Term
|
Definition
| neurologic deficit that lasts from a few minutes to no more than 24 hours |
|
|
Term
| What defines a "Reversible ischemic neurologic deficit"? |
|
Definition
| a TIA that lasts longer than 24 hours, but less than 2 weeks |
|
|
Term
| TIA implies a high risk of impending. . . |
|
Definition
| stroke in the next few months. |
|
|
Term
| Pts with carotid stenosis of > 75% are at risk for stroke if. . . |
|
Definition
| they experience hypOtension. |
|
|
Term
| What percentage of risk for stroke in individuals who experience TIA? |
|
Definition
The risk of stroke in a pt with TIA is 10% per year.
TIAs carry a 30% 5-year risk of stroke |
|
|
Term
| What are the two most important risk factors for stroke? |
|
Definition
|
|
Term
| What two systems can be involved in a CVA/TIA? |
|
Definition
Carotid system
Vertobrobasilar system |
|
|
Term
| What is involved in the work-up of an embolic stroke? |
|
Definition
1. echocardiogram
2. Carotid Doppler
3. ECG, Holter monitoring |
|
|
Term
| Which is the most common location for a occlusion to cause CVA? |
|
Definition
|
|
Term
| Of the different types of stroke, which is the most common etiology? |
|
Definition
| EMBOLIC - origins include heart, internal carotid artery, Aorta, and Paradoxical (comes from a vein and goes through a PFO in the heart towards the brain) |
|
|
Term
| In carotid artery disease, where is the most common site of thrombus formation that causes stroke? |
|
Definition
| BIFURCATION of the COMMON CAROTID |
|
|
Term
| What are LACUNAR STROKES? |
|
Definition
| SMALL VESSEL THOMBOTIC disease |
|
|
Term
| What is the main predisposing factor for developing LACUNAR STROKES? |
|
Definition
|
|
Term
| How does HTN cause Lacunar strokes? |
|
Definition
| is causes hypertrophy of the smooth muscle of the arteries resulting in stenosis of the aterial lumen. |
|
|
Term
| When does a pt classically present with a THROMBOTIC STROKE? |
|
Definition
| the pt awakens from SLEEP with the neurologic deficit |
|
|
Term
| What is SUBCLAVIAN STEAL SYNDROME? |
|
Definition
| exercise of the left arm casuses reversal of blood flow down the ipsilateral vertebral artery to fill the subclavian artery distal to the stenosis bc it cannot supply adequete blood to the left arm |
|
|
Term
| What is the PATHOPHYSIOLOGY of SUBCLAVIAN STEAL SYNDROME? |
|
Definition
| caused by STENOSIS of the SUBCLAVIAN ARTERY proximal to the origin of the veterbral artery - exercise of LEFT ARM causes reversal of blood. |
|
|
Term
| What ultimately happens in SUBCLAVIAN STEAL SYNDROME? |
|
Definition
| Leads to DECREASED CEREBRAL BLOOD FLOW (blood is "stolen" from the basilar system) |
|
|
Term
| What are the NEUROLOGIC symptoms that manifest with subclavian steal syndrome? |
|
Definition
| causes symptoms of VERTEBROBASILAR ARTERIAL INSUFFICIENCY |
|
|
Term
| What are the physical symptoms associated with SUBCLAVIAN STEAL SYNDROME? |
|
Definition
BP in LEFT ARM is less than that in the right arm
upper extremity CLAUDICATION |
|
|
Term
| What is the tx for SUBCLAVIAN STEAL SYNDROME? |
|
Definition
|
|
Term
| What is the dominant cerebral hemisphere for most people? |
|
Definition
|
|
Term
| If the DOMINANT hemisphere is involved in a stroke, what main symptom with manifest? |
|
Definition
|
|
Term
| If the NON-DOMINANT hemisphere is involved in a stroke, what main symptom with manifest? |
|
Definition
APRAXIA (inability to practice learned purposeful movements)
CONTRALATERAL BODY NEGLECT
CONFUSION |
|
|
Term
| With lacunar strokes, the symptoms are usually either. . . |
|
Definition
pure MOTOR
or
pure sensory |
|
|
Term
| Where is the lacunar stroke if the symptoms are purely MOTOR? |
|
Definition
|
|
Term
| Where is the lacunar stroke if the symptoms are purely SENSORY? |
|
Definition
|
|
Term
| What are the four lacunar stroke syndromes? |
|
Definition
pure Motor
pure sensory
Ataxic Hemiparesis - incoordination ispslaterally
Clumsy hand dysarthria |
|
|
Term
| Where is the lesion of the lacunar stroke if the person develops CLUMSY HAND SYNDROME? |
|
Definition
|
|
Term
| What is the most common location of occlusion involved in CVA? |
|
Definition
|
|
Term
| How long does it take for an ischemic infarct to appear on noncon CT? |
|
Definition
|
|
Term
| How will an ischemic infarct appear on NCCT? |
|
Definition
|
|
Term
| How will a hemorrhagic stroke appear on NCCT? |
|
Definition
|
|
Term
| When do you scan stroke pts with a CAROTID DUPLEX? |
|
Definition
if they have. . .
Carotid bruit
PVD
Coronary artery disease |
|
|
Term
| What do you look for in a stroke pt who is less than 50 yo? |
|
Definition
Vasculitis
hypercoagulable state
thrombophilia |
|
|
Term
| What do you order in a stroke pt less than 50 yo? |
|
Definition
Protein C and S
Antiphospholipid Antibodies
Factor V Leiden
ANA, ESR, rheumatoid factor
VDRL/RPR
Lyme Serology
TEE |
|
|
Term
| What tests are ordered in a pt presenting with a stroke? |
|
Definition
NCCT
ECG, CXR
CBC, platelet count
PT, PTT
Serum electrolytes
Glucose level
Bilateral Carotid Ultrasound
Echo |
|
|
Term
| What can you give a pt who canNOT receive ASA or plavix? |
|
Definition
|
|
Term
| Is heparin or Warfarin used as a part of the treatment for stroke? |
|
Definition
| NO! they have not been proven to have efficacy in acute stroke |
|
|
Term
| Are BP medications given during treatment for stroke? |
|
Definition
| No, not unless there is an indication |
|
|
Term
| When do you give BP medications during a stroke? |
|
Definition
if the pt has . . .
BP > 220 or diastolic >120 (MAP > 130)
acute MI
Aortic dissection
severe heart failure
hypertensive encephalopathy
Pt has high BP and is on antiplatelet therapy |
|
|
Term
| When does a pt get a carotid endarterectomy? |
|
Definition
| If carotid stenosis is >70% and the pt is symptomatic. |
|
|
Term
| What are the two major categories of hemorrhagic stroke? |
|
Definition
Intracerebral hemorrhage
Subarachnoid hemorrhage |
|
|
Term
| Where does one bleed with a ICH? |
|
Definition
| bleed into the brain parenchyma |
|
|
Term
| Where does one bleed with a SAH? |
|
Definition
|
|
Term
| Where is the most common location for ICH? |
|
Definition
|
|
Term
| Where is the ICH located if the pt has PINPOINT PUPILS? |
|
Definition
|
|
Term
| Where is the ICH located if the pt has PORRLY REACATIVE PUPILS? |
|
Definition
|
|
Term
| Where is the ICH located if the pt has DILATED PUPILS? |
|
Definition
|
|
Term
| If a pt is found to have an ICH, where are they sent? |
|
Definition
|
|
Term
| How is the airway managed in a pt with ICH? |
|
Definition
|
|
Term
| What is the treatment for ICH? |
|
Definition
| Supportive (there is no specific therapy) |
|
|
Term
| Are steroids used in ICH? |
|
Definition
|
|
Term
| What is done if a pt is found to have CERENELLAR HEMATOMA? |
|
Definition
| RAPID SURGICAL EVACUATION (could be lifesaving) |
|
|
Term
| Where do SACCULAR ANEURYSMS occur? |
|
Definition
| bifurcations of arteries of the circle of willis |
|
|
Term
| Where are the three most common sites for SAH? |
|
Definition
1. junction of ANTERIOR COMMUNICATING a. with ANTERIOR CEREBRAL a.
2. junction of POSTERIOR COMMUNICATING a. with INTERNAL CAROTID a.
3. BIFURCATION of the MCA |
|
|
Term
| What inherited disorder is associated with BERRY ANEURYMS? |
|
Definition
| POLYCYSTIC KIDNEY DISEASE |
|
|
Term
| With SAH, an OPTHALMOLOGIC EXAM is mandatory to rule out. . . |
|
Definition
|
|
Term
| if PAPILLEDEMA is present, what other procedure can you NOT perform? |
|
Definition
|
|
Term
| Why can you NOT perform an LP in someone with PAPPILEDEMA? |
|
Definition
| can cause herniation (repeat the CT scan first) |
|
|
Term
| In Parkinson's disease, dopiminergic receptors are depleted in what two parts of the midbrain? |
|
Definition
SUBSTANTIA NIGRA
LOCUS CERULEUS |
|
|
Term
| What disese process is PARKINSON'S + AUTONOMIC INSUFFICIENCY? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Does the tremor with Parkinson's get better or worse at rest? |
|
Definition
|
|
Term
| What is PROGRESSIVE SUPRANUCLEAR PALSY? |
|
Definition
denegerative condition of the brainstem, basal ganglia, and cerebellum, most commonly affecting middle-aged and elderly men.
Very similar to parkinson's with a few notable differences |
|
|
Term
| What are the differences between PSP and PARKINSON'S? |
|
Definition
Unlike Parkinson's, PSP:
- DOES NOT CAUSE TREMOR
- DOES CAUSE OPTHALMOPLEGIA (palsy of eye movement) |
|
|
Term
| Do pts with tremor as a major symptom of parkinson's disease have a better or worse prognosis? |
|
Definition
|
|
Term
| What causes HUNTING'S CHOREA? |
|
Definition
| it is caused by a mutation on chromosome 4 (expanded triplet repeat) - CAG leads to a loss of GABA-producing neurons in the striatum |
|
|
Term
| What are the general CHARACTERISTICS of HUNGTING'S CHOREA? |
|
Definition
AUTOSOMAL DOMINANT, so lack of family history makes this diagnosis unlikely.
Onset is between 30 - 50.
15 years between onset of disease and death |
|
|
Term
| What are the CLINICAL FEATURES of HUNTING'S CHOREA? |
|
Definition
CHOREA - involving face, head, neck, tongue, trunk, and extremities
ALTERED BEHAVIOR - irritability, personality changes,antisocial behavior, depression, OCD, psyhcosis
DEMENTIA - worsens with disease progression
GAIT is unsteady and irregular. Bradykinesia and rigidity prevail.
INCONTINENCE |
|
|
Term
| What will MRI show with HUNTING'S CHOREA? |
|
Definition
| atrophy of the HEAD OF CAUDATE NUCLEI |
|
|
Term
| What disease should always be kept in mind in a YOUNG PATIENT with movement disorders? |
|
Definition
|
|
Term
| What type of tremor is WORSE with INTENTIONAL ACTIVITY such as drinking from a cup, or use of utensils? |
|
Definition
|
|
Term
| Which type of tremor is MARKEDLY DECREASED WITH ALCOHOL? |
|
Definition
|
|
Term
| What is used to treat ESSENTIAL TREMOR? |
|
Definition
|
|
Term
|
Definition
| involuntary swearing seen in Tourette's Syndrome (although not seen in all pts with Tourette's) |
|
|
Term
| If you suspect a pt has Tourette's, what other diagnosis must be ruled out? |
|
Definition
Seizures
Tardive Dyskinesias
Huntington's Disease |
|
|
Term
| What is BINSWANGER'S DISEASE? |
|
Definition
| a type of dementia, that has an insidious onset, due to diffuse subcortical white matter degeneration, most commonly seen in pts with LONG-STANDING HTN and ATHEROSCLEROSIS |
|
|
Term
| What is the pharmacologic treatment of dementia? |
|
Definition
vitamin E
tacrine
donepezil |
|
|
Term
|
Definition
| an anticholinesterase that also acts as an anticholinergic |
|
|
Term
| How will the brain look in someone with Alzheimer's disease? |
|
Definition
| CEREBRAL ATROPHY secondary to neuronal loss. VENTRICLES will correspondingly be ENLARGED |
|
|
Term
| CT SCAN or MRI of the brain of an Alzheimer's pt will show . . . |
|
Definition
| CORTICAL ATROPHY and ENLARGEMENT of the VENTRICLES |
|
|
Term
| What part of the brain is affected with Binswanger's disease? |
|
Definition
SUBcortical (white matter)
(whereas AD affects the cortical layer of the brain) |
|
|
Term
| If a pt is in a coma, and they have a pupillary light reflex, what does this imply? |
|
Definition
| the MIDBRAIN IS INTACT and not the cause of the coma |
|
|
Term
| If a pt is in a coma, and they are breathing on their own, what does this imply? |
|
Definition
| their brainstem is functioning |
|
|
Term
| If a pt is in a coma, and they have DOLL'S EYES, what does this imply? |
|
Definition
| they have a brainstem injury |
|
|
Term
| What is LOCKED IN SYNDROME? |
|
Definition
| a syndrome that mimics a coma, pts are completely paralyzed (with sparing of muscles required for RESPIRATION, BLINKING, and VERTICAL EYE MOVEMENT |
|
|
Term
| With LOCKED IN SYNDROME pts are _________ and capable of __________ |
|
Definition
|
|
Term
| What causes LOCKED IN SYNDROME? |
|
Definition
| usually caused by infarction of the VENTRAL PONS |
|
|
Term
| What are the "plaques" in MS? |
|
Definition
| multifocal zones of demyelination |
|
|
Term
| Where are the classic locations of the plaques in MS? |
|
Definition
| ANGLES of the LATERAL ventricles |
|
|
Term
| Does MS affect the white matter or the grey matter? |
|
Definition
|
|
Term
| What makes a CLINICALLY DEFINITE diagnosis of MS? |
|
Definition
TWO episodes of symptoms
EVIDENCE of TWO white matter lesions |
|
|
Term
| What is considered a LABORATORY-SUPPORTED DEFINITE MS diagnosis? |
|
Definition
TWO episodes of symptoms
evidence of at least ONE WHITE LESION on MRI
OLIGOCLONAL BANDS IN CSF |
|
|
Term
| What makes a PROBABLY MS diagnosis? |
|
Definition
TWO epidoses of symptoms
AND
ONE white matter lesion
or OLIGOCLONAL BANDS in CSF |
|
|
Term
| What is one of the most common complaints in MS? |
|
Definition
|
|
Term
| the symptom of INTERNUCLEAR OPHTHALMOPLEGIA strongly suggests what diagnosis? |
|
Definition
|
|
Term
| Do steroids alter the outcome of MS? |
|
Definition
| NO - they are only used to shorten a ACUTE exacerbation |
|
|
Term
| Can you use oral steroids when treating an ACUTE EXACERBATION of MS? |
|
Definition
| NO - oral steroids have not shown to be efficacious. Only IV STEROIDS |
|
|
Term
| What diagnostic tests are used to evaluate for MS? |
|
Definition
MRI
CSF
Evoked action potentials |
|
|
Term
| How are EVOKED ACTION POTENTIALS used to diagnose MS? |
|
Definition
| Evoked action potentials measures speed of nerve conduction within the brain - Newly remyeliniated nerves will conduct sensory impulses more slowly |
|
|
Term
| What is Myasthenic crisis? |
|
Definition
a medical emergency in pts with Myasthenia Gravis that occurs in 15% of pts.
DIAPRAGM and INTERCOSTAL FATIGUE result in RESPIRATORY FAILURE (often requires mechanical ventilation) |
|
|
Term
| What is the TEST OF CHOICE diagnosing MYASTHENIA GRAVIS? |
|
Definition
| Acetylcholine receptor antibody test (most specific) |
|
|
Term
| Can someone have Myasthenia Gravis and be antibody negative? |
|
Definition
| YES - up to 20% of people with Myasthenia Gravis are antibody negative |
|
|
Term
| What imaging test must you get when diagnosing someone with Myasthenia Gravis? |
|
Definition
| CT of the neck to look for Thymoma |
|
|
Term
| What percentage of people with Myasthenia Gravis will have a THYMOMA? |
|
Definition
| 15% (but 75% of pts will have abnormal Thymoma Tissue) |
|
|
Term
| What medications exacerbate symptoms of Mysthenia Gravis? |
|
Definition
Antibiotics - aminoglycosides, tetracyclines
beta-blockers
Antiarrhythmics - quinidine, procainamide, and lidocaine |
|
|
Term
| What is the inheritence pattern of Duchenne's muscular dystrophy? |
|
Definition
|
|
Term
| What is the pathophysiology in Duchenne's muscular dystrophy? |
|
Definition
| mutation on the gene that codes for DYSTROPHIN PROTEIN (dystrophin is absent causing muscle cells to die) |
|
|
Term
| Is there inflammation in Duchenne's Muscular Dystrophy? |
|
Definition
|
|
Term
| What are the clinical signs and symptoms of Duchenne's Muscular Dystrophy? |
|
Definition
muscle weakness is progressive, symmetric, and starts in childhood
PROXIMAL MUSCLES are primarily affected (PELVIC GIRDLE). Eventually involves the respiratory muscles. |
|
|
Term
|
Definition
| Pt uses hands to get up from the floor bc the weakness in the proximal lower extremity muscles makes it difficult to arise without support |
|
|
Term
| What will be noticed in the lower extremities in someone with Duchenne's Muscular Dystrophy? |
|
Definition
| PSEUDOHYPERTROPHY - (true muscle hypertrophy at first, followed by PSEUDOHYPERTROPHY as FAT REPLACES MUSCLE |
|
|
Term
| When do individuals with Duchenne's Muscular Dystrophy typically die? |
|
Definition
|
|
Term
| What is the tx for DUCHENNE'S MUSCULAR DYSTROPHY? |
|
Definition
1. Prednisone - sig increase in strength, muscle function, and pulmonary function (may reduce risk of scoliosis)
2. Surgery to correct progressive scoliosis |
|
|
Term
| What is BECKER'S MUSCULAR DYSTROPHY? |
|
Definition
less common than DUCHENNE'S
X-linked recessive
Similar to Duchenne's, but there is LATER ONSET and LESS SEVERE COURSE. (some dystrophin is present) |
|
|
Term
| What medications exacerbate symptoms of Mysthenia Gravis? |
|
Definition
Antibiotics - aminoglycosides, tetracyclines
beta-blockers
Antiarrhythmics - quinidine, procainamide, and lidocaine |
|
|
Term
| What medications exacerbate symptoms of Mysthenia Gravis? |
|
Definition
Antibiotics - aminoglycosides, tetracyclines
beta-blockers
Antiarrhythmics - quinidine, procainamide, and lidocaine |
|
|
Term
| What are the characteristics of NEUROFIBROMATOSIS TYPE I? |
|
Definition
Cafe Au Laits Spots
neurofibromas
CNS tumors
axillary or inguinal freckling
iris hamartomas (Lisch Nodules)
bony lesions |
|
|
Term
| What are some other features of both types of NEUROFIBROMATOSIS? |
|
Definition
seizures
mental retardation, learning disability
short height
macrocephalic |
|
|
Term
| What is the inheritance pattern of Neurofibramatosis? |
|
Definition
|
|
Term
| What are the clinical features of NEUROFIBROMATOSIS TYPE II? |
|
Definition
BILATERAL ACOUSTIC NEUROMAS - classic finding
cataracts
similar symptoms to that of type I |
|
|
Term
| What is RAGGED RED MUSCLE FIBERS? |
|
Definition
| MITOCHONDRIAL disorder caused by accumulation of diseased mitochondria in the subsaccrolemal space |
|
|
Term
| What are the physical manefestations of RAGGED MUSCLE FIBERS? |
|
Definition
progressive myoclonic epilepsy
short stature
hearing loss
lactic acidosis
exercise intolerance
poor night vision |
|
|
Term
| What is the inheritence pattern of VON HIPPEL-LINDAU? |
|
Definition
|
|
Term
| What are the important features of Von Hippel-Lindau? |
|
Definition
Cavernous Hemangiomas of the brain stem
Renal Angiomas
Cyst in multiple organs |
|
|
Term
| What TUMOR is associated with Von Hippel-Lindau? |
|
Definition
|
|
Term
| What ADRENAL DYSFUNCTION is associated with Von Hippel-Lindau? |
|
Definition
|
|
Term
|
Definition
| central cavitation of the CERVICAL CORD due to abnormal collection of fluid within the SPINAL CORD PARENCHYMA |
|
|
Term
| What are the clinical features of SYRINGOMYELIA? |
|
Definition
bilateral loss of PAIN AND TEMPERATURE in a CAPE LIKE DISTRIBUTION around the shoulders
(Most often asymptomatic and discovered incidentally on MRI) |
|
|
Term
| What is involved in LOSS OF PAIN AND TEMPERATURE? |
|
Definition
|
|
Term
| What is involed in LOSS OF VOLUNTARY MOVEMENT? |
|
Definition
| LATERAL CORTICOSPINAL TRACT |
|
|
Term
What is the diagnosis when the pt presents with . . .
CONTRALATERAL loss of Pain and temp
IPSILATERAL hemiparesis
IPSILATERAL loss of position/vibration? |
|
Definition
|
|
Term
| What is BROWN-SEQUARD SYNDROME? |
|
Definition
| hemisection of the spinal cord |
|
|
Term
| What is the prognosis for BROWN-SEQUARD SYNDROME? |
|
Definition
|
|
Term
| What is TRANSVERSE MYELITIS? |
|
Definition
| rare condition that specifically affects the tracts across the HORIZONTAL aspect of the spinal cord at a given level. THORACIC SPINE is most commonly involved. |
|
|
Term
| What are the CLINICAL FEATURES of Transverse Myelitis? |
|
Definition
LOWER extremity weaknes or plegia
Back Pain
Sensory Deficits below the level of lesion
Sphincter Disturbance - especially URINARY RETENTION |
|
|
Term
| What is the IMAGING study of choice for Transverse Myelitis? |
|
Definition
|
|
Term
| What is TX for Transver Myelitis? |
|
Definition
| HIGH DOSE Steroid therapy |
|
|
