Term
| Most CNS tumors are ____, followed by ___ |
|
Definition
|
|
Term
| CNS mets come from what 6 common areas? |
|
Definition
Pesky Bone Lesions Keep Getting Tested
Prostate, Breast, Lung, Kidney, GI, Testes |
|
|
Term
| Clinical manifestations of CNS tumors depend on what 4 things? |
|
Definition
size of tumor
location of tumor
rapidity of growth
hemorrhage products |
|
|
Term
| General manifestation of CNS tumors |
|
Definition
mental status change (esp decision making)
HA due to stretching of dura
Generalized convulsions
nausea
vomiting
papilledema due to elevated IOP |
|
|
Term
| Adult with new onset seizures has ___ until proven otherwise |
|
Definition
| CNS tumor (esp low grade glioma) -- get MRI |
|
|
Term
| Focal Manifestations of CNS tumor |
|
Definition
focal seizures
weakness
sensory abnormalities
language disturbance
visual defect
cerebellar defect (ataxia)
cranial nerve deficits |
|
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Term
| ___ should be your initial screening tool when you suspect a CNS tumor, but ___ is more sensitive |
|
Definition
|
|
Term
What dx?
Median age 30-40's, sometimes 20's
new onset seizures
gross pathology: ill-defined, subtle color change between disease and normal tissue
Histology: elongated, irregular hyperchromatic nuclei. dense fibrillatory matrix. no significant pleomorphism, vascular proliferation or necrosis
Radiographic characteristics: well defined mass wtih little edema (mass effect). Hyperattenuated on T2, hypoattenuated on T1 |
|
Definition
| astrocytoma (usually low grade glioma) |
|
|
Term
What diagnosis?
Median age 50-60 y/o
Presentation: new onset seizures, sx of increased ICP, focal deficit
Prognosis: 40-50% 2 year survival, 18% 5 year survival w/ tx
Histology: WHO grade IV tumor. hypercellularity, nuclear and/or cytoplasmic pleomorphism, endothelial hyperplasia, necrosis, hemorrhage products
IMaging: butterfly pattern in corpus callosum. central area of symmetric necrosis (can mimic abscess)
Tx? |
|
Definition
Glioblastoma Multiforme (GBM)
tx: surgery (if possible) but it will usually come back, radiation |
|
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Term
What diagnosis?
Median age 13 y/o
30% of all posterior fossa tumors of childhood
80% located in posterior fossa
Slow-growing
90-100% 10 year survival rate
Gross pathology: circumscribed mass, cycstic component, mural nodule
Histopathology: WHO grade 1, benign-looking, biphasic pattern, fusiform cells with piloid processes, rosenthal fibers, eosinophilic granular bodies
Imaging: well circumscribed, cystic mass. enhancing mural nodule
Sx: headache, CN deficits, numbness. If kid, "just not acting right"
tx? |
|
Definition
pilocytic astrocytoma (often juvenile)
tx: surgery - chemo and radiation NOT indicated unless recurrence |
|
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Term
| a child with a tumor in the hypothalamus, think ____ |
|
Definition
|
|
Term
What diagnosis?
0..8-6.6% of primary intracranial neoplasms
Peak incidence 6-7th decades
M:F 3:2
Often associated with HIV
Gross pathology: single or multiple masses, circumscribed partially necrotic parenchymal-based tumor. firm, friable, necrotic, or hemorrhagic. commonly affecets cerebral hemispheres
Histology: angiocentric pattern, diffuse large b-cell
Imaging: butterfly pattern |
|
Definition
Lymphoma
tx: steroids and radiation. NOT surgery |
|
|
Term
What diagnosis?
F:M 3:2
6th-7th decade
typically benign
Gross pathology: well demarcated, rubbery, firm mass. may compress adjacent parenchyma
Histology: WHO grade I, monomorphic cells, nuclei oval to round with inconspicuous nuclei, psammoma bodies, whorl
Imaging: well circumscribed mass
tx? |
|
Definition
meningioma
tx: none, surgery |
|
|
Term
What diagnosis?
Peak during 4th decade
Survival: inversely proportional to age. WHO II: 10-15 years, WHO III: 3-5 years
tend to degrade into GBM over time
gross pathology: in cerebral hemispheres, rarely brainstem, cerebellum, spinal cord
histology: WHO grade II. Uniform round nuclei, clear perinuclear halo "FRIED EGG PATTERN". Chicken wire-like branching capillary network
Imaging: calcium deposits
presentation: focal deficits, increased IOP, seizure
tx? |
|
Definition
Oligodendroglioma
tx: surgery |
|
|
Term
| Common sites of primary tumors that met to brain |
|
Definition
lung
breast
melanoma
colorectal
renal |
|
|
Term
imaging: concentric mass with lots of cerebral edema (greatly exceeds the size of the tumor)
dx?
tx? |
|
Definition
brain mets
Tx: surgery followed by radiation
Look for mets elsewhere with imaging |
|
|
Term
| If you see several small speckled mets in the brain, it's usually _____ |
|
Definition
|
|
Term
4 types of spinal tumor:
1. ____: typically mets. in kids, think osteoma
2. ___: benign, schwannoma, neurofibroma, meningioma. tx with surgery
3. ___: astrocytoma, epineuroma, oligodendroma
4. ____: myxopapillary epineuroma. good prognosis with surgery |
|
Definition
bony/vertebral
extradural/extramedullary
intrinsic
intradural/extramedullary --> not a "main" type |
|
|
Term
| if pt has swelling on the brain, prescribe ___ before you do anything else |
|
Definition
|
|
Term
Pituitary tumor: immediately refer to what 3 specialists.
Get what 7 labs? |
|
Definition
neuro, ophtho, endocrine
FLAT PIG: FSH, LH, ACT, TSH, Prolactin, Ignore, Growth hormone/somatostatin |
|
|
Term
|
Definition
| excision followed by IV abx |
|
|
Term
Which is a sign of alzheimer's as opposed to normal memory loss?
sudden onset of cognitive impairment
difficulties finding fimiliar words
difficulties using new gadgets
difficulty recalling people's names |
|
Definition
| difficulties using new gadgets (executive function) |
|
|
Term
____: cognitive impairment that does not appear to interfere with daily/social functioning. this is a precursor to all kinds of dementia
____: cognitive impairment that signficiantly interferes with daily functioning |
|
Definition
mild cognitive impairment (MCI)
dementia
|
|
|
Term
evaluating pts wtih early signs of memory or cognitive impairment is important because:
1. Early tx of MCI can reverse cognitive deterioration
2. Identification of MCI enables pts to address contributing factors and plan for the future
3. Younger age at first diagnosis predicts rapid functional decline
4. Early tx can prevent development of psychiatric sx and prevent caregiver burnout |
|
Definition
| Identification of MCI enables pts to address contributing factors and plan for the future |
|
|
Term
What dx?
Increased risk for dementia/alzheimers
faster rate of cognitive decline
may result from contributing factors that are treatable (heart disease, HTN, DM)
can be precursor of several types of dementia
older persons (>65( with MCI are 5 times more likely to develop dementia than persons w/o it |
|
Definition
|
|
Term
A brain condition that results in:
-memory loss
- possible damage of several brain areas
- cognitive problems (loss of executive fxn, confusion, psychosis)
- behavioral disturbance (agitation, personality change) |
|
Definition
|
|
Term
Top 5 causes of dementia
1. (50-75%)
2. 10-20%
3. 10-15%
4. 5-10%
5. 5-15% |
|
Definition
Alzheimer's
Vascular dementia
Dementia with Lewy Bodies
Frontotemporal dementia
Others (metabolic, substance induced) |
|
|
Term
____: Starts in the temporal lobe. Fluent/Wernicke's/Receptive Aphasia
___: starts in the frontal lobe. Non-fluent/Broca's/Expressive aphasia |
|
Definition
Alzheimers - fluent Frontotemporal dementia - non-fluent |
|
|
Term
Which kind of aphasia?
1. ____ can speak fairly well but wihtout meaningful content. seen in alzheimer's
2. ____ can understand what is being said to them but cannot produce the words (spoken or written) that they want to
3. ____ both kinds of aphasia together |
|
Definition
Fluent/Wernicke's/Receptive Aphasia
Non-fluent/Broca's/Expressive Aphasia
Mixed aphasia |
|
|
Term
What dx?
The development of multiple congitive deficits manifested by:
- memory impairment plus 1 or more:
- aphasia, apraxia, agnosia, disturbance in executive functioning (planning, organizing, sequencing, abstracting)
Significant impairment in social/occupational functioning. signficant decline from a previous level of functioning.
Gradual onset and continuing cognitive decline
the cognitive deficits are NOT related to other causes |
|
Definition
|
|
Term
What lobe is each function found in?
1. Planning/language expression/speech/movement
2. taste/touch, visuospatial
3. language reception
4. vision |
|
Definition
frontal
parietal
temporal
occipital |
|
|
Term
___: most important part of the brain in terms of memory
___: part of the brain that produces NE
___: part of the brain that produces serotonin
All areas are dysfunctioning in Alzheimers |
|
Definition
hippocampus
locus coeruleus
raphe nucleus |
|
|
Term
Clinical features of ____:
1. amnestic memory defect (difficulty learning and recalling new info.. progresses to long term memory loss)
2. progressive language disorder (first anomia [forgetting names], then progression to fluent aphasia)
3. disturbances of visuospatial skills - environmental disorientaation (getting lost, inability to figure out a map), coordination problems (apraxia), difficulty copying figures
4. Loss of executive functions (insight, judgment, planning)
5. Personality changes (loss of interest, anger, hypersexuality, impulsivity)
6. psychosis: delusions, confabulation, visual/auditory hallucinations
7. pt denies a problem
8. gradual disease progression |
|
Definition
|
|
Term
| most common cause of death in alzheimer's pts? |
|
Definition
|
|
Term
| ____ is the main neurotransmitter affected by Alzheimer's |
|
Definition
|
|
Term
Pathophysiology of Alzheimer's:
1. hyperphosphorylation of ___ proteins cause microtubules in neurons to collapse and the proteins to clump together, causing _____. This is the first characteristic histopathological finding in AD. Build up INSIDE the nerve cell.
2. amyloid precursor protein sticks through the neuronal membrane, where it is cut into pieces of beta-amyloid. These beta-amyloids clump together and form ____. These plaques obstruct blood flow and cause neurons to die. This is the second characteristic histopathological finding of AD. Build up OUTSIDE the nerve cell. |
|
Definition
1. tau proteins, neurofibrillary tangles
2. amyloid plaques |
|
|
Term
Amyloid cascade hypothesis (AD Pathophys):
amyloid buildup is taken care of by the body in 5 ways: ___. ____. ____. ____. ____.
These processes result in extra damage to neurons |
|
Definition
oxidation, inflammation, Beta amyloid aggregation, excitotoxicity, taue hyperphosphorylation
|
|
|
Term
what dx?
histopathological findings:
beta amyloid plaques
neurofibrillary tangles
granulovacuolar degeneration of shimkowicz (in hippocampus)
neuropil threads of braak
neuronal loss and synaptic degeneration
mitochondrial cascade |
|
Definition
|
|
Term
| ___ is usually the first sign of alzheimers |
|
Definition
|
|
Term
| What actual changes to the structure of the brain happen during AD? |
|
Definition
| ventricles enlarge, cortex degnerates |
|
|
Term
What dx?
Neurochemistry:
Activity of choline acetyltransferase (CAT) and acetylcholinesterase is greatly reduced
Nucleus basalis of Meyner and diagonal band of broca (provide main cholinergic input) are lost
glutamate overproduction - produces psychosis |
|
Definition
|
|
Term
ApoE4 gene on chrom 19 (more copies = higher chance)
Lack of ApoE E2 gene
Down's syndrome
Presenilin
DM, HTN, dyslipidemias, hypothyroidism, stroke, head injury, increased homocystein
Low serum folate/vit B12
all are risk factors for ____ |
|
Definition
|
|
Term
| What tests do you run on a pt wtih suspected alzheimer's? |
|
Definition
chemistry panel (Ca, phosphorus)
liver/renal function
CBC/RPR/TSH/B12
Drug screen
All to rule out other causes of dementia
Also: MMSE, CT, PET, CT/MRI, EEG, CSF |
|
|
Term
|
Definition
1. Cholinergic: Aricept (ACE inhibitors)
2. Antioxidants: N-acetylcysteine, berres, red wine
3. Anti-inflammatories: fish oils, NSAIDS
4. Alzheimer's vaccine (destroys amyloid plaques)
5. Excitotoxicity: NMDA receptor stabilizer (namenda), Ca channel blockers
other drugs to treat each sx:
Haldol for sundowning |
|
|
Term
| ___ is the #1 cause of neurologic cause in the western hemisphere. ___ is #2. |
|
Definition
|
|
Term
What dx?
Pathophys:
Perivenular cuffing with inflammatory Th cells that release cytokines
Demyelinzation of central nerves cause conduction blocks
Stimulated macrophages and microglial cells
astrocytes proliferate (gliosis)
Remyelinization or total axonal destruction |
|
Definition
|
|
Term
___: occurs when a nerve impulse is unable to traverse a demyelinated segment
___: occurs with raised body temp or metabolic alterations and may explain clinical fluctations that vary from hour to hour in MS patients = "pseudoflare" |
|
Definition
|
|
Term
what dx?
MRI:
Dawson's fingers - plaques extending outward from a ventricle
Long, tumor-mimicking segments in the spinal cord
Brain atrophy (over time)
Other plaques that "light up" on MRI |
|
Definition
|
|
Term
| If an MS pt begins to have signs that do not go away and the disease seems to be progressing, you can be sure that ____ has occured. |
|
Definition
|
|
Term
Sx of what disease?
Listed in decreasing order:
sensory loss
optic neuritis - dulling of colors, blurring/darkness of vision. maybe eye pain. unreactive pupil (APD)
weakness
paresthesias
diplopia
ataxia
vertigo
paroxysmal attacks of ballismus
bladder problems
Lhermitte's
pain
dementia
visual loss
facial palsy
impotence
myokymia - "dancing of muscles"
epilepsy
falling |
|
Definition
|
|
Term
What are the 4 variable courses of MS?
1. ___: 85% of cases. attacks that tend to resolve over a few weeks. pts are neurologically stable between attacks
2. ____: always begin as #1 and at some point progress to this. defined as steady deterioration in fxn not associated wtih acute attacks.
3. ____: pts do not experience attacks but only a steady functional decline
4. ____: steady decline PLUS acute attacks. Combo of #2 and 3. |
|
Definition
1. relapsing/remitting (RRMS)
2. Secondary progressive (SPMS)
3. Primary progressive (PPMS)
4. Progressive/relapsing (PRMS) |
|
|
Term
| major concept behind diagnosis of MS |
|
Definition
| dissemination in time and space -- two areas of cns are immunologically attacked at two different times |
|
|
Term
| Tests to perform if MS is suspected |
|
Definition
NO DEFINITIVE TEST
PE FINDINGS:
1. Objective findings: APD, hemiparalysis
2. white matter long tract signs: hyperreflexia, spasticity, distal upper limb weakness, variable distribution lower lib weakness
3. sx lasting >24 hr and occuring at least one month apart or in progression over 6 mos
MRI:
two or more areas of plaques
LP:
reactive CSF (antibodies in CSF)
|
|
|
Term
|
Definition
Cannot be attributed to another disease
McDonald Criteria - dissemination in time and space
Barkhof MRI criteria for dissemination in space |
|
|
Term
25 y/o female presents with hyperreflexia, numb foot
hx of optic neuritis at age 18
MRI: areas "lighting up" around ventricles
dx? |
|
Definition
|
|
Term
B12 deficiency, vasculitis, ADEM, lymphoma, infection, genetic problems, leukodystrophy, behcet's disease, spinal dural fistula, sjogren's, lupus
all can mimic ?? |
|
Definition
|
|
Term
MS Tx
acute and immunomodulatory to delay onset of disease |
|
Definition
Acute: Methylprednisone/glucocorticoids (Steroid) 1000mg IV for 3-5 days, plasmapharesis (plasma exchange), IVIG
immunomodulatory:
interferon IM or SQ
copaxone SQ
tysabri IV -- check JC ab's before giving it to a pt due to risk of PML
Gilyena
|
|
|
Term
| Pt wtih MS is given tysabri and then has an MS attack. How do you know if it's the MS or the tysabri? |
|
Definition
| do an LP and look for JC antibodies in CSF |
|
|
Term
| 3 cardinal signs of parkinsons |
|
Definition
1. 4-6 hz (slow) asymmetrical rest tremor. "pill rolling"
2. rigidity - increased tone having nothing to do with speed of muscle stretch
3. asymmetrical bradykinesia - slow movement (eye blink, hesitation of movement)
also - response to therapy. if it doesn't respond, it's not parkinson's |
|
|
Term
sx of what dz?
bradykinesia
bradyphrenia
cogwheeling - rotate hand and wrist catches
orthostasis
REM sleep behavior disorder
cognitive/psych disturbance (executive dysfunction, dementia, psychosis, punding, compulsions, hypersomnulence, sleep apnea)
rigidity
tremor
stooped posture (camptocormia) |
|
Definition
|
|
Term
what dx?
pathology:
- loss of dopaminergic cells in substantia nigra - pars compacta area due to genetics, oxidative stress, and abnormal kinase activity
- lewy body accumulation in midbrain
- later progression involves degeneration of thalamus and cortex |
|
Definition
parkinson's
pars compacta = parkinson's causing |
|
|
Term
Sx course of what dz?
Listed in order of appearance:
- non-motor sx: depression, speech disorder, sleep disorder, dementia, urgency, constipation, orthostasis
- early motor sx (clinical diagnosis made here): fluctuations, dyskinesias, falls
- decreasing motor response, dementia, psychosis |
|
Definition
|
|
Term
DDX for parkinson sx -- Parkinson's Plus diseases:
1. ____ - multiple system atrophy. prominent orthostasis. striatonigral degeneration, olivopontocerebellar atrophy (ataxia, dementia). lewy body disease (prominent, scary hallucinations)
2. ____ - progressive supranuclear palsy (early, frequent falls), corticobasal degeneration (asymmerical cortical signs), alien limb
3. ___ - amyloid deposition |
|
Definition
alpha synucleinopathy
tau-opathy
alzheimer's
these are distinguished by lack of tremor, symmetrical, axial rigidity, and early dementia |
|
|
Term
young person with parkinson sx, slurred speech, trouble swallowing, chorea, athatosis
24 hour urine: high copper
dx?
tx? |
|
Definition
wilson's disease
chelation |
|
|
Term
| difference between parkinson's tremor and essential tremor |
|
Definition
parkinson's: slow, unilateral, rest
essential: faster, bilateral, more prominent with action |
|
|
Term
|
Definition
helps sx but does not alter course of disease
started when functionality is lost
1. dopamine agonist (pramipexole, ropinirole)
2. Levodopa/Carbidopa - helps well with motor control
3. Add COMT or MAO-B inhibitor
4. Adjunct therapy (anticholinergic, amantadine, apomorphine)
5. deep brain stimulation |
|
|
Term
Pt with neuropathy.. what kind is it likely to be?
1. vague/wide distribution
2. definitive territory
3. distal "stocking-glove" |
|
Definition
1. wide: CNS or plexopathy
2. definitive territory: dermatome or individual peripheral nerve
3. stocking-glove: polyneuropathy |
|
|
Term
Pt with family hx of these diseases is at increased risk for ____:
tapered legs
weakness
trouble walking
high arches
flat feet
charcot marie tooth disease (CMT) -- hereditary motor sensory neuropathy
muscular dystrophy |
|
Definition
|
|
Term
Where do motor nerves cross over?
where do senosry nerves cross over? |
|
Definition
|
|
Term
| what senses does the spinothalamic system control? The dorsal columns? |
|
Definition
spinothalmaic: pain, temp
dorsal column: precise touch, kinesthesia, position, vibraiton
|
|
|
Term
| Pt's great toe is numb to pinprick but still has joint position sense. where is the problem? |
|
Definition
| spinothalamic tract - spinal cord |
|
|
Term
| status post cardiac catheterization, pt presents with lost pulses in feet and inability to raise leg |
|
Definition
| bleeding in pelvis is compressing nerves |
|
|
Term
where is the problem?
1. loss of DTR
2. hyperreflexia, pos babinski |
|
Definition
1. peripheral nerve problem
2. cns problem |
|
|
Term
nerve conduction study results:
1. AP is small = ___ problem
2. AP is late = ___ problem |
|
Definition
|
|
Term
what kind of neuropathy?
single nerve is affected, usually due to compressive or traumatic etiology
tx: surgical
Types:
1. presents with wrist drop due to loss of extension of the hand. what do you need to r/o?
2. Presents with abduction weakness/pain/parasthesia of hand/thumb/first 3.5 fingers
3. presents with inability to spread fingers, numbness on 4th & 5th fingers
4. diminished/absent patellar reflex + numbness/weakness in upper leg
5. burning/numbness in lateral thigh. common in DM, obese, pregnancy, tight clothes
6. pain/weakness in hamstring down to foot. common in people who drive a lot or who are bedridden or s/p pelvic fx
7. dorsiflexion, eversion, big toe extension lost (foot drop). numbness between first and great toes. can caused by fibular fx or by crossing legs too much.
8. numbness/pain in foot. common in runners. tx is surgery or steroids |
|
Definition
mononeuropathies
1. radial nerve (saturday night) palsy. need to r/o humerus fx. will get better in 6 weeks
2. median nerve palsy (carpal tunnel). may need surgery
3. ulnar nerve (funny bone, condylar tunnel syndrome)
4. femoral nerve palsy
5. lateral femoral cutaneous nerve
6. sciatic neuropathy
7. peroneal nerve
8. tibial nerve (tarsal tunnel syndrome) |
|
|
Term
what neuropathy?
clavicle and first rib compress brachial plexus
sx in medial hand
reproduce sx by stretching head to opposite side |
|
Definition
| neurogenic thoracic outlet syndrome |
|
|
Term
what neuropathy?
multifocal involvment of peripheral nerves
often painful
systemic vasculitides (polyarteritis, RA, SLE, wegener's) |
|
Definition
|
|
Term
what dx can cause these?
- symmetric neuropathy in stocking-glove distribution
- cranial neuropathies due to nerve infarct (Vi, III, VII, V)
- limb mononeuropathies
- radiculopathies and plexopathies (amyotrophy) |
|
Definition
|
|
Term
what dx?
nerve root plexus inflammation caused by DM
bilateral
achy back pain + weak proximal legs
loss of reflexes
tx? |
|
Definition
diabetic amyotrophy
tx: high dose steroids |
|
|
Term
what dx?
ptosis, eye is down and out, headache
PUPIL IS SPARED |
|
Definition
| diabetic third nerve palsy |
|
|
Term
What kind of nutritional neuropathy?
1. acute or subacute paresthesias, dysesthesias, mild weakness in legs (stocking-glove). loss of ankle reflex. could cause dementia or ataxa. "wet beriberi"
2. axonal damage caused by diet or tb drugs
3. distal sensory loss, disequilibrium, Lhermitte's, absent ankle relfex, glossitis, upgoing toe. CBC: pancytopenia
4. pellagra - dermatitis, diarrhea, dementia, neuropathy |
|
Definition
1. thiamine deficiency (b1)
2. pyridoxine (B6)
3. cobalamin (b12)
4. niacin
all are treated with supplements |
|
|
Term
all are caused by what disease?
distal symmetric polyneruopathy
guillain barre/chronic inflammatory demyelinating polyneuropathy
mononeuropathy multiplex
CMV polyradiculopathy
herpes zoster, TB, lymphoma, toxic neuropathy |
|
Definition
|
|
Term
painful, small fiber neuropathy caused by HIV antiretroviral drugs
painful paresthesias, distal sensory loss, absent ankle jerk |
|
Definition
| distal symmetric polyneuropathy |
|
|
Term
| radiculoneuropathy + CN VII palsy (facial droop on one side) |
|
Definition
|
|
Term
distal stocking glove sensorimotor neuropathy
20-40/100,000 incidence
tapered legs, hammer toes, high arches, inability to walk on heels or do tandem gait
walk in a march |
|
Definition
| charcot marie tooth disease |
|
|
Term
acute, fulminate polyradiculoneuropathy
autoimmune
areflexic paralysis, distal more than proximal
spinal pain
loss of vasomotor (ANS) control (bradycardia, hypotension)
rarely loss of bowel or bladder control
70% of cases occur after resp or GI viral infection
EMG/NCS: velocity greatly slowed, evidence of proximal damage
LP: elevated proteins in CSF, elevated WBC |
|
Definition
guillain barre syndrome
tx: must start within 2 weeks! plasma exchange + IVIG |
|
|
Term
| basically chronic, relapsing guillain barre syndrome |
|
Definition
chronic inflammatory demyelinating polyneuropathy
tx with IVIG, plasma exchange, glucocorticoids, and immunosuppression |
|
|
Term
asymmetric PAINFUL sensory ataxia syndrome
usually small cell lung cancer
Anti-Hu antibodies
typical pt: smoker. lost weight, feels sick, funny walk, rapid paiful asymmetrical neuropathy. |
|
Definition
paraneoplastic neuropathy
check anti-hu levels
PET scan |
|
|
Term
| pt has very high intracranial pressure (eg, non-communicating hydrocephalus). what do you NOT want to do to them? |
|
Definition
|
|
Term
1. CNS infection predominantly localized to the subarachnoid space
2. brain tissue viral infection
3. diffuse bacterial fungal or parasitic infection of the brain tissue. inflammation of the brain
4. local bacterial fungal or parasitic infection of the brain tissue.
5. a clinical description of a process involving the meninges, subarachnoid space, and parenchyma
6. infection localized to the space between the dura and arachnoid |
|
Definition
1. meningitis: CNS infection predominantly localized to the subarachnoid space
2. encephalitis: brain tissue viral infection
3. cerebritis: diffuse bacterial fungal or parasitic infection of the brain tissue. inflammation of the brain
4. abscess: local bacterial fungal or parasitic infection of the brain tissue.
5. meningoencephalitis: a clinical description of a process involving the meninges, subarachnoid space, and parenchyma
6. empyema: infection localized to the space between the dura and arachnoid
|
|
|
Term
| pt is given bactrim or IVIG and comes in a few days later with HA, fever, and elevated (100) wbc in csf. dx? |
|
Definition
|
|
Term
classic triad of meningitis?
other sx? |
|
Definition
triad: headache, fever, stiff neck
others: visual sx (decreased acuity), seizures, confusion, localized pain, pupura, photophobia |
|
|
Term
pt presents with ha, fever, stiff neck, and purpura
brudzinski's and kernigs +
dx?
cautions?
labs?
tx? |
|
Definition
meningiococcal meningitis
contagious!
Blood culture and abx FIRST
CSF study
Ct/MRI - do first if posturing, coma, decreased alertness, focal neuro findings
CBC, chem profile, drug and alcohol screens if appropriate |
|
|
Term
1. test that is positive when the pts knees bend when you bend their neck to their chest
2. test is pos when you straighten one leg from a supine position |
|
Definition
brudzinksi's -- Bend the head
KErnig's -- Knee Extension |
|
|
Term
| 3 CNS infections that are an emergency |
|
Definition
bacterial meningitis
herpetic encephalitis
epidural abscess (due to risk of paralysis) |
|
|
Term
papilledema
altered mental state
nerve palsy
focal neurologic signs
posturing
all are red flags for??
what should you do about it? |
|
Definition
|
|
Term
| Tests done when you suspect bacterial meningitis |
|
Definition
ct/mri - if abnormal neuro exam
blood culture
LP - need opening pressure under 18
CSF study |
|
|
Term
| 5 most important causes of bacterial meningitis |
|
Definition
group b strep- dangerous if pregnant
listeria monocytogenes
*strep pneumonia -- most prevalent in adults
*neisseria meningitidis -- college kids
*H. influenza
* = vaccine |
|
|
Term
dx?
most common cause of meningitis in adults
recent pneumonia, sinusitis, or otitis media
immunocompromised pts
head trauma, skull fx, or csf leak
mortality 20% with tx
lancet-shaped diplococci |
|
Definition
| strep pneumonia meningitis |
|
|
Term
dx?
most common cause of meningitis in college kids
only type that occurs in outbreaks
exposure via close intimate contact
fulminant presentation: petechia or purpura, immunocompromised rapidly succumb to sepsis
vaccine available
gram neg intracellular diplococci |
|
Definition
neisseria meningitidis
"meningococcal" |
|
|
Term
dx?
common cause of neonatal sepsis
dangerous if mom with this dx
uncommon after age 2, before age 50
seen in DM and lymphedema
tx with penicillin or cephalosporin |
|
Definition
|
|
Term
accounts for 8% of meningitis
gram pos rod in CSF or blood
bimodal peak of incidence: 20% under 1 m/o, 20% over 60
food borne (processed foods, dairy)
treatment? |
|
Definition
listeria monocytogenes
ampicillin |
|
|
Term
Meningitis tx
pneumococcus/meningicoccus
gram+, MRSA
listeria |
|
Definition
cephtriaxone - pneumococcus/meningicoccus
vancomycin - gram +/MRSA
ampicillin - Listeria |
|
|
Term
Common cause of COPD exacerbation
rarely seen if children are vaccinated |
|
Definition
|
|
Term
meningitis caused by gram neg bacilli
seen in neonates
seen following trauma or neurosurgery (due to incision through skin)
can be spotaneous - DM, alcoholism, cirrhosis, chronic UTI
common pt: had VP shunt put in and developed meningitis following surgery |
|
Definition
|
|
Term
Meningitis Vaccines
1. ____: polysaccharide vaccine against strep pneumonia used in adults
2. ____: polysaccharide vaccine against strep pneumonia used in kids >2
3. ____: conjugated vaccine against strep pneumonia used in kids <2
2 other viruses with vaccines? |
|
Definition
penumovax
pnu-immune
prevenar
n. meningitidis
h. flu |
|
|
Term
| prophylaxis for those exposed to meningitis |
|
Definition
| rifampin, quinolone, azithromycin, ceftriaxone |
|
|
Term
Pt presents with acute onset severe headache, fever, photophobia, meningismus in late summer/early fall
LP: lymphocytic pleocytosis, no identifiable causative agent
dx?
tx? |
|
Definition
aseptic (viral) meningitis
or drug-caused
no tx if viral
start abx until you get csf back
|
|
|
Term
most common causes of viral meningitis
how can you differentiate? |
|
Definition
enteroviruses (Coxsackie), herpes, and leptospira
diagnosed via PCR |
|
|
Term
sx: chronic headache, neck pain, double vision, hearing loss, sphincter dysfunction, falling
exam: papilledema, cn deficits, delerium/dementia, myelopathy, radiculopathy
dx? |
|
Definition
chronic meningitis
causes:
recurrent aseptic from drugs
mollaraise from recurrent HSV2
syphillis
lyme disease
helminthic (cysticercosis)
fungus (crypto) |
|
|
Term
| causes of aseptic meningitis |
|
Definition
abx
bartonella (cat scratch)
rabies
HCV
thyroiditis
paraneoplastic
EBV
|
|
|
Term
sx: 1-7 upper resp sx, behavior changes & delirium, followed by sudden onset ha + fever + seizure
MRI: temporal lobe blebs
dx?
tx? |
|
Definition
HSV encepalitis (caused by HSV1)
immediate IV acyclovir for 14 days
|
|
|
Term
sx of space-occupying lesion in brain
spread from another infection (lung abscess, endocarditis, sinusitis, OM)
often caused by multiple organisms
dx?
treatment? |
|
Definition
brain abscess
abx + drainage |
|
|
Term
fever, ha, subdural fluid collect on CT
complication of sinuisitis or OM
dx?
tx? |
|
Definition
subdural empyema
surgical drainage and IV abx |
|
|
Term
20-40 y/o female with fever + focal, referred neuro sx (pain/weakness in legs, decreased sphincter tone)
complication of pyogenic osteomyelitis of spine or psoas abscess
dx?
tx? |
|
Definition
spinal epidural abscess
tx: abx
can result in paralysis... must be closely watched |
|
|
Term
prion disease
sx: dementia, parkinsonism, myoclonus, deaht in months to years |
|
Definition
| Creutzfeldt Jacob disease |
|
|
Term
toxoplasmosis
primary CNS lymphoma
cryptococcus
TB
PML
all are ___ infections associated with HIV |
|
Definition
|
|
Term
mold, aspergillus
bacterial brain abscess
VZV
all are opportunistic infections caused by _____ |
|
Definition
|
|
Term
22 y/o male private from ft wood
sx: HA, fever, photophobia, neck stiffness
Temp 102, meningismus on exam, no rash
PE otherwise nml, AOX3
Peripheral blood: WBC 1,800, PMN=40, B=25, Meta=10, Myeolcytes=5, Lympho=5, PLT=45
Na=122, AST=250, ALT=195, Tbili 2.0
dx?
tx? |
|
Definition
bacterial meningitis - n. meningitidis
steroids, abx (vanc and ceph) |
|
|
Term
|
Definition
| used to interpret CSF studies - takes into account age, season, neutrophil, CSF:serum glucose |
|
|
Term
31 WF into ED with 5 days of back pain, 24h of fever, and chills.
ROS otherwise negative
PMH, ALL, FAM HX all neg.
Remote hx of IVDU – IV drug user |
|
Definition
| epidural abscess -- BACK PAIN with FEVER |
|
|
Term
pt with herpes zoster ophthalmicus (first trigeminal division)
tx? |
|
Definition
IV acyclovir x 2 d
followed by high dose valtrex |
|
|
Term
| most strokes are what kind |
|
Definition
|
|
Term
| How does atherosclerosis cause strokes intracranially v. extracranially? |
|
Definition
intracranial: hard plaques build up an oclude a vessel or throw clots
extracranial: soft plaques break off and send emboli |
|
|
Term
| ways that vessels can cause stroke |
|
Definition
1. embolism/thomrbus
2. vasculitis - due to blockae by wbc
3. dissection - trauma
4. fibromuscular dysplasia - excess collagen formation
5. aneurysm - congenital weakness of elastic lamina |
|
|
Term
>45 y/o
visual loss (central scotoma or amorosis fugax) on one side
temporal tenderness
elevated ESR
polymyalgia rheumatica (aches and pain in neck, shoulder, weight loss)
dx?
tx? |
|
Definition
temporal arteritis
do temporal artery bx
pt needs to be on steroids ASAP to preserve vision |
|
|
Term
growth factor mutation cuases transformation of smooth muscle cells into myofibroblasts and excess collagen formation. leads to arterial stenosis, dissections of arterial wall and aneurysm
more in women
variable severity
carotid angiogram: "pearl necklace" beading in artery
dx? |
|
Definition
fibromuscular dysplasia
check renals too! |
|
|
Term
| ways that cardiac pathology can lead to stroke |
|
Definition
1. stasis in heart chambers (MI, Afib)
2. patent foramen ovale + atrial septal defect
3. congenital heart disease
4. vascular disaese |
|
|
Term
pt with MI - why do you give them heparin?
why do you give recurrent afib coumadin? |
|
Definition
|
|
Term
|
Definition
stroke caused by DVT that travels through the heart and to the brain
pulmonary AV malformations and patent foramen ovale cause this |
|
|
Term
|
Definition
acquired coagulopathy
congenital - factor mutations, sickle cell
liver/kidney dysfuntion
DIC
infection
cancer
malnutrition
dialysis/plasma exchange
pre-eclampsia
|
|
|
Term
how is sickle cell treated?
what % have stroke? |
|
Definition
transfusions & bone marrow transplant
30% |
|
|
Term
| opiates, amphetamines, >2 drinks a day can cause? |
|
Definition
|
|
Term
lateral stroke will affect what parts of the body?
medial? |
|
Definition
lateral: mouth, hands, arms
medial: legs, genitalia |
|
|
Term
| broca's aphasia + right handed drift + right sided facial weakness = what artery had the stroke? |
|
Definition
|
|
Term
1. inappropriate regulation of muscle tone
2. reflex distraction to sights and sounds |
|
Definition
|
|
Term
| Horner's syndrome as distinguished from 3rd Nerve palsy |
|
Definition
horners: miosis, ptosis, anhydrosis
3rd nerve: ptosis, mydriasis, eye down and out |
|
|
Term
| midbrain infarction causing CNIII palsy ipsilaterally and hemiplegia contralaterally |
|
Definition
| Weber syndrome (due to PCA infarction) |
|
|
Term
Where is the stroke?
cortical fxn loss: expressive aphasia, agraphia, acalcula, alexia, neglect, gaze deviation toward infarction
contralateral hemiparesis/sensory loss arm > leg
contralateral hemianopia (visual field loss) |
|
Definition
|
|
Term
Where is the stroke?
Horner's sign: miosis, ptosis, anhydrosis --> ISPSILATERAL
cortical fxn loss: expressive aphasia, agraphia, acalcula, alexia, neglect, gaze deviation toward infarction
contralateral hemiparesis/sensory loss arm > leg
contralateral hemianopia (visual field)
lethargy/stupor |
|
Definition
|
|
Term
Where is the stroke?
contralateral hemiparesis/sensory loss: leg > arm
apraxia, abulia, expressive aphasia
frontal release signs: contralateral grasp reflex, sucking reflex, gegenhalten
Alzheimer's sx: personality changes, amnesia, confusion |
|
Definition
|
|
Term
Where is the stroke?
Weber syndrome: ipsilatery CN III palsy + contralateral hemiplegia
contralateral homonomous hemianopia, sensory loss, memory loss |
|
Definition
|
|
Term
Where is the stroke?
ataxia, diplopia, coma
CROSSED FINDINGS:
ipsilateral - CN neuropathy, facial paralysis, sensory loss
contralateral - limb paralysis, sensory loss |
|
Definition
| vertebral-basilar artery --> brainstem infarction |
|
|
Term
Where is the stroke?
contralateral limb paralysis + ipsilateral facial paralysis |
|
Definition
|
|
Term
Where is the stroke?
lenticulostrial occlusion -- internal capsule
weakness problems only |
|
Definition
| pure motor lacunar stroke |
|
|
Term
Where is the stroke?
thalamoperforant artery (thalamus)
numbness only |
|
Definition
| pure sensory lacunar stroke |
|
|
Term
Where is the stroke?
internal capsule
speech and hand problems only |
|
Definition
| dysarthria clumsy hand syndrome |
|
|
Term
Where is the stroke?
paralysis with retained joint position sense
Watershed area: above the area of stroke
often due to aortic aneurysm/dissections |
|
Definition
|
|
Term
| transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia wihtout acute infarction proven by scan |
|
Definition
|
|
Term
| if pt has focal neuro sx that clear up but still has evidence of damage on MRI... is it a tia? |
|
Definition
|
|
Term
| 70-80% of hemorrhagic strokes are in ___ pts |
|
Definition
|
|
Term
alzheimer's pt presents with stroke sx
no hx of htn
MRI: blooming of micro hemorrhages
dx? |
|
Definition
|
|
Term
| presentation: depressed level of consciousness (lethargy, stupor), posturing, hyper-reflexia, hemiparesis |
|
Definition
| intraparenchymal hemorrhage |
|
|
Term
Pt presents wtih sudden onset "worst headache of my life"
may have LOC
no neuro deficits (usually)
MRI: bright white in sulci |
|
Definition
SAH
** initial CT can be neg in 10% ** |
|
|
Term
| pt with stroke-like sx and fever, think .... |
|
Definition
|
|
Term
| What do you do when a pt comes in with stroke like sx? |
|
Definition
secure ABC
follow AHA ACLS protocols
place IV and O2
CT w/o contrast or MRI
CBC, BMP, PT, PTT
EKG - afib? MI?
CXR - tumor? aortic aneurysm?
LP - for severe headache only - blood or meningitis?
carotid US |
|
|
Term
|
Definition
| post-seizure deficit - can mimic stroke |
|
|
Term
|
Definition
MRI with diffusion weighted imaging
screen for vessel dz: carotid US, MRA, CTA, transcranial doppler, EKG (afib), echo, blood work (coagulopathy) |
|
|
Term
|
Definition
TPA
mechanical clot retrieval
aspirin (ASA)
fluid managment (normal saline)
HTn managment (labetolol or hydralazine)
DM managment (70-150 glucose)
avoid fever
|
|
|
Term
intravenous TPA should be done within ___ hours of stroke
intraarterial TPA should be done within ___ hours of stroke
contraindications? |
|
Definition
4.5
6
contraindications: can they bleed out? htn, abnormal glucose, thrombocytopenia, hemorrhages recently, trauma/stroke recently, major surgery (14 days) |
|
|
Term
|
Definition
STOP SMOKING
treat underlying dz
aspirin regimen
statins
possibly stent
|
|
|
Term
| Headache red flags suggesting a serious underlying disorder |
|
Definition
worst headache ever
first severe headache
subacute worsening over days to weeks
abnormal neuro exam
fever or unexplained systemic signs
vomiting before headache - indicates increased pressure
induced by bending, lifting, coughing
disturbs sleep or presents immediatley upon wakening
known systemic illness (cancer, HIV)
onset after age 55 |
|
|
Term
serious underlying causes of headaches
1. HA, nuchal rigidity, photophobia, prostration, fever,. DO LP
2. sudden severe HA, nuchal rigidity, clouded consciousnness, seizure, DO CT. LP is bloody,
3. prostrating, pounding HA, n/v, neuro sx
4. HA behind eyes. n/v, painful, red eye, pupil dilated |
|
Definition
meningitis
itracranial hemorrhage
brain tumor
glaucoma |
|
|
Term
impaired CSF absorption by arachnoid vili (probably cause)
morning HA worsened by straining/coughing/eye movement
transient visual obscurations
papilledema
enlarged blind spots
loss of peripheral visual fields (bitemporal hemianopsia)
most are young, obese females
provacative agents:
vit A
steroids
naproxen
minocycline
tx? |
|
Definition
Idiopathic intracranial hypertension (Pseduotumor cerebri)
can result in blindness
tx: 20% weight loss as fast as possible |
|
|
Term
causes cough headache
more common in males
brain slips down throguh enlarged foramen magnum |
|
Definition
|
|
Term
| a benign cough headache responds dramatically to 50-200 mg ___ daily. |
|
Definition
|
|
Term
due to dural leak or LP
postural headache
MRI shows dural enhancement WITHOUT sulcal abnromalities and SPINE MRI: "crescent moon sign" - fluid outside dura
LP: may show lymphocytic pleocytosis (unless it was caused by LP)
tx? |
|
Definition
low pressure headache
tx: IV caffeine, epidural blood patch |
|
|
Term
very abrupt headache that occurs periorgasmically and subsides in a few minutes
tx? |
|
Definition
coital headache
indomethacin
must r/o SAH |
|
|
Term
sudden hemorrhage into pituitary that causes severe HA and bitemporal hemianopsia from pressure on optic chiasm
can cause panhypopituitarism & adrenal crisis (low bp -- shock)
tx? |
|
Definition
pituitary apoplexy
100 mg hydrocortisone IV |
|
|
Term
bilateral tight, bandlike headache
tight posterior neck muscles
builds slowly, fluctuates in severity and may persist for a few days
exertion does NOT worsen it
tx? |
|
Definition
tension headache
tx: OTC, fiorcet, fiorinal
prevention: amitriptyline, nortriptyline, doxepin |
|
|
Term
| typical course of a migraine |
|
Definition
| prodrome --> aura --> headache --> postdrome |
|
|
Term
|
Definition
nausea
photophobia
lightheadedness
scalp tenderness
vomiting |
|
|
Term
|
Definition
mostly genetic (80%)
p/q gene product
SPREADING DEPRESSION: slowly moving potassium-liberiating depression of cortical activity.
increased activity in dorsal raphe and locus coeruleus
release of substance P and calcitonin gene-related peptide from trigeminal nerve
factors that activate sympathetic NS trigger migraine |
|
|
Term
moderate to severe head pain
pulsating
unilateral
aggravated by activity
n/v
photophobia/phonophobia
recurrent, each lasting 4-72 hours
no neurologic sx |
|
Definition
| migraine w/o aura --> common migraine |
|
|
Term
premonitory sensory, motor, or visual sx
can be:
1. migraine equivalent/accompaniment: neuro sx w/o headache or vomiting
2. complicated migraine: neuro sx persist for days/weeks
3. fortification spectrum: C shaped paracentral scotoma, expands and moves toward periphery of visual field. lasts 20-25 min |
|
Definition
| classic migraine --> migraine w/ aura |
|
|
Term
vertigo, dysarthria, diplopia
includes bickerstaff's migraine
may have altered sensorium for 5 days. mimics brainstem stroke
full recovery |
|
Definition
|
|
Term
adolescent females
begins wtih total blindness
vertigo, ataxia, dysarthria, tinnitus, distal and perioral paresthesia
confusion
20-30 min
throbbing occipital HA |
|
Definition
|
|
Term
older pts
neck or jaw pain
continuous deep, dull, aching --> pounding/throbbing
superimposed sharp jabs
one to several times/week
several minutes to hours
tenderness and pulsations of carotid + soft tissue swelling
common precipitant: dental trauma |
|
Definition
| carotidynia - lower half ha or facial migraine |
|
|
Term
|
Definition
maxalt (5HT-1 agonist)
naproxen
dopamine agonists - metoclopramide or prochlorperazine
anti-emetics |
|
|
Term
| Preventative migraine meds |
|
Definition
propranolol
timolol
amitriptyline
topiramate
valproic acid |
|
|
Term
Raeder's syndrome, histamine cephalagia, sphenopalatine neuralgia
1-3 attacks of short-lived periorbital pain per day over a 4-8 week periods followed by 1 year of pain free period
eye watering, horners
wakes out of sleep
alcohol provokes attacks
men >>> women
elevated suicide risk
tx? |
|
Definition
cluster HA
acute: oxygen, prednisone for 10 days
SQ sumatriptan
ergotamine
preventative: lithium, verapamine, valproic acid
|
|
|
Term
1. the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons. firing tat is synchronous in a part of the brain.
2. a tendency toward recurrent seizures (2 or more) unprovoked by systemic or neurologic insults
3. sequences of events that converts a normal neuronal network into a hyperexcitable network |
|
Definition
1. seizure
2. epilepsy
3. epileptogenesis |
|
|
Term
___ is the major excitatory neurotransmitter involved in epilepsy
2 kinds of those receptors:
___ - fast synaptic transmission
___ - slow synaptic transmission
___ is the major inhibitory (downregulating) neurotransmitter
2 kinds of those receptors:
___ - post synaptic
___ - presynaptic |
|
Definition
glutamate
inotropic (NMDA, AMPA -- gated Ca channels)
Metabotropic
GABA
GABAa & GABAb
(something about Cl channels) |
|
|
Term
| factors that modify neuronal excitability |
|
Definition
- ion channel type, number, distribution
- biochemical modification of receptors
- activation of 2nd messenger system
- modulation of gene expression after injury
- changes in extracellular ion concentration
- remodeling of synapse location or configuration
- modulation of transmitter metabolism or uptake by glial cells |
|
|
Term
___ is the most common single site of epilepsy.
all seizures must go through the ___ |
|
Definition
|
|
Term
graphical depiction of CORTICAL electrical activity, usually recorded from the scalp. these signals are downregulated compared to what they actually are because they have to get through a lot of tissue between the brain and the electrodes
the electrical field is made by similarly oriented pyramidal cells in the cortex |
|
Definition
|
|
Term
Normal EEG frequencies
Alpha - normal, waking posterior
Beta - normal waking anterior, drowsiness
Theta - normal drowsy, light sleep
Delta - deep sleep |
|
Definition
alpha 8-14 hz
beta >14
Theta 4-8 hz
Delta <4 hz |
|
|
Term
partial seizures:
1. does not affect consciousness. abnormal smells, paresthesia, etc without change in consciousness. may have focal motor symptoms, autonomic sx (sweating, flushing, dilation), or somatosensory (paresthesia). special sensory (smell, flashes), hallucinations, deja vu
2. cannot remember what happened. preceded, accompanied or followed by psychic sx. automatisms such as lip smacking, chewing, aimless walking, or complex motor behaviors may occur. 15 s - 3 min
3. spread to both hemispheres and produces a generalized seizure. occurs after partial seizure of the frontal lobe. begins with subtle sx and spreads to tonic-clonic. post-ictal confusion, somnolence. 30-120 s |
|
Definition
1. simple partial seizure
2. complex partial seizure
3. secondary generalized
|
|
|
Term
primary generalized seizure in thalamus wiht brief impairment of consciousness lasting 5-10 sec but can occur many times a day
little or no loss of postural control (continuation of activity). can present with autonomic sx like enuresis (bedwetting) or automatisms (lip smacking, chewing)
abrupt onset and termination
frequently stop by age 20
can be triggered by hyperventilation
EEG: 3 hz spike and slow wave
dx?
tx? |
|
Definition
absence seizure (petit-mal)
tx: valproic acid (depakote) + ethosuximide (zarontin) |
|
|
Term
class of seizure in which the EEG shows only a restricted part of the brain has been activated
duration: 15 sec to 3 min |
|
Definition
|
|
Term
seen in 10% of epilepsy
most common kind resulting from metabolic derangement
sx: stiffening of muscles, arms up and legs out
ictal cry (tonic phase): impaired respirations, maybe biting of tongue, sympathetic tone (HR, BP, pupil size increase)
anterior shoulder dislocation common
clonic phase: progressive relaxation, unresponsive, flaccid, drool, incontinence
gradually regain consciousness
post ictal confusion and fatigue |
|
Definition
tonic-clonic seizure
valproic acid
lamotrigine
carbamazepine |
|
|
Term
partial epilepsy terms:
___ - inborn network disorder
___ - tumor, stroke, injury
___ - unknown cause |
|
Definition
idiopathic
symptomatic
cryptogenic |
|
|
Term
| pt presents with anterior shoulder dislocation after waking up on the floor. doesn't know what happened. may be confused/fatigued |
|
Definition
|
|
Term
seizure etiology based on onset of seizures
infancy and childhood (3)?
childhood and adolescence (2)
young adult
older adult |
|
Definition
infancy: birth injury, inborn metabolic error (pyridoxine deficiency), congenital malformation
childhood/adolescence: idiopathic/genetic, CNS infection
young adult: head trauma, ETOH/Drugs
older adult: stroke, brain tumor, acute metabolic disturbance |
|
|
Term
low glucose
low sodium
low calcium
low magnesium
stimulant intox (meth, cocaine)
sedative withdrawal
severe sleep deprivation
medications |
|
Definition
|
|
Term
| tests to run for evaluation of first seizure |
|
Definition
CBC, electrolytes, glucose, Ca, Mg, hepatic and renal function
LP if meningitis or encephalitis are suspected AND brain herniation is ruled out
blood/urine drug screen
electroencephalogram
CT or MRI |
|
|
Term
| principles of switching from polytherapy to monotherapy for epilepsy tx |
|
Definition
eliminate sedative drugs first
withdraw antiepileptics slowly over several months |
|
|
Term
tx for each kind of seizure
generalized tonic clonic
primary generalized
partial epilepsy
absence
lennox gastaut
complex partial |
|
Definition
tonic clonic: carbamazepine, phenytoin (dilantin)
primary generalized: NOT CARBAMAZEPINE. lamotrigine (lamictal)
partial epilepsy: topiramate (topamax)
absence: clonazepam, ethosuximide
lennox gastaut: clonazepam
complex partial: carbamazepine, phenytoin
ab |
|
|
Term
| how should therapeutic range be used in antiepileptics? |
|
Definition
a guide, not a goal
useful to provide initial targets in pts with new seizure |
|
|
Term
| pretty much all antiepileptics have ___ as a side effect |
|
Definition
|
|
Term
| When should we discontinue an antiepileptic? |
|
Definition
age of onset >2 y/o, less than 12
seizure free for >2 years
-infrequent initial seizures
- prompt initial response to AED
- benign rolandic epilepsy of childhood
- control achieved easily on one drug at low dose
- no previously unsuccessful attempts at withdrawal
- normal neuro status & EEG
|
|
|
Term
| lifestyle modifications as epilepsy tx |
|
Definition
adequate sleep & diet (ketogenic)
avoidance of alcohol and stimulants
stress reduction |
|
|
Term
non-pharmacological seizure treatment involving surgical implantation of a device that dysregulates synchronous, seizure-causing brain rhythms
used when there is inadequate seizure control despite max tolerated doses of 2-3 monotherapies
NOT used for absence seizures
most effective in temporal lobe epilepsy with unilateral atrophy and scarring on MRI
pt must have the same kind of seizure all the time
no or only subtle neuro findings
other surgical tx? |
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Definition
vagal nerve stimulator (VNS)
resection of epileptogenic region
corpus callostomy (disconnection to prevent seizure spread) |
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Term
| first aid for tonic clonic seizures |
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Definition
turn person on side with head inclined toward group to keep airway clear
protect from hazards
DO NOT put anything in the mouth or try to restrain them
transfer to hospital if:
-multiple seizures/status epilepticus
- pregnant, DM, or injured
- new onset seizure |
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Term
more than 30 min of continuous seizure or two or more sequential seizures in 30 min without full recovery between them
medical emergency: hypoxia, hypotension, acidosis, hyperthermia, death
what do you do for it? |
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Definition
status epilepticus
ensure abc, IV/O2
send for CMP, CBC, tox, AED, troponin
get glucose level
6-10 min: IV lorazepam
11-30 min: IV fosphenytoin
31-50 min: intubate, state EEG, IV phenobarbitol, midazolam, propofol, valproate, or levetiracetam |
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Term
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Definition
phenobarbital
phenytoin
diazepam
lorazepam
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Term
Epileptic encephalopathies:
1. infantile onset, hypsarrhtmic EEG, tonic/myclonic seizures, idiopathic
2. childhood onset, slow spike EEG, tonic, atypical absence, atonic
3. myoclinic, infancy and early childhood |
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Definition
west syndrome
lennox-gastaut
no name |
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Term
| Do not give kids what AED? |
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Definition
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Term
| <30 of tonic > clonic seizure after passing out |
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Definition
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Term
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Definition
risk of increased seizures, risk of seizure during delivery
risk of fetal anomolies (10%) - mostly due to drugs |
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Term
| seizure meds should be lipid or water soluble? |
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Definition
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Term
| AEDs make other meds less effective, such as? |
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Definition
birth control pills (steroid hormones)
antidepressants,
vitamins
warfarin |
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Term
effect of old age on aed:
absorption
distribution
metabolism
excretion |
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Definition
absorption: none
distribution: less body fat = decreased distribution
metabolism: decreased hepatic enzyme and blood flow
excretion: decreased renal clearance |
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Term
| pharmacokinetics in kids with AEDs |
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Definition
babies: lower per kg dose
kids: higher more frequent dose |
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Term
| AED pharmacokinetics in pregnancy |
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Definition
| need more frequent dosing |
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Term
| Common side effects of AEDs |
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Definition
sedation
unsteadiness/incoordination
tremor
dizziness/diplopia/blurred vision
mood/behavior changes
mental/motor slowing
changes in libido/sexual fxn
suicidal ideation
fever
rash
changes in teeth/gums
weight and appetite changes |
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Term
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Definition
alzheimer's
confusion
seizure
head injury
infection
sleep disorder
during brain surgery
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Term
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Definition
CNS infection
SAH
neurosyphilis
Guillan-barre
pseduotumor cerebri
removal of csf
MS
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Term
| Before doing an LP, always check for ___ |
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Definition
| papilledema - indicating increased ICP |
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Term
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Definition
carotid and vertebral circulation
larger intracranial arteries and sinuses
detection of aneurysm and vascular malformation |
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Term
proximal muscle weakness
no influence on reflexes
ACh problem
tx: ACh agonist (edrophonium)_, immunosuppression |
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Definition
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Term
problem with a nerve root
problem with nerve plexus |
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Definition
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Term
Skull fxs:
1. depressed forehead. frontal/paranasal sinus trouble. empyema?
2. raccoon eyes, hematympani, battle's sign (bruising on mastoid)
3. pituitary hormone problems. CN VI. Optic nerve damage. air-fluid levels in sphenoid sinuses
4. VII nerve palsy. auditory ossicles affected. IAC affected |
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Definition
1. frontal fx
2. basilar skull fx
3. sellar fx
4. petrous fx (part of temporal bone) |
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Term
1. neurofibromas, cafe au lait spots
2. tumor (schwannoma) that needs to be removed. bilateral deafness |
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Definition
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Term
genetic defect of heart, kidneys, skin tumors
seizures, retardation, |
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Definition
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Term
ataxia, dementia, urinary urgency/incontinence
enlarged ventricles on imaging due to slow accumulation of CSF
tx: shunting, serial LP |
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Definition
| normal pressure hydrocephalus |
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Term
port wine stain on face
seizures, paralysis, learning disability, glaucoma |
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Definition
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Term
athetosis (snake-like writhing), chorea, behavioral distubrance, frontal executive disorder
tx is symptomatic |
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Definition
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Term
1. characterized by trendelenburg's sign: the torso shifts over the contralateral side during the swing phase bc of weakness of gluteus medius
2. due to loss of proprioception - the loss of sensitivity to the positions of the joint and body parts
3. a quick, involuntary muscle jerk
4. characteristic gait resulting from pain on weight bearing wtih shortedned stance phase on affected side
5. involuntary jerking movements due to metabolic and toxic encephalopaties
6. tremor seen when person holds a position against gravity
7. unsteadiness of gait or lack of muscle coordination due to problems with the cerebellum |
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Definition
1. dystrophic gait
2. sensory ataxia
3. myoclonus
4. antalgic gait
5. asterixix
6. postural tremor
7. cerebellar ataxia
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