Thursday, February 26, 2015

Neurology List of Most Commons for Physician Assistant Students

Most Commons in Neurology
  • Tension Headache - most common type of headache
    • Episodic Tension-Type Headache - most common headache subtype (<15 days monthly)
  • Migraine - most common recurrent headache disorder
  • Medication Overuse Headache (Analgesic Rebound) - most common cause of migraine-like and “mixed” headaches that occur > 15 days per month
  • Epilepsy - most common in childhood due to perinatal injury, infection and genetic factors and old age due to stroke, tumors, or dementia
  • Seizures
    • Most common toxic causes of seizures: drugs, alcohol, and medications
    • Most common metabolic causes of seizures: hypocalcemia, hypoglycemia, hyponatremia, hypoxia
  • Temporal Lobe Epilepsy - most common symptomatic partial epilepsy syndrome in adults
  • Simple Partial Seizures - most commonly results from structural abnormalities in the cortex
    • Most adults (70%) with new-onset epilepsy have partial (focal) seizures
    • The most common specific lesions are: hippocampal sclerosis, neuronal and glial tumors, vascular malformations, neuronal migration disorders, hamartomas, encephalitis, cerebral trauma, embolic stroke, and ehmorrhage
  • Absence Seizures - occur most commonly in children (6-7) and are genetic
    • Childhood absence epilepsy - most common type of childhood epilepsy
  • Tonic Seizures - most commonly occur in children with Lennox-Gastaut Syndrome
  • Gelastic Seizures - most commonly occurs in patients with maternal family history of migraines and is more common in males
    • “classic Mirthless Laughter”
  • Huntington’s Chorea - most common in 30s
  • Sydenham’s Chorea - most common in female teenagers
  • Amyotrophic lateral sclerosis - the most common upper motor neuron disease
  • Drug induced Parkinsonism - most common cause is treatment with neuroleptic medications
  • Tremor - most commonly caused by essential tremor
  • Acute viral Meningitis - most commonly caused by enteroviruses (echovirus and coxsackievirus)
  • Most common fungal infection of the CNS: cryptococcal meningoencephalitis
  • Most common cause of encephalitis: HSV-1 (Herpes Simplex Encephalitis)
    • Most common in children and young adults
  • West Nile Virus - most common in june and november; caused by Arbovirus and spread by mosquitoes
    • WNV Encephalitis - most common in older age (median: 70), rare in children unless immunocompromised
    • WNV Acute Flaccid Paralysis - most common in patients with meningoencephalitis, but can occur in isolation
  • Multiple Sclerosis - most common immune mediated inflammatory demyelinating disease of the CNS; common cause of disability among young adults
    • Most common in women age 20-50 of Northern European descent
    • Relapsing Remitting MS (RRMS) - most common form of multiple sclerosis (85% of patients)
    • MRI brain: Dawson’s Fingers
    • MRI spinal cord: Cervical Skip Lesions
    • CSF: oligoclonal bands
  • Plexopathy - most commonly caused by trauma
  • Neuronopathy - most commonly caused by ALS or polio
  • Distal symmetric polyneuropathy - most common neuropathic complication of diabetes mellitus
  • Peripheral neuropathy - most commonly caused by Diabetes Mellitus (DM)
  • Lead toxicity - most common heavy metal toxicity causing asymmetric finger and wrist drop, abdominal pain, constipation, and anemia
  • Spinal Muscular atrophy - most commonly autosomal recessive, found on chromosome 5
  • Stroke - leading cause of serious and long-term disability
    • Most common non-modifiable risk factor: age (60+)
    • Most common modifiable/treatable risk factor: hypertension
    • Most common type: ischemic stroke
  • Hemorrhagic Stroke (ICH)
    • Most commonly occur in basal ganglia
  • Most common cause of disability in aSAH (acute subarachnoid hemorrhage): delayed cerebral ischemia (DCI)

Other Helpful Hints
  • NeuroExam Tips - This is a great website!
  • How to Identify a Migraine
    • Is it POUNDing? This retrospective review revealed that 4/5 characteristics had a likelihood ratio of 24 compared to 3/5 with a likelihood of 3.5. (Detsky, ME et al. JAMA 2006; 296: 1274-1283.)
      • Pulsating
      • Ongoing (4-72 hours)
      • Unilateral
      • Nausea
      • Disabling
  • Movement Disorders
    • Chorea occurring in successive generations is most likely caused by Huntington’s Disease
    • Parkinson disease is most likely the cause of resting tremor in an older patient with rigidity and bradykinesia (slow movement)
    • Essential tremor (common inherited disorder) is most likely the cause of action tremor in a patient without rigidity or bradykinesia
  • The Flow of CSF: The order of CSF flow can be difficult to remember, so hope this mnemonic helps. "Lady Monro has 3 Aqueducts that go to 4 Luscious and Magical Arachnoid places."


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