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146 Cards in this Set
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- Back
- 3rd side (hint)
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Receptive, pt speaks fluently but words do not make sense
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Wernickes is wordy
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Expressive, pt is unable to verbalize
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Broca's is broken
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When does edema occur?
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2-4 days postinfarct
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2-4 days post infarct, a patient has decreased consciousness, projectile vomiting, pupillary changes. What has happened?
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Edema, occurs 2-4 days post infarct
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Flexion of arms
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Decorticate posturing (cortex)
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Arm extension
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Decerbrate posturing (midbrain or lower lesion)
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Tx for a stroke 3-6 hours of onset?
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TPA if occlusive disease only
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What is an absolute contraindication to tPa use?
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Intracranial bleeding
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For embolic stroke, what anticoagulation does one give for prophylaxis?
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Aspirin/warfarin
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If carotid is 70% occluded, what must be done?
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Endarterectomy
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Amaurosis fugax
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Carotid (emboli)
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Ophthalmic artery
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Drop attack/vertigo/CN palsy/coma
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Vertebrobasilar (emboli)
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Brainstem
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Aphasia
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Middle cerebral
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Dominant frontal or temporal
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Sensory neglect & apraxia
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Middle cerebral
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Non dominant frontal or temporal
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Hemiplegia
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Middle or anterior cerebral
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Contralateral parietal
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Urinary Incontinence & grasp reflex
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Middle or anterior cerebral
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Frontal
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Homonymous hemianopia
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Middle or posterior
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Temporal or occipital
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What type of meningitis is seen in neonates, elderly, immunocompromised?
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Listeria
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What is the number one cause of neonatal meningitis?
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Group B Strep
(Strep agalactiae) |
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What is the number two cause of neonatal meningitis?
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E-Coli
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Patient cannot touch chin to chest
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Meningismus
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Patient is supine with hip and knees flexed 90 degrees, examiner cannot extend the knee.
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Kernigs
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Pt is supine, when examiner flexes neck, pt involuntary flexes hip and knees
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Brudzinski's Sign
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Bacterial Meningitis, neutrophils?
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Elevated
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Bacterial Meningitis, protein?
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Elevated
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Bacterial Meningitis, glucose?
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Decreased
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Viral Meningitis, what type of cells are present?
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Mononuclear
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Viral Meningitis?, glucose?
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GLUCOSE IS NORMAL
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Neonates (<1 mo)
Regimen?, Common Etiology? |
Ampicillin, cefotaxime
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S. Agalactiae, listeria, Ecoli
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Children to teens
Regimen? Common Etiology? |
Cefotaxime, vancomycin
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Strep pneumonia
N. Meningitis |
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Adults
Regimen? Common Etiology? |
Cefotaxime, vancomycin
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S. Pneumonia
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Tx for HSV meningitis?
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Acyclovir
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Tx for HIV meningitis?
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AZT
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Of viral causes, only HSV & HIV can be treated, o/w treatment is...
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SUPPORTIVE!
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What type of fungal meningitis is seen in AIDS pts?
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Cryptococcus
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What stain will show Cryptococcus in CSF?
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India ink stain
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With coccidioides, what is seen on CSF pathology?
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Blastocysts
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How is ex of TB Meningitis made?
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TB PCR of the CSF
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What is the treatment of TB Meningitis?
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RIPE
Rifampin Isoniazid Pyrazinamide Ethambutol |
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Number one cause of bacterial meningitis in adults: old age, asplenia, poor health predispose
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Strep pneumoniae
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>1 year old or in adults in epidemics in close populations (military barracks)
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N. Meningitis
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Formerly number one cause in children, until vaccine
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H. Influenzae type B
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Number one cause in neonates
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Strep agalactiae
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Common in neonates
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E-Coli
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Elderly, neonates, AIDS, diabetes, steroids
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Listeria monocytogenes
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Trauma/neurosurgery
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Staph aureus
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Can progress from otitis media, sinusitis, or bacteremia
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Strep pneumo
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Petechiae on trunk, kegs, conjunctivae-beware of Waterhouse-Friderichsen Syndrome (adrenal infarction)
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N. Meningitis
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Difficult CSF Gram stain, diagnosis by blood culture
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Listeria monocytogenes
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Wound infection from skin
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staph aureus
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Treatment for strep Pneumo
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1. Pen G
2. Cefotaxime 3. Vancomycin |
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Tx for N. Meningitis
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Pen G
Rifampin/Fluroquinolone for close contacts |
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Tx for H. Influenzae
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Cefotaxime
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Tx for Strep agalactiae
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Ampicillin
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Tx for E-coli
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Cefotaxime
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Tx for Listeria Monocytogenes
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Ampicillin
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Tx for Staph aureus
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Oxacillin/vancomycin
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Transplacental congenital dz-->hydrocephalus/mental retardation
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Toxoplasmosis
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Adults exposed via cat feces get dz if immunocompromised
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toxo
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Number one CNS lesion in AIDS
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Toxo
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Multiple ring-enhancing lesions-->focal neurological deficits
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Toxo
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What test is very sensitive for Toxo?
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Toxo antibody
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Tx for Toxo?
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Bactrim
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When does an AIDS pt need prophylaxis for Toxo?
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CD4<200
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Number one cause of viral encephalitis
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HSV
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Olfactory hallucinations, bloody CSF, personality changes EEG/MRI-->temporal lobe dz
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HSV
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HSV Tx
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Acyclovir
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Bilateral spinal cord demyelination
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Tabes Dorsalis
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Cortical atrophy, neuron loss, gliosis
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Dementia paralytica
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Meningovascular disease
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Syphilis
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What encephalitis process involves tabes dorsalis, dementia paralytica?
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Syphilis
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Argyll-Robertson Pupil
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Syphilis
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Pain, hypotonia, decreased tone, decreased DTRs, decreased proprioception, incontinence
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Tabes Dorsalis (Syphilis)
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Psychosis, dementia, personality change
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Dementia paralytica (Syphilis)
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Tx for Syphilis
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IV penicillin
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Pupil accomodates but does not react to direct light
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Argyll Robertson pupil
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Helminthic infection found in brain abscesses, eggs are transmitted by fecal-oral route
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Cysticercosis
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Cysticercosis
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(Taenia solium)
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Encephalitis in Latin American immigrant results from___ until proven otherwise
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Cysticercosis (Taenia solium)
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What is the treatment for cystericosis (taenia solium)?
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Praziquantel with steroids (dead cyst-->inflammation)
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What brain abscess is acquired by dog feces, can cause focal Sx and Seizures?
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Hydatid cysts (Echinococcus)
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These cysts can rupture and cause fatal anaphylaxis?
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Hydatid cysts (Echinococcus)
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What is the tx for Hydatid cysts (Echinococcus)?
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Mebendazole
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Demyelinating disease that is common in pts who lived first decade of life in northern latitidues
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Multiple Sclerosis
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Relapsing asymmetric limb weakness, increased deep tendon reflexes (DTRs), nystagmus, tremor, scanning speech, paresthesias, optic neuritis, Babinski's sign
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Multiple Sclerosis
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MRI-->periventricular plaques, multiple focal demyelination scattered in brain and spinal cord (lesions disseminated in space and time)
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Multiple Sclerosis
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Lumbar puncture-->Increased CSF immunoglobulins manifested as multiple oligoclonal bands on electrophoresis
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Multiple Sclerosis
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What is the treatment for MS?
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Interferon Beta
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Acute autoimmune demyelinating dz involving peripheral nerves
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Guillain-Barre Syndrome
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Muscle weakness & paralysis ascedning up from lower limbs, decreased reflexes, can cause bilateral facial nerve palsy
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Guillain-Barre Syndrome
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CSF-->albumin-cytologic dissociation (CSF protein increased without increase in cells seen)
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Guillain-Barre Syndrome
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What is the tx for GBS?
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IVIG, plasmapharesis
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Diamond-shaped region of demyelination in basis pontis
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Centralo Pontine Myelinolysis
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Results from rapid correction of hyponatremia, liver dz
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Central Pontine Myelinolysis
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What is the tx for central pontine myelinolysis?
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No tx once condition has begun. Coma/death are common outcomes
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What vitamin deficiency occurs secondary to alcoholism?
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Thiamine
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What type of peripheral neuropathy occurs with Thiamine deficiency?
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Berberi
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What type of peripheral neuropathy occurs secondary to thiamine deficiency?
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Beri beri
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What is Wernicke's triad?
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Confusion (confabulation), ophthalmoplegia, ataxia
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In what deficiency is Wernicke's encephalopathy seen?
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Thiamine deficiency
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What is the etiology of Wernicke's Encephalpathy?
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Lesions of mamillary bodies
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What is the treatment of Wernicke's Encephalopthy?
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Give thiamine prior to glucose (e.g. thiamine should be run in IV fluid without glucose) or will exacerbate mamillary body damage
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Subacute degeneration of posterior columns & lateral corticospinal tract
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B12 deficiency
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Weakness and decreased vibration sense (both worse in legs), paresthesias, hyperreflexia, ataxia, personality change, dementia
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B12 deficiency
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Neurologic deficits can occur even if no hematogic abnormalities are present with this vitamin deficiency?
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B12 deficiency
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Hepatolenticular Dengeneration is also known as?
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Wilson's Disease
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Defect in copper metabolism-->lesions in basal ganglia
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Wilson's Disease
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Extrapyramidal tremors & rigidity, psychosis, manic depression
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Wilson's Disease
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How is Wilson's Disease diagnosed?
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Decreased serum ceruloplasmin
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What is the tx for Wilson's Disease?
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Penicillamine or liver transplant if drug fails
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What is the treatment for Hepatic Encephalopathy?
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Lactulose, neomycin, and protein restriction to decrease ammonia related toxins
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Hexosaminidase A defect-->Increase ganglioside GM2
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Tay-Sachs Disease
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Cherry-red spot on macula, retardation, paralysis, blind
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Tay-Sachs Disease
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How is Tay-Sachs Disease diagnosed?
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Biopsy of rectum or by enzymatic assay no Tx
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What type of sz with LOC?
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Complex Sz
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What type of Sz without LOC?
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Simple Sz
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What type of Sz? Entire brain involved?
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Generalized Sz
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What type of Sz involves a focal area of the brain?
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Partial Sz
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What type of Sz involves prolonged contraction?
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Tonic Sz
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What type of Sz involves twitches?
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Clonic Sz
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What type of Sz is a complex generalized Sz with brief LOC?
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Absence
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What type of Sz is a complex generalized tonic-clonic Sz?
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Grand mal
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What is first line therapy for a partial Sz?
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Phenytoin/Carbamazepine
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What is first line therapy for a grand mal Sz?
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Valproate
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What is the first line therapy for an absence Sz?
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Ethosuximide
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What is the first line therapy for a myoclonic Sz?
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Valproate
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What Sz therapy causes gingival hyperplasia and hirsutism?
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Phenytoin
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What Sz therapy causes leukopenia/aplastic anemia, hepatotoxic?
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Carbamazepine
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What Sz therapy causes neutropenia, thrombocytopenia, hepatotoxic?
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Valproate
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When should Sz medication be stopped.
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Stop Tx if no Sz for 2 yr and normal EEG
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What is status epilepticus?
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Continuous seizing lasting > 5 min
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What is the treatment for status epilepticus?
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Tx with benzos for immediate control, followed by phenytoin loading & phenobarbital for refractory cases
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Acute, stepwise decrease in neurologic function, multiple focal deficits on exam, hypertension, old infarcts by CT or MRI
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Multi-Infarct Dementia
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Clinically resembles Alzheimer's, more in women, onset, onset at younger age (50s)
Predominates in frontal (more personality changes seen) & temporal lobes MRI-->symmetric frontal or temporal atrophy, confirm by autopsy |
Pick's dz
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Syndrome of tremor, cog-wheel rigidity, bradykinesia, classic shuffling gait, masklike facies, dementia from loss of dopaminergic neurons in substantia nigra
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Parkinsonism
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What is the best Parkinsonism treatment for bradykinesia?
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Sinemet (Levodopa=carbidopa)
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What is the best Parkinsonism treatment for tremor?
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Anticholinergics (Benzotropine/trihexyphenidyl)
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What is the best Parkinsonism treatment for mild dz?
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Amantidine, increases dopamin release
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Progressive choreiform movements of all limbs, ataxic gait, grimacing-->dementia, usually 30s-50s (can be earlier or later)
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Huntington's Chorea
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Autosomal CAG triplet repeat expansion in HD gene-->atrophy of striatum (especially caudate nucleus), with neuronal loss & gliosis
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Huntington's Chorea
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What is seen on MRI for Huntington's Chorea?
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Atrophy of caudate, positive FHx
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Upper and lower motor neuron dz-->muscle weakness with fasciculations (anterior motor neurons) progressing to denervation atrophy, hyperreflexia, spasticity, difficulty speaking/swallowing
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Amyotrophic Lateral Sclerosis
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Group of conditions that affect control of movement and posture
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Cerebral Palsy
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Most common form of cerebral palsy, individual's muscles are stiff, making movement difficult
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Spastic cerebral palsy
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Characterized by fluctuations in muscle tone, associated with uncontrolled movements
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Athetoid or dyskinetic cerebral palsy
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Name two treatments for cerebral palsy??
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Botox for spastic muscles
Baclofen to decrease spasticity |
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