Flashcards in Neurology Deck (128)
What is Bell palsy?
hemifacial weakness/paralysis of muscles innervates by CN VII due to swelling of the cranial nerve
What are the characteristics of Bell palsy?
-the prognosis is very good; 80% of patients recover fully within weeks to months
-cause is uncertain
-possible viral etiology (herpes simplex) - immunologic and ischemic factors implicated as well
-upper respiratory infection is a common preceding event
-there is an acute onset of unilateral facial weakness/paralysis
-both the upper and lower parts of the face are affected (differentiate quickly from stroke - can wrinkle forehead)
-diagnosis is clinical, but consider Lyme disease in endemic areas (do not use steroids if Lyme is suspected)
-consider EMG testing if paresis fails to resolve within 10 days
What is the tx fo Bell Palsy?
-usually, none is required, as most cases resolve in 1 month
-a short course of steroid therapy (prenisone) and acyclovir, if necessary
-patient should wear an eye patch at night to prevent corneal abrasion
-surgical decompression of CN VII is indicated if the paralysis progresses or if tests indicate deterioration
What is a cerebral aneurysm?
weak bulging spot on the wall of brain artery like thin balloon/weak spot of inner tube; usually there's a genetic predisposition
-usually asymptomatic unless ruptured; when ruptured = sudden, severe, headache
How is a cerebral aneurysm classified?
by size and shape
-small: diameter <15 mm
-large: 15 -25 mm
-giant: 25-50 mm
-supergiant: >50 mm
What is a saccular ("berry") aneurysm?
MC type; account for 80-90% and MC cause of SAH; occur at arterial bifurcations and branches of large arteries at the base of the brain (circle of Willis)
What is a fusiform?
dilation of the entire circumference of the vessel
What is a traumatic?
caused by a closed head injury or penetrating trauma to the brain
What is a mycotic?
What is a ruptured (AVM)?
causes bleeding into CSF in subarachnoid space - ruptured berry account for 75% - mortality rate 50%
-r/f: smoking, hypertension, hypercholesterolemia, heavy alcohol use; associated with polycystic kidney and coarctation of the aorta
-s/sx: sudden onset unusually severe worst headache of life, n/v, seziure, altered state consciousness; increased bp, fever 102F
-herald bleed: less severe headhace
How is a cerebral aneurysm dx?
found incidentally or when a patient presents with subarachnoid hemorrhage; non-contrast head CT for investigational
-LP has elevated opening pressure, bloody fluid (xanthochromia, RBC)
-cerebral angiography = gold standar
What is the tx for a cerebral aneurysm?
surgical clipping, endovascular coiling within first 24 hours; restore respiration
What is cerebral vascular accident?
there are two main types of cerebrovascular accident or stroke: An ischemic stroke is caused by a blockage; a hemorrhagic stroke is caused by a blockage; a hemorrhagic stroke is caused by a rupture of a blood vessel
-acute onset of focal neurologic deficits resulting from - diminished blood flow (ischemic stroke) or hemorrhage (hemorrhagic stroke)
-contralateral paralysis, motor function
-right-sided symptoms = left side stroke
-left-sided symptoms = right-side stroke
What is carotid/ophthalmic?
amaurosis fugal (monocular bling)
What is MCA?
aphasia, neglect, hemiparesis, gaze preference, homonymous hemianopsia
What is ACA?
leg paresis, hemiplegia, urinary incontinence
What is PCA?
What is basilar artery?
coma, cranial nerve palsies, apnea, drop attach, vertigo
What is lacunar infarcts?
occur in areas supplied by small perforating vessels and result from atherosclerosis, hypertension, and diabetes: silent, pure motor or sensory stroke, "Dysarthria-Clumsy hand syndrome", ataxic hemiparesis
How is cerebral vascular accident dx?
CT without contrast for acute presentation - important to diagnose as ischemic or hemorrhagic
What is the tx for cerebral vascular accident?
for occlusive disease treat with IV tPA if within 3-4.5 hours of symptom onset
-can consider intra-arterial thrombolysis in select patients (major MCA occlusion) up to 6 hours after onset of symptoms
-for embolic disease and hyper coagulable states give warfarin/aspirin once the hemorrhagic stroke has been ruled out
-endarterectomy if carotid >70% occluded
What is a cluster headache?
unilateral, excruciating, sharp, searing, or piercing pain (often at nigh), lacrimation, and nasal congestion
-males > females
How do you tx cluster headache?
treat with oxygen 100% at 6-12 L/min for 15 minutes via nonrebreathing mask provides relief within 15 minutes and Imitrex
What is a coma?
a deep state of prolonged unconsciousness in which a person cannot be awakened
-fails to respond to normally to painful stimuli, light or sound; lacks a normal wake-sleep cycle; and does not initiate voluntary actions
What is the Glasgow Coma Scale/
score of < 9 = coma
-score 13-15 may indicate mild dysfunction, although 15 is the score a person with no neurologic disabilities would receive
-score 9 -12 may indicate moderate dysfunction
-score 8 or less in severe dysfunction
What is complex regional pain syndrome?
idiopathic - a pain syndrome disproportionate to injury with continuing pain that is disproportionate to any inciting event
-non-dermatomal limb pain
-pain disproportionate to the injury
-following trauma, injury
-extremity pain and at least 1 other sensory, motor, vasomotor, edema, sudomotor symptom
How is complex regional pain syndrome dx?
Budapest consensus criteria for clinical diagnosis of continuing pain disproportionate to inciting event
-At least 1 sx in 3 or 4 categories:
-sensory: hyperalgesis and/or allodynia = evidence of hyperalgesia to pinprick/allodynia to light touch/temperature
-vasomotor: skin, temperature, color aysmmetry = temperature asymmetric > 1C and/or skin color changes
-sudomotor/edema: edema, sweating changes, sweating asymmetry = edema and/or sweating changes/asymmetry
-motor/trophic: decreases ROM or motor dysfunction and/or trophic changes (hair, anil/skin) = weakness, tremor, dystonia
What is the tx of complex regional pain syndrome?
-Stage 1: neuroontin, elavil, and bisphosphonates
-Stage 2: add steroids
-Stage 3: include pain management specialist = regional nerve block/spinal cord stimulators
What is a concussion?
a mild traumatic brain injury (TBI) due to contact or acceleration/deceleration injury
-a concussion results in an altered mental state that may include becoming unconscious
-concussions are characterized by a Glasgow Coma Score of 13-15 thirty minutes after injury