Flashcards in Neurology Deck (280)
Pt with dizziness, n/v, loss of pain/tmep sensation L half of face adn R side body, wavy lines, tends to fall to left while trying to sit up, hoarsemneess, dysphagia
Left Lateral Meduallary syndrome
32yo F no Pmhx p/w stroke - exam pain and tenderness over calk - etio?
45yo F lupus and Antiphospholipid syndrome with h/o DVT in past on warfarin PT 3.4 with TIA with R eye blury vision whic resolves in 10 min wtd?
Echo with bubble study
82yo M brought in with h/a and R wkness - CT hyperdense lesion in pareital area suggestive of subarachnoid hematoma BP 135/76 - no h/o trauma cause?
see bubbles q4 beats
fluent speech but non-sensical
CAN comprehend and read
Sensory and motor aphasia
Branch of middle cerebral or internal carotid artery
Pure word blindness
can't read - occipital lobe - PCA
Thunderclap headache, hit by hammer headache, worst h/a of life
nausea, vomiting, alter conciousness, neck stiffness, seizure, CNIII palsy wtd?
If neg -> LP check for xanthochormia
LP neg? - MRA r/o reversible cerebral vasocontriction syndrome (tx'd with CCB)
Best test to confirm prior to surgery: Cerebral angiogram
Complications of SAH
Rebleed 24hrs - 1 month
Vsaospasm 4 to 10 days
Hydrocephalus - late
Best drug to tx vasospam
Best time to do surgery
ASAP - clipping or coiling for causative aneursym
1 week after aneurysm surgery stroke develops - cuase?
vasospasm induced infarct
Vertigo - Central
Cause - brainstem/cerebellar dz, MS, cerebellar atrophy, basilar infarct, arnold chiari malformation
Nystagmus - Horizontal OR vertical
Visual fixation - NO inhibition of nystagmus
Hearing loss/tinnitis +-
N/V - Pos
Severity - severe
Vertigo - peripheral
Cause - vestibular neuritis, labrythnthitis, Menier's dz, benign positional vertigo
Nystagmus - ONLY horizontal
Visual fixation - inhibition of nystagmus
Hearing loss/tinnitus - labyrinthitis (vestibular nerutis - ), Menier's dz +
N/V - very bad
Severity - very bad
Pt with vertigo and horizontal nystagmus - on visual fixation nystagmus dissappears - dx?
Pt with vertigo/horizontal nytagmus - visual fixation negates nystagmus - - inovlvmenet of vestbular portion of 8th nerve with diziness lasting hours to days - no deafness - URI 1 week ago dx?
Vestibular neuritis (Labyrinthitis)
35yo recurrent dizzziness and tinnitius and sensation fullness in ear for months aw n/v - exam horizontal nystagmus disappears with visual fixation - audiogram with hearing loss dx?
Meniere's dz (tinnitus, hearing loss, vertigo)
Tx: Salt restriction, diuretics, surgical ablation
70yo M with new onset dizziness x 2 hours, BP high wtd?
MRA posterior vessels r/o brainstem stroke
Dx of benign positiional vertigo?
Dix halpike maneurver
Pt with vertigo, unilateral tinnitus, progressive hearing loss dx?
Etio - Schwann cells
Dx test - MRI
Pt with vertigo while turing in bed, getting in and out of bed, bending over and straightening up, extending neck to look up, epsisoes >30s NO hearing loss dx?
Benign positional vertigo - Dx with Dix halpike maneuver
Tx: Epley otiolith manuever -> Vestibular rehab
Pt with vertigo, dysarthria, diplopia, ataxia dx?
Vertebral bulabar insufficiency
Duration of vertigo
Seconds: BPPV, TIA
Minutes: Migraine, orthostatic hyptension, TIA
Hours: Migraine, Meniere's
Days: Migraine, Labryrinthitis, Meneire's
Normal: Webber - tuning fork on forehead - both ears hear same, Rhinne test AC>BC b/l ears
Unilateral air conduction deafness - Webber - hear better in affected ear (from forehead) - BC>AC Rhinne test
b/l conductive deafness/otosclerosis - webber - both ears hear equally, BC>AC both ears (rhinne)
Unilateral sensory deafness - no bone or air conduction from rhine test - webber test on forehead - only normal ear hears
b/l sensory deafness - both rhine and webber no hearing either ear...
Vertigo with fluctuating hearing loss, tinnitis lasting hours to days
Vertigo with progressie hearing loss and tinnitus, whisper test decreased - tuning for non left mastoid without response - tuning for on forehead with better hearin gon right
Acoustic neuroma (unilateral sensory hearing loss) - lateralize to good ear