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61 Cards in this Set

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How long does a benign febrile seizure last?
15 minutes or less

No focal features usually
How likley is a person with a single benign febrile seizure likely to have a second benign febrile seizure?
two thirds have only a single seizure, fewer than 1/10 have more than 3

seizure in first hour of of fever in children less than 18 months or family history of febrile seizure

90% occur within 2 years of initial episode
What are seizures in AIDS most commonly associated with. 2 other common diagnoses?
AIDS dementia complex

toxoplasmosis, cryptococcal meningitis
What is toxicity associated with bromide compounds used in porphyria seizure treatment?
rash, GI symptoms, psychiatric disturbances, impaired consciousness
What are drug overdoses most commonly associated with seizure?
antidepressants, antipsychotics, cocaine, insulin, isoniazid, lidocaine, methylxanthines
Which chemotherapeutics are most commonly associated with seizures?
etoposide, ifosfamide, cisplatinum
Which neurons are especially vulnerable to hyperthermia? What sort of neurologic syndome are patients who have undergone significant hyperthermic injury prone to?
Cerebellar neurons

Ataxia
How long do seizures have to continue for a person to be in status?
>30 minutes

Also if full consciousness is not restored between successive episodes
What is the characteristic pattern on EEG for absence seizures?
3 Hertz spike and wave pattern
What are genetic syndromes in which myclonic seizures occur?
Unverricht, Lundborg disease
Lafora body disease
neuronal ceroid lipofuscinosis
sialidosis
Mitochondrial encephalopmyopathy
In what setting do atonic seizures typically occur?
developmental disroders especially Lennox Gastaut
What are myoclonic seizures typically treated with?
Valproic acid or clonazepam
Which AEDs should be avoided in genearlized seizures?
gabapentin, tiagabine
How should a person be changed from one AED to another
Discontinue first drug gradually once therapeutic levels of second drug are achieved
Who is eligable for a trial off of AEDs?
seizure free for 25 years on meds
At what neutrophil count should carbamazepine be discontinued?
1500 or lower
Treatment of status?
Ativan at .1mg/kg not greater than 2 mg/min or diazepam 10 mg IV over 2 min, diastat .2 mg/kg

fosphenytoin 1g-1.5 g IV at 150 mg/min or phenytoin 1g-1.5g at rate not greater than 50 mg/min

Another 10 mg/kg of fospheny or pheny can be given

Phenobarbital 1g - 1.5 g at 50mg/min

General anesthesia
What proportion of patients with TIA will go on to have stroke in 5 years?
1/3
What is ischemic brain injury which lasts longer than 24 hours but resolves completely or almost completely within a few days called?
RIND - reversible ischemci neurological deficit
What are the major branches from the posterior cerebral artery?
thalamoperforate, thalamogeniculate
Diagnosis of primary angiitis or granulomatous angiitis?
angiography showing focal or segmental narrowing of small arteries and veins

Meningeal biopsy is diagnostic
How is primary angiitis treated?
corticosteroids alone or with cyclophosphamide
When after primary infection does syphilitic arteritis occur?

Which sized vessels are typically involved?
within 5 years after primary infection

Medium sized penetrating vessels
What vessels, areas are typically involved by fibromuscular dysplasia?
Extracranial more than intracranial, cervical portion of IC is more involved than vertebral artery

Bilateral lesions often
Treatment of carotid or vertebral artery dissection?
Controversial
No treatment, removal of intramural hematoma, measures to prevent embolization from site of dissection (aspirin, anticoagulants, occlusion of vessel distal to dissection
When does recurrant dissection occur relative to initial episode when it does occur?
Within 1 month of initial event
What are the distinguishing features of moya moya?
bilateral narrowing or occlusion of the distal internal carotid arteries and adjacent anterior and middle cerebral artery trunks

presence of fine network of collateral channels at base of brain
Demographic amongst whom moya moya is most common?
Japanese girls

Sometimes inherited AR
Disease associations for moya moya?
atherosclerosis
sickle cell disease
history of basilar meningitis
How to people with moya moya present?
children - ischemic strokes
adults - intracerebral, subdural, subarachnoid hemorrhage
What is most common cause of stroke in cancer patients?
Marantic endocarditis
Which cancers are most commonly associated with marantic endocarditis?
Lung, GI
What platelet counts predispose to thrombosis?
> 1500
At what hematocrits can polycythemia cause stroke?
hematocrit over 46%
Further increases in risk with hematocrits over 50% and over 60%
What is the most frequent neurologic complication of sickle cell disease?
stroke affecting intracranial IC, proximal middle or anterior cerebral artery
What intervention must be done in sickle cell disease requiring angiography?
Reduce hemoglobin S by exchange transfusion to less than 20% - contrast induces sickling
What levels of leukocytosis produce stroke?
>150
What is the most common cause of death in cerebral infarct within the first week?
Cerebral edema causing herniation of ipsilateral cingulate gyrus across dural falx and tehn downward displacement of brain along tentoria incisure
What areas are affected by superior middle cerebral artery stroke?
motor and sensory areas supplying face, arm, hand, Broca's area
What areas are affected by inferior middle cerebral artery stroke?

Clinical syndrome produced by stroke?
loss of visual radiations, loss of visual cortex responsible for macular vision, receptive language area (Wernicke's area)

homonymous hemianopia denser inferiorly, marked impairment of cortical sensory functions - graphesthesia, sterognosis and disorders of spacial thought, anosagnosia, neglect, dressing apraxia, constructional apraxia

If dominant hemisphere, Wernicke's aphasia
What ares are supplied by the lenticulostriate arteries?
basal ganglia, motor fibers related to face, hand, arm, leg as they descend in genu and posterior limb of internal capsule.
How does clinical syndrome produced by occlusion of the trifurcation/bifurcation of MCA differ from that produced by occlusion of the stem of the MCA?
motor/sensory fibers of the leg are affected as well in the IC and so contralateral hemiplegia nd sensory loss
What areas does the PCA supply?
occipital cerebral cortex, medial temporal lobes, thalamus, rostral midbrain
Clinical syndrome of posterior cerebral artery occlusion?
hmonymous hemianopia of contralateral visual field, sometimes sparing of macular vision

Vision defects may be denser superioroly (in contrast to MCA lesions)

Ocular abnormalities - vertical gaze palsy, oculomotor nerve palsy, INO, vertical skew deviation of eyes

anomic aphasia, alexia without agraphia, visual agnosia
Clinical syndrome produced by bilateral psoterior cerebral artery infarction?
cortical blindness, memory impairement, inability to recognize familiar faces, other exotic visual and behavioral syndromes
Infarct causing locked-in syndrome?
ventral portion of pons (basis pontis) is infarcted and tegmentum is spared.
Syndrom produced by embolism to the tip of the basilar artery?
unilateral or bilateral oculomotor nerve palsies, hemiplegia or quardiplegia with decerebrate or decorticate posturing from involvement of cerebral peduncles in midbrain, impairment in consciousness

may be confused with uncal herniation syndrome
Wallenberg syndrome?
Ipsilateral cerebellar ataxia, Horner syndrome, facial sensory deficit

Contralateral impaired pain and temperature

nystagmus, vertigo, nausea, vomiting, dysphagia, dysarthria, hiccup
Anterior inferior cerebellar artery occlusion syndrome?
Ipsilateral facial weakness, gaze palsy, deafness, tinnitus
Superior cerebellar artery occlusion syndrome?
Impaierd optokinetic nystagmus or skew deviation of eeys

contralateral sensory disturbance involving touch, vibration, position sense, pain and temperature
What are the structures supplied by the long penetrating paramedian arteries?
Medial cerebral peduncle, sensory pathways, rednucleus, reticular formation, midline cranial nerve nuclei (III, IV, VI, XII)
Lacunar infarct syndromes?
Pure motor
Pure sensory
Clumsy hand dysarthria - dysarthria facial weakness, mild weakness and clumsiness of hand on side of facial involvment (contralateral IC or pons)
Ataxic hemiparesis - hemiparesis and ataxia usually of the leg.
What should be done for ppx for further stroke when stroke on aspirin?
Raise dose, add plavix or other antiplatelet, or 3 month course of warfarin

Maintain INR in 3-4 range
Which levels of the spinal cord are most vulnerable to drops in perfusion pressure?
upper and lower levels of thoracic cord
Pupils in thalamic compression?
slightly smaller - maybe from sympathetic pathway interruption
What do pinpoint pupils indicate?
Focal damage at pontine level, opioid overdose

less likely - organophosphate toxociity, miotic eye drops, neurosyphilis
What sort of limb movements are never associated with posturing or reflex?
limb abduction
Describe decorticate response to pain
flexion of arm at elbow, adduction at shoulder, extension of leg and ankle
Describe decerebrate response to pain
extension at elbow, internal rotation at sholder and forearm, leg extension
What metabolic disturbances also impair pupil reactivity?
massive barbiturate overdose with apnea, hypotension

acute anaoxia

hypothermia

anticholinergic poisoning

opioid overdose
How long can hypoglycemic coma be tolerated with expectation for significant recovery?
60-90 minutes