Clin Med: Neuro III Flashcards
How is epilepsy defined?
2 or more unprovoked seizures more than 24 hrs apart
Non pharm tx for epilepsy
avoidance of triggers
- sleep deprivation
- caffeine
- fever
- alcohol
1st line drug for focal seizures
- Carbamazepine/Oxcarbazepine
- Lamotrigine
- Phenytoin
1st line drugs for absence seizures
Ethosuximide
1st line drug for tonic-clonic seizures
- Lamictal
- Levetiracetam
Define status epilepticus
seizure that last >5mins or multiple seizures in a row w/ incomplete recovery in b/t
1st line tx for status epilepticus
IV diazepam (or lorazepam)
2nd line tx for status epilepticus
fosphenytoin or phenytoin
3rd line tx for status epilepticus
barbiturates
4th line/refractory tx for status epilepticus
propofol
Bact
When is a PE sign seen with a specific bacterial meningitis?
Meningococcal meningitis
- rash
CT prior to lumbar puncture if:
- immunocompromised
- hx of CNS dz (such as stroke, mass lesion, focal infx)
- papilledema
- focal neurologic deficit
- new onset seizure ≤ 1 wk prior to presentation
- abnormal level of consciousness
What is a normal ICP?
20 mmHg
CSF analysis: Bacterial
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Opening pressure:
Appearance:
Protein:
Glucose:
Gram stain:
Glucose CSF ratio:
WBC:
Empiric Tx given in bacterial meningitis to decr risk of hearing loss & mortality
Dexamethasone
What else should be managed w/ bacterial meningitis?
- fluid & electrolytes
- (+/-) ICP monitoring
Who should receive the meningococcal vaccine?
- 11 & 12 yo
- booster at 16 yo
Which adults should receive the meningococcal vaccine?
- no spleen
- HIV
- microbiologist
- travel to place where it is common
- population at incr risk
- close courters (college military)
Prophylaxis Tx for Meningococcal meningitis
- Ciprofloxacin (adults only)
- Rifampin (all ages)