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PANCE/EOC > Neurology #2 > Flashcards

Neurology #2 Flashcards

(49 cards)

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1
Q

What is normal pressure hydrocephalus?

A

Dilation of cerebral ventricles with normal opening pressures on LP

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2
Q

Triad of symptoms of normal pressure hydrocephalus?

A
  • Dementia/Cognitive dysfunction
  • Gait disturbance
  • Urinary incontinence
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3
Q

Diagnostics for normal pressure hydrocephalus

A
  • MRI > CT: enlarged ventricles in absence of sulcal dilation
  • LP: CSF pressure normal
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4
Q

Treatment for normal pressure hydrocephalus

A

-Ventriculoperitoneal shunt

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5
Q

What abnormalities are usually the most improved with a ventriculoperitoneal shunt?

A

Gait abnormalities

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6
Q

MCC of aseptic (viral) meningitis?

A

Enteroviruses (Coxsackievirus and Echovirus)

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7
Q

Symptoms of aseptic meningitis

A

Classic symptoms but milder

-headache, stiff neck, photosensitivity, fever

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8
Q

How do you differentiate encephalitis and aseptic meningitis?

A

In aseptic meningitis, there are no focal deficits (AMS, changes in speech, personality, and movement)

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9
Q

What does an LP and CSF exam show if the meningitis is aseptic in nature?

A
  • Normal pressure
  • Clear appearance
  • Normal protein
  • Normal glucose
  • Lymphocyte predominance
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10
Q

Treatment for aseptic meningitis?

A

Supportive: IVF, antipyretics, analgesics

Self-limited course without therapy most times

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11
Q

MCC of encephalitis

A

HSV-1

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12
Q

Symptoms of encephalitis

A
  • headache
  • neck stiffness
  • photosensitivity
  • Fever
  • AMS changes: changes in personality, speech, and movement
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13
Q

Diagnostics for encephalitis

A
  • CT scan of head must be performed to rule out space-occupying lesion
  • LP performed after CT
  • MRI preferred imaging
  • PCR testing
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14
Q

What is the most accurate test for herpes encephalitis?

A

PCR testing of CSF fluid

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15
Q

What does an LP with CSF exam show in encephalitis?

A
  • Normal glucose
  • Increased lymphocytes
  • Normal pressure
  • Normal protein
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16
Q

Treatment for encephalitis

A
  • IV Acyclovir started ASAP

- Supportive

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17
Q

Huntington Disease is an ________ neurodegenerative disorder

A

Autosomal dominant

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18
Q

What is the pathophysiology of Huntington Disease?

A

Inheritance of trinucleotide repeats (CAG/glutamine) on Huntingtin gene (Chromosome 14)

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19
Q

Symptoms of Huntington Disease

A
  • Symptoms appear at 30-50 years old
  • Mood, memory, movement
  • -Behavioral and mood changes
  • -Chorea
  • -Dementia
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20
Q

What is shown on CT/MRI for Huntington Disease?

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A

-Cerebral and striatal (caudate nucleus and putamen) atrophy

21
Q

Management of a patient with Huntington Disease

Study These Flashcards
A

No cure; usually fatal 15-20 years after presentation
No medication stops progression
Tetrabenazine for chorea or dyskinesia

22
Q

What are the characteristics (exacerbating factors and improving factors) of an essential familiar tremor?

Study These Flashcards
A

Intentional tremor: worsened with intentional movement, stress, and anxiety
Tremor improved with alcohol ingestion and slight improvement with rest

23
Q

True or False: An essential tremor affects the head and the voice as well?

24
Q

Treatment for essential tremor

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A
  • Treatment usually not needed
  • Propanolol may help if severe
  • Primidone (added to Propanolol or if no relief with Propanolol)
  • Thalamotomy in refractory cases
25
Parkinson Disease is a movement disorder that is due to
idiopathic loss of dopaminergic neurons in the substantia nigra
26
Triad of symptoms for Parkinson's Disease
Resting tremor: pill-rolling, worse at rest, improves with voluntary activity Bradykinesia: slowness of voluntary movement Rigidity: increased resistance to passive movement
27
Facial symptoms of Parkinson's Disease
- Face involvement: immobile face (fixed facial expressions) - Myerson's Sign: tapping forehead causes blink - Decreased blinking - Seborrhea of skin common
28
Postural instability is a late finding in those with Parkinson's Disease. What is one test you can do to test for this and what happens?
Pull test -Stand behind patient and pulling the shoulders causes patient to fall or take steps backwards
29
On post-mortem histology what is seen in a patient with Parkinson's?
Cytoplasmic inclusions (Lewy Bodies) and loss of pigment cells in substantia nigra
30
Most effective treatment for Parkinson's Disease?
-Levodopa-Carbidopa
31
What are other medications that can be used as initial treatment in Parkinson's?
Dopamine Agonists (Bromocriptine, Pramipexole)
32
How does Levodopa work?
Levodopa is converted to dopamine once it crosses the blood-brain barrier. -Carbidopa reduces the amount of Levodopa needed and reduces the adverse effects of Levodopa
33
Dopamine agonists, such as Bromocriptine and Pramipexole, can be used as first-line agents for Parkinson's in who
Patients younger than 65 to delay use of Levodopa
34
When should anticholinergics (Trihexyphenidyl, Benztropine) be used for treatment of Parkinson's?
-Monotherapy in younger patients (<70) with tremor as the predominant symptom (without gait disturbance or bradykinesia)
35
Amyotrophic Lateral Sclerosis (ALS) is
Neurodegenerative disorder due to necrosis of BOTH upper and lower motor neurons, leading to progressive motor degeneration
36
MC presenting symptom of ALS
Asymmetric limb weakness -Also difficulty chewing, aspiration
37
What motor functions are spared in ALS (there are 4)
- Sensation - Voluntary eye movement - Sphincter Function (bowel and bladder) - Sexual function
38
Hallmark symptoms of ALS
- Mixed upper and lower motor neuron signs - -Upper: spasticity, stiffness, weakness - -Lower: muscle atrophy, hyporeflexia, weakness
39
diagnostic of choice for ALS
-Electromyography: elevated CPK levels
40
What is the only drug to impact ALS
Riluzole
41
How does Riluzole work?
Reduces glutamate buildup in neurons
42
What is the MCC of death in those with ALS?
Respiratory failure
43
First-line management for tourette syndrome
Habit reversal therapy (most don't need medical management)
44
Tourette Disorder is thought to be due to
Excess dopamine + GABA deficiency in the caudate nucleus
45
If the patient does not see improvement with habit reversal therapy in tourette syndrome, what are some medical treatment options?
- Dopamine blocking agents: Tetrbenazine, Haloperidol | - Alpha-2-adrenergics: Clonidine or Guanfacine
46
Another name for Restless Leg Syndrome
Willis-Ekbom Disease
47
Common etiologies of Willis-Ekbom Disease
- CNS iron deficiency (MC) - Pregnancy - Peripheral neuropathy - Chronic alcohol use
48
Symptoms of Willis-Ekbom Disease
- Uncomfortable or unpleasant sensation in legs that creates an urge to move the legs - Symptoms improve with leg movement - Worse at night and with prolonged periods of rest
49
Treatment for Willis-Ekbom Disease
- Dopamine Agonists: Pramipexole, Ropinirole (1st line) | - Iron supplementation

PANCE/EOC (63 decks)

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