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Neurology > Test #2 > Flashcards

Test #2 Flashcards

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
Q

Brainstem Cranial Nerves Housed:

A

Midbrain: 3,4

Pons: 5,6,7,8

Medulla: 9,10,11,12

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26
Q

TBI Features that indicate ICH

A

Worsening HA

Confusion

Lethargy

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27
Q

Diffuse Axonal Injury

A

Indirect trauma

Axonal neurofilament disruption causing impaired thought and axonal swelling

-Shaken baby syndrome, severe whiplash

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28
Q

Reading a Head CT scan

A

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

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29
Q

Open Skull Fracture

A

Overlying scalp lac with disrupted dura OR

Fracture through a paranasal sinus or middle ear

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30
Q

Life-threatening Headache DDx

A

Subarachnoid hemorrhage

Bacterial meningitis

Cerebral ischemia

Subdural hematoma

Brain tumor

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31
Q

Decorticate posture indicates damage in:

A

Cerebrum

Internal capsule

Thalamus

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32
Q

Decerebrate posturing indicates damage in:

A

Uncal herniation -> brainstem damage

Poor prognosis

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33
Q

Seizure Treatment - 1st and 2nd line

A

1st line: Benzodiazepines - terminate ictal activity

2nd line: Phenytoin and Phenobarbital

34
Q

Distinguishing Vertigo

A

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
Q

Determining TIA Cause

A

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
Q

Positive Symptoms

A

Indicate active discharge from CNS neurons

37
Q

Negative Symptoms

A

Indicate absence or loss of function

38
Q

Symptoms that rule out Guillian-Barre Syndrome

A

Abrupt sensation demarcation

Prolonged asymmetry of weakness

Severe and persistent bladder/bowel dysfunction

>50 wbc in CSF

39
Q

Stroke Distinction by Symptoms

ACA

MCA

Brainstem

Lacunar

A

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
Q

NIH Stroke Scale

A

0 = No stroke

1-4 = Minor stroke

5-15 = Moderate stroke

16-20 = Moderate/Severe stroke

21-42 = Severe stroke

41
Q

Rheumatic mitral stenosis associated w/ what type of stroke

A

Ischemic stroke

42
Q

Lacunar Infarct

A

<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
Q

Aphasia

A

Difficulty processing language, speaking, understanding others, or reading/writing

No impact on actual intelligence

44
Q

Global Aphasia

A

Most severe form of aphasia

Produces few recognizable words, understands no speech, cannot read or write

45
Q

Anomic Aphasia

A

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
Q

Broca’s Aphasia

A

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
Q

Wernicke’s Aphasia

A

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
Q

Hemorrhagic strokes

A

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
Q

Tissue Plasminogen Activator (tPA) contraindications that aren’t bleeding

A

BP >185/110

Glucose <50

Platelet <100,000

INR >1.7 or PT >15 seconds

Heparin w/in 48 hours

NIHSS >25

50
Q

Primary Headaches

A

90% all headaches

Usually start between 20-40 years old

Migraine, Tension-type HA, Cluster (least common)

51
Q

Secondary Headache

A

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
Q

Migraines

A

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
Q

Migraine w/ Brainstem aura

A

Uncommon form

7-20 yo, females

Vertigo, dysarthria, tinnitus, diplopia, ataxia, decreased LOC

-need two of above to make this Dx

54
Q

Hemiplegic Migraine

A

Unilateral motor weakness

Severe HA, scintillating scotoma, visual field defect, numbness, paresthesia, aphasia, fever, lethargy, coma, seizures

55
Q

Retinal, Vestibular, Menstrual migraines

A

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
Q

Migraine without aura diagnosis

A

@ 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
Q

Migraine with aura diagnosis

A

@ 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
Q

Migraine Tx - 1st, 2nd, and 3rd line

A

1st: NSAIDs/ASA
2nd: Triptan
3rd: Triptan + NSAID

59
Q

Tension-Type Headache (TTH) and Treatment

A

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
Q

Cluster Headaches and Treatment/Prevention

A

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
Q

Temporal Arteritis Brief and Treatment

A

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
Q

Guillain-Barre Syndrome (GBS) and Treatment

A

Symmetric ascending muscle weakness with absent DTRs and dysantonia (tachy, HTN-HOTN, bradycardia)

Dx: LP -> increased protein, normal wbc

Tx: plasmapheresis or IVIG

63
Q

Bell’s Palsy and Treatment

A

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
Q

Myasthenia Gravis and Treatment

A

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
Q

Polyneuropathies

A

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
Q

Diabetic Neuropathy

A

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
Q

Alcoholic Polyneuropathy

A

ETOH is a direct neurotoxin

Demyelination and shrinking of fibers (normal thiamine), plus axonal neuropathy w/ coexisting nutritional deficiency (thiamine/B12/Vit E)

68
Q

Vitamin B12 Polyneuropathy

A

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
Q

Vitamin E Deficiency

A

Spinocerebellar syndrome

Often chronic cholestasis and pancreatic insufficiency

Tx: Prescription oral doses of alpha-tocopherol

70
Q

Thiamine Polyneuropathy

A

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
Q

Meningitis Community-Acquired Bugs by Age and Nosocomial

A

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
Q

Meningitis Triad and PE

A

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
Q

LP Gram stain and shape indicators:

Diplococci

Coccobacilli

A

Gram + diploccoci = S. pneumo

Gram - diplococci = N. meningitis

Gram + rod/coccobacilli = Listeria

Gram - coccobacilli = H-flu

74
Q

Empiric Therapy for Meningitis

A

S.pneumo/Meningococcal = Cefotaxime or Ceftriaxone + Vancomycin

Listeria = Ampicillin + Gentamycin (TMP-SMX or Meropenem as PCN alternatives)

Nosocomial = Ceftazidime + Vancomycin

75
Q

Brain Abscess Treatment: Otogenic or No obvious source

A

Otogenic: Cefotaxime 2g q8hr

No obvious source: Cefotaxime + Flagyl 1 g then 500mg q6hrs

76
Q

Brain Abscess Treatment: Sinogenic/Odontogenic or Hematogenous

A

PCN 24 mill units/d divided q4hrs + Flagyl 1g then 500 mg q6hr

77
Q

Brain Abscess Treatment: Penetrating trauma or neurosurgery

A

Nafcillin 2g q4h + Ceftazidime 2g q8h

78
Q

CNS Neoplasm Classifications

A

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
Q

Schwannoma

A

Cranial and paraspinal nerve tumor of Schwann cell

Slow growing

Acoustic neuroma most common

-Unilateral hearing loss, tinnitus, and HA are key signs

80
Q

Primary CNS Lymphoma

A

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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