1-12-07

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What is the mcc of hemorrhage in elderly patients?: HTN ICH
Rule of thumb to operate on hematoma? How to estimate?: Volume of clot > 30mL

Estimate the VOLUME of the clot by (A x B x C) * .5
What peaks 3 days post hemorrhage in ICH?: vasogenic edema
IVC often come from? common in?: intraparenchymal hemorrhage from the thalamus

patiens with HTN or cocaine uses
Clot for acute SDH? Tx?: Thick, gelatinous clot

ARTERIAL in origin

CRANIOTOMY is necesary!!
Clot for chronic SDH: liquid nature

VENOUS in origin

Cranitomy is NOT necessary...can jsut evacuate liquid with burr holes
Where do aneurysms normally occur?: Where there's a defect in the INTERNAL ELASTIC LAMINA
First step in management of SAH? How (2)?: Protecting the dome from re-rupture

Clipping, Coiling (Pt w/ mild platelet-activating effect)
Advanage of coiling over clipping?: less invasive (open craniotomy)
A major problem with 30% of SAH patients? Mech?: Vasospasm

As the clot at the base of brain dissolves, leaches out ENDOTHELIN and other molecues that cause spastic result in artery wall
Factors that increase risk of ICAs?: -Family history (strongest)
-Age
-Polycystic kidney disease
-Smoking (biggest modifiable risk)
-HTN
Is the discover of a small, unruptured, ICA a medical emergency?: No, risk ^ for larger aneurysms and aneurysms in POSTERIOR circulation
Name the 4 kinds of neurosurgical Intracranial Vascular Malformations (IVM)?: 1)Arteriovenous Malformations (AVM) (MOST COMMON)

2)Dural arteriovenous (AV) fistulas

3)Venous angioma

4)Cavernous malformations
How do Arteriovenous Malfomations develop? Potential effects? Small AVM may be treated by?: Congenitaly (3rd trimester) - contain NIDUS (cluster of abnormal BVs)

Seizures, Mass effect & ruptures

Radiosurgery
Symptoms of a Dural arteriovenous (AV) fisturla include (2)?: 1) Hemorrhage

2) Pulsatile TINNITUS (hear heart beat w/out stethscope)
Venous angiomas are?: Cerebellar veins that are LARGER THAN NORMAL VEINS and

NOT associated with hemorrhage
Describe a Cavernous Malformation: Parenchymal lesion within the brain tissue with typical "popcorn" appearance on MRI

CAN cause hemorrhage (although fairly benign)

typically associated with Venous Angiomas
For what time frame are intra-arterial thrombolytics effective for ischemic stroke patients?: 3-8 hours post-stroke
What is the penumbra?: The surrounding area of strock-affected brain tissue that is being kept alive and potentially salvageable by COLLATERAL VESSELS or RECANALIZATION
What is the use of CT perfusion? Diff from MRI?: Separate patients with reversible (penumbra) versus irreversible brain injury from a stroke

Easier and faster than MRI
25% of people with stroke or TIA have? measure degree of stenosis by?: Associated atherosclertoic carotid dz

Dividing diameter of stenotic area by th diameter of intact artery and multiplying by 100 (>50% = signifcant)
Preserve normal consciousness during Simple Partial Sz?: Yes, patients are aware of the envitonment
A purely sensory phenomenona is called an?: Aura
Most common presentation of Simple Partial Sz?: Aura that progresses into a complex partial sz (spreads across brain)

-if it effects entire brain, then called Secondary generalized seizure

Sz CANNOT reverse in severity (just increase & spread)
Preserve normal consciousness during Complex Partial Sz?: Yes, but ALTERATION of consciousness (not loss)

-retain some ability to intreact w/ envionment

-usually dont remember anything
Main factors that different causes of simple vs complex partial sz?: 1) amount

2) location of involved cortex

-region determined by symptoms (Todd's paralysis)
Sz that starts in WHOLE brain at SAME time from the onset?: Generalized Onset Sz
If absence seizure began as an adult suspect what?: Temporal lobe complex partial sz
Name the 4 types of Generalized Onset Sz and key characteristics?: 1)Tonic-Clonic ("Grand mal") - blood-curdling cry, clonic phase: high freq/low amp to low freq/high amp jerking

2) Absence ("Petit Mal")- ALWAYS starts during childhood (usually grow out of it)

3) Myoclonic - like clonic jerks but isolated event (non-epileptic), no LOC

4) Atonic - brief & sudden loss of tone, opposite of myoclonus; mainly occurs in kids w/ encephalopathies
Dosing off in class causes?: physiologic myoclonus
Atonic sz mainly occur in what population?: Kids w/ encephalopathies
Cortical orgin of jerking?: motor cortex
Classic features of temporal lobe sz (important!)...aura, complex partial symp, duration, post-ictal symp?: 1) Aura - epigastric rising sensation, deja vu, jamais vu & foul smell/metallic taste

2)Complex partial - staring, oral automatisms (ie lip smack), manual automatisms (ie picking; ipsi to sz-side), dystonia (contra to sz-side

Duration - 30sec to 2 min

Post-ictal - confusion, Todd's paralysis, fatigue

USUALLY AWARE OF HAVING SZ
Primary Epilepsy syndrome characteristics?: Idiopathic/Genetic

More common in CHILDREN

NOT associated with MR

usually grow out of it

mainly GENERALIZED
Secondary Epilepsy syndrome characteristics?: Cryptogenic (partial), Lennox Gastaut (generalized)

more common in ADULTS

Arises from either 1)acquired damage or 2)manifestation of dz with broader clinical scope (ie MR or cerebral palsy)
Recurrent sezures that are not epilepsy can be caused by (3)?: 1) Alcohol withdrawal

2) Hypoglycemia

3) Cocaine
When do you look for abnormalities on of brain wave with EEG for sz? how do you make the EEG more sensitive?: when patient is NOT having a seizure

make patient SLEEP DEPRIVED
Reason for completing an MRI for sz patients?: to R/O underlying pathology such as tumor or AV malformation
____ is the gold standard for sx diagnosis when is it necessary?: Video EEG monitoring

During surgical evaluation (but otherwise not normally necessary)
Never _____ when a patient is having a seizure?: Never put anything in mouth
When are CT's useful for sz dx?: MEDICAL EMERGENCIES (otherwise MRI will suffice)
Can all New Generation AEDs be used in monotherapy?: Yes, but not all are approved for monotherapy by FDA
Choice of AED is usually made on the basis of? One key differentiation?: AED's SE

Whether a patient has PRIMARY GENERALIZED EPILEPSY OR NOT
Most common idiosyncratic SE of AEDs?: rash
Dose related SE of AEDs usually problems where?: CNS

fatigue, dizziness, diplopia
Beneficial SE of AEDs?: Help with MIGRAINES and NEUROPATHIC PAIN
Drug with highest incidence of birth defects?: Valproate
Change medication if woman is pregnant and seizure free?: NO
Most common type of epilepsy surgery?: Mesial temporal lobe epilepsy
T or F...If patient does not become sz free on one of the 1st few AEDs, then will probably never be sz-free: True!
Traditional 1st choicce amongst neurologists for PARTIAL-onset seizures?: Carbamazepine
DOC for Primary Generalized epilepsy: Valproate
Great AED for migraines: Topiramate
Great AED for weight loss: Topiramate
Least sedating drug in most patients (esp elderly): Lamotrigine
Starting dose is dose for this AED: Levetiracetam
No known drug interactions for this AED: Levetiracetam
Less potent as add-on than other AEDs: Gabapentin
AED w/ very long 1/2 life (QD dosing): Zonisamide
AED w/ Enormous OFF-LABEL USE especially for PAIN: Gabapentin

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Number of cards 60