Day 8 Flashcards by Patrick Robbins

IIH Demographics (4)

Young, obese, black women

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IIH RFs (5)

Hypervitaminosis A
High-dose steroids
Tetracyclines
OCPs
Head Trauma

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IIH Presentation (2)

Waxing/waning HA

Intermittent visual obscurations

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IIH Neuro/PE (2)

Papilledema on fundoscopic exam

Incr blind spot on VF

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IIH Brain Imaging

Generally normal, can be slit-like ventricles

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IIH Diagnosis

LP w/ OP > 20mmHg

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2 Pharmacologic and 2 Procedural Txs for IIH

Pharma (1st):
Acetazolamide or prednisone
Procedural:
Shunting or optic nerve fenestration (if ventricles too small)

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NAMI Make-Up

Family members of mentally ill

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Migraine w/o Aura Criteria (1/4/2)

At least 5 HAs lasting 4-72 hours that have 2 of following characteristics:
Unilateral location
Pulsating quality
Moderate/severe intensity
Aggravated by stairs/routine physical activity
Also one of following sx occurs during HA:
Phono/photophobia
N +/- v

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Migraine w/ Aura Criteria (4/4)

At least 2 attacks w/ at least 3 of following:
1+ fully reversible aura sx involving focal cortical or brainstem fxn
1+ aura sx develops gradually over 4 min, or 2+ occur in succession
No aura sx lasts for > 60 min
HA follows aura w/ free interval of at least 60 min (or can start simultaneously w/ aura)
OR: 1+ of following aura features:
Homonymous visual disturbance
Unilateral paresthesia/numbness
Unilateral weakness
Aphasia/unclassifiable speech difficulty

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TPA Timeframe

Gen w/in 3 hours, but w/in 4.5hrs for some pts

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TPA Contraindications (4)

Major surgery w/in past 14 days
BP > 185/110
Bleeding parameters: PT > 15 or INR > 1.7
CT w/ signs of ICH

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RLS Tx (category + 4 non-category meds)

DA Agonists, like ropinirole 1st line

Also helpful: BZDs, opioids, gabapentin, levodopa-carbidopa

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RLS Cause (1 + 3 associations)

Usually idiopathic

Has been associated w/ polyneuropathy, Fe deficiency, and uremia

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Suvorexant Mech

Orexin antagonist

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Wallenberg’s Syndrome Location + 5 Sx

Lateral Medulla
Ispsi: Horner’s, Loss of Pain/Temp in Face, Cerebellar Ataxia, and Weakness of Vocal/Pharynx/Palate
Contra: Loss of Pain/Temp to rest of body

CSF Level Associated w/ Aggression

Decr 5-5HIAA

Metachromatic Leukodystrophy (MLD) Inheritance, Deficiency, and Result

Autosomal recessive deficiency in arylsulfatase A, leading to incr sulfatides in neurons and progressive demyelination

MLD Juvenile vs. Adult Onset

Juvenile: Gait d/o w/ hypotonia and LE areflexia
Adult: Progressive dementia and behavioral problems

MLD Neuropathologic Findings (2)

Segmental nerve demyelination and metachromatic inclusions w/in Schwann cells and macrophages

MLD Diagnostic Test

MRI + urine sulfatide + abnormal ASA enzyme in leukocytes

Nerve bx is diagnostic, tho

MLD Tx

Bone marrow transplantation may increase ASA levels in brain enough to slow/stop progression

Tay-Sachs Ds (what it is, inheritance pattern, chromosome, deficiency)

Infantile form of AR gangliosidosis

Hexosaminidase A deficiency, coded by Ch 15

Tay-Sachs Sx/Progression/PE

Infantile retardation, paralysis, dementia, blindness, hyperreactivity/startle to loud noise, death in 1st or 2nd year
“Cherry red” spot on fundoscopic examination

Krabbe's Ds Other Name

Globoid cell leukodystrophy

Krabbe's Ds Inheritance Pattern/Deficiency/Result

AR deficiency in galactocerebrosidase Beta-galactosidase | Multinucleated macrophages in CNS white matter associated w/ extensive central and peripheral demyelination

Krabbe's Ds Presentation

Rapid infantile deterioration in motor/intellectual, hypertonicity, optic atrophy, opisthotonic, and seizures

Krabbe's Ds Tx

Stem cell transplant can return some missing enzyme

Moro Reflex

Startle reflex: in response to loud sound, baby extends head/extremities, cries, and then withdraws them

Parachute Reflex (+ notable feature)

Baby extends its arms outward symmetrically in response to rapid lowering of head, breaking the fall Persists past 6 mo

Tonic Head Reflex (+ timeframe)

When head turned to one side, ipsi arm extends and contra arm bends up, fencing position Like between 3-6 mo

Grasp and Rooting Reflex in Adulthood

Frontal release signs, extensive white matter damage

SAD in DSM 5

Added qualifier to affective disorders, "with seasonal presentation"

SAD Remission

Has to show complete remission at certain times of the year

Pseudocyesis DSM Category

Other Specified Somatic Sx and Related Disorders

Most Common Cause of AIDS-Associated Retinopathy

CMV

JC Virus

PML in AIDS

IM Phenytoin

Erratic absorption, so not good choice for status