cards Flashcards
Features of neuroleptic malignant syndrome
Develops over days rather than hours
Fever
AMS
Muscle rigidity
Autonomic instability
Features of serotonin syndrome
Rapid development within 24 hours
Hyperreflexia
Clonus
Confirming dx of MS
Gadolinium enhanced MRI
Clin F of MS
Diplopia
Ataxia
Optic neuritis- blurry vision, reduced color detection, RAPD
Lhermitte phenomenon
Treatment of severe acute MS
IV methylprednisolone 1g for 3 days
If steroid refractory, plasma exchange
Long term management of MS
Disease modifying agents - 1. interferons, glatiramer acetate, monoclonal Abs, teriflunamide
Management of fatigue in MS
Amantadine
What is AIDS related psychosis
Psychotic symptoms in the context of advanced HIV infection
Ddx of psychosis in HIV patients
Delirium
Substance induced psychosis
Opportunistic CNS infections
Management of wearing off effect in Parksinsons
Changing to a MR formulaiton of levodopa/carbidopa
or
Addition of COMT inhibitor
or
Addition of dopamine agonist, selective MAO- B inhibitor
or
Use of portable intraduodenal pump
or
Increase frequency with/without reducing the dose
https://app.emedici.com/storage/media/9614a449-3636-4973-b7e1-9307d698be8e.jpg
Vascular dementia
- Small vessel disease with white matter hyperintensities
Clin F of normal pressure hydrocephalus
Urinary incontinence, gait instability, cognitive impairment
https://app.emedici.com/storage/media/ea637f3e-d109-4c0c-978a-703147ae19f4.jpg
Normal pressure hydrocephalus
- MRI showing ventriculomegaly out of proportion with underlying brain atrophy
Mng of normal pressure hydrocephalus
Large volume CSF removal via LP
Treatment with ventriculoperitoneal shunt
What type of gait does Parkinsons disease cause
Hypokinetic, festinating gait with en-bloc turning
What type of gait does normal pressure hydrocephalus cause
Broad based, shuffling, magnetic gait
What type of gait does muscular dystrophy cause
Waddling gait
What type of gait does UMN lesions cause
Spastic gait
What type of gait does proprioceptive loss cause
Wide based, high steppage gait
What type of gait does vestibular atiaxia cause
Ataxic gait with minimal movements of the head while waking
WHat type of gait does cerebellar ataxia cause
Other cerebellar signs seen, patient tend to fall toward side of lesion
https://app.emedici.com/storage/media/43b0e74d-6f20-405d-ac0d-5cc24a5990bd.jpg
Normal pressure hydrocephalus
- enlarged lateral ventricle and widened sylvian fissures out of proportion to cortical sulci
Diagnosis of normal pressure hydrocephalus
Ventricular enlargement with Evans’s index >0.3 (the ratio of maximum width of the frontal horns of the lateral ventricles and maximal internal diameter of skull at the same level on axial CT or MRI images)
Absence of macroscopic obstruction to CSF flow.
At least one of these supporting features:
Enlarged temporal horns of the lateral ventricles not entirely due to hippocampus atrophy;
Callosal angle of 40° or greater
Periventricular signal changes on CT and MRI due to altered brain water content and not entirely attributable to microvascular ischemic changes or demyelination;
Flow void in the Sylvian aqueduct or fourth ventricle on MRI.
