Pestana11 Neuro

Question 1

Transient ischemic attack (HA +/-)

Answer 1

Without headache

Question 2

TIA (workup, mgmt)

Answer 2

• Duplex studies (sono+Doppler)

- CEA, Angioplasty+stent (need filter first)

Question 3

TIA (mc etiology)

Answer 3

• High grade stenosis (>70%) of internal carotid

- Ulcerated plaque at the carotid bifurcation

Question 4

TIA (clinical significance)

Answer 4

Predictors of stroke

Question 5

TIA vs Ischemic stroke (onset, sequela)

Answer 5

• Suddent for both

- No sequela w/ TIA, permanent sequela w/ stroke

Question 6

Ischemic stroke (complication)

Answer 6

Hemorrhagic stroke

Question 7

Ischemic stroke (initial step)

Answer 7

CT scan to r/o extensive infarcts or presence of hemorrhage

Question 8

Ischemic stroke (mgmt)

Answer 8

• tPA w/in 4hr

- Rehabilitation

Question 9

Ischemic stroke (workup after initial evaluation)

Answer 9

Vascular workup to identify lesions that may cause recurrence

Question 10

Hemorrhagic stroke (dem, presentation)

Answer 10

• Uncontrolled hypertensives

- Very severe HA of sudden onset

Question 11

Hemorrhagic stroke (dx, mgmt)

Answer 11

• CT scan
• Control HTN
• Rehabilitation

Question 12

Subarachnoid hemorrhage (presentation)

Answer 12

• Worst HA of sudden onset
• May not have any neurological deficits (in subarachnoid space, ergo no mass effect); may have signs of meningeal irritation

Question 13

Subarachnoid hemorrhage (etiology)

Answer 13

Ruptured aneurysm in the Circle of Willis

Question 14

Subarachnoid hemorrhage (dx, mgmt)

Answer 14

• CT scan (also bloody spinal tap, but not first line) followed by arteriogram to locate the aneurysm
• Clipping (surgical)
• Endovascular coiling (radiological alternative)

Question 15

Brain tumors (presentation)

Answer 15

• HA (worse in morning, progressive over mos)

- ICP (blurred vision, papilledema, projectile vomiting; Cushing reflex: bradycardia+HTN)

Question 16

Brain tumors (dx)

Answer 16

MRI

Question 17

Brain tumors (sxs mgmt)

Answer 17

High-dose steroids (dexamethasone: Decadron)

Question 18

Tumors at the base of the frontal lobe (presentation 4)

Answer 18

Foster-Kennedy syndrome:

• Inappropriate behavior
• Ipsilateral optic nerve atrophy
• Contralateral papilledema
• Anosmia

Question 19

Craniopharyngioma (features 3)

Answer 19

• Short stature
• Bitemporal hemianopsia
• Calcified lesions above sella (xray)

Question 20

Prolactinomas (presentation)

Answer 20

Amenorrhea and galactorrhea in young woman

Question 21

Prolactinoma (work up 4)

Answer 21

• Pregnancy test (r/o pregnancy)
• TSH (r/o hypothyroidism)
• Serum PRL
• MRI of sella

Question 22

Prolactinoma (mgmt)

Answer 22

• Bromocriptine (or analog)

- Transnasal, trans-sphenoidal removal (fertility; resistance to bromocriptine)

Question 23

Acromegaly (clinical features)

Answer 23

• Huge hands, feet, tongue and jaw

- HTN, DM, sweaty hands, HA, rings/hats no longer fit

Question 24

Acromegaly (workup)

Answer 24

• Somatomedin C (IGF-1) levels

- MRI of pituitary

Question 25

Acromegaly (tx)

Answer 25

- Surgical removal | - Radiation (alternative)

Question 26

Pituitary apoplexy (definition)

Answer 26

Bleeding into a pituitary tumor

Question 27

Pituitary apoplexy (phases)

Answer 27

- Indolent phase | - Acute phase

Question 28

Pituitary apoplexy (indolent phase sxs 3)

Answer 28

Pituitary tumor sxs: - HA - Vision loss - Endocrine problems

Question 29

Pituitary apoplexy (acute phase sxs 3)

Answer 29

- Severe HA - Compression of nearby strxs (deterioration of remaining vision, b/l optic nerve pallor) - Destruction of pituitary (stupor, hypotension)

Question 30

Pituitary apoplexy (dx)

Answer 30

CT/MRI

Question 31

Pituitary apoplexy (initial mgmt)

Answer 31

-Steroid and hormone replacement

Question 32

Tumors of the pineal gland (features 2)

Answer 32

- Loss of upper gaze | - "Sunset eyes" (Perinaud syndrome)

Question 33

Brain tumors in children (location)

Answer 33

Posterior fossa

Question 34

Brain tumors in children (sxs)

Answer 34

- Cerebellar sxs | - Children often assume knee-chest position to relieve HA

Question 35

Brain abscess vs brain tumor

Answer 35

- Similar manifestation d/t space-occupation | - Abscess has a shorter timetable (1-2wks)

Question 36

Brain abscess (features)

Answer 36

- Fever (not always) | - Obvious source of infection (eg, otitis media, mastoiditis, dental caries)

Question 37

Brain abscess (dx)

Answer 37

CT w/ contrast

Question 38

Tumors affecting the spinal cord (origin)

Answer 38

Metastatic/extradural

Question 39

Tumors affecting the spinal cord (dx)

Answer 39

MRI

Question 40

Tumors affecting the spinal cord (tx)

Answer 40

Decompression

Question 41

Neurogenic claudication (clinical features)

Answer 41

- Exacerbated by walking - Relieved by rest - But both are position-dependent (hip flexion relieves; extension exacerbates)

Question 42

Neurogenic claudication (etiology)

Answer 42

Spinal stenosis

Question 43

Neurogenic claudication (dx)

Answer 43

MRI

Question 44

Neurogenic claudication (mgmt)

Answer 44

Block affected nerves

Question 45

Trigeminal neuralgia, aka tic douloureux (presentation)

Answer 45

Extremely severe, sharp, shooting pain in face triggered by touch (60s)

Question 46

Trigeminal neuralgia, aka tic douloureux (workup)

Answer 46

MRI to r/o organic lesions

Question 47

Trigeminal neuralgia, aka tic douloureux (mgmt)

Answer 47

- Anticonvulsants (first line) | - Radiofrequency ablation

Question 48

Reflex sympathetic dystrophy, aka causalgia (onset)

Answer 48

Several months after crushing injury

Question 49

Reflex sympathetic dystrophy, aka causalgia (features)

Answer 49

- Constant, burning, agonizing pain refractive to usual analgesics - Slightest stimulation aggravates pain

Question 50

Reflex sympathetic dystrophy, aka causalgia (extremity appearance)

Answer 50

- Cold - Cyanotic - Moist

Question 51

Reflex sympathetic dystrophy, aka causalgia (dx)

Answer 51

Sympathetic block

Question 52

Reflex sympathetic dystrophy, aka causalgia (tx)

Answer 52

Sympathectomy