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EM Neuro
Emergency Medicine Neurology
41
Medical
Post-Graduate
01/21/2009

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Cards

Term
Central vs Peripheral vertigo
Definition
Peripheral:
-85-90%
-self-limiting
-less serious
-abrupt onset, severe intensity
-↑ w/change in position
-N/V, tinnitus
-Nystagmus fatigable
Central:

-10-15%

-not self-limited
-insidious onset
-not assoc. w/postural changes
-HA, Diplopia, dyarthria
-Nystagmus non-fatigable
Term
Conditions assoc. w/SAH
Definition
Coarctation, polycystic kidneys, Marfan's, Ehlers-Danlos, fibromuscular hyperplasia
Term
Reitr's syndrome classic triad
Definition
Urethritis, arthritis, conjunctivitis
"Can't see, can't pee, can't climb a tree"
Term
What is Reye's syndrome
Definition
A reactive arthritis immuno triggered by infectious urethritis, cervicitis, dysentery
Term
DDX of polyarticular arthritis
Definition
RA, SLE, Viral (Rubella or hepatitis), Rheumatic fvr, Reiter's Syndrome, Lyme' dz, serum sickness
Term
DDx of monoarticular arthritis
Definition
G-Spot: Gout, Gonorrhea, sepsis, pseudogout, osteoarthritis, trauma/injury
Term
Cold Caloric test (oculovestibular test)
Definition
Ice cold saline or H2O to the ear, pt at 30 degree inclination
COWS:
-Nystagmus both eyes fast opposite side, slow return toward cold side:Not comatose, intact midbrain
-Both eyes tonically deviate toward cold water: Coma with intact brainstem
-No eye movement: Brainstem injury
-Movement only of eye on side of stimulus: Internuclear ophthalmoplegia, suggests brainstem structural lesion
Term
Horizontal nystagmus
Definition
Peripheral dz (unilateral vestibular pathology)
Term
Vertical nystagmus
Definition
Central dz (brain stem lesion)
Term
Ataxic breathing
Definition
Irregular pattern, precedes death, assoc. w. medulla lesion
Term
MCC of Cerebral emboli
Definition
Plaques from large neck vessels
Mural thrombi from heart (A-Fib, ANI)
Endocarditis
FAt emboli - long bone f
Air emboli - thoracic or dysbaric injury
Term
Tx Cluster HA
Definition
O2 - 75% sucess
Term
Si/Sx Cluster HA
Definition
Awoke from sleep w/HA,
Burning, unilateral w/ flushing, lacrimation, rhinorrhea, nasal stuffiness, horners (ptosis, miosis, anhydrosis)
Term
Who usually gets cluster HA
Definition
Male, >25 y/o, tob/EtOH use
Term
Mortality of diffuse axonal injury
Definition
33%
Term
Extrapyramidal symptoms
Definition
Tremor, torticllis, trismus, rigidity, opisthotonus,oculogyric crisis, dysphonia, dysphagia
Term
Drugs that causes extrapyramidal symptoms
Definition
Thorazine
Promazine
Haloperidol
Metoclopramide
Term
What is apneustic breathing
Definition
End expiratory pause assoc. w/ lesions of the pons/CN 5
Term
Definition: cluster breathing
Definition
Short bursts of breath assoc. w/ lower pontine lesions
Term
Central Cord Syndrome
Definition
•MC: Incompletete cord Sy • Elederly pts w/DJD •EtOH •Hyperextension •Cord contussion/centrally •Weakness arms >> legs •Variable bladder •Non-surgical •Tx: Steroids?
Term
MCC sudden conduct hearing loss
Definition
Conduct - cerumen impactation
Term
MCC sudden hearing loss sensorineural-unilateral
Definition
Viral neuronitis
Term
MCC sudden hearing loss sensorineural-bilateral
Definition
Noise or ototoxicity
Term
Brown-Sequard Syndrome
Definition
Penetrating cord injury-cord hemisection: ipsilateral motor (paralysis), propioception & touch/vibratoty loss + contralateral pain/temp loss •hemitransection •Crossed findings below level of injury
Term
DDx of sensorineural hearing loss
Definition
•Unilateral- viral neuritis, acustic neuroma, Menieres Dz, loud noise •Bilateral-ototoxic drugs (aminoglyc, e-mycin, vanco, antimalarials, NSAIDS, loop diuretics, antineoplastics), loud noise
Term
Brain hemorrhage w/pin-poin pupils
Definition
Pontine hemorrhage: severe occipital HA ->rapid coma ->decerebrate posturing
Term
Retrobulbar neuritis
Definition
•Loss of central vision, loss of vision or blurred, periorbital pain (↑ w/EOM), Marcus-Gunn pupil, red vision changes, 25% MS changes •Consult ophthalmology
Term
Behcet's Syndorme
Definition
•Vascuitis - Possibly autoimmune •Triad: chronic oral ulcers, relapsing iridocyclitis, genital ulcers. Also, polyarthritis, erythema nodosum ❑ Tx: Steroids suppress
Term
What is Todd's paralysis
Definition
Transient focal paralysis. Indicates that a seizure has occurred.
Term
Painful unilateral vision loss
Definition
•Temporal arteritis (↑ESR, HA, temporal tenderness) ❑ Dx: need a Bx for Dx) ❑ Tx: steroid 60 mg/d
Term
Types of migrane auras
Definition
•MC: visual-scintillating scotoma or visual field defects. •Motor-hemiparesis, ophthalmoplegia, aphasia •Sensory-dysesthesia •Brainstem-vertigo, ataxia
Term
Corneal reflex
Definition
CN-V: Sensory / CN-VII:motor
Term
What is the difference b/w neuropathy & myopathy
Definition
•Neuropathy: distal weakness w/prox progression, paresthesias, ↓sensation, ↓DTR's, normal abs •Myopathy: diffuse or proximal weakness, sensory usually intact, DTR's intact, abnormal labs: ↑ESR, WBC, mm enxymes
Term
Posterior cerebral circulation supplies what structures?
Definition
20% of cerebral blood-medial aspect of temporal lobes, visual occipital cortex, thalamus, brainstem, upper spinal cord, cerebellum, auditory & vestibular fxns of the ear.
Term
Tx Cluster HA
Definition
O2
Term
MC bacteria in meningitis 18-50 y/o? Tx?
Definition
Strep, neisseira. Tx: ceftriaxone
Term
Lab values in DI
Definition
•↑Seum osmol >290 + serum Na •↓urine osmol <150
Term
DOC for DI
Definition
DDAVP 0.4 mg/kg intranasal. If urine output do not slow down: nephro DI or improper administration of DDAVP
Term
MC sequela of temporal arteritis
Definition
Blindness. if one loses vision, the other eye has 75% chance of vision loss in 1-20 days
Term
Uncal herniation
Definition
•Fixed dilated ipsilateral pupul (CN3) •Contralateral hemiparesis •Posturing •Apnea, coma, death
Term
Anterior cord syndrome
Definition
•Flexion injury •Younger pts •Complete motor paralysis •Preserved vibration, propioception •Loss sensation & temp distal to lesion •Needs surgery
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