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CMS II Final Comprehensive Review - Neurology
Winter Semester 2011
190
Medical
Graduate
03/26/2011

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Cards

Term
Which CN are involved in taste?
Definition
CN V - somatosensory sensations (hot peppers)
CN VII, IX, X - Regular Taste
Term
What type of taste loss is observed with Bell's Palsy?
Definition
Loss of anterior 2/3rd of tongue
Term
What type of taste lost is observed with CN IX disruption?
Definition
loss of taste posterior 1/3 of tongue
Term
If there is a diminished gag reflex or disturbed swallowing, what CN is affected?
Definition
CN IX
Term
If there is asymmetric rise of the uvula, which CN is affected?
Definition
CN X
Term
A lesion of which CN causes drooping shoulder, muscle atrophy, weakened or limited elevation of the shoulder or arm, scapula winging?
Definition
CN XI - Accessory
Term
A lesion of which CN causes flaccid paralysis of tongue and atrophy, as well speech difficulties?
Definition
CN XII
Term
What CN is involved with Ramsey Hunt syndrome?
Definition
CN VII
Term
What is the difference between Bell's Palsy and a Central Lesion?
Definition
Bell's Palsy affects the entire 1/2 of the face causing facial weakness/paralysis.
Central lesions causes facial weakness/paralysis but SPARES the forehead (wrinkles across)
Term
What is the treatment for Bell's Palsy?
Definition
- Most often complete recovery - 80%
- Prednisone burst
- Acyclovir
- If no improvement in 2 weeks refer to ENT eval
Term
If a pt presents with aural pain, numbness on 1/2 of the face, impaired taste and auditory hyperacusis as well as facial paresis affecting entire 1/2 of face (including forehead)?
Definition
Bell's Palsy
Term
What is the cause of tic Douloureux or trigeminal neuralgia? Which vessel is affected most often?
Definition
Microvascular compression of the sensory fibers of the trigeminal root by a blood vessel
MC vessel involved - Superior Cerebellar Artery
Term
If a patient presents with unilateral sharp, electric-like pains lasting seconds or minutes along the trigeminal nerve branch(es) of the lower 2/3 of face that seems to occur with eating or drinking, what condition is suspected?
Definition
Tigeminal Neuralgia (Tic Douloureux)
Term
What is the treatment for trigeminal neuralgia (Tic Douloureux)?
Definition
Carbemazepine, phenytoin, or baclofen
Term
What are the MC causes of CN VI palsy?
Definition
Trauma, microvascular disease, and basal intercranial neoplasms
Term
What is bilateral CN VI palsy an indication of?
Definition
Indicates ICP
Term
If the pt presents with an affected eye that at rest is adducted and cannot abduct, what CN is suspected? What test should you get if a pt presents this way?
Definition
CN VI Palsy
CT Scan
Term
If a pt presents with complaints of vertical diplopia, and on exam has an elevated gaze with one eye at rest, and the elevation is made more pronounced with head tilting to the affected side, what condition should you suspect?
Definition
CN IV Palsy
Term
What muscle is affected in CN IV palsy?
Definition
Superior Oblique
Term
What is the MC cause of CN IV palsy?
Definition
blunt head trauma
Term
What muscle is affected in CN VI palsy?
Definition
Lateral Rectus
Term
What are the three components of Horner's Syndrome?
Definition
Ipsilateral ptosis, anhydrosis and miosis
(Lid drooping, lack of sweating and pupil contraction)
Term
How can Horner's syndrome and CN III palsy be differentiated?
Definition
Horner's syndrome - ptosis and SMALL pupil ipsilateral
CN III - ptosis and LARGE pupil ipsilaterally
Term
If CN III palsy is suspected, but the pupil is spared, what underlying conditions may be causing the disruption?
Definition
Diabetes and HTN
Term
If a pt has an eye that is abducted at rest, and cannot look up, look down, or adduct their gaze with that eye, what condition do you suspect? What other physical finding might also be indicative of this condition?
Definition
CN III Palsy
Myadriac (Dilation) Pupil
Term
What type of visua deficit is seen with a pituitary tumor? What other symptoms may be present?
Definition
Bitemporal Hemianopsia
HA
Endocrine Sx - galactorrhea, amenorrhea, acromegaly etc
Term
What are the symptoms of alcohol cerebellar degeneration?
Definition
gait ataxia
tremor
alcohol related neuropathy
Term
What causes Wernicke's encephalopathy? What type of pts are MC affected?
Definition
Thiamine deficiency
Alcoholics
Term
What is the classic triad of Wernicke's encephalopathy?
Definition
gait ataxia
ophthalmoplegia
Confusion
Term
How is Wernicke's encephalopathy diagnosed?
Definition
Administer Thiamine 100mg IV and resolution of symptoms should occur if they are caused by Wernicke's Encephalopathy
Term
What is the pathophysiology of Myasthenia Gravis?
Definition
less functioning ACh receptor = less conduction
Term
If a pt complains of not being able to brush their hair without fatigue, has an increase in fatigue throughout the day, and you notice asymmetric ptosis, what condition do you suspect?
Definition
Myasthenia Gravis
Term
Are sensation or reflexes affected by Myasthenia Gravis?
Definition
No
Term
How is Myasthenia Gravis diagnosed?
Definition
Blood = ACh receptor antibodies detected
"Tensilon Test" - Edrophonium (short-acting cholinesterase inhibitor) given and transient weakness should improve dramatically
Term
What is the treatment for Myasthenia Gravis?
Definition
Anticholinesterase drugs
Pyridostigmine
*Use steroids if pts don't respond well to Pyridostigmine*
Term
What type of peripheral neuropathy distribution is typical of diabetic neuropathy? Which type of sensation is the first to go?
Definition
Stocking and Glove; Vibratory first to go
Term
What are some common manifestations of diabetic autonomic neuropathy?
Definition
Exercise Intolerance, dizziness, Hypoglycemic indicators (lack of sweating and shaking), orthostatic hypotension, gastric atony, bladder dysfunction, ED
Term
In Guillain-Barre syndrome, what is the MC complaint?
Definition
symmetrical weakness beginning in the legs
Term
In guillain-Barre is the weakness/paralysis in an ascending or descending pattern?
Definition
ascending
Term
If a pt presents with sudden onset weakness in the legs that seems to be worsening, now they can barely walk and on physical exam there are absent achille's tendon reflex as well as elevated protein levels in the CSF and a demyelination pattern on their Nerve conduction study, what condition should you suspect?
Definition
Guillain-Barre
Term
Which disease has transient sx of paresthesia, gait disorders, focal weakness, visual blurring, diplopia, vocal slurring and is MC in women?
Definition
MS
Term
What is the MC type of MS?
Definition
Secondary Progressive
Term
How are acute relapses of MS treated?
Definition
Prednisone 60 day with taper
Term
What is given to MS pts to help with long-term immune suppression to help slow the course of the disease?
Definition
beta-interferon (avonex)
Term
What is given to help with muscle spasticity seen with MS?
Definition
baclofen or diazepam
Term
What MS subtype is the MC initial course?
Definition
Relapsing Remmiting
Term
Which subtype of MS is described as unpredictable relapses followed by periods of no new signs of the disease?
Definition
Relapsing Remitting
Term
Which subtype of MS is described as having the greatest amount of disability, may include new neurologic symptoms and worsening cognition?
Definition
Secondary Progressive
Term
Which type of MS is described as a rapid decline that occurs continually without clear attacks?
Definition
Primary Progressive
Term
Which type of MS is described as pts who from the onset of MS symptoms have a steady neurologic decline but also suffer from superimposed attacks?
Definition
Progressive Relapsing
Term
What is the isolated peripheral neuropathy that affects the trigeminal nerve, causing palsy?
Definition
Bell's Palsy
Term
What is a "classic finding" of ALS?
Definition
Tongue fasiculations
Term
Does ALS affect the intellect?
Definition
No
Term
If a pt presents with UMN and LMN deficits, and symptoms including limb fatigue, weakness, but with normal sensations, what condition should be suspected?
Definition
ALS
Term
What spinal pathway is affected in ALS?
Definition
Corticospinal (peripheral limb sx) and corticobulbar (difficulty chewing and swallowing)
Term
What is the treatment for ALS?
Definition
NO cure, but riluzole slows the progression of the disease
Term
If a pt presents with delirium, has fruity breath and a history of diabetes type 1, what condition should you suspect? How is it treated?
Definition
DKA; Insulin/K/IVF
Term
If pt presents with acute delirium, signs of dehydration, and a history of Type 2 diabetes, what condition should you suspect? How is it treated?
Definition
HONK - Hyperosmolar Hyperglycemic Non-Ketotic Coma; Treated with IVF & Insulin
Term
If a pt presents with acute delirium, is tachycardiac and profusely sweating, and has a history of diabetes and is on insulin, what condition should you suspect? How is it treated?
Definition
Hypoglycemia; Treated with IV Dextrose
Term
If a pt presents with acute delirium, asterixis (intermittent lapse of assumed posture or position), seizures, and coagulation d/o, what condition do you suspect? How do you treat it?
Definition
Hepatic Encephalopathy (accumulation of ammonia due to LF)
Treated with lactulose and fix coagulopathy
Term
What nutritional deficiency can cause acute delirium and mild confusion that can lead to dementia or psychosis if left untreated? In what populations of pts is this deficiency MC?
Definition
Vitamin B12 deficiency
Common in pts with abnormal GI absorption - Crohn's disease, pernicious anemia, atrophic gastritis, Gastric Bypass surgery, Celiac Disease
Alcoholics and Vegetarians may also be deficient
Term
If a pt presents with acute delirium and opthalmoplegia (weakness or paralysis of eye muscles), nystagmus and ataxia, what condition should you suspect? How is it treated?
Definition
Wernicke's Encephalopathy; Give thiamine then glucose bolus
Term
If a pt presents with photphobia, fever, papilledema, N/V, changes in mental status, toxic appearance and stiff neck, what condition should you suspect?
Definition
Meningitis
Term
What is the symptom triad for meningitis?
Definition
Fever, Nuchal Rigidity and Mental Status changes
Term
If a pt presents with seizures, neuro deficits, increased CSF pressure, increased protein, and increased monocytes and organisms are seen on blood smear, what condition should be suspected?
Definition
Cerebral Malaria - caused by Plasmodium species
Term
What is the MC cause of dementia?
Definition
AD
Term
What is the major symptom of AD?
Definition
Gradual forgetfullness
Term
If a pt presents with complaints of forgetting where they parked etc, they are disoriented to time and their spouse has noticed changes in their behavior, with all of this worsening gradually, what condition should you suspect?
Definition
AD
Term
What stage of AD has symptoms including abnormalities in short term memory, hesitant speech, apraxia, and shuffling?
Definition
First or Early AD
Term
Which stage of AD is described as having symptoms including paranoia, hallucinations, delusions, primitive reflexes, and mute/bedbound?
Definition
Later AD (Moderate)
Term
What stage of AD is described as having symptoms including social skills lost, psych problems, seizures, rigid/bradykinesias, grasp/suck reflexes, myoclonus, UI, spasticity, hemiparesis and death?
Definition
Late AD
Term
What will you see on MRI with AD?
Definition
enlarged ventricles, cerebral atrophy and widened sulci
Term
What will you see on PET with AD?
Definition
diminished temporal lobe activity
Term
What is the treatment for Mild/Moderate AD?
Definition
Acetylcholinesterase Inhibitors: Donezepil, rivastigmine, galantamine
Term
What is the treatment for severe AD?
Definition
Acetylcholinesterase Inhibitors AND ADDING MEMANTINE (Glutomate r. agonist)
Term
What are some Alternate therapies for AD?
Definition
Vitamin E
Antioxidants
Gingko Biloba
Term
Where are the inclusions in Lewy Bodies?
Definition
In cortex and brainstem
Term
If a pt presents with gradual memory loss, gait and balance disorders (Parkinsonian features), hallucinations, delusions and episodic delirium, what condition do you suspect?
Definition
Lewy Bodied Dementia
Term
What drugs should be avoided with pts who have Lewy Body Dementia?
Definition
AVOID Antipsychotics
Term
What is the triad of changes in the brain that occur with AD?
Definition
Tangles, Cortical Atrophy and amyloid plaques
Term
What are the characteristic brain changes associated with Lewy body dementia?
Definition
Diffuse cortical neuronal involvement w/Lewy Body Inclusions
Term
If a pt presents with mild memory loss, slowed thinking, walking/balance problems, dysarthria and dysphagia, with emotional lability (depression, irritability, or apathy) that seem to be progressing step-wise, what is your diagnosis?
Definition
Vascular Infarct
Term
What are the risk factors for vascular dementia?
Definition
HTN, Heart Dz, Smoking, Alcoholism, hyperlipidemia
Term
How is vascular dementia treated?
Definition
CCB
Anti-Platelet Meds
Exercise
Good Diet
Cholinesterase Inhibitors and Glutamate Receptor Agonists (Memantine)
Term
What is seen on MRI with Vascular Dementia?
Definition
Subcortical Lucencies known as Lacunar infarcts
Term
Which type of movement disorder is described as rhythmic oscillatory movement accentuated with voluntary motor activity?
Definition
Tremors
Term
When is an intentional tremor present?
Definition
during movement, but not at rest
Term
When is a resting tremor present?
Definition
occurs when limb is at rest
Term
What type of movement disorder is described as rapid, irregular muscle jerks that occur involuntarily and unpredictably?
Definition
Chorea
Term
Which type of movement disorder is described as abnormal movements that are slow, sinuous and writhing in character?
Definition
Athetosis
Term
What type of movement disorder is described as sustained muscle contraction, frequently causing twisting and repetitive movements or abnormal postures?
Definition
Dystonia
Term
What are the movements characteristic of focal dystonia?
Definition
torticollis, blepharospasm, writer's cramp
Term
Which type of mvement disorder is described as SUDDEN onset of sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures?
Definition
Acute Dystonia
Term
What condition is chorea commonly associated with?
Definition
Huntington's Dz
Term
What condition is Acute dystonia commonly associated with?
Definition
Commonly presents early in the tx for schizophrenia
Term
What condition is clinically defined as resting tremor, cogwheel rigidity, Akinesia/bradykinesia and impairment of postural reflexes?
Definition
Parkinson's Dz
Term
What is the pathology of Parkinson's?
Definition
damage to the substantia nigra w/cell loss in basal ganglia that cause an increase in GABA output which disrupts the balance of GABA and Ach /in the Basal Ganglia
Term
If a pt presents with slower walking, a tremor with hands resting in lap, c/o muscle stiffness and a slowing of every day movements such as eating and dressing, what condition should you suspect?
Definition
Parkinson's
Term
What is the treatment for Parkinson's Dz?
Definition
Dopamine Replacement: Carbidopa, Levidopa (helps with bradykinesis and rigidity)
Anticholinergics: Benztropine (helps with rigidity and tremor
Term
What is the preferred treatment of Parkinson's for young pts or those with mild disease?
Definition
Dopamine agonists (bromocriptine)
Term
What are the differences between syncope and seizure?
Definition
With syncope there is NO post-ictal state
Term
What is the MC trigger for seizures?
Definition
Not taking meds as instructed
Term
What are the types of primary seizures?
Definition
Benign febrile convulsions of childhood
Epilepsy
Head Trauma
Stroke/TIA
Mass Lesions
Term
What are the causes of secondary seizures?
Definition
Hyperosmolar States
Hypocalcemia
Hypoglycemia
Hyponatremia
Uremia
Term
What is the first line imaging for seizure diagnosis in an ER setting?
Definition
Non-contrast CT
Term
What are life-threatening seizure conditions usually related to?
Definition
hemorrhage
brain swelling
mass effect
Term
Which seizure pts do not require emergent imaging?
Definition
Pts with previously diagnosed epilepsy
Term
What test is preferred in the diagnosis of seizure pts if the pt is stable?
Definition
MRI is preferred as they have a greater sensitivity for detecting abnormalities
Term
What is the best test for a first time seizure pt who is stable?
Definition
MRI
Term
What is status epilepticus?
Definition
Prolonged seizure activity for greater than 30 minutes
Term
What is the treatment for status epilepticus?
Definition
Thiamine (alcoholism)
Diazepam or Lorazepam
Term
What can anti-convulsant meds cause? How should these conditions be monitored?
Definition
hematologic or hepatic toxicity
Monitored with CBCs, LFTs at 2 wks, 1 mon, 3 mon, 6 mon, and every 6 mon. following
Term
With which category of seizures is there a LOC?
Definition
Generalized Seizures
Term
What is the MC type of seizure category?
Definition
Partial
Term
What is the first line treatment for partial seizures?
Definition
Phenytoin
Term
What are the 6 types of generalized seizures?
Definition
Absence Seizures
Tonic/Clonic Seizures
Myoclonic Seizures
Atonic Seizures
Clonic Seizures
Tonic Seizures
Term
hat are the three types of partial seizures?
Definition
Simple Partial
Complex Partial
Simple partial that develops into generalized seizure
Term
If pt has no LOC, but experiences clonic movements of a single muscle group in his leg, what type of seizure do you suspect?
Definition
Simple partial
Term
If a pt presents with a report of an event in which he had olfactory hallucinations, and amnesia after the event and his mom reported that he kept picking at his clothes and wouldn't respond, what type of seizure would you suspect?
Definition
Complex Partial Seizure
Term
What is the treatment for absence seizures?
Definition
Valproic Acid
Term
If a pt's parent presents with c/o their child seems to lapse into dazes where they blink their eyes rapidly and they cannot be aroused, but their posture remains constant and the child is unaware of the event, what type of seizure would you suspect?
Definition
Generalized: Absence
Term
Which type of seizure is described as a sudden, brief lapse in consciousness without a loss of postural control in which the pt may exhibit a blank stare or rapid blinking?
Definition
Absence seizure
Term
Which type of seizure is described as involving both hemispheres of the brain and induces major motor events including jerking of the extremities and the pt has a LOC and a postictal period?
Definition
Tonic/Clonic Seizures (aka Grand Mal)
Term
Which type of tonic/clonic seizure is described as sudden shock-like contractions localized to a few muscles or a limb?
Definition
Myoclonic Seizures
Term
Which type of tonic/clonic seizure is described as sudden loss of muscle tone with loss of body posture?
Definition
Atonic Seizures (drop attacks)
Term
Which type of tonic/clonic seizure is described as slow single or multiple sharp , repetitive jerking movements of arms, legs or torso?
Definition
Clonic Seizures
Term
Which type of tonic/clonic seizure is described as a sudden increase in muscle tone (stiffening) of face and upper body, flexion of arms and extension of legs?
Definition
Tonic Seizures
Term
What are the physiologic effects of seizures lasting under 15 min?
HR
BP
sugar
Temp
Addit.
Definition
Tachycardia
Elevated BP
Hyperglycemia
Elevated Temp
leukocytosis
Term
What are the physiologic effects of seizures lasting between 15 - 30 min?
HR
BP
Addit.
Definition
Dysrhythmias
hypotension
hypoglycemia
Pulmonary edema
Term
What are the physiologic effects of seizures lasting more than 1 hr?
BP
Addit.
Definition
hypotension w/decreased cerebral blood flow
disruption of BBB leading to cerebral edema
Term
What is the gold standard for diagnosing seizures?
Definition
Video EEG Monitoring
Term
What is the DOC for Tonic/Clonic seizures?
Definition
Valproic Acid
Term
If an infant presents with an earache and a fever of 104 has a seizure, what type of seizure do you suspect? What is the prognosis?
Definition
Febrile Seizure; typically benign
Term
What are the cardinal signs of brain death?
Definition
Coma/unresponsiveness (no response to painful stimuli)
Absence of brainstem reflex (fixed pupils, oculocephalic, gag, grimacing)
Apnea (No respiratory attempts even with PCO2 > 60mmHg)
Term
What term means a sudden, focal interruption of cerebral blood flow resulting in neurological deficits?
Definition
Stroke
Term
What is the main risk factor for ALL stroke types?
Definition
Arterial HTN
Term
What is the pathology of HTN leading to strokes?
Definition
HTN leads to thickening of the vessel resulting in lacunar infarcts
Term
What are the risk factors for stroke?
Definition
HTN
Smoking
Diabetes
A-Fib
High Cholesterol
Preceding TIA
Term
Which type of stroke is due to an infarction from a disruption of blood supply?
Definition
Ischemic
Term
Which type of stroke is due to ruptured blood vessels and local blood collection?
Definition
Hemorrhagic
Term
What are the two types of ischemic strokes?
Definition
Thrombolytic
Embolytic
Term
What is the MC type of stroke?
Definition
Ischemic Thrombolytic
Term
What are the types of hemorrhagic strokes?
Definition
Intracerebral
Subdural/Subarachnoid
Term
Which type of hemorrhagic stroke is described as bleeding within the brain tissue?
Definition
Intracerebral hemorrhagic
Term
Which type of hemorrhagic stroke is described as a mass lesion that results in elevated ICP?
Definition
Subdural & Subarachnoid
Term
What is the causative factor of thrombolytic strokes?
Definition
Atherosclerosis
Term
If a pt has a stroke that had an abrupt onset with progression to maximal deficits over minutes to hours, onset during sleep, or a stepwise progression with gradual improvement over days to weeks, what type of stroke would you suspect?
Definition
Thrombolytic
Term
If a pt has an abrupt onset stroke and rapid improvement, what type of stroke should you suspect?
Definition
Embolytic Stroke
Term
What are most deaths that occur within 1 week of stroke event caused by?
Definition
Cerebral Edema
Term
If a pt has stroke symptoms including amaurosis fugax, horner's syndrome, hemiparesis, hemisensory loss, slurred speech, transient aphasia, what artery is affected?
Definition
Internal Carotid artery
Term
If a pt has stroke symptoms including abulia (spontaneous lack of concern that something is wrong), contralateral grasp reflex, sucking reflex, weakness of leg (legs affected more than arms), and apraxia, what artery is affected?
Definition
Anterior Cerebral Artery
Term
If a pt present s/p stroke and has severe disability, homonymous hemianopsia, global aphasia, gaze deviated toward infarcted hemisphere, which artery is affected?
Definition
Middle Cerebral Artery
Term
If a pt presents with stroke symptoms including memory deficit, unformed visual hallucinations, paralysis of eye movement, alexia without agraphia, thalamic syndrome (Sensory los, athetosis- weird movement), what artery is affected?
Definition
Posterior Cerebral Artery
Term
If a pt has stroke symptoms including BINOCULAR visual disturbances, drop attacks, vertigo, tinnitus, N/V, numbness around face and lips, what artery is affected?
Definition
Vertebral Basilar artery
Term
What is the only approved therapy for an ischemic stroke?
Definition
TPA
Term
What are the contraindications to TPA therapy?
Definition
Bleeding d/o
Hx of ICH
Evidence of hemorrhage on head CT
Sx suggestive of SAH event even w/CT w/in NL
Stroke or head trauma in the past 3 months
Uncontrolled HTN
Pregnant/Lactating
LP w/in last 7 days
MI in past 3 months
Medical surgery in past 14 days
Term
How should high BP with ischemic strokes be controlled?
Definition
If SBP is over 220 or DBP is over 120 then use labetalol to slightly decrease BP
Term
If a pt presents with the worst HA they have ever had with rapid deterioration over a few hours, what stroke do you suspect?
Definition
Intracerebral bleed
Term
What is a subarachnoid hemorrhagic stroke usually due to?
Definition
usually due to ruptured cerebral artery aneurysm or AVM (Atrial Venous Malformation)
Term
If a pt presents with the worst HA of their life, LOC, neck stiffness, non-focal neurologic symptoms, what type of stroke should you suspect?
Definition
Subarachnoid
Term
What type of diagnostic studies should be done for a hemorrhagic stroke?
Definition
Non-Contrast CT - hemorrhage appears white
MRI - center of hemorrhage is white with dark periphery
Term
When is an LP indicated for a hemorrhagic stroke? What are the positive findings?
Definition
Indicated if CT is neg, but hemorrhagic stroke is suspected; Xanthochromia or yellow CSF develops approx 4 hrs after hemorrhage
Term
How should BP with a hemorrhagic stroke be addressed?
Definition
Addressed with IV Nitroprusside, Nicardipine or Labetalol if SBP is btwn 140 - 160mmHg
Term
What are the three most predictive exam findings for an acute stroke?
Definition
1) Asymmetric Facial Weakness
2) Arm drift/Weakness
3) Abnormal Speech (dysarthria)
Term
What is the best diagnostic test for an emergent stroke?
Definition
Non-contrast CT
Term
What are TIAs indicative of?
Definition
Non-contrast CT
Term
What are TIAs indicative of?
Definition
an Impending stroke
Term
What is the treatment of a TIA?
Definition
TPA
Antiplatelet Therapy (Ticlopine is better than ASA)
Term
What is the #1 prevention of strokes?
Definition
aggressive control of BP
Term
What med can be used to control the hyperlipidemia risk factor for strokes?
Definition
Statins
Term
What med can be used to control the risk of a-fib for stroke?
Definition
Warfarin
Term
If a pt presents with c/o presyncope, neurological deficits in hand, and on physical exam their is a difference is BP between arms, what condition should you suspect?
Definition
Subclavian Artery Steal
Term
What is the most serious cause of an acute HA?
Definition
Subarachnoid Hemorrhage
Meningitis/Encephalitis
Term
What are some of the causes of subacute HA?
Definition
Giant Cell Arteritis
Brain Tumor
Pseudotumorcerebri
Trigeminal neuralgia
Post-herpetic neuralgia
Term
If a pt presents with a chronic HA that has worsened over the past months, that is worse in the morning and with exertion or valsalva, and has associated symptoms including NV and an aura accompanying their HA, what condition should you suspect?
Definition
Brain Tumor
Term
Which CN palsy is papilledema seen in?
Definition
CN VI
Term
Which type of chronic HA is described as being caused by Increased serotonin leading to intracranial vasoconstriction which occurs during aura phase resulting in hypoxia and is also described as having rebound vasodilation during headache phase, drop in 5HT levels?
Definition
Migraine HA
Term
What are the characteristics of a migraine HA?
Definition
Pulsatile
Onset/duration: 4-72 hours
Unilateral in location
Nausea and vomiting (Phono/Photophbia)
Disabling in intensity: headache is severe
Term
How is a migraine HA tx?
Definition
Simple analgesics
5-Ht agonists (Sumatriptan-imitrex)
Ergot Preps (Cafergot or hihydroergotamine)
Term
Which type of HA is described as unilateral headache may start as a burning sensation over lateral aspect of nose or pressure behind the eye, that commonly occurs at night, and may awaken patient from sleep. What condition do you suspect?
Lacrimation and tearing on same side as headache – Horner’s syndrome possible
Definition
Cluster HA
Term
What is the tx for Cluster HA?
Definition
Acute relief
100% oxygen
Sumatriptan 4-6mg SC (2 doses in 24 hrs)
Dihydroergotamine 1mg IV
Prednisone may stop cluster attacks
Term
Which type of chronic HA is described as HA’s of unapparent cause that lack features of migraine or cluster HA with an unknown underlying pathophysiology?
Definition
Tension HA
Term
Which disease is described as A progressive disorder with degeneration of the corticospinal pathways down to the anterior horn cells?
Definition
ALS
Term
What condition has symptoms including paresthesia, gait d/o, focal weakness, visual loss (blurring in one eye), and diplopia?
Definition
Multiple Sclerosis
Term
What condition is described as focal demyelination and damage to axons due to immune reaction against myelin?
Definition
MS
Term
What is Internuclear Ophthalmoplegia? Which nerve does it involve? What disease condition is this a symptom of?
Definition
Paresis of eye adduction in lateral horizontal gaze but not in convergence
Failure of adducting eye to follow
Abducting eye exhibits nystagmus
CN III
Symptom of MS
Term
How is MS diagnosed? What does it show? What enhances the scan?
Definition
MRI: test of choice
Bright lesions in the white matter of the cerebral hemispheres, brain stem, and spinal cord
Contrast (gadolinium) enhances the lesions
Term
What does a CSF show in pts with MS?
Definition
Protein electrophoresis shows discrete bands in the immunoglobulin g (IgG) region (oligoclonal bands)
Term
What is the tx for MS during an acute relapse?
Definition
Prednisone 60mg qd with taper
Term
What treatments provide long-term immunomodulation for MS?
Definition
Beta-interferon – ie Avonex 30mcg IM qweek
Glatiramer acetate 20mg SQ qd
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