Neurology Review Flashcards

Flashcards based on neurology lecture notes for exam preparation.

What medications are used as abortive treatments for migraines?

Triptans (5HT Agonist); NSAIDs/acetaminophen; Antiemetics; Ergotamine (5HT Agonist)

What medications are used as preventative treatments for migraines?

Anticonvulsants (topiramate/valproate); Beta Blockers; Antidepressants

What are the autonomic manifestations of a cluster headache?

Ptosis, lacrimation, pupillary changes, nasal congestion

What is the treatment for Cluster headaches?

100% O2 is the most rapid; sumatriptan for attacks; Verapamil, Lithium for prophylaxis

Where is the pain located in tension headaches and what other symptoms are present?

Temporal and occipital regions or frontal; muscle tenderness in head, neck or shoulders

What is a concussion?

Transient disturbance of neuronal function

What are the symptoms of post-concussive syndrome?

Headache, confusion, amnesia, difficulty concentrating/multitasking, vertigo, mood alteration, sleep disturbance, anxiety.

What is the treatment for Temporomandibular Joint Syndrome?

NSAIDs and muscle relaxants

What other underlying medical conditions can be associated with Trigeminal Neuralgia?

Can be due to compression from amyloidosis and malignancy

What medication treats Trigeminal Neuralgia?

Carbamazepine

What are the symptoms of Paroxysmal Sympathetic Hyperactivity following TBIs?

Rapid onset episodes of tachycardia, HTN, and tachypnea

What treatment can be used for Paroxysmal Sympathetic Hyperactivity?

Supportive; Opioids to reduce sympathetic tone, GABA agonists, alpha 2 agonists

In oculomotor nerve palsy, where do parasympathetic and motor fibers run, and how are they affected?

Peripheral -> compression -> affects pupillary action; Motor fibers run in center -> droopy eye -> susceptible to ischemia and compression.

What do you check for in Non-pupil sparing CN III Palsy?

Check for intracranial aneurysm: MR/CT Angiography -> Posterior Communicating A Aneurysm

What are the risk factors for Pupil sparing CN III Palsy?

Microvascular ischemia: DM; HTN

What can cause Infectious Cavernous sinus thrombosis?

Uncontrolled infection of skin, sinuses, and orbit can spread to cavernous sinus -> facial/ophthalmic venous system valveless

What are the signs and symptoms of Intracranial HTN related to Cavernous sinus thrombosis?

intolerable headache is the most common symptom

Low-grade fever w/ bilateral periorbital edema due to impaired venous flow in orbital veins

What is the diagnostic imaging for cavernous sinus thrombosis?

MRI

What is the treatment for cavernous sinus thrombosis?

Broad spectrum IV Abs; prevention/reversal of cerebral herniation

What are the symptoms of Periorbital (preseptal) cellulitis?

Mild infection of eyelid anterior to orbital septum; Fever with eyelid erythema/edema

What are the signs of increased ICP when examining the eyes?

Optic Fundi cannot be visualized

What are the Focal neurological deficits associated with increased ICP?

Nystagmus, extremity weakness; altered mental state; immunocompromised

How do you decrease brain volume in raised ICP?

Osmotic therapy (hypertonic saline, mannitol)

How do you decrease cerebral blood volume in raised ICP?

Head elevation; sedation (lowers metabolic demand); Hyperventilation

How do you decrease CSF Volume in raised ICP?

CSF removal (drain)

How do you increase cranial capacity in raised ICP?

Decompressive craniectomy

What is Cushing's Triad and what does it suggest?

1. HTN

2. Bradycardia

3. irregular respirations; all suggests brainstem dysfunction

What is a complication of prolonged IVIg treatment?

Aseptic meningitis

What is the presentation of Vertigo?

Patient falls to same side as lesion

What are the characteristics of Central Vertigo?

No tinnitus/hearing loss. Gradual onset; brainstem/CNS findings present in most.

What are the characteristics of PERIPHERAL Vertigo?

Walking often preserved; usually benign; lesions cochlear or retrocochlear.

What is Benign Positional Vertigo caused by?

Crystalline debris (canaliths) in semicircular canals

What are the signs and symptoms of Benign Positional Vertigo?

Nystagmus, episodic attacks brief (moments); No effect on hearing; Dix-Hallpike manoeuvre best provocative test

What is the treatment for Benign Positional Vertigo?

Epley manoeuvre (reposition canaliths)

What is the triad observed in Meniere Disease?

1. Vertigo

2. Tinnitus

3. Sensineural hearing loss (can become permanent)

What is the treatment for Meniere's Disease?

Sodium restriction and diuretics

What is Vestibular Neuritis and its common cause?

Acute onset Vertigo. Often follows viral syndrome -> HSV

What is Acute Labyrinthitis?

Vestibular Neuritis + Hearing Loss

What causes Perilymphatic Fistula?

Complication of head injury or barotrauma that causes leakage of fluid from semicircular canal

What are the symptoms of Acoustic neuroma (schwannoma) of CN8?

Ataxia, nystagmus, hearing loss and tinnitus

How can MS present with vertigo?

Demyelination of vestibular pathways of brainstem

What are the symptoms of Vertebrobasilar Insufficiency?

Ataxia; Diplopia; perioral numbness; dysarthria

How can vertebral aortic dissection occur?

Stroke symptoms after neck extension and torsion (hair salon)

What can Posterior circulation stroke cause?

Lateral Medullary (Wallenberg) Syndrome

What is the the first step in assessing Syncope?

Rule out cardiac cause

When does Vasovagal Syncope occur?

Only occurs if patient sitting or standing, not supine

What are the autonomic response alterations that occur in vasovagal syncope?

Increased parasympathetic stimulation, decreased sympathetic output: vasodilation, Brady etc

What is the treatment for vasovagal syncope?

Beta blockers, disopyramide, avoid triggers; counterpressure techniques

What causes Carotid Hypersensitivity?

Baroreceptor hypersensitivity -> exaggerated vagal response d/t tactile stimulus of carotid sinus whilst standing

What triggers seizures?

Lack of sleep; flashing lights; emotional stress; alcohol withdrawal; idiopathic

What is the presentation of seizures?

Preceding aura; pt transiently unresponsive post seizure -> delayed return to baseline -> postictal drowsiness/confusion

What is a clinical clue for seizures?

Lateral tongue laceration

In the rinne and weber test, where will the sound lateralize in conductive and sensorineural hearing loss?

Sensineural hearing loss - lateralized to unaffected ear; Conductive loss - lateralized to affected ear

What characterizes Generalized Seizures?

Engage bilaterally distributed networks, may be asymmetric; a generalized presentation can still arise from a focal lesion

What characterizes Focal Seizures?

Originate in networks limited to one hemisphere

What is nonconvulsive Generalized convulsive status epilepticus (GCSE) and how is it treated?

20 mins w/o return to baseline or seizure >5 min; Give IV BZD (midazolam IM if no IV acces) + non BZD anti epileptic

Which Anti Epileptic Drugs can reduce efficacy of OCPs and cause Vit K Def in newborn?

Levetiracetam (lowest side effects; focal seizures)/Valproic acid/Lamotragine

What is the definition of Epilepsy?

2 or more seizures separated by >24 hrs

Which medications are DOC in focal seizures?

Carbamazepine/phenytoin

What is Catamenial Epilepsy?

Intensity increases in menses

How is Juvenile Myoclonic Epilepsy diagnosed and treated?

EEG shows Bilateral polyspike and slow wave activity; Tx with Valproic Acid and avoid triggers

What are the symptoms of Lennox-Gestaut Syndrome?

Severe seizures with intellectual disability, presents in children <5yrs

What is the treatment and EEG finding for Infantile Spasms and West Syndrome?

ACTH first line; Vigatrabin also used; EEG shows chaotic pattern of spikes and waves

What are the risk factors for Febrile Seizures?

Family hx; Fever (viral typically)

How are Febrile Seizures managed?

Abortive tx if >5 min; symptomatic care; Reassurance

What is Landau Kleffner Syndrome?

Regression of language skills d/t severe epileptic attacks

What is the pathology of Parkinson Disease?

Loss of dopaminergic neurons from substantia nigra and locus ceruleus (midbrain)

Which system is affected in Parkinson Disease and what is the imbalance between choline and dopamine?

Extrapyrimidal motor system affected (not UMN); Imbalance in AChE (Too much) and DA (too little)

What is the presentation of Parkinson Disease tremor?

Pill rolling tremor at REST (worse with emotional stress)

What are the motor symptoms of Parkinson Disease?

Bradykinesia; Narrow based gait; Rigidity

What is a common complication of Parkinson Disease?

Neurogenic orthostatic hypotension -> degenerative changes and decreased release of NE

What is Shy-Drager Syndrome?

Parkinson's with autonomic insufficiency

What are the side effects of Carbidopa-levodopa?

Dyskinesias after 5-7 years shows on-off phenomenon

Which Dopamine R Agonist increases dopamine activity?

Selegeline (MAO B Inhibitor)

Which Anticholinergics are used in Parkinson disease?

Trihexyphenidyl and Benztropine (good for tremor, avoid in elderly/demented pts)

What are the side effects of increasing dopamine in Parkinson's?

Increased DA -> orthostatic hypotension, dizziness and nausea

What is Progressive Supranuclear Palsy?

Degenerative condition of brainstem, basal ganglia and cerebellum atypical parkinsonian syndrome but NO TREMOR

What are the eye movement findings in Progressive Supranuclear Palsy?

Opthalmoplegia (cannot look down) -> upward gaze may also be affected

What is the genetic cause and the pathophysiology in Huntington Chorea?

Autosomal dominant; Chromosome 4 has CAG repeat, which causes loss of GABA producing neurons in Caudate -> Decreased AChE and increased DA (imbalance)

What are the clinical features of Huntington's disease?

Motor impersistence (inability to maintain grip); delayed saccades

Altered behavior and personality, depression, OCD features etc

What is the treatment for Huntington's Disease?

Dopamine blockers for psychosis and chorea (tetrabenazine), antidepressants etc

What are the symptoms of Creutzfeldt Jakob Disease?

Rapidly progressive dementia; Myoclonus (usually arm) -> startle myoclonus

What are the lab findings for Creutzfeldt-Jakob Disease (CJD)?

Triphasic bursts Periodic sharp wave complexes on EEG; Positive 14-3-3 CSF assay

What is the triad of Normal Pressure Hydrocephalus?

1. Wobbly (mandatory)

2. wacky

3. wet

How is Normal Pressure Hydrocephalus diagnosed?

CT/MRI shows hydrocephalus; Spinal tap shows normal opening pressure

What are the characteristics of Functional/Psychogenic Tremor?

Abrupt onset functional disability out of proportion; top tremor magnitude is decreased w distraction; Fingers often spared Changeable eg frequency or location

What are the characteristics of Essential Tremor?

Induced/exacerbated by intentional activity; AD in up to 1/3 pts; Alcohol markedly decreases issue

What is used in the treatment of essential tremor?

Propanolol/Primadone

What are the signs and symptoms of Cerebellar Tremor?

Intention tremor (improves with rest); Ataxia, nystagmus, dysarthria

What is the triad observed in Friedrich's Ataxia?

1. Scoliosis

2. HOCM

3. dorsal column problems -> HF by 40

What is the cause of Friedrich's Ataxia?

Frataxin gene on chromo 9, trinucleotide GAA repeat

What are the 4 A's in Ataxia Telangiectasia?

ATM gene, Ataxia (<2 yrs old), spider Angiomata, IgA deficiency

What is Tourette Syndrome?

Associated with OCD and ADHD; onset prior to 21 years old; motor and phonic tics for 1 year

How is tourette syndrome treated?

Behavioural, Clonidine/Guanfacine, Pimozide, Atypical antipsych, Tetrabenazine

What are the signs and symptoms of Alcohol Withdrawals?

Tonic Clonic Seizures, HTN, Tachy, and high Temp, up to 48 hrs

What medications are used in the treatment of alcohol withdrawal seizure?

Diazepam or chlordiazepoxide (Librium) as both v long half lives

If Cirrhotic or ELDERLY then use lorazepam/oxazepam/temazepam

What are the signs and symptoms of Delirium Tremens?

Confusion, fluctuations in consciousness and feeling of ants crawling on them

What is zero-order kinetics?

Amount of drug not %: 25mg/hr metabolised

What clinical finding differentiate cocaine withdrawals and alcohol withdrawal?

Hyperreflexia will be seen in alcohol withdrawal

What is Carbohydrate deficient transferrin?

Most specific test for EtOH