MTB3- Neurology Flashcards
Fqirst step when you’re suspeciouse of TIA?
Head non-contrast CT Scan to R/o hemorrhagic stroke
appraoch to TIA or stroke?
- First step is to take a non contrast head CT to R/o hemorrhagic stroke. If it’s less than 3 hours start theombolytics , if it’s more than 3 hours then start ASA. If the patient is already on ASA switch to Clopidogrel or add Dipyridamole.
Statins for all the patients with non-hemorrhagic stroke.
Contraindications to thrombolytic therapy?
- mass or tumor - cerebral trauma or brain
- Hx of hemorrhagic strokes Surgery within 6 months
- Active bleeding or surgery within 6 weeks - Aortic dissection
- bleeding disorder - CPR within 3 weeks
- stroke within 1 year
Ophtalmic A. Leision?
- Amaurosis Fugas
Tx of cluster headache?
Prophylaxis of cluster headache?
Triptanes + o2
Verapamil
Charactristics of Pseudotumor cerebri?
- pupilledema with NL CT n MRI, headache, double vision ( sixth nerve palsy) , pulsutile tinitus
- Weight loss
- Acetazolamide
- surgery, if it’s not possible then shunt or optic nerve sheath fenestration
How is the management of stroke after non- contrast CT and ASA or thrombolytics?
- find the origine of the stroke:
- echo to fanid vegetations or clot
- ECG holter monitoring( if ECG is NL then Warfarin & dabigartan , Rivaroxaban for atrial fibrilation )
- carotid dopler/ sono=> if there is more than 70 but less than 100 occulosion then end- Artherectomy
- Always consider HTN, DM, Hyperlipidemia
- if the patient is young then: ESR/ AnA / DS DNA/ protein c and s and factor v leiden and anti phospholipid syn. & VDRL/ RPR
Lacunar stroke charactristics?
- absence of cortical deficits - possible bulbar signs
- Ataxia
- Parkinsonian signs
- Sensory deficit
- Hemiparesis
Pos. Inf. cerebral A leision:
- Ipsilateral face
- contralateral body
- vertigo n horner
Pos. Cerebral A. Leision?
Prosopagnosia( inability to recognise faces)
Vertebrobasilar A leision?
1- Vertigo 6- Ataxia
2-Nausea n vomitting 7- bilateral findings
3- drop attack loss of conciousness 8- vertical nystagmus
4- dysarthria n dystonia
5- sensory changes in face and scalp
Ant cerebral A leision?
- profound lower extremity weakness
- mild upper extremity weakness
- urinary incontinence
- Personality change
Middle cerebral A leision?
- upper extremities weakness
- Aphasia
- Apraxia/ Neglect
- eyes deviate toward the leision
- contralateral homonymous Hemianopia
Treatmentof MILD Parkinson’s disease under 60 and over 60?
Under 60 => Benzotropine/Hydroxyzine
Over 60=> Amantadine
1st and 2nd line for long term management of Parkinson?
1st line=> 1- valproic acid 2- Carbamazepine3- Phenytoin4- Levetiracetam 5- maybe Lamotrigine
2nd line=> Gabapantin / Phenobarbital
What med to substitute for Levodopa when there is psychosis with levopdopa?
Quetiapine
When parkinson meds are not effective which med to use?
COMPT inh. Tolcapone/ Entecapone
Mao inh. Selgiline/ Rasagiline
Treatment of severe parkinsonism ?
1- Levodopa carbidopa
2- RPG=> Ropirinole/ pramopaxole/ carbergoline
What is the best initial test to DX MS?
What is the most accurate test to DX MS?
Tx of MS?
- MRI
- MRI/ if not diagnostic then lumbar tap and oligoclonal bands
- steroids/ b- interferone/ glatiramer/ mitoxantrone/ natalizumab/ fingolimod/ dalfapiridine
Diagnostic test for NPH ?
Head CT
What tests need to be done in a patient with memory loss?
- B12 level
- thyroid function tests
- head CT
- VDRL or RPR
Side effect of Natalizumab?
PML
What is Lewy body dementia?
Parkinson+ dementia
CJD management?
- abnormal EEG
- LP shows 14-3-3 pr
- Brian Biopsy
Is there dementia in Pick disease?
Management of Huntington?
Yes
Antipsychotics/ tetrabenzain for movement disorders
What are the causes of Vertigo?
- BPPV : changes with position
- Vestibular Neuritis : vertigo occurs without position changes
- Labyrinthitis : Acute+ hearing loss
- Menieres disease: Chronic+ hearing loss
- Acoustic Neuroma: Ataxia+ hearing loss - perilymph fistula: hx of trauma + hearing loss
Tx of BBPV?
Tx of Vestibular neuritis?
Tx of Labyrinthitis?
- Meclizine ( Antivert )
- Meclizine
- Steroids
DDX for vertigo solo!?
- BPPV ( Hallpike n Apply)
- Vestibular Neuritis ( Meclizine )
DDX for Vertigo + tinitus+ hearing loss?
Labyrintitis ( meclizine ) Menieres disease ( salt restriction n Diuretics)
Dx for Vertigo+ hearing loss+ tinitus + Ataxia?!
Acoustic Neuroma
Thousands of neurofils in csf?
Meningitis - start IV ceftriaxone/ Steroids/ Vancomycine
When cryptoccocus is the answer?
Hiv patient CD
Charactristics of rocky mountain spotted fever?
Tx for Rocky Mountain spotted fever?
Rash started from wrists and ankles.
Doxycycline
Tx for lyme disease?
IV ceftriaxone or Penicillin
Best initial test for encephalitis?
Most accurate test for encephalitis?
- Brain CT
- LP ( PCR of CSF)
Next step in genoccocal meningitis?
- Respiratory isolation and start prophylaxis with Rifampin, Cipro, ceftriaxone in people in close contact
How is the management of PML?
Because it’s basically is in HIV positive patients , there is no specific TX other than raise CD4
DX of Neurocysticercosis?
Tx for Neurocysticercosis?
Patient comes from Mexico with Seizure.
When the lesions are still active and there is no calcificationd Albendazole. When there are calcified and then only antiepileptics.
How is the management of large intracranial hemorrhage?
- hyperventilation by intubaion and decreasing Pco2 to 28-32 to have the brain vessles to be constricted
- Manitol
- Surgery
Mechanismof cycosporine and Azathioprine?
Idecrease the function of T lymphocytes
Best diagnostic test for myasthenia gravis?
Management of Myastenia gravis?
- Anti Acetyl cholin RS Antibody, if it’s not charactristic then using Edrofonium and Tensilon test
- Pyridostigmine and Neostigmine —- noresponse? ——> Steroids
Need long term steroids? ———-> Azathioprine and Cyclophosphamide
Tx of Diabetic Neuropathy?
Gabapantin/ pregabalin
TIA & Stroke?
- TIA takes less than 24 hours / stroke is more than 24 hours
- TIA invloves the face and causes Aphasia
- Stroke is more than 24 hours and has more seriouse consequences
Tx for spinal epidural abcess?
Most of the time it’s staph and tx is Oxacillin or Naficillin.
Urgent step in cord compression management?
Steroids to decrease the pressure
Tx for proneal N palsy?
No Tx
Tx for Radial N Palsy?
Splint+ anti inflammatory meds
Tx for facial N palsy?
Steroids
Other locations involved in facial N palsy other than face?
- 2/3 ANT tongue
- ears( Hyperacusis )
What is reflex sypathetic Dystrophy?
Excruciating burning pain by light touch of the prevoiuse injured organ.
NSAIDS/ Gabapantin/ Surgical Sypathectomy
