Neurology Flashcards
(139 cards)
1
Q
what are you assessing for in mental status evaluation?
A
oriented to person, place, and time
2
Q
5 Major parts of Neuro exam
A
mental status/ GCS cranial nerves motor/sensation reflexes cerebellar
3
Q
Most common type of stroke
A
ischemic → 87%
4
Q
Risk factors for stroke
A
HTN DM hyperlipidemia obesity smoking
5
Q
sudden loss of blood circulation in brain resulting in ischemia and loss of neuro function
A
ischemic stroke
6
Q
rupture of small blood vessels with bleeding inside parenchyma
A
hemorrhagic stroke
7
Q
How do you differentiate between ischemic and hemorrhagic stroke?
A
Head CT
8
Q
MC cause of hemorrhagic stroke
A
HTN
spontaneous rupture of Berry aneurysm/AVM due to infection, neoplasm
9
Q
In acute setting, what type of stroke will you not see on CT?
A
ischemic stroke
10
Q
Key sign/symptom of CVA/Tia
A
sudden onset
11
Q
atypical presentation of CVA/TIA
A
subtle motor deficits, minimal ataxia, vague facial asymmetry
12
Q
Most common symptoms of CVA/TIA
A
slurred speech, facial droop, unilateral weakness (UE/LE or both)
13
Q
Other symptoms possibly seen with CVA/TIA
A
aphasia, dysphagia, ataxia, visual changes, memory loss, nause/vomiting
14
Q
Timeline for resolution of TIA
A
80% resolve within 60 minutes
all resolve in 24 hours
15
Q
CVA/TIA Differentials
A
Bells Palsy hypoglycemia complex migraine hypertensive encephalopathy labyrithitis/meniere's/BPV
16
Q
when would you manage BP with CVA/TIA
if they are tPA candidate?
A
if >220/120
185/110
17
Q
this type of stroke needs strike BP control
A
hemorrhagic stroke
18
Q
Meds used to control BP
A
labetolol/nicardipine/nitroprusside
19
Q
Timeframe where patient with CVA/TIA can be considered for tPA
A
less than 4.5 hours
20
Q
With CVA/TIA if it has been less than 6 hours from last known normal, what therapy can you consider?
A
endovascular therapy → mechanical thrombectomy/intra-areterial tPA
21
Q
First step in managing hemorrhagic CVA
A
stop/slow bleed → strict BP control → evacuation/coils/anti-coag reversal
22
Q
Reversal for Warfarin/Coumadin
A
Vitamin K
23
Q
Reversal for Heparin
A
Protamine
24
Q
Potential reversals not NOAC (non-vitamin K Oral Anti-Coagulant)
A
rivaroxiban (Xarelto)
eloquiz (apixiban)
25
this bleed crosses suture lines and is usually venous blood
subdural hematoma
26
this bleed doesn't cross suture lines and is usually arterial blood
epidural hematoma
27
MC traumatic head bleed
subdural hematoma
28
This is due to shearing force causing disruption of veins bridging brain and venous dural sinuses
subdural hematoma
29
Symptoms of subdural hematoma
```
HA
Nausea/Vomiting
personality change
decreased level of consciousness
speech difficulties
impaired vision or double vision
weakness
```
30
Other signs present with subdural hematome related to trauma
basilar skull fracture
bilateral periorbital ecchymosis (raccoon eyes)
retroauricular ecchymosis (Battle sign)
presence of CSF rhinorrhea or otorrhea
31
What diagnostic test should you order for subdural hematoma?
Head CT without contrast
32
Elderly patient on blood thinners, what should you consider when ordering head CT?
delayed bleeds in anticoagulated patients
33
traumatic accumulation of blood between the skull and dural membrane
epidural hematoma
34
MC area for epidural hematoma
middle meningeal artery
35
Why is epidural hematome caught early have excellent prognosis?
underlying brain has usually been minimally injured
36
Classic presentation of epidural hematoma
Loss of consciousness
interval Lucid period
death
37
If you see dilated, sluggish or fixed pupils think….
heniation
38
"worse headache of my life"
subarachnoid hemorrhage
39
extravasation of blood into subarachnoid space between pial and arachnoid membranes
subarachnoid hemorrhage
40
most common cause of subarachnoid hemorrhage
trauma
| also berry aneurysm or AVM
41
Thunderclap onset, severe headache, N/V, photo dizziness, seizure, meningismus
subarachnoid hemorrhage
42
this bleed has HIGH morbidity and mortality
subarachnoid hemorrhage
43
When is the best time to order CT head for SAH?
within 6 hours
44
If you are highly suspicious for SAH and negative head CT, what would you order?
LP → after 2 hours but < 24 hours
45
What will you see on LP for SAH?
XANTHOCHROMIA
non clearing RBC
elevated opening pressure
46
BP goal for SAH
| Medications?
systolic between 110-150/MAP < 130
| labetalol, hydralazine, nicardipine
47
Pain management for SAH
fentanyl > morphine/dilaudid
48
In SAH patient, what can you give to prevent vasospasms of cerebral arteries?
CCB → Nimodipine
49
In SAH patient, what do you give to decrease ICP?
Mannitol
50
what can mimic TIA/CVA?
complex migraine
51
Gradual onset, unilateral, throbbing/pulsatile
| photophobia/hyperacousis, N/V
migraine
52
Treatment for Acute Migraine
```
IVF
Benadryl
compazine
toradol
magnesium
```
53
Why do you avoid opioids with migraines?
cause reboudn headache
54
group of headaches lasting 15-180 minutes/episode, may be multiple a day
cluster headache
55
cluster headache lacks …
N/V
aura
photophobia
56
at least one of the following symptoms must be present for cluster headache
```
rhinorrhea
nasal congestion
injection
facial swelling
ptosis
miosis
eyelid edema
lacrimation
```
57
Treatment for cluster headaches
100% oxygen
triptan, DHE
No opioids
58
systemic inflammatory vasculitis in temproal artery → older people
temporal arteritis (Giant Cell Arteritis)
59
MC form of systemic vasculitits in adults?
| Established risk factors?
temporal arteritis
| age and female
60
New presentation of HA or new type of HA in temporal or occipital area → throbbind and continuous pain
temporal arteritis
61
Symptom highly predictive of temporal arteritis
jaw claudication
62
Patient with Temporal Arteritis will have neck, shoulder, torso, and pelvic girdle pain consistent with ….
polymyalgia rheumatica
63
New onset HA + 50 years or older + elevated ESR
Giant Cell arteritis
64
Gold standard for diagnosing temporal arteritis
temporal artery biopsy
65
Component usually seen with temporal arteritis
unilateral visual blurring or vision loss
66
Laboratory hallmark for temporal arteritis
elevated ESR and C-reactive protein (CRP
| > 50 mm/hr
67
Management for patient presenting to ED with Temporal Arteritis
prednisone (temporal artery biopsy done within 1 week)
68
Patients with Temporal Arteritis + Acute Visual Changes treatment?
methylprednisolone IV for 3 days
69
treatment for steroid resistant cases of temporal arteritis
tocilizumab, cyclosporine, azathioprine, methotrexate
70
cause of peripheral vertigo
vestibular apparatus malfunction → less concerning in ED
71
cause of central vertigo
cerebellar or brain stem issue → bad
| posterior circulation stroke, MS, tumor
72
sudden onset + tinnitus + hearing loss + N/V + room spinning
peripheral vertigo
73
ataxia/feel off balance + falls + "feel like wlaking drunk" + dysarthria + dysphagia + focal weakness
central vertigo
74
suspect central vertigo, order?
MRI
| CT not sensitive for posterior circulation
75
Medical management for vertigo
antiemetic
meclizine/valium
IVF
76
procedure that can be tried last resort to fix peripheral vertigo
Epley Menauver
77
#1 cause of encephalitis in US
Herpes Simplex Virus
78
#1 cause of encephalitis in immunocompromised patient
toxoplasmosis
79
viral prodrome seen with encephalitis
several days of fever, HA, N/V, lethargy, myalgia
80
behavioral/personality changes + decreased level of consciousness + neck pain/stiffness + photophobia + AMS + ataxia + CN defects + seizures + paralysis + dysphagia (particularly in rabies)
encephalitis
81
this test is done on suspicious lesions for encephalitis
HSV culture → Taznck smear
82
You see "ring enhancing lesion" on head CT
Encephalitis → due to toxoplasmosis
83
diagnostic standard for encephalitis
brain biopsy
84
Treatment for encephalitis
Acyclovir → especially if suspect it is in neonates
85
```
#1 cause of bacterial meningitis in adults
#1 cause of bacterial meningitis ins kids
```
pneumococcal in adults
| neisseria meningitides
86
risk factors for meningitis
< 5 and > 60, immunocompromised, DM, CKD, trauma, alcoholism, IV drug abuse, endocarditis, VP shunt
87
which is worse, bacterial or viral meningitis?
Bacterial → high morbidity/mortality
88
Fever + AMS + HA + Neck stiffness
| N/V, photophobia, nuchal rigidity, PETECHIAL rash, seizure
meningitis
89
Key finding for meningitis in an infant
```
bulging fontanelles
(+ paradoxical irritability, hypotonia, poor feeding)
```
90
Two positive signs for meningitis in infant
Kernig and Brudzinski
91
first test to order if you suspect meningitis
CT of head → r/o bleed, mass, herniation
92
diagnostic test for meningitis
lumbar puncture
93
What are some other thing you may need to test for in HIV patient with meningitis?
CMV, cryptococcal
94
order of testing and treating suspected meningitis
Blood culture → empiric antibiotics → CT and LB
95
Antibiotics for meningitis in neonate
ampicillin
cefotaxime
gentamycin
AND acyclovir
96
antibiotics for meningitis in 3 mo - 7 year old
cefotaxime
ceftriaxone
+/- Vanc
97
antibiotics for meningitis in 7 - 50 year old
rocephin
Vanc
Ampicillin (if at risk for Listeria)
98
Treatment for viral meningitis (HSV and CMV specifically)
supportive care
HSV → acyclovir
CMV → Ganciclovir/foscarnet
99
treatment for fungal meningitis
amphotericin B
100
What patients are brain abscesses more common in?
immunocompromised
101
How do brain abscess symptoms differ from meningitis?
sinusitis or otitis 1-7 weeks prior
102
Diagnostic test for brain abscess
CT Head with contrast
103
Treatment for brain abscess
cefotaxime PLUS metronidazole
104
Fever + midline back pain + neurological deficits → think?
epidural abscess
105
High risk patients for epidural abscess
IV drug users !!
immunocompromised
recent surgery/procedure
106
MC organism in epidural abscess
Staphylococcus aureus
107
Early urinary sign for epidural abscess?
| Late urinary sign for epidural abscess?
urinary retention → first
| Incontinence → late
108
gold standard for diagnosing epidural abscess
MRI with and without contrast
109
Cause of Cauda Equina
compression of multiple lumbosacral nerve roots below the conus medullaris
110
low back pain (radicular) + unilateral or bilateral sciatica + saddle and perineal hypoesthesia/anesthesia + bowel/bladder issues + loss of rectal tone
cauda equina
111
Diagnostic test is confirmative of cauda equina
MRI
| PVR for bladder dysfunction, poor DRE
112
acute demyelinating neuropathy with preogressive ASCENDING SYMMETRICAL weakness → progresses over hours to days
Guillain-Barre Syndrome
113
when will Guillain-Barre Syndrome present?
2-4 weeks after respiratory or GI illness
114
How will symptoms of Guillain-Barre Syndrome present?
ascending and symmetrical
115
Subtle + descending symptoms
epidural abscess
116
Diagnostic test for Guillan Barre Syndrome ?
| Descripotion of findings?
LP
Protein → elevated
glucose → normal
color → clear or xanthochromia
117
Treatment of Guillan Barre Syndrome.
| What should you not give?
```
IV immunoglobulin (IVIG) OR plasma exchange
NO steroids
```
118
What do you want to order on patient with GBS?
PFT → get baseline to track
119
Two types of seizures
generalized → tonic-clonic, grand mal
| partial → localized to one area of the brain
120
Two types of partial seizures
Simple → no LOC
| Complex → altered LOC
121
HTN + Edema + Proteinuria → 20 weeks to 8 weeks postpartum
eclampsia
122
result of high body temperature but no underlying condition, self limited, 6 mo - 5 yr, MC in children
febrile seizures
123
treatment of active seizure
protect airway + suction + roll onto side + IV ativan STAT + IVF + normal seizure med or Phenytoin
124
what do all seizures have that pseudoseizures do not?
post-ictal state → amnesia, sleepiness, Ha, myalgia
125
Patient present with new onset seizures → what do you think?
mass or trauma
126
If you suspect exlampsia related seizure what do you administer?
IV magnesium
127
#1 cause of brekathrough seizure
noncompliance of meds
128
Complications of Status Epilepticus
Hyperthermia, acidosis, hypotension, respiratory failure, rhabdomyolysis, aspiration
129
criteria for Status Epilepticus
2+ seizures with incomplete recovery
130
first line management of Status Epilepticus
Ativan
131
Second and Third line management for Status Epilepticus
second → phenytoin or fosphenytoin
| third → intubate, phenobarbitol
132
Bell's Palsy is dysfunction of ___
CN VII (Facial nerve)
133
sudden symptom onset (48 hr) + symptoms on unilateral side + upper/mid/lower face
Bell's Palsy
134
#1 cause of Bell's Palsy
HSV infection
135
Bell's Palsy usually presents after a
URI
136
How do you differentiate Bell's Palsy from Stroke?
Stroke will SPARE the FOREHEAD
| Bells palsy will NOT
137
Deep ear pain and vesicular rash
Ramsay-Hunt
138
duration of Bell's Palsy
3 weeks - up to 6 months
139
Treatment for Bell's Palsy
prednisone
