Term
| MC type of stroke ischemic or hemorrhagic? |
|
Definition
|
|
Term
| third most common cause of death in the US |
|
Definition
|
|
Term
| symptoms of a stroke that resolve within 24 hours |
|
Definition
|
|
Term
| symptoms of a stroke that last 24 hrs - 1 wk |
|
Definition
| reversible ischemic neurologic deficit |
|
|
Term
| symptoms of a stroke that last 24 hrs - 1 wk |
|
Definition
| reversible ischemic neurologic deficit |
|
|
Term
stroke that is currently worsening...
stroke that has reached maximal deficit... |
|
Definition
evolving stroke
completed stroke |
|
|
Term
| a pt who has a TIA is at significantly increased risk for? |
|
Definition
stroke.
risk of stroke is about 10% per year after a TIA. |
|
|
Term
| most important risk factors for ischemic stroke |
|
Definition
age and hypertension.
others include smoking, DM, hyperlipidemia, atrial fibrillation, CAD, family hx of stroke, previous stroke/TIA, carotid bruits. |
|
|
Term
| unique stroke risk factors in younger patients |
|
Definition
| Oral contraceptive use, hypercoagulable states (protein C and S deficiency), vasoconstrictive drug use, polycethemia vera, sickle cell disease. |
|
|
Term
| carotid vs vertebrobasilar TIA sxs |
|
Definition
carotid - temporary loss of speech, paralysis/paresthesias of contralateral extremity, clumsiness of one limb, amaurosis fugax.
Vertebrobasilar - dizziness, double vision, vertigo, numbness of ipsilateral face and contralateral limbs, dysarthria, hoarseness, dysphagia, projectile vomiting, headache, drop attacks. |
|
|
Term
| MC etiology of an ichemic stroke |
|
Definition
| embolism - heart (MC), carotid, aorta, paradoxical |
|
|
Term
| small vessel thrombotic disease caues what kind of stroke? |
|
Definition
|
|
Term
| what kind of stroke? pt awakens from sleep with neurologic deficits? |
|
Definition
|
|
Term
| clinical findings of subclavian steal syndrome |
|
Definition
similar to vertebral basilar TIA.
BP in left arm < BP in right arm.
Decreased pulse in left arm.
Upper extremity claudication.
Treatment = surgical bypass. |
|
|
Term
| what kind of stroke? onset of sxs is rapid and max deficit is reached initially. |
|
Definition
|
|
Term
| MC artery involved in stroke? |
|
Definition
|
|
Term
| clinical features of a stroke involving the MCA |
|
Definition
contralateral hemiparesis, or hemisensory loss.
aphasia (dominant hemisphere)
apraxia, contralateral body neglect, confusion (non dominant hemisphere) |
|
|
Term
| lacunar stroke involving the inernal capsule |
|
Definition
|
|
Term
| lacunar stroke involving the thalamus |
|
Definition
|
|
Term
| anterior cerebral artery deficits |
|
Definition
| contralateral lower extremity and face |
|
|
Term
|
Definition
| aphasia, contralateral hemiparesis |
|
|
Term
| vertebral/basilar deficits |
|
Definition
ipsilateral: ataxia, diplopia, dysphagia, dysarthria, and vertigo.
contralateral: homonymous hemianopsia with basilar - PCA lesions. |
|
|
Term
| lacunar infarct of the pons |
|
Definition
|
|
Term
| first imaging study to be obtained in suspected stroke |
|
Definition
CT without contrast.
ischemic = dark
hemorrhagic = white |
|
|
Term
| benefit of MRI over CT in identifying a stroke |
|
Definition
can identify all infarcts and does so ealier than CT.
Not preferred in an emergency because it takes longer and is not suitable for unstable pts. |
|
|
Term
| definitive test for identifying stenosis of vessels in the head and neck or for aneurysms. |
|
Definition
| magnetic resonance arteriogram (MRA) |
|
|
Term
| major complication of stroke |
|
Definition
cerebral edema occurs within 1-2 days and can cause a mass effect for up to 10 days.
Tx = hyperventilation and mannitol |
|
|
Term
| contraindications to t-PA |
|
Definition
elapsed time > 3 hrs
uncontrolled HTN
bleeding disorder or anticoagulated pt.
hx of recent trauma or surgery |
|
|
Term
| what should you order in a suspected stroke pt? |
|
Definition
non contrast CT
ECG, CXR
CBC, platelet count, PT, PTT, electrolytes, glucose level
bilateral carotid ultrasound
echocardiogram |
|
|
Term
| 2 major categories of hemorrhagic stroke |
|
Definition
intracerebral hemorrhage - bleeding into the brain parenchyma
subarachnoid hemorrhage - bleeding nto the CSF |
|
|
Term
| MCC of hemorrhagic stroke |
|
Definition
| HTN - particularly a sudden increase in BP |
|
|
Term
| MC location of hemorrhagic stroke |
|
Definition
|
|
Term
| MCC of stroke in young pts |
|
Definition
|
|
Term
| steadily increasing neurologic deficit over 30 to 90 minutes |
|
Definition
|
|
Term
location of hemorhhagic stroke based on pupillary response...
pinpoint
poorly reactive
dilated |
|
Definition
pinpoint - pons
poorly reactive - thalamus
dilated - putamen |
|
|
Term
| when is BP treatment indicated in hemorrhagic stroke |
|
Definition
if BP > 160-180/105
agent of choice = nitroprusside |
|
|
Term
| polycystic kidney disease is associated with what type of aneurysm? |
|
Definition
|
|
Term
| what exam should be performed before lumbar puncture in suspected SAH? |
|
Definition
| ophthalmologic exam to rule out papilledema. If papilledema is present LP is contraindicated as you may cause herniation. |
|
|
Term
| "the worst headache of my life" |
|
Definition
|
|
Term
| what test is diagnostic for SAH? |
|
Definition
| LP - blood in the CSF and/or xanthochromia (results from RBC lysis) |
|
|
Term
| definitive study for determining the location of SAH? |
|
Definition
|
|
Term
| what areas of the brain are affected by Parkinsons? |
|
Definition
| substantia nigra and locus ceruleus in the midbrain. |
|
|
Term
| what is Shy-Drager syndrome? |
|
Definition
| Parkinsonion symptoms + autonomic insufficiency |
|
|
Term
| clinical features of Parkinson's disease (10) |
|
Definition
pill rolling tremor at rest
bradykinesia
cogwheel rigidity
poor postural reflexes
masked facies
dysarthria and dysphagia, micrographia
dementia
autonomic dysfunction (orthostatic hypotension, constipation, increased sweating, oily)
personality changes
progressive course |
|
|
Term
|
Definition
no cure
carbidopa - levodopa
dopamine-receptor agonists (pergolide, bromocriptine, pramipexole)
selegilne - inhibits MAO-B (adjunctive)
amantadine - antiviral agent
anticholinergic - trihexyphenidyl and benztropine
amytriptyline
surgery - deep brain stimulation |
|
|
Term
chorea involving the face, head, and neck, tongue, trunk, and extremities.
altereted behavior, impaired mentation, gait that is unsteady and irregular. |
|
Definition
|
|
Term
| how do you diagnose Huntington's Chorea? |
|
Definition
MRI - atrophy of the head of caudate nuclei
DNA confirmation |
|
|
Term
| causes of physiologic tremor |
|
Definition
fear, anxiety, fatigue
hypoglycemia, hyperthyroid, pheochromocytoma
toxic causes - alcohol withdrawal, valproic acid, lithium, caffeine, theophylline |
|
|
Term
| tremor that is induced or exacerbated by intentional activity |
|
Definition
|
|
Term
|
Definition
can be tx with alcohol - although beware of rebound effects.
rx = propranolol |
|
|
Term
| characteristics of ataxia (3) |
|
Definition
gait instability
loss of balance
impaired limb coordination |
|
|
Term
| presentation of Friedreich's ataxia (3) |
|
Definition
ataxia
nystagmus
impaired vibratory sense and proprioception |
|
|
Term
|
Definition
clonidine
pimozide
haloperidol |
|
|
Term
| progressive deterioration of intellectual function, typically characterized by preservation of consciousness |
|
Definition
|
|
Term
| most important risk factor for dementia |
|
Definition
|
|
Term
|
Definition
|
|
Term
| disease that is clinically identical to Alzheimers? |
|
Definition
|
|
Term
| step wise neurologic decline indicates |
|
Definition
| mutli-infarct vascular dementia |
|
|
Term
| pseudodementia is more commonly known as |
|
Definition
|
|
Term
| chromosomes linked to Alzheimer's disease |
|
Definition
|
|
Term
| beta-amyloid plaques, neurofibrillary tangles, cortical atrophy |
|
Definition
|
|
Term
|
Definition
|
|
Term
| sxs of Alzheimers and Parkinsons + hallucination |
|
Definition
|
|
Term
| acute period of cognitive dysfunction due to a medical disturbance or condition |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
causes of delirium
structural brain pathology
meningitis, mental illness
alcohol, acidosis
seizures
hypercapnia, hyperglycemia, hyperthermia, hyponatrremia, hypoglycemia, hypoxia, hypotension, hypothermia
endocrine causes
drugs, dangerous compounds |
|
|
Term
|
Definition
more causes of delirium
postoperative state
dehydration and malnutrition
infection
medications and drug intoxication
metals
withdrawal states
inflammation, fever
trauma, burns |
|
|
Term
| rapid deterioration in mental status, fluctuating leve of awareness, disorientation, abnormal vital signs |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
1 - doesn't open
2 - to pain
3 - to voice
4 - spontaneous |
|
|
Term
|
Definition
1 - none
2 - decerebrate
3 - decorticate
4 - withdraws
5 - localizes
6 - obeys |
|
|
Term
|
Definition
1 - none
2 - incomprehensible
3 - inappropriate
4 - confused
5 - oriented |
|
|
Term
|
Definition
pupillary light reflex
doll's eye reflex
self breathing |
|
|
Term
| bilateral fixed, dilated pupils |
|
Definition
|
|
Term
| bilateral pinpoint pupils |
|
Definition
|
|
Term
| unilateral fixed, dilated pupil |
|
Definition
| herniation of CN 3 with compression |
|
|
Term
| infarction or herniation of the ventral pons leads to this |
|
Definition
| "locked in" syndrome - mimics coma but the pt is fully aware of their surroundings and feeling pain |
|
|
Term
| 3 most common sites of brain herniation |
|
Definition
uncal - compresses the midbrain
tonsillar - compresses the medulla
central - increased muscle tone, bilateral Babinski reflex |
|
|
Term
| classic location of MS plaques |
|
Definition
|
|
Term
|
Definition
transient sensory deficits
fatigue
motor symptoms
spasticity
optic neurits, internuclear ophthalmoplegia
cerebellar involvement - ataxia, intention tremor, dysarhtria
loss of bladder control
autnomic involvement - impotence, constipation
cerebral involvement - memory loss, personality change, emotional lability
neuropathic pain |
|
|
Term
|
Definition
silent - stable or benign
relapsing/remitting - most common
secondary progressive
primary progressive |
|
|
Term
|
Definition
essentially clinical
MRI - most senesitive
LP and CSF analysis - oligoclonal bands of IgG
evoked potentials can suggest demyelination |
|
|
Term
|
Definition
high dose IV corticosteroids
DMARDs - interferon,or non specific immunosuprressive therapy
symptomatic therapy - baclofen, cabamazepine, gabapentin |
|
|
Term
| abrupt onset of rapidly ascending weakness/paralysis of all four extremities. usually symmetric with weakness progression from distal to proximal. |
|
Definition
|
|
Term
|
Definition
CSF analysis - elevated protein, normal cell count.
electrodiagnostic studies - decreased motor nerve conduction velocity |
|
|
Term
|
Definition
carefully monitor pulmonary function
administer IV immunoglobulin if pt has significant weakness. Plamsaphoresis may be helpful.
DO NOT give steroids. |
|
|
Term
| MC intracranial neoplasm in adults |
|
Definition
|
|
Term
| classic HA associated with brain neoplasms |
|
Definition
| HA upon awakening or with dependent head position |
|
|
Term
| imaging test of choice for brain neoplasms |
|
Definition
MRI with and without gadolinium
only way to definitively dx = brain tumor |
|
|
Term
| type of brain tumor that typically cannot be resected |
|
Definition
| gliomas - both astrocytomas and oligodendrogliomas |
|
|
Term
| chemotherapy has limited effectiveness in brain tumors |
|
Definition
|
|
Term
|
Definition
|
|
Term
| this tumor typically arises in the cerebral hemispheres, spreads along white matter tracts and may cross the corpus callosum into the opposite hemisphere |
|
Definition
|
|
Term
| MC primary sites that mets to the brain |
|
Definition
| lung, breast, skin, kidney, GI tract |
|
|
Term
| extracerebral, founded masses with well defined dural bases that compress the underlying brain and attach to the duar |
|
Definition
|
|
Term
| bilateral schwannomas is pathognomonic for what? |
|
Definition
| neurofibromatosis type II |
|
|
Term
|
Definition
volume of the brain
volume of blood
volume of CSF |
|
|
Term
| secondary insults after initial head injury (6) |
|
Definition
hypotension
hypoxia
hypercapnia
increased ICP
intracranial mass effect
anemia |
|
|
Term
| MC herniation associated with increased ICP |
|
Definition
|
|
Term
| MCC of death after severe head injury |
|
Definition
|
|
Term
| ICU goal for management of incraesed ICP |
|
Definition
MAP > 80
ICP < 20
CPP of atleast 60 |
|
|
Term
periorbital ecchymosis
postauricular ecchymosis |
|
Definition
raccoon eyes
Battle's sign |
|
|
Term
| signs of basilar skull fracture (4) |
|
Definition
raccoon eyes
Battle's sign
hemotympanum
CSF rhinorrhea/otorrhea |
|
|
Term
|
Definition
coup = side of impact
countrecoup = injury at site opposite the point of impact |
|
|
Term
| Cushing's triad - physiologic response to increased ICP |
|
Definition
hypertension
bradycardia
respiratory irregularity |
|
|
Term
|
Definition
ABC
lower ICP - reverse trendelenberg (if spine is clear), intubation + hyperventilation (PaCO2 of 30-35), mannitol, narcotics for sedation, lower body temp slightly, neuromuscular paralysis
treat subdural or epidural hematoma |
|
|
Term
| classic presentation of epidural hematoma |
|
Definition
brief loss of consciousness followed by a lucid interval, and then coma.
Ipsilateral blown pupil is also classic. |
|
|
Term
| blood between the skull and dura |
|
Definition
|
|
Term
| hematoma between dura and brain |
|
Definition
|
|
Term
| results from venous bleeding after blunt head trauma |
|
Definition
|
|
Term
| typical findings in subdural hematoma (3) |
|
Definition
decreased level of consciousness
headache
cortical dysfunction |
|
|
Term
| crescent shaped (concave) hematoma on CT scan |
|
Definition
|
|
Term
| brain bruise, also known as |
|
Definition
|
|
Term
| autoantibodies directed against the nicotinic acetylcholine receptors of the neuromuscular junction which leads to reduced postsynaptic response to acetylcholine and results in significant muscle fatigue |
|
Definition
|
|
Term
skeletal muscle weakness with preservation of sensation and reflexes. Ptosis, diplopia, and blurred vision.
generalized weakness, dysarthria, dysphagia. |
|
Definition
|
|
Term
|
Definition
| medical emergency that resutls from diaphragm and intercostal muscle fatigue --> respiratory failure |
|
|
Term
| test of choice to dx myastehnia gravis |
|
Definition
| acetylcholine receptor antibody test |
|
|
Term
| what needs to be ruled out when the dx of myasthenia gravis is made? |
|
Definition
|
|
Term
| screening test for myasthenia gravis |
|
Definition
| edrophonium (tensilon) test - high false positive rate |
|
|
Term
| treatment of myasthenia gravis |
|
Definition
| anticholinesterase drugs - pyridostigmine (symptomatic benefit only) |
|
|
Term
| meds that can exacerbate the sxs of myasthenia gravis |
|
Definition
antibiotics - aminoglycosides, and tetracyclines
b-blockers
antiarrhythmics - quinidine, procainamide, lidocaine |
|
|
Term
| caused by autoantibodies directed against presynaptic calcium channels and associated with small cell lung cancer. features = proximal muscle weakness and hyporeflexia |
|
Definition
| Lambert Eaton Myasthenic Syndrome |
|
|
Term
| how can you distinguish myastehenia gravis from lambert eaton myasthenic syndrome? |
|
Definition
| Lambert-Eaton sxs improve with repeated muscle stimulation. |
|
|
Term
| muscle weakness is progressive, symmetric, and starts in childhood. Primarily affects the proximal muscles. |
|
Definition
| Ducehnne's Muscular Dystrophy |
|
|
Term
|
Definition
| pt uses hands to get up from floor because the weakness in the proximal lower extremity muscles makes it difficult to arise without support. |
|
|
Term
|
Definition
serum creatinine phosphokinase - levels markedly elevated.
DNA testing has now replaced muscle biopsy |
|
|
Term
| disease similar to DMD but with later onset and a less severe course, some dystrophin is present |
|
Definition
| Becker's Muscular Dystrophy |
|
|
Term
| cafe au lait spots, neurofibromas, and CNS tumors (gliomas, meningiomas), axillary or inguinal freckling, iris hamartomas (Lisch Nodules), bony lesions |
|
Definition
|
|
Term
| bilateral acoustic neuromas, multiple meningiomas, cafe au lait spots, neurofibromas (less common), and cataracts |
|
Definition
|
|
Term
| complications of neurofibromatosis 1 |
|
Definition
| scoliosis, pheochromocytomas, optic nerve gliomas, renal artery stenosis, and erosive bone defects. |
|
|
Term
| features of tuberous sclerosis (3) |
|
Definition
cognitive impairment
epilepsy
skin lesions (facial angiofibroma, adenoma sebacum) |
|
|
Term
| key pathologic feature of Sturge Weber Syndrome |
|
Definition
presence of capillary angiomatoses in the pia mater - classic feature is facial vascular nevi (port wine stain).
Epilepsy and mental retardation are usually present. |
|
|
Term
| tx of Sturge Weber Syndrome |
|
Definition
|
|
Term
cavernous hemangiomas of the brain or brainstem, renal angiomas, and cysts in multple organs.
Associated with renal cell carcinoma |
|
Definition
| Von Hippel-Lindau Disease |
|
|
Term
| contralatearl loss of pain and temperature, ipsilateral hemiparesis, ipsilateral loss of position/vibration |
|
Definition
|
|
Term
| bilateral loss of pain and temperature sensation over the shoulders in a "capelike" distribution, preservation of touch, thoracic scoliosis may occur, muscle atrophy of the hands may occur. |
|
Definition
|
|
Term
| MC site of involvement for Transverse Myelitis |
|
Definition
|
|
Term
| lower extremity weakness or plegia, back pain, sensory deficits below the level of the lesion, and sphincter disturbance |
|
Definition
|
|
Term
| study of choice for Transverse Myelitis |
|
Definition
|
|
Term
| characteristics of Horner's syndrome (3) |
|
Definition
ipsilateral ptosis
ipsilateral miosis
ipsilateral anhidrosis |
|
|
Term
| disease that affects the anterior horn cells and motor neurons of spinal cord and brain stem - causes lower motor neuron involvement. |
|
Definition
|
|
Term
| asymmetric muscle weakness (legs more commonly), absent DTR's, flaccid atrophic muscles, normal sensation |
|
Definition
|
|
Term
| 3 major causes of dizziness |
|
Definition
presyncope (lightheadedness)
vertigo
multisensory stimuli |
|
|
Term
| sensation of spinning or hallucination of movement |
|
Definition
|
|
Term
| causes of peripheral vertigo (5) |
|
Definition
BPPV
Meniere's disease
Acute Labyrinthitis
Ototoxic drugs
Acoustic neuroma |
|
|
Term
| vertigo, tinnitus, and hearing loss |
|
Definition
|
|
Term
| abrupt vertigo that lasts for only a few seconds |
|
Definition
|
|
Term
| cause of acute labyrinthitis |
|
Definition
| viral infection of the cochlea and labyrinth |
|
|
Term
| 3 main causes of central vertigo |
|
Definition
MS - demyelination of vestibular pathways of brainstem
vertebrobasilar insufficiency
migraine associated vertigo - HA may or may not be present |
|
|
Term
|
Definition
| vasovagal AKA neurocardiogenic, vasodepressor, or simple faints |
|
|
Term
| causes of seizures (4M's, 4I's) |
|
Definition
metabolic and electrolyte disturbances
mass lesions
missing drugs
miscellaneous
Intoxication
Infection
ischemia
Increased ICP |
|
|
Term
| simple vs complex partial seizures |
|
Definition
simple = retained consciousness
complex = impaired consciousness |
|
|
Term
| tonic clonic - grand mal seizure |
|
Definition
bilateral symmetric and without focal onset.
tonic - rigid
clonic - musculature jerking of hte limbs and body for at least 30 seconds.
Followed by postictal confusion (10-30 minutes).
tongue biting, vomiting, apnea, and incontinence |
|
|
Term
| absence - petit mal seizure |
|
Definition
school age children
"stare into space", episodes are brief but may be quite frequent.
impairment of consciousness but no loss of postural tone or continence and no postictal confusion.
Minor clonic activity - eye blinks, head nodding |
|
|
Term
| lab values to check immediately in an unfamiliar seizing patient (4) |
|
Definition
serum calcium
serum sodium
serum glucose or accu-check
BUN |
|
|
Term
| most helpful diagnostic test for seizure disorders |
|
Definition
|
|
Term
| MCC of seizures is a previously dx pt |
|
Definition
|
|
Term
| tx of tonic clonic seizures |
|
Definition
| phenytoin and carbamazepine are the drugs of choice. |
|
|
Term
|
Definition
| ethosuximide and valproic acid |
|
|
Term
| disorder affecting the antrior horn cells and corticospinal tract at mnay levels - presence of upper and lower motor neuron signals is a hallmark. |
|
Definition
| ALS - amyotrophic lateral sclerosis "Lou Gehrig's Disease" |
|
|
Term
| progressive muscle weakness, no pain, muscle cramps and spasticity, fasiculations, impaired speech and swallowing, respiratory muscle weakness, weight loss and fatigue. |
|
Definition
|
|
Term
| 4 items that remain normal even in the late stages of ALS |
|
Definition
bowel/bladder control
sensation
cognitive funciton
extraocular muscles |
|
|
Term
|
Definition
mainly supportive
riluzole is a glutamate blocking agent - may delay death by 3-5 months |
|
|
Term
| loss or defect of language |
|
Definition
|
|
Term
|
Definition
| Wernicke's, Broca's, Conduction, Global |
|
|
Term
| what kind of aphasia - impaired comprehension of written or spoken language |
|
Definition
| Wernicke's aphasia - pts articulate well but often use the wrong words because they cannot understand their own words |
|
|
Term
| expressive, non fluent aphasia |
|
Definition
| Broca's - often associated with right hemiparesis and hemisensory loss |
|
|
Term
| aphasia with a disturbance in repetition - |
|
Definition
|
|
Term
| disturbance in all areas of language function - comprehension, speaking, reading, fluency |
|
Definition
| glocal aphasia - often associated with right hemiparesis |
|
|
Term
| acute onset of unilateral facial weakness/paralysis, both upper and lower parts of the face are affected. |
|
Definition
|
|
Term
| what med should always be avoided if Lyme disease is suspected? |
|
Definition
|
|
Term
| severe, lancinating facial pain affecting the jaw, lips, gums, and maxillary area. |
|
Definition
|
|
Term
|
Definition
carbamazepine
other choices - baclofen and phenytoin |
|
|
