Neuro Flashcards
What is the typical dosing for gabapentin? starting and effective
starting - 300mg at night
effective dosing 1200-1800mg, as part of a TID regimen
If CrCl < 50, then need to reduce dose by 25%, then 50%, then 75% as crcl gets worse (900/600/300 daily total dose)
Best treatment for DM neuropathy
duloxetine (esp if comorbid depression)
pregabalin
gabapentin
What are the parts of the GCS?
eyes opening (4); verbal (5): motor (6)
What are the eye opening scores of the GCS?
4: Spontaneously
3: To verbal command
2: To pain
1: No response
What are the verbal scores of the GCS?
6: Obeys command
5: Localizes pain
4: Flexion withdrawal
3: Flexion abnormal (decorticate)
2: Extension (decerebrate)
1: No response
What are the motor scores of the GCS?
5: Oriented and converses
4: Disoriented and converses
3: Inappropriate words; cries
2: Incomprehensible sounds
1: No response
What the Canadian head CT rules for head trauma?
MILD TBI and any ONE of the following:
High risk for NS intervention:
- GCS <15 two hours after injury
- Suspected open or depressed skull fracture
- Any sign of basilar skull fracture: hemotympanum, raccoon eyes (intraorbital bruising), Battle sign (retroauricular bruising), or cerebrospinal fluid leak, oto- or rhinorrhea
•Two or more episodes of vomiting
•Sixty-five years of age or older
- Neurologic deficit
- Seizure
- Presence of bleeding diathesis or oral anticoagulant use
Medium risk:
•Amnesia for events occurring more than 30 minutes prior to impact
•Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from ≥3 feet or ≥5 stairs)
- Return visit for reassessment of a head injury
What is the Canadian cervical spine rules for CT imaging?
Assess for any reason to get cervical C spine
If NO obvious reason, check for atleast one criteria to test ROM; if unstable get c-spine imaging
The CCR involves the following steps:
●Condition one: Perform imaging in patients with any of the following: Age 65 years or older; Dangerous mechanism of injury:Fall from 1 m (3 feet) or five stairs, Axial load to the head (such as diving accident), Motor vehicle crash at high speed (>100 km/hour [>62 mph]). Motorized recreational vehicle accident. Ejection from a vehicle. Bicycle collision with an immovable object, such as tree or parked car; Paresthesias in the extremities
●Condition two: In patients with none of the high-risk characteristics listed in condition one above, assess for any low-risk factor that allows for safe assessment of neck motion. The low-risk factors are as follows:
•Simple rear-end motor vehicle accident; excludes: pushed into oncoming traffic, hit by bus or large truck, rollover, hit by high-speed (>100 km/hour [>62 mph]) vehicle; Sitting position in emergency department; Ambulatory at any time; Delayed onset of neck pain; Absence of midline cervical spine tenderness
Any patient who does not meet at least one of the low-risk conditions listed here must be assessed with imaging. Such patients are NOT suitable for testing of neck motion.
If a patient meets any of the low-risk conditions, perform range-of-motion testing as described in condition three.
●Condition three: Test active range of motion. Perform imaging in patients who are not able to rotate their neck actively 45 degrees both left and right. Patients able to rotate their neck, regardless of pain, do not require imaging.
Whats the newest definition of TIA
a brief episode of neurological dysfunction caused by focal brain or retinal ischeimia, with symptoms lasting less than ONE hour and without evidence of acute infarction
What is the typical treatment after a stroke or TIA?
DAPT for 21 days, then aspirin monotherapy afterwards
Also Statin!
What diagnostic work-up should happen after a TIA/Stroke, esp in absence of carotid disease?
Holter monitor / heart monitoring for 21 days
What is the ABCD2 scale for TIA? What is 48-hr stroke risk if ABCD2 > 6?
Age - > 60 years 1 point
BP > 140/90 on first eval 1 point
Clinical symptoms of focal weakness with the spell (2 points) or speech impairment with out weakness (1 point)
Duration 60 minutes (2 points) OR 10 to 59 minutes (1 point)
Diabetes (1 point)
If person scores 6-7, then 8% stroke within 48 hours.
what is preferred neuroimaging within 24 hours?
MRI within 24 hours including MRA to get cervicocephalic vessels; also ECG/Echo with bubble/Holter for 30 days if possible
Causes of stroke - name a few
1) cardiac source - Afib, dilated CM
2) atherosclerotic - large vessel, small vessel
3) prothrombotic disorders
what is utliity of non-con head CT in acute stroke eval?
can be rapidly done
can help to r/o hemorrhage to guide catheter directed treatment
