Step Up- CNS and PNS Flashcards by Ben Dover

Symptoms of a vertebrobasillar stroke

dizzyness

double vision

numbness of ipsilateral face and contralateral body

dysarthria

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Most common predisposing condition in people with lacunar infarcts

HTN

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Most common location of origin of embolic strokes

Heart

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Lacunar infarcts are either pure ______ or pure ______.

Either pure motor or pure sensory

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What determines if a lacunar infarct is purely motor or sensory?

Pure motor– lesion involves internal capsule

Pure sensory– lesion involved the thalamus

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Describe the blood flow in subclavian steal syndrome

Narrowed subclavian proximal to the vertebral artery

Retrograde flow results in the vertebral artery to supply the subclavian distal to the stenosis

Leads to vertebrobasillar insufficiency

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A lack of blood flow to the area supplied by the anterior cerebral artery would result in deficits to these locations

Contralateral lower extremity and face

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A patient <50 with a stroke should be evaluated for

hypercoagulable states:

Protein C

Protein S

antiphospholipid

Factor V leiden

VDRL/RPR, lyme, ANA, ESR

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Two common treatments to lower ICP

Hyperventilation and mannitol

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Order of preferred antithrobotics in stroke (pre-3hr, post etc)

If within 3 hours– give t-PA if not contraindicated

If after 3 hours– give aspirin

If allegic to aspirin give clopidogrel–if not possible give ticlopidine

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Treatment of patient with asymtomatic carotid stenosis <60%

Aspirin and risk reduction

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This test is the gold standard to Dx SAH…why?

Xanthochromia

yellow color of CSF caused by the breakdown of blood products. Will only be present in patients whom have a bleed.

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most common cause of a hemorrhagic stroke

HTN or a sudden increase in BP

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Shy-drager syndrome

parkinsonian symptoms with autonomic insufficiency

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Difference between pregressive supranuclear palsy and parkinson

PSP does not cause tremors

PSP does cause opthalmoplegia

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Use of bromocriptine or pramipexole in parkinson

used to decrease the “freezing” that occurs before initiating a movement

Start as soon as diagnosis is establised

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Transmission pattern of huntington dz

Autosomal dominant

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Mutated chromosome and repeat present in huntington

Chromosome 4

CAG

Hunting 4 prey using a CAGe

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There is a lack of this neurotransmittier in huntington disease

GABA in the striatum

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MRI finding in huntington disease

Atrophy of the caudate

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Thiamine deficiency in alcoholics can lead tot his kind of dimentia

Korsakoff dimentia

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This kind of medication should always be avoided in alzheimer patientes

Anticholinergics

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Visual disturbances in MS

Optic neuritis and intranuclear opthamoplegia

monocular vision loss
pain on movement of eyes
central scotoma
decreased pupillary reation

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Which two immunomodulating drugs can be used to treat MS? Major side effect?

Interferon B-1a and B-1b

Persistent flu-like symptoms

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Inflammatory demyelinating polyneuropathy

Guillian-Barre

Common infections that preceed gullian barre

C. jejuni CMV Hepatitis HIV Lupus Hodgkin disease

Should steroids be given in guillian barre?

NO they are harmful in GBS

Ab against this exist in mysthenia gravis

Post-synaptic nicotine acytylcholine receptors

Imaging study to be performed in myasthenia gravis

Chest CT for Thymoma

This procedure leads to resolution of symptoms in many patients with mysthenia

Thymectomy-- even with no known thymoma

Steroid recommendations for duchenne muscular dystrophy

Boys over the age of 5 with motor deficits should be on steroids

Lesions noted in NF1

Cafe au lait spots neurofibromas CNS tumors freckling iris hamartoma (lisch nodules) bony lesions Pheochromocytoma

Port wine stain with epilepsy and mental retardation

Sturge-Weber syndrome

Cavernous hemangioma of the brain, renal angiomas and cysts

Von hippel-lindau disease

Renal lesions associated with VHL

Renal cell carcinoma pheochromocytoma

Cape-like distribution of sensory loss

syringomyelia

Describe brown sequard lesion

contralateral loss of pain and temp sensation Ipsilateral loss of vibratory and proprioception ipsilateral hemiparesis

Difference between central and peripheral vertigo

Central: gradual in onset with other neurologic findings Peripheral: Rapid and severe onset, dependant upon head positioning

Triad of meniere disease

Vertigo tinitus hearing loss

Drug of choice for generalized tonic-clonic seizures

phenytoin and carbamzepine

Drug of choice for absent seizures

ethosuxamide or vaproic acid

Upper and lower motor neuron signs in a 60 year old patient

ALS until proven otherwise

Four types od aphasia

Wernike Broca Conduction Global

Wernike aphasia is characterized by these findings

Fluent aphasia Inpaired comprehension of written or spoken language Fluent and articulate but words are nonsense becuase patient doesn't understand what he or she is saying

Broca aphasia is characterized by these findings

nonfluent slow speech meaningful content with broken words normal comprehension often associated with right hemiparesis and hemisensory loss

Conduction aphasia is characteried by the inability to...

repeat phrases, words, sentences

Steroids should be used to treat bell palsy except...

When Lyme disease is suspected!

Name the deficits seen in an MCA stroke

Contralteral weakness Contralateral hanonomys hemianopsia (eyes will deviate towards the lesion) Aphasia (if dominant hemisphere involved)

Name the deficits in an ACA stroke

Personality and cognitive deficits Leg more than arm weakness Urinary incontinence

Deficits in PCA stroke

Ipsilateral sensory loss on the face (9th and 10th CN as well) Contralateral sensory loss on limbs Limb ataxia

What is the treatment for a patient with an ischemic stroke who is already on aspirin?

Add dipyrimidole or Add clopidogrel

Target LDL for a patient with carotid stenosis

\<100

Physical exam findings in pseudotumor cerebri

Papilledmea with doplopia from CNVI (abducens) deficit

Treatment for pseuotumor cerebri

Acetazoleamide to decrease CSF production

Prophylaxis and treatment for cluster headaches

Prophylaxis: verapamil Treatment: 100% O2 is abortive, also prednisone and lithium

Prophylactic therapy for recurrent migranes

Propanolol

Tx for trigeminal neuralgia

oxcarbazepine or carbamazepine

Treatment for pain of posterherpetic neuralgia

TCA Gabapentin pregabalin carbamazepine phenytoin

indications for zoster vaccine

all persons over the age of 60

Treatment for status epillepticus

Benzo or phenytoin or fosphenytoin

Side effect of phenytoin? Why?

AV block and hypotension because it is a class1b antiarrythmic

What is the last line agent to stop seizing?

Neuromuscular blockage with vecuronium or succinylcholine and then general anesthsia

Order of treatment in status epillepticus

1. benzo 2. fosphenytoin 3. phenobarb 4. Neuromuscular blockade

Step Up- CNS and PNS Flashcards

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