Neurology Flashcards by Lauren Chorny

stroke symptoms

> 24 hours
permanent residual neurologic deficits
ischemic or hemorrhagic
spares upper third of face

How well did you know this?

Not at all

Perfectly

TIA symptoms

<24hrs
resolve completely
may only have amaurosis fugax
never hemorrhage

How well did you know this?

Not at all

Perfectly

young stroke patient likely:

vasculitis or hypercoaguable state

How well did you know this?

Not at all

Perfectly

anterior cerebral artery stroke

contralateral profound LE weakness
contralateral mil UE weakness
personality changes or psychiatric disturbance
urinary incontinence

How well did you know this?

Not at all

Perfectly

middle cerebral artery stroke

contralateral profound UE weakness
aphasia
apraxia/neglect
eyes deviate TOWARD lesion
contralateral homonymous hemianopsia

How well did you know this?

Not at all

Perfectly

posterior cerebral artery stroke

prosopagnosia (inability to recognize faces)

How well did you know this?

Not at all

Perfectly

vertebrobasilar artery stroke

vertigo
nausea/vomiting
"drop attack"
vertical nystagmus
dysarthria
sensory changes in face and scalp
ataxia
bilateral findings

How well did you know this?

Not at all

Perfectly

posterior inferior cerebellar artery stroke

ipsilateral face
contralateral body
vertigo and Horner syndrome

How well did you know this?

Not at all

Perfectly

lacunar infarct stroke

absence of cortical deficits
ataxia
Parkinsonian signs
sensory deficits
hemiparesis (most notable on face)
possible bulbar signs

How well did you know this?

Not at all

Perfectly

ophthalmic artery stroke

amaurosis fugax

How well did you know this?

Not at all

Perfectly

best initial diagnostic test for stroke

head CT without contrast

How well did you know this?

Not at all

Perfectly

most accurate image of brain for stroke

MRA

- can be positive within 30-60mins of stroke

How well did you know this?

Not at all

Perfectly

head CT in stroke

best initial diagnostic test
sensitive for blood
needs 3-5d before it can detect nonhemorrhagic stroke with >95% sensitivity

How well did you know this?

Not at all

Perfectly

MRI in stroke

achieves >95% sensitivity for a nonhemorrhagic stroke within 24hrs

How well did you know this?

Not at all

Perfectly

MRA in stroke

most accurate image of brain for stroke

can be positive within 30-60mins of stroke

How well did you know this?

Not at all

Perfectly

treatment of stroke/TIA depends on:

time elapsed

How well did you know this?

Not at all

Perfectly

when can tPA be used

within 3-4.5hrs
a stroke that is not severe, NIHSS > 25
age < 80
no diabetes with history of stroke
no anticoagulation

How well did you know this?

Not at all

Perfectly

absolute contraindications to tPA

history of hemorrhagic stroke
presence of intracranial neoplasm/mass or a bleeding disorder
active bleeding or surgery within 6wks, cerebral trauma or brain surgery within 6 months, or nonhemorrhagic stroke within 1yr
suspicion of aortic dissection

How well did you know this?

Not at all

Perfectly

when tPA is not given

remove clot with catheter (useful up to 24hrs after stroke)

How well did you know this?

Not at all

Perfectly

treatment of stroke

tPA within window
remove clot within window
nonhemorrhagic: start statin

How well did you know this?

Not at all

Perfectly

what is indicated in all stroke/TIA patients

antiplatelet therapy

How well did you know this?

Not at all

Perfectly

antiplatelet therapy after tPA

start after 24hrs

How well did you know this?

Not at all

Perfectly

antiplatelet therapy for small strokes

NIHSS <6 or TIA
dual antiplatelet therapy: aspirin & clopidogrel
stop clopidogrel after several weeks, but continue aspirin indefinitely

How well did you know this?

Not at all

Perfectly

antiplatelet therapy for large strokes

aspirin

if pt was already on aspirin, add dipyridamole or switch aspirin to clopidogrel

other things to control with stroke

hypertension, diabetes, and hyperlipidemia

when is PFO closure next step in management?

when pt has an embolic appearing cryptogenic ischemic stroke and right to left shunt

cerebral venous thrombosis signs/symptoms

headache over several days (can mimic SAH) same weakness and speech difficulty seen in stroke LP normal OCPs contraindicated

most accurate test in CVT

MRV

treatment of CVT

LMW heparin followed by direct oral anticoagulant

direct oral anticoagulants

edoxaban, apixaban, rivaroxaban, dabigatran

further management following a stroke

move the clock forward: determine origin of stroke - paradoxical emboli through PFO need closure; also indicated if cryptogenic and left to right shunt - use DAPT for first several weeks

further management following a TIA

same as stroke, but no thrombolytics

what's indicated in alll patients with stroke/TIA?

echocardiogram: anticoagulation for clots, possible surgery for valve vegetations carotid doppler/duplex: endarterectomy for stenosis >70%, but not if 100% only if pt is symptomatic EKG and holter if EKG normal: DOACs indicated for all stroke/TIA with Afib/Aflutter

what to do if stroke is <50 and no pmhx

ESR, VDRL or RPR, ANA, dsDNA, protein C, protein S, factor V leiden mutation, antiphospholipid syndromes

hypertension goal after stroke

at least <140/90 in diabetic

diabetic goal after stroke

same glycemic control as general population: HgA1c <7%

hyperlipidemia goal after stroke

LDL < 70 mg/dL | add statins for all nonhemorrhagic strokes

status epilepticus therapy

benzo (lorazepam) if persists after move clock 10-20mins and add fosphenytoin if persists after move clock 10-20mins, add keppra if seizure persists after moving another 10-20mins, add general anesthesia (pentobarbital, thipental, midazolam, propofol)

diagnostic tests for seizure

electrolytes: sodium, calcium, glucose, oxygen, creatinine, and magnesium head CT (urgently); if -, consider MRI later urine tox liver and renal function EEG if other tests do not reveal etiology

treatment of seizure - single seizure

chronic AEDs not indicated unless strong family history of seizures, abnormal EEG, status epilepticus that required benzos, or uncorrectable precipitating cause (tumor)

treatment of seizures - chronic

first-line: keppra, depakote, carbamazepine, phenytoin (all equal) second-line: gabapentin, phenobarbital, lacosamide, zonisamide

treatment of seizures - absence/petit mal

ethosuximide

side effects of carbamazepine

severe skin reactions (SJS) | associated with hyponatremia

side effects of phenytoin

decreases folate levels

Parkinson's disease physical findings

``` cogwheel rigidity resting tremor hypomimia micrographia orthostasis intact cognition and memory ```

treatment of mild parkinson's

anticholinergic (benztropine or trihexyphenidyl if <60-70) | amantadine if >60-70

treatment of severe parkinson's

``` unable to perform ADLs dopamine agonists (pramipexole, ropinirole, rotigotine, apomorphine) levodopa/carbidopa ```

drugs that worsen PD

antiemetics that inhibit dopamine | metoclopramide, prochlorperazine, antipsychotics

adverse effects of anticholinergics

memory loss constipation glaucoma urine retention

if initial meds do not control PD

COMT inhibitors (block metabolism of dopamine): tolcapone, entacapone, opicapone MAOis: selegiline, rasagiline, safinamide DBS

shy-drager syndrome

PD characteraized by orthostatic hypotension | add fludrocortisone or midodrine

what can be misdiagnosed as PD

progressive supranuclear palsy | can't look up or down

what if levodopa causes psychosis

add pimavanserin or quetiapine to control those symptoms

essential tremor

tremor that is worse with action

diagnostic test for essential tremor

none

treatment of essential tremor

propranolol

if tremor persists after 1-2wks

add primidone

if tremor persists following primidone

switch to topamax or gabapentin

if multiple medical therapies fail and severe tremor

thalamotomy | - unilateral is standard