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Neurology_Board_Review - NEUROLOGY REVIEW For those who...

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NEUROLOGY REVIEW For those who still suffering from Neuro … Here is my gift … Enjoy … 1 www.brain101.info
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Condition Pathogenesis Sx / Dx Rx Notes Sleep Disorders (dyssomnias) Intrinsic Extrinsic Circadian rhythm disorders Insomnia drugs (caffeine, antidepressants, MAO-I, bronchodilators, stimulants, steroids), stress, medical causes difficulty falling asleep or staying asleep hypnotics, sleep instructions, sleep restriction Obstructive sleep apnea syndrome narrow airway (blockage by tongue, pharynx, uvula) loud snoring ; frequent arousal at night; headache, depression, irritability, memory probs CPAP (continuous positive air pressure); surgery; weight loss risk Fx: obesity, EtOH, large tonsils or palate, retrognathia, micrognathia; assoc. w/ HTN, MI, stroke Narcolepsy genetic ( HLA-DR15 ); linked to orexin deficiency cataplexy (sudden loss of postural tone while awake, triggered by emotion/laughter); sleep paralysis; hypnagogic hallucinations; excess sleepiness; Dx: multiple sleep latency test stimulants (Ritalin, dextroamphetamine), tricyclic ADs for cataplexy atonia like REM sleep -> intrusion of REM sleep into wakefulness Restless legs syndrome assoc. w/ peripheral neuropathy, myalopathy, pregnancy, Fe-deficiency urge to move legs while sleeping dopamine agonists; pain meds, benzodiazepines Parasomnias NREM arousal disorders mosr common in 1st 1/3 of night (delta NREM) in children w/ family Hx different every time avoid precipitants, prevent injury Somnambulism during stage 3-4 of NREM sleepwalking Sleep Terror unexplained fright upon awakening vague memory of impending doom REM sleep behavior disorder not paralyzed during REM -> act out dreams; lack of atonia, disinhibition of brainstem centers abnl REM (Dx: incr. EMG); violent or injurous behavior during REM assoc. w/ Parkinson's, dementia, narcolepsy, meds, EtOH withdrawal Nightmare vivid memory of scary dreams (during REM) full alertness upon awakening Epilepsy Idiopathic Partial Benign Rolandic epilepsy onset age 2-13; AD inheritance w/ incomplete penetrance absence seizures; nocturnal clonic facial twitching, drooling; begins/ends abruptly; no post-ictal confusion; can be induced by hyperventilation usu. remits by 18 benign Symptomatic/ cryptogenic Partial Frontal lobe epilepsy brief (seconds); often nocturnal or upon awakening; agitated hypermotor behavior; no post-ictal state often misdiagnosed as psychogenic seizure Temporal lobe epilepsy aura of epigastric rising (nausea), psychic phenomena; blank wide-eyed stare & dilated pupils; lip-smacking Parietal lobe epilepsy aura of somatosensory Sx, vertigo Occipital lobe epilepsy visual hallucinations; post-ictal blindness if secondary to TLE or FLE Idiopathic Generalized Childhood Absence epilepsy onset age 2-10 brief; blank stare; abrupt onset & end; frequent; induced by hyperventilation usu. remits by 18 benign Juveline Absence epilepsy onset after puberty tonic-clonic seizures; infrequent less remission Juvenile Myoclonic epilepsy onset in adolescense, early adults morning myoclonic seizures; no impairment of consciousness; exacerbated by sleep deprivation
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