Neuro Flashcards
Stroke treatment
CT noncon to ensure no bleeding. Then if <3-4.5 hrs of sx, tpa. Else catheter retrieval and asa +/- dipyridamole
Cerebral artery stroke key sx
- ACA - LE weakness, personality, UI
- MCA - UE weakness, CL homon Hemianopsia, eyes deviate toward lesion
- PCA - prosopagnosia
- Vertebrobasilar- CBL and bst stuff (vertigo, n/v, nystagmus, drop)
- pica - lateral medullary (ipsi face and cl body, Horner, vertigo)
- lacunar - striatum and capsule - PD like, hemiparesis, bulbar, ataxia
Cerebral vein thrombosis - sx, imaging, tx
Subacute ha
MRV
Lmwh then warfarin for months
Stroke/TIA fup
After thrombolysis (if in window and symptomatic) and anticoag, echo, ekg and holter if ekg nml for afib, carotid u/s and endarterectomy for sx + stenosis 70-99%
- esr, protein c and s, vdrl, ana etc if otherwise young and healthy
Status epilepticus management
Benzo—>fosphenytoin —> phenobarbital —> general
10-20 min bw steps to let tx work
Seizure initial work up
CMP, utox, head ct, ca and mg, neuro consult
Pregnancy safe AED
Lamotrigine and levetiracetam
Note OCPs and estrogen increase metab of lamotrigine
PD treatments
Initial: antichol (Benz, trihex) or amant of age>60
Severe: lev/carb, DA agonists (pramipex, ropin, caberg via patch, apomorphine) less effective but fewer AEs
Can add comt inhib (-capone), maoi (-giline), dbs, 5ht inhib antipsychotic (pimavanserin)
Essential tremor tx
Propan or other beta blocker, add primidone if persists after 1-2 wks, then switch to topiramate or gabapentin
Occurs at rest and with action
MS dx and tx
MRI!
Steroids for acute, then vit d, ca, dz modifying: anti-cd20 (ocrelizumab), beta interferon, glatiramer, mitoxantrone, natalizumab, fingolimod, dimethyl fumsrate, amant for fatigue, dalfampridine for walking, baclofen or tizan for spasticity
Work up of memory loss
Head ct, b12, thyroid, rpr/vdrl
Migraine tx
First, abortive with triptans or ergotamine
If status or contraindicated, give DA antag plus Benadryl to prevent dystonia
Ppx: beta blockers, alt = CCBs, tcas, ssris
Cluster headache sx and tx
Sx - unilateral pain, red and tearing eye, rhinorrhea
Tx - triptans or 100% O2 to abort, CCBs (eg verapamil) for ppx
Most common causes of encephalitis
HSV and VZV
Imaging to look for blood
CT without contrast
CSF - wbc dt infection or blood?
1:500 wbc to rbc is normal ratio. Increased ratio in infection
ALS tx
Riluzole to block accum of glutamate (disease of both umn and lmn)
Also edaravone (antioxidant)
RLS - common cause and tx
Iron deficiency
Tx: pramipexole or ropinirole (da agonists)
GBS vs MG bs LEMS
GBS - ascending weakness with loss of DTRs often after virus, worry about resp failure
MG - descending weakness, worsens with use (Ig against AchR), assoc with thymoma, tx acetylcholinesterase inhib - stigmine) or thymoma, acute crisis can also cause resp failure —> ivig and plasmapheresis as in gbs
LEMS - descending weakness improves with use (Ig against Ca channels), assoc with lung cancer
GBS vs MG vs LEMS
- GBS: asc weakness and loss of dtrs after virus
- mg: Ig against achr, tx with acetylcholinesterase inhib (stigmine) with antichol (glycopyrr) for AEs, sx worsen with use
- LEMS: Ig against ca channels, sx improve with use, great with -fampridines to increase ach
Acute crisis in mg and gbs - worry about diaph weakness and resp failure —> ivig or plasmapheresis, steroids in MG (not gbs)
ACS initial orders
EKG, trop, ckmb (both take 3-6 hours to rise, ckmb drops fast so good for reinfarction, myoglobin rises earlier), asa etc
Mechanism of botulism
Prevent presynaptic ach release
Dx of Mg
AchR ig first
If neg, musk
If neg, NCS or EMG
Tx - pyridostigmine, add steroids for escalation, everyone gets thymectomh even if no thymoma
Cushing’s triad
Bradycardia, htn, and low resp rate
Seen in increased icp
Epilepsy definition
At least two unprovoked seizures over 24 hours apart
Dx and Tx for jme
EEG bl poly spike and slow wave, tx valproic acid
Infantile spasms - what are they and how do we treat?
Epilepsy of infancy with bilateral spasms, delay, and hypsarrhythmia (disorganized eeg)
Tx corticoteopin and vigabatran
ASM side effects
Valproic acid - low plt, liver injury, teratogen
Phenytoin - gingival hyperplasia
Cmz and oxcarb - Siadh —>hypona
Mechanisms of pd meds
Carbidopa-levodopa da receptor stim
Mao b inhib prevent da breakdown
Amantadine increases da release
Comt inhib prevent breakdown of sinemet
Carpal tunnel syndrome management
First splint
If that doesn’t work, do emg and ncs to confirm dx, then operate
Tx for postherpetic neuralgia
Tca, gbp, pregab, then opioids or steroid injn if tx resistant
NSAIDs for herpetic neuralgia (<4mo since tx onset)
What respiratory metrics do you monitor in GBS?
Vital capacity and negative inspiratory force
Versus Peak expiratory flow rate in obstructive lung disease
Botulism mechanism
C botulinum toxin inhibits pre synaptic ach release at nmj
Sleep terror vs nightmare
Sleep terror during nrem so don’t remember
Vs rem sleep behavior disorder act out rem dreams
Parinaud syndrome
Tumor of pineal
Lose pupillary rxn, lose vertical gaze and optokinetic nystagmus, ataxia, headache
Pt can’t let go when shakes hand, think…
Myotonic dystrophy
AD CTG repeat expansion
Classic presents in adulthood with myotonia and weakness esp in face so look flat, ptosis (cognitive and behavioral issues in kids, hypotonia etc in babies)
Also GI, cardiac, hypo ventilation, insulin resistance, hypogonad, cataracts, sleepy
Tx supportive
MG treatment
Anticholinesterase meds for sx mgmt (eg pyridostigmine) plus immunosuppressant (eg prednisone, azathioprine), then try plasmapheresis, then ivig
