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Neuro3Flashcards|Quizlet

Neuro 3

392 terms by Mariesa_Sahleen

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Sensory:SmellandTaste

CNI:Olfactory

Aninabilitytosmellordetectodors,lackof
flavordiscrimination,loosesenseoftaste.

Anosmia

Sensory:Vision

CNII:Optic

TestOpticNervewith:

VisualAcuity,Fundoscopic

Whichsideofthecup/diskisalwaysblurry?

Medialnasalside

Whatdoyouhavewhenyouloosethelateral
cup/disc?

PapillaryEdema

CausesofPapillaryEdema?(10)

SAH,SDH,EDH,Meningitis,increaseICP,
Hydrocephalus,AVM,Psuedotumorcerebri,
Braintumor

WhatcanhappenifyoudoaLPwithincreased
ICP?

Brainherniation

Papillaryedema:whathappensanatomically?

OpticNerveispushedforwardbecauseofthe
ICP,blursthecup/disc,loosemargins.

EvenwithPapillaryEdema,whatremains
intact?

Visualacuity,colorvision,pupilarydilation.

Pupilconstriction,eyemovements:Motor

CNIII,Occulomotor

Inferiorgaze:motor

CNIV:Trochlear

LateralGaze:motor

CNVI:Abducens

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TestCNIII,IV,VIwith?

PERRLA:PupilsEqual,Round,Reactiveto
Light,Accommodation,EOMs

ReactivePupils:

MetabolicCondition

NonReactivePupils:

StructuralCondition:PONS,Midbrain,
Brainstem

PINPOINTPUPILS:Reactive:

Narcotics,Morphine,Heroin,unopposed
parasympatheticactivityduetoinactivationof
sympatheticpathways.

PINPOINTPUPILS:NONReactive:

DamageinPons

CranialNervesarepartofwhatNS?

Peripheral

HowmanyCNarethere?

12pairs,24total

WhichCNcomefromthebrainstem?

IIIXII

Sensory,Motor,orMixed?

CN

HowmanyCNareSensory?

HowmanyCNareMotor?

HowmanyCNareSensoryandMotor
(mixed)?

BilateralLargePupils:Reactive

LSD,Amphetamines,Cocaine

LR6

LateralRectusCNVI

SO4

SuperiorObliqueCNIV

Twitchingoftheeyes:

Nystagmus

Nystagmushasa______andslowcomponent

Quick

3TypesofNystagmusGazes...

Horizontal,Vertical,andRotational

Whendescribingnystagmus,wedescribethe
____component

Fast

WhatcausesNystagmus?(3)

CerebellarDisease,Labyrinthitis,Medications,
andothers.

MostimportantCNintermsofeye
movements?

CNIII

IfyoudisruptCNIII,whatwillhappentothe
eye?

Loosemuchofitsmovements.

DisruptedCNIIIleadstoPtosis,whichisa
disruptionofwhat?

LevatorPalpebraeMuscle

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IftheLevatorPalpebraemuscleisdisturbed,
whatwillhappentotheeye?

Eyelidwilldroop

WhichCNisconsideredtheAneurysmNerve?

CNIII

WhatdoestheCNIIIrunnear?

TheCircleofWillis

WhichlocationsoftheCircleofWillisdoesCN
IIIrunnear?

Posteriorcommunicatingarterywhichconnects
totheInternalCarotidArtery.

WhatdevelopsontheInternalCarotidArtery?

BerryAneurysms

WhatrunsalongtheoutsideoftheCNIII?

Parasympatheticpathway

Whatcausestheeyepupiltoconstrict?

Parasympathetics

Ifthereispressureontheoutsideofthe
parasympatheticsbecauseofananeurysmor
tumorwhatwillhappen?

Thepupilwilldilate

Whatisbadaboutpupilinvolvement?

Itmeansaspaceoccupyinglesion.Pupilis
largeandfixed.

InnewonsetCNIIIpalsy,whatshouldyou
ruleout?

AneurysmorTumor

IfyouhaveCNIIIpalsywithnopupildilation,
whatshouldyouthinkisthecause?

StrokeordisruptionofbloodflowtotheCNIII
fromtheinsidevasculaturewithinthenerve:
EX:ministroke,deathofCNsecondarytoDM
orHTNbecauseofdecreaseinbloodflow.

WhichCNisanatomicallymorevulnerableto
traumathantheotherocularnerves?

CNIV

WhatisCNIVmorepronetotrauma?

becauseasitexitsthebrainstem,itcourses
throughthesubarachnoidspace,andhasto
travelthelongestdistance.

WhichCNisassociatedwiththeheadtilt?

CNIV

Whydochildren/peoplehaveaheadtiltwith
CN__problems?

Theyaretryingtorectifyvisionalissues,they
tilttheirheadstowardsunaffectedeye.

WhatisthecomplaintwithCNIVdamage?

VerticalDiplopia.especiallywhenlooking
downandinreading,walkingdownstairs.
Theytilttheirheadsobotheyeslineupsothey
cansee.

WhatcausesCNIVdamage?

idiopathic,trauma,vascularinfarct

WhichCNistheonemostcommonlyaffected
byapalsy?

CNVI

WhenCNVIisdamaged,whatis
lost/diminished?

LateralGaze

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WithincreasedICPandbrainstemherniation
throughtheforamenmagnum,whichCNis
stretchedagainsttheclivuswithinthe
subarachnoidspace?

CNVI

WithCNVIpalsy,patientscannotdowhat?

Lookofftotheside

NervethatisinvolvedwithJawclinchingand
lateralmovementsofthejaw?

CNV

Whichnerveisresponsibleforebranchesof
thefaceandcornealreflex?

CNV

Unilateralfacialdroop,cannotlifeeyebrown,
andnoforeheadraisingisadescriptionof
what?

BellsPalsy

WhichCNisaffectedwithBellsPalsy?

CVVII

WhichCNisresponsibleforthetrapeziusand
SCM?

CNXI

CNXIiswhichnerve?

SpinalAccessory

WhattestdoyoudoforCNXI?

Shrugshoulders,turnheadleftandright
againstresistance.

CNXIIiswhichnerve?

Hypoglossal

WhichtestsarerunforCNXII?

stickouttongue,watchfortonguemovements,
presstongueagainstcheekresistance,gag
relex.

Iftongueisdeviatedtotheright,whichsideof
thebrainhasalesion?

Rightsidebrainsteminvolvement,doesn't
crossover.

TongueatrophycanbeseenduringwhatCN
exam?

CNXII

Inflammationofthebrainitself?

Encephalitis

Membranesthatsurroundthebrainandspinal
cord?

Meninges

Infectionofthemeninges?

Meningitis

Whatarethethreecategoriesofmeningitis?

Bacterial,viral,fungal

Ararebutpotentiallyfatalformofmeningitis?

Bacterial

Bacterialmeningitiscanbecausedbyseveral
typesofbacterialthatfirstcausewhattypesof
infections?

URIthentravelthroughbloodstreamtobrain
DirectSpreadfromanearbysevereinfection,
ex:otitismediaornasalsinusitis

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Bacterialorganismsinmeningitistransiently
colonizetheoropharynxandinvadeinflammed
tissuesaftera____.

ViralURI

Whattypesofthingcancausethebacterialto
invadethemeningesdirectlyandcause
bacterialmeningitis?

Traumaorsurgery,orspinalcordinjections.
EX:skullfractures,LP,steroidinjections

Bacterialmeningitiscanbecausedfrom
hematoganeousspread:

sepsis:examplepneumonia.

Bacteriagrowswhere?

Moistplaces

Thereisoftenahistoryofwhatpriortothe
onsetofbacterialmeningitissymptoms?

URI

Whatetiologicalpathogensaremostcommonly
seenwithbacterialmeningitisinchildrenolder
than3monthsandadults?

Streptococcuspneumoniae,Nisseria
meningitidis

Whichbacterialmeningitisusetobemore
commonuntilaimmunizationwasdeveloped?

HaemophilusInfluenzeBHIB

Themostcommonandmotseriousformof
bacterialmeningitis?

Pneumococcalmeningitis

Pneumococcalmeningitisiscausedbywhat
organism?

streptococcuspenumonia,whichalsocauses
pneumonia,septiciemia,andear/sinus
infections.

Whatparticularpeoplearemoreatriskfor
developingpneumococcalmeningitis?

Underage2adultswithdepressedimmune
systems

Whatisthemostimportantriskfactorfor
penumococcalmeningitis?whatareother
predisposingconditions?(8)

Pneumoniaalcoholism,acuteorchronicotitis
media,DM,splenectomy,headtrauma,HIV,
transplants,cancer

IstherearashwithPneumococcalmeningitis?

NO

Whattypeofgramstainisseenwith
Penumococcalmeningitis?

Grampositive

Whichmeningitisiscausedbythebacterium
NeisseriaMeningitidis?

MeningococcalMeningitis

HowisMeningococcalMeningitistransmitted?

PersontoPersonNasopharyngealsecretion,
requiresclosecontact

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Whoismoreatriskforcontracting
meningococcal?

Livinginthesamehousehold,daycarecenters,
hospitalpersonnel.Highriskgroups:Ages3
months2years(lackofprotectiveantibodies),
immunesuppressed,travelerstoforeign
countries,collegestudentsdorms,military
barracks

WhatshouldbegivenforMeningococcal
meningitisProphylaxis?

ChemoprophylaxiswithRifampin

Whatagegroupismostcommonfor
MeningococcalMeningitis?

218yearolds

ComplicationsofMeningococcalMeningitis?

Fatal,deafness,braindamage,convulsions,
paralysis,impairedintellectualfunction

DoesMeningococcalMeningitishavearash?

YES:lookforarash.Macularand
erythematousrashatfirstthenpetechialor
purpuriconlowerextremitesandmucous
membranes.

Wasoncethemostcommonformofbacterial
meningitis?

HaemophilusMeningitis

Whathasgreatlyreducedthepresenceof
HaemophilusMeningitis?

HIBvaccine

WhoaremostatriskofgettingHaemophilus
Meningitis?

Childreninchildcaresettings,andchildren
whodonothaveaccesstothevaccine?

TriadofMeningitissymptoms:

Fever,NuchalRigidity,Alteredmentalstatus

Mostcommonsymptominadultswith
meningitisis?

abruptdiffuseheadache

Othersymptomsonmeningitisinclude:

nausea,vomiting,delirium,convulsions,
seizures,focalneurologicaldeficits

Whoshouldyouwatchoutforbecausethey
maypresentdifferentlywithmeningitis?

Veryyoungandveryold

WhataretwoclassicsignsseenonthePEin
meningitis?

KernigsandBrudzinksi's

Whatdowewanttolookforonameningitis
HEENTPE?

Siteofinfection

Pupillarychanges,hemiparesis,andocular
palsiessuggestwhattypeofmeningitis?

BacterialtheseareNOTseeninViral

OthersignsseenonmeningitisPE:

alteredmentalstatus,photophobia,febrile,
weakness,RashwithN.Meningitidis

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WhatisoftenNOTseenonthePEininfants
andElderly?

FeverandStiffneckHaveahighindexof
suspicion

Patientwithmeningitiscandecompensate
quickly,whatshouldyourepeatedlydo?

Neurologicalchecks:checkprogression

Whatcanyoucheckoninfantsformeningitis?

palpatethefontanellebulgingisabnormal
"softspot"

Whatlabsshouldbedrawninapatientwith
meningitis?

CBCwithDiff:evaluateleukocytosis
neutrophils
SerumChemistryPanel
BloodCultureX2evaluateforbacteremia
whichcancausemeningitis.
CTHead
LP

WhatshouldbedonebeforeanLP?

lookforsignsofincreasedICP:papilledema,
breathingchanges(cheynestokes),tonic
posturing,absenceofdoll'seyereflex

Cloudy/TurbidCSFonLPis:

largenumberofWBCs:suggestsinfection

WhatshouldyouexpecttheresultsofaLP
positiveformeningitis?

>100WBCs
Proteinincreased
Glucosedecreased
IncreasedPMNsNeutrophils
+culture:identifyorganism

Whatisthegramstainresultsfor
meningococcalmeningitis?

negativeintracellularandextracellular
diplococci

whatisthegramstainresultsforpneumococcal
meningitis>Spneumonia?

positive

WhendoyoustartAntibioticsforpossible
Meningitis?

ASAPStartempiricAntiobiotics:Vancomycin,
Ceftriaxone/cefotaxime,anddexamethasone
afterbloodculturesdrawn0.15mg/kg

Whatmedicationsdoyougivefor
HaemophilusMeningitis?

Ceftriaxone4g/dtwodivideddosesfor1014
days

WhatmedicationssoyougiveforN
Meningitides?

Adults:PenicillinG,CeftriaxoneIVtxuntil
patientisafebrileX5days.
Peds:PenicillinG,Ceftriaxone,orCefotaxine
IVX7days.

WhatmedicationdoyougiveforS.
pneumonia?

PenicillinG(300,000400,000IV46divides
doesX1014days)orwithceftriaxone,
cefotaxine.

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What3vaccinesareavailableforMeningitis?

S.pneumonia:3dosesagainst7strains
HIB:4dosesgiventochildren
N.Meningitis:teenagers,collegestudents

Whatistheprophylaxismedicationsfor
Meningitis?

HaemophilusB:Chemoprophylaxis
N.Meningitides:Chemoprophylaxis,and
RifampinBIDX2days,600mgforadults,10
mg/kgforpeds.

Whatisthemostcommonformofmeningitisin
theU.S?

Viral

Alsoknownas"AsepticMeningitis"?

ViralMeningitis

Whatusuallycausesviralmeningitis?

Enteroviruses:coxsackieviruses

Howisvialmeningitistransmitted?

Entersbodythroughthemouthandtravels
throughthebrainandsurroundingtissues,
presentinsaliva,mucus,andfeces,transmitted
persontoperson,orfrominfected
objects/surfaces.

WhatothervirusescancauseViralMeningitis?

HIV,HSV2,VZV,Zoster,Mumps,Influenza

Whataretheclinicalmanifestationsofviral
meningitis?

Headache(lessseverethanbacterial),Nuchal
rigidity,lowgradefever,ST,Photophobia,abd
discomfort,N/V

Howisviralandbacteriameningitis
differentiated?

cannotbedoneonsymptomsalone,musthave
aLPCSFfluid.

Howdoyoutreatviralmeningitis?

Supportive/Conservativecare:rest,analgesics,
fluidshospitalizationisnotneededususally.

WhatmedicationdoyougivetotreatHSV,
EBV,andVZVandmeningitis?

Acyclovir:oralorIV,10mg/kgQ8Hours

Whatdiseasehassimilarsymptomstoviral
meningitis,butpatientsalsohaveconfusion,
alteredlevelsofconsciousness
(lethargy/Coma),andevidenceofneurological
symptoms/signs?

ViralEncephalitis

Whatare3signsthatmayalsopresentwith
ViralEncephalitis?

Hallucinations,BehavioralChanges,and
PersonalityChanges

WhatarePEfindingthatarecommonwith
ViralEncphalitis?

Ataxia,Aphasia,Hemiparesis,Involuntary
movements:tremor,CranialNerveDeficits:
ocularpalsiesorfacialweakness.

BirdstoMosquitoestoHuman

WestNileEncephalitis

WhenareyoumostlikelytogetWNV?

Dawn/Dusksummermonths

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IncubationperiodforWNE?

16days,andisperhapsaslongas14daysin
immunosuppressedpatients.

WhatpercentofpeoplewithWNVbecome
symptomatic?

26%

Although50%ofinfectedindividualsdidseek
sometypeofmedicalattention,on___%were
diagnosedwithWNV.

Whatsymptomsmaypeoplehavewhoare
infectedwithWNV?

GIsymptoms,vomiting,diarrhea,flulike
symptoms,neurologicaldisease,ST,HA,
mentalconfusion,tremor,backache,myalgias,
arthralgias.Encephalitis,asepticmeningitis,or
both.Febrile,mentalconfusion,enlarged
liver/spleen,coma

Whatdeterminestheclinicalexpressionof
WNE?

TheextentandseverityofCNSviralinvasion

PatientspresentwithpositiveKernigor
Brudzinskisignsinpatientswith?

AsepticMeningitis,ormeningoencephalitis

WhattestisdoneforWNE?

EnzymeImmunoassy

WhatisthetreatmentforWNE?

Supportivecare

VirusisinAsiaandWesternPacific?

JapaneseEncephalitis

HowlongtosymptomsoccurinJE?

515daysafterbite

SymptomsofJEinclude?

Mildornone!Inseverdisease,fever,chills,ha,
fatigue,n/v,inflammationofbrain
(encephalitis),coma,paralysis,seizures.

HowdoyoudiagnoseJE?

Cerebrospinalfluid:IgMantibodiesforJE

TreatmentforJE?

Supportivecare,hospitalization,respiratory
support,IVfluids

Whatdiseaseisusuallyasecondaryinfection
outsidetheCNS?

BrainAbscess

Whatusuallycausesabrainabscess?

Pneumonia

Maymimicabraintumor,butevolvesfaster?

BrainAbscess

Howdoyoudiagnoseabrainabscess?

CTwithoutcontrastorMRIMRIistestof
choice

Whichpresentfaster?Meningitisorbrain
abscess?

Meningitis

onlyone(orveryfew)nervesare
injured/damaged?

Focalneuropathy

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Numbness,tingling,paininconfiedlimb,small
regionofthetrunkorheadareexamplesof
what?

FocalNeuropathy

Mononeuropathy(CTS)isanexampleofwhat?

FocalNeuropathy

duetodamaged,dysfunctional,orinjured
nervefiberssecondarytodisease/injuryofthe
CNSandPNS.

PathophysiologyofNeuropathy

________ofnervefibersleadstoimmunecell
activation,whichreleasesnumerous
compoundswhichcontributetopain.

Inflammation

_______ofnervefiberscanleadtoreduced
bloodflow,axonaldegeneration,andeventual
demyelination.

Compression

Occurswhenanindividualnerveisinjured
alongitscourse?

Mononeuropathy

Whatcausesmononeuropathy?

Compression,angulation,orstretchingofthe
nervesecondarytodysfunctionofneighboring
anatomicstructures.

Whereispainfeltwithmononeuropathy?

Distaltothelesion

CarpalTunnelSyndromecausedfromwhich
nerve?

MedianNerveNeuropathy

RiskfactorsforCarpelTunnel?(6)

SPwritsinjury,frequentuseofhands,
pregnancy,autoimmunecondition,
hypothyroidism,RA.

WhatarethesignsandsymptomsofCTS?

Pain,burning,tinglinginthedistributionofthe
nerve:1,2,3,andlateral1/2of4thdigit.NOT
PINKY.Achingpaininforearm,exacerbation
bywristmovements,wristweakness,Thenar
atrophy.

Whattestsdoyoudotocheckmedialnerve
compression?

Phelan,andtinnel'stestusedmostly,canalso
domediannervecompressiontests.

Radialnerveneuropathyoftenoccursto
compression/injuryofwhat?

axilla,ex:crutches,havedecreased
brachioradialisreflex.

Whatarethesignsandsymptomsofradial
nerveneuropathy?

weaknessand/orparalysisofallmuscles
suppliedbytheradialnerve.

WhatisSaturdaynightPalsy?

Injuryofthatradialnerveinthespinalgroove.
usuallyoccursduringsleep.

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Ulnarnerveneuropathyrunsthewhatgroveof
theelbowandpassesthroughwhatanatomical
structure?

Medialcondylargroove,andpassesthrough
thecubitaltunnel.

whatcausesulnarnerveneuropahty?

pressure/traumaatelbow,increasingthe
carryingangleoftheelbow,anddegenerative
changescanstretchthenervewhentheelbow
ifflexed.Weaknessofsomeforearm/hand
muscles.

Whatarethesigns/symptomsofUlnarNerve
Neuropathy?

parenthesis/painin4thmedialhalfand5th
digit.

MisplacedIMinjections,traumato
buttock/hip/thigh,compressionofthenerve
rootduetoHerniateddisc(HNP),DJD,spinal
stenosis,piriformissyndrome,tumorcause
whattypeofneuropathy?

SciaticNerveNeuropathy

Whatarethesigns/symptomsofsciaticnerve
neuropathy?

parethesia/burning/painalongtherouteofthe
sciaticnerve,decreasedachillesreflexes,knee
weakness,+SLRtest,weaknesswith
inversion/plantarflexionofthefoot.

Whatisanothertypeofneuropathythatishard
todistinguishfromSciaticnerveneuropahty?
Why?

CommonPeronealNeuropathy,becauseit
branchesfromthesciaticnerve.

WhatcausesCommonPeronealNeuropahty?

traumatohead/neck,fibula,sittingwithlegs
crossed,highboots.

Whatarethesigns/symptomsofthecommon
peronealneuropathy?

paresthesia/painalongthelateralaspectofthe
thigh,somtimes,relievedbysittingwith
associateddecreasedsensationoverthearea.

WhattypeofneuropathyiscausedbyDM,
compressionbyretroperitoneal
neoplasms/hematomas,expandingaortic
aneurysm,pressurefromtheinguinalligament
whenthethighsareflexedandabducted
(lithotomyposition),andpelvisfracture?

FemoralNeuropathy

Whichnerveinnervatesthedeltoidmuscle?

AxillaryNerve

Whatneuropathyisoftenassociatedwith
humeralneckfx,anteriorlydislocatedshoulder,
overstretching,ortrauma?

Axillaryneuropathy

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Whenyouhaveaninjurytotheaxillarynerve,
whathappens?

decreasedabilitytoabductshoulder,deep
achinglateralshoulderpain.neuropathicpain
alsooccurs,andincreaseswithshoulder
movementsorshoulderROM.

WhichnerveelvolvesfromthenerverootsC5
C7andsuppliestheserratusanteriormuscle?

Longthoracicnerve

WhatdoestheLongThoracicnervedo?

retainsthescapulatothechestwall(protracts
scapula),andassistswithupwardrotationof
scapular(liftingsomethingabovethehead)

WhattypesofthingscandamagetheThoracic
longnerve?

traumatoribs,overstrenuous/overstretching
activitiesofthearms,sustainedbearingof
excessiveweightsontheshoulders.Secondary
toradicalmastectomyprocedures

Whattypesofsignssymptomsareseenwith
Thoraciclongnerveneuropathy?

shoulderpain,reducedabilitytoperform
overheadactivities,wingedscapula,atrophyof
musclessuppliedbythenerve.

whatconditioniscommonwithLateral
cutaneousneuropathy?

MeralgiaParesthetica

Aconditioninobese,diabetic,andpregnant
patientsduetostretching/compressionofthe
nerve.Canalsobeduetohyperextensionofthe
hiporseverelumbarlordosis.

meralgiaparesthetica

Signs/SymptomsofMeralgiaparesthetica
lateralcutaneousneuropahty?

paresthesias/painalongthelateralaspectofthe
thight,sometimesreliedbysittingwith
associateddecreasedsensationoverthearea.

ListallthetypesofMononeuropahty?(9)

medialnerveCTS,radialnerveaxilla
saturdaynightpalsy,Ulnarnerve,sciaticnerve,
commonperonealnerve,lateralcutaneous
meralgiaparesthetica,Femoralnerve,axillary
nerve,longthoracicnerve.

WhatisthetreatmentforMononeuropathy?

Selflimiting2monthsmaytakemore,may
bepermanent.Compressiveneuropanthies:
cortisoneinjections,meds,surgical
decompression.

BellsPalsyiscausedfromwhichCN?

Idiopathicfacialparesisoflowermotorneuron
typeduetoinflammatoryreactionofthefacial
nerve.

BellsPalsy

WhatmaybeacauseofBellsPalsy?

HSVvirus,diabetes,pregnantwomen

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Whatarethesign/symptomsofbellspalsy?

abruptfacialparalysis,stiffnessintheface,
restrictionofeyeclosure,difficultyeating,and
tastedisturbances.

Howisbellsplasydiagnosed?

Clinically

Howisbellspalsytreated?

spontaneousresolution,permanent,
corticosteroids.

Whathasshownnobenefitinthetreatmentof
bellsplasy?

Antrivirals

AKATicDouloureux

TrigeminalNeuralgia

WhataretheriskfactorsforTrigeminal
Neuralgia?

Middle/olderage,females

WhataretheetiologiesofTrigeminal
Neuralgia?

vesselpressingonnerveintheposteriorfossa,
MS,tumorinposteriorfossa

sx/symptomsoftrigeminalneuralgia?

momentaryshock,electricunilateralfacial
pain,

Whataretriggersoftrigeminalneuralgia?

Touch,movement,drafts,eating.

Howistrigeminalneuralgiadiagnosed?

clinically

Whatmustyouruleoutwithtrigmenial
neuralgia?

MS

Howdoyoutreattrigeminalneuralgia?

CarbamezepineandOxcarbexepine,monitor
CBC

WhatissecondlinetreatmentforTrigeminal
Neuralgia?

Dilatin,otheroptionsarebaclofen,topamax,
gabapentin,andlamotrigine

Whatisthedecompressionprocedurefor
trigeminalneuralgiacalled?

posteriorFossaExporlationsurgery

Whatdestroysthenerveviaheatfortrigeminal
neuralgia?

RadiofrequencyRhizotomy

Whatistheradiationutilizedtodestroythe
nerveintrigeminalneuralgia?

GammaRadiosurgery.

Whatcausesdiffusepolyneuropthy?Multiple
nerves

ETOH/nutritionb12/folatedeficiency,DM,
Hypothyroism,Lyme'sdisease,MS,Drugs,
HIV,CTdisease,Vasculitis,Heavymetal
poisoning

Whatareperiphealnervoussystemsx/signs?

SYMMETRICsensory,motor,mixeddeficits
(parasthesias,burning,tingling,numbness,
sensoryloss,decreasedstrengthandreflexes)/

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Diffusepolyneuropathyaffectswhatnervous
system?

Autonomic

Whataresigns/symptomsofAutonomicNS
diffusepolyneuropathy?

Orthostatishypotension,anhidrosis,
hyperhydrosis,dryeyes,xerostomia,
gastroparesis,bladderdysfunction,ED.

whatisMononeuritisMultiplex?

Groupofsymptoms,notadisease.Occurs
when2+nerveareasaredamaged,usually
unrelated.

WhatmaybeassociatedwithMononueuritis
Multiplex?

DM,CTdisease,vasculitis

Whatisthetreatmentformononeuritis
multiplex?

treattheunderlyingcauseoftheneuropathies.

WhatisthemostcommoncomplicationofDM
IandII?

DiabeticNeuropathy

WhendoesdiabeticneuropathyoccurinDMI?

Afterlongtermhyperglyciemia

WhendoesdiabeticneuropathyoccurinDM
II?

muchsoonerfollowingdxorDM.

WhatarethesymptomsofDiabetic
neuropathy?

stockinggloveparesthesias,burning,pain,
sensory,loss,motorweakness,autonimicsx/

Whatarethesignsofdiabeticneuropathy?

decreasedabsentmonofilament
Decreasedabsentlighttouch
decreasedabsentpinprick
decreasedabsentvirbrationsense
decreasedDTR
Muscleatrophy/weakness

WhatarethediagnostictestsusedinDiabetic
neuropathy?

EMGwithNerveCondution
CT/MRIr/ospinalnerve
Gastricemptyingstudy
tilttable

Whatmedicationsareusedfordiabetic
neuropathy?

Lyrica,gabapentin,opiates,SNRI,SSRI,TCAs,
topicalanalgesics,Viagra,reglan,Miralax,
Florinef.

Acuteorsubacutepolyradiculoneuropathy?

GuillainBarreSyndrome

Oftenfollowsillness,inoculation(flushot),or
surgicalprocedure.Canbeassociatedwith
CampylobactorJejuniEnteritis

GuillainBarreSyndrome

Whatmayprobablybeaimmunologic
pathophysiologicaldiseaseautoantibodies
attackaxonalmembranes?

GuillainbarreSyndrome

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Whatarethesx/signsofGuillainBsyndrome?

symmetricalweakness,beginninginlower
limbsandprogressingtoupperlimbs.
Paresthesia,neuropathicpain,tachycardia,
hypo/hypertension,flusihing,persipiratory
changes,impairedsphinctercontrol

WhatarethedxstudiesforGBS?

LPhighproteins,normalcellcount
MRIDemylination

WhatistheTXforGBS?

plasmapheresis,IVIG,respiratorycompramise,
chestPT,VTEprophylaxis

Whatistoxictonervetissues?

ETOH

Whatcancausedistalsensorimotor
polyneuropahty?

ETOH

Whatisassociatedwithpainfulmusclecramps,
muscletenderness,andparesthesias?

ETOH

WhatshouldyouassesswithETOH
neuropathies?

Folicacid,b1,3,6,A

HowdoyoutreatETOHneuroopathies?

Folicacid,vitamins,d/cETOH,neuological
signsmaybepermanent.

Whataresomenutritionalcausesof
neuropathies?

B12,beriberi,

whatisthetreatmentofnutritional
neuropathies?

vitamins

Whatisararedisorderoftheextremities
characterizedbyvasomotorandautonomic
instability?Usuallyprecededbydirectphysical
trauma.

ComplexRegionalpaindisorder

whatarethesx/signsofComplexregionalpain
disorder?

painandswellinglocalizedtoonearea,often
accompaniedbycolor,temp,dystrophic
changesintheskin.

Howdoyoudiagnosecomplexregionalpain
syndrome?

xray,bonescan

TreatmentforComplexregionalpain
syndrome?

NSAIDS,prednisone,PT/Ot,TCAs,SSRIs,
SNRIs,Neurontin,regionalnerveblock,
bisphosphonates.

Whereiscomplexregionalpainsyndrome
usuallylocated?

handcatchersmitthand.

GlasgowComaScoreisbasedonwhat3
criteria?

EyeOpeningresponse,verbalresponse,motor
response.

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EyeOpeningresponseOptions:

1:Noeyeopening
2:Openseyestopain
3:Openseyestoverbalstimuli
5:Openseyesspontaneously

VerbalresponseOptions:

1:Noverbalresponse
2:Incomprehensiblesounds
3:Inappropriatewords
4:Confusedbutconversant
5:oriented/appropriate

MotorResponseOptions

1:noresponse
2:Decerebrateposturing
3:decorticateposturing
4:withdrawlsfrompainfulstimulus
5:localizestopainfulstimulus
6:followscommands

WhatdoyoususpectwithAlteredMental
Status?

AEIOUTIPS
A:Alcohol/Drugs/Toxins
E:Endocrine/environmentalAmmonia,
electrolytes,hypo/hyperthryroidism
I:Insulin/Impairedglucoseutilization
hypo/hyperglycemia
O:oxygendeprivation/opiates
U:Uremia
T:trauma
I:infection
P:Psychiatric/porphyria
S:spaceoccupyinglesion

Whatdoyoudowhenyouhaveapatientwith
alteredmentalstatus?

ABCs,IVs,Monitoring,O2,pulseox,
accucheck,PE,Labs:headct,ekg,drugtox,
cbc,cmp,pt/inr,abgs,glucose,tsh,ua,amonia,
bloodcultures,LP,lactate

OrganicBrainDisorder

Dementia

Whatsymptomscorrespondswithpatientbeing
agitatedandconfused?

Dementia

Whattypeofpatientmayneedsedationto
allowworkup?

Dementia,Delirium

Rapidonsetofimpairedcognitionor
orientation?

Delirium

Whatisoftencausedbydrugs,metabolicissues
orstructuralabnormality?

Delirium

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Whattypeofpatientsdoyouwanttoisolate
fromnoise,bells,whistlesbecauseofover
stimulus?

Dementia/delirium

Benignintracranialhypertension

Pseudotumorcerebri

Typicallyseeninyoungobesefemaleswith
irregularmenses?

Pseudotumorcerebri

CtwillshowincreasedICPwithoutmasseffect,
willhavepapillaryedema.

Pseudotumorcerebri

Howdoyoutreatpseudotumorcerebri?

LPdecreasepressure.Possibleshunt

____isthemostdevastatingofthe
astrocytomas.

GlioblastomaMultiforme

Namesthetypesofbraintumors(5)

astrocytomas,oligodendorogliomas,
meningiomas,schwannomas,andlymphomas

Howdoyoudiagnoseabraintumor?

CT/MRI

IncreasedICP,focalneurologicalsignsand/or
seizuresaresymptomsorwhat?

CNStumors

RadiologicalGoldStandard?

MRI

Migrainesarecausedby?

Vasodilation

prodromalphasewithsharplydefinedarua.

classicmigraine

prodromalphaseisnotsharplydefined(most
common)

commonmigraine

neurologicalsymptomspersistpastthe
headachephase

complicatedmigraine

visualsymptomswithvertigoandataxia

basilararterymigraine

HAipsilateraltoocularnervepalsy

Ophthalmic

HAoncontralateralside

hemiplegic

Treatmentofmigrains?

sumatriptans,ergotamine,antiemetics,NSAIDs

HeadacheCocktail

Solumedrol,Benadryl,Compazineshortlived,
willreoccur

Howmanypeoplewillhaveaseizureduring
theirlifetime?

10%

initiatedinthetemporallobe.Mayhave
psychiatricsymptoms.

complexpartialseizure

1stlinetherapyforseizure?

benzodiazepines.Mayalsorequire
fosphenytoin,phenytoin,pheonbarbital

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bacteriaenterthesubarachnoidspace,either
viabloodstreamorbyduraldefect.

meningitis

mostserioustypeofmeningitis?

bacterial

howmanytypesofmeningitisarethere?

Whatarethecommonbacterialpathologiesof
meningitis?

streppneumonia,neisseriameningitides

empiricalbacterialmeningitistreatment?

rocephin12grams,steroidsinchildren

Whatwilllikelyhavefocalneurologicaldeficits
andseizuresarecommon?

Encephalitis

CommonViraletiologiesofEncephalitis?

WestNile,HSV,Mumps,Measles,rubella,
rabies,influenza,tickscarecausebacterial
encephalitis.

Howdoyoudiagnoseencephalitis?

headctmayshowabscess,MRImayshow
demyelination

Howdoyoutreatencephalitis?

ABXempiricallyuntiltypecanbeascertained,
acyclovirifHSVinfection.ICPmonitoring

Howarebrainabscessesdeveloped?

hematogenousspreadmultiplefoci,ordirect
spreadsingleabscess.Sinus,dental,orotitis
media.

WhatistheclassicresultofBrainCTwithbrain
abscess?

hypodenseirregulararea,thentheclassicrim
lesionwillpresesnt

Howdoyoutreatabrainabscess?

Antibiotics,surgicaldrain.Tailorabxcoverage
basedonblood,csf,abscesscultures.

Newonsetfacialdroop,speechdisturbances,
dysphagia,extremityweakness,headache,
alteredmentalstatus.

Cerebrovascularaccident

DoyouneedtocontroltheBPduringaCVA?

yes,goalissystolic<220,Diasolitc<120,<185
and<110ifreceivingTPA

MAP(mainarterialpressure)ICP=?

Cerebralperfusionpressure.MainArterial
Pressure=1/3systolic+2/3diastolic

WhoisnotacandidateforTPA?

HemorrhagicCVA

Morecommoninolderpatients,females,
possiblegeneticsyndrome:EhlersDanlos,
AutosomalDominatePCKD.Smoking,HTN,
estrogen,areallriskfactorsforwhat?

Cerebralaneurysm

Hereditaryhemorrhagictelangiestasis

AVM

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AVMspresentin4ways?

Intracranialhemorrhage,seizures,headache,
focalneurologicaldeficit

HowdoyoudiagnoseaAVM?

headCtw/wocontrast

Mildtraumaticbraininjury?NOBLOOD

concussion

Headinjurywithblood:

TBI

CommonlypresentswithHA,dizziness,
n/v,photophobia,sonophobia,repetitive
questioning,retrograde/anterogradeamnesia

concussion

IspositiveLOC,thenthepatientdefinitelyhad
a______.IfnotLOC,lookforothersignsof
neurodisruptionsuchasvisualdistrubances,
amnesia.

Concussions

WhattypeofresultsareseenonaheadCTina
concussion?

Normal

Concussion:GCS1415,whatmaythepatient
do?

gohome

Mostsymptomsofaconcussionwill
improve/resolveoverthecourseof?

2448hours

Maygetsecondimpactsyndromewith_____?
4xmorelikelytogetasecond,7xmorelike
tohavea3rd.

concussions,getedemaanddie.NOsports,
danceetcX1week,orsymptomfree.

WithSDH,whatmedicationprophylaxisare
patientsputone,forALLheadinjuries,doesn't
hurt.

Keppra

Mostcommontypeofheadbleedaftertrauma?

SAH

WhatarethekeystomanagingaTBI?(6)

ControlAirway
RapidHeadCT
EarlyNeurosurgeryconsult
Antiseizureprop.
MaintainCPP
FrequentNurochecks

GCSof8orlessare?

Intabated

Duetoincreasedintracranialpressure?

HerniationSyndromes

OneHemisphereprotrudesunderthefalxtothe
otherside?

SubfalcineHerniation

Uncusoftemporallobeprotrudesthrough
openingoftentoriumcompressesCNIIIand
producesipsalateralfixed/dilatedpupils?

Uncalherniation

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Throughfoamenmangnum,causesbradycardia
anddeath?

CerebellarTonsillarHerniation

Whatisthebigquesitionswithskullfractures?

Intracranialbleeding?evaluatewith
neurosurgeryifstepoff

ManyCTscansmisswhat?

BasilarSkullFractures

Hemotympanum,raccooneyes,battlesign's,
CSFrhinorrhea/otorrhea,hearingloss,cranial
nervepalsiesaresignsofwhat?

BasilarSkullFractures

IfcribiformfractureispresentinBasilarSkull
Fractures,whatisnotdone?

NGtube

Scalplacerationscanbewhat?

LifeThreating!dontbefooled!Highly
vascularized

Whatisgenerallynotneededwithscalp
lacerations?

Antibiotics,sometimesdrains:vascularizations.

Significantabrasionsandcontusionstothe
anterior/lateralneckshouldraisesuspicionof
what?

BluntVascularInjury:alsolookoutfor
trachealinjurieshangings

Whatimagingisneededinbluntvascular
injury?

CTAneck

Neckisdividedinto____zones?Alsodivided
intowhat?

I,II,IIItriangles

Emergentangiogramtoevalaortaand
mediastinalstructures.needsevaluationof
esophagusaswell.

zoneI

ORforneckexpoloration

zoneII

angiogramandcarefulinspectionof
oropharynx

ZoneIII

WhatAntimicrobialAgentspenetratetheCSF?
Providestherapeuticlevelswithorwithout
inflammation.

Sulfonamides,Chloramphenical,Rifampin,
Metronizadole,Trimethoprim,Isoniazid,
Cycloserine

WhatAntimicrobialAgentspenetratetheCSF?
Providestherapeuticlevelswithinflammation.

PenG,Cefotaxime,Ceftriaxone,Ceftazidime,
Acyclovir,Vanco

1stand2ndcephalosporinshavenoactivity
against?

L:ListeriaMonocytogeneses
A:AtypicalMycoplasm
M:MRSA
E:Entercocci

ActivityagainstbothGramPositiveand
Negative?

Thirdgenerationcephalosporins

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EffectiveagentsagainstS.pneumonia,butless
potentagainstMSSA.

Cetriaxone,Cefotaxime

Haveincreasedpotencyagainstpenicillin
resistantpneumococci?

Cefotaxime

Someanaerobiccoverage,noagentscoverB.
Fragilis.

3rdgencephalosporins

WhichthirdgenerationscanbeIV/IM?

Ceftriaxone,Cefotaxime,Ceftazidimeall
approvedinchildren

Whichantibioticinthe3rdgenerationsdoes
notneedrenaldoseadjustments?

Ceftriaxone

EmpiricAntibioticsforNewBorn1monthfor
possiblegramnegenterics,groupbstrep,
listeriamoncytogenes.

Ampicillin+cefotaximeorampicillin
+gentamicin.Ceftriaxoneorcefotaximecanbe
usedinsteadofpcn.

EmpiricAntibioticsfor1monthtoage50for
S.pneumo,meningococci,Hflu,listeria

Cefotaxime,orCeftriaxone+Vancomycin+
Dexamethasone

EmpiricAntibioticsforage50andoverforS.
pneumonia,gramenterics,L.monocytogenes.

Ampicillin+CeftriaxoneorCefotaxime+
vancomycin+dexamethasone

Dexamethasoneisusedtoblockwhat?

TNF.Mayavertmajorneurological
consequencesincludinghearinglossin
children.

BacterialMeningitisGram+Streptococcus
PneumoniaPCNsusceptible

PenicillinG,orCeftriaxone/Chloramphenicol

BacterialMeningitisGram+Streptococcus
PneumoniaPCNresistance

CefotaximeorCeftriaxone+Vancomycin

BacterialmeningitisGramNeisseria
Meningitidis

Ceftriaxone

BacterialmeningitisGramEscherichiaColi

Ceftazidime

BacterialmeningitisGramHIB(BLpos)

Ceftriaxone

BacterialmeningitisGramHIB(BLneg)

Ampicillin

Herpessimplexencephalitismedication

Acyclovirearlytreatmentisimperativereduce
mortalityratesby70%

ProphylaxisbacterialorviralMeningitis:

Rifampinalsoavailableinasuspension,and
ceftriaxone.

WhatcanRifampincause?

Orangebodyfluids,takeonemptystomach,
decreasesOC,cyp450inducer.

MCV4forwhatagegroup?

under55,IM1118,notrecommendedfor
underage11

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MPSV4forwhatagegroup?

peopleolderthan55,SQ

Anabnormalmassoftissue

tumor

"newgrowth",tumor

neoplasm

"borntobebad",cancerous

malignant

Noncancerous

benign

canmeaneithermalignantorbenign

spaceoccupyinglesion

mostimportantorganinthebody

brain

cellsdividerapidlywithoutnormalcontrol,if
thecellsinvadesurroundingtissues,theyare?

malignant

Startinthebrain,rarelyspreadtootherpartsof
thebody

Primarybraintumor

Twomainclassificationsofprimarybrain
tumors:

Neuroectodermal,mesoderma

invasionofactualbraintissue

neuroectodermal

tumorsofbraincoverings,cranialnervesand
adjacentstructures

mesodermal

commonsiteofprimarycancerthatmetastasize
totheCNS?

lung,breast,melanoma,colon

Howmanyprimarybraintumorsarisefrom
abovethetentoriuminadults?

2/3

Howmanyprimarybraintumorsarisefrom
belowthetentoriuminchildren?

2/3

Mostcommonbenignbraintumor:Primary
braintumor

Meningiomas

Wheredomeningiomasoriginatefrom?How
dotheytendtogrow?

Duraslowly

Whatisthemostcommonbraintumorin
womenages3050?

Meningioma

Whatarethe4typesofGliomas:Primarybrain
tumors?

Astrocytomas,Oligodendorgliomas,
Ependymoma,Primitiveneuroectodermal
Tumor.

originateinastrocyes?

Astrocytomas

Originateincellsthatproducemyelin,arisein
cerebrumandgrowslowly,notspreadingto
surroundingbraintissues?

Oliogodendrogliomas

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usuallydevelopsintheliningoftheventricles,
butcanalsooriginateinthespinalcord,most
commoninchildrenandadolescents.

Ependyomas

Medulloblastomamostcommoninchildren,
canspreadtothespinalcordVIACSF?

PrimitiveNueroectodermaltumor

associatedwithHIVinfection,Bcellderived,
increasinginfrequency?

Primarybrainlymphoma

CanPrimarybrainLymphomasberemoved

Theycannotberemoved?

HowdoyoutreatPrimaryBrainLymphomas?

Steroids,Chemomeansurvival~3years.

LeastMalignant,SlowGrowing,Primary
affectsChildren?

GradeIAstrocytoma

MoreMalignant,morediffuse,growsfaster,
tendstoprogresstohighergradeandrecur,
meanage35?

GradeIIAstrocytoma

Aggressive,oftendiagnosedwhentumoris
largeandcausingmasseffect,oftencalled
"anaplasticastrocytoma",seenprimaryaround
age50?

GradeIIIAstrocytoma

Aggressivewithrapidgrowth,prognosisis
poor,alsoknownasaglioblastomamultiforme,
typicallyoverage50?

GradeIVAstrocytoma

Headache,N/V,seizures,dizziness,balance
disturbances,mentalchangesarewhattypeof
manifestation?

Generalized

Cranialnervepalsy,focalseizures,visualfield
defects,ataxia,weakness,dysphasiaarewhat
typeofmanifestations?

Focal

Howdoyoudiagnosebraintumors?

MRIofbrainshowsgreaterdetailthanCT,with
andwithoutcontrast.CTchest,abdomen,
pelvismayshowprimarysize.EEGifseizure
occurring.

Optionsfortreatmentarebasedonwhatfor
braintumors?

pathologyandsite

SterotacticRadiosurgery,optionforcertain
tumors

GammaKnife

surgicalresectionoftumor

craniotomy

canreducesymptomsofbraintumor

debulking

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Treatmentthatmaybeappropriatefor
malignanttumors?

Chemo,radiation

Whatmayhelptoreducecerebraledema?

Steroids

201beamsofradiationdirectedattumor,
beamsthroughdifferentangles,spares
surroundingtissues,killscancerandshrinks
tumors,greatnonoperableoption.

GammaKnifeSterotacticRadiosurgery

insidethecordspinalneoplasm?

intramedullary

Mostcommonintramedullaryspinalneoplasm?

ependymoma

outsidethecord,maybeintraduralor
extradural?

Extramedullary:neurofibraomasand
meningomasarecommon.

Signsandsymptomsofspinalneoplasms
correspondwith?

Locationoftumor.Pain,Abnormalsensation,
muscleweakness,bowel/bladderincontinence,
musclecontractions/spasms,abnormal
appearance,reflexesdiminished.

DiagnosticstudyforSpinalNeoplasms?

MRIstudyofchoice,maydopainxrayto
showbonychanges.

Treatmentofspinalneoplasms?

corticosestroidstodecreaseedema,surgical
resection,chemo/rad.

MidpositionedFixedPupils

Midbraindamage

BilateralFixedandDilatedPupils,nonreactive

Atropene,TricyclicAntidepressants,severe
Anoxia

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