(2_3) Neurology in 1 week Flashcards
Neurology Overview Map
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Types of Dementia
Dementia (7)
1) Alzheimer’s disease
2) CJD
3) Frontotemporal dementia (Pick’s)
4) Huntington’s disease/Chorea
5) Lewy Body Dementia
6) Normal Pressure Hydrocephalus
7) Wernicke-Korsakoff syndrome
CCS: Dementia workup
Labs: BOUPI
CBC with diff
CMP
TFT: TSH/T4
B9 (Folic acid)/B12 (Cobalamin)
VDRL/RPR, HIV
Urine tox screen
Imaging:
CT/MRI brain
MMSE, neuro-psych testing
Donepezil, Olanzapine, Vit. E,
PSAF counseling
(ie Patient/Supportive care/Advance Directive/Family counseling)
CCS: Alcohol withdrawal management
1) thiamine then IV D5W NS
2) pyridoxine (B6)
3) folic acid
4) IV diazepam
5) follow K and Mg
6) naltrexone for maintenance therapy
7) addiction unit consult
8) social work consult
Thiamine IM, Lorazepam IV, Folic acid oral, multi-vitamin oral, Chlordiazepoxide oral, Haloperidol IV if agitated, replace phosphate, magnesium, Vit.K IV
Seizure and aspiration precaution, Thiamine, Dextrose, Lorazepam, Vit.K, Folic acid, replace Ph, Mg, and then Chlordiazepoxide, addiction unit consult, Rehabilitation, Anonymous
What are the late manifestations of Alzheimer’s?
Apathy and imprecise speech
What is the only abnormality seen on Alzheimer’s workup?
CT shows diffuse symmetrical atrophy
How do you treat Alzheimer’s?
Galantamine, rivastigmine, donepezil and memantine
What is the mechanism of action of memantine?
Blocks NMDA receptor
What are the main features of Pick’s disease?
Frontotemporal atrophy
Personality changes before dementia
Treatment same as Alzheimer’s
What is Lewy body dementia?
Parkinsonism plus dementia
What is CJD disease?
1) Prion is the cause
2) Rapid progressive dementia
3) Myoclonus
4) 14-3-3 protein in CSF
5) Abnormal EEG and no need for biopsy
What are the main features of normal pressure hydrocephalus?
WWW:
Wobbly /wide gait (ataxia)
wet ( urinary incontinence)
weird (dementia)
How do you diagnose normal pressure hydrocephalus?
CT and LP (normal pressure)
How do you treat normal pressure hydrocephalus?
Shunt
CCS: Headache
ESR
Temporal artery bx
Depression index
What percentage of migraine is bilateral?
40%
What is the indication of CT/MRI in headache?
>40, sudden severe and neurological deficit
What is the treatment for migraine?
1) Dark and quiet room
2) analgesics
3) Sumatriptan and ergotamine
What is the migraine prophylaxis?
If > 3 attacks in a month or severely disabling use beta blockers, calcium channel blockers, tricyclic antidepressants or SSRI
CCS: initial management migraine
IV NS
IV promethazine, prochlorperazine, metoclopramide
ASA, NSAIDs, acetaminophen
caffeine
IM sumatriptan
Phenergan IV, Sumatriptan IM, prophylactic therapy if >4/ months then give propranolol
CCS: long term management migraine
prophylaxis- B-blockers- propranolol, metoprolol,
antidepressants- SSRIs, TCAs (amy/nortryptyline)
anticonvulsants-valproic acid, gabapentin
calcium channel blockers-verapamil, nimodipine
CCS: Subarachnoid Hemorrhage
- ESR, CT( lumbar puncture if negative), ketorolac for pain, follow-up q1h, send to ICU
- PT/PTT, stool softener (docusate), Neurosurgery consult, Acetaminophen, nimodipine for ischemic stock, labetalol for hypertension, omeprazole, transcranial dler for predicting vasospasm, pneumatic compression stocking, Percoset, iv normal saline for hyponatremia
Orders Pulse oximetry, Blood pressure monitor, Cardiac monitor
Exam General, HEENT, Heart, Lungs, Extremities, Neuro
Orders Head CT without contrast, ECG 12-lead, Oxygen. If indicated:
Suction airway, Intubation endotracheal, Mechanical ventilation.
Clock Advance to results of head CT.
Orders Cerebral angiography, Labetalol, Morphine, CBC, BMP, PT/PTT,
Troponin, ABG, Chest X-ray, Foley catheter, Urine output
Clock Advance to results of cerebral angiography.
Orders Vital signs, Consult neurosurgery
Location Change to ICU.
Clock Advance to additional updates and case end.
End Orders None
Ketorolac IV, Percocet, Docusate, Nimodipine, neurosurgical consult,
Neurology Map
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What is the prophylactic treatment for cluster headache?
None
How do you treat cluster headache?
1) 100% 02
2) Steroids
3) Sumatriptan
Can cluster headache be bilateral?
Never
What are the main features of pseudotumor cerebri?
Female, headache
Double vision, papilledema, CN VI palsy
CT/MRI normal, LP shows high opening pressure
What is the treatment of pseudotumor cerebri?
1) Acetazolamide
Weight loss
Steroids
Stop Vit A if the cause
What is the one test that generally all patients with vertigo should have?
MRI of the auditory canal
CCS: AMS
Fingerstick glucose
ECG
ABG
CT head wo
UA
Urine Cx
Blood Cx
Ammonia
CBC
B12
Toxicology
AMS of unknown Etiology
- Fingerstick glucose
- IV Thiamine and Dextrose
- Naloxone (narcan)
- Urine tox
- Blood Alcohol
- NPO
- CXR to r/o Aspiration
Lab Tests to Consider for CCS cases
Lab Tests to Consider
*CBC, BMP, and UA is warranted for all patients
*BOUPI
1. Blood: Electrolytes, Vitamin levels, Infxns
CBC, BMP, TFT, LFT, Lipid Panel, PT/INR, PTT
Cultures (for fevers/infection); Type and Screen, Crossmatch
2. Other: EKG, PEFR, Pulse Ox
3. Urine: UA/UC, Urine Tox
4.Pregnancy: urine BHCG
5. Imaging
What are the causes of vertigo?
1) Benign positional vertigo
2) Vestibular neuronitis
3) Acoustic neuroma
4) Meniere’s disease (tinnitus, vertigo & hearing loss)
5) Perilymph fistula
B-VAMP
CCS Case Presentation
After noting chief complaint assess the following:
- Setting (Office, ED, Ward, ICU)
- Demographics: Age, Ethnicity, Gender
- Abnormal Vitals: Is patient stable or unstable?
- Change location as appropriate
- IVF/access for hypotension
- Pulse ox and Oxygen for dyspnea/tachypnea - DM?
- Allergies
- Social Hx: Drugs, ETOH, Tobacco
Types of Dizziness/Vertigo
Dizziness/Vertigo (6)
1) Acoustic neuroma
2) Benign positional vertigo
3) Labyrinthitis
4) Meniere’s disease
5) Perilymph fistula
6) Vestibular neuritis
Types of Headaches
Headache (5)
1) Cluster HA
2) Migraine
3) Pseudotumor Cerebri
4) Temporal arteritis
5) Tension HA
