Neurology - 7% Flashcards

Question

Neoplasms

Answer 1

MC CNS Tumor in children - Astrocytomas, Medulloblastomas, Ependymonas MC CNS Tumors adults - Gliomas, Meningiomas \*MC benign, a/w Neurofibromatosis Type 2 Sxs * Triad * early morning occurence * N/V * very severe * Increased ICP * Irritability, lethargy, Changes in behavior, gait and balance Dx * Head CT or contrast MRI Tx * Complete surgical removal of tumor * CS to reduce edema * Anticonvulsants

Answer 2

Basal ganglia degeneration in **substantia nigra (**extrapyramidal system) **loss of Dopamine** Sxs * **Tremor at rest** - disappears w/ voluntary movement =\> pill rolling * Cogwheel (catching and releasing) **Rigidity** * Akinesia - difficulty initiating motion * **masked facies, shuffling gait** Dx * clinical Tx * \< 65 yo - Dopamine agonists - used in younger patients to delay levodopa (less SE) * **Bromocriptine/parlodel, pramipexole/Mirapex, ropinirole/requip** * \>65 * **Sinemet (levodopa/carbidopa)**

Answer 3

Cognitive or behavioral manifestations present for few days to weeks following concussion Sxs * chronic HA * short term memory difficulty * difficulty sleeping * Irritability/mood swings * Sensitivity to light + noise Dx - clinical Tx - symptomatic - PRN analgesic, brain rest

Answer 4

Focal - discrete region of brain (in one cerebral hemisphere); **structural;** MC in eldery May be proceeded by **aura;** can progress to generalized _Simple vs Complex_ **_Simple Partial_** * consciousness fully maintained * focal motor sxs or somatosensory sxs w/o loss of consciousness **_Complex Partial_** * impaired consciousness that lasts \> 30secs * loss of awareness and similar to absence sz * blank stares, automatism (lip smacking or eyelid fluttering) * **post ictal state** - confusion or loss of memory Dx * ECG and EEG, CT or MRI in adults * Electrolytes Na, Ca, Mg * Glucose, Preg test Tx * Tx underlying cause * Phenytoin * Phenobarbital * Valproate * Lamotrigine * Gabapentin

Answer 5

Starts midbrain/brainstem and spreads to both cortices **_Absence Seizures (Petite Mal)_** * kids "blank stare" - brief impairment of consciousness \< 15 seconds * EEG - 3 Hz spike and wave activity * no post ictal state, loss of body tone * Resolves by 2oyo, if not progress to Grand mal * tx **ethosuximide** **_Tonic-Clonic (Grand Mal)_** * Tonic - very stiff and rigid 10-60 seconds * respiration is arrested, hypothermic * Clonic - generalized convulsion and limb jerking * Postictal phase - confused state - minutes to hours * Dx - glucose, CT, EEG (rapid spike) * tx - **phenytoin/dilantin**

Answer 6

**Single epileptic seizure that lasts \> 5 mins OR 2 or more seizures w/in 5 min period w/o person returning to normal btwn them** _Two forms - convulsive and non convulsive_ _Convulsive_ * contration/extension of arms and legs _Nonconvulsive_ * complex partial status epilepticus and absence status epilepticus * prolong ep of mental status change Dx * check blood sugars, antiepileptic drug levels Tx * MED EMERGENCY * **Lorazepam -** initial 0.1mg/kg or 4 mg - repeat if still seizing * **phenytoin** 20mg/kg

Answer 7

**Hemorrhagic Stroke (15%)** Bleeding into the brain parenchyma Eti - MC d/t **sudden increase in HTN**, * Ischemic stroke converts to hemorrhagic stroke - reperfusion causes bleeding into dead tissues = hemorrhagic Sxs: * Abrupt onset of focal neurological deficity - sxs depending on location of bleed * Anterior or MCA - numbness and muscle weakness * Broca's Area - slurred speech * Wernicke's area - difficulty undertanding speech * PCA - vision * Headache that becomes worse and worse until obtunded Dx: * **Non contrast CT or MRI** * **CT angio for specific location** Tx: * BP control with **IV labetalol** * Reduce ICP - **Mannitol** * **Craniotomy** - skill removed to drain blood and relieve pressure

Answer 8

**_Ischemic (85%)_** vs Hemorrhagic _Risk factors:_ **HTN\***, **athersclerotic disease**, hypercholesterolemia, DM, Afib, carotid artery disease, smoking, age, fam hx, M 2/3 are **_thrombic_**; 1/3 are embolic * **Thrombic -** clot that forms inside the brain vessel, usu follows a TIA * **Embolic -** clot that forms elsewhere and travels to the brain - acute presentation Causes lack of blood flow to a specific brain area - surrounding that area is the **penumbra** (is still perfused by collateral vessles; can be saved if reperfused quickly) 20% are lacunar infarcts, 20% embolic (cardiac or atherothrombic) Sxs: * Facial drooping * Arm weakness * Speech difficulties * Time - get reperfused ASAP Dx: * **Non-contrast Head CT** - differentiates btwn hemorrhagic and ischemic * **MRI -** tissue changes * Carotid duplex scan - degree of stenosis * EKG - MI or A-Fib * MRA - level of stenosis in head Tx: * **t-PA therapy - within 4.5 hours** **of onset.** * Do not initiate if * \> 3 h * unctrl HTN \<185/110 * bleeding disorder or anticoagulated, * hx of recent trauma or surgery * Do not give Aspirin within 24 hrs if + t-PA * **Aspirin** - best If given w/in 24 hr of symptom onset * if within 3 h - give thrombolytics * if \> 3 h = give aspirin, if allergic give **Clopidergrel/Plavix** * Supprotive tx - ABC, O2, IV fluids * **Gradual BP control** * **IV labetalol 20mg** * Do not give antihypertensives unless SBP \>200, DBO \> 120, MAP \>130mmHg * Carotid endarterectomy - if \> 70% stenosed

Answer 9

**t-PA therapy** - within 4.5 hours of onset.Do not initiate if * \> 3 h * unctrl HTN \<185/110 * bleeding disorder or anticoagulated, * hx of recent trauma or surgery * Do not give Aspirin within 24 hrs if + t-PA Aspirin - best If given w/in 24 hr of symptom onset * if within 3 h - give thrombolytics * if \> 3 h = give aspirin, if allergic give Clopidergrel/Plavix * Supportive tx - ABC, O2, IV fluids **Gradual BP control** * IV labetalol 20mg * Do not give antihypertensives unless SBP \>200, DBO \> 120, MAP \>130mmHg **Carotid endarterectomy** - if \> 70% stenosed Maintenance * BP control * Antiplatelet - ASA and Plavix * Statin * Aticoag with Afib * Blood glucose * Stop smoking

Answer 10

Bleeding into the CSF - outside brain parenchyma Eti: 1. 1. Traumatic injury 2. **Aneurysms** - MCC saccular cerebral aka berry aneurysms * most on anterior Half * marfan's syndrome * Rupture with ICP 3. Arteriovenous Malformation Sxs: * **Sudden onset severe headache - THUNDERCLAP headache** * **worse headache of life** * **Nuchal rigidity** - blood irritating meniges * Seizures * N/V * Decr LOC Dx * **Non contrast CT** * ****most are negative if \< 2 hrs, most sensitive \> 12 h * if negative - do CSF * **CSF via LP** * Xanthochromia - yellowish blood * Fresh Red blood * C/i if ele ICP (??) * Cerebral angiograph y - gold to id area Tx: * emergency surgery * **Clip artery - pressure** * Catheter to insert coil to promote clot formation * BP control - CCBs to prevent vasospasms

Answer 11

Transient ep of neurologic dysfunction d/t focal brain, retinal or cord ischemia = **no acute Infarction** Sxs: * Sudden onset neurological deficit \< 24 hrs * Lasts \< 1-2 hr * Atherosclerotic plaques reducs BF in ICA * 10% of TIA will have a stroke in 30 days Dx: * **Non contrast CT** * MRI more sensitive * Carotid doppler US Tx: * ABCD2 Score - likelihood of stroke In 2 days * risk is highest 24 hrs after initial event * Carotid endarterectomy if ICA or CCA stenosis \>70%

Answer 12

Head injury from fall =\> Sudden blow tears blood vessels, usu eldery w/ multiple falls =\> presents w/ neurological sx (AMS/neuro signs) =\> etoh or elderly Sxs: * injury to **bridging veins** - acute = 48 hrs * subacute 3- 14 days * chronic \> 2 wks = elderly * Blood collects btwn **dura and arachnoid\* mater** Dx * non contrast CT - **crescent shape concave hyper density** Tx * same as epidural

Answer 13

Life threatening cause of syncope Strng fam hx - sudden cardiac death before 50 yo, heart dz, symptoms (CP, palps, SOB) eti: * Arrhythmias - MCC of cardiac syncope * ischemia * Valvular abn * aortic stenosis * cardiac tamponade * pacemaker malfunction

Answer 14

Loss of consciousness/postural tone 2/2 acute decrease in cerebral blood flow - rapid recovery in consciousness w/o resuscitation Four main etiologies **Neurogenic Syncope** * Carotid sinus hypersensitivity * Prodrome sxs before LOC - dizziness, warm/cold, N, pallor, visual disturbances, hearing abns * Normal PE, and normal EKG **Orthostatic Hypotension** * drop in systlic BP \> 20mmHg or * Reflex tachcyardia of \> 20bpm * Failure of veins to constrict when patient is upright = reduce cardiac output * MCC deH2O, meds (CCB/BB, alpha Blockers, nitrates, diuretics, TCA) **Metabolic** * hypoglycemia, hypoxia **Psychiatric** * aniety and panic disorders * young, no cardiac dz, multiple eps

Answer 15

Conditions that can mimic syncope but not true syncope - Seizures, stroke, sleep disturbances, ad incjury **Dx:** * PE and comprehensive Hx * Get the #, frequency, and duration of episodes * Onset, triggers, position & recent changes prior to syncopal eps * Most patient w/ prodromes - Neurocardiogenic or orthostatic hypotension * Medications * Vital signs * EKG * TTE - structural heart disease * CT Scan

Answer 16

MC type, younger in 30s, stress\* Sxs: * a/w with stress triggers * bilateral, **band like** * non pulsatile, squeezing * can last 30 mins to 7 days Dx: clinical * episodic - \<15 days/month * chronic - \> 15 days / month Tx: * NSAID * Aspirin * Acetaminophen * Head & muscle relaxants

Answer 17

Involuntary **motor and vocal tics**; sxs present for \> 1yr and age onset \< 18yo Sxs * throat clearing, blinking, lip smacking * Echolalia - imitate what you're saying * Echopraxia - do * Palilalia - do or say * Coprolalia - curse word Dx * Tourette - both motor and vocal ticks \> 1 year before 21yo * Persistent Chronic Tic disorder * sing or multiple motor or vocal tick \> 1 year * Provisional tic disorder * single or multiple motor and/or vocal tics present \< 1 year Tx * Clonidine or antipsychotic * tics tend to lessen over time * Pimozide * Haldol * Tetrabenazine

Answer 18

2nd MC type - brain disease d/t chronic ischemia and multiple infarctions (**lacunar infarcts)** HTN - most important RF Sxs * Cortical - forgetfulness, confusion, amnesia, executive diff, speech abn * Subcortical - motor def, gait abn, urinary diff, personality changes Tx - control HTN

Answer 19

Sensation of movement in the absence of actual movement **_Peripheral_** * sudden onset - intermittent * tinnitus * hearing loss * nystagmus - **horizontal w/ rotary component** * Dx with **Dix Hallpike** **_Central_** * eti MS, brain tumor, head injury * Gradual onset - continuous * N/V * **Vertical nystagmus** * **No auditory symptoms** * motor, sensory, cerebellar deficits * **Romberg sign** Dx: * Dix Hallpike - for nonfatigable causes = central etiology * Audiometry * EMG * MRI Tx: * Peripheral * Vestibular suppressants to help w/ auditory sxs * Diazepam, Meclizine * Epley manuveur * Central * Deep head hanging manuveur * tx source

Neurology - 7% Flashcards

(43 cards)