation of T calcium channels Ethosuximide! Cmz, oxcz, phenytoin might precipitate absence status! Early onset absence = best prognosis, but 33% get GTC in young adult!

Answer 23

Clonzepam = first line, 90% effective If progress to PD, give Ropinirole and amantadine Restless legs = different, tx w/ pramipexole /other direct dopamine agonist post iron deficiency

Answer 24

months of weakness in arm/lightheaded w/ exertion, with cool arm and hand, and decreased pulse in that arm Dx w/ MRA

Answer 25

Assoc with Polycystic Kidney Disease, or if 2 + first degree relatives had SAH/aneurysm

Answer 26

H/a, vom, visual problems, growth issue, bilat temp hemianopia, cystic mass Need to resect and then give hormone replacement

Answer 27

Inital do cbc, b12, lft, thyroid Maybe RPR Ask about depression! No need for PET/SEPCT...might get worse after illness, thats still AD donepezil + galantamine, TAU proteins are the problem!

Answer 28

weight gain, myopathy, low voice

Answer 29

``` PD = alpha synuclein AlS = superoxide dismutase ```

Answer 30

Behavior and lnguage changes, largely speaking in stock phrases, poor word retrieval, but good memory! MRI w/ temporal atrophy (not symmetric is OK!)

Answer 31

HSV if seems infectious anti-NMDA paraneoplastic or anti Hu or Ma from lung or testicular tumor... Do a pet scan to figure out whats up

Answer 32

Left leg pain/weakness fo rmonths, on prednisone w/ multiple meloma...pain on STANDING means w/ weight baring, think hip MRI!

Answer 33

less common, with bilateral schwanommas, with Rinne lateralizing to the better side

Answer 34

memory issue, gait MAGNETIC glued to floor, urinary difficulties Apathetic to urinary issue/indifference b/c voiding center in brain, has failure to inhibit voiding reflex! Just pees Ventricular size enlarged (no pleo, and no nigral pathology)

Answer 35

increasing BP and decreased pulse b/c of raised ICP (maybe epidural hematoma) Tx = mannitol infusion and emergent operation (no time for dex!)

Answer 36

Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy") is the most common form of hereditary stroke disorder, and is thought to be caused by mutations of the Notch 3 gene on chromosome 19. The disease belongs to a family of disorders called the Leukodystrophies.

Answer 37

CAG on chromo 4p16, maybe asx, children inherit larger expansion degen of striatal GABA neurons (caudate atrophy)

Answer 38

reorient, then do quetiapine or haldol | NO lorazepam b/c paradoxical resp depression or oversedation! (only give for withdrawal, pd, or NMS)

Answer 39

if failed 2 drugs, only 5-10% chance of getting control w/ a third drug Eval for surgery, best for hippocampally derived seizures

Answer 40

If normal exam and no bowel/bladder problems, just give analgesics If numbness, incontinece, decreased pp, decreased anal tone, probably Cauda equina!

Answer 41

Elevated temp, resting tremor, tachy, disoriented, hallucinating bugs, at 3 days after last drink Give thiamine Alcohol hallucinosis is earlier

Answer 42

at 2 weeks, papilledema, weak ocular abduction, L babinski, hyperreflex??! Aduction weakness b/c nonlocal 6th nerve up ICP

Answer 43

Bilateral leg swelling, inability to move legs, hyperkalemia is possible so treat w/ calcium if EKG changes, check for oliguria/blood in urine

Answer 44

w/wout cataplexy, early REM onset at sleep tx Provigil or Ritalin Cataplex tx w/ sodium oxybate Make sure it's not ictal Kleine-Levine = different w/ lots of eating and sex and dissociation...?

Answer 45

Poor prioprioception, posterior column or peripheral neuropathy, loss of vib, + Romberg, diffculty with RAM with eyes closed If rapid onset, think about anti-hu with SCLC Are there reflexes?

Answer 46

Pts who respond well to tx w/ complete control can discontinue (70% kids and 60% adults can stop!) 20% refractory pts should be considered for surg (70% get free, 15-25% get reduced freq) 20% pts w/ epilep have depression with higher suicide rates 2-3X increased mortality, sometimes from SUDEP and status 2x risk of suicide on AEDS (black box) Women w/ epilepsy lower fertility rates b/c less marriage and less sex steroids on the drugs..AED polytherapy = infert!!! Buproprion lowers seizure threshold, so do others

Answer 47

Growing patient! ACTH secreting adenoma and Cushin syndrome => weight gain and striae, less libido! No periods! Prolactin adenomas also => bitemp hemianop (tx galctorrhea = bromocriptime)

Answer 48

PPPPP, acute sweeling and fracture => risk, with tissue necrosis

Answer 49

Pain behind eye, hard to keep it open, partial ptosis, PERRLA, diplopia/incomplete elevation/depression of eye! Spares the pupil!!! microinfarction w/ good prognosis

Answer 50

Irritable, anxious, labile affect, loose associations, vivid dreams

Answer 51

SEIZURE if dose is greater than 40 mg/day!

Answer 52

Can look like pseudotumor with small ventricles, LP OP of 300, CSF normal, and papiledema. Compromised venous outflow leads to up ICP! Also headaches, irregular menses and weight gain!

Neuro Review Flashcards

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