Neurology Flashcards
(158 cards)
1
Q
What are the 4 D’s of posterior circulation strokes?
A
Diplopia
Dizziness
Dysphagia
Dysarthria
2
Q
Ischemic strokes take how long to show up on CT?
A
6 hours
3
Q
What is the function of the lateral corticospinal tract? What is the clinical presentation of a lesion here?
A
Movement of ipsilateral limbs and body
Ipsilateral paresis at and below level of lesion
4
Q
What is the function of the dorsal columns? What is the clinical presentation of a lesion here?
A
Fine touch, vibration, proprioception
Ipsilateral loss at and below lesion
5
Q
What is the function of the spinothalamic tract? What is the clinical presentation of a lesion here?
A
Pain, temperature
Contralateral loss of pain and temp at and below level of lesion
6
Q
What areas of the spinal cord does polio affect? Symptoms?
A
Anterior horns
LMN symptoms
7
Q
What areas of the spinal cord does MS affect? Symptoms?
A
random areas of the dorsal columns and anterior corticospinal tracts
8
Q
What areas of the spinal cord does ALS affect? Symptoms?
A
Anterior horns and lateral corticospinal tracts
UMN and LMN s/sx
9
Q
What treatment for MS ALS?
A
Riluzole (riLOUzole for LOU Gehrig’s disease)
10
Q
What areas of the spinal cord does complete occlusion of the anterior spinal artery affect? Symptoms?
A
Everything but dorsal columns
11
Q
What areas of the spinal cord does tabes dorsalis affect? Symptoms?
A
Dorsal columns and nerve roots
Sensory ataxia and poor coordination
12
Q
What areas of the spinal cord does syringomyelia affect? Symptoms?
A
Anterior white commissure of spinothalamic tract
cape like, bilateral loss of pain and temperature in upper extremities.
13
Q
What areas of the spinal cord does Vit B12 affect? Symptoms?
A
-Dorsal columns, lateral corticospinal tract, and spinocerebellar tracts
14
Q
What is the presentation of an UMN lesion to the facial nerve?
A
Contralateral deficits of the LOWER face only
15
Q
What is the presentation of an LMN lesion to the facial nerve?
A
Ipsilateral facial paralysis
16
Q
What are the disease that Bell’s palsy is commonly seen in? (5)
A
AIDS Lyme disease Sarcoidosis Tumors DM
17
Q
What are the components of the CHANGes mnemonic for s/sx that occur with MCA stroke?
A
Contralateral paresis / sensory loss Hemiparesis Aphasia (dominant side) Neglect (nondominant side) Gaze preference toward side of lesion
18
Q
tPA is indicated if a stroke has occurred within what timeframe?
A
Less than 3 hours
19
Q
What is the max BP that is allowable prior to the use of tPA?
A
185/110
20
Q
When is ASA indicated in the treatment of a stroke?
A
If it has been more than 3 hours since onset, and not hemorrhagic
21
Q
What is the role of treating fever/hyperglycemia in an acute stroke?
A
Better prognosis if treated
22
Q
What is the treatment for increased ICP in the setting of ischemic stroke?
A
Mannitol and hyperventilation
23
Q
What spinal level does the biceps reflex test?
A
C5
24
Q
What spinal level does the triceps reflex test?
A
C7
25
What spinal level does the patellar reflex test?
L4
26
What spinal level does the achilles reflex test?
S1
27
What is the single greatest risk factor for stroke?
HTN
28
What are the components of the SAMPLE STAGES contraindications for tPA administration?
- Stroke / head trauma in the last 3 months
- Anticoagulation with INR more than 1.7
- MI in the past 3 months
- Prior intracrainial bleed
- Low platelets
- Elevated BP
- Surgery in past 14 days
- TIA within 6 months
- GI or urinary bleeding past 21 days
- Elevated BG
- Seizures at onset of stroke
29
A stroke or head trauma within what timeframe is a contraindication to tPA?
3 months
30
An INR above what is a contraindication for tPA?
1.7
31
A MI within what timeframe is a contraindication to tPA?
3 months
32
A hemorrhagic stroke within what timeframe is a contraindication to tPA?
Ever
33
Major surgery within what timeframe is a contraindication to tPA?
14 days
34
Gi/GU bleeding within what timeframe is a contraindication to tPA?
21 days
35
What BG levels are a contraindication to tPA?
Below 50 or above 400
36
Name the artery likely affected: Contralateral paresis and sensory loss in the leg; cognitive or personality changes.
ACA
37
Name the artery likely affected: Contralateral paresis and sensory loss in the face and arm; gaze preference toward the side of the lesion.
MCA
38
Name the artery likely affected: vertigo, homonymous hemianopsia
PCA
39
Name the artery likely affected: Pure motor, pure sensory, ataxic hemiparesis, or dysarthria
Lacunar
40
What is the definition of a TIA?
Neurological deficit lasts less than 24 hours, and without findings on MRI
41
What are the indications for carotid endarterectomy in symptomatic and asymptomatic patients respectively?
```
Symptomatic = 60%
Asymptomatic = 70%
```
42
What are the top three causes of subarachnoid hemorrhage?
- Ruptured berry aneurysm
- AV malformations
- Trauma to the circle of Willis
43
What are the s/sx of a subarachnoid hemorrhage? (2)
Thunderclap HA
| Neck stiffness
44
What is a "Sentinel bleed" in terms of patients with SAH?
Warning bleed that occurs a few days prior to presentation
45
If CT is negative, but there is a strong clinical suspicion of a SAH, what should be done?
LP to look for bleeding or xanthochromia
46
What imaging should be performed once SAH is confirmed? Why?
four vessel angiography to identify exact source of bleeding
47
What are the components of the "MAKE an SAH" more likely?
Marfan
Aortic coarctation
Kidney disease (AD polycystic)
Ehler-danlos
Sickle cell or smoking
Atherosclerosis
HTN
48
What are the treatment focuses after a SAH has been repaired? (3)
- Maintaining BP below 150
- prevent vasospasm
- Decreased increased ICP
49
What is the drug of choice to prevent vasospasm in patients post SAH repair?
Nimodipine
50
What is the effect of vasospasm post SAH repair?
Major increase in morbidity and mortality
51
Where in the brain does intracerebral hemorrhage generally occur?
Deep brain regions (e.g. basal ganglia, pons, cerebellum, etc.)
52
What is the most common underlying cause of intracerebral hemorrhage?
HTN
53
What are the early symptoms of intracerebral hemorrhage? Late?
- Focal motor or sensory deficits
| - Features of increased ICP
54
What is the common cause of subdural hematoma?
Rupture of bridging veins
55
What is the common cause of epidural hematoma?
Middle meningeal artery tear
56
What are the s/sx of a subdural hematoma?
HA, changes in mental status, and/or focal neurological deficits
57
What are the s/sx of an epidural hematoma?
Immediate LOC, followed by lucid interval from minutes to hours
58
What are the CT findings of a subdural hematoma?
Crescent shaped, concave density
59
What are the CT findings of an epidural hematoma?
Lens-shaped biconvex density
60
How can you differentiate an acute vs chronic subdural hematoma?
```
Isodense = acute
Hypodense = chronic
```
61
What does a blown pupil suggest?
Impending ipsilateral brainstem compression
62
What is the most common agent to cause septic cavernous sinus thrombosis?
Staph Aureus
63
What are the s/sx of cavernous sinus thrombosis?
*HA*
Fever
visual disturbances
64
What is the best imaging modality to diagnose cavernous sinus thrombosis?
MRI
65
What is the treatment for cavernous sinus thrombosis?
Penicillinase-resistant penicillin + 3rd gen cephalosporin
66
What is the treatment for cavernous sinus thrombosis if a oral source is suspected?
Metronidazole
67
Name the type of HA: unilateral, pulsating HA tha lasts 4-72 hours
Migraine
68
Who is classically affected by migraines?
Women in their 20's
69
What is the underlying pathophysiology of migraine HAs?
Vasospasm and serotonin release
70
What is the abortive therapy for a migraine HA?
Triptans
71
What is the prophylactic therapy for migraine HAs? (4)
- Anticonvulsants (e.g. gabapentin, topiramate)
- TCAs
- Beta blockers
- CCBs
72
Who is classically affected with cluster HAs?
25 year old man
73
Name the type of HA: excruciating, brief, unilateral periorbital HA that occur many times a day
Cluster HA
74
What is the classic associated symptom of a cluster HA?
Ipsilateral lacrimation
75
When is an extensive workup for cluster HAs indicated?
First onset to r/o more severe causes
76
What is the acute and chronic therapy for cluster HAs?
```
Acute = oxygen
Chronic = verapamil or anticonvulsants
```
77
Name the type of HA: bilateral pain, not aggravated by physical activity
Tension
78
What is the treatment for tension HAs?
NSAIDs
| Avoid exacerbating factors
79
Jaw claudication + HA in an older person should be worked up for what disorder?
Temporal arteritis
80
Complex partial seizures classically affect what part of the brain?
Temporal lobe
81
What are the classic EEG findings of a absence seizure?
3 Hz spike and wave discharges
82
What is a common triggering factor of absence seizures?
Hyperventilation
83
What are the EEG findings of a tonic-clonic seizure?
10Hz during the clonic phase, and slow waves during the clonic phase
84
What hormone levels may be elevated in the postictal state?
Prolactin
85
Focal seizures in an adult should alway prompt evaluation for what pathology?
Tumors
86
What is the first line anticonvulsant in children?
Phenobarbital
87
What are the first and second line agents for absence seizures?
```
1 = Ethosuximide
2 = Valproic acid
```
88
What is the treatment for intractable temporal lobe seizures?
Anterior temporal lobe lobectomy
89
What are some of the first line agents, besides anticonvulsants or benzos, in the treatment of status epilepticus?
Thiamine, then glucose
| Naloxone
90
When evaluating suspected BPPV, Nystagmus lasting longer than how long is concerning for a central lesion?
1 minute
91
What is the typical presentation of vestibular neuritis (labyrinthitis)?
Acute onset of severe vertigo, head motion intolerance, and gait unsteadiness
92
What is the difference in presentation of vestibular neuritis vs labyrinthitis?
Labyrinthitis = Auditory or aural symptoms (tinnitus, ear fullness, hearing loss)
Vestibular neuritis = Lacks auditory or aural symptoms
93
What are the three major findings of peripheral vestibulopathy that differentiates it from strokes?
■ An abnormal vestibulo-ocular reflex as determined by a bedside head impulse test (ie, rapid head rotation from lateral to center while staring at the examiner’s nose).
■ A predominantly horizontal nystagmus that always beats in one direction, opposite the lesion.
■ No vertical eye misalignment by alternate cover testing.
94
What is the treatment for labyrinthitis / vestibular neuritis? Prognosis?
Steroids and antivertigo agents
| Resolves in two weeks
95
What are the general s/sx of Meniere's disease?
Vertigo with hearing loss, tinnitus, and ear fullness
96
What is one of the first signs of Meniere's disease?
Progressive, Low frequency hearing loss
97
What are the diagnostic criteria for Meniere's disease?
Two episodes lasting over 20 minutes with remission of s/sx between episodes
98
What is the acute and chronic treatment for Meniere's disease?
```
Acute = Meclizine or benzos + antiemetics
Chronic = Avoid salt, diuretics
```
99
Do cardiac etiologies of syncope typically have prodromal s/sx?
No
100
Which heart valve disease is classically associated with syncope?
Aortic stenosis
101
What is the general workup of new onset syncope?
- Telemetry / holter for arrhythmias
- ECG and cardiac enzymes to r/o MI
- Echo to tilt-table test
102
What, generally, is the pathophysiology behind Myasthenia gravis?
Antibodies directed against the postsynaptic acetylcholine receptors
103
What is the best initial test for myasthenia gravis?
serology for the antibodies
104
What is the role of a chest CT in the diagnosis of myasthenia gravis?
evaluate for a thymoma
105
What is the treatment for myasthenia gravis?
Pyridostigmine or prednisone
106
Why should patients with myasthenia gravis not be given beta blockers?
Due to its effects at the neuromuscular junction
107
What are the abx that should be avoided in patients with myasthenia gravis?
Aminoglycosides
| Fluoroquinolones
108
What are the three muscles that are spared with Eaton-Lambert syndrome?
EOMs
Respiratory
Bulbar
109
What is the treatment for eaton-lambert syndrome?
Corticosteroids
| Azathioprine
110
What are the cells that mediate MS?
T cells
111
Which type of MS has the best prognosis?
The relapsing and remitting type
112
What is charcot's triad for MS?
Scanning speech
Internuclear ophthalmoplegia
(Intention tremor)
Nystagmus
(SIIN)
113
Symptoms of MS classically worsen under what conditions?
Heat (how showers, hot summer, etc)
114
Where are the white matter lesions classically located with MS?
Periventricular and in the corpus callosum
115
What will CSF show with MS?
Increased IgG, or oligoclonal bands
116
What is the treatment for MS?
Corticosteroids
| Plasma exchange if not respond
117
What are the ABCs of MS treatment?
Avonex (IFN-beta1a)
Betaseron (IFN-beta1b)
Copaxone
118
What generally happens to the s/sx of MS with pregnancy?
Decrease
119
What is the treatment for optic neuritis?
IV corticosteroids (Not oral)
120
What are the 4 A's of guillain-Barre syndrome?
Acute inflammatory demyelinating
Ascending paralysis
Autonomic neuropathy
Albuminocytological dissociation
121
What are the CSF findings of Guillain-Barre syndrome?
Increased albumin in CSF (Albuminocytological dissociation)
| -Protein more than 55 mg/dL
122
What is the treatment for Guillain-barre syndrome?
IVIG
| Plasmapheresis
123
What is the role of corticosteroids in the treatment of Guillain-Barre syndrome?
NOT indicated
124
What is the prognosis for ALS?
Dead in 5 years
125
What is the general history of ALS?
Asymmetric, slowly progressive weakness, with fasciculations,
126
What is nerve functions are generally spared with ALS? (3)
Sensation
Eye movement
Sphincter tone
127
Is pronator drift and UMN or LMN sign?
UMN
128
Fasciculations are an UMN or LMN sign?
LMN
129
Bulbar muscle weakness (CN XII, IX, X) excludes what neurological causes of ALS like symptoms?
Any pathology below the foramen magnum (cervical spondylosis, or compressive myelopathy)
130
What are the pathological changes to the brain with alzheimer's disease?
Neurofibrillary tangles and amyloid
131
What will brain imaging show in a patient with vascular dementia?
Old infarction of extensive deep white matter changes 2/2 chronic ischemia
132
True or false: there is no substantial motor involvement with AD
True
133
What are the pathological brain findings in a patient with Pick's disease (frontotemporal dementia)?
Pick bodies (round intraneuronal inclusions)
134
What will imaging show in a patient with frontotemporal dementia?
Frontotemporal atrophy
135
What is the time course of normal pressure hydrocephalus?
Gradual or abrupt in onset
136
What is the time course of Creutzfeldt-Jakob disease?
Abrupt in onset
137
What will an EEG show with CJD?
Periodic sharp wave complexes
138
What are the pathological findings of lewy body dementia?
alpha-synuclein
139
What are the two general treatments for AD?
```
Cholinesterase inhibitors (donepezil)
NMDA receptor antagonists (memantine)
```
140
How are the s/sx of vascular dementia different than other forms of dementia?
May be associated with motor or sensory deficits
141
When is imaging indicated in the work up of vascular dementia?
Only if other etiology is suspected
142
What is the treatment for vascular dementia?
Same as stroke prophylaxis
143
What are the classic symptoms of frontotemporal dementia?
Disinhibition and significant behavior/personality changes early on
144
What is the treatment for frontotemporal dementia?
Symptomatic
145
What is the etiology of normal pressure hydrocephalus?
Inability to absorb CSF
146
What are the three classic symptoms of normal pressure hydrocephalus?
Wet wacky and wobbly
147
True or false: papilledema is uncommon in the setting of normal pressure hydrocephalus
True
148
What is the treatment for normal pressure hydrocephalus?
LP of continuous lumbar CSF drainage for several days, followed by VP shunt
149
What are the symptoms of CJD?
Dementia with myoclonic jerks
150
What is the general progression of CJD?
Acute deterioration
151
What are the CSF findings of CJD?
14-3-3 and tau proteins are seen
152
What is the treatment for Lewy body dementia?
Symptomatic
153
What is the nucleotide repeat found in HD?
CAD on chromosome 4
154
What two areas of the brain are affected with HD?
Caudate nucleus and putamen
155
What is the treatment for HD? (movement, psychosis, and depression)
- Reserpine or tetrabenazine for movement
- Atypical antipsychotics
- SSRIs
156
What is the deficiency seen in parkinson's disease?
Idiopathic loss of dopamine in the substantia nigra
157
What are the components of the parkinson tetrad?
Resting tremor
Rigidity
Bradykinesia
Postural instability
158
What is the frequency of the pill rolling tremor of parkinson's? What classically decreases the tremor?
4-6 Hz
| Decreases with voluntary movement
