Exam 4; Neurology Flashcards
CNS neoplasms are often diagnosed via
MRI
Tx of Glioblastoma
1) RADIATION
2) Surgical decompression
Epilepsy is best dx by
medical history
Tx of juvenile myoclonic epilepsy
Anticonvulsants
Tx of adult onset seizure
Anticonvulsants is first line
MC early manifestation of alcohol withdrawal syndrome is
a tremor
medical emergency in which a pt is having continuous seizures that do not permit the pt to regain consciousness between them
Status Epilepticus
Tx of Status Epilepticus
- Diazepam 5-10mg IV q5-10mins until seizure stops OR until 20mg IV have been given
IF pt is still seizing 2) give loading dose of phenytoin 15-20mg/kg dose x 1; may give another 10mg/kg after 20 mins
IF STILL SEIZING: 3) MUST Intubate and give phenobarbital
Wernicke’s encephalopathy TRIAD is
- Ocular disorders
- Ataxic gait
- Mental status changes
Tx of Wenicke’s encephalopathy
Thiamine 250mg-500mg IV TID x 3 days
Then 250mg IM or IV QD x 5 days
Tx of Korsakoff’s pyschosis
Thiamine 250mg-500mg IV TID x 3 days
Then 250mg IM or IV QD x 5 days
Tx of Polyneuropathy
Daily B vitamins
Asterixis is a sign of
Hepatic Encephalopathy
Tx of vasovagal rx
Reverse trendelenburg position
what are the four major neurological symptoms of Parkinson’s disease
(TRAP)
- T = Tremor (resting)
- R = Rigidity (cogwheel)
- A = Akinesia (bradykinesia)
- P = Postural instability
repetitive purposeless movements such as tongue rolling, lip smacking, or the tongue protruding from lips are all signs of
Tardive dyskinesia
Tx of restless leg syndrome
Dopamine agonists (Pramipexol or Ropinirole)
and Iron replacement
Tx of benign essential tremor
Beta blocker: Propranolol 120 mg day divided BID or TID
Benign essential tremor is most common in
The hands
Tx of tardive dyskinesia
- Stop the offending medication
- Tetrabenazine (depletes dopamine/serotonin)
Tardive dyskinesia is MC caused by
MC a side effect of neuroleptic agents - Antipsychotic meds!
First line Tx of Parkinson’s disease
Selective MAO-B inhibitors (first line bc they have very little side effects)
Best drug to Tx Parkinson’s but is not first line due to many side effects is
Levodopa
Choreiform movements, psychiatric problems (personality changes/aggression/depression), and dementia suggests
Huntington’s disease
Dx of Huntington’s disease is
Confirmed via genetic testing IT15 gene
Tx of Huntington’s disease if 1) it is interfering with function and 2) THERE IS depression, agitation, or psychosis present …
2nd gen antipsychotics
Tx of Huntington’s disease if 1) it is interfering with function and 2) WITHOUT the presence of depression, agitation, or psychosis …
VMAT inhibitor
Painless and progressive weakness makes you think of what condition?
Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrig’s disease
What neurological functions are SPARED in ALS?
- Mentation (Mental status)
- EOMs
- Sensation
- Bowel/bladder function
ALS tx
Slow progression = Riluzole
Another med in trials currently = Edararone
How is Bell’s palsy differentiated from Herpes zoster optics OR stroke?
Bell’s palsy - CANNOT close eye or wrinkle forehead
Herpes zoster oticus - Ear pain and herpetic rash on the external ear
Stroke - CENTRAL facial weakness and SPARES the forehead and eye closure
Excessive daytime sleepiness
Hypersomnia
Inability to fall or remain asleep (Worsening quality NOT volume of sleep)
Insomnia
Insomnia is dx by
Sleep studies and an interview
First line tx for insomnia is
Cognitive behavioral therapy
Undesirable behavior patterns associated with sleep (sleep walking/night terrors/ or bed wetting)
Parasomnias
Collapse of the upper airway that results in low O2 levels leading to frequent awakenings and poor sleep is
Obstructive sleep apnea
Dx of Obstructive sleep apnea
Polysomnography
Tx of Obstructive sleep apnea
CPAP machine or surgery
SUDDEN onset of REM sleep at any time and could have triggers such as laughing, crying, or anger
Narcolepsy
Dx of narcolepsy is
- Polysomnography to R/O other causes
- Multiple sleep latency test: MSLT testing
UMN lesions especially in the LOWER EXTREMITES (spastic paresis, hyper flexion, clonus, and + babinski) is a hallmark of what condition?
Multiple sclerosis (MS)
Dx of multiple sclerosis
- MRI = White matter plaques*
- CSF findings = Oligoclonal bands*
Type of MS: episodes of acute worsening with recovery and a stable course between relapses
Relapsing-remitting
Type of MS: Gradual, nearly continuous neurological deterioration from the onset of Sx
Primary-Progressive
Type of MS: Gradual neurologic deterioration. With or without superimposed acute relapses in pt who previously had relapsing-remitting MS
Secondary-progressive
Type of MS: Gradual neurologic deterioration from onset of sx, but with subsequent superimposed relapses
Progressive-relapsing
To definitively dx MS one must have:
- Evidence of 2 inflammatory demyelinating lesions referable to different locations in the CNS occurring at DIFFERENT times (usually >1 mo)
Weakness due to MS can be tx with
Potassium channel blockers
