Neurology

CN and their function?

1. Olfactory: Smell

2. Optic: Vision

3. Oculomotor: Eye movement

4. Trochelar: Coordination of binocular vision

5. Trigeminal: Sensory & motor to face

6. Abducens: Lateral eye movement (abduction)

7. Facial: Facial expression, Taste in anterior 2/3 of tongue

8. Vestibulocochlear: Hearing, balance, equilibrium

9. Glossopharyngeal: Taste in post 1/3 of tongue, swallowing, specific BP

10. Vagus: Speech, digestion, respiration, cardiac activity

11. Accessory: Head, neck, shoulder movement

12. Hypoglossal: Tongue movement & speech articulation

Guillain-Barre Syndrome?

• RF: Campylobacter jejuni —> Follows resp/GI illness

• S/S: Destruction of myelin in schwann cells —> Progressive symmetric ascending flaccid paralysis & weakness, ambulatory dysfunction, paresthesias, resp compromise, DTE decreased/absent

• Dx: LP & CSF analysis —> Elevated CSF protein, EMG/nerve conduction studies

• Tx: Vent support, plsamapharesis/IVIG

Cluster headache s/s, tx, prophylaxis?

• S/S: Sudden onset of severe unilateral pain that occurs multiple times daily lasting 5min-3hrs, lacrimation, rhinorrhea, ptosis, miosis

• Tx: 100% O2 + Sumatriptan

• Prophylaxis: NDPH-CCB (Verapamil)

Trigeminal neuralgia vs Cluster headache?

• Same s/s but trigeminal neuralgia has NO autonomic symptoms (lacrimation, rhinorrhea, ptosis) & precipitated by tapping nerve or movement

  • TN: Carbamazepine (anticonvulsant) vs CH: 100% O2

Migraine s/s, abortive tx, preventative tx?

• S/s: Moderate-severe throbbing pain, photo/phono-phobia, N/V ± Aura (scotomna, decreased visual acuity, flashing lights, paresthesia), normal neruo exam

• Abortive Tx: NSAID, acetaminophen, triptans

• Preventative Tx: Anticonvulsants (valproate, topiramate), BBs (propanolol). TCAs (amitriptyline)

Tension headache s/s, abortive tx, preventative tx?

• S/S: Gradual onset, pressure/tightness in band like distribution, muscle tension in head/neck, NO aura, N/V

• Abortive tx: NSAIDS, acetaminophen

• Preventative tx: TCAs (amitriptyline)

Encephalitis MCC, s/s, dx, tx?

• Infection of brain parenchyma —> MCC HSV T1

• S/S: Altered consciousness, AMS, confusion, personality changes, fever, headache, focal neuro deficits (hemiparesis, hyperreflexia)

• Dx: CSF shows Normal glucose, ↑ protein, lymphocytosis + Head CT to r/o space occupying lesion

• Tx: IV acycylovir

Bacterial meningitis

• S/s: Fever, neck stiffness, headache, AMS, seizures, meningeal signs (Kernig & Brudzinski)

  • Petechial/ecchymotic rash if Neisseria meningitidis

• Dx: CSF shows ↑ opening pressure, predominant neutrophils, ↓ glucose, ↑ protein

• Neonate Tx: Cefotaxime/Ceftriaxone + Ampicillin

• Older children/Adults Tx: Cefotaxime/Ceftriaxone + Vancomycin

What do we give for listeria coverage in bacterial menigitis?

Ampicillin

Parkinson’s Disease patho, s/s, tx?

• Patho: Deficiency of dopamine in basal ganglia

• S/S: Resting tremor, bradykinesia, muscular rigidity, postural instability (impaired balance & coordination), resting “pill rolling” tremor, cogwheel rigidity (rigidity + tremor)

• Tx: Carbidopa-Levodopa, dopamine agonists (pramipexole), MAO-B inhibitors (selegiline) amantadine

Glioblastoma s/s & dx?

• S/S: Chronic headaches, N/V, cognitive/personality/ visual changes, seizure

• Dx: Biopsy + Head MRI with gadolinium

Vascular dementia

• Prior stroke or small vessel changes in the brain —> cognitive decline following stroke

• CT/MRI: White matter lesions

• Tx: No tx, focus on preventing progression by controllong RFs

Dementia with Lewy Bodies

• Lewy body deposits on brain —> fluctuating cog impairment, hallucinations, REM sleep behavior disorder, Parkinsonism features

• CT/MRI: Atrophy of frontal & temporal lobes

• Tx: Cholinesterase inhibitors: donepezil, rivastigmine, galantamine

Frontotemporal dementia s/s & tx?

• S/S: Genetic mutations cause early degeneration of frontal & temporal lobes —> Behavior/personality changes & word finding difficulty

• No effective pharmacotherapy tx

Alzheimer’s s/s, dx, tx?

• S/S: Amyloid plaques cause progressive decrease in cognition & memory, difficulty completing ADLs, short term memory loss

• CT/MRI: Atrophy of medial temporal lobes & hippocampus

• Tx: Cholinesterase inhibitors: donepezil, rivastigmine, galantamine

Multiple Sclerosis s/s, PE, dx, tx?

• S/S: Demyelination of CNS —> fatigue, sensory changes, muscle spasticity, optic neuritis (painful monocular vision loss) & internuclear ophthalmoplegia (impaired horizontal eye movements)

• PE: Relative afferent pupillary defect/Marcus Finn pupil (pupils dilate when light is shown), Lhermitte sign (electric shock-like sensation down the spine and into limbs when the neck is flexed), stoaccato speech pattern

• Dx: MRI with gadolinium shows white plaques and Dawson’s fingers

• Tx: IV CCS for acute, IV monoclonal antibodies for long term therapy

Myasthenia Gravis

• Disorder of IgG antibodies at postsynaptic membrance

• S/S: Improves in cooler temps, muscle weakness worsens with use & improves with rest, bulbar sxs (breathing, swallowing, facial mvmt problems), ocular sxs

Lambert Eaton

Glasgow Coma Scale

Protect the airway at 8 or below

What occurs when there is a pituitary adenoma of the central optic chiasm?

#4: Bitemporal hemianopia (Tunnel vision)

Patient has a circular defect in their vision. What is the most likely dx?

Lesion on the retina —> Central scotomata #2

Child gazing to the right and unable to abduct the right eye while the adduction of the left eye is intact. What is the most likely dx?

CN 6 palsy (Abducens)

What is oculomotor (III) nerve palsy do?

Ptosis, mydriasis (dilation of pupil), down & out position of eye

Bells palsy vs Stroke

• Bells cannot move forehead

• Stroke can move forehead

BPPV

Meniere’s Disease