Neurology Review Flashcards

A set of Q&A style flashcards covering key points from the neurology portion of the lecture, including migraines, headaches, imaging, stroke, seizures, neurodegenerative and movement disorders, neuromuscular diseases, and peripheral neuropathies.

What are the core diagnostic features of migraine headaches?

Unilateral, fairly severe headache lasting hours with nausea/vomiting and photophobia/phonophobia; prodrome in ~75% and aura in ~25%.

What is the first-line abortive medication for an acute migraine headache?

Acetaminophen and ibuprofen.

What are common prophylactic options for migraine prevention?

Beta-blockers (e.g., propranolol), calcium channel blockers; antidepressants (amitriptyline or nortriptyline) for comorbid depression; anticonvulsants if seizures; CGRP antagonists (injectable) for prevention.

What is a key caution with triptan medications for migraines?

Used only a few days per month due to potential medication interactions and risk of rebound effects.

What is the characteristic presentation of cluster headaches?

Severe unilateral headaches in short bursts with a pattern; often in males; ipsilateral lacrimation, nasal congestion, eye redness.

How are acute cluster headaches typically aborted?

100% oxygen via a non-rebreather mask; second line with intranasal or injectable triptans; prevent with calcium channel blockers.

What are the features of tension-type headaches?

Mild to moderate bilateral band-like pain often related to stress; can be managed with OTC analgesics and non-pharmacologic relief.

How is idiopathic intracranial hypertension (pseudotumor cerebri) managed?

Acetazolamide to reduce CSF pressure, weight loss, and ophthalmology follow-up for papilledema.

What does the Glasgow Coma Scale assess and what is its significance?

Level of consciousness; maximum score 15; lower scores indicate reduced consciousness; intubation recommended at 8 or less.

In head injuries, what is the imaging of choice?

Non-contrast CT head.

How are head injury severity levels defined by GCS score?

Mild 13–15, Moderate <13, Severe <8.

What symptoms accompany concussion and when is CT typically indicated for mild head injury?

Retrograde amnesia, confusion, or balance issues with a normal neuro exam; CT indicated if any red flags or worsening symptoms.

What are the CT appearances of subdural vs epidural hematomas?

Subdural: crescent-shaped; Epidural: lens-shaped (biconvex) between skull and dura.

What is the lucid interval in head injury?

A period of apparent normal function after head trauma followed by rapid deterioration, typical of epidural hematoma.

How is intracerebral hemorrhage managed on presentation?

Non-contrast CT to confirm bleed; involve neurosurgery; manage blood pressure and other supportive measures.

What are the main etiologies of ischemic stroke?

Large vessel atherosclerosis, cardioembolism (e.g., AFib), and small vessel disease (lacunar).

What are the two broad categories of ischemic stroke location and their key signs?

Anterior circulation (ACA: leg > arm weakness; MCA: arm > leg; aphasia with dominant hemisphere; gaze deviation) and posterior circulation (balance, cranial nerve palsies; often bilateral symptoms).

What is the time window for administering IV alteplase (rt-PA) in ischemic stroke and how is onset determined when unclear?

Within 4.5 hours of onset or last known well; if onset time is unknown (e.g., wake-up stroke), use last time seen normal as the reference.

When is carotid endarterectomy considered after a stroke?

Indicated if carotid ultrasound shows 70–99% stenosis on the affected side; can be done within ~2 weeks; not done for 100% occlusion.

What signs suggest a posterior circulation stroke?

Bilateral symptoms, cranial nerve findings, balance/ataxia, and variable presentations depending on affected structures.

What tools are used to assess stroke severity and prognosis initially?

NIH Stroke Scale for initial severity; guides prognosis and treatment decisions.

What is the typical initial imaging and management pathway for suspected SAH when CT is negative?

Lumbar puncture to look for xanthochromia indicating subarachnoid bleeding; urgent neurosurgical evaluation.

What are common brain neoplasms and metastasis patterns to the brain?

Primary: meningiomas, glioblastomas, pituitary adenomas; metastases from lung, melanoma, kidney, breast.

What are key MRI/CSF findings in multiple sclerosis?

MRI with contrast shows white matter lesions (Dawson’s fingers); CSF may show oligoclonal bands.

What is the pathophysiology and main treatment approach for myasthenia gravis?

Autoimmune antibodies to acetylcholine receptors at NMJ causing fatigable weakness; treat with pyridostigmine; thymoma screening; immunosuppression; plasmapheresis if crisis.

What are the four cardinal signs of Parkinson’s disease and its main treatments?

Tremor at rest, rigidity, akinesia/bradykinesia, postural instability; treated with levodopa/carbidopa and dopamine agonists.

What is restless leg syndrome and its common associated factor and treatments?

Irresistible urge to move legs, often with iron deficiency; treated with gabapentinoids (pregabalin/gabapentin) and dopamine agonists.

What is Huntington’s disease and its inheritance pattern?

Autosomal dominant on chromosome 4 with anticipation; choreiform movements; depression/dementia; genetic testing.

What is tardive dyskinesia and how is it managed?

Involuntary orofacial movements from antipsychotics/metoclopramide; stop offending agent or switch to second-generation antipsychotics; tetrabenazine/valbenazine can help; obtain informed consent due to liability.

What is Tourette syndrome and its management focus?

Chronic motor and vocal tics with high comorbidity; management emphasizes treating comorbidities (CBT; SSRIs for OCD/anxiety) rather than tics alone.

What is the hallmark of amyotrophic lateral sclerosis (ALS)?

Combined upper and lower motor neuron disease with spasticity/hyperreflexia (UMN) and muscle wasting/weakness (LMN); progressive with no cure.

What is Bell’s palsy and its typical management?

Unilateral facial nerve (CN VII) palsy causing inability to close eye and facial droop; commonly precipitated by herpes; prednisone recommended if within 3 days; eye lubrication/patching.

What is Guillain–Barré syndrome (GBS) and its main treatment?

Peripheral demyelination with ascending paralysis after infection or similar trigger; can cause respiratory failure; treat with IVIG or plasmapheresis.

What is cauda equina syndrome and why is it an emergency?

Impingement of nerve roots in the lumbar canal causing urinary retention, fecal incontinence, and saddle anesthesia; requires emergent MRI and decompression.

What is complex regional pain syndrome and its key clinical clue?

Pain out of proportion to minor trauma with changes in limb temperature, color, and swelling; treat with NSAIDs and physical therapy; recognize early.