Ou Tulsa Pa Neuro Dx

Front 1

At least 5 Attacks
Severe unilateral periorbital pain lasting 15-180 minutes
HA associated w/ ipsilateral sign/symptom
1 attack every other day up to 8 per day

Back 1

Cluster Headache

Front 2

unilateral pain, throbbing, worsened by movement, and moderated/severe pain

How many do you need?

Back 2

Migraine


2

Front 3

Need 1 of these: Nausea/vomiting, photophobia, phonophobia

may also have tension like features

Back 3

Migraine

Front 4

This headache is not throbbing, is not unilateral, and is not worsened by movement, and is has mild/moderate pain

How many do you need?

Back 4

Tension Headache


2

Front 5

An absence of: Nausea, Vomiting, and both photophobia and phonophobia

(1 may be present)

Back 5

Tension Headache

Front 6

Progressive intellectual decline in two or more areas and documented by Mental Status Exam

Neuropsychological testing confirms DX

Labs

Back 6

Dementia

Front 7

What labs should be ran for Dementia patients?

Back 7

Labs always measured with dementia: serum B12, free T4, TSH

Front 8

Neuropsychological testing confirm DX

CSF: beta-amyloid decrease, tau protein increase

Back 8

Alzheimer disease

Front 9

Progressive mental decline that interferes with occupational or social functioning

Back 9

Dementia w/ Lewy Bodies

Front 10

CT/MRI could show multiple focal "lacunar infarctions"

Back 10

Vascular Dementia

Front 11

Enlarged ventricles on MRI and overall brain atrophy
Normal pressure

Difficult to DX

Back 11

Normal pressure Hydrocephalus

Front 12

Physical finding: Prominent atrophy in Anterior 1/3 of frontal and temporal lobes

Neuropsychiatric assessment/test

MMSE = unreliable for DX

Back 12

Frontotemporal Demential disease
a.k.a.
Picks Disease

Front 13

Dx clinically
Confirmation w/ nerve conduction study or EMG

Back 13

Bell Palsy

Front 14

CSF: contains high protein w/ normal cell count

EMG: slowing of nerve conduction in both Motor and sensory --> Indicated demyelination

Back 14

Guillan-Barre Syndrome

(Acute idiopathic polyneuropathy)

Front 15

MRI w/ gadolinium of the brain and spinal cord --> shows multiple lesions = "Black Holes"

Should not DX unless evidence shows 2 or more different regions of central white matter being affected

CSF may show elevated protein, IgG
CBC: lymphocytosis

Back 15

Multiple Sclerosis

Front 16

Electrophysiological study: decreased muscle response
Serum Assay: circulating Acetylcholine receptor antibodies

CT of chest to R/O Thymoma

Back 16

Myasthenia Gravis

Front 17

MS must be suspected, even w/o neurological symptoms
CT/MRI should R/O posterior fossa tumor

Back 17

Trigeminal neuralgia (Tic douloureux)

Front 18

What should be done for PT in Coma/Stupor?

Back 18

All PT should be admitted to hospital and referred to neurology

Front 19

Diffusion-Weighted MRI = GOLD STANDARD

CT to R/O hemorrhage

Electrocardiography, echocardiography
Labs

Back 19

Cerebral infarction

Front 20

MRI: MOST sensitive to acute lesion and defines the area

CT: some PT small punched out, hypo dense areas
Other PT normal

Back 20

Lacunar Infarction

Front 21

Clinically dx symptoms

Absence of infarct on imaging
Diffusion-weighted MRI preferred to R/O infarction

Labs

Back 21

Transient Ischemic attack (TIA)

Front 22

What labs are ordered for Transient ischemic attack?

Back 22

CBC: look for polycythemia, Hba1c, Lipid panel

Front 23

CT scan IMMEDIATELY to confirm hemorrhage
AND
CSF examination for Blood

Cerebral arteriography: determine source of bleed

Back 23

Subarachnoid Hemorrhage

Front 24

DEFINITIVE evaluation by angiography

CT indicates Subarachonid Hemorrhage

Back 24

Intracranial Aneurysm
(Berry aneurysm)

Front 25

CT to CONFIRM hemorrhage and locate size/location (Superior to MRI < 48hrs)

Angiography to R/O aneurysm/arteriovenous malformation(AVM)

DO NOT PERFORM LUMBAR PUNCTURE

Back 25

Intracerebral Hemorrhage

Front 26

CT reveals bleed
MRI may be useful

Angiography demonstrates Vascular Anatomy

Back 26

Arteriovenous Malformations (AVM)

Front 27

CT before Lumbar Puncture

Prompt Lumbar Puncture

CBC and Blood culture

Back 27

Bacterial Meningitis

Front 28

What results are expected of a CSF with bacterial meningitis?

Back 28

Increased pressure
slightly turbid to purulent

Front 29

Prompt Lumbar Puncture
CSF analysis = opening pressure normal, lymphocytes or monocytes

protein, glucose, serum blood count = mostly normal

Back 29

Aseptic (Viral) Meningitis

Front 30

CT: contrast enhancement surround low-density core
MRI: permit early recognition
Arteriography indicates presence of space-occupying lesion

Back 30

Brain Abcess

Front 31

CSF normal or show lymphocytes
May show RBC in herpes simplex

Back 31

Encephalitis

Front 32

No testing is needed/warranted

Back 32

Benign essential (familial) tremor

Front 33

Motor Delay, Neurological signs, Persistence of primitive reflex, abnormal posture

Back 33

Cerebral Palsy

Front 34

Motor Milestones = effective screening process

Clues to an early diagnosis:
Abnormal Behavior
Psychomotor delay
Abnormal oromotor or reflexes or clonus

Back 34

Cerebral Palsy

Front 35

Clinical presentation
Myerson Sign (repetitive tapping over bridge of nose = sustained blink response)

No muscle weakness, or alteration to reflexes, or plantar response

Back 35

Parkinsonism

Front 36

MRI = BEST
EEG to determine classification

Lumbar puncture if sign of infection or new onset of symptom

Back 36

Seizure

Front 37

History of Fever and Seizure

CSF, Blood count, urinalysis for origin of fever

Back 37

Febrile Seizure

Front 38

CT/MRI or PET Scan

Cerebral Atrophy and atrophy of caudate nucleus

Back 38

Huntington Disease

Front 39

Clinical DX
Most have underlying anemia

Back 39

Restless leg syndrome

Front 40

No abnormalities other than Tics

DX often delayed b/c misdiagnosed as psychiatric illness

Back 40

Tourette Syndrome