Notes 5 Flashcards by Guy Greco

Infective endocarditis tx?

Antibx, AP and AC is contraindicated as it can cause hemorrhage.

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SAH from aneurysm ruptures are usually/not usually assoc with vasospasm

Not usually

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Sickle cell: ICH or ischemic is more common

ischemic

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In children with sickle cell + concern for stroke, whats special about management?

TCDs periodically, when inc velocities are detected, blood transfusions have been shown to reduce risk of stroke.

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Antibody assoc with Miller Fischer variant of GBS?

Anti-GQ1b

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DIC vs TTP
PLTS
schistocytes
D-dimer
fibrinogen
clotting time

DEC DEC
PRESENT PRESENT
ELEVATED NORMAL
REDUCED NORMAL
INCREASED NORMAL

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uremic encephalopathy can cause myoclonus due to?

alterations in cerebral phosphate metabolism

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Dialysis dysequilibrium syndrome

can range from mild encephalopathy to fatal cerebral edema.
Results from shifts of water into the brain due to changes in osmotic gradient.

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Polyarteritis nodosa: Neuro manifestations

Seizures
mononeuritis multiplex
Cranial neuropathies
peripheral neuropathies

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Churg Strauss Syndrome

Asthma, eosinophilia, sinua and pulmonary involvement

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Wegener granulomatosis
What is it and how to dx

sinus, pulmonary involvement + glomeruonephritis
Dx: granulomas on biopsy, c-ANCA+ and proteinase-3 Ab +

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Kawasaki Disease

fever, conjunctivitis, mucositis, rash, lymphadenopathy
- inc risk of coronary artery disease
- neuro manifestation of aspeptic meningitis

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Pituitary blood supply?

Superior/Inferior hypophyseal arteries which arise from ICA

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Diabetes insipidus (central)

deficiency of ADH (responds to ADH/desmopressin trial)

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Diabetes insipidus (peripheral)

due to inadequate renal response to ADH
does not respond to desmopressin trial

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Urine osmolality in diabetes insipidus

low (not absorbing any water so you are peeing it all out)

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Cerebral salt wasting
what is it and tx

from excessive renal losses of sodium
seen in patients with CNS injuries
(pathology unclear, thought to be from inc atrial natriuretic peptide released from cardiac atria)

tx with salt supplementation or iso/hypertonic IV fluids

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SIADH: tx?

fluid restrict and correct underlying cause (medication induced, head trauma, paraneoplastic ADH production_

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postpartum cerebral angiopathy
what is it and tx

on the spectrum of RCVS due to multifocal vasospasms
p/w HA, seizures, focal deficits

Tx with CCBs +/- steroids

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pre/eclampsia
what is it, sx and tx

HTN + proteinuria and often edema in the face/feet
Eclampsia = pre-eclampsia + seizures

Sx: headache, visual changes, seizures, PRES

Tx: delivery, IV mag, IV anti-hypertensives

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Patient’s with antiphospholipid syndrome + acute onset chorea

chorea gravidarum

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MOA of amphetamine

causes immediate release of dopamine and NE and inhibits their reuptake.

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MOA of cocaine

inhibits reuptake or dopamine and NE (no direct release)

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Both cocaine and amphetamine act on the reward centers:

ventral segmental area
nucleus accumbens

to produce a euphoria feeling

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classic MRI finding in Wernicke's encephalopathy

petechial hemorrhages in mamillary bodies, hypothalamus, medial thalami, periaqueductal grey matter

MOA of alcohol

stimulates GABA receptors (similar to benzos)

MOA of nicotine

nicotinic Ach receptor agonist inc release of dopamine)

MOA of caffeine

adenosine receptor inhibitor = less inhibition on excitatory NTs -> more cortical excitability

MOA of PCP/ketamine

glutamate NMDA receptor antagonist (can cause hallucinations, seizures)

excess zinc can lead to

a copper deficiency which presents as a myelopathy similar to SCD seen in B12 def. sensorimotor peripheral neuropathy with axonal loss, spastic paresis and posterior column dysfunction

Vitamin E deficiency Caused by sx

caused by chronic diarrhea and subsequent malabsorption of fat soluble food can resemble friedrich's ataxia: ataxia, dysarthria, areflexia, large fiber sensory loss

B1 thiamine deficiency?

2 types Dry beriberi: axonal sensory loss Wet beriberi: cardiac involvement (CHF, arrhythmias, cardiomegaly), peripheral edema

Arsenic poisoning presents with

garlic odor on the breath, encephalopathy, seizures

cyanide poisoning p/w

bitter almond odor, rapidly lethal

mercury toxicity p/w

previously known as mad hatter's disease as hatters used to work with mercury when making hats. p/w cerebellar signs, tender gums, excessive salivation, psych changes

lead intoxication p/w? path?

abdominal pain, constipation, wrist/ankle drop basophillic stippling of RBCs

manganese toxicity seen in patients w/ sx? MRI?

chronic liver disease, those receiving TPN, and weilding/steel industry parkinsons sx, personality changes, hallucinations, psychosis high T1 signal in globus pallidus

methanol toxicity is assoc with what neuro finding?

optic nerve necrosis

vincristine and cisplatin assoc with

peripheral neuropathy

methotrexate is assoc with

leukoencephalopathy and aseptic meningitis

cytarabine is assoc with

aseptic meningitis, cerebellar syndrome

5-fluorouracial is assoc with

cerebellar syndrome

bevacizumab is assoc with

hemorrhagic stroke and ICH

Rituximab is assoc with

PML!!

Wernicke's is due to

thiamine def

Wernicke encephalopathy tried

Confusion ataxia nystagmus/ophthalmoplegia

Wernicke MRI finding

hemorrhagic mamillary bodies

Garlic breath

arsenic

almond odor

cyanide

alopecia + painful neuropathy: what exposure causes this

thallium

Cherry red skin from exposure?

CO, cyanide

wirst/foot drop in a patient with encephalopathy

lead poisoning

globus pallidus necrosis

putamen necrosis

methanol

Which brain organs do not have a blood brain barrier?

area postrema, subfornical organ, organum vasculosum, neurohypophysis, median eminence, pineal gland, subcommisural organ

Post-transplant acute limbic encephalitis is usually caused by

HHV6, requires antiviral tx

best predictor of poor outcome after anoxic injury

absence of pupil/corneal reflex after 3 days

innervation of the dura?

supratentorial dura innervated by CN V while infratentorial is innervated by CN 10, 9, first 3 cervical nerves.

CPP formula

MAP-ICP

transtentorial (uncal) herniation

herniation of the medial temporal lobe -> compresses CN3 = blown pupils and corticospinal tract = contralateral hemiplegia

Central herniation

downward displacement of the brainstem -> traction on CN6 = lateral rectus palsy and if more severe can cause BL uncal herniation

subfalcine herniation

parenchyma (usually cingulate gyrus) herniates under the falx cerebri = usually asx but can cause ACA infarcts

Most common location of saccular aneurysms (berry)

1. Acomm 2. Pcomm 3. MCA

cerebral vasospasm 2/2 ruptured aneurysm can be treated by

triple H therapy HTN hypervolemia hemodilution

located in deep vessels, the usual cause of deep BP related ICH?

Charcot Bouchard aneurysms

spinal cord blood supply?

throughout it is supplied by posterior (from vertbral/PICA) or anterior spinal arteries. however, the T spine is supplied by a branch of the Aorta, making the T spine the most sensitive to ischemia

Artery of adamkiewicz

arteries coming from the aorta to supply lumbosacral spinal cord

somatotropic organization of the internal capsule?

anterior-> face posterior->legs

corticospinal pathway?

cortex -> corona radiata ->internal capsule -> cerebral peduncle (basis pedunculi) -> pons (basis pontis) -> medullary pyramids (85% decussate and 15% do not)

somatotropic organization of the lateral corticospinal tract

leg laterally and hand medially

sympathetic vs parasympathetic pathway for pre and post ganglionic tracts

Symp: short pre and long post Para: long pre and short post

NT in preganglionic neurons in both para and symp?

Ach

NT in post ganglionic neurons in both para and symp?

Para: Ach Symp: NE

Cuneate carries info from trunk at what levels?

Above T6

VPL of the thalamus

body sensation

VPM of the thalamus

face sensation

lateral geniculate of the thalamus

relay for vision

medial geniculate nucleus of the thalamus

relay for hearing

ventral lateral nucleus of the thalamus

receives projections from cerebellum and BG

List the episodic ataxia syndromes

Episodic Ataxias 1: facial twitching, KCN1A mutation, responds to CBZ 2: brainstem sx: CACNA1A4, responds to diamox 3: vertigo/tinnitus 4: ocular motion abnormalities

Notes 5 Flashcards

(80 cards)