Neuro Flashcards
Etiologies of IIH
associated with use of tetracyclines, retinoic acid, and progesterone or estrogen supplements
discontinuation of any potential offending agent is the first step in management
Preventative treatment for tension headaches
Amitriptyline is the only agent shown to be effective in controlled trials; venlafaxine and mirtazapine have more limited data
Treatment to prevent vasospasm in SAH
Nimodipine should be started as early as possible once the patient is stabilized to improve neurologic outcomes.
Best Test for Creutzfeldt-Jakob disease
real-time quaking-induced conversion assay (most sensitive and specific test for prion proteins in the cerebrospinal fluid)
Pain with eye movement, unilateral visual deficit, and an afferent pupillary defect in the left eye.
Optic Neuritis
How do you treat orthostatic hypotension in pts with Parkinson’s?
This is often a peripheral side effect of levodopa, and can be treated with higher carbidopa doses.
Droxidopa and fludrocortisone can be used for symptomatic management of neurogenic orthostatic hypotension and would be the appropriate next options.
myopathy with muscle mounding after percussion
hypothyroidism
clinical presentation of proximal symmetric weakness, myalgia, and cramps without sensory loss or upper motor neuron signs is consistent with a myopathy, myoedema = hypothyroidism
Management of an unruptured aneurysm
Risk for rupture at 5 years is low for unruptured intracranial arterial aneurysms less than 7 mm in the posterior circulation and less than 12 mm in the anterior circulation.
Annual noninvasive imaging is recommended in patients with an unruptured aneurysm.
Treatment for a seizure patient who gets a rash with an AED
Gabapentin
Lamotrigine, phenobarbital, phenytoin, and carbamazepine are all known to cause rash which may be severe and life-threatening so these drugs should be avoided in patients with prior drug rash (owing to cross-reactivity), unless no other good medication options are available.
Treatment of Frontotemporal Dementia
Selective serotonin reuptake inhibitors have shown effectiveness in treating some of the symptoms of frontotemporal dementia, especially compulsive behaviors.
Rivastigmine
Rivastigmine and donepezil (acetylcholinesterase inhibitors) can improve cognition, global function, and activities of daily living in dementia
Neuromyelitis Optica
immune-mediated demyelination and axonal damage primarily affecting the spinal cord and optic nerves; similar to MS but bilateral (not unilateral) optic neuritis and longitudinally extensive (rather than segmental) myelitis
aquaporin-4 antibody is a specific biomarker for NMO and has a direct role in the pathogenesis
How to treat intracranial hypotension
Epidural blood patch (blind if no known etiology)
Treatment of Tardive Dyskinesia
First step in management should be removal of the offending drug. If dyskinesia persists, treatment with a vesicular monoamine transporter 2 inhibitor, such as valbenazine, deutetrabenazine, or tetrabenazine, can be helpful.
Seizure treatment in a patient with childbearing potential
Because she is planning a pregnancy, lamotrigine and levetiracetam are the preferred treatment options and are considered among the safest seizure medications from a teratogenicity standpoint and for general, long-term safety. However, lamotrigine has been reported to worsen myoclonic seizures in some patients.
