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Flashcards in NEUROLOGY 3 Deck (15)
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1
Q

In Guillian Barre Syndrome, 30% experience respiratory failure, requiring intubation….

What test should you do to follow respiratory function?

A

Frequent monitoring of:

Vital Capacity and Negative Inspiratory Force.

2
Q
  1. What is the natural course of Guillian Barre Syndrome?
  2. How does trx effect recovery time?
  3. What are the two indications for TRX?
  4. What is the TRX?
A
  1. Worsens over 2 weeks, plateaus 2-4 weeks, spontaneous recovery over months.
  2. TRX decreased recovery time by 50%
  3. TRX if 1) non ambulatory and < 4 weeks of symptom onset.
  4. TRX = IVIG or Plasmapheresis (not both); NO STEROIDS.
3
Q

What physical exam findings in evaluating paralysis +/- paresthesia, prompts immediate MRI of spine?

What three broad categories of diseases can cause this picture?

A
  1. Sensory Level
  2. Bowel/Bladder dysf.
  3. Compressive neuropathy (abscess, herniation, ext)
  4. Inflammatory myelopathy (Transverse Myelitis)
  5. Non-Inflammatory Myelopathy
4
Q

What is the immediate management of compressive neuropathy (spinal cord impingement) ?

A
  1. Immobilization
  2. STEROIDS
  3. Surgical consult ASAP
5
Q

What is the classic presentation of Transverse Myelitis?

How does presentation changed from early disease vs later disease?

What does MRI show?

CSF show?

A

Progressive LE muscle weakness following URI.
Accompanied by sensory loss and Bowel/bladder dsf.

EARLY = Flaccid Paralysis + Decreased DTR
LATE = Spastic Paralysis + Increased DTR (UMN signs) 

MRI = Gladolineum enhancement in cord

CSF shows = Increased IgG and WBC

6
Q

After acute management of stroke, what 3 tests do you want to perform to work up etiology?

A
  1. EKG –> r/o MI/arrhythmia
  2. Carotid duplex +/- MRA/CTA
  3. Echocardiogram –> thromboembolic disease
7
Q

What are the two mechanisms in which you can get HYPOcalcemia AFTER parathyroidectomy?

A
  1. Relative hypoparathyroidism
    - -> TRANSIENT Suppression of left over parathyroid gland, due to increased Ca levels (while patient was hyperPTH, before surgery)
    - -> Recovery in days.
  2. Hungry Bone syndrome.
    - -> Sudden decrease in PTH hormone (in prior hyperPTH patient) causes influx of Ca into bone.
    - ->Develops 2-4 days post surgery.
8
Q

What are the two physical exam maneuvers to test for hypocalcemia?

A

Chevostek sign –> tap jaw causing contractions

Trousseaus sign –> Carpopedal spasm when blood supply is cut off with tourniquet.

9
Q

What are the 4 hallmark symptoms of HYPOca?

A

Perioral numbness, paresthesias
Muscle cramps
INCREASED DTR
AMS/Seizure (if severe)

10
Q

What are the symptoms of HYPER Ca?

A

“stones, bones, groans, moans and psych overtones”

Stones --> Kidney stones
Bones --> bone pain
Groans --> lethargy/fatigue
Moans --> Abd pain
Psych overtones --> Depression, confusion
11
Q

In order to meet criteria for brain death you need to have a CNS catastrophe of know etiology AND you cannot have confounding effects of what 4 things?

A
  1. HYPOthermia
  2. Electrolyte
  3. Endocrine
  4. Drug intoxication
12
Q

What are the 5 reflexes you look for (that looks at cortical and brainstem function) for initial evaluation of BRAIN DEATH?

A
  1. Fexor/Extensor posturing (brain originating motor response)
  2. -ve caloric testing (occulorvestibular response)
  3. No gag
  4. No corneal or pupillary response
  5. No rooting or sucking reflex.
13
Q

In patient who do not have cortical and brainstem functioning bc they exhibit:

  1. COMA
  2. Fexor/Extensor posturing (brain originating motor response)
  3. -ve caloric testing (occulorvestibular response)
  4. No gag
  5. No corneal or pupillary response
  6. No rooting or sucking reflex.

After meeting above criteria…What is the test that CONFIRMS brain death?

A

APNEA test.

  • -> pre-oxygenate and disconnect ventilator
  • -> Brain death confirmed if no respiratory response in 8-10 min.
14
Q

What tests can you do if initial testing for cortical and brain stem activity is Equivocal?

A

EEG –> electrocerebral silence

MRA/CTA –> no cerebral perfusion

15
Q

Pineal Gland tumor can cause Parinaud’s Syndrome…

What are the 4 defending S/S of Parinaud’s Syndrome?

Besides Parinaud’s Syndrome what is another common symptoms of Pineal Gland tumor?

A
  1. Loss of pupillary response to light
  2. Vertical gaze palsy
  3. Loss of optokinetic reflex (rapid saccades when tracking)
  4. Ataxia.

HA –> obstructive hydrocephalus