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Neurology > Test #2 > Flashcards

Test #2 Flashcards

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1
Q

Upper Motor Neuron lesion vs Lower Motor Neuron lesion

A

Upper motor neuron lesions may have both ipsilateral and contralateral manifestations due to decussation in the pyramids

Lower motor neurons are entirely ipsilateral

Bell’s Palsy is a LMN lesion

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2
Q

Extremely high CPK DDx

A

Muscular dystrophy

Thyroid disease

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3
Q

Complete lesion

A

Total or partial extremity loss

Paraplegia, quadriplegia

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4
Q

Incomplete lesion:

Anterior cord syndrome

Central cord syndrome

Brown-Sequard Syndrome

A

Depends on the part of the cord injured

Anterior = flexion injury; lose motor, pain, temperature

Central = ischemia or hemorrhage; UE affected more than LE

  • reverse paraplegia

Brown-Sequard = penetrating injury on one side causes motor loss to that side and sensory loss on the other side

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5
Q

DTR’s and nerve roots

A

Biceps: C5, C6

Brachioradialis: C6

Triceps: C7

Patellar: L4

Achilles: S1

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6
Q

Muscular Dystrophy

A

Progressive loss of muscle tissue

Causes progressive weakness, drooling, ptosis, problems walking

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7
Q

Concussion Pathophysiology

A

Neuronal depolarization with excitatory neurotransmitters released - potassium and calcium influx

Get impaired glucose metabolism, cerebral blood flow, axonal function

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8
Q

Initial TBI Evaluation

A

Mental status: Orientation, concentration/cognition, memory

Gait and balance assessment: Rhomberg

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9
Q

Concussion Signs of an Emergency

A

Increasing HA

N/V

Progressive consciousness impairment

Gradual BP rise

Diminution pulse rate

Blown pupil

Disorientation

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10
Q

Emergent TBI Referrals

A

Suspected hematoma

C-spine injury

Worsening LOC

Focal motor weakness

Transient quadriparesis

Seizure

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11
Q

TBI Non-Emergent Referrals

A

Persistent HA >7days

Post-concussion syndrome >2 weeks

Abnormal neuropsych testing

Hx multiple, high-grade concussions

USE YOUR CLINICAL JUDGEMENT

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12
Q

Disorders that concussions may mimic

A

Substance Abuse/Dependency

Intermittent Explosive Disorder

Suicidal Ideation/Tendencies

Depression/Mood Disorders

Impulse Control

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13
Q

Indications for Emergent Transfer to ER (Athletic injuries)

A

LOC

Possible C-spine deformity or skull fracture

High risk for ICH

Post-traumatic seizure

Worsening mental status

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14
Q

Mild Concussion Treatment

A

Physical and Cognitive (no TV/phone) rest

  • allow to sleep

Avoid NSAIDs 1st 48 hours post-injury

No recreational activity w/ head injury risk until healed

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15
Q

Return to Play/Rule of 3’s

A

Return to play according to where they are on rule of threes

May slowly work up to full contact with several baby steps to put off full contact

Rule of 3’s

1 concussion = sit out rest of the game

2 concussions = sit out rest of season

3 concussions = end of that sport

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16
Q

Second Impact Syndrome

A

Metabolic cascade causing sudden, severe swelling

May be minor or worsen to mental status which will progress to death

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17
Q

Post-Concussive Syndrome

A

Chronic cognitive and behavioral symptoms following injury

Can take months to recover, watch for depression

Sx: HA, fatigue, sleep issues, emotional and concentration problems, dizziness

Tx: Physical and Cognitive rest, physical therapy

No long-term issues once healed

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18
Q

Chronic Traumatic Encephalopathy

A

Progressive degenerative disorder in pts w/ hx of multiple concussions or head injuries

Sx: Memory loss, confusion, impaired judgement, paranoia, impulse control, aggression, depression, progressive dementia

Can only Dx on autopsy -> Tau protein in the brain

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19
Q

Dysarthria

A

Problems with the muscles that produce speech

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20
Q

Dysconjugate gaze

A

Failure of the eyes to turn together in the same direction

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21
Q

Apraxia

A

Difficulty with the motor planning to perform tasks of movement when asked

Do they know how to start? Can they follow two-step instructions

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22
Q

Dystaxia

A

Lack of muscle coordination

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23
Q

Agnosia

A

Inability to process sensory information

Loss of ability to recognize objects, persons, sounds, shapes, smells

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24
Q

FAST campaign

A

Facial droop

Arm weakness

Speech difficulties

Time to call 911

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25
Brainstem Cranial Nerves Housed:
Midbrain: 3,4 Pons: 5,6,7,8 Medulla: 9,10,11,12
26
TBI Features that indicate ICH
Worsening HA Confusion Lethargy
27
Diffuse Axonal Injury
Indirect trauma Axonal neurofilament disruption causing impaired thought and axonal swelling -Shaken baby syndrome, severe whiplash
28
Reading a Head CT scan
Look at cranial contours Look for lesions; type and location Look to see if cisterns are open or closed Check for midline shift Acute blood = white, older blood is darker
29
Open Skull Fracture
Overlying scalp lac with disrupted dura OR Fracture through a paranasal sinus or middle ear
30
Life-threatening Headache DDx
Subarachnoid hemorrhage Bacterial meningitis Cerebral ischemia Subdural hematoma Brain tumor
31
Decorticate posture indicates damage in:
Cerebrum Internal capsule Thalamus
32
Decerebrate posturing indicates damage in:
Uncal herniation -\> brainstem damage Poor prognosis
33
Seizure Treatment - 1st and 2nd line
1st line: Benzodiazepines - terminate ictal activity 2nd line: Phenytoin and Phenobarbital
34
Distinguishing Vertigo
Peripheral: N/V, recurrent, lasts 2-3 hours max - positional, vestibular neuritis, herpes zoster, Aminoglycoside toxicity Central: gait disturbances, lasts hours to days - Migraine, brainstem ischemia, cerebellar infarct or hemorrhage, MS
35
Determining TIA Cause
Low flow: Internal carotid (US), MCA or vertebrobasilar (CT Angio) Embolic: EKG/Echocardiograph looking for clots Lacunar: r/o all other, Dx of exclusion
36
Positive Symptoms
Indicate active discharge from CNS neurons
37
Negative Symptoms
Indicate absence or loss of function
38
Symptoms that rule out Guillian-Barre Syndrome
Abrupt sensation demarcation Prolonged asymmetry of weakness Severe and persistent bladder/bowel dysfunction \>50 wbc in CSF
39
Stroke Distinction by Symptoms ACA MCA Brainstem Lacunar
ACA: Leg weakness and numbness, +/- mental changes MCA: Aphasia, gaze deviation, cut visual field, face and arm weakness Anterior bleed sx are always ipsilateral Brainstem: Crossed findings (ipsilateral and contralateral), ataxia, eye movement/pupil dysfunction (CN) Lacunar: Pure motor or pure sensory loss
40
NIH Stroke Scale
0 = No stroke 1-4 = Minor stroke 5-15 = Moderate stroke 16-20 = Moderate/Severe stroke 21-42 = Severe stroke
41
Rheumatic mitral stenosis associated w/ what type of stroke
Ischemic stroke
42
Lacunar Infarct
\<5 cm lesions in penetrating arterioles of basal ganglia, pons, cerebellum, internal capsuel, thalamus, and deep white matter -Lower morbidity and mortality CT: Clean or punched out hypodense areas May be caused by HTN
43
Aphasia
Difficulty processing language, speaking, understanding others, or reading/writing No impact on actual intelligence
44
Global Aphasia
Most severe form of aphasia Produces few recognizable words, understands no speech, cannot read or write
45
Anomic Aphasia
Cannot supply words for things they want to talk about Poor writing ability Nouns and verbs are hardest Understand speech well, adequate reading skills
46
Broca's Aphasia
Expressive aphasia Speech output severely reduced; short utterances w/ less than 4 words Reading and writing are also affected Broca's area supplied by superior division L MCA
47
Wernicke's Aphasia
Receptive aphasia Fluent, but meaningless spontaneous speech; pt is unaware of speech errors Poor comprehension, writing, and reading as well Wernicke's area supplied by inferior division L MCA
48
Hemorrhagic strokes
Intracerebral Hemorrhage (ICH) - poorly controlled HTN -arterial bleed into brain parenchyma; sx increase as hematoma increases Subarachnoid Hemorrhage - trauma, ruptured AVM/aneurysm - Thunderclap HA, bleed into CSF and area around brain - Often only bleeds for a few seconds, high risk for rebleed
49
Tissue Plasminogen Activator (tPA) contraindications that aren't bleeding
BP \>185/110 Glucose \<50 Platelet \<100,000 INR \>1.7 or PT \>15 seconds Heparin w/in 48 hours NIHSS \>25
50
Primary Headaches
90% all headaches Usually start between 20-40 years old Migraine, Tension-type HA, Cluster (least common)
51
Secondary Headache
Are caused by an underlying disease Can be harmless or dangerous Watch for red flags indicating that HA is dangerous Dangerous: Infectious, Subarachnoid hemorrhage, Temporal arteritis, Intracranial pressure
52
Migraines
HA results from blood vessel dilation from trigeminal nerve innervation -\> get PNS neuropeptide release Usually unilateral; throbbing/pulsating pain w/ N/V Photophobia or phonophobia +/- prodrome (60%) or aura (25%)
53
Migraine w/ Brainstem aura
Uncommon form 7-20 yo, females Vertigo, dysarthria, tinnitus, diplopia, ataxia, decreased LOC -need two of above to make this Dx
54
Hemiplegic Migraine
Unilateral motor weakness Severe HA, scintillating scotoma, visual field defect, numbness, paresthesia, aphasia, fever, lethargy, coma, seizures
55
Retinal, Vestibular, Menstrual migraines
Retinal: Rare, repeated monocular scotomata/blindness attacks \< 1hour followed by HA Vestibular: Episodic, vertigo in pt w/ migraine hx - no confirming test, Dx of exclusion Menstrual: Migraine before/throughout menstruation -usually 2 days before or 3 days after bleeding onset
56
Migraine without aura diagnosis
@ least 5 attacks fulfulling below criteria - HA attacks between 4-72 hours long - @ least 2: unilateral, pulsating, moderate-severe pain, avoidance of routine physical activity - @ least 1 during HA: N/V, photophobia and phonophobia
57
Migraine with aura diagnosis
@ least 2 attacks fulfilling criteria below - 1 reversible aura sx: Visual, Sensory, Motor, Speech - \>=2: \>1 aura symptom gradually spread over 5 minutes, or \>=2 symptoms occur in succession - Each aura sx lasts 5-60 minutes, accompanied or followed (\<60min) by a HA - @ least 1 aura sx unilateral
58
Migraine Tx - 1st, 2nd, and 3rd line
1st: NSAIDs/ASA 2nd: Triptan 3rd: Triptan + NSAID
59
Tension-Type Headache (TTH) and Treatment
Band-like, bilateral, non-throbbing mild/moderate HA Peaks @ 4th decade TX: ASA/Tylenol/NSAIDS 1st line w/ relaxation techniques 2nd line: Add caffeine to 1st line meds 3rd line: Butalbital (Fioricet/Fiorinal)
60
Cluster Headaches and Treatment/Prevention
Middle-aged men Unilateral, recurrent, severe HA around eye w/ eye sx -watering, congestion, swelling, rhinorrhea, lacrimation MRI w/o contrast Tx: 1st line: SubQ Sumatriptan + 100% O2 NRB Verapamil for prevention - 2-3 weeks for effect
61
Temporal Arteritis Brief and Treatment
50-70 yo, Scandinavian descent Temporal HA w/ scalp tenderness, fever, amaurosis fugax Tx: Prednisone 4-60 mg daily, low dose ASA -Start tx before bx results to save eye function
62
Guillain-Barre Syndrome (GBS) and Treatment
Symmetric ascending muscle weakness with absent DTRs and dysantonia (tachy, HTN-HOTN, bradycardia) Dx: LP -\> increased protein, normal wbc Tx: plasmapheresis or IVIG
63
Bell's Palsy and Treatment
Acute peripheral facial palsy with decreased tearing Tx: early, short-term glucocorticoids (w/in 3 days sx) Recovery may be disorganized Eye care: Eye drops, keep it shut
64
Myasthenia Gravis and Treatment
Progressive muscle fatigability - Abs to acetylcholine receptors (AChR-Ab) 2nd-3rd decade for women (estrogen); 6th-8th decade men Tx: Pyridostigmine (anticholinesterase) + chronic and rapid immunotherapies -SE: diarrhea, decreased HR, increased salivation
65
Polyneuropathies
Symmetric distal sensory loss with weakness or burning sensation Stocking and glove loss; r/o spinal problem Diabetic, Alcoholic, Vitamin B12 and E, Thiamine deficiency
66
Diabetic Neuropathy
Most common polyneuropathy in US Glycosylation end products, sorbitol accumulation, increased oxidative stress Loss of vibratory, reflexes, pain, touch, temp; altered proprioception Tx and prevention: Tight glycemic control
67
Alcoholic Polyneuropathy
ETOH is a direct neurotoxin Demyelination and shrinking of fibers (normal thiamine), plus axonal neuropathy w/ coexisting nutritional deficiency (thiamine/B12/Vit E)
68
Vitamin B12 Polyneuropathy
Need adequate absorption - IF from parietal cells to bind Cbl Subacute degeneration of dorsal and lateral spinal columns Tx: IM B12 injections: 2X weekly for 2 weeks, then weekly for 2 months - once levels restored, monthly for life if issue still exists
69
Vitamin E Deficiency
Spinocerebellar syndrome Often chronic cholestasis and pancreatic insufficiency Tx: Prescription oral doses of alpha-tocopherol
70
Thiamine Polyneuropathy
Dry Beriberi: Neuropathy w/ calf cramps, muscle tenderness, burning feet; +/- autonomic neuropathy Wet Beriberi: High output CHF and neuropathy Dx: UA and serum thiamine levels Tx: 50-100 mg IV/IM/PO - give before glucose in unconscious to prevent encephalopathy
71
Meningitis Community-Acquired Bugs by Age and Nosocomial
S. pneumo, N. meningitis, Group B strep, H-flu, Listeria Newborn-1 mo: Group B strep 1-23 mo: S. pneumo 2-18 yo: N. meningitis Adults (\>18): S. pneumo Nosocomial: E. coli, Klebsiella, P. aeruginosa
72
Meningitis Triad and PE
Triad: Fever (\>38/100.4), Nuchal rigidity, AMS -Also get late stage non-blanching rash Kernig sign: cannot extend leg w/ hip flexed while supine Brudzinski's sign: Spontaneous hip flexion w/ passive neck flexion
73
LP Gram stain and shape indicators: Diplococci Coccobacilli
Gram + diploccoci = S. pneumo Gram - diplococci = N. meningitis Gram + rod/coccobacilli = Listeria Gram - coccobacilli = H-flu
74
Empiric Therapy for Meningitis
S.pneumo/Meningococcal = Cefotaxime or Ceftriaxone + Vancomycin Listeria = Ampicillin + Gentamycin (TMP-SMX or Meropenem as PCN alternatives) Nosocomial = Ceftazidime + Vancomycin
75
Brain Abscess Treatment: Otogenic or No obvious source
Otogenic: Cefotaxime 2g q8hr No obvious source: Cefotaxime + Flagyl 1 g then 500mg q6hrs
76
Brain Abscess Treatment: Sinogenic/Odontogenic or Hematogenous
PCN 24 mill units/d divided q4hrs + Flagyl 1g then 500 mg q6hr
77
Brain Abscess Treatment: Penetrating trauma or neurosurgery
Nafcillin 2g q4h + Ceftazidime 2g q8h
78
CNS Neoplasm Classifications
Based on cellular origin and histologic appearance Grade 1: benign Grade 2: malignant Grade 3: actively growing, malignant tissue Grade 4: Grows quickly; cells look very abnormal; malignant
79
Schwannoma
Cranial and paraspinal nerve tumor of Schwann cell Slow growing Acoustic neuroma most common -Unilateral hearing loss, tinnitus, and HA are key signs
80
Primary CNS Lymphoma
In immunodeficient pts Derived from B lymphocytes, often in cerebral hemispheres Tx: **Once Dx is confirmed**, Steroids to reduce edema and shrink tumor Followed by chemo and radiation - usually too deep to operate

Neurology (5 decks)

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