(3_3) Neurology in 1 week Flashcards
What are the main features of pseudotumor cerebri?
Female, double vision, headache, papilledema, CN VI palsy, CT/MRI normal, LP shows high opening pressure
Neurology Overview Map
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What is the one test that generally all patients with vertigo should have?
MRI of the auditory canal
What are the causes of vertigo?
Meniere’s disease (tinnitus, vertigo & hearing loss), benign positional vertigo, acoustic neuroma, perilymph fistula and vestibular neuronitis
What is the treatment for BPV or vestibular neuronitis or labyrinthitis?
Meclizine
What is the treatment for Meniere’s disease?
Salt restriction and diuretics
How do you differentiate Meniere’s disease and labyrinthitis?
Meniere’s is chronic and labyrinthitis is acute but both have tinnitus, hearing loss and vertigo
What are the main features of acoustic neuroma?
Tinnitus, hearing loss, vertigo and ataxia
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
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What are the main features of Wernicke encephalopathy and Korsakoff psychosis?
Chronic alcohol use, confusion, confabulation, ataxia, nystagmus, gaze palsy and memory loss
How do you treat Wernicke Korsakoff - psychosis?
B1 before glucose (if glucose is given first B1 may be used for glucose metabolism)
Which test is usually done before LP in CNS infection?
CT
Neurology Map
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What are the indications of CT before LP?
Papilledema, seizure, altered level of consciousness, focal neurological deficit, history of CNS diseases and significant delay in lumbar puncture performance
Types of CNS infections
CNS Infections (11)
1) Brain abscess (PML, Neurocysticercosis, PRES)
2) Encephalitis
3) Infection
1-Cryptococcus
2-Listeria
3-Lyme disease
4-Rocky Mtn Spotted fever
Meningitis
5-Amoebic
6-Bacterial
7-Neisseria
8-TB meningitis
9-Viral meningitis
What do you do in CNS infection before doing CT and LP?
Do culture and start antibiotics
What is the best initial test for meningitis?
CSF cell count; if thousand neutrophils then start ceftriaxone + vancomycin + steroids
What are the main features of CSF analysis?
G stain ( 60% positive), glucose ( must be <60% of blood level), protein (if normal bacterial meningitis is ruled out and cell count
CSF Analysis
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What bacteria are seen on G stain of CSF?
Pneumococcus, Neisseria, Hemophilus and Listeria
What are the main features of Cryptococcus meningitis?
CD4 < 100 India ink is the best initial test Cryptococcus Ag testing is the most accurate test
How do you treat Cryptococcus meningitis?
Amphotericin followed by life time fluconazole unless CD4 is raised
What are the main features of Rocky Mountain spotted fever?
Rash on wrist and ankle, fever before rash, serology and treatment is doxycycline
What is the treatment for TB meningitis?
RIPES: RIPE ( rifampin, INH, pyrazinamide and ethambutol) and steroids; RIPE is continued for a year
What is the Listeria meningitis coverage?
Ampicillin is added to ceftriaxone and vancomycin
What is the Listeria meningitis prophylaxis?
Rifampin or ciprofloxacin is given to close contact (kissing or sharing utensils)
What are the main features of encephalitis?
Fever + confusion develops very fast; almost always herpes simplex virus is the cause
How do you diagnose encephalitis?
CT is the best initial test to rule out other causes; LP & PCR of CSF, no need for brain biopsy
What is the treatment of encephalitis?
Acyclovir and if resistant use foscarnet
Neurology Map
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What is the management of fever +headache + focal neurological deficit?
Contrast CT; if positive it is either tumor or abscess
What is the next step in brain abscess?
If HIV negative do biopsy; if HIV positive treat for 2 weeks with pyrimethamine and sulfadiazine if resolves nor further tests needed
What is the treatment of neurocysticercosis?
Albendazole + steroids
What is the treatment of head trauma?
Concussion: observe Contusion: mostly none Epidural and subdural hematoma: surgery if large Increased ICP: hyperventilate, mannitol and intubation to keep CO2<25-30; steroids
Ulcer prophylaxis in head trauma is needed
What are the main features of subarachnoid hemorrhage?
“Meningismus, loss of consciousness and absent of fever
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What do you do if CT is positive in SAH?
No need for LP; if negative do LP
What result of LP is considered positive for infection?
If WBC/RBC is > 1/500 it is considered infection
What is the treatment of SAH?
Nimodipine, angiography, surgery (clip or embolization), shunt
What is the prognosis of rebleed in SAH if we don’t do surgery?
50% die
Types of Spine disorders
Spine disorders (7)
1) Anterior Spinal artery infarction
2) Brown-Sequard Syn
3) Cord compression
4) Epidural abscess
5) Lumbosacral strain
6) Spinal stenosis
7) Syringomyelia
What are the clinical features of syringomyelia?
Hand and shoulder loss of spinothalamic tract bilaterally; diagnose with MRI
What are the causes of syringomyelia?
Trauma, tumor and congenital
What is the treatment of syringomyelia?
Surgery
What is the most urgent treatment of cord compression?
Steroids and maybe surgery
What are the causes of cord compression?
Bone: fracture, dislocation, spondylosis and abnormal growth
blood (hematoma)
tumor (usually metastasis)
disc herniation
Neurology Map
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What is the treatment of spinal cord abscess?
Oxacillin, nafcillin and maybe surgery
What are the signs of anterior spinal artery occlusion?
Loss of pain and temperature (intact vibration and sense of position)
What is Brown-Sequard syndrome?
Lateral knife trauma can cause loss of ipsilateral position and vibration + contralateral spinothalamic
What is the treatment of amyotrophic lateral sclerosis?
Riluzole blocks accumulation of glutamate
What is Saturday night palsy?
Wrist drop due to radial nerve palsy
What kind of nerve damage is seen with high boots?
Peroneal nerve palsy
What is the treatment of Bell’s palsy?
Acyclovir and steroids (maybe doxycycline)
How do you treat reflex sympathetic dystrophy?
Gabapentin, NSAIDS, surgical block and sympathectomy
Types of Peripheral neuropathies
“Peripheral neuropathies (9)
1) 7th Cranial nerve (Bell’s palsy)
2) Carpal tunnel syndrome
3) Diabetes
4) Guillain Barre Syndrome
5) Myasthenia Gravis
6) Peroneal nerve palsy
7) Radial nerve palsy
8) Reflex sympathetic dystrophy
9) Restless legs syndrome (RLS)
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How do you treat restless leg syndrome?
Pramipaxole or ropinerole
What is the treatment of Guillain-Barre syndrome?
Peak inspiratory pressure, IVIG or plasmapheresis
How do you diagnose myasthenia gravis?
Clinical diagnosis and acetylcholine receptor Ab
What is the treatment of myasthenia gravis?
Pyridostigmine, neostigmine, thymectomy, prednisone, AC
What is the treatment of myasthenia gravis in order?
First neostigmine and if it doesn’t work thymectomy and if it doesn’t work steroids and if it doesn’t stop it switch to azathioprine and cyclophosphamide
Neurology Map
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