Neurology 2 Flashcards Preview

3rd year_Neurology > Neurology 2 > Flashcards

Flashcards in Neurology 2 Deck (58):
1

What types of stroke have no Tx to reverse them?

Hemorrhagic stroke

2

Surgical drainage will NOT help where?

outside of the Posterior Fossa

3

If patient is already on Aspirin at the time of stroke, after 3 hours what would you give for Tx?

- Add Dipyridamole
or
- Switch to Clopidogrel

4

Most common type of headache?

Tension headache
(though it is a dx of exclusion)

5

Type of Headache?
Visual disturbance, systemic symptoms such as muscle pain, fatigue, & weakness

Giant Cell Arteritis
- also includes Jaw Claudication

6

Type of Headache?
Ass'd w/ obesity, venous sinus thrombosis, oral contraceptives, & vitamin A toxicity

Pseudotumor Cerebri
- Mimics a brain tumor w/ nausea vomiting, & visual disturbance

7

Type of Headache?
Mimics a brain tumor w/ nausea vomiting, & visual disturbance

Pseudotumor Cerebri
- Ass'd w/ obesity, venous sinus thrombosis, oral contraceptives, & vitamin A toxicity

8

PE findings in Tension headaches?

None

9

PE findings in Migraine?

Usually none, but rare cases have aphasia, numbness, dyarthria, or weakness

10

PE findings in Cluster headache?

- Red, tearing eye w/ rhinorrhea
- Horner syndrome occasionally

11

PE findings in Giant Cell Arteritis?

- Visual loss
- Tenderness of the Temporal area

12

PE findings in Pseudotumor Cerebri?

- Papilledema w/ diplopia from 6th cranial nerve (abducens) palsy

13

What does Pseudotumor Cerebri show on LP?

Increased pressure only.
CSF itself is normal

14

Most accurate Dx test for Giant Cell Arteritis?

Biopsy.
Also ass'd w/ markedly elevated ESR

15

Tx?
Tension headaches

NSAIDS & other analgesics

16

Tx?
Migraine

Triptans or Ergotamine as abortive therapy

17

Tx?
Cluster headaches

Triptans, Ergotamine, or 100% Oxygen as abortive therapy

18

Tx?
Giant Cell (Temporal) Arteritis

Prednisone

19

Tx?
Pseudotumor Cerebri

Weight loss
- Acetazolamide - to dec CSF prod
- Steroids help
- Repeated LP rapidly lowers ICP

- Place V-P shunt or fenestrate (cut into) the Optic Nerve if medical therapy doesn't control

20

Prophylaxis Tx for Cluster headaches?

Verapamil

21

Prophylaxis Tx for Migraines? When do you give proph Tx?

- Propranolol
- Give this if having 3 or more migraines per month

others include CC-blockers, TCAs, SSRIs, Topiramate, Botulinum toxin injections

22

Trigeminal Neuralgia Tx?

Oxcarbazepine or Carbamazepine

- Baclofen & Lamotrigine also have been effective
- Gamma knife surgery if meds ineffective

23

Postherpetic Neuralgia Tx?

TCAs, Gabapentin, Pregabalin, Carbamazepine, or Phenytoin

- Topical Capsaicin helpful
- Most antiepileptic meds are effective, but none of them in more than 50-70% of patients

24

Indication for Zoster vaccine?

All persons >60 yrs.

25

Status Epilepticus Tx?

1st = Benzodiazepine
- if persists, give Fosphenytoin or Phenytoin
- if still persists, give Phenobarbitol
- if still, give neuromuscular blocking agent such as Succinylcholine, Vecuronium, or Pancuronium to allow intubation & anesthesia such as Midazolam or Propofol

26

IV Phenytoin adverse effects?

Hypotension & AV block (Class 1b anti-arrhythmic)
(Fosphenytoin has fewer SEs & same efficacy)

27

Can neuromuscular blocking agents stop seizure?

No, they just stop muscular contraction or the external manifestation of the seizure

28

What is a partial seizure?

Seizure focal to one part of the body
Can be simple (intact consciousness) or complex (loss or alteration of consciousness)

29

Opioids used for diarrhea?

Loperamide & Diphenoxylate

30

Opioid used for cough suppression?

Dextromethorphan

31

Tramadol MOA?

- Very weak opioid agonist
- Also inhibits 5HT & NE reuptake

"Tram-it-all"

32

Initial Tx for MS?

- Steroids during exacerbations

- B-interferons or glatiramer Acetate (Copaxone) for proph

33

How long should a patient be seizure-free for you to D/C antiepileptics?

2 years

34

Dx?
Sudden onset severe headache w/ meningeal irritation (stiff neck, photophobia), & fever

Subarachnoid Hemorrhage
(ruptured aneurysm of ant. circle of Willis)
- LOC in 50% due to inc'd ICP

35

How does SAH differ from meningitis?

SAH is very sudden in onset & is ass'd w/ LOC

36

SAH: best initial test?

CT w/out contrast (95% sensitive)

37

SAH: most accurate test?

Lumbar Puncture showing bleed

38

Normal WBC:RBC ratio in CSF?

WBC:RBC = 1:500 - 1:1000

39

In general, when do you use contrast on CT?

When looking for mass lesions like cancer or abscess.
Do NOT use contrast when looking for blood!

40

After SAH dx, how do you determine which vessel ruptured?

CT angiography, standard angiography w/ catheter, or MRA

41

Best initial Tx for bacterial meningitis?

Vancomycin, Metronidazole, & Ceftriaxone

42

Pseudotumor Cerebri: ass'd w/ what 4 things?

- Obesity
- Venous Sinus Thrombosis
- Oral Contraceptives
- Vitamin A toxicity

43

4 primary presenting symptoms of meningitis?

- Fever
- Headache
- Neck stiffness (nuchal rigidity)
- Photophobia

44

Meningitis: best initial test?

LP

45

Meningitis: most accurate test?

LP

46

Suspected Meningitis:
When would a head CT be necessary prior to LP?

Only if there is a possibility of a space-occupying lesion. I.e. if there is:
- Papilledema
- Seizures
- Focal neurological abnormalities
- Confusion interfering w/ neuro exam

47

Papilledema - what's it look like on fundoscopic exam?

Blurred, fuzzy disc margin
(from increased ICP)

48

When do you give ABX prior to LP in suspected meningitis?

If there is a c/i to IMMEDIATE LP, then give ABX as first step

49

What test is indicated if patient has received ABX prior to LP in suspected meningitis?

Bacterial Antigen Detection (Latex Agglutination Test)
-- necessary b/c of ABX, culture may be falsely negative

-- extremely specific
-- not sensitive enough to exclude if negative

50

Decorticate posturing consists of what?

Upper-extremity adduction and flexion at the elbows, wrists, and fingers, together with lower-extremity extension, which includes extension and adduction at the hip, extension at the knee, and plantar flexion and inversion at the ankle

51

Decerebrate posturing consists of what?

Upper-extremity extension, adduction, and pronation together with lower-extremity extension

52

Decorticate posturing means what?

This occurs with dysfunction at the cerebral cortical level or below and may reflect a "release" of other spinal pathways

53

Decerebrate posturing means what?

Traditionally implies dysfunction below the red nucleus, allowing the vestibulospinal tract to predominate

54

Which response to pain has better prognosis -- decorticate or decerebrate?

Decorticate

55

Major cause of morbidity in the first 24 hrs after SAH?

Rebleeding

56

Major cause of morbidity 3-10 days after SAH?

Vasospasm
(likely caused by arterial narrowing @ base of brain due to degradation of blood & its metabolites leading to cerebral infarction)

57

How to prevent vasospasm following SAH?

Initiate tx w/ Nimodipine

58

How to detect vasospasm following SAH?

CT angiography