-
Definition of a TIA
A transient neurological episode that resolves completely within 24 hours (usually, 30 min), with no infarcted tissue detectible on MRI
-
Anosognosia
Inability to identify a physical dysfunction--patients are unaware of their neurological deficits
-
Wernicke's aphasia
Fluent speech with no rational meaning and impaired comprehension
-
Apraxia
Inability to perfom learned motor tasks (e.g. teeth brushing)
-
Dysarthria
Difficulty in articulating speech
-
Left MCA stroke
- Right hemiparesis and sensory defects
- Right visual field defect
- Aphasia
-
Right MCA stroke
- Left hemiparesis and sensory defects
- Left visual field defect
- Apraxia and left-sided body neglect
-
Anterior cerebral artery stroke
- Contralateral (or bilateral) leg or foot weakness
- Broca's aphasia
- Incontinence
-
Internal carotid stroke
Presents similarly to an MCA stroke
-
Posterior cerebral artery stroke
- Contralateral homonymous hemianopsia
- Vertical gaze defect and CN III palsy
- Anomic aphasia (difficulty naming things)
- Alexia
-
PICA stroke
- Sudden onset nausea, vomiting, vertigo, and hoarseness
- Ataxia
- Ipsilateral palate and tongue weakness
- Contralateral loss of pain and temperature
- Dysphagia, dysarthria, hiccup
- Ipsilateral Horner's syndrome
-
AICA stroke
- Ipsilateral facial weakness and gaze palsy
- Deafness or tinnitus
- (No Horner's, dysphagia, or dysarthria)
-
Lacunar stroke
- Usually associated with chronic HTN
- Typically presents with pure motor or pure sensory loss
-
Onset of different strokes: thrombotic, embolic, and hemorrhagic
- Thrombotic--slow, gradual, often during sleep
- Embolic--stepwise, waking hours
- Hemorrhagic--quickly, waking hours
-
Diagnosis of stroke
- CT, for quick diagnosis
- MRI for follow-up
- Carotid US to screen for carotid stenosis
-
Treatment for a TIA
- Aspirin
- Anticoagulation (heparin, warfarin)
-
Treatment for a stroke
- Thrombolysis within 3 hours of onset
- Antiplatelet therapy
- Anticoagulation for cardiac embolus
- Neurosurgical consult in the case of a hemorrhagic stroke
-
Symptoms of rabies
- Pain, paresthesia
- Hydrophobia, aerophobia
- GI/resp symptoms
- Irritability
- Hyperventilation, hyperactivity, and seizures, in the "excitation phase"
-
Most common cause of bacterial meningitis
Strep pneumonia
-
Common cause of bacterial meningitis in young adults
Neisseria meningitidis
-
Common cause of meningitis in IC patients
Listeria
-
Kernig's sign
- Pain in the back and hamstring when extending the knee with the thigh at a right angle
- Sign of menintitis
-
Brudzinski's sign
- Forced flexion of the neck triggers flexion of the knee and hip
- Sign of meningitis
-
Signs of meningitis
- Headache, nuchal rigidity
- Fever
- Photophobia
- Mental changes (confusion, lethargy, coma)
- Seizures (10-30% of pxs)
-
What causes low CSF glucose in bacterial meningitis?
Bacteria inhibit transport of glucose into the CNS
-
Treatment for strep pneumonia meningitis
Vancomycin + cefotaxime or ceftriaxone
-
Treatment for N. meningitidis pneumonia
Penicillin G or ceftriaxone
-
Treatment for listeria pneumonia
Ampicillin + gentamycin
-
Most common CNS tumor
Astrocytoma
-
Brain tumor that tends to calcify
Oligodendroglioma
-
Brain tumor commonly found in the spinal canal (or in the fourth ventricle, in children)
Ependymoma
-
Tumor that can cause unilateral deafness
Acoustic neuroma
-
Cancers that commonly metastasize to the CNS
Lung, breast, melanoma
-
Prolonged headache followed by vomiting several hours later, vs. prolonged headache followed immediately by vomiting
- Headache followed by vomiting several hours later suggest a migraine
- Headache followed immediately by vomiting suggests a brain tumor
-
Absence seizure
- Type of generalized seizure
- Brief episode of non-responsiveness to external stimuli, with no loss of motor tone
- Characteristic spike and wave pattern on EEG
-
Difference between a simple and a complex seizure
- Simple seizure--no loss of consciousness or postictal state
- Complex seizure--loss of consciousness may or may not be present, but there is always a postictal state
-
Causes of seizures
- Fever
- Trauma
- Stroke
- Mass lesions
- Meningitis/encephalitis
- Electrolyte abnormality
- Uremia/hepatic encephalopathy
- Porphyria
- Drugs
-
Status epilepticus
A long, continuous seizure that lasts > 30 minutes
-
Drug to give acutely for a seizure
Benzos
-
Anti-TB drug that can cause seizures
INH--prevent with B6 (pyridoxine)
-
Diurnal progression of myasthenia gravis symptoms
Symptoms worsen as day goes on (opposite of RA)
-
Tests for a patient suspected of having myasthenia gravis
- Serology for ACH receptor antibodies
- CXR to screen for thymoma
-
Way to distinguish between MG and Lambert-Eaton
- In MG, repetitive muscle use quickly causes fatigue
- In Lambert-Eaton, repetitive muscle use lessens fatigue
-
Drugs that can precipitate a myasthenia gravis crisis
Aminoglycosides
-
Top ten causes of headache
- Chronic headache syndrome (migraine, tension, cluster)
- Subarachnoid hemorrhage
- Meningitis
- HTN
- Mas lesion
- Temporal arteritis
- Trigeminal neuralgia
- Brain abscess
- Pseudotumor cerebri
- Subdural hematoma
-
Typical headache of migraine
Unilateral, throbbing head pain that may last several hours
-
Danger of using 5-HT agonists (sumatriptan, migraine therapy)
Can cause coronary vasospasm
-
Tension headache
- Band-like pain around head and neck, accompanied by neck stiffness
- Usually bilateral
-
Cluster headache
Severe, unilateral facial pain, that may be accompanied by lacrimation, rhinorrhea, nasal congestion, ptosis, and miosis
-
Treatment for cluster headache
- High-flow oxygen
- Intranasal lidocaine
- Ergotomines or sumatriptan
- Verapamil or methysergide for prophylaxis
-
Flashes of light with floaters and vision loss
Retinal detachment
-
Painful, unilateral visual loss with partial resolution
May be accompanied by headache and eye pain with movement
- Suggests optic neuritis--inflammatory demyelination of the optic nerve
- Many patients progress to MS
-
Normal pressure hydrocephalus
- Increases CSF without increased intracranial pressure
- Presents with ataxia, urinary incontinence, and dementia (reversible)
-
Use of amantadine in Parkinson's
- Blocks dopamine reuptake by presynaptic neurons
- May improve tremor and bradykinesia in the early stages of the disease
-
What should be administered with levodopa, and why?
Carbidopa--cannot cross BBB, so stays in peripheral tissues and blocks metabolism of levodopa in the periphery
-
Selegiline
- Selective MAO B inhibitor
- Can be used to treat Parkinson's--blocks central metabolism of dopamine
-
Dopamine receptor agonists
|
|
