Neurology #3 Precision and Pearls

Question 1

There are two types of focal (partial) seizure. Explain the difference between the two types
-Simple
-Complex

Answer 1

-Simple: consciousness maintained
-Complex: consciousness impaired

Question 2

What diagnostic should be done for focal/partial seizures?

Answer 2

EEG

Question 3

On an EEG, what is seen in a simple focal seizure?

Answer 3

Focal discharge at onset of seizure

Question 4

On the other hand, what is seen with a complex focal seizure on an EEG?

Answer 4

-Interictal spikes at temporal or frontotemporal area

Question 5

An absence (petit mal) seizure involves _________ and is MC seen in childhood. Explain the symptoms of this type.

Answer 5

Both hemispheres

-Pause/stare without loss of body tone
-Episodes last 5-10 seconds, eyelid twitching, lip smacking
-No postictal phase

Question 6

What is seen on EEG in an absence seizure?

Answer 6

Bilateral symmetric 3 Hertz spike and wave activity

Question 7

What is the first-line treatment for an absence seizure?

Answer 7

Ethosuximide

Question 8

What two medications can exacerbate absence seizures?

Answer 8

Carbamazepine and Gabapentin

Question 9

With generalized (grand mal) seizures, which are simultaneous neuronal discharge of both hemispheres, what are some symptoms?

Answer 9

Tonic Clonic (Grand Mal): sudden loss of consciousness with tonic activity (contraction and rigidity) followed by 1-2 minutes of clonic activity (repetitive movements) followed by postictal confusion phase.
-Cyanosis and urinary incontinence can occur

Question 10

What two labs are elevated following seizures?

What is seen on EEG in a patient with a grand mal seizure?

Answer 10

Prolactin and lactic acid

High amplitude rapid spiking

Question 11

What are some long-term treatment options for epilepsy?

Answer 11

Levetiracem, Phenytoin, Valproic Acid

Question 12

What is status epilepticus?

Answer 12

Single, continuous seizure lasting 5 minutes or more, or more than 1 seizure in 5 minutes without recovery between

Question 13

What is the first line treatment for status epilepticus

Answer 13

Benzodiazepines (Lorazepam)

Question 14

Phenytoin has a MOA of _________ and some side effects include…..

Answer 14

Blocks voltage gated sodium channels

-P450 Inducer (Lupus Like Sx)
-Hyperplasia of gums and Hirsuitism
-Erythema Multiforme
-Osteopenia
-Nystagmus

Question 15

On the other hand, Carbamazepine __________ and is the drug of choice for _________. Some other side effects of this medication are

Answer 15

-Blocks Na+ channels
-DOC in trigeminal neuralgia

-Hyponatremia (causes SIADH)
-SJS, Hepatotoxicity
-P450 Inducer (Lupus)

Question 16

Ethosuximide is only used for what type of seizures?

What does this drug do?

Answer 16

Absence seizures

Blocks calcium channels, decreases neuronal firing

Question 17

Another treatment option for seizures, topiramate, blocks Na+ channels and increases GABA, and is a glutamate receptor antagonist, has a side effect of…

Answer 17

Renal stones

Question 18

Tourette Disorder, onset in childhood and MC in boys, has two diagnostic criteria. Name them.

Answer 18

Onset before age 18

Multiple motor and 1 or more vocal tic for > 1 year

Question 19

What are some symptoms of Tourette Disorder?

Answer 19

-Motor tics: blinking, sniffling, etc.
-Verbal tics: obscene words, throat clearing, echolalia (repeat others)
-Self Mutilating tics: hair pulling, nail biting

Question 20

What is the treatment for Tourette Disorder?

Answer 20

-Habit reversal therapy (1st line)
-Dopamine blockers (Tetrabenazine)
-Clonidine, Guanfacine are other options

Question 21

MC etiology of TBI

Answer 21

Falls

Question 22

What scoring system is used to quantify a TBI? What is the worst and what is the best? What are the components?

Answer 22

-Glascow Coma Scale
3 is worst, 15 is best
-Eye Response, Verbal, Motor

Question 23

Treatment for a TBI

Answer 23

-ICU admission
-Endotracheal intubation
-Decrease ICP: elevate head of bead, Mannitol

Question 24

What exactly is a concussion? What are some symptoms?

Answer 24

Mild TBI leading to AMS with or without LOC

-Headache, confusion, amnesia, blurry vision, emotional instability, vomiting, etc.

Question 25

What diagnostics should be done for a concussion? When should an MRI be done

Answer 25

CT head without contract (DOC) -MRI if symptoms > 7-14 days or worsening symptoms

Question 26

Treatment for a concussion

Answer 26

-Cognitive and physical rest -Observe for 24 hours -Resume activity after all symptoms resolve

Question 27

Post concussive syndrome is 3 symptoms for > 3 months after concussion. What is the MC symptom?

Answer 27

Headache

Question 28

What are the symptoms of a lower motor neuron injury. Think FLABBY

Answer 28

-Fasiculations, Flaccid Paralysis -Loss of muscle tone/strength -Areflexia -Babinski Downward -Young

Question 29

What are conditions that cause lower motor neuron injury (think B's)

Answer 29

-Botulism -Guillan Barre -Bell Palsy -Cauda Equina Syndrome

Question 30

What are symptoms of an upper motor neuron injury. Think, muscles are SPASTIC

Answer 30

-Slight muscle loss -Positive Babinski (toe up) -Absence of Fasiculations -Strong Tone -Increased DTR's -Clonus

Question 31

What conditions cause upper motor neuron injuries? Think of the S's

Answer 31

-Stroke -Multiple Sclerosis -Spinal Cord or Brain Damage (TBI) -Cerebral Palsy

Question 32

What are symptoms of cerebral palsy

Answer 32

-Spasticity (hallmark) -Motor deficits -Intellectual or learning deficits -Non progressive -Limb length discrepancies -Gross motor delay -Asymmetric crawling -Most onset before 3 years old

Question 33

What diagnostic is done for cerebral palsy?

Answer 33

MRI

Question 34

Treatment for cerebral palsy

Answer 34

-Pain management -Baclofen or Diazepam for spasticity

Question 35

Trigeminal neuralgia is........ It is MC in who?

Answer 35

Compression of cranial nerve V MC in middle-aged women

Question 36

If trigeminal neuralgia occurs in someone YOUNG, think....

Answer 36

Multiple Sclerosis

Question 37

Symptoms of Trigeminal neuralgia

Answer 37

-Brief episodic sharp pain on face -Worse with touch, chewing, wind gusts -Starts near mouth --> eye --> nose --> ear

Question 38

Treatment for Trigeminal Neuralgia

Answer 38

-Carbamazepine (FIRST LINE) -Oxcarbazepine

Question 39

What is Amyotrophic Lateral Sclerosis (ALS)

Answer 39

Necrosis of both upper and lower motor neurons, leading to progression motor degeneration

Question 40

Symptoms of ALS

Answer 40

-Asymmetric limb weakness (MC initial) -Bulbar symptoms (chewing, aspiration) -Mixed upper and lower motor neuron signs -Sensation, eye movement, sphincter function, and sexual function spared

Question 41

How do you diagnose ALS? What lab is elevated

Answer 41

EMG Elevated Creatine Phosphokinase

Question 42

Treatment for ALS

Answer 42

-Riluzole: reduces glutamate buildup in neurons -Fatal within 3-5 years because respiratory failure MCC of death

Question 43

What is the MCC of death in those with ALS?

Answer 43

Respiratory failure in 3-5 years