Neuro Flashcards
Generalized convulsive status epilepticus is generalized tonic clonic seizure lasting more than 5 min or two gtcs occurring within 5 minutes of each other without a return to baseline mental status
Psychogenic non epileptic spells often related to ptsd and conversion disorder which has
Asynchronous flailing of variable limbs
Side to side head shaking
Pelvic thrusting
Prolonged duration > 5min or even hours
Idiopathic intracranial hypertension has been associated with kidney failure, endocrine disorder, tetracycline, retinoic acid, progresterone or estrogen supplements
Treat idiopathic intracranial hypertension
Acetazolamide
Topiramate
Amitriptyline is the only agent that has been shown to be effective in the prevention of tension type headache
Onabotulinum toxin a use for
Chronic migraine
First line preventive treatment for episodic migraine < 15 days month and chronic migraine > 15 days month
Dexamethasone can be used in craniotomy case by case to reduce surgery related edema
In reversible cerebral vasoconstriction syndrome, a rare condition that can be triggered by medications, such as amphetamine or ssri, verapamil can reduce neurologic adverse events
Creutzfeldt jakob disease diagnosed by real time quaking induce conversion assay in the csf
14-3-3 protein and tau protein also increase but non sensitive and specificity
In alzheimer disease, decrease csf Abeta 42 and increase tau and phosphorylate tau level are highly specific
Inotersen and patisiran is approved for hereditary amyloid neuropathy
Anti muscle specific kinase antibody use for a variant of myasthenia gravis
Serum GQ1b antibody is specific for the miller fisher variant of guillain barre syndrome
Pompe disease test
Acid maltase activity in leukocyte and genetic testing for the alpha glucosidase gene
Treatment of fatigue is modafinil
Amyloid specific pet scan uses 18 F flurodeoxyglucose to detect amyloid plaques to differentiate frontal temporal dementia from alzheimer disease
Treat gait dysfunction in multiple sclerosis is dalfampridine
multiple sclerosis spasticity treat by tizanidine, baclofen, cyclobenzaprine and benzo
Treat attack of cluster headache
Subcu sumatriptan and 100% oxygen
Treat trigeminal neuralgia
Carbamazepine
Headache treat by indomethacine
Chronic paroxysmal hemicrania
Hemicrania continua
Primary cough headache
Thrombectomy in ischemic stroke should be within 6 hours
Anticoagulation should be held 24 hours after intravenous thrombolysis
Bo goal following thrombolytic therapy is
180/105
Treat bp on ischemic stroke ineligible for thrombolytic therapy when bp higher than
220/120
Muscle mounding after percussion is myoedema, happen in hypothyroid myopathy
Poly myalgia rheumatica will have increased esr and crp but normal ck
Fibromyalgia with normal esr crp and ck
Risk for rupture is low if arterial aneurysm less than 7mm in posterior circulation and less than 12 mm in anterior circulation
Base on Mini Mental State Examination
Score 20-23 mild dementia
Score 10-19 moderate dementia
Score less than 10 severe dementia
Mild to moderate treat with donepezil, rivastigmine, galantamine
Moderate to sever: add memantine as an adjunctive
Ocp will not increase stroke risk in migraine without aura
Treat behavioral variant frontotemporal dementia by ssri
Treat dementia with lewy bodies by
Rivastigmine
Treat rapid eye movement sleep behavior disorder in dementia with lewy bodies
Clonazepam
If treat dementia with lewy bodies by antipsychotic drug, behavioral problem will be more
Levetiracetam can worsen depression anxiety suicidal ideation
Zonisamide also cause psychiatric and behavioral side effect
Carbamazepine clobazam gabapentin lamotrigine oxcarbazepine phenytoin valproic acid can decrease the risk of psychiatric and behavioral side effect
Amantadine is an NMDA receptor antagonist used to treat levodopa induced dyskinesia
Deep brain stimulation is used for experienced moto fluctuations or have a refractory tremor
Treatment for end-of-dose weaning off phenomenon include
Increase levodopa
Add catechol O methyltransferase inhibitor like entacapone
Add dopamine agonist like ronipirole
Add monoamine oxidase type B inhibitor like selegiline
Differentiate MS and neuromyelitis optica
NMO bilateral optic neuritis, longitudinal extensive myelitis, csf mostly neutrophils
MS unilateral optic neuritis, segmental myelitis
Neuromyelitis optica test is aquaporin 4 antibody
The cerebella tonsillar descent in the presence of dural thickening and enhancement suggest intracranial hypotension
Ocrelizumab is a disease modifying therapy for long term management of MS
Pharmacologic prevention of episodic migraine
Level A
Propranolol timolol metoprolol
Valproate topiramate
Candesartan
Level B
Amitriptyline atenolol venlafaxine
Biologic therapy in migraine
Rimegepant episodic
Atogepant episodic and chronic
Erenumab
Frenamezumab
Eptinezumab
Galcanezumab
All these for episodic and chronic
Onabotulinum toxin a use for chronic migraine, not episodic
Verapamil can be used to prevent of episodic cluster headache
Antiepileptic medications in pregnancy
Lamotrigine can worsen myoclonic seizure in some patients
Levetiracetam
Oxcarbazepine
Gabapentin use to treat focal seizure, not generalized seizure
Topiramate can cause cleft lip and cleft palate in offspring
Valproic acid can cause weight gain, pcos, teratogenicity on women
Bo should be lower 185/100 before alteplase and lower 180/105 after ateplase
Lamotrigine gabapentin and levetiracetam are better use in older adult
Oxcarbazepine carbamazepine and eslicarbazepine can cause hyponatremia due to siadh
Treat essential tremor
Propanolol
Primidone
Topiramate
Second line
Clonazepam
Deep brain stimulation
Focused ultrasound thalamotomy
Topiramate is contraindicated in kidney stone
Aspirin should be held for 24 hours after thrombolysis to reduce intracerebral hemorrhage
Patient with asymptomatic carotid artery stenosis less than 80% have a low annual risk for stroke.
Just intervene if stenosis more than 70%
In intracranial hemorrhage and sbp more than 150, acute lowering of sbp to 140 mmHg is safe and effective
Iv nitroprusside can increase intracranial pressure
Diagnose vascular dementia base on lack of hippocampal atrophy and presence of confluent white matter hyperintensities on MRI
In MS, Uhthoff phenomenon in which chronic neurologic symptoms become more prominent in the setting of fever
Tics can be suppressible
