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150 Cards in this Set
- Front
- Back
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kind of stroke normally caused by HTN
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lacunar
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what kind of vessels are involved in lacunar strokes
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small vessels
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2 causes of carotid bruits
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- murmur from heart
- turbulence in internal carotid |
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what is subclavian steal?
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exercise of left arm takes blood from ipsi vertebral artery distal to subclavian artery stenosis
causes decreaased cerebral blood flow |
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blood pressure in left arm less than in right
decreased pulse in left arm upper extremity claudication |
subclavian steal
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tx for subclavian steal
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surgical bypass
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patient awakes from sleep with neurologial deficits
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thrombotic stroke
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most common site for embolic strokes
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MCA
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stroke with motor deficits
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IC
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stroke with sensory deficits
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thalamus
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strokes with ataxia
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pons
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stroke with dysarthria
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pons
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stroke with deficiency in contralateral lower extremity and face
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ACA
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stroke with aphasia, contralateral hemiparesis
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MCA
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storke with ipsi ataxia
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vertebral/basilar
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stroke with ipsi diplopia
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vertebral/basilar
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stroke with ipsi dyshpagia
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vertebral/basilar
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stroke with ipsi dysarthria
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vertebral/basilar
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stroke with ipsi vertigo
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vertebral/basilar
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storke with contralateral homonymous hemianopsia
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basilar--- PCA lesions
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how to differentiate ischemic from hemorrhagic infarct
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CT WITHOUT CONTRAST (because would be bad if hemorrhage)
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stroke tx
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tPA if within three hours of acute ischemic stroke
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contraindications to tPA for storke
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uncontrolled HTN
bleeding disorder on anticoagulation history of recent trauma or surgery |
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in CT without contrast what color is ischemic? hemorrhagic?
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ischemic is dark, hemorrhagic is white
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what med not to give if doing tPA
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aspirin
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when do you treat HTN in context of stroke
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if systolic >>220
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% stenosis for carotid enderatectomy
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70% if symptomatic, otherwise not
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common cause of stroke in young patients
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cocaine
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in intracerebral hemorrhage where does blood go?
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brain parenchyma
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in subarachnoid hemorrhage where does blood go?
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CSF
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most likely site for intracebral hemorrhagic stroke
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basal ganglia
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abrupt onset of a focal neurologic deficit that worsens steadily over 30 to 90 minutes
altered level of consciousness, stupor, coma headache, vomiting sings of increased ICP |
hemorrhagic stroke
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pinpoint pupils
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pons hemorrhage
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poorly reactive pupils
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thalamic hemorrhage
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dilated pupils
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putamen hemorrhage
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vomiting
WHOL nuchal rigidity photophobia retinal hemorrhages |
subarachnoid hemorrhage
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xanthochromia
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blood to CSF - SAH
cause is RBC lysis |
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SIADH can result from what kind of stroke
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Subarachnoid hemorrhage
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tx for Berry aneurysm
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usually surgical
bed rest stool softeners analgesia with tylenol IV fluids gradual lower of BP nifedipine for vasospasm |
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rx for reducing vasospasm
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nifedibine
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parkinsonian symptoms plus autonomic insufficiency
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Shy Drager
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meds that cause parkinsonian side effects
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chlorpromazine
haldol perhphenazine metoclopramide reserpine |
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inhibits monoamine oxidase B activity
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selegiline
used for Parkinsons |
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increases availability of endogenous dopamine
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amantadine (antiviral)
used in Parkinsons |
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antichonilinergics used in parkinsons
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trihexyphenidyl
benztrokpine amitryptelene |
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drugs for Parkinsons patient with tremor as a major finding
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trihexyphenidyl
benztropine (anticholinergics) |
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no tremor
ophthalmoplegia bradykinesia limb rigidity cognitivie decline progressive course |
Progressive supranuclear palsy
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young patietn with movement disorders
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always remember to think of Wilson's
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metabolic causes of physiologic tremor
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hypoglycemia
hyperthyroidism pheo |
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inheritance pattern of essential tremor
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AD
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tx for essential tremor
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BB - propranolol
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neurologic diseases causing tremor
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Parkinsons
Cerebellar disease Wilson's |
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rest tremor
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parkinsons
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intention tremor
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cerebellar
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tremor in certain postures
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essential
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coarse tremor
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cerebella
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fine tremor
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essential tremor
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tremor improved by alcohol
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essential
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inheritance of Friedrich's ataxia
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AR
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ataxia
nystagmus impaired vibratory sense and proprioception |
Friedreich's
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inheritance for ataxia telangiectasia
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AR
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ataxia
nystagmus impaired vibratory sense and proprioception telagniectasias increased incidence of cancer |
ataxia telangiectasia
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ataxia telangiectasia = friedrich's ataxia plus?
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tenagiectasias and increased incidence of cancer
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inheritance pattern of tourette's
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AD
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tx for tourettes
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clonidine
pimozide haldol Halt Phonic Cursing |
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what drugs to avoid in alzheimers
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anticholinergics (because pts have lower levels of acth)
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chromos involved in alzheimers
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12, 14, 19
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meds for alzheimers
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anti che's like donezepil (and tacrine, which has to be dones 4x per day))
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dementia with VH at onset
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Lew y Body
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causes of delirium
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P DIMM WIT
postop dehydration, malnutrition infection meds (TCAs, stroids, antiche, hallucinogens, cocaine) Metals Withdrawal (etoh, benzos) Inflammation, fever Trauma, burns |
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sundowning is associated with
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delerium
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bilateral fixed, dilated pupils
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severe anoxia
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unilateral fixed, dilated pupil
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herniationn with CN III compression
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abnormal pupillary light reflex
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intracranial lesion
drugs like morphine or atropine anoxic encephalopathy recent eye drops |
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doll's eye
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brainstem trouble
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site of injury in locked in
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pons
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aniscoria
sluggish Pupillary light reflex dilated pupils contralateral hemiparesis changes in respiration |
uncal herniation
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clinically definite MS
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2 episodes
2 lesions |
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probabl MS
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2 episodes and either
- one lesion - oligoclonal bands in CSF |
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lab-supported definite MS
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2 episodes
1 white matter lesion on MRI abnormal CSF (oligoclonal bands) |
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ipsilateral medial rectus palsy on attempted lateral gaze
hoizontal nystagmus of abducting eye (contralateral( |
internuclear opthalmoplegia in MS
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monocular visual loss
pain on movement of eyes central scotoma decreased pupillary reaction to light |
optic neuritis
may suggest MS |
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what is abnormal 90% of the time in MS
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MRI
CSF evoked potentials |
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rx for MS
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steroids for acut
interferon beta-1a, b and glatiramer acetate |
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rx for muscle spasticity in MS
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baclofen
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rx for neuropathic pain in MS
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carbamazepine or gabapentin
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rapid ascending weakness of all 4 extremities
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Guillain Barre
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what do you NOT give to Guillain Barre patients
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steroids!!
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ring enhancing lesion
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metastatic cancer
brain abscess glioblastoma lymphoma toxo |
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most common primary CNS neoplasm
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astrocytomas (inc GBM)
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cancers that met to the brain, in order of occurrence
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Lung
Breast Skin Kidney GI |
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plus and minus of meningioma
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resectable
but recurrent |
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malignancy of schwannomas
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not
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brain tumor associated with NF II
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schwannoma (II for 2 ears)
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baccoon eyes
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basilar skull fracture
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hypertension
bradycardia respiratory irregularity |
Cushing's triad = too high ICP
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effect of PaCO2 on brain
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vasodilation
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MMA laceration
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epidural hematoma
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decreased level of consciousness
headache cortical dysfunction |
subdural hematoma
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autoantibodies to ACh receptors
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Myasthenia gravis
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skeletal muscle weakness with use
preserved sensation and reflexes |
myasthenia gravis
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ptosis
diplopia blurred vision |
most common initial symptoms of myasthenia gravis
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diagnosis of MG
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ach receptor antibody test
(20% false negative) |
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autoantibodies against presynaptic calcium channels
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eaton lambert
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proximal muscle weakness and hyporeflexia
symptoms improve with use |
Eaton Lambert
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inheritance pattern of tuberous sclerosis
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AD
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angiofibromas
adenoma sebaceum |
tuberous sclerosis
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cafe au lait spots
glioma axillary/inguinal freckling iris hamartomas bony lesions |
NF I
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bilateral acoustic neuromas
multiple meningiomas cafe au lait spots cataracts |
NF II
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inheritance pattern of NFI, II
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both AD
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capillary angiomatoses of pia
facial vascular nevi (port-wine) epilepsy |
Sturge-Weber
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inheritance of von hippel lindau
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AD
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cavernous hemaniomas of brain or brainstem
renal angiomas cysts in multiple organs |
VHL
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VHL associated with
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renal cell carcinoma
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bilateral loss of pain and temp over shoulders
preservation of touch thoracic scoliosis muscle atrophy of hands |
syringomyelia
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collection of fluid in spinal cord parencyma
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syringomyelia
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tx for synringomyelia
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surgical - synringosubarachnoid shunt
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contralateral loss of pain and temp
ipsilateral hemiparesis ipsilateral loss of position and vibration |
brown sequard
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in brown sequard which tract is involved in loss of pain and temp contralaterally
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spinothalamic
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in brown sequard which tract is involved in loss of ipsilateral paralysis
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corticospinal
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in brown sequard which tract is involved in loss of ipsilateral position vibration
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dorsal columns
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in brown sequard wht is contralateral
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pain and temp in spinothalamic
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area of spinal cord affected in polio
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anterior horn
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tile test responds every time
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central vertigo
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tinnitus
nausea/vomiting with change in head position |
peripheral vertigo
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vertigo
tinnitus hearing loss |
meniere's
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neuro side effect of aminoglycosides
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peripherael vertigo
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which vertigo is more worrisome, central or peripheral?
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central (with nystagmus)
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causes of central vertigo
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MS
vertebrobasilar insufficiency migraine |
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multidirection and even vertical nystagmus
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central vertigo
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syncope with no warning signs
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cardiac
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key labs for seizure
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calcium
sodium glucose BUN |
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rx for absence seizures
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ethosuximide
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rx for complex parital and simple parital seizures
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phenytoin and carbmazepine
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rx for tonic clonic or myoclonic seizures
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phenytoin and carbamazepine
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tracts affectd by ALS
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anterior horn
cortico spinal |
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upper AND lower motor neuron signs
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ALS
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fibrillations and fasciculations at rest
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LMN lesion
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amplitude of elecrical activity decreases with muscle contraction
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myopathy
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progressive muscle weakness, starting in legs or arms
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ALS
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short sentences without grammatical construction but content is apppropriate and meaningful
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Broca's
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speech is grammatically correct and fluid but does not make sense
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Wernicke's aphasi
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which aphasia is receptive? expressive?
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wernicke's is receptive; Broca's is expressive
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what not to use in tx of bell's palsy if Lyme suspected
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steroids
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decussation in dorsal column
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at junction of spinal cord and brainstem (2nd neuron)
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decussation in spinothalamic
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almost as soon as entering spinal column (2nd neuron)
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decussation in corticospinal tract
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pyramidal decussatio (primary neuron)
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level of lesion corresponds directly to?
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sensory level
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radiculopathy vs plexopathy
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plexopathy involves more than one nere and are peripheral
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key finding in NMJ lesion
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fatiguability
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