Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| aphasia, focal weakness, double vision |
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Term
| generalized signs and symptoms |
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Definition
| dysarthria, generalized weakness, confusion, blurry vision, lightheadedness |
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Term
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Definition
| increased tone, spasticity, increased reflexes. in the arms, flexors stronger than extensors. in the legs, extensors stronger than flexors |
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Term
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Definition
| muscle fasciculations, atrophy, cramping |
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Term
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Definition
| trouble understanding language |
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Term
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Definition
| trouble creating language |
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Term
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Definition
| visual field cut contralateral to lesion; macular visual area often spared. alexia without agraphia |
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Term
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Definition
| pure motor hemiplegia contralateral; pure hemisensory deficit contralateral |
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Term
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Definition
| pure hemisensory deficit contralateral; maybe language disturbance, gaze preference, and other cortical signs similar to cortical lesion |
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Term
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Definition
| cranial nerve deficits/face deficits ipsilateral to the lesion. limb deficits contralateral to the lesion. |
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Term
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Definition
| ocular motility including double vision. limb and gait ataxia. hemiplegia contralateral. |
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Term
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Definition
| facial weakness ipsilateral (can't raise both eyebrows). dysarthria. pupillary changes. |
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Term
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Definition
| absent gag reflex (9 and 10). trouble swallowing ipsilateral (10). can't turn head or raise shoulder (11). tongue deviation toward the lesion (12). |
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Term
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Definition
| "scanning" speech pattern (monotonous, irregular cadence). ipsliateral limb ataxia. speech dysarthria. dysphagia. conjugate but uncoordinated eye movements. problems with movement without weakness |
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Term
| lateral cerebellar lesions |
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Definition
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Term
| central cerebellar lesions |
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Definition
| affect trunk, lower limbs, and gait |
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Term
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Definition
| severe limb dysfuction in the absence of cranial nerve findings. bowel and bladder. |
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Term
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Definition
| bilateral lower extremity weakness with loss of sensation from one point downward on the body. |
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Term
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Definition
| cape like pattern of weakness and numbness across upper extremities with increased reflexes, weakness, and spasticity in the lower extremities |
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Term
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Definition
| upper and lower motorn neuron signs |
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Term
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Definition
| numbness in bilateral hands and feet (stocking glove). weakness distal. |
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Term
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Definition
| worsening weakness with exercise |
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Term
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Definition
| improving weakness with exercise |
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Term
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Definition
| muscle issues with skin rash, alopecia, joint pain, swelling |
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Term
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Definition
| exercise intolerance and progressive weakness |
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Term
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Definition
| vascular even that results in focal brain injury |
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Term
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Definition
| vascular even that reults in focal brain injury symptoms, but may not result in injury. short lasting. do not result in visualized brain injury on imaging. |
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Term
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Definition
| homocysteine > 12, oral contraceptive use by smokers, sickle cell |
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Term
| non modifiable risk factors for stroke |
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Definition
| over 75, male, family history, cardiac disease, black |
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Term
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Definition
| SAH, ICH, large ischemic stroke |
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Term
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Definition
| headache, vomitting, loss of consciousness |
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Term
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Definition
| headache and vomitting at onset followed by progressive neurological symptoms |
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Term
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Definition
| headache, seizures, vomitting |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| heart enlarged, murmurs, rhythm abnormal. carotid, vertebral, and supraclavicular bruits. Hypertension, febrile. peripheral vascular disease. persisting neurological deficits. |
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Term
| patients you can give r-tPA |
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Definition
| symptoms clearly started within 3 hours. deficits fixed or worsening, not improving. systolic BP under 185. normal bleeding. not on anticoagulant. CT normal, no bleeding, no large infarct. no head injury or surgery within 3 months. no history of head bleed ever! no seizure at onset of symptoms (sign of lobar hemorhage or Todds) |
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Term
| Treatment for non r-tPA candidates |
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Definition
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Term
| evaluation first 72 hours |
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Definition
| person is not a t-PA candidate. cardiac monitoring for arrythmia. labwork including toxicology. imaging/angiography. echocardiogram. neuro checks ever 2-4hrs (if suddenly worsens could be hemorhagic stroke). monitor for aspiration. MRI with diffusion weighted detects ischemic stroke. |
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Term
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Definition
| goal is to avoid stroke extension and protect ischemic penumbra. normal saline (no dextrose). keep normovolemic. keep O2 above 92%. keep blood surgars below 150. keep temp below 99. aspirin 325mg. do not lower BP unless above 210 and lower slowly. early therapy |
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Term
| long term stroke treatment |
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Definition
| aspirin, clopidogrel, extended release aspiring (dipyridamole), anticoagulation |
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Term
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Definition
| stunned neural tissue surrounding the region of stroke |
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Term
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Definition
| areas where overlap between cerebral arteries occurs don't get enough blood because of hypotension or stenosis |
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Term
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Definition
| lacunar stroke. lesion in contralateral posterior limb of the internal capsule |
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Term
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Definition
| lacunar stroke. lesion in contralateral VPL nucleus. |
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Term
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Definition
| vertebrobasilar artery and brain stem syndrome. lesion in bilateral ventral pons with sparing of reticular activating system. wakefulness maintained but can't speak or move except eyes. |
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Term
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Definition
| common tumor in kids. aberrant cerebellar granule cell formation via sonic hedgehog pathway |
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Term
| gliobastomultiform/glioblastoma |
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Definition
| epidermal growth factor amplification |
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Term
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Definition
| most common tumor of brain. no sx may be present |
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Term
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Definition
| lowest grade, completely curable. signs are headache, behavioral change, GI, gait change, school work suffers, falling, short attention span, visual or hearing impairment. pupilary changes, papilledema, seizures, neglect, memory changes, galactorrhea, menigismus. |
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Term
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Definition
| tend to present with seizures |
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Term
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Definition
| present with subtle changes |
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Term
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Definition
| temporal lobe lesion protrudes through the tentorial notch. impinges upon PCA and contralateral peduncle and ipsilateral CN 3. |
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Term
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Definition
| midline tumor compresses basal ganglia, thalamus, and midbrain. small pupils, lethargy, cheynes stokes respirations |
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Term
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Definition
| medial frontal lobe tissue is pushed under the falx cerebri anteriorly. may be asx |
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Term
| transcalvarial herniation |
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Definition
| generalized brain edema causes outward herniaition through a fractured skull |
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Term
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Definition
| cerebellar signs. cerebellum goes up |
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Term
| tonsilar or downward cerebellar syndrome |
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Definition
| sneeze or cough causes dizziness. tonsils down into foramen magnum. posterior headache, cough induced syncope, vomiting, respiratory changes. lhermittes sign |
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Term
| emergency management of herniation |
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Definition
| intubate and hyperventilate. IV mannitol, Dexamethasone |
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Term
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Definition
| young adults. seizure as first sign. nonenhancing lesion on MRI with glucose hypometabolism. no edema on MRI. resect. controle seizures. radiation if worsening. chemotherapy. survive 5 years |
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Term
| decision to operate for low grade tumors |
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Definition
| age and performance status, proximity to eloquent structures, feasibility of debulking, feasibility of complete resection, time since last attempted resection |
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Term
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Definition
| anaplastic is 20%, glioblstoma is 80%. enhancing, ring like, edematous, herniation possible, tumors are beyond capsule |
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Term
| gamma knife, cyber knife, and synergy S |
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Definition
| pin point radiation. minimizes collateral damage, and because whole brain radiotherapy can only be done once |
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Term
| glioblastoma therapeutic decisions |
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Definition
| resect, radiation to all, fliadel (biodegradable polymers soaked in carmustine), concomitant XRT plus temozolomide. stereotactic radiosurgery |
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Term
| tyrosine kinase inhibitors |
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Definition
| end in "ib" and given orally |
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Term
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Definition
| end in "mab" and given IV |
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Term
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Definition
| used in medulloblastoma and basal cell tumor treatment |
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Term
| intracranial germ cell tumors |
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Definition
| pineal region. sings are panhypopituitarianism, diabetes insipidus, visual disturbances. |
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Term
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Definition
| only makes hCG. use radiation to kill them |
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Term
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Definition
| hCG as well as alpha fetoprotein |
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Term
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Definition
| not much chemo is given, not a very important step |
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Term
| symptoms of intracerebral hemorhages |
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Definition
| severe headache, focal cerebral symptoms, sudden onset, seizure, alteration of consciousness, worsening symptoms in a short period of time, "blown" pupils from increased ICP, rapidly fatal |
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Term
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Definition
| deficits may worsen within minutes to hours |
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Term
| Evaluation of hemorhagic stroke |
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Definition
| CT without contrast, because contrast material is white and will mask the presecne of blood. lumbar puncture. BP. Fever which would indicate meningitis. |
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Term
| treatment of hemorhagic stroke |
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Definition
| no anticoagulants! keep BP lower. decompression occasionally necessary. |
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Term
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Definition
| loss of consciousness with focal findings. severe headache. increased ICP. breathing irregularities, dilated fixed pupil, extraocular movement abnormalities |
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Term
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Definition
| clipping or coiling for bleeding. seizure prevention. medications to prevent arterial spasm. intubation. BP monitoring and stabilization. |
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Term
| aneurysms <8mm in diamter |
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Definition
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|
Term
| aneurysms >8mm in diamter |
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Definition
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Term
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Definition
| associated with polycystic kidney disease. located in circle of willis. multiple and saccular. commonly found at bifurgation of arteries |
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Term
| charcot bouchard aneurysm |
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Definition
| associated with chronic hypertension. arterioles in basal ganglia, thalamus, and brainstem weakened by hypertension and swell. <1mm. rupture into parenchyma causing hemorrhagic stroke. fusiform. not saccular. |
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Term
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Definition
| intima is split off from the media and a flap of tissue. carotid most commonly. associated with SAH. pain, headache, focal neurological deficits. |
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Term
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Definition
| heparin, transition to coumadin. arterial bypass, vein grafting to close intima flap. clip involved portion of the vessel. intraarterial balloons and grafts reverse flow through vertebral artery to press flap against the vessel wall |
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Term
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Definition
| aberrant connections between vesssles not as astrong as normal connections. |
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Term
| vein-vein vascular malformations |
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Definition
| can bleed asymptomatically. cavernous hemangioma, venous angioma |
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Term
| artery-veing malformations |
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Definition
| higher risk due to higher pressure arterial blood entering the vein leading to bleeding |
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Term
| evaluation of vascular malformations |
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Definition
| can use CT or MRI with contrast because looking for blood within blood vessels |
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Term
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Definition
| embolization, radiation, resection |
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Term
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Definition
| recurrent lobar hemorhages. petechial lobar hemorhages seen on gradient echo MRI. |
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Term
| Evaluation for amyloid angiopathy |
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Definition
| cerebral biopsy stained for amyloid |
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Term
| treatment for amyloid angiopathy |
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Definition
| patients will continue to have recurrent hemorhages so don't give them anticoagulants and antiplatelet agents |
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Term
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Definition
| glioblastoma multiforme, primary CNS lymphoma, melanoma, choroicarinoma, renal cell carcinoma, bronchogenic carcinomas(most common) |
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Term
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Definition
| common early sign of meningeal irritation. neck stiffness that prevents flexion. |
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Term
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Definition
| flexing the patients hip 90 degrees then extending knee causes pain. demonstrates meningitis. |
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Term
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Definition
| flexing patients neck causes flexion of the patients hips and knees. sign of meningitis |
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Term
| viral vs bacterial meningitis |
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Definition
| bacterial meningitis has very elevated C-reactive protein level. viral meningitis has only slightly elevated C-reacive protein level. |
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Term
| peripheral leukocytosis with left shift |
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Definition
| indicative of bacterial meningitis |
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Term
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Definition
| indicative of viral meningitis |
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Term
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Definition
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Term
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Definition
| 0-5 cells/mm3 (all lymphocytes) |
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Term
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Definition
| 50-70 mg/dL or 65% of the serum glucose level |
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Term
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Definition
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Term
| acute bacterial meningitis CSF findings |
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Definition
| elevated opening pressure 200-300. elevated WBC 100-5,000, mostly neutrophils. reduced glucose level under 40. increased protein level over 100. |
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Term
| acute viral meningitis CSF findings |
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Definition
| normal opening pressure 90-200. elevated WBC 10-300, all lymphocytes. normal glucose level. normal protein level. |
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Term
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Definition
| extremely elevated body temp. positive for blood cultures for N meningitidis. skin purppuric rash on forearm that corresponds to the histopathologic lesions of vasculitis in the dermis. finding of gram-negative diplococci. |
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Term
| acute bacterial meningitis |
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Definition
| fever, nuchal rigidity, altered mental staus (triad). Kernig. Brudzinksi. elevated plasma levels of C-reactive protein, and peripheral leukicytosis with left shift. positive CSF culture for N meingitdis. neutrophilic infiltration of the leptomeningeal space at autopsy. |
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Term
| acute bacterial encephalitis |
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Definition
| signs of cerebral dysfunction (consciousness, stupor, coma) in the context of proven acute bacterial meningitis. severe brain edema with transtentorial and tonsillar herniation. neutrophilic infiltration with Virchow-Robin spaces in the cerebral cortex. |
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Term
| N meningtidis and S pneumoniae |
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Definition
| most common etiologies of acute meningitis in patients 3mo to 18yr |
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Term
| 3rd generation cephalosporin (ceftriaxone) and vancomycin |
|
Definition
| good empiric treatment for acute meningitis |
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|
Term
| risk factors for neonatal meningitis |
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Definition
| low birth weight, premature (<37 weeks gestation, peripartum infection, traumatic delivery, fetal hypoxia, premature rupture of membranes |
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|
Term
| empiric treatment for neonatal meningitis |
|
Definition
| cefotaxime plus ampicillin (for Listeria) |
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|
Term
| early onset sepsis syndrome |
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Definition
| acquisition of microorganisms from the mother. organisms in mothers GU tract. Group B strep. E coli. Haemophilus influenzae. Listeria. |
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Term
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Definition
| 4-90 days of life. acquired from caregiving environment. increase in coagulase-negative strep. |
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Term
|
Definition
| MRI reveals temporal abnormalities. treat with acyclovir |
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Term
|
Definition
| motor, sensory, and urinary disturbances. UMN lesion. dysautonomias. preceding fever, then paresthesia/back pain/leg weakness |
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Term
| workup for transverse myelitis |
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Definition
| spinal MRI is the procedure of choice. also CBC, blood cultures. |
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