Term
| What is the rank of stroke as a cause of death? |
|
Definition
|
|
Term
| What is teh leading cause of neurologic disability? |
|
Definition
|
|
Term
| What is the time limit of a TIA? |
|
Definition
| less than 24 hrs however most last less than 30 minutes |
|
|
Term
| What do you call a enurologic deficit due to ischemia that lasts longer than 24 hours but resolves in 2 weeks? |
|
Definition
| reversible ischemic neurologic deficit |
|
|
Term
| what do you call a stroke that has symptoms that are worsening? |
|
Definition
|
|
Term
| What do you call a stroke with no increase in symptoms? |
|
Definition
|
|
Term
|
Definition
| usually embolic; however transient hypotension in the presence of severe carotid stenosis (>75% occlusion) can lead to TIA |
|
|
Term
| What is the risk of stroke in a person who has had a TIA? |
|
Definition
| 10% per year; 30% 5 yr risk of stroke |
|
|
Term
| What are the two most important risk factors for stroke/ |
|
Definition
|
|
Term
| What drugs increase your risk of stroke? |
|
Definition
| vasoconstrictive drugs such as cocaine and amphetamines |
|
|
Term
| TIA involving clumsiness of one limb probably occured in what vascular system? |
|
Definition
|
|
Term
| Dizziness due to a TIA probably involves what vascular system? |
|
Definition
|
|
Term
| Double vision as a TIA is due to a disturbance in what vascular bed? |
|
Definition
|
|
Term
| Numbness of ipsilateral face and contralateral limb due to a TIA involves what vascular bed? |
|
Definition
|
|
Term
| Dysarthria as a TIA probably involves what vascular bed? |
|
Definition
|
|
Term
| Hoarseness as a TIA symptom probably involves what vascular system? |
|
Definition
|
|
Term
| Projectile vomiting as a TIA symptom involves what vascular bed? |
|
Definition
|
|
Term
| What is the most common etiology of TIA/CVA? |
|
Definition
|
|
Term
| What are the various origins of an embolus that results in stroke? |
|
Definition
| heart, internal carotid artery, aorta, paradoxical |
|
|
Term
| Atherosclerotic disease of the carotids occurs most commonly where? |
|
Definition
| at the bifurcations of the carotid |
|
|
Term
| What is a lacunar stroke? |
|
Definition
| small vessel thrombotic disease |
|
|
Term
| What percent of strokes are lacunar? |
|
Definition
|
|
Term
| Lacunar strokes involve what parts of the brain? |
|
Definition
| subcortical strucutres (basal ganglia, thalamus, internal capsule, brainstem) |
|
|
Term
| What percent of pts with lacunar infarcts have a history of diabetes? |
|
Definition
| 80-90%; diabetes is another big risk factor |
|
|
Term
| Sources of embolic stroke are evaluated by what tests/ |
|
Definition
| echocardiogram, carotid dopplers, ECG/Holter monitoring |
|
|
Term
| Lis tthe different types of ischemic strokes and percent occurance? |
|
Definition
| 20% atherosclerotic cerebrovascular disease (hypoperfusion or arteriogenic emboli), 25% penetrating artery disease (lacunes), 20% cardiogenic embolism, 30% cryptogenic, 5% other |
|
|
Term
| Where is the stenosis in subclavian steal syndrome? |
|
Definition
| proximal to the vertebrals |
|
|
Term
| Describe the course of a thrombotic stroke? |
|
Definition
| onset of symptoms are either rapid or stepwise; classically the pt awakens from sleep with the neurologic deficit |
|
|
Term
| What is the course of embolic stroke? |
|
Definition
| onset of sympmtoms is very rapid and deficits are maximal initially |
|
|
Term
| What are the four main syndormes of lacuna stroke? |
|
Definition
| pure motor; pure sensory; atasic hemiparesis; clumsy hand dysarthria |
|
|
Term
| pure motor stroke is a stroke of the... |
|
Definition
|
|
Term
| Symptoms of vertebral/basilar stroke= |
|
Definition
ipsilateral= atasia, diplopia, dysphagia, dysarthria, and vertigo
contralateral= homonymous hemianopsia with basilar/PCA lesions |
|
|
Term
| What percent of SAH are identified by CT? |
|
Definition
|
|
Term
| What pts should get a screening carotid duplex scan? |
|
Definition
|
|
Term
| If a young pt presents with stroke, look for vasculitis, hypercoagulable states and thrombophilia by ordering what tests? |
|
Definition
| protein C, protein S, antiphospholipid antibodies, factor V leiden mutation, ANA, ESR, rheumatoid factor, VDRL/RPR, lyme serology TEE |
|
|
Term
| What percent of infarcts can be identified on MRI within 24 hrs? |
|
Definition
|
|
Term
| If a pt comes to the ED with findings suggestive acute stroke what should you order? |
|
Definition
| noncontrast CT, ECG, cxr, CBC, platelet count, PT, PTT, serum electrolytes, glucose level, bilateral carotid ultrasound, echo |
|
|
Term
| What complications should you be aware of for pts in the post stroke period? |
|
Definition
| cerebral edema occuring within 1 to 2 days and cuasing mass effects for up to 10 days, hemorrhage into the infarction, seizures (fewer than 5%) |
|
|
Term
| How should you manage a pt you gave tPA to? |
|
Definition
| no aspirin for the first 24 hrs, perform neurologic checks every hour, keep bp <185/110 |
|
|
Term
| what do you give a pt who had stroke symptoms starting 9 hrs ago who is allergic to aspirin? |
|
Definition
| clopidogrel (if cannot tolerate clopidogrel use ticlopidine) |
|
|
Term
| T/F anticoagulants like heparin or warfarin are indicated in acute stroke. |
|
Definition
|
|
Term
| When do you give pts with stroke medicine to lower their BP? |
|
Definition
| if the BP is very high (>220/>120) if pt has significant medical indication for antiHTN drugs, the pt is recieving thrombolytic therapy |
|
|
Term
|
Definition
| if stenosis is >70% and pt is symptomatic you decrease risk of stroke from 17.5% to 6% per year |
|
|
Term
| How do you treat pts with asympomatic carotid artery stenosis? |
|
Definition
| reduction of atherosclerotic risk factors and use of aspirin |
|
|
Term
| What are teh two main categories of hemorrhagic stroke? |
|
Definition
| ICH (brain parenchyma), SAH (into the CSF) |
|
|
Term
| What is the mortality rate of ICH? |
|
Definition
|
|
Term
| What is one of the main causes of stroke in young patients? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ICH + poorly reactive pupils= |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the treatment for intraparenchymal hemorrhagic stroke? |
|
Definition
|
|
Term
| What is the most common cause of ICH? |
|
Definition
| 50-60% are due to HTN (particularly a sudden increase in BP) |
|
|
Term
| Besides HTN and hemorrhagic conversion of ischemic stroke, what are some other causes of ischemic stroke? |
|
Definition
| amyloid angiopathy (10%), anticoagulant/antithrombolytic use (10%), brain tumors (5%), and AV malformations (5%) |
|
|
Term
|
Definition
| 66% in the basal ganglia, 10% in the pons, 10% cerebellum |
|
|
Term
| What is the course of a hemorrhagic stroke? |
|
Definition
| abrupt onset of a focal neurologic deficit that worsens steadily over 30 to 90 minutes |
|
|
Term
| Name some complications of ICH? |
|
Definition
| increased ICP, seizures, rebleeding, vasospasm, hydrocephalus, SIADH |
|
|
Term
| In pts with hemorrhagic stroke, what should you do with their BP? |
|
Definition
|
|
Term
| What med should you use to lower BP in a patient with hemorrhagic stroke? |
|
Definition
|
|
Term
| How do you reduce ICP in hemorrhagic stroke? |
|
Definition
| DO NOT GIVE STEROIDS; give mannitol and diuretics only if there are signs of increased ICP; do not give prophylactically; if there is a cerebellar hematoma, you should have neurosurgery rapidly evacuate it |
|
|
Term
| What is the moratlity rate of SAH? |
|
Definition
|
|
Term
| Name some causes of subarachnoid hemorrhage? |
|
Definition
| ruptured berry aneurysm, trauma, AV malformation |
|
|
Term
| What % of pts with SAH have a sudden, transient LOC? |
|
Definition
|
|
Term
| What percent of pts with SAH die at the first rupture? |
|
Definition
|
|
Term
| What percent of pts with SAH have retinal hemorrhages? |
|
Definition
|
|
Term
| What is the gold standard for diagnosis of SAH? |
|
Definition
|
|
Term
| How do you manage pt with subarachnoid hemorrahge? |
|
Definition
| bed rest in a quiet, dark room; stool softeners to avoid straining, analgesia for headaches (acetaminophen), IV fluids, control of HTN (lower slowly), calcium channel blocker (nifedipine) for vasospasm |
|
|
Term
| What is teh data on using nifedipine for pts with SAH? |
|
Definition
| lowers the incidence of cerebral infarction by 1/3 |
|
|
Term
| What is shy-drager syndrome? |
|
Definition
| parkinsonian symptoms + autonomic insufficiency |
|
|
Term
| What is the histologic finding in pts with parkinson's? |
|
Definition
| lewy bodies (hyalin inclusion bodies) |
|
|
Term
| What is the difference between PSP and parkinson's? |
|
Definition
| PSP does not cause tremor but does cause an ophtalmoplegia |
|
|
Term
|
Definition
| a degenerative condition of the brainstem, basal ganglia, and cerebellum, most commonly affecting middle-aged and elderly men |
|
|
Term
| Describe the autonomic dysfunction associated with Parkinson's? |
|
Definition
| orthostatic hypotension, constipation, increased sweating, and oily skin |
|
|
Term
|
Definition
|
|
Term
| How long after being treated with levodopa before you get dyskinesias? |
|
Definition
|
|
Term
| Name some side effects of sinemet? |
|
Definition
| dyskinesias, nausea/vomiting, anorexia, HTN, hallucinations |
|
|
Term
| Name some medications known to cause parkinsonian side effects. |
|
Definition
| neuroleptic drugs (chlorpromazine, haloperidol, perphenazine), metoclopramide, reserpine |
|
|
Term
| Dopamine receptor agonists are especially useful for parkinson pts with what problem? |
|
Definition
| sudden episodes of hesitancy or immobility |
|
|
Term
|
Definition
| inhibitor of monoamine oxidase B activity so it increases dopamine activity and reduces metabolism of levodopa; used as adjunct in early parkinsons |
|
|
Term
| Name some anticholinergic drugs used for parkinson's? |
|
Definition
| benztropine, trihexylphenidyl |
|
|
Term
| When is surgery indicated for parkinson's? |
|
Definition
| if the patient does not respond to medication or develops severe disease before age 40 |
|
|
Term
| The increase in CAG associated with Huntington's disease causes what to happen? |
|
Definition
| loss of GABA-producing neurons in the striatum |
|
|
Term
| What percent of patients with huntington's are demented by age 50? |
|
Definition
|
|
Term
| What causes physiologic tremor? |
|
Definition
| fear, anxiety, fatigue, hypoglycemia, hyperthyroidism, pheochromocytoma, toxic causes (alcohol withdrawal, valproic acid, lithium, methylxanthines, caffeine and theophylline) |
|
|
Term
| How do you treat essential tremor? |
|
Definition
|
|
Term
| WHat is teh inheritance of Friedrich's ataxia? |
|
Definition
|
|
Term
| What are the symptoms of Friedrich's ataxia? |
|
Definition
| onset in young adulthood of ataxia, nystagmus, impaired vibratory sense, and proprioception |
|
|
Term
| What is the inheritance pattern of ataxia telangiectasia? |
|
Definition
|
|
Term
| What are the symptoms of ataxia telangiectasia? |
|
Definition
| childhood onset of ataxia, nystagmus, impiared vibratory sense and proprioception; physical exam reveals telangiectasias; pts have increased risk of cancer |
|
|
Term
| What are some acquired casues of ataxia? |
|
Definition
| alcohol intoxication, vitamin B12 or thiamine deficiency, cerebellar infarction or neoplasm, demyelinating disease (MS, AIDS), and tertiary syphilis (tabes dorsalis) |
|
|
Term
| Tourette's syndrome is associated with what psychiatric illness? |
|
Definition
|
|
Term
| What is the typical age of onset for tourette's? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Before diagnosing tics or tourette's syndrome, you should rule out what disorders? |
|
Definition
| seizures, tardive dyskinesias, and huntington's disease |
|
|
Term
| What is the medical term for involuntary swearing? |
|
Definition
|
|
Term
| What are the clinical features of tourette's? |
|
Definition
| multiple motor tics and at least one kind of phonic tic |
|
|
Term
| What is the treatment for tourette's? |
|
Definition
| if symptoms are affecting quality of life= clonidine, pimozide, haloperidol |
|
|
Term
| T/F Some degree of memory loss is accepted as a normal part of aging. |
|
Definition
| true; benign forgetfulness of the elderly |
|
|
Term
| What is the most important risk factor for dementia? |
|
Definition
|
|
Term
| Name some potentially reversible causes of dementia? |
|
Definition
| hypothyroidism, neurosyphilis, vitamin B12/folate/thiamine deficiency, medications, normal pressure hydrocephalus, depression, subdural hematoma |
|
|
Term
| What percent of dementias are due to alzheimer's? |
|
Definition
|
|
Term
| What is Binswanger's disease? |
|
Definition
| insidious onset of dementia due to diffuse subcortical white matter degeneration, most commonly seen in patients with long standing hypertension and atherosclerosis |
|
|
Term
| What are the features of normal pressure hydrocephalus? |
|
Definition
| dementia, gait disturbance and urinary incontinence, normal CSF pressure and dilated ventricles |
|
|
Term
| Name some infections that can cause dementia? |
|
Definition
| HIV, neurosyphilis, cryptococcal, Creutzfeldt-Jakob disease (spongiform encephalopathy), progressive multifocal leukoencephalopathy |
|
|
Term
| T/F Korsacoff's dementia is reversible? |
|
Definition
|
|
Term
| What studies should you get when investigating causes of dementia? |
|
Definition
| CBC with diff, CMP, TSH, folate, B12, VDRL, HIV, CT or MRI of the head |
|
|
Term
| What is tacrine used for? |
|
Definition
|
|
Term
| What rank does Alzheimer's have as a cause of death in the US? |
|
Definition
|
|
Term
| What chromosomes have been linked to Alzhiemer's? |
|
Definition
|
|
Term
| Describe the histologic pathology associated with Alzheimer's? |
|
Definition
| senile plaques (focal collections of dilated, tortuous neuritic processes surrounding a central amyloid core), and neurofibrillary tangles (bundles of neurofilaments in cytoplasm of neurons) |
|
|
Term
| What CT/MRI findings would correlate with a diagnosis of Alzheimer's? |
|
Definition
| diffuse cortical atrophy with enlargement of the ventricles |
|
|
Term
| T/F Hormone replacment therapy decreases the risk of Alzheimer's. |
|
Definition
|
|
Term
| How much vitamin E is the dose for Alzheimer's? |
|
Definition
|
|
Term
| Besides alzheimer's, anticholinesterase meds are also indicated for what other type of dementia? |
|
Definition
|
|
Term
| What is dementia with Lewy Bodies? |
|
Definition
| dementia with features of both alzheimer's and parkinson's but progression may be more rapid than in Alzheimer's; initially visual hallucinations predominate; other symptoms include extrapyramidal features and fluctuating mental staus |
|
|
Term
| How do you treat dementia with lewy bodies? |
|
Definition
| avoid neuroleptic agents because they exacerbate sympotms; treat like alzheimer's with neuroleptics if they are psychotic; selegiline may slow the progression of disease |
|
|
Term
| What kinds of things can cause delirium? |
|
Definition
| postoperative state, dehydration, malnutrition, infection/inflammation/fever, medications and drug intoxications, drug withdrawal states, metals, trauma/burns |
|
|
Term
| What types of drugs can cause delirium? |
|
Definition
| TCAs, corticosteroids, anticholinergics, hallucinogens, cocaine |
|
|
Term
| What is teh lab workup for delirium? |
|
Definition
| CMP, B12, thiamine, perform LP in any pt that is also febrile and has no contraindications |
|
|
Term
|
Definition
| depressed level of consciousness to the extent that the patient is completely unresponsive to any stimuli |
|
|
Term
| IF a patient is in a coma and has an abnormal pupillary light response, what should you be thinking? |
|
Definition
| structural intracranial lesions, drugs that affect teh pupil (morphine and atropine-like agents), anoxic encephalopathy, recent eye drops |
|
|
Term
| Coma + bilateral fixed, dilated pupils= |
|
Definition
|
|
Term
| Coma + unilateral fixed, dilated pupil= |
|
Definition
| herniation with CN III compression |
|
|
Term
|
Definition
| narcotics, ICH into the pons |
|
|
Term
| A 15 on the GCS means teh pt can... |
|
Definition
| open eyes spontaneously, obeys commands, and has appropriate and oriented speech |
|
|
Term
| A 3 on the GCS means the patient... |
|
Definition
| does not open his eyes, does not withdraw to pain, and does not make any sounds |
|
|
Term
| "locked in" syndrome means that a patient is completely paralyzed except for.... |
|
Definition
| muscles of respiration, blinking and vertical eye movement |
|
|
Term
| What causes locked in syndrome? |
|
Definition
| infarction or hemorrhage of the ventral pons |
|
|
Term
| What are the criteria for diagnosing brain death? |
|
Definition
| absence of brainstem reflexes despite adequate oxygenation and ventilation/apneic, no drug intox or metabolic condition, core body temp >32 C, clinical evidence or imaging that suggests cause for brain death, repeat exam or EEG performed |
|
|
Term
| Name some tracts commonly involved in the MS demylination. |
|
Definition
| pyramidal, cerebellar, medial longitudeinal fasciculus, optic nerve, posterior columns |
|
|
Term
| How long does an MS relapse last? |
|
Definition
|
|
Term
| How often do pts with MS get relapses in general? |
|
Definition
| 1/yr but decrease over time |
|
|
Term
| What are symptoms of optic neuritis? |
|
Definition
| monocular visual loss, pain on movement of eyes, central scotoma, decreased pupillary reaction to light |
|
|
Term
| Does a lesion of the MLF lead to an ipsilateral or contralateral defect? |
|
Definition
|
|
Term
| What is teh most common initial presentation of MS? |
|
Definition
| decreased sensation or pareshtesias in upper or lower limbs |
|
|
Term
| What is the most common complaint of pts with MS? |
|
Definition
|
|
Term
| At what age does primary progressive MS present? |
|
Definition
|
|
Term
| What is the usefulness of diagnostic tests for MS? |
|
Definition
| MRI, CSF, and evoked potentials are abnormal in 90% of pts with MS |
|
|
Term
| What factors make it more likely that MS will cause severe disability? |
|
Definition
| frequent attacks early in the disease course, onset at an older age, progressive course, and early cerebellar or pyramidal involvement |
|
|
Term
| T/F The number of lesions on the MRI are proportional to disease severity and speed of progression. |
|
Definition
|
|
Term
| What is teh test of choice for MS? |
|
Definition
| MRI (because it is the most sensitive) |
|
|
Term
| Most attacks of MS resolve within what time frame? |
|
Definition
|
|
Term
| How effective is TPE (therapeutic plasma exchange) for steroid-refractory acute demyelinating disease? |
|
Definition
|
|
Term
| Are IV steroids used for MS? |
|
Definition
| yes they can lessen an acute attack but do not result in any improvement in long term outcome |
|
|
Term
| What kinds of interferons can be used for MS? How effective are they? |
|
Definition
| IFN beta 1a, IFN beta 1b, glatiramer acetate; 37%, 33%, 29% respectively |
|
|
Term
| When should you start interferon therapy for MS? |
|
Definition
| early in the course of disease before teh disability becomes irreversible |
|
|
Term
| When do you use cyclophosphamide for MS? |
|
Definition
| only for rapidly progressive disease because of toxic side effects |
|
|
Term
| What kind of meds are often used for symptoms of MS? |
|
Definition
| baclofen or dantrolene for msucle spasticity, carbamazepine or gabapentin for neuropathic pain, treat depression if indicated |
|
|
Term
| Name some common infections that precede Guillain-Barre Syndrome? |
|
Definition
| ivral or mycoplasmal infection of the URI or GI tract; campylobacterjejuni, CMV, hepatitis, and HIV |
|
|
Term
| What diseases, besides recent viral URI or gastroenteritis, are associated with Guillain-Barre Syndrome? |
|
Definition
| Hodgkin's disease, lupus, after surgery or after HIV seroconversion |
|
|
Term
| T/F Guillain Barre is asymmetric. |
|
Definition
| false; more often symmetric |
|
|
Term
| What types of sensory abnormalities are seen in Guillain Barre? |
|
Definition
| extremities may be painful but sensory loss is not typical |
|
|
Term
| T/F Bowel and bladder incontinence often occur with guillain barre? |
|
Definition
| false; sphincter control is maintained |
|
|
Term
| What should you never give pts who have guillian barre? |
|
Definition
|
|
Term
| How do you make the diagnosis of guillain barre? |
|
Definition
| combination of CSF fluid analysis, clinical findings, and nerve conduction velocities |
|
|
Term
| What types of patient's often have myasthenia gravis symptoms limited to extraocular muscles? |
|
Definition
|
|
Term
| At what age is the typical onset of myasthenia gravis? |
|
Definition
| age 20-30 in women; age 50 to 70 in men |
|
|
Term
| Besides extraocular muscles, what other muscle groups are affected by myasthenia gravis? |
|
Definition
| proximal limbs (asymmetric) |
|
|
Term
| Is the limb weakness associated with myasthenia gravis symmetric or assymetric? |
|
Definition
|
|
Term
| What are the symptoms of Lambert-eaton myasthenic syndrome? |
|
Definition
| proximal muscle weakness and hyporeflexia |
|
|
Term
| What percent of patients get myasthenic crisis? |
|
Definition
|
|
Term
| What percent of patients with myasthenia gravis are antibody negative? |
|
Definition
|
|
Term
| What percent of MG patients have thymoma? |
|
Definition
| 10-15% have thymoma; but the thymus is histologically abnormal in 75% of pts |
|
|
Term
| What limits the utility of the edrophonium test? |
|
Definition
|
|
Term
| Name some medications that can exacerbate myasthenia gravis? |
|
Definition
| antibiotics (aminoglycosides and tetracyclines), beta blockers, antiarrhythmics (quinidine, procainamide, and lidocaine) |
|
|
Term
| If a patient with myasthenia gravis has a poor response to AChE inhibitors, what should you give them? |
|
Definition
| immunosuppressive drugs like corticosteroids; azathioprine and cyclosporine are alternative third-line agents |
|
|
Term
| What should you do for pts in myasthenic crisis? |
|
Definition
|
|
Term
| How can you tell whether you need to intubate someone with myasthenia gravis? |
|
Definition
| at a FVC of 15 mL/kg (about 1 L); you should have a very low threshold for intubation and not wait until the pt is hypoxic |
|
|
Term
| Describe the muscle weakness associated with Duchenne's? |
|
Definition
| progressive, symmetric, and starts in childhood; affects pelvic girdle |
|
|
Term
| What causes the enlarged calf muscles of Duchenne's? |
|
Definition
| true muscle hypertrophy at first, followed by pseudohypertrophy as fat replaces muscle |
|
|
Term
| What tests are used for diagnosis of Duchenne's muscular dystrophy? |
|
Definition
| serum CPK elevation; DNA testing has now replaced muscle biopsy for diagnosis |
|
|
Term
| How do you treat Duchenne's? |
|
Definition
| prednisone will increase strength, muscle function, pulmonary function and may reduce the risk of scoliosis |
|
|
Term
| When do you start Pts with Duchenne's on chronic steroid therapy? |
|
Definition
| boys 5 yoa and older whose motor skills are declining |
|
|
Term
| Which is more common Duchenne's or Becker's muscular dystrophy? |
|
Definition
|
|
Term
| Besides Becker's and Duchenne's, what are some other hereditary causes of muscle weakness? |
|
Definition
| mitochondrial disorders, glycogen storage diseases |
|
|
Term
| Deficiency of what enzyme causes McArdle's disease? |
|
Definition
| glycogen phosphorylase deficiency |
|
|
Term
| Name some neurocutaneous syndromes. |
|
Definition
| neurobiromatosis type I, neurofibromatosis type II, tuberous sclerosis, sturge-weber, von hippel-lindau disease |
|
|
Term
| What is the inheritance pattern of neurofibromatosis? |
|
Definition
|
|
Term
| What is the inheritance pattern of tuberous sclerosis? |
|
Definition
|
|
Term
| What is the inheritance pattern of sturge weber? |
|
Definition
|
|
Term
| What is teh inheritance pattern of von hippel-lindau disease? |
|
Definition
|
|
Term
| What are the cutaneous stigmata of neurofibromatosis? |
|
Definition
| cafe au lait sponts, neurofibromas, axillary or inguinal freckling, iris hamartomas (Lisch's nodules); sometimes can have short height and be macrocephalic |
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Term
| What are the tumors/serious complications of Neurofibromatosis? |
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Definition
| CNS tumors (gliomas, meningiomas), pheochromocytomas, optic nerve gliomas, renal artery stenosis; spinal deformity and congenital tibial dysplasia |
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Term
| T/F Seizures is associated with NF types 1 and 2. |
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Definition
|
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Term
| T/F MR and learning disabilities is associated with NF (both types). |
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Definition
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Term
| Name some musculoskeletal abnormalities associated with NF type 1. |
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Definition
| spinal dformity; congenital tibia dysplasia |
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Term
| Which is more common NF type 1 or 2? |
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Definition
| type 1 is much more common |
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Term
| What are the clinical features of NF type II? |
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Definition
| bilateral (sometimes unilateral) acoustic enuromas (classic finding), multiple meningiomas, cafe au lait spots, neurofibromas (much less common than type 1), and cateracts |
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Term
| Pts with tuberous sclerosis often rpesent becasue of... |
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Definition
| cognitive impairment, epilepsy, and skin lesions (including facial angiofibromas and adenoma sebaceum) |
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Term
| What kinds of tumors are associated with tuberous sclerosis? |
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Definition
| retinal hamartomas, renal angiomyolipomas, and rhabdomyomas |
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|
Term
| How do you treat tuberous sclerosis? |
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Definition
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Term
| What is teh key pathologic feature of sturge weber syndrome? |
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Definition
| capillary angiomatoses of the pia mater |
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Term
| What is teh classic finding on physical exam of pts with sturge weber? |
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Definition
| facial vascular nevi (port wine stain) |
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|
Term
| What neurologic problems are common in pts with tuberous sclerosis? |
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Definition
|
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Term
| What are the important features of VHL disease? What are teh associated neoplasms? |
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Definition
| cavernous hemangiomas of the brain or brainstem, renal angiomas, and cysts in musltiple organs; associated with renal cell carcinoma and pheochromocytoma |
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Term
|
Definition
| central cavitation of the cervical cord due to abnomral collection of fluid within the spinal cord parenchyma |
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Term
| Syringomyelia can be caused by... |
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Definition
| most commonly= arnold chiari malformations; also, posttraumatic, postinfectious, tethered cord, intramedullary tumors |
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Term
| What are the clinical features of syringomyelia? |
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Definition
| most are asymptomatic and discovered incidentally; symptoms= bilateral loss of pain and temperature sensation over the shoulders in a "capelike" distribution (lateral spinothalamic tract involvement), with preservation of touch, thoracic coliosis and muscle atrophy of the hands may occur |
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|
Term
| How do you diagnose syringomyelia? |
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Definition
|
|
Term
| How do you treat syringomyelia? |
|
Definition
| depends on size of the syrinx, symptoms, and associated findings; eval by neurosurgery recommended |
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Term
| Where does brown-sequard syndrome usually occur? |
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Definition
| cervical levels where spinal cord enlarges |
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Term
| What are the clinical features of Brown Sequard syndrome? |
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Definition
| contralateral loss of pain and temperature (spinothalamic tract), ipsilateral hemiparesis (corticospinal tract) and ipsilateral loss of position/vibration (dorsal columns) |
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|
Term
| What is the prognosis of Brown sequard? |
|
Definition
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|
Term
| What is transverse myelitis? |
|
Definition
| inflammation that specificly affects the tracts across the horizontal aspect of the spinal cord at a given level (most commonly thoracic), cause is unkown but it can occur after viral infections and progression is usually rapid |
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Term
| What are the clinical features of transverse myelitis? |
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Definition
| lwer extremity weakness or plegia, back pain, sensory deficits below the level of the lesion, and sphincter disturbance 9esp urinrary retention) |
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|
Term
| How do you diagnose transverse myelitis? |
|
Definition
| MRI with contrast is the imaging study of choice |
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|
Term
| How do you treat transverse myelitis? prognosis? |
|
Definition
| high dose steroid hterapy is often used but evidence is equivocal; prognosis is highly variable and unpredictable, ranging from full recovery to death |
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|
Term
| A postganglionic lesion causing horner's syndrome means the lesion is... |
|
Definition
| distal to the superior cervical ganglion |
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|
Term
| Which is more worrisome: preganglionic or postganglionic horner's? |
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Definition
|
|
Term
| What are some common causes of Horner's syndrome? |
|
Definition
| most are idiopathic, pancoast tumor, internal carotid dissection, brainstem stroke, neck trauma |
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|
Term
| What is a pancoast tumor? |
|
Definition
| pulmonary neoplasm of the superior sulcus at lung apex |
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|
Term
| What are the characteristics of polio? |
|
Definition
| asymmetric muscle weakness (legs more commonly involved), absent DTRs, flaccid atrophic muscles and normal sensation |
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|
Term
| What are the three major types of dizziness? |
|
Definition
| presyncope, vertigo, and multisensory stimuli |
|
|
Term
|
Definition
| vertigo and nystamus that are position dependent without hearing loss or innitus |
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|
Term
| By what mechanism does meclizine work? |
|
Definition
| anticholinergic and antihistamine |
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|
Term
| How long does it take BPV to get better? |
|
Definition
|
|
Term
| What age are most people when they get BPV? |
|
Definition
|
|
Term
| What are the symptoms of meniere's disease? |
|
Definition
| vertigo, tinnitus and hearing loss |
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|
Term
| What is the prognosis of symptoms in Meniere's disease? |
|
Definition
| attacks may last for hours to days and recur several months or years later; hearing loss eventually becomes permenent |
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|
Term
| What is the prognosis of acute labyrinthitis? |
|
Definition
| may last for several days |
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|
Term
| If a patient has vertigo EVERY time you do the tilt test then it is probably due to a pathologic process where? |
|
Definition
| centrally; peripheral vertigo is rapidly refractory |
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|
Term
| T/F Pt falls to same side as lesion in both central and peripheral vertigo. |
|
Definition
|
|
Term
| What are teh symptoms of acoustic neruoma of CNVIII? |
|
Definition
| ataxia, gait unsteadiness, nystagmus, hearing loss, tinnitus |
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|
Term
| Name some causes of central vertigo? |
|
Definition
| vertebrobasilar insufficiency, MS, migraine associated vertigo |
|
|
Term
| What is the typical characteristics of cardiac syncope? |
|
Definition
| usually sudden and without prodromal symptoms; pts face hits the floor |
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|
Term
| What types of cardiac issues can cause syncope? |
|
Definition
| obstruction of blood flow, arrhythmia, massive MI |
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|
Term
| What are some other terms for vasovagal syncope? |
|
Definition
| "neurocardiogenic" "vasodepressor" "simple faints" |
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|
Term
| Syncope during exertional effort; you should be worried about: |
|
Definition
|
|
Term
| What clues can you have to diagnose vasovagal syncope? |
|
Definition
| emotional stress, pain, fear, extreme fatigue or clastrophobic situations, premonitory sympotms, be reluctant to make this diagnosis if first episode is after age 40, tilt table study can reproduce the symptoms in susceptible peopel |
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|
Term
| If you have to resort to meds to treat vasovagal syncope, what can you use? |
|
Definition
| beta blockers and disopyramide |
|
|
Term
| What can cause orthostatic hypotension causing syncope? |
|
Definition
| old age, ganglionic blocking agents, diabetes, prolonged bed rest |
|
|
Term
| How do you treat syncope secondary to orthostatic hypotension? |
|
Definition
| increased sodium intake and fluids; consider fludrocortisone |
|
|
Term
| Why is it important to determine between cardiac and noncardiac etiologies when evaluating syncope? |
|
Definition
| because prognosis is poorest for those with underlying heart disease |
|
|
Term
| How should you work up syncope? |
|
Definition
| ECG FOR ALL PTS!!! CBC and metabolic panel may be appropriate |
|
|
Term
| Name some causes of seizures? |
|
Definition
| metabolic and electrolyte/endocrine disturbances, mass lesions, missing drugs, acute withdrawal, pseudoseizures, eclampsia, hypertensive encephalopathy, intoxications, infections, ischemia, increased ICP |
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|
Term
| What is the most common cause of poor seizure control in epileptics/ |
|
Definition
| noncompliance with anticonvulsants |
|
|
Term
| What is the difference between eclampsia and preeclampsia? |
|
Definition
|
|
Term
| What is the treatment for ecclampsia? |
|
Definition
| magnesium infusion is pharmacologic treatment of choice but the only definitive treatment is delivery |
|
|
Term
| 70% of patients with epilepsy older than 18 yoa have what type of seizures? |
|
Definition
|
|
Term
| How long does the postictal phase last after a tonic clonic seizure? |
|
Definition
|
|
Term
| HOw long does the clonic phase last? |
|
Definition
|
|
Term
| What percent of absence seizures involve minor clonic activity like eye blinks or head nodding? |
|
Definition
|
|
Term
| Laboratory values you should immediately check in an unfamiliarl patient who is seizing includes... |
|
Definition
| sodium, calcium, BUN, glucose, |
|
|
Term
| What is the mortality rate of status epilepticus? |
|
Definition
|
|
Term
| What is the treatment for status epilepticus? |
|
Definition
| establish an airway, giving IV diazepam, IV phenytoin, and 50 mg dextrose; treat resistant cases with phenobarbital |
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|
Term
| What percent of adult pts can be controlled on one antiepileptic drug? |
|
Definition
|
|
Term
| What test should you do before giving pts anticonvulsants? |
|
Definition
| PREGNANCY TEST! antiepileptic agents are teratogenic |
|
|
Term
| How long should a patient be seizure free before you think about d/cing their meds? |
|
Definition
| 2 years at least; taper meds cautiosly and confirm this decision with a normal EEG |
|
|
Term
| What percent of cases of ALS are familial? |
|
Definition
|
|
Term
| What is a treatment you can use for ALS and what is the effectiveness? |
|
Definition
| riluzole is a glutamate blockign agent; it may delay death by only 3 to 5 months |
|
|
Term
|
Definition
| contractile properties of sckletal muscles; will show fibrillations and fasciculations of muscles if there is LMN disease; will amplitude decreased with muscle contraction if there is a myopathy |
|
|
Term
| What are nerve conduction studies useful/ |
|
Definition
| slow nerve conduction velocity indicates demyelination; repetitive stimuli resulting in fatigue is indicative of MG |
|
|
Term
| Disturbance in repitition= |
|
Definition
|
|
Term
| What is the workup for Bell's palsy? |
|
Definition
| cause is often uncertain, possible viral etiology (herpes simplex) and URI is common preceding event; consider lyme disease an ddont' use steroids if lyme is suspected; consider EMG testing if paresis fails to resolve within 10 days |
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|
Term
| How do you treat idiopathic bell's palsy/ |
|
Definition
| short course of steroids (unless lyme disease is suspected), and acyclovir if necessary; pt should where eye patch at night to prevent corneal abrasion; surgical decompression of CN VII is indicated if the paralysis progresses or if tests indicate deterioration |
|
|
Term
|
Definition
| truama, lyme disease, tumor, guillain barre syn drome, herpes zoster |
|
|
Term
| What is the prognosis of trigeminal neuralgia? |
|
Definition
| complete resolution in 85%; mild residual in 10%; no resolution in5% |
|
|
Term
| What is the work up for tic douloreux? |
|
Definition
| MRI to rule out cerebellopontine angle tumor; but diagnosis is clinical |
|
|
Term
| How do you treat trigeminal neuralgia? |
|
Definition
| carbamazepine, baclofen and phenytoin; surgical decompression if medical therapy fails |
|
|
Term
| Visual-spatial deficits mean a lesion where... |
|
Definition
| righ sided cerebral cortex |
|
|
Term
|
Definition
|
|
Term
| Deficit on one side of face and the other side of the body= |
|
Definition
| lesion on brainstem on the side of the face lesion; this is because the corticospinal, dorsal columns an dspinothalamic tracts cross bu teh cranial nerves do not |
|
|
Term
| decrease in sensation below a sharp band in teh abdomen/trunk indicates... |
|
Definition
| spinal cord lesion (pathognomonic) |
|
|
Term
| What are the most common causes of plexopathies? |
|
Definition
| trauma is the most common cause overall esp for the brachial plexus; a postsurgical hematoma is a more common cause in lumbosacral plexopathy |
|
|
Term
| Nerve roots of the lumbosacral plexus= |
|
Definition
|
|
Term
| Key finding of radiculopathy= |
|
Definition
|
|
Term
| Dermatome and/or myotome affected indicates a lesion where... |
|
Definition
|
|
Term
| Where does the dorsal column medial lemniscus system decussate? |
|
Definition
| junction between teh spinal cord and the brainstem |
|
|
Term
| Distal, asymmetric weakness indicates a lesion where? |
|
Definition
|
|
Term
| What nerves are commonly involved in neuropathies? |
|
Definition
| radial, ulnar, median, musculocutaneous, long thoracic nerve, axillary nerve, common perioneal nerve, and femoral nerve |
|
|
Term
| Key finding of neuromuscular junction pathology= |
|
Definition
|
|
Term
| What's the difference between myopathy and dystrophy? |
|
Definition
| myopathy is acquired; dystrophy is inherited |
|
|
Term
| What's teh difference between teh atrophy associated with neuropathies and the atrophy associated with myopathies? |
|
Definition
| muscular atrophy in myopathies occurs late due to disues; in contrast to the rapid atrophy in motor neuron disease |
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