First Aid: Neurology

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shosh114
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108033
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First Aid: Neurology
Updated:
2011-10-11 12:31:04
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internal medicine neuro
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internal medicine neuro
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  1. Definition of a TIA
    A transient neurological episode that resolves completely within 24 hours (usually, 30 min), with no infarcted tissue detectible on MRI
  2. Anosognosia
    Inability to identify a physical dysfunction--patients are unaware of their neurological deficits
  3. Wernicke's aphasia
    Fluent speech with no rational meaning and impaired comprehension
  4. Apraxia
    Inability to perfom learned motor tasks (e.g. teeth brushing)
  5. Dysarthria
    Difficulty in articulating speech
  6. Left MCA stroke
    • Right hemiparesis and sensory defects
    • Right visual field defect
    • Aphasia
  7. Right MCA stroke
    • Left hemiparesis and sensory defects
    • Left visual field defect
    • Apraxia and left-sided body neglect
  8. Anterior cerebral artery stroke
    • Contralateral (or bilateral) leg or foot weakness
    • Broca's aphasia
    • Incontinence
  9. Internal carotid stroke
    Presents similarly to an MCA stroke
  10. Posterior cerebral artery stroke
    • Contralateral homonymous hemianopsia
    • Vertical gaze defect and CN III palsy
    • Anomic aphasia (difficulty naming things)
    • Alexia
  11. PICA stroke
    • Sudden onset nausea, vomiting, vertigo, and hoarseness
    • Ataxia
    • Ipsilateral palate and tongue weakness
    • Contralateral loss of pain and temperature
    • Dysphagia, dysarthria, hiccup
    • Ipsilateral Horner's syndrome
  12. AICA stroke
    • Ipsilateral facial weakness and gaze palsy
    • Deafness or tinnitus
    • (No Horner's, dysphagia, or dysarthria)
  13. Lacunar stroke
    • Usually associated with chronic HTN
    • Typically presents with pure motor or pure sensory loss
  14. Onset of different strokes: thrombotic, embolic, and hemorrhagic
    • Thrombotic--slow, gradual, often during sleep
    • Embolic--stepwise, waking hours
    • Hemorrhagic--quickly, waking hours
  15. Diagnosis of stroke
    • CT, for quick diagnosis
    • MRI for follow-up
    • Carotid US to screen for carotid stenosis
  16. Treatment for a TIA
    • Aspirin
    • Anticoagulation (heparin, warfarin)
  17. Treatment for a stroke
    • Thrombolysis within 3 hours of onset
    • Antiplatelet therapy
    • Anticoagulation for cardiac embolus
    • Neurosurgical consult in the case of a hemorrhagic stroke
  18. Symptoms of rabies
    • Pain, paresthesia
    • Hydrophobia, aerophobia
    • GI/resp symptoms
    • Irritability
    • Hyperventilation, hyperactivity, and seizures, in the "excitation phase"
  19. Most common cause of bacterial meningitis
    Strep pneumonia
  20. Common cause of bacterial meningitis in young adults
    Neisseria meningitidis
  21. Common cause of meningitis in IC patients
    Listeria
  22. Kernig's sign
    • Pain in the back and hamstring when extending the knee with the thigh at a right angle
    • Sign of menintitis
  23. Brudzinski's sign
    • Forced flexion of the neck triggers flexion of the knee and hip
    • Sign of meningitis
  24. Signs of meningitis
    • Headache, nuchal rigidity
    • Fever
    • Photophobia
    • Mental changes (confusion, lethargy, coma)
    • Seizures (10-30% of pxs)
  25. What causes low CSF glucose in bacterial meningitis?
    Bacteria inhibit transport of glucose into the CNS
  26. Treatment for strep pneumonia meningitis
    Vancomycin + cefotaxime or ceftriaxone
  27. Treatment for N. meningitidis pneumonia
    Penicillin G or ceftriaxone
  28. Treatment for listeria pneumonia
    Ampicillin + gentamycin
  29. Most common CNS tumor
    Astrocytoma
  30. Brain tumor that tends to calcify
    Oligodendroglioma
  31. Brain tumor commonly found in the spinal canal (or in the fourth ventricle, in children)
    Ependymoma
  32. Tumor that can cause unilateral deafness
    Acoustic neuroma
  33. Cancers that commonly metastasize to the CNS
    Lung, breast, melanoma
  34. Prolonged headache followed by vomiting several hours later, vs. prolonged headache followed immediately by vomiting
    • Headache followed by vomiting several hours later suggest a migraine
    • Headache followed immediately by vomiting suggests a brain tumor
  35. Absence seizure
    • Type of generalized seizure
    • Brief episode of non-responsiveness to external stimuli, with no loss of motor tone
    • Characteristic spike and wave pattern on EEG
  36. Difference between a simple and a complex seizure
    • Simple seizure--no loss of consciousness or postictal state
    • Complex seizure--loss of consciousness may or may not be present, but there is always a postictal state
  37. Causes of seizures
    • Fever
    • Trauma
    • Stroke
    • Mass lesions
    • Meningitis/encephalitis
    • Electrolyte abnormality
    • Uremia/hepatic encephalopathy
    • Porphyria
    • Drugs
  38. Status epilepticus
    A long, continuous seizure that lasts > 30 minutes
  39. Drug to give acutely for a seizure
    Benzos
  40. Anti-TB drug that can cause seizures
    INH--prevent with B6 (pyridoxine)
  41. Diurnal progression of myasthenia gravis symptoms
    Symptoms worsen as day goes on (opposite of RA)
  42. Tests for a patient suspected of having myasthenia gravis
    • Serology for ACH receptor antibodies
    • CXR to screen for thymoma
  43. Way to distinguish between MG and Lambert-Eaton
    • In MG, repetitive muscle use quickly causes fatigue
    • In Lambert-Eaton, repetitive muscle use lessens fatigue
  44. Drugs that can precipitate a myasthenia gravis crisis
    Aminoglycosides
  45. Top ten causes of headache
    • Chronic headache syndrome (migraine, tension, cluster)
    • Subarachnoid hemorrhage
    • Meningitis
    • HTN
    • Mas lesion
    • Temporal arteritis
    • Trigeminal neuralgia
    • Brain abscess
    • Pseudotumor cerebri
    • Subdural hematoma
  46. Typical headache of migraine
    Unilateral, throbbing head pain that may last several hours
  47. Danger of using 5-HT agonists (sumatriptan, migraine therapy)
    Can cause coronary vasospasm
  48. Tension headache
    • Band-like pain around head and neck, accompanied by neck stiffness
    • Usually bilateral
  49. Cluster headache
    Severe, unilateral facial pain, that may be accompanied by lacrimation, rhinorrhea, nasal congestion, ptosis, and miosis
  50. Treatment for cluster headache
    • High-flow oxygen
    • Intranasal lidocaine
    • Ergotomines or sumatriptan
    • Verapamil or methysergide for prophylaxis
  51. Flashes of light with floaters and vision loss
    Retinal detachment
  52. Painful, unilateral visual loss with partial resolution
    May be accompanied by headache and eye pain with movement
    • Suggests optic neuritis--inflammatory demyelination of the optic nerve
    • Many patients progress to MS
  53. Normal pressure hydrocephalus
    • Increases CSF without increased intracranial pressure
    • Presents with ataxia, urinary incontinence, and dementia (reversible)
  54. Use of amantadine in Parkinson's
    • Blocks dopamine reuptake by presynaptic neurons
    • May improve tremor and bradykinesia in the early stages of the disease
  55. What should be administered with levodopa, and why?
    Carbidopa--cannot cross BBB, so stays in peripheral tissues and blocks metabolism of levodopa in the periphery
  56. Selegiline
    • Selective MAO B inhibitor
    • Can be used to treat Parkinson's--blocks central metabolism of dopamine
  57. Dopamine receptor agonists
    • Bromocriptine
    • Pergolide

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