Term
| What Hz tuning fork is used to test hearing? |
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Definition
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Term
| What Hz turning fork is used to test vibration sense? |
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Definition
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Term
| What are contraindications to a spinal tap? |
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Definition
| suspected intracranieal mass lesion, local infection, a spinal cord mass, and coagulopathy |
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Term
| What patients should recieve a CT before getting an LP? |
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Definition
| any patient who presents with altered mental status, focal enurologic deficits, or immunosuppression |
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Term
| What are the parts of the neuro exam in order? |
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Definition
| mental status, cranial nerves, motor, sensory, coordination, gait |
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Term
| What are the parts of the mental status exam? |
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Definition
| a/o, attention (digit span), language (repeat, comprehension, fluency, naming), concentration, mood, memory, and higher cognitive function (fund of knowledge, calculations, abstractions, constructions) |
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Term
| How do you test the cranial nerves? |
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Definition
| visual acuity, visual fields, pupillary reaction, fundoscopic exam, extraoccular movements, light touch and masseter strength (corneal reflex if decreased level of consciousness), facial muscles, finger rub in front of ear, gag reflex or palate elevation, trap/SCM, tongue |
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Term
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Definition
| a lesion in the sympathetic nerves (above T1) that innervate the smooth muscle of the eyelid or a CN III palsy or dysfunction of the neuromuscular junction |
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Term
| Difference between spacticity and rigidity= |
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Definition
| spasticity= persistent state of increased involuntary reflex activity in response to a stretch; by contrast, the term rigidity is used to describe an involuntary increase in the resistance of a muscle to a passive stretch that is uniform throughout the range ofmotion NOT velocity dependent |
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Term
| What are the components of the motor portion of the screening neurological exam? |
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Definition
| tone, strength (esp finger extension, index finger abduction, big toe dorsiflexion and plantar flexion); pronator drift, orbit sign, DTRs and plantar response |
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Definition
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Term
| Brachioradialis reflex tests= |
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Definition
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Definition
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Definition
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Definition
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Definition
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Term
| Xiphoid process dermatome= |
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Definition
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Term
| Dermatomal pattern of the umbilicus= |
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Definition
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Term
| Dermatomal pattern of the inguinal ligament= |
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Definition
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Term
| Dermatomal pattern of the penile/anal zone= |
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Definition
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Term
| What are the components of the screening exam for sensation= |
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Definition
| pain or temperature sensation in the hands and feet, vibration or joint position sense in the hands and feet, light touch |
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Term
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Definition
| changes in tone over time/position caused by an inability to relax |
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Term
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Definition
| ask the patient to make fists and revolve them around each other as if boxing a punching bag; cortical spinal tract weakness leads the weak hand to "orbit" around the strong hand |
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Term
| What are two types of rigidity? |
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Definition
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Term
| Name some superficial reflexes? |
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Definition
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Term
| What are frontal release reflexes? |
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Definition
| reflexes that occur when a patient's frontal lobe has been damaged; include lots of neonatal reflexes like rooting, sucking, and palmar reflex; also glabellar reflex seen in parkinson's patients |
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Term
| How do you check coordination? |
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Definition
| finger to nose test; heel to shing test and rapid movements (strength and coordination) |
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Term
| How do you test distal weakness when evaluating gait? |
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Definition
| ask pt to walk on toes and walk on heels |
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Term
| How do you test for proximal weakness? |
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Definition
| have the patient hop on one foot or try a knee bend while standing on one foot; ask the patient to get out of his/her chair without using their arms |
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Term
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Definition
| no movement or contraction |
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Definition
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Term
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Definition
| full range of motion with gravity eliminated |
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Definition
| full range of motion against gravity |
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Term
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Definition
| full range of motion against gravity and some resistance |
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Term
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Definition
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Term
| What are the specific circumstances in which CT is preferred over MRI? |
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Definition
| suspected skull fracture, suspected intracranial bleeds, trauma, monitoring hydrocephalus |
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Term
| How long does it take for a bleed to show up on imaging? |
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Definition
| within 20 minutes will appear white on CT scans; takes hours to appear on MRI |
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Term
| Why is CT preferred over MRI to eval head trauma? |
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Definition
| CT is faster and you don't have to worry about issues with metallic foriegn bodies causing more damage like if you did an MRI |
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Term
| Why is CT preferred for monitoring hydrocephalus? |
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Definition
| high resolution isn't needed to monitor increasing ventricular size; CT is faster and cheaper |
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Term
| How do you test higher sensory function? |
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Definition
| graphesthesias, point localization, extinction |
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Definition
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Definition
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Definition
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Definition
| hyperactive with spread across a joint |
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Term
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Definition
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Term
| T1 images are used for looking at... |
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Definition
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Term
| How do things look on T1 MRI? |
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Definition
| grey matter is darker, white matter is lighter, CSF is black, bone doesn't produce an MRI signal |
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Term
| Very bright areas on T1 MRI= |
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Definition
| high degree of protein, fat, subacute blood, or contrast agent |
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Term
| What is the perpose of using contrast with MRI? |
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Definition
| gadolinium enhancement can be used to increase the resolution of certain pathologic processes |
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Term
| What do things look like on T2 weighted imaging? |
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Definition
| gray matter is lighter, white matter is darker, and CSF appears white |
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Term
| What are T2 images used to evaluate? |
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Definition
| pathology which appears white owing to edema |
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Term
| What does FLAIR imaging stand for? |
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Definition
| fluid attenuation inversion recovery |
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Term
| What is the purpose of FLAIR imaging? |
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Definition
| a flair image is similar to a T2 image except that the bright CSF has been subtracted away; thus one's eye is drawn to areas of abnormal signal, making th esignal easier to recognize |
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Term
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Definition
| diffusion-weighted imaging |
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Term
| What is the purpose of DWI? |
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Definition
| a specific T2 sequence; DWI is used in suspected cases of acute stroke to determine if an ischemic event is occurring in the brain. as expected the ischemic area appears white; DWI is especially useful because it reveals ischemic areas within minutes of onset |
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Term
| What is the purpose of adding contrast to a study? |
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Definition
| elucidates vascular anatomy (can show occlusion or blood brain barrier leak), this tells the clinician about th eseverity of the condition and can also increase the resolution of the study |
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Term
| What contrast agents are used for CT vs MRI? |
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Definition
| CT= iodinated contrast; MRI= gadolinium |
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Term
| On rare occasions gadolinium can cause what disease? |
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Definition
| nephrogenic fibrosing dermopathy or nephrogenic systemic fibrosis, a syndrome that clnically resembles slceroderma and eosinophilic fasciitis |
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Term
| Which patients are at increased risk of getting nephrogenic fibrosing dermopathy with gadolinium use? |
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Definition
| those with renal insufficiency |
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Term
| An LP is performed between which vertebrae? |
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Definition
| between L4 and L5 (the level of the iliac crests) |
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Definition
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Definition
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Definition
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Definition
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Term
| Normal LP opening pressure= |
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Definition
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Term
| Normal LP % gamma globulin of total protein= |
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Definition
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Term
| What are the findings on LP of SAH? |
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Definition
| increased RBCs, increased WBCs and protein and maybe increased opening pressure or gamma globulin |
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Term
| What percent of stroke is hemorrhagic vs ischemic? |
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Definition
| 85% ischemic; 15% hemorrhagic |
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Term
| What does an LP of GBS show? |
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Definition
| increased protein; normal or increased glucose |
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Term
| What does an LP of MS show? |
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Definition
| increased gamma globulin % and normal or increased WBCs |
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Term
| What are the LP findings of pseudotumor cerebri? |
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Definition
| very high opening pressure |
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Term
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Definition
| a stroke that does not resolve symptomatically |
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Term
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Definition
| focal neurologic deficit resulting from a disturbance in blood flow that reverses within 24 hours |
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Term
| What are the categories of etiologies of ischemic stroke? |
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Definition
| cardiac,large vessel atherothrombosis, small vessel atherothrombosis, hematologic disorders including hypercoagulable states, fibromuscular dysplasia, inflammatory diseases, arterial dissection, migraine venous thrombosis |
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Term
| What is the most common cardiac cause of stroke? other causes? |
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Definition
| afib; mural thrombi, thrombi from diseased or prosthetic valves, other arrhythmias, endocarditis, and paradoxic or venous emboli in patients with right to left shunt in the heart |
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Term
| Nonmodifiable stroke risk factors= |
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Definition
| age, male gender, ethnicity (african american, hispanic, asian) genetics |
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Term
| What are some modifiable risk factors for stroke? |
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Definition
| hypertension, DM, smoking, heavy alcohol intake, cocaine use, obesity, hypercholesterolemia, carotid stenosis, AF |
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Term
| Pts with Afib have how much a greater risk of stroke than the general population? |
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Definition
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Term
| What percent of strokes are due to large vessel atherothrombosis? |
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Definition
| 35% of all strokes; and roughly 40% of all ischemic strokes |
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Term
| Describe the course of a stroke due to large vessel atherothrombosis? |
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Definition
| symptoms maximal at onset and roughly 40% of ischemic strokes |
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Term
| What causes strokes due to small vessel atherothrombosis? |
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Definition
| lacunar infarcts occur in regions supplied by small perforating vessels and results from either atherosclerotic or hypertensive occlusion |
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Term
| What percent of strokes are ccaused by lacunar infarcts? |
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Definition
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Term
| Where do small vessel atherothrombosis strokes typically occur? |
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Definition
| basal ganglia, brain stem, and internal capsules (due to small vessel disease) |
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Term
| What hypercoagulable states can cause strokes? |
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Definition
| sickle cell disease, polycythemia, thrombocytosis, leukocytosis, malignancy, hereditary coagulopathies, and collagen vascular disease |
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Term
| What causes hemorrhagic strokes? |
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Definition
| hypertensive rupture of small vessels, AVMs, hemorrhagic conversion of ischemic strokes, amyloid angiopathy, cocaine use, and/or bleeding diatheses |
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Term
| What is the time course for thrombotic strokes? |
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Definition
| evolve in minutes to hours and may follow a TIA |
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Term
| What is the time course for an embolic stroke? |
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Definition
| often present with the full deficit acutely and do not evolve |
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Term
| What is the time course of a hemorrhagic stroke? |
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Definition
| onset can include headache and/or altered mental status; deficits may not strictly follow vascular territories due to hematoma expansion and edema surrounding the bleed |
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Term
| What is Todd's paralysis? |
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Definition
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Term
| Trunk/arm/face paralysis= |
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Definition
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Definition
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Definition
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Definition
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Definition
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Term
| stroke with cognitive changes= |
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Definition
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Term
| stroke with bladder incontinence= |
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Definition
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Term
| Stroke with vision changes= |
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Definition
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Term
| Stroke with reading/writing deficits= |
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Definition
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Term
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Definition
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Term
| "locked in" syndrome stroke= |
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Definition
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Term
| stroke with cranial nerve palsies= |
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Definition
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Term
| stroke with drop attacks= |
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Definition
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Term
| What is the goal of stroke workup? |
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Definition
| 1) urgently determine whether the stroke is ischemic or hemorrhagic; 2) if the stroke is ischemic, to ascertain whether it can be reversed within a three-hour window using tPA both to salvage ischemic brain and to prevent further strokes |
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Term
| region supplied by the MCA= |
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Definition
| lateral cerebral hemispheres; deep subcortical structures |
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Term
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Definition
| combined deficits of superior/inferior divisions; may see coma an dincreased intracranial pressure |
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Term
| region supplied by superior division of MCA= |
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Definition
| motor/sensory areas of the face,arm hand; broca's area |
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Term
| Stroke of superior division of the MCA= |
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Definition
| contralateral hemiparesis of face, arm and hand, expressive aphasia if dominant hemisphere |
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Term
| REgion supplied by inferior division of the MCA? |
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Definition
| parietal lobe (vvisual radiations, wernicke's area), macular visual cortex |
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Term
| Stroke of inferior division of MCA= |
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Definition
| homonymous hemianopia, receptive aphasia (dominant), impaired cortical sensory functions, gaze preference apraxias and neglect (nondominant) |
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Term
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Definition
| parasaittal cerebral cortex |
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Term
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Definition
| contralateral leg paresis and sensory loss |
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Term
| REgion of the brain supplied by opthalmic artery= |
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Definition
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Term
| Neurologic deficit caused by opthalmic arter stroke= |
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Definition
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Term
| Area supplied by the PCA= |
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Definition
| occipital lobe, thalamus, rostral midbrain, medial temporal lobes |
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Term
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Definition
| contralateral homonymous hemanopia, memory or sensory disturbances |
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Term
| Area of the brain supplied by the basilar artery= |
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Definition
| ventral midbrain, brain stem, posterior limb of the internal capsule, cerebellum, PCA distribution |
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Term
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Definition
| coma, cranial nerve palsies, apnea, cardiovascular instability |
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Term
| Name some arteries of deep circulation in the brain: |
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Definition
| lenticulostriate, paramedian, thalamoperforate, circumferential arteries |
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Term
| What areas of the brain are supplied by the lenticulostriate, paramedian, thalamoperforate, and circumferential arteries? |
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Definition
| basal ganglia, pons, thalamus, internal capsule, cerebellum |
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Term
| Stroke of the lenticulostriate, paramedian, thalamoperforate, and circumferential arteries= |
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Definition
| "lacunes" pure motor or sensory deficits, ataxic hemiparesis, "dysarthria-clumsy hand" syndrome |
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Term
| What tests should you get for suspected stroke? |
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Definition
| CT withotut contrast to distinguish ischemic from hemorrhagic stroke; MRI, CBC, coagulation panel, lipid panel, ESR, CRP, TSH RPR, B12/folate, glucose and HBA1c, ECG, echo, perhaps carotid ultrasound, blood cultures, screen for hypercoagulable states |
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Term
| What do ischemic strokes look like on CT and how long does it take for changes to show up? |
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Definition
| loss of gray-white differentiation or as a hypodensity, and are generally not visible for at least 3-6 hours after symptom onset |
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Term
| Why might you get an MRI to evaluate a stroke? |
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Definition
| MRI can identify early ischemic changes (DWI to see new ischemia; flair to see old ischemic regions) to identify neoplasms and to adequately image the brain stem and posterior fossa |
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Term
| What tests might be involved in a hypercoaguable workup for stroke? |
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Definition
| INR, aPTT, antithrombin III, protein C/S, antiphospholipid/anticardiolipin antibody, sickle cell trait) |
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Term
| What are major contraindications to tPA therapy for stroke= |
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Definition
| SBP>185 or DBP >110 despite aggressive treatment; prior intracranial hemorrhagic, stroke, or head trauma in the past 3 months; recent MI; current anticoagulant therapy with an INR >1.7, use of heparin in the last 48 hours with prolonged PTT; platelet count <100,000; major surgery in the past 14 days or GI/urinary bleeding in the past 21 days; seizures present at the onset of stroke; blood glucose <50 or >400; age <18 |
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Term
| What is the time frame in which tpa can be administered to stroke victims? |
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Definition
| victims must have been confirmed to have been well within three hours of ischemic onset |
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Term
| IF you are past the three hour window to give tPA what can you give ischemic stroke patients instead? |
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Definition
| aspirin has been shown to decrease morbidity and mortality in acute ischemic stroke presenting less than 48 hours from onset |
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Term
| How can you treat small vessel strokes? |
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Definition
| antiplatelet agents such as aspirin, clopidogrel, and dipyridamole/aspirin for small vessel strokes and when anticoagulation is either not indicated or contraindicated |
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Term
| What complications should you be on the lookout for in stroke pts? |
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Definition
| brain swelling, increased intracranial pressure, or herniation |
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Term
| When is carotid endarterectomy indicated? |
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Definition
| in the setting of asymptomatic stenosis > 60% or symptomatic/asymptomatic stenosis > 70%; do not use in 100% blockage |
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Term
In treating stroke, what "hypo"
s shoudl you avoid? |
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Definition
| hypotension, hypoxemia and hypoglycemia; maintain SBP approximately 20 mmHg above pts baseline to ensure adequate cerebral perfusion and do not lower unless it is >220/>130 |
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