Ryan Shared "M3: Neuro" - 228 Picmonics
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M3: Neuro
Posterior Column (Dorsal Column)
- Ascending Pathway (Sensory)
- Sensations
- Proprioception
- Fine Touch
- Pressure
- Vibration Sensation
- Anatomy
- Dorsal Root
- Fasciculus Cuneatus
- Arms
- Fasciculus Gracilis
- Lower Limbs
- Lesions
- Vitamin B12 Deficiency
- Tabes Dorsalis
2 mins
Cluster Headache
- Presentation
- More Common in Men
- Unilateral Periorbital Headache
- Ipsilateral Tearing
- Precipitated by Alcohol
- Stabbing Pain
- Duration
- 15 min - 3 Hours
- Repetitive Attacks in Clusters
- Treatment
- High Flow 100% O2
- Ergots
- Sumatriptan
2 mins
Central cord syndrome
- hyperextension
- Elderly
- pre-existing degenerative changes
- Re-experience Traumatic Event
- Trauma
- central portions of the corticospinal tracts
- lateral spinothalamic tract
- weakness that is more pronounced in the upper extrem ities than the lower
- mri without contrast
Pseudotumor cerebri (Idiopathic intracranial hypertension)
- Increased ICP (Intracranial Pressure) with no apparent cause on imaging
- Risk Factors
- Being a woman of childbearing age
- Obesity
- Excessive Vitamin A
- Danazol
- Tetracycline
- Symptoms/Findings
- Headache
- Diplopia
- No change in Mental Status
- Papilledema
- Increased Opening Pressure
- Treatment
- Weight loss
- Acetazolamide
- CSF shunt
- Topiramate
- Lumbar Puncture
- CN II fenestration surgery
Multiple Sclerosis Features and Mechanisms
- Features
- More Common in Women
- Presents in 20's and 30's
- Northern Europeans
- Mechanism
- Unknown mechanism, genetic factor
- HLA-DRB1
- Autoimmune Demyelination of CNS
- White Matter of Brain and Spinal Cord
- T Cell Mediated Inflammation
2 mins
Multiple Sclerosis Symptoms and Diagnosis
- Symptoms
- Optic Neuritis
- Internuclear Ophthalmoplegia
- Scanning Speech
- Urinary and Fecal Incontinence
- Motor Issues (Intention Tremor, Paresis)
- Numbness and Pain
- Depression
- Relapsing Symptoms
- Diagnosis
- Gold Standard = Plaques on MRI
- Increased CSF Immunoglobulins (IgG)
- Oligoclonal Bands
4 mins
Progressive Multifocal Leukoencephalopathy
- Progressive Multifocal Leukoencephalopathy (PML)
- Demyelination of CNS due to destruction of oligodendrocytes (white matter)
- Caused by JC virus
- Immunosuppression (e.g., AIDS or leukemia) leads to reactivation of the latent virus
- JC virus (reactivation) at CD4+ count below 200 in AIDs patients
- Increased risk associated with natalizumab, rituximab
- Presents with rapidly progressive neurologic signs (visual loss, weakness, dementia) leading to death
- Positive babinksi
- Asymmetric/focal, nonenhancing areas of demyelination on MRI
- Rapidly progressive, usually fatal
- Dx: PCR on CSF sample
- Brain biopsy is gold standard for diagnosis
Various recombinant immunosuppressants 2
- Eculizumab
- Natalizumab (Tysabri)
- Denosumab
- Omalizumab (Allergies)
- Palivizumab (Synagis)
Amyotrophic Lateral Sclerosis (ALS)
- Assessment
- Progressive Muscle Weakness
- Systemic Muscle Wasting
- Fasciculations
- Spasticity
- Fatigue
- Considerations
- Riluzole (Rilutek)
- Stretching
- Little to No Cognitive Decline
- Respiratory Support
- Palliative Care
2 mins
Motor Neuron Signs UMN and LMN
- Upper Motor Neuron (Increases)
- Increased DTRs
- Positive Babinski
- Spastic Paralysis
- Clasp-Knife Reaction
- Lower Motor Neuron (Decreases)
- Decreased DTRs
- Negative Babinski
- Flaccid Paralysis
- Muscle Atrophy
- Fasciculations
2 mins
Myasthenia Gravis
- Mechanism
- Antibodies to Acetylcholine Receptor
- Symptoms
- Ptosis
- Diplopia
- Weakness with Muscle Use
- Respiratory Death
- Thymus Associated
- Treatment
- Acetylcholinesterase Inhibitors
- Plasmapheresis
- Thymectomy
1 min
Alzheimer Disease
- Most common cause of dementia in elderly
- Down syndrome patients have an Increased risk of developing Alzheimer
- Associated with the following altered proteins:
- EARLY ONSET (Familial)
- APP (Chr 21)
- Presenilin-1
- Presenilin-2
- LATE ONSET (sporadic)
- ApoE4 in Chr 19: Increases risk of sporadic form
- ApoE2 in Chr 19: Decreases risk of sporadic form (protective) due to Increase in Ach
- Findings
- Decrease Acetylcholine (ACh)
- Widespread cortical atrophy (Narrowing of gyri and widening of sulci)
- Senile plaques (Amyloid Beta plaques)
- Neurofibrillary tangles
- Can lead to intracranial hemorrhage
- Hyperphosphorylated tau protein
- The hippocampus is the area of the brain demostrating the greatest degree of atrophy. Hippocampal atrophy in MRI is highly suggestive of the diagnosis.
Pick's Disease (Frontotemporal dementia)
- Early changes in personality and behavior (behavioral variant)
- Aphasia (primary progressive aphasia) and repetition of phrases
- May have associated movement disorders
- Parkinsonism
- UMN/LMN degeneration
- Frontotemporal degeneration
- Difficulty Making Own Decisions
- Spares Parietal, Occipital Lobes and posterior 2/3 of superior temporal gyrus
- Round Pick Bodies: Inclusions of hyperphosphorylated tau protein
- Ubiquitinated TDP-43
- Autosomal Dominant in 20 - 40% of the cases
Normal Pressure Hydrocephalus
- Mechanism
- Elderly
- Idiopathic
- Decreased Absorption of CSF
- Ventricular Enlargement
- Symptom Triad
- Urinary Incontinence
- Ataxia (Gait)
- Cognitive Dysfunction
2 mins
Tick paralysis
- neurotoxin present in tick saliva
- Presentation
- Paresthesia
- Fatigue
- followed by...
- ascending muscle paralysis
- Ataxia
- absent deep tendon reflexes
- Treatment
- tick removal
Status epilepticus
- ≥ 5 min of continuous seizures
- OR ≥ 2 seizures with consciousness not being fully regained in the interictal period
- Initial treatment phase
- Benzodiazepines
- IV lorazepam OR
- IV diazepam OR
- IM midazolam
- Second treatment phase Non benzodiazepne antiseizure drugs
- Second treatment phase Non benzodiazepne antiseizure drugs
- fosphenytoin
- IV valproic acid OR
- IV levetiracetam OR
- IV phenobarbital
- Refractory status epilepticus
- Refractory status epilepticus
- Third treatment phase Continuous administration, anesthetic doses
- Thiopental OR
- Propofol OR
- Midazolam OR
- Pentobarbital
Narrow vs Broad spectrum seizure medications
- Narrow spectrum (in narrow part of river) are carbamazepine, gabapentin, phenobarbitol, phenytoin
- Broad spectrum seizure meds include valproate, lamotrigine, levetiracetam, topiramate
- levitracetam is keppra, valproate is depakote, lamotrigine is lamictal
Seizure Workup
- History of epilepsy?
- Yes: Check drug/med levels
- No: Actively seizing?
- Yes: Abort
- 1) IV Benzos
- 2) Phenytoin
- 3) Midazolam + propofol
- 4) Phenobarbitol
- No: EEG, CT
- Workup (Only if new onset seizure)
- Blood glucose
- Serum electrolytes
- LFTs
- UTox
- Kidney function tests
- Differential
- A) Syncope
- Migraine/aura
- Narcolepsy
- Movement disorders
- Psychological Disturbances
- Reversible Causes
- B6 deficiency (due to INH)
- Eclampsia
- Hyponatremia
- Hypoglycemia
Types of Seizures
- Tonic-clonic
- Tonic
- Clonic
- Absence (Petit Mal)
- Myoclonic
- Atonic
- Partial (Focal) Seizure
- Simple Partial
- Complex Partial
2 mins
Valproic Acid
- Indications
- First Line Tonic-Clonic Seizure Treatment
- Bipolar Disorder
- Migraine Prophylaxis
- Mechanism of Action
- Increases GABA Concentration
- Blocks Voltage-Gated Na+ Channels
- Side Effect
- GI Distress
- Contraindication
- Contraindicated in Pregnancy
1 min
