neuro
treatment of choice for alzheimers dz and secondary add on?
donepezil (cholinesterase inhib) memantine
good first line for parkinson that works on the 20% dopamine receptors left over
dopamine agonist pramipexole, rapinirole try to save sinemet
A 61-year-old male presents with left-sided hand weakness and trouble with walking. On physical exam, tongue fasciculations are appreciated. He has slow speech. The left upper extremity shows forearm atrophy and depressed reflexes. The right lower extremity is hypertonic, with 3+ reflexes, and positive Babinski sign
ALS (UMN AND LMN SIGNS)
what allele if used with clinical criteria improves specificity of dx of alzheimer
APOE4
4 basic features of parkinson how many for definite dx
BRIT: bradykinesia, idigity, tremor, impaired postural reflexes, need 3 for definite dx.
Guillain barre dx and tx
CSF with high protein 2-3 wks later Tx: plasmapheresis and IVIG
for encephalitis, first test via __ and __ but what is the gold standard for dx
CT , LP, but viral cultures/brain biopsy gold standard
pt has syncope, postural hypotension, abnormal HR regulation, tx
dysautonomia avoid abrupt postural change, sleep in semierect, salt intake, FLUDROCORTISONE
absence seizure first and 2nd line tx
ethosuximide, valproic
pt has bilateral constant urge to move legs worse at night. suspect what 3 possible conditions
fe deficiency, pregnancy, peripheral neuropathy
seizure of this lobe has prominent motor manisfestations (bicycle, head turning) often nocturnal arising from sleep and brief
frontal lobe focal seizure
gait that is magnetic, in NPH
gait apraxia
generalized seizures typically arise in___ while partial seizures typically arise in ___
general- childhoood or teen partial focal- older
what type of astrocytoma has necrosis and is the MC malignant, high grade. what age
glioblastoma multiforme. 70 yo.
tumor located at cerebellum, cystic with a mural nodule
hemangioblastoma
Most effective for parkinson motor sx (rigidity and bradykinesia)
sinemet levodopa
type of stroke with punched out hypodense areas on CT
small lacunar
MC overall organism of meningitis and 2nd
step pneumoniae n. meningiditis
gait that results from foot drop (injury to peripheral nerve)
steppage gait
occipital lobe seizure has
sudden visual changes, may spread to other lobes
Most congenital ateriovenous malformations are ___ lying at the ___ and what imaging is needed
supratentorial near MCA CT determines if hemorrhage Arteriography to exclude aneurysm or AV malformation even if findings on CT suggest it
MC focal seizure with olfactory or gustatory involvement, automatisms (chewing, lip smacking, mumbling, fumbling) , DEJA VU feeling
temporal lobe focal seizure
pt has a band like headache, not worse with movement and NO photophobia, phonophobia or assoc. sx besides mild NAUSEA
tension headache, MC primary headache
mysathenia gravis can have associated ____ and is tx with___
thymoma, Mestinon
pt has ictal cry, contraction of muscles and loss of postural control followed by rhythmic relaxation
tonic clonic seizure
child has sudden behavioral arrest, staring, unresponsiveness, 10-20 secs with sudden return to activity (no confusion) with generalized 3-4 Hz spike and slow wave complexes on EEG
absence seizure
Generalized 3-4 hz spike and slow wave complex on EEG is characteristic of
absence seizures
MC tumor in cerebello pontine angle, benign,
acoustic neuroma
treatment for cluster headache? acute attack and prophylaxis
acute- oxygen at 12-15 L and sumatriptan injection Prophylaxis- verapamil is first line preventative
plaques with beta amyloid peptide and neurofibrillary tangles containing tau protein is what dz
alzheimer
young pt present with foot deformity, gait disturbance
charcot marie tooth tx: nsaids
3 main sx of huntington
chorea, dementia, behavioral change
small vessel lacunar infarcts are MC with what underlying condition
chronic htn or dm
first line tx for tourettes/TICs
clonidine, haldol
pt has headaches many times in couple weeks/ months then has an extended pain free interval of 9-11 months with a seasonal pattern
cluster headache
an occluded bilateral vertebral or basilar a. will result in
coma with pinpoint pupils, flaccid quadriplegia, sensory loss
what is the most common seizure overall
complex focal/partial seizure
what is the diffference between a simple partial/focal seizure vs a complex? similarity?
complex- consciousness is impaired both have AURA
Gold standard for epilepsy dx
concurrent EEG and video monitoring
status epilepticus defined as
30 min of continuous seizure activity or 2 seizures occurring within a 30 min period without recovery of consciousness inbetween
huntington gene is identified on chromosome _ with unstable ___ trinucleotide repeat in huntingtin gene
4, CAG
A 46-year-old male is brought to the emergency department by his wife due to a seizure event. She reports that prior to the event, he complained of headache, fever, and nausea. She also reports her husband appeared confused. On exam, the patient cannot clearly answer questions. A CT of the head shows no evidence of a hemorrhage, or a space-occupying lesion. MRI of the brain is shown. A lumbar puncture is performed, and cerebral spinal fluid analysis shows a normal opening pressure, a lymphocytic pleocytosis, normal glucose, and elevated protein. PCR is positive for herpes simplex virus-1 what test to order
CT to rule out space occupying lesion then LP for etiology ENCEPHALITIS
obstruction of the cerebellar arteries result in
IPSILATERAL limb ataxia and CONTRALAERAL spinothalamic sensory loss in limbs
A 35-year-old banker presents to the ED after hitting his head when he tripped while climbing the subway stairs. He has noted his legs feeling heavy over the last 5 days and reported trouble pushing himself up after the fall. nausea, vomiting, and diarrhea 3 days ago (admits to eating discount sushi). Exam is remarkable for symetric 3/5 lower and upper extremity weakness, absent ankle and patellar reflexes and 1+ biceps reflex. He is only able to count to 10 in one breath. Routine labs, chest x-ray, and head CT are unrevealing.
Guillain barre
pt presents with dementia, urinary incontinence, gait ataxia (magnetic)
NPH
pseudotumor cerebri dx and tx
LP confirms intracranial HTN but CSF is normal ACETAZAMIDE (reduce formation of CSF)
pt has contralateral hemiplegia, hemisensory loss homonymous hemianopia, GLOBAL aphasia, (face) what artery is occluded
MCA
Gold standard dx of MS what does it show
MRI with gadolinium 4+ white matter lesions 3mm or larger 3 white matter lesion with at last 1 periventricular lesion
pt presents with optic neuritis, unilateral vision loss, color desaturation, leg paresthesias, cerebellar ataxia
MS
A 20-year-old woman is brought to the ER 30 minutes after acute onset of double vision in the left eye. Two months ago, she had an acute episode of pain with movement of the left eye along with loss of both central vision and pupillary light reflex. These symptoms subsided spontaneously. Examination shows a delay in the adduction of the left eye with nystagmus of the right eye on lateral gaze
MS (2 EPISODES - dissemination in time)
how to tx the medical emergency of status epilepticus acute and long term
Maintain airway. IV lorazepam Fosphenytoin or phenytoin for IV long term control
thalamic syndrome with contralateral hemisensory disturbance and spontaneous pain, what is occluded
PCA posterior cerebral artery
pt has horner syndrome what is occluded
PICA posterior inferior cerebellar artery
n obese 31-year-old female presents to the neurologists office complaining of severe headaches, visual obscurations, ringing in the ears and "papilledema". She has been taking large amounts of vitamin A because a friend told her that it would give her more energy. Examination of the patient shows limited ABduction of both eyes.
PSEUDOTUMOR CEREBRI abducens nerve CN VI dysfunction.
most sig. complication of intracranial aneurysm and how to dx/eval
SAH, angiography
where is cluster headache pain localized
Short, severe unilateral headaches in clusters Pain is deep, usually periorbital, often excruciating in intensity, nonfluctuating, and explosive in quality.
large vessel cva often affect what
cortex resulting in aphasia, visual field deficits or transient monocular blindness
NPH dx and tx
ct/mri LP will be relieving Ventricular shunt by neurosurgeon
edema due to NA/K pump failure BBB intact, na and water enter cells mcc?
cytotoxic edema caused by hypoxia ischemia
type of dementia with quicker onset, rigidity, fluctuation in alertness and cognition, visual hallucinations, paranoid delusions
diffuse lewy body
what gives rise to meningiomas
arachnoid capsules (meningothelial cells)
this seizure often in children with lennox- gastaut syndrome (type of epilepsy with multiple different types of seizures.)
atypical absence seizure
pt has headache fever and focal neurologic deficit, what management is needed
before abscess capsule has formed entirely (during cerebritis stage) abx essential. Surgical interventions NEEDLE ASPIRATION is preferred.
pt has 3 or more migraines a month with impaired function. start them on..
beta blockers, CCBs, seizure meds,
tx for relapsing MS
beta interferons, natalizumab (PML risk), ocrelizumab
facial paralysis that does not spare forehead. how to tx.
can resolve completely without tx, steroids 2 week taper. lyme titer.
CT/MRI of huntington dz will show
cerebral and caudate nucleus atrophy
development of granulation tissue in the first 7-14 days before formation brain abscess is called
cerebritis
MC type of hemorrhagic stroke
intracerebral hemorrhage bleeding directly into brain parenchyma
how to tx acute exacerbations of MS
iv corticosteroids
what is the MC type of CVA and mcc of it
large vessel (ischemic) caused by atherosclerotic plaques at arterial bifurcation
aphasia, apraxia incontinence in what phase of dementia
late
diffuse astrocytoma is __ grade and tx is to ___
low grade, remove what you can since total removal not possible
loss of orientation and psychotic sx in what phase of dementia
middle to late
aura results from cortical spreading depression in this type of headache
migraine
Pt has lateralized headache, throbbing w n/v, photophobia and phonophobia
migraine headache
difference between migraine and cluster headaches in terms of movement
migraine- like to be motionless cluster- move about during attacks, pacing, rocking, or rubbing their head for relief; some may even become aggressive during attacks
A 62-year-old man presents to his primary care physician for "seeing double." He reports that he has been experiencing these symptoms for a few months. His diplopia is worse after reading a book or watching television. He says that at times he notices his left eyelid "droops" at the end of the day and improves after waking up from sleep. He notes episodes of fluctuating weakness when chewing harder foods. On physical examination, there is left-sided ptosis. Pupillary reflex is intact. A plastic glove with ice is applied on the ptosis for approximately 2 minutes and the ptosis markedly improves. Serology is positive for anti-acetylcholine receptor antibodies and preparations are made for a computerized tomography scan of the chest.
myasthenia gravis
jerky movements either diffusely or locally
myoclonic seizure
drug for prophylaxis of arterial vasospasm in SAH
nimodipine
Guillain-Bare Syndrome ___ WBC, ___Protein ___ glucose
normal wbc high protein normal glucose
tx of trigeminal neuralgia
oxcarbazepine or caramazepine
Loss of dopamine in the substantia nigra in the indirect system leading to EPS Imbalance between dopamine and ACh
parkinson
pt with meningitis has fever stiff neck headache. what is a very bad sign.
petechial skin rash.
young child with MRI of midline tumor. only FOCAL one out of the astrocytomas
pilocytic astrocytoma (most benign) tx with surgery
MC cause of chiasmal syndrome
pituitary adenoma
in what tumor can a bitemporal superior quadrant progresss to a bitemporal hemianopia
pituitary adenoma
germinoma, teratomas, endodermal sinus tumor, embryonal CA, choriocarcinoma are all what king of tumors. which one is benign
primary germ cell tumors teratoma benign
tumor that presents with amenorrhea, loss of libido and infertility
prolactin secreting lactotroph adenoma
treatment of choice for benign essential tremor
propanolol
classic sx of myasthenia gravis
ptosis, diplopia, dysphagia, dysarthria, muscle weakness
most common variant of MS, resolution of sx after active demyelination period
relapsing remitting MS (RRMS) months or years after initial episode, sx recur or new ones appear
MC sx of parkinson
resting hand tremor
only tx to slow down ALS progression
riluzole
A 54-year-old female presents with severe, stabbing pain on her left mandible. The pain lasts a few seconds and is triggered by brushing her teeth or chewing food. The pain episodes lasts a few seconds and occur 20 times per day. She denies any recent trauma or dental procedures. Over the counter simple analgesics do not improve the pain. On physical exam, touching the mandibular region reproduces the pain. Neurological exam is otherwise normal.
trigeminal neuralgia
standard of care for abortive therapy of migraine headaches
triptans, best one is injectable sumatriptan
MS should not be dx until there is evidence that
two or more different regions of the central white matter (dissemination in space) have been affected at different times (dissemination in time)
first seizure in an adult is commonly due to _
underlying tumor
edema due to BBB failure (endothelial cell) as protein rich plasma swells up brain tissue
vasogenic edema
benign essential tremor is worse with __ and may improve with ___
worse with stress, cold, improve with alcohol