Flashcards in Neurology Deck (62):
LMN injury = anterior horn cell destruction
seen in Polio and werdnig hoffman dz
What is the only area spared in an anterior spinal artery occlusion?
The Dorsal Columns
What areas are affected in B12 neuropathy and Friedricks atacia?
demyelination of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts
symptoms of strokes in territory:
Basal ganglia lacunar-
MCA- aphasia, contra neglect, paresis, and sensory loss in face and arm. GAZE TOWARDS THE LESION w/ homo hemi
ACA- Contra paresis and sensory loss in leg. Cognitive defects
PCA- homo hemi, memory deficits, dyslexia/alexia
Basilar artery- locked in syndrome, weakness/sensory deficits to ipsi face and contra body!
Basal ganglia lacunar- pure motor or sensory w/ ataxic hemiparesis
For strokes that just happened, do MRI first
Acute HA w/ CN III palsy and pupillary involvement?
Think berry aneurysm
Most likely occurance
Marfans, Ehlers Danlos, and ADPKD all associated with...
Cavernous hemangiomas associated with...
What type of herniation?
Flexor/extensor posturing, small reactive pupils, cheyne-stokes respirations
downward transtentorial (central) herniation
Subdural hematoma is crescent shaped and does NOT cross midline
Epidural hematoma has luccid interval, is lens shaped and does NOT cross sutures
If a headache with acute ocular disease, what 2 things are on your diff?
Cluster vs Angle closure glaucoma. For ACG - look for a FIXED PUPIL!
What is the headache after an LP due to?
Tx for migraine headaches:
Ppx for migraine headaches:
Tx = NSIADs -> triptans or metaclopramide
Ppx = gabapentin, topiramate, amitriptyline, BBs, CCBs
What protocol screening should you follow for pts who present with their FIRST cluster headache ever?
exclude Horners syndrome (carotid artery dissection, cavernous sinus infection
Tx for cluster headaches
PPx for cluster headaches
Tx = high flow O2, DHE, octreotide/sumatriptan
PPx = prednisone, verapamil, lithium
Tx for cavernous sinus thrombosis (can present as headache)
Naf/Oxacillin + Ceftriaxone or cefepime
If anearobe (dental/sinus) use metronidazole
What hormone is elevated after epileptic seizures in postictal period?
Simple partial seizures
Complex partial seizures
Simple = motor and sensory features w/ hallucinations but is NOT ASSOCIATED WITH LOC
Complex = temporal lobe. b/l motor/sensory features (LIP SMACKING) w/ LOC
Be aware of postictal confusion or todd's paralysis
Tx for an active seizing pt?
Benzos and Phenytoin
What to use in kids as a first line anticonvulsant?
In adults can use phenytoin, oxcarb, carbamaz, phenobarb, or valproate
Teen w/ a family history of "seizures" stares out the window alot in class. Dx? Tx? Will he recover?
Petit Mal (Absence) seizures (EEG shows 3mg blah blah)
Ethosuximide or Valproate
Pts usually recover before adulthood
Pt w/PKU or tuberous sclerosis and a FAMILY HISTORY starts to have seizures at 6 months of birth where she jerks her head and trunk in 5-10s bursts. Mental retardation. Dx? Tx?
Infantile Spasms (West Syndrome)
(EEG while seizing shows hypsarrhythmia)
Tx = ACTH, prednisone, clonazepam
Kid w/ mental retardation has multiple seizures per day (lots of nocturnal ones.) Dx? What does the EEG look like?
Slow spike and wave complexes
Resistant to treatment :(
What causes BPP Vertigo?
a dislodged otolith causing semicircular canal (posterior) disturbances
Tx = Epley maneuver or will go away on its own
Labrynthitis vs Vestibular Neuritis?
Laby = auditory and aural symptoms (tinnitus, ear fullness)
Vestibular Neuritis = No auditory or aural symptoms
Tx = meclizine and corticosteroids
What strokes mimic labyrinthitis and vestibular neuritis?
Laby = AICA stroke (lateral pontine/cerebellar)
VN = PICA stroke (lateral medullary/cerebellar)
Pts with MG who have a thymoma will have autoAbs towards what?
ACh receptors, but also probably antibodies against striated muscle (anti-MuSK Abs)
How does repetitive nerve stimulation differ in MG and LE syndromes?
MG - decremental response
LE - incremental response
What is the viral link that is believed to somehow cause MS?
T-cell mediated viral infections
What area of the CNS is affected in Guillain Barre? Tx?
THe myelin. It is an acute inflammatory demyelinating polyneuropathy
It can cause arrhythmias as well. WORST THING WOULD BE RESP FAILURE
Tx = plasmapheresis and IVIG. NO STEROIDS
What is the main cause of death for alzheimers pts?
What is a key feature between alz dementia and pseudodementia?
alz dementia pts are NOT concerned about their symptoms and will be brought in by family members. Pseudodementia pts are concerned about their symptoms
What will imaging look like for:
Alz dementia = b/l temporoparietal hypometabolism
Vascular dementia = old infarcts, white matter changes
Picks = frontotemporal atrophy
NPH = ventricular enlargement
CJD = increased T2 and FLAIR in putamen and caudate. EEG shows pyramidal signs and periodic sharp waves
Tx for alz dementia?
Cholinesterase inhibitors (increase the ACh levels) = donepezil, rivastigmine, galantamine, tacrine
What does the gait look like in NPH?
"Magnetic" or "Glued to the floor."
What CSF labs are seen in CJD?
elevated CSF 14-3-3 and tau protein. Make Dx w/ brain bx
What genetic phenomena is seen in Huntingtons dz?
What will imaging look like?
Anticipation (number of CAG repeats expands in subsequent generations leading to earlier expression and more severe dz.)
CT/MRI shows caudate/putamen atrophy
Tx = Reserpine or Tetrabenazine (decrease movement)
Adjectives to describe parkinson gait:
Slow, wide stance w/ short accelerated steps, no arm swing
Tx = levodopa/carbidopa (carb blocks peripheral conversion of levo (D precursor) to prevent side effects of levodopa (N/V)
-Selegiline (MAO-B blocker can be neuroprotective)
What are the most common primary brain tumors in adults? kids?
Glio Multiforme and Meningioma (the only brain tumor that is more common in women)
kids = Astrocytoma, Medulloblastoma
NOTE: 2* TUMORS FROM METZ ARE WAY MORE COMMON IN CNS THAN 1*
What type of tumor is a GBM?
It is a grade IV astrocytoma. Causes ring enhanced lesions on MRI
What type of cells spawns a meningioma?
Dura mater or arachnoid cells. Can leave a dural tail
What cells span an acoustic neuroma?
What tissue spawns a medulloblastoma?
Neuroectodermal tissue. These are popular in kids and come from the 4th ventricle
What is the most common supracellular tumor in kids? Signs?
Craniopharyngioma. Calcification is common
2/3 adult tumors are supratentorial
1/3 kid tumors are supratentorial
NF1 vs NF2
Both are AD
NF1 = Age 15; cafe au lait spots, neurofibromas, freckling axilla, OPTIC GLIOMAS, kyphoscoliosis
NF2 = Age 20; B/l acoustic neuromas, some sort of neurofibroma, meningiomoa, gliomas...
What 1 test do you want to do?
ash-leaf hypopigmentations on skin, mental retardation, seizures, RETINAL HAMARTOMAS, sebaceous adenomas (shaped like butterflies) and orange peel rash on lumbosacral area.
Must evaluate for rhabdomyoma of heart. Also want to check the kidneys forangiomyolipoas
No resp drive = brain death
Resp drive but eyes closed and unconscious = coma
resp drive, but eyes open, seemingly awake = PVS
Resp drive w/ eye/lid control = Locked In Syndrome (caused by CPM, stem stroke, or advanced ALS
Artificial life support can be discontinued only after 2 physicians have declared the patient legally brain dead
when does korsakoff's dementia occur?
Typically in the resolution phase of wernicke's syndrome that was treated too late/incorrectly
When does glaucoma occur?
When the natural flow of aqueous humor is disrupted and IOP is increased
Open angle = flow through trabecula is messed up
Closed angle = angle is too narrow to let fluid out of posterior chamber
WHAT medication should you avoid like crazy in pts with acute angle glaucoma? What tx instead?
Atropine or anything that will dilate the eye (this would cause a higher IOP and would be really bad
tx = timolol, pilocarpine, apraclonidine
tx for open angle glaucoma?
BBs to decrease aqueous fluid
Pilocarpine to increase aqueous outflow
Signs of macular degeneration?
painless loss of central vision and distortion of straight lines.
Central retinal artery occlusion, Tx?
Central retinal vein occlusion, Tx?
CRA = painless unilateral blindness w/ cherry-red spot on the fovea and swelling. Tx = thrombolysis
CRV = fast painless blindness w/ swollen optic disk w/ hemorrhages and cotton wool spots. Tx = photocoagulation
What area of the brain corresponds to a lacunar infarct?
What would the symptoms be?
= basal ganglia (putamen, GP, thalamus, caudate) or Subcortical white matter (internal capsul, corona radiata) or Pons.
They are small, due to HTN, and may not show on CT
symptoms = unilateral motor impairment, NO SENSORY/CORTICAL DEFICITS, no visual field abnormalities
What would a stroke in the vertebrobasilar area look like?
This would affect the brainstem
CROSSED syndrome (contra hemiplegia and ipsi CN involvement.)
Central Cord Syndrome
selective damage to the central portion of the anterior spinal cord - causes weakness in UE and can cause decreased pain/temp due to STT damage.
This will happen due to HYPEREXTENSION in a pt who already has degenerative changes in the spinal cord
Anterior (Ventral) Cord Syndrome
b/l spastic motor paresis any area distal to the lesion
usually due to occlusion of the anterior spinal artery
Posterior (Dorsal) Cord Syndrome
b/l loss of vibratory/proprioceptive sensation, may have URINARY RETENTION/INCONTINENCE.
Often due to MS or vascular injury (vertebral artery dissection)
Gait where you flex the hip and knee and slap your foot on the ground =
Peroneal nerve injury