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
|
|
Term
| If there is asymmetric rise of the uvula, which CN is affected? |
|
Definition
|
|
Term
| A lesion of which CN causes drooping shoulder, muscle atrophy, weakened or limited elevation of the shoulder or arm, scapula winging? |
|
Definition
|
|
Term
| A lesion of which CN causes flaccid paralysis of tongue and atrophy, as well speech difficulties? |
|
Definition
|
|
Term
| What CN is involved with Ramsey Hunt syndrome? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What muscle is affected in CN IV palsy? |
|
Definition
|
|
Term
| What is the MC cause of CN IV palsy? |
|
Definition
|
|
Term
| What muscle is affected in CN VI palsy? |
|
Definition
|
|
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
|
|
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
|
|
Term
| Are sensation or reflexes affected by Myasthenia Gravis? |
|
Definition
|
|
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
|
|
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
|
|
Term
| Which disease has transient sx of paresthesia, gait disorders, focal weakness, visual blurring, diplopia, vocal slurring and is MC in women? |
|
Definition
|
|
Term
| What is the MC type of MS? |
|
Definition
|
|
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
|
|
Term
| What is given to help with muscle spasticity seen with MS? |
|
Definition
|
|
Term
| What MS subtype is the MC initial course? |
|
Definition
|
|
Term
| Which subtype of MS is described as unpredictable relapses followed by periods of no new signs of the disease? |
|
Definition
|
|
Term
| Which subtype of MS is described as having the greatest amount of disability, may include new neurologic symptoms and worsening cognition? |
|
Definition
|
|
Term
| Which type of MS is described as a rapid decline that occurs continually without clear attacks? |
|
Definition
|
|
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
|
|
Term
| What is the isolated peripheral neuropathy that affects the trigeminal nerve, causing palsy? |
|
Definition
|
|
Term
| What is a "classic finding" of ALS? |
|
Definition
|
|
Term
| Does ALS affect the intellect? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What is the major symptom of AD? |
|
Definition
|
|
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
|
|
Term
| What stage of AD has symptoms including abnormalities in short term memory, hesitant speech, apraxia, and shuffling? |
|
Definition
|
|
Term
| Which stage of AD is described as having symptoms including paranoia, hallucinations, delusions, primitive reflexes, and mute/bedbound? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| What drugs should be avoided with pts who have Lewy Body Dementia? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| Which type of movement disorder is described as abnormal movements that are slow, sinuous and writhing in character? |
|
Definition
|
|
Term
| What type of movement disorder is described as sustained muscle contraction, frequently causing twisting and repetitive movements or abnormal postures? |
|
Definition
|
|
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
|
|
Term
| What condition is chorea commonly associated with? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What is the MC type of seizure category? |
|
Definition
|
|
Term
| What is the first line treatment for partial seizures? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the treatment for absence seizures? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What is the DOC for Tonic/Clonic seizures? |
|
Definition
|
|
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
|
|
Term
| What is the main risk factor for ALL stroke types? |
|
Definition
|
|
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
|
|
Term
| Which type of stroke is due to ruptured blood vessels and local blood collection? |
|
Definition
|
|
Term
| What are the two types of ischemic strokes? |
|
Definition
|
|
Term
| What is the MC type of stroke? |
|
Definition
|
|
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
|
|
Term
| What is the causative factor of thrombolytic strokes? |
|
Definition
|
|
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
|
|
Term
| If a pt has an abrupt onset stroke and rapid improvement, what type of stroke should you suspect? |
|
Definition
|
|
Term
| What are most deaths that occur within 1 week of stroke event caused by? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What is the only approved therapy for an ischemic stroke? |
|
Definition
|
|
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
|
|
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
|
|
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 |
|
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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
|
|
Term
| What are TIAs indicative of? |
|
Definition
|
|
Term
| What are TIAs indicative of? |
|
Definition
|
|
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
|
|
Term
| What med can be used to control the hyperlipidemia risk factor for strokes? |
|
Definition
|
|
Term
| What med can be used to control the risk of a-fib for stroke? |
|
Definition
|
|
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
|
|
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
|
|
Term
| Which CN palsy is papilledema seen in? |
|
Definition
|
|
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
|
|
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
|
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
|
|
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
|
|
Term
| Which disease is described as A progressive disorder with degeneration of the corticospinal pathways down to the anterior horn cells? |
|
Definition
|
|
Term
| What condition has symptoms including paresthesia, gait d/o, focal weakness, visual loss (blurring in one eye), and diplopia? |
|
Definition
|
|
Term
| What condition is described as focal demyelination and damage to axons due to immune reaction against myelin? |
|
Definition
|
|
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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