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43 Cards in this Set
- Front
- Back
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berry aneurysm vs basal ganlia infarct
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- both pts with HTN
- MC is basal ganglia, cerebellum, thalamus, pons - berry aneurysm => subarachnoid hemorrhage = worst HA, LOC, no focal defect |
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cerebral lesions
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- motor deficit on opposite side of lesion, gaze is towards lesion
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MCC delirium in elderly
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- UTI, PNA, met distrubance
- do UA and electrolytes |
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symmetric muscle weakness and rash?
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- dermatomyositis
- if older, look for possible lung ca causing dermato - 2/2 muscle inflammation, no decrease in reflexes, - check CK level and electromyograph |
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dermatomyositis, lambert eaton, myasthenia gravis, paraneoplastic syndrome
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- D: muscle weakness, intact DTR
- LE: muscle weakness, decreased DTR, better with repetitive tasks = presynaptic involvement - Myasthenia gravis: facial and occular muscle weakness, worse with reptittion = post synaptic involvement - PNM: para/quadplegia with decreased sensation, urinary retention, incontinence |
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glaucoma
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- increasd oculuar pressure => damages optic nerve
- sx: sudden onset photophobia, eye pain, HA, nausea - NON-REACTIVE MID-DILATED PUPIL = acute glaucoma - dx by tonometry |
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hemi-neglect syndrome
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- neglects left side, only responds to stimuli from right
- do clock test - 2/2 lestion of right (non dominant) parietal lobe = spatial recognition |
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frontal, parietal, left temporal, occipital lesions
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- f: hemiparesis (motor aphasia if dominant lobe involved)
- P: spatial recognition - T: receptive aphasia - O: visual |
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tx of heat stroke
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- pt with sudden HA, dizziness, fainting, HIGH temp
- evaporative cooling |
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normal pressure hydrocephalus
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- pt with memory loss, shuffling gait, urinary incontinence
- normal opening pressure on LP - tx: LP or ventriculoperitoneal shunt |
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GBS
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- pt with lower extremity weakness, decreased sensation, paresthesia, decreased reflexes
- 2/3 are 2/2 resp or GI infx, MC campy, herpes, myco, h flu |
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s4 on heart exam
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- LV hypertrophy
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TIA
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- sx less than 24 hrs
- if thrombotic : ASA or dipyridoamle if no ASA - if embolic e.g hx of afib = warfarin |
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intention tremor vs resting tremor vs chorea?
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- essential tremor => propranolol
- parkinson => carbidopa/levdopa - Huntingtons |
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NF1 vs NF2
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- 1: cafe au lait spots, macrocephaly, MR => later dvlp fibromas, neurofibrams
- 2: bilateral acoustic neuromas, cataracts |
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diabetic CN neuropathy?
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- mostly affects CNIII by ischemia => affects somatic fibers not parasympathetic fibers => ptosis, down and out gaze, intact accomodation, light reaction
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CN III neuropathy
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- if ischemic => nerve has separate blood supply to somatic vs parasymp => e.g. down and out gaze and ptosis but intact accommodation and response to light
- if compression 2/2 inflammation or uncal herniation = down and out, and fixed dilated pupil with no accommodation |
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lacunar stroke
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- either pure motor or pure sensory
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ipsilateral ataxia? hemiparesis
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- pt with weak left side, sways to affected side = CEREBELLAR TUMOR
- can block CSF flow => increased ICP => n/v, papilledema - HEMIPARESIS = LEGS AND ARM ARE IMMOBILE => SWING LEG AROUND |
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tabes dorsalis
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- pt walking with wide gait, lifts feet higher than usual, may have +romberg = neurosyphilis
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- pronator drift
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- eyes closed, right palm turns inward and downward = UMN DISEASE
- ddx stroke |
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vertigo
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- head spinning 2/2 vestibular system d/o
- BPPV: vertigo with head turning, 30% s/p trauma |
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aura before seizure? dx?
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- PARTIAL SEIZURE: aura (smell something), sseizure is generalized to brain thus LOC; aura = secondary generalization
- COMPLEX PARTIAL = no aura, + LOC, staring spell, automatisms (lip smacking), post ictal confusion - simple partial = no LOC - absence = no post ictal confusion |
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when to screen HIV
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- clinical picture similar to depression but no anhedoina thus not major depression; with hx of risky behavior
- b/c HIV demetion = lots of vague complaints: weight lossm malaise |
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weakness getting up from chair, going down stairs
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- no pain, hx of long term steroid use = steroid induced myopathy
- PAIN = polymyalgia rheumatica |
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EEG in complex partial vs absence?
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- CP: normal or slow with no change with hyperventilation, + post ictal
- absence: 3Hz spikes with hyperventilation, no post ictal |
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MS tx
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- acute exacerbation e.g. paraplegia, incontinence => IV corticosteroids
- long term therapy to prevent exacerbation: no corticosteroids, use interferon, plasmapharesis, cyclophosphamide, IV immunoglobulin |
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HIV and the brain!
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- PML: JC virus; MULTIPLE NON-ENHANCING LESIONS, NO MASS EFFECT, white matter, brainstem, cerebellar, MC sx: hemiparesis, speech, vision, gait distrubance => NO TX
- toxo: RING ENHANCING, basal ganglia, periventricular - primary CNS lymphoma: solitary, periventricular ring enhancing lesion, +EBV DNA in CF - dementia: cortical, subcortical atrophy, ventricular enlargement |
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alzheimers vs lewy body dementia
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- A: antegrade memory loss, visuospatial deficits (lost in own neighborhood), personality changes; LATE MANIFESTATIONS: hallucinations, GAIT IMPAIRMENT, URINARY RETENTION
- Lewy: decreased alertness, visual hallucination, extrapyramidal, and LATER THERE ARE MEMORY DEFICITS |
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normal aging
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- preserved ADLs, memory loss that pt is concerned about versus family; +recent memory and important events; expressive aphasia (word finding is OK), good social interests
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cluster HA tx
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- ppx: verapamil, lithium, ergotamine
- acute attack: 100% O2, subQ sumatriptan |
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shy drager syndrome
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- aka multiple system atrophy
- PARKINSON WITH ORTHOSTATIC HYPOTENION, OR IMPOTENCE OR INCONTINENCE - 1. parkson 2. autonomic dysfunction 3. widespread neuro signs (cerebellum, pyramidal, LMN) - tx: intravascular volume expansion + fludrocortisone, salt, alpha adrenergic agonist |
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STROKE AREAS
- posterior limb of internal capsule - middle cerebral |
- P: aka lacunar stroke; motor impariment without cortical dysfunction, visual field changes,
- middle cerebral: contralateral hemiplegia, conjugate eye deviation towards infarct, hemianesthesia, homonymous hemianopsia, aphasia (Dominant), hemineglect (nondominant) |
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STROKE AREAS
- anterior cerebral - vertebrobasilar |
- anterior: contralateral weakness of lower l imb, abulia, akinetic mutism, emotional disturbance, deviation of head and eyes towards lesion, sphincter incontinence
- V: brainstem = alternate syndrome = contralateral hemiplegia and ipsilateral CN involvement |
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carotid endarterectomy?
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- >60% occlusion
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amaurosis fugax
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- painless loss of vision from emboil = MC is carotid bifurcation => duplex U/S
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wenicke's encephalopathy? ddx?
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- thaimine (b1) deficiency = MS changes, gait instability, conjugate eye palsy
- ddx b12: no occulomotor symptoms |
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cerebellar infarction
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- medial vermis = vertigo, nystagmus
- lateral = dizziness, ataxia, weakness |
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syringomyelia
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- decreased pain, temp in cape like distribution
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pseudotumor cerebri?
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- idiopathic intracranial HTN
- HA, blurry vision, PAPILLEDEMA - can be 2/2 meds - LP => increased opening pressure, normal CSF |
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dx of MS?
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- MRI OF BRAIN => demyelinating lesions
- not consistent CFS: oligoclonal, pleocytosis, increased IgG or myelind basic protein |
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myasthenia gravis
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- young woman, intermittent dysarthria, dysphagia, ptosis (droopy eye lids), diplopia
- generalized weakness of arms, worse as day goes on, HALLMARK = RESOLUTION OF WEAKNESS WITH REST - don't need pain as sx |
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treatment pseudotumor
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- first line medical = acetazolimide
- 2nd: CS or repeated lumbar punctures - surgery: nerve sheat decompression and lumboperitoneal shunting |
