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Terms in this set (103)
Which spinal tract decussates in the ventral white commissure?
Spinothalamic, pain and temperature
How does tabes dorsalis present and what is the cause?
Presents with impaired proprioception and pain. Tertiary syphilis
B/l loss of pain and temperature at one level below the lesion with b/l flaccid paralysis at the level of the lesion?
Ipsilateral loss of vibration and discrimination and spastic paresis below the lesion, ipsilateral flaccid paralysis at the level of the lesion, contralateral loss of pain and temperature below the lesion.
What is the most common type of TIA?
What are the most important risk factors for stroke?
Age and HTN
How can you distinguish TIAs involving the carotid system from those involving the vertebrobasilar system?
Carotid-amaurosis fugax, vertebrobasila-projectile vomiting, numbness of ipsilateral face and contralateral limbs, hoarseness, dysphagia
What is a major predisposing factor for lacunar strokes?
HTN seen in 80-90% of strokes
What is subclavian steal?
Stenosis of subclavian artery whereby exercise of the left arm causes reversal of blood flow down the ipsilateral artery to fill the subclavian-->decreased cerebral blood flow.
How to differentiate thrombotic from embolic stroke?
Thrombotic-stepwise onset of symtpoms, patient awakens from sleep with neurologic defecits. Embolic-onset is very rapid and defecits are maximal initially.
Aphasia, apraxia, contralateral hemiparesis and hemisensory loss, ToW?
Contralateral LE and face weakness, ToW?
Contralateral visual abnormalities, ToW?
Pure motor hemiparesis, ToW?
Internal capsule (lacunar)
Dysarthria, clumsy hand, ToW?
Pure sensory deficit, ToW?
What is the time frame in which you can administer t-PA for an ischemic stroke?
At what BP is it appropriate to treat in a patient suffering an ischemic stroke?
>220/>120 or map>130 or if the patient has a significant medical indication for treatment such as MI or aortic dissection.
When is carotid endarterectomy indicated?
Symptomatic with stenosis of 50%, asymptomatic with stenosis of 60% for men. Only treat symptomatic women with >70% stenosis.
What does pronator drift indicate?
UMN lesion. When people feign UE weakness the "affected" arm will drop instead of pronating.
What is Dejerine-Roussy syndrome?
Stroke involving the VPL nucleus of the thalamus that presents with contralateral hemianesthesia and dysasthesia.
What is the difference between in intracerebral hemorrhage and a subarachnoid hemorrhage?
ICH is bleeding into the brain parenchyma itself, SAH is bleeding into the CSF outside the brain parenchyma
What is the most common location for intracerebral hemorrhage?
What is the presentation of intracerebral hemorrhage?
Abrupt onset of focal neurologic defecit that worsens steadily over 30 to 90 minutes, altered level of consciousness, headache, vomiting, signs of increased ICP.
What are pupillary findings will help you determine the location of ICH?
Pinpoint-pons, opioid OD
Dilated-putamen, possible uncal herniation
At what point is it appropriate to treat BP in ICH? What is the drug of choice?
Is the use of steroids recommended in the treatment of ICH?
No, it is actually harmful
Worst headache of my life, ToW?
What is the most common cause of SAH?
Rupture of berry aneurysm
What are the feared complications of SAH and their timetable?
24 hours-rebleed, 72 hours-vasospasm (prophylax with nifedipine)
What is the gold standard for diagnosing SAH?
Which type of brain bleed commonly presents with an initial "lucid interval" followed by decreased consciousness and pupil abnormalities?
Which type of bleed shows a biconvex hyperdensity on non-contrast CT?
Which type of brain bleed presents with a slowly progressive headahce, change in mental status and contralateral hemiparesis with increased DTRs?
Difficulty producing words but good comprehension?
Broca-frontal and anterior parietal cortex
Meaningless words and phrases, poor comprehension?
Wernicke-inferior parietal and posterior superior temporal
Nonfluent speech and poor comprehension?
Global-large infarcts of left hemisphere
What is the pathophys of Parkinson disease? Treatment?
Loss of dopaminergic neurons in the substantia nigra pars compacta and locus ceruleus. DA agonists-levodopa, carbidopa, bromocriptine, pramipexole, amantadine. MAO-B inhibitors-selegeline. Anticholinergic-benztropine.
What syndrome can present very similarly to Parkinson?
Lewy body-hallucinations. Also MTPT SE from illicit opioid production.
What type of tremor is present in parkinson?
Resting, goes away while performing tasks.
What is Shy-Drager syndrome?
Parkinsonian symptoms + autonomic insufficiency
What are two common side effects of levidopa-carbidopa?
Dyskinesias and hallucinations
Which Parkinson drugs should not be used in older patients?
Anticholinergic-trihexyphenidyl and benztropine
What medications are known to cause Parkinsonian side effects?
Neuroleptics (chlorpromazine, haloperidol, perphenazine), metoclopramide and reserpine
What is progressive supranuclear palsy?
Similar presentation to parkinson disease but does NOT cause tremor and DOES cause ophthalmoplegia. Most commonly affects middle-aged and elderly men.
What is the pathophys of Huntington's Chorea?
AD mutation in chromosome 4 causes an expanded CAG repeat-->loss of GABA-producing neurons in the striatum (caudate atrophy).
What should be in your diff for a young man with movement disorders?
Huntington's and Wilson's
What are the common causes of seizures?
Vascular (CVA, AVM)
Metabolic (glucose, Ca, Na)
What separates generalized from partial seizures?
Generalized involve the entire cortex
How to distinguish simple from complex seizures?
Complex=loss of consciousness. Also commonly see hallucinations and automatisms (repeated coordinated movements) with complex
What is the treatment of choice for generalized seisures?
EEG shows spike and wave pattern, ToW?
Absence seizure. Treat with ethosuxamide or valproic acid
What anticonvulsant has gingival hyperplasia as a side effect?
What anticonvulsant is teratogenic?
What is the algorithm for treating status epilepticus?
Try benzos (alprazolam) several times, if no improvement-->fosphenytoin-->midazolam + propafol-->phenobarbital
Status epilepticus is defined as uninterrupted seizures lasting longer than?
What medication is useful in the treatment of young patients with Parkinson's with tremor as the predominant symptom?
What is Friedrich ataxia?
AR syndrome, onset in young adulthood. Presents with ataxia, nystagmus, impaired vibratory sense and proprioception.
What is ataxia telangiectasia?
AR syndrome, onset is in childhood. Similar to Friedrich ataxia but with telangiectases.
What is the most important risk factor for Alzheimer's?
What is the treatment for Alzheimer's?
Cholinesterase inhibitors such as rivastigmine, donepazil and galantamine
What is the predominate initial symptom in Lewy body dimentia?
How can you distinguish delirium from dementia?
Delirium generally has hallucinations and fluctuating levels of consciousness
What is the treatment for agitation/psychotic-like delirious behavior?
What two things cause pinpoint pupils?
Narcotics and ICH
Anisocoria may be a sign of what?
What is the cause of locked in syndrome?
Infarction/hemorrhage of the ventral pons
What does LP show in a patient with MS?
Increased protein, oligoclonal bands, increased IgG
What is the treatment for MS?
Interferon-beta and glatiramer acetate decrease frequency of exacerbations
What are the criteria for brain death?
Unresponsiveness, apnea despite adequate oxygenation and ventilation, no brainstem reflexes. No drug/metabolic conditions. Core body temp >89.6. EEG shows isoelectrical activity.
Involvement of the MLF in patients with MS results in what?
INO-medial rectus palsy on attempted lateral gaze and horizontal nystagmus of abducting eye.
How do you treat an acute attack of MS?
IV steroids, oral have not shown the same efficacy.
What is Riley-Day syndrome?
aka familial dysautonomia. Seen primarily in Jewish children, presents with gross dysfunction of the ANS with severe orthostatic hypotension.
What will you see in the CSF of someone with GBS?
Elevated protein, all other counts normal
What is the treatment for GBS?
IVIG. DO NOT GIVE STEROIDS!
How can you distinguish MG from Lambert-Eaton?
In Lambert-Eaton the symptoms improve with repeated muscle stimulation.
What is the treatment for MG?
AChE inhibitors-pyridostigmine. If in respiratory failure use plasmapheresis
What is the pathophys of Duchenne muscular dystrophy?
XLR deficiency of dystrophin-->muscle death. Treat with steroids.
What is Becker's muscular dystrophy?
Similar to Duchenne's but there is later onset and a less severe course.
What is myotonic muscular dystrophy?
AD, presents at age 12-30 with hand-grip weakness, facial weakness, dysphagia, arrhythmias, cataracts, balding and testicular atrophy.
What are the characteristics of von Recklinghausen's disease?
NF-1. At least two of the following; COFFINS-Cafe au lait spots, Optic gliomas, axillary or inguinal Freckling, Familial, Iris hamartomas (Lisch's nodules), Neurofibromas, Skeletal lesions.
What are the characteristics of tuberous sclerosis?
Cognitive impairment, epilepsy and skin lesions (facial angiofibromas and adenoma sebaceum), ash-leaf spots, cardiac rhabdomyoma
What are the characteristics of Sturge-Weber?
Port-wine stains in V1 ophthalmic distribution, pheochromocytoma, capillary angiomatoses, epilepsy and mental retardation.
What are the characteristics of Von Hippel-Lindau?
Cavernous hamangiomas of brain or brainstem, renal angiomas, and cysts in multiple organs. Associated with RCC and pheochromocytoma.
Loss of pain and temperature and flaccid paralysis in a cape-like distribution, think of what?
What are the characteristics of Polio?
Asymmetric muscle weakness, absent DTRs and NORMAL sensation.
What is transverse myelitis?
Most commonly involves the thoracic cord. Affects specifically the tracts across the horizontal aspect of the spinal cord at a given level.
How to distinguish central from peripheral vertigo?
Central-gradual onset, nystagmus may be bideirectional or vertical.
Peripheral-abrupt onset with associated N/V.
What is the treatment for Meniere's disease?
Na restriction and diuretics
What is the most common cause of syncope?
Vasovagal, dx by tilt-table
What is the only definitive treatment for eeclampsia?
Delivery, MgSO4 in the mean time
Automatisms are specific to which type of seizure?
What is the drug of choice for partial seizures? tonic-clonic?
Phenytoin and carbamazepine
What is impaired in conductive aphasia?
How to distinguish subcortical lesions from those in the cerebral cortex?
Cortical lesions generally
What diseases are associated with athetosis?
Cerebral palsy, encephalopathy
What is the treatment for Tourette syndrome?
Fluphenazine, primozide, tetrabenazine
What is the most common primary brain tumor in adults? In children?
Glioblastoma, astrocytoma. Medulloblastoma is the most common MALIGNANT brain tumor in children (vermis)
What is the treatment of choice for narcolepsy?
Modafinil. TCAs may help prevent cataplexy.
What is decorticate posture? Decerebrate?
Decorticate-elbows flexed, legs extended. Indicates lesion at the cortex or thalamus.
Decerebrate-elbows and legs extended. Indicates lesion at the midbrain.
What is the pathophys of Tay-Sachs?
Absence of hexoaminidase A. Presents with cherry red spots on retina, progressive paralysis, vision loss.
What is the number one risk factor for cerebral palsy?
Prematurity. Also perinatal asphyxia and birth trauma.
Which ear does the Weber test lateralize to in conductive hearing loss? Sensorineural?
Abnormal ear, normal ear.
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