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Neurology Flashcards

(74 cards)

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1
Q

Define stroke

A

Sudden onset of a neurological deficit from the death of brain tissue

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2
Q

Risk factors for stroke

A

HTN

DM

Hyperlipidemia

Tobacco

Same as those for MI

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3
Q

Weakness/sensory loss

Homonymous hemianopsia

+/- Aphasia

A

MCA stroke (more than 90% of cases)

  • Weakness/sensory loss on the contralateral side of the lesion
  • Loss of visual field on the opposite side of the stroke w/ eyes looking towards the side of the lesion
  • Aphasia if the stroke occurs on the same side as the speech center
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4
Q

Personality/congitive defects (e.g., confusion)

Urinary incontinence

Leg > arm weakness

A

ACA stroke

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5
Q

Sensory loss of the face

Sensory loss of the limbs on the opposite side

Limb ataxia

A

PCA stroke

  • Ipsilateral sensory loss of the face
  • Contralateral sensory loss of the limbs
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6
Q

The best initial therapy for a nonhemorrhagic stroke is:

A

< 3 hours since onset = thrombolytics

> 3 hours = ASA

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7
Q

Patient presents 6 hours after the onset of a nonhemorrhagic stroke and is currently taking aspirin daily, what is your initial therapy?

A

Add dipyridamole

or

Switch to clopidorgrel

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8
Q

Every patient with a stroke should be started on what type of long-term medication?

A

Statin (regardless of LDL)

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9
Q

True/False

Carotid angioplasty and stenting are of proven value for stroke patients

A

False

It is always a wrong answer

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10
Q

When is endarterectomy indicated?

A

> 70% stenosis of the carotid

If the stenosis is 100% no intervention is needed (no point in opening a passage that is 100% occluded)

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11
Q

Headache:

Bilateral “bandlike” pressure

Lasts 4-6 hours

Normal physical exam

A

Tension headache

Treat with NSAIDs and Acetaminophen

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12
Q

Headache:

Aura w/ photophobia

Related to food/emotions/menses

A

Migraine

Treat by avoiding triggers, taking NSAIDs and triptans (5-HT1 agonists)

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13
Q

When is prophylaxis indicated for migraine headaches and what is it?

A

When attacks occur 3 or more times per month

Propranolol or

Sodium valproate

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14
Q

Headache:

Episodic pain

Unilateral

Lacrimation

Eye reddening

Nasal stuffiness

A

Cluster headache

Treat with sumitriptan, octreotide, or oxygen

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15
Q

Prophylatic treatment for cluster headaches

A

Verapamil

or

Prednisone

or

Sodium valproate

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16
Q

What else should you evaluate for when someone presents with signs/symptoms of a cluster headache (specifically headache + red eye)?

A

Glaucoma

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17
Q

How do you diagnose pseudotumor cerebri?

A

Diagnosis cannot be made without a CT or MRI to exclude an intracranial mass lesion and a lumbar puncture (LP) showing increased pressure

Associated with obesity, venous sinus thrombosis, OCPs, and vitamin A toxicity

Look for papilledema with diplopia from 6th cranial nerve palsy (mimics brain tumor)

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18
Q

Treatment for pseudotumor cerebri

A

Wt loss + acetazolamide (decreases production of CSF)

Steroids help

Repeated LPs

Last resort = shunt or fenestrate the optic nerve

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19
Q

First step if someone is suspected of having Giant cell arteritis

A

Critical to start steroids without waiting for biopsy

Look for visual disturbance, systemic symptoms, and jaw claudication

Markedly elevated ESR

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20
Q

Difference in abortive therapy for migraine and cluster headache

A

Both can be interrupted with either ergotamine (5-HT1, DA, and NE) or one of the triptans (5-HT1)

Only cluster headaches respond to 100% oxygen, prednisone, and lithium

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21
Q

What is the best prophylatic therapy for migraines?

A

Propranolol

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22
Q

Treatment for trigeminal neuralgia?

A

Carbamazepine or oxcarbazepine

If unimproved by meds, gamma knife surgery

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23
Q

How to reduce the incidence of postherpetic neuralgia?

A

Treatment with antiherpetic medications

Steroids DO NOT help

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24
Q

Treatment for postherpetic neuralgia?

A

TCAs

Gabapentin

Pregabalin

Carbamazepine

Phenytoin

Topical capsaicin

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25
Define epilepsy
Seizures of unclear etiology
26
Angina is to MI, as confusion is to:
coma and seizure
27
What is status epilepticus?
Status epilepticus (SE) is an epileptic seizure of greater than five minutes or more than one seizure within a five-minute period without the person returning to normal between them.
28
Treatment for Status Epilepticus
1. Benzodiazepine 2. Fosphenytoin 3. Phenobarbital 4. General anesthesia
29
Why is fosphenytoin preferred over phenytoin?
Fewer adverse effects Phenytoin in a class 1b antiarrhythmic (when given IV it is associated with **hypotension and AV block**)
30
Indications for long-term treatment of a seizure
Status Epilepticus Focal neurological signs Abnormal EEG or lesion on CT FHx of seizures
31
Best treatment for epilepsy
Unclear Levetiracetam, phenytoin, valproic acid, and carbamazepine all have nearly equal efficacy **(Levetiracetam has the fewest adverse effects)** *Ethosuximide is the best for absence seizures*
32
When can you discontinue antiepileptic drugs?
When the patient has been seizure-free for 2 years Sleep deprivation EEG is the best way to tell if there is possibility of recurrence (lacks high sensitivity)
33
Polycystic kidney disease Tobacco HTN Hyperlipidemia High alcohol consumption
Look out for aneurysms (i.e., SAH)
34
Severe headache Stiff neck and photophobia Fever
SAH
35
How does SAH differ from meningitis
SAH = very sudden in onset with LOC and normal WBC to RBC ratio
36
How to diagnose SAH
Best initial test = CT without contrast Most accurate = LP showing blood (only necessary for the 5% that have a falsely negative CT scan) *Normal WBC to RBC ratio is 1:500-1000*
37
Treatment for SAH
**Nimodipine (CCB)**: prevents subsequent ischemic stroke **Embolization**: better than surgical clipping at preventing repeated hemorrhage ***Shunt***: only if hydrocephalus develops **Seizure prophylaxis**: phenytoin
38
Best initial therapy for bacterial meningitis
Ceftriaxone and vancomycin
39
Best initial test for brain abscess
head CT or MRI Cancer and infection are indistinguishable based on imaging; biopsy is essential
40
Empiric therapy for suspected brain abscess
Penicillin (vancomycin if indicated) + Ceftriaxone (or cefepime) + Metronidazole
41
Neurological abnormalities Adenoma sebaceum Shagreen patches Ash leaf patches Retinal lesion Cardiac rhabdomyomas
Tuberous Sclerosis No specific treatment, control seizures
42
Soft, flesh-colored lesions attached to peripheral nerves Cafe au lait spots
Neurofibromatosis Type I (von Recklinghausen disease) Eighth cranial nerve lesions may need surgical decompression to help preserve hearing
43
Port-wine stain of the face Seizures
Sturge-Weber Syndrome
44
Tremor at rest and with exertion Improved with alcohol Worse with caffeine
Essential Tremor The best therapy is propranolol
45
Define parkinsonism
loss of cells in the substantia nigra resulting in a decrease in dopamine ***PA**rkinson's **D**isease = do**PA**mine **D**own* ***A**lzheimer's **D**isease = **A**Ch **D**own*
46
Why is postural instability (aka orthostatic hypotension) seen with parkinsonism
The same slowness that results in bradykinesia (slow movements) results in the inability of the pulse and blood pressure to reset appropriately
47
Treatment of mild Parkinson's
Anticholinergic medications (**benztropine** and **trihexyphenidyl**) **Amantadine** (definitely the answer in patients \> 60 who are intolerant of anticholinergic adverse effects)
48
Treatment for severe Parkinson's
DA agonists (**pramipexole** and **ropinirole**) = best initial therapy **Levodopa/carbidopa** = most effective COMT inhibitors (**tolcapone**, **entacapone**) = extended duration of levodopa/carbidopa and decreased on/off phenomena MAO inhibitors (**rasagiline**, **selegiline**) **Deep brain stimulation**
49
Which medication for Parkinson's has the only possibility of retarding the progression of the disease?
MAO inhibitors **Rasagiline** and **selegiline**
50
Shy-Drager syndrome
Parkinsonism predominantly with orthostasis
51
Define spasticity
painful, contracted muscles from damage to the CNS often associated with MS Treat with *baclofen, dantrolene, or tizanadine*
52
Treatment for Restless Leg Syndrome
Pramipexole (DA agonist) * Iron supplementation if deficient* * Gabapentin or Ropinorole are alternatives*
53
CAG trinucleotide repeat sequences on chromosome 4
Huntington Disease
54
Treatment for Huntington Disease
Dyskinesia is treated with **tetrabenazine** *(reversible depletion of DA, 5-HT, and histamine from nerve terminals)* Psychosis is treated with **haloperidol** or **quetiapine**
55
Treatment for Tourette Disorder
Fluphenazine, clonazepam, or pimozide Associated with ADHS (treat with methylphenidate)
56
Define MS
Idiopathic disorder of CNS white matter
57
What is internuclear ophthalmoplegia (INO)?
the inability to adduct one eye with nystagmus in the other eye INO is characteristic of MS
58
Diagnostic tests for MS
Best initial test = MRI LP is only the answer in the 3-5% of patients with an equivocal or nondiagnostic MRI (looking for oligoclonal bands)
59
Treatment for MS
High-dose steroids (shortens the duration of MS exacerbations) **Glatiramer** and **beta-interferon** are the best first choice for prevention of relapse
60
A patient with MS develops worsening neuro deficits with the use of a chronic suppressive medication. MRI shows new, multiple white matter hypodense lesions. What happened?
Likely taking **Natalizumab** (also used for Crohn's), which has been associated with the development of **PML**
61
Weakness of unclear etiology Difficulty chewing and swallowing Decrease gag reflex
ALS
62
Weakness Spasticity Hyperreflexia Extensor plantar responses
UMN lesion
63
Weakness Wasting Fasciculations
LMN lesion
64
Treatment for ALS
**Riluzole** reduces glutamate buildup and may prevent progression **Baclofen** treats spasticity CPAP and BiPAP help with repiratory difficulties (will ultimately need tracheostomy and maintenance on a ventilator)
65
Most common cause of peripheral neuropathy
DM Best initial treatment is **pregabalin** or **gabapentin**
66
Difference in presentation between stroke and Bell Palsy
If the patient can wrinkle their forehead on affected side = stroke If the patient cannot wrinkle their forehead on the affected side = Bell palsy
67
Hyperacusis Taste disturbances
Features of Bell's Palsy Hyperacusis because the 7th cranial nerve normally acts as a "shock absorber" on the ossicles of the middle ear Taste disturbances because the 7th cranial nerve supplies the sensation of taste to the anterior 2/3 of the tongue
68
Treatment for Bell's Palsy
60% of patients have full recovery without treatment The best initial therapy is **prednisone**
69
What is the most common complication of Bell's palsy?
Corneal ulceration 7th cranial nerve palsy makes it difficult to close the eye on the affected side, leading to dryness and ulceration
70
Which infection is Guillain-Barre Syndrome associated with?
Campylobacter jejuni
71
Ascending weakness + Loss of reflexes
GBS
72
Diagnostic tests for GBS
Most specific = nerve conduction/electromyography (takes 1-2 weeks to become abnormal) CSF will show increased protein and a normal cell count *PFTs are the most important initial test (decrease in FVC is the earliest way to detect impending respiratory failure)*
73
Best initial test for Myasthenia Gravis
**Acetycholine receptor antibodies** - For patients without these, get anti-MUSK antibodies (muscle-specific kinase) - Edrophonium test - Most accurate = electromyography
74
Treatment for Myasthenia Gravis
Neostigmine or pyridostigmine If unimproved, thymectomy in patients \< 60 and prednisone if \> 60

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