Neuro Step Up

Regions of brain and blood supply

• ACA

• MCA

• PCA

• Basilar artery

• AICA

• PICA

neuronal pathways in the spinal cord cross section

Tracts affected in

• ALS

• Poliomyelitis

• Tabes dorsalis (Tertiary syphilis)

• Spinal artery syndrome

• Vitamin B12 def

• syringomyelia

• brown sequard syndrome

Bacterial meningitis tx and complication

What should be perfomed before LP

Common causes of meningitis by age group

• newborn

• 1mo-2yrs

• 2-18 yrs

• 18-60 yrs

• 60+ yrs

CSF findings

• healthy

• bacterial

• fungal/TB

• Viral

Wbcs/ pressure/ glucose/ protein

Viral meningitis treatment

fungal meningitis tx

Encephalitis

-radiology

-tx

Brain Abscess

-Workup

-Imaging, what kind and what does it show

-What to use for culture

-Tx

-brain biopsy or culture of abscess material during sx draining to confirm bacterial identity 

MRI/CT shows ring enhancing lesions.

Can use CT guided biopsy to get culture 

tx: empiric abx until you figure out what bug, steroids and sx drainage

polio

-labs

-tx

-Complication of ORAL vaccine

-Positive polio specific antibody

-LP shows viral meningitis 

-Viral culture helpful for diagnosis 

-Tx: supportive care and respiratory care if respiratory muscles affected 

-Complications: after polio ORAL vaccine you can get poliomyelitis. So inactivated IM polio is more commonly used 

Rabies

-Workup

-prophylaxsis

-Catch the suspected animal and test or observe for signs of rabies 

-If suspicion: kill animal and check brain for Negri bodies (round eosinophilic inclusions in neurons) 

-viral testing in humans (CSF, skin, serum) if sxs is confirmatory of disease 

Proph: clean wound, administer rabies IG and vaccine if suspicion is high 

TIA

-Tx

• if d/t atherosclerosis: anti platelet (ex. ASA) and antilipid (statin) 

• Carotid endarterectomy or angioplasty if carotid narrowing

  • >60 in asymptomatic men,

  • >50 in sxs men,

  • >70 in sxs women 

• BB, valvuloplasty or valve replacement if aortic stenosis 

• long term anticoagulant if arrhythmia 

• tx underlying disorders 

CVA/ Stroke

-common cause of thrombotic ischemic stroke

-most common artery involved in embolic ischemic stroke

-most emboli originate in

Most common cause of thrombotic ischemic stroke: atherosclerosis of

• carotid,

• basilar

• or vertebral arteries 

Most common artery involved in embolic ischemic stroke:

• MCA 

Most emboli originate in:

• heart,

• aorta,

• carotid,

• intracranial arteries 

Location of stroke and signs and symptoms

• ACA
  MCA
  PCA
  Lacunar stroke

• basilar artery

-ACA- opposite lower extremity 

-MCA- opposite face and upper extremity +/- visual abnormalities if dominant, neglect if not dominant 

-PCA: opposite visual/ blindness if bilateral PCA 

-Lacunar: focal motor or sensory deficits, no coordination, dysphagia 

-Basilar artery: locked in syndrome 

tPA inclusion and exclusion criteria

Inclusion: 

-ischemic stroke 

-<3-4.5 hours of normal 

-18 years or older 

Exclusion: 

-no head trauma or stroke in past 3 months

-no SAH 

-no arterial puncture in last 7 days 

-no history of intracranial hemorrhage 

-no brain cancer, AVMF, or aneurysm in past 

-recent intracranial or intraspinal surgery 

-BP 185/110+ 

-active internal bleeding 

-PLT <100k 

-heparin in last 48 hrs with elevated aPTT

-INR>1.7 

-PT> 15s

-current use of direct thrombin inhibitors or direct factor 10a inhibitors with elevated lab tests (PTT, INR, PLT) 

Treatment stroke/ CVA

Stroke Tx

-TPA within 4.5 hours of last normal 

-only lower BP if > 220/120 OR if concurrent hypertensive emergency such as aortic dissection 

-ASA within 48 hours 

-statins after acute stages of stroke 

-if ICH:

• ABCs,

• maintain BP at 140-160 or less,

• reverse

  • blood thinners and

  • direct thrombotic inhibitors (dabigatran- idarucizumab or PCC),

  • factor 10A inhibitors (antidote andexanet alfa or PCC),

• if mass effect or herniation (mannitol or hypertonic saline)

Parenchymal hemorrhage

-def

-sxs

-radio

-tx

-complications

Berry aneurysms assoiciated with

ADPKD

ehlers-danlos

SAH

-Labs

-radio

-tx

-complications

epidural vs subdural on CT

Epidural hematoma

-sxs

-radiology

convex

if SAH suspected despite negative CT

do LP

Traumatic LP vs SAH

Epidural hematoma

-tx

-complications

Subdural hematoma

-sxs

-radio

-tx

Status epilepticus

-def

-sxs

-labs

-eeg

-tx

-complications

delay what during status epilepticus until pt is stablilized

CT and EEG

Parksinsons disease drugs, mechanisms, indications, adverse effects

• levadopa

• carbidopa

• bromocriptine

• selegiline

• amantadine

• antimuscarining agents

ALS

-sxs

-labs

-EMG

-radio

-tx

-complications

Huntington disease

-def

-characteristic signs

-sxs

-labs

-radio

-tx

-complications

MS

-labs

-radio

-tx

-complications

-next step

syringomyelia

-def

-pathophysiology

-radio

-tx

MG

-labs

-tx

LES is a

-occurs because of

-tx with

GBS

-def

-sxs

-labs

-emg

-tx

-complications

If MG dx in pt, then

always get CHEST CT to look for thymoma

Edrophonium is

Bells Palsy

-def

-sxs

-tx

-difference vs cortical stroke

Most common primary brain trauma in adults vs children.

Tumors in adults tend to be vs children

Primary brain cancer

-labs

-radio

-tx

Most mets to the brain are

supratentorial

Mets CNS neoplasms

-labs

-radio

-tx

-complications

If intracranial tumor is the initial lesion detected

workup should include a full search for a source neoplasm- full body CT, blood cancer antigens, etc.

NFT1

-genetics

-dx requires

-labs

-radio

-tx

-complications

Normal sleep cycle

-half of sleep spent in

-benzos do what

Narcolepsy

-labs

-tx

Coma pathway

Eye nerves and functions

• optic

• trochlear

• abducens

• pculomotor

  • mlf

Vision pathway and lesions

Conjuntivitis facts x4

-labs

-tx

pupil issues

presentation and cause

• argyll robertson pupil

• marcus gunn

• horner

• adie

• ino

uveitis

-sxs

-tx

cataracts

-sxs

-tx

Glaucoma

-most common type

-patho

-open angle

• patho

• rf

• sxs

• labs

• tx

-closed

• patho

• rf

• sxs

• labs

• tx

• complications

Macular degeneration

-def

-rf

-sxs

-radio

-tx

-complications

-most common cause of

Retinal detach

-def

-rf

-sxs

-tx

Retinal vessel occlusion

-def

-most commonly caused by

-sxs

-tx

-complications

OM

-sxs

-tx

-complications

OE

-sxs

-tx

BPPV

-patho

-sxs

-radio

-tx

Meniere disease

-aka

-patho

-sxs

-tx

-complications

Acoustic neuroma

-patho

-sxs

-labs

-radio

-tx

-complications

Review conductive vs sensonurial

Alzheimer

-patho

-rf

-sxs

-labs

-radio

-tx

-complications

-dementia vs alzheimer

Frontotemporal dementia (pick dz)

-def

-sxs

-labs

-radio

-tx

Dementia with lewy bodies

-def

-sxs

-labs

-radio

-tx

-may cause movement sxs similar to

NPH

-sxs

-labs

-radio

-tx

avoid what drugs when tx delirium or dementia related agitation