management for transient ischemic attack(TIA)Secondary prevention of future stroke includes antiplatelet agents (eg, aspirin, clopidogrel) to prevent thrombus formation and ☆statin therapy (HMG-CoA reductase inhibitor; eg, atorvastatin, rosuvastatin) to reduce atherosclerotic plaque formation. Lifestyle modifications (eg, exercise, tobacco cessation) are also recommended. neurologyUWorld May 24, 2020, 12:25 AM HirotoShishido
character/duration of each headachesmigrane
pulsatile, throbbing and lasts for 4-72hrs
cluster
excruciating, sharp&steady and lasts
for 15-180mins
treatment for myoclonic seizurebroad spectrum anticonvulsant (☆valproic acid, levetiracetam)
myoclonic seizure is often due to juvenile myoclonic epilepsy(JME)
A genetic epilepsy syndrome characterized by recurrent myoclonic seizures, generalized tonic-clonic seizures, and absence seizures. The onset of seizures occurs between the ages of 8 and 25, and seizures characteristically occur ☆immediately after waking up or following sleep deprivation. neurologypharmacologyUWorld May 22, 2020, 12:12 AM HirotoShishido
cutaneous innervation of the external auditory canalCNⅤ-3, Ⅶ,Ⅸ, Ⅹ
Ⅴ-3→ anterior wall, external portion of the tympanic membrane
Ⅸ→ internal portion of the tympanic membrane
Ⅹ→ ☆posterior wall
(stimulation of the posterior wall can trigger vasovagal syncope) neurologyENTUWorld May 20, 2020, 12:52 AM HirotoShishido
neonatal intraventricular hemorrhage
sourse of bleeding, predisposing factor☆germinal matrix (sources of neurons and glial cells during brain development)
IVH almost always manifest within the first 5 postnatal age in patients born before 32 weeks gestation and/or with birth weight<1500 g neurologypediatricsUWorld May 20, 2020, 12:42 AM HirotoShishido
treatment for nausea/vomiting in migraine headachemetoclopramide(dopamine antagonist)
Consider extrapyramidal syndrome (EPS) prophylaxis with ☆diphenhydramine. (due to its anticholinergic activity) neurologypharmacologyUWorld May 16, 2020, 6:38 PM HirotoShishido
ALS
mean age of onset, the most concerning site of LMN degeneration65 (male>female)
summation, length constant, time constantspatial summation→ input from multiple nurons
temporal summation→ multiple inputs from a single neuron
the distance an impulse can propagate depends on the membrane resistance (longer in myelinated)
the time takes for the membrane potential change depends on the membrane resistance (☆shorter in myelinated) neurologyUWorld May 11, 2020, 4:16 AM HirotoShishido
Example of a developmental field defect
[viewer discretion is advised]☆Holoprosencephaly
Field defect causes multiple malformations by disrupting the development of adjacent tissues and structures within a particular region
watershed infarctInfarct due to severe hypoperfusion(¥more prevalent in patients following cardiac surgery) proximal upper and lower extremity weakness (“man- in-the-barrel syndrome”), ¥higher order visual dysfunction (if posterior cerebral/middle cerebral cortical border zone stroke).
excitatory/ inhibitory neurotransmittersexcitatory postsynaptic potentials(EPSPs)
Ach, norepinephrin, epinephrin, dopamine, glutamate(☆glutamine is the one which accumulates in astrocyte in patients with hepatic encephalopathy), and serotonin
amyloid angiopathy
common age, characteristicsthe most common cause of spontaneous lobar hemorrhage in adults age>60
hemorrhage tends to be recurrent
and often involves the ☆occipital and parietal lobes neurologyUWorld Apr 26, 2020, 1:11 AM HirotoShishido
cerebral edema
etiology①cytotoxic edema begins hours after the ischemic injury. The ☆failure of ATP-dependent ion pumps leads to the accumulation of intracellular Na+ and water in neural and glial cells despite an intact blood-brain barrier.
②Vasogenic edema follows 24-48 hours later, when the release of inflammatory mediators disrupts the tight junctions of the blood-brain barrier, allowing proteins (eg, albumin) and water to enter the interstitial space.
☆neoplastic lesion can also disrupt
BBB neurologyUWorldUWorld SIM2 Apr 25, 2020, 7:22 PM HirotoShishido
Alzheimer's disease
manifestations, pathological findingsA patients presents insidiously with memory loss of recent events.
executive dysfunction+visuospatial impairment early in the disease course,
language and behavioral abnormalities often later
☆neuritic(senile) plaques→ in gray matter: extracellular β-amyloid core; may cause amyloid angiopathy→intracranial hemorrhage
(no α secretase
neurofibrillary tangles→ intracellular, hyperphosphorylated tau protein = insoluble cytoskeletal elements; number of tangles correlates with degree of dementia. neurologyUWorld Apr 25, 2020, 1:59 AM HirotoShishido
osmotic demyelination syndrome
etiology, manifestationiatrogenic correction of hyponatremia
→☆cerebral demyelinatiom
☆pons is commonly affected, but can occur to basal ganglia, or cerebral white matter
→spastic quadriplegia, pseudobulbar palsy, locked in syndrome, acute paralysis, dysarthria, dysphagia, diplopia
common complication of adult-type coacrctation of the aortahypertension associated complications including left ventricular failure, ruptured dissecting aortic aneurysm, and ☆intracranial hemorrhage(congenital berry aneurysms of the Circle of Willis) cardiologyneurologyUWorld Apr 22, 2020, 6:29 AM HirotoShishido
shaken baby syndrome
manifestationsacute on chronic subdural hemorrhages
rentinal hemorrhages
posterior rib fractures neurologypediatricsUWorld Apr 21, 2020, 7:11 AM HirotoShishido
which bones joins together at pterion?
what can be caused due to the fracture at pterion?frontal, parietal, temporal, and sphenoid bones
