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Clinical Medicine: Ocular Manies of Neurological Disorders
Terms in this set (25)
This is the third leading cause of death and disability in the developed world, only exceeded by Heart Disease and Cancer. Declining incidence with better treatment of HTN and reduction in smoking. A lot of sequelae for this type of disease.
Major Risk Factors for Cerebro Vascular Disease: HTN, smoking, ___ _______, myocardial infarction, hyperlipidemia, ______, and congestive heart failure. Other risk factors include acute _____ abuse; TIA >___% occlusion of carotid arteries; oral contraceptives when combined with smoking; hypercoagulability; High RBC count and hemoglobinopathy; age, gender, ____ (African American males before menopause); prior stroke and heredity.
This is a lack of blood flow to the brain caused by a clot or rupture of a blood vessel leads to sudden brain damage.
This type of stroke makes up 75-85% of all strokes it is caused by a clot.
This type of stroke is less common and results in bleeding around or into the brain.
Stroke Syndromes: ICA occlusion, ACA occlusion, MCA occlusion, PCA occlusion, Vertebrobasilar occlusion (AICA, PICA, and SCA), ______ infarct, and spinal stroke.
Anterior Circulation TIA/Stroke:
a) Caused by involvement of what two arteries?
b) Face-arm-hand-leg (contralateral or ipsilateral) hemiparesis?
d) What is an ocular symptom associated with this?
a) Anterior and Middle Cerebral Artery
c) Amaurosis Fugax (monocular blindness)
Middle Cerebral Artery Occlusion:
a) (Contrateral or ipsilateral) hemiplegia in face-arm-hand?
b) Dominant hemisphere problem = _______?
c) Nondominant Right hemisphere problem results in confusion, spatial disorientation, sensory and emotional ___.
Anterior Cerebral Artery Occlusion:
a) Sensorimotor deficit in (contralateral or ipsilateral) foot and leg?
b) Brocas ro anterior conduction aphasia in dominant hemisphere is possible (deep frontal lobe nuclei).
Posterior Circulation TIA/Stroke:
a) More ______ like symptoms
c) Sensorimotor defects: (ipsi or contra) face and (ipsi or contra) limbis
Ocular symptoms include: ______/_____ gaze, ocular palsy and homonymous heminaopsia
c) Ipsi, Contra
Vertebro-Basilar- PICA- VA Stroke:
a) (ipsi/contra) face and (ipsi/contra) body
e) Paralysis of _______ and ______
Big ocular symptom is what?
a) Ipsi; Contra
b) Tongue and swelling
c) Horner's Syndrome
Vertebro-Basilar Junction Stroke:
a) Lower extremity _____ or _____
b) Respiratory depression
Ocular: Conjugate or dysconjugate gaze paralysis and _______ pupils
a) Paraplegia or tetraplegia
Basilar Apex-PCA Junction:
b) Stupor and coma
Ocular symptoms: ______ and _____ paralysis; VF defects
b) Pupillary and oculomotor
a) ________ or __________ hemianospia
b) Proximal branches affect thalamus involvement resulting in ______ loss and sensorimotor hemiplegias
a) Quadrantic or Homonymous
Diagnosis of Stroke/TIA: ABC's; History and Physical Exam, a thorough neurological exam, EKG, monitor, pulse oximetry, LABS (CBC/electrolyte/glucose/ABG/PT/PTT/Urine drug/LP); CT or MR head scan; Echocardiography and EEG; Carotid Duplex; MRI and Angiography.
Treatment: Maintain _______ to the brain and avoid ______ BP. Fluid Resuscitation. Antiplatelet (______ inhibitor (aspirin); ADP receptor inhibitor (Ticlopidine and clopidogrel); thromboxane synthase inhibitor (__________).
Acute Stroke Treatments:
a) Ischemic Stroke (Brain Clot): Clot _____ medication (t-PA -tissue plasminogen activator) and clot-_______ device (merci retriever and penumbra).
b) Hemorrhagic Stroke (Brain Bleed): what are two treatments?
c) Clipping and coiling
This is also known as idiopathic intracranial hypertension.
Pseudotumor Cerebri: Two possible causes include rise in _____ _____ pressure (possibly from extracellular edema causing partial compression of the major venous sinuses) and _____ _______ of CSF outflow pathways.
a) Sagittal Sinus
b) Low Conductance
This is the pressure of the brain, CSF, and the brain's blood supply with the intracranial space. Since the skull is a closed system an increase in volume will crease an increase in pressure. A normal ICP in an adult ranges from _____-___ mmHG. Elevated ICP can affect the perfusion to the brain and lead to damage. ICP is direct related to what type of prognosis?
a) Intracranial Pressure
c) Poor Prognosis
What are three most common symptoms of increased ICP? Others are ataxia, torticollis, parethesias, facial numbness, pain, dizziness, and radicular pain.
b) Nausea and Vomiting
Ocular symptoms of increased ICP include _____ or _____ pain; ______ visual obscurations; blurry vision/vision loss; and diplopia.
a) Neck and retroocular pain
Implicated Etiologic Meds (medications that can cause increased ICP): NSAIDS, tetracycline, OCPs, nitrofurantoin, isotrentinoin, _______, ________, nalidixic acid, _________, and steroids (Starting or stopping them).
Possible Risk factors for increased ICP: Obesity; Vitamin ______ (too much or too little); Cushing's disease; HYPOparathyroidism; HYPOthyroidism; CKD; and anemia.
Diagnosis of increased ICP: Signs and symptoms without a cause. _____ of localized neuro exam findings (EXCEPT for _______ paresis). Normal ____ findings except for increase pressure. MRI. CT. Venography. Lumbar Puncture.
Treatment of increased ICP: Treatment of obesity; diuretics such as _________; dietary changes (low salt/low tyramine diet); steroids.
Surgical: _____ _____ _____ decompression/fenestration; lumboperitoneal shunting; craniectomy.
b) Optic nerve sheath
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