Neuro 2 Flashcards
Acute Rx for cluster HA?
Oxygen and Subq Sumatriptan.
Pt in ICU develops Intermittent Twitching of Shoulder and Eyelids. Dx? Next step to confirm diagnosis?
24 hour EEG
Weakness, loss of balance, orthostatic syncope, 2 year hx of burning paresthesia in lower extremities, dry mouth, glaucoma, dry eyes. Hx of ED, constipation, Carpal tunnel. Father had sensory neuropathy, uncle and paternal uncle had restrictive cardiomyopathy. Dx?
Familial Amyloidosis.
-Progressive sensory, motor and autonomic neuropathy that’s genetic
They have Transthyretin gene mutation.
After Rx with Plasma exchanged for GBS what is the next step in management?
Discharge to rehabilitation (80% resume ambulation in 6 months)
Indications for Lamotrigine as Anti-Seizure ppx (4)?
- Old
- Osteoporosis
- Pregnant
- Psychiatric Disease
Medication for Non-Hypotensive patients with Subarachnoid Hemorrhage that is associated with Improved Neurological Outcomes?
Nimodipine
Transient Localized Sharp HA pain isolated to Parietal region/or any region that occur Spontaneously in the Absence of organic disease and last seconds.
Primary Stabbing Headache
Combination of Parkinsonism, Cerebellar ataxia, Dysautonomia, Orthostatic hypotension, Early Postural Instability, Falls, Anosmia, Acting out dreams during sleep. Dx?
Multiple System Atrophy
Most appropriate test to determine candidacy for Endovascular therapy (embolectomy) in patients with Cardioembolic Stroke who have undergone thrombolysis (low recanalization rates)?
CT angiography
Rx for brain herniation Secondary to Tumor?
IV dexamethasone
- Elevate had of bed
- hyperventilation,
- mannitol/hypertonic saline.
4 drug types that lower seizure threshold?
1, Carbapenems (Meropenem)
2. Levofloaxicin (Fluoroquinolones)
3. Cefepime (4th generation cephalosporins)
4. Wellbutrin
Pts with cardioembolic stroke (hypodensity seen on CT) and < 60% stenosis in ICAs beyond the treatment for thrombolysis that are normotensive which antiplatelet regime should they receive?
Aspirin (to reduce the risk of secondary stroke)
After initial neurological screening (cognition and balance) s/p TBI from concussion what is next step?
Neuropsychological testing
Dx and Rx for a patient who developed Statin Myopathy but still has persistent symptoms with weakness and elevated CK levels?
Immune-Mediated Necrotizing myopathy Antibodies to HMG COA reductase
Prednisone
HA pain with Rising from Bed and Improves with Lying Down, HA global, steady, severe, b/l tinnitus, Horizontal diplopia, R abducens nerve palsy, MRI showing diffuse Nonnodular Patchy Meningeal enhancement, cerebellar tonsillar descent of 3 mm and clinically insignificant b/l subdural fluid collections. Rx
Intracranial hypotension due to CSF leak. Epidural blood patch to repair CSF leak
Pt present with b/l LE weakness and numbness, Hyperintense lesion at T4 level which test should be done to evaluate for MS?
Brain MRI. Most common cause of new onset transverse myelitis is MS
When can prophylactic heparin be given after hemorrahagic stroke ?
48 hrs after a hemorrhagic stroke to prevent development of DVT
Best medication to use in dementia patients wit Sick Sinus, LBBB, Uncontrolled asthma, Ulcer disease or Angle-closure glaucoma. Dx?
Memantine
New HA after age 50 yrs, use of AC, progressive HA patterns, abrupt-onset, thunderclap, HA associated with neurologic symptoms last > 1 hr are all indications for what test?
Brain MRI
What routine test is required for patients with MS on Fingolimod?
Opthalamic examinations
Dementia but Language predominate domain affected for many ears, left brain involvement only?
Primary Progressive Aphasia (language variant fronto-temporal dementia)
Persistent Choreiform involuntary movements involving Face, Lips and Hands despite stopping reglan 6 months ago. Dx?
Tardive dyskinesia
8 hr of facial paralysis, notes droopiness on R side of face , difference in taste and vision, difficulty closing eye and elevating eye brow on R side all other neurologic examination unremarkable. Next step?
Oral prednisone and sometimes give Acyclovir
Bells palsy
Severe piercing facial pain lasting several seconds, occur intermittently or by washing, chewing and applying facial cosmetics. Dx? Rx?
Trigeminal neuralgia
Carbamazepine
What test would help identify Alzheimer’s disease as the reason for cognitive impairment in individual?
CSF to look for decreased AB42 peptide and increased tau protein levels.
S/p hypoxic brain injury pt presents with rapid jerky movements that impairs ambulation Dx?
Post-hypoxic myoclonus
What test should a person get with MCI and Daytime Sleepiness?
Sleep Study
Focal seizure with alteration of awareness preceded by aura, before losing consciousness, pt are unaware that they have become impaired and may have no recollection of the seizure. Dx? What is found on MRI ?
Temporal Lobe Epilepsy
Medial Temporal Sclerosis finding on MRI
Aby combination of tonic-clonic seizures, absence seizures and myoclonic seizures. MRI is normal and EEG may show generalized spike-wave abnormality?
Idiopathic (genetic) generalized epilepsy
Continuous seizure > 5 minutes, most common cause is low AED level. Complications are aspiration, pneumonia, fever, hemodynamic instability. Dx?
Convulsive Status Epilepticus
- Indication to start AED therapy?
- When is surgery indicated
- When can you stop therapy
- After 2 unprovoked seizures or After 1 high risk unprovoked seizure caused by focal findings on MRI or EEG, or if there are significant risk factors for epilepsy (head trauma, brain tumor resection)
- Refractory epilepsy, usually have removal sclerotic lesions of temporal lobe
- After 2-5 years
Name that Peripheral Neuropathy:
What lab test she be ordered first (5)?
- Multiple, noncontiguous nerve deficits (mononeuritis multiplex) ?
- Distal symmetric (stocking-glove) sensory and sensorimotor neuropathy
- Severe unilateral leg pain, numbness, proximal weakness, atrophy and weight-loss?
- Acute, Ascending, areflexic paralysis and paresthesia preceded by Campylobacter infection? Rx?
- Progressive proximal motor and sensory neuropathy that evolves over months (Chronic) EMG and CSF similar to GBS? Rx?
- Symmetric distal sensory neuropathy in the setting of MGUS, MM, Amyloidosis , Cryoglobulinemia
A1C, BMP, B12, TSH, Vit D, Syphilis, HIV
- Consider Vasculitis (Lyme, Amyloid, Sarcoid)
- DM and Alcohol
- DM lumbar-sacral radiculoplexus neuropathy (diabetic amyotrophy)
- GBS, plasma exchange only no steroid
- Chronic inflammatory demyelinating, plasma exchange and steroid
- Paraproteinemic neuropathy
Name that myopathy:
- Recurrent episodes of myelitis without brain lesions typical of MS. + NMO-IgG autoantibody
- Subacute onset weakness, sensory changes in bowel/bladder dysfunction, after viral infection
- Paresthesia and Anemia
- Paresthesia Mimics B12 deficiency , can happen after bariatric surgery
- Flaccid paralysis, weakness, pinprick sensation loss after emboli, hypotension, surgery
- Neuromyeltiis optica
- Idiopathic Transverse myelitis
- B12 deficiency
- Copper deficiency
- Infarction to spinal cord
Side Effects: Name the Drug
1. Gingival Hypertrophy
2. Hyponatremia
3. Weight loss, kidney stones
4. Irritability/Agitation
5. Weight gain, hair thinning, thrombocytopenia
6. Rash ( Stevens Johnson Syndrome)
7. Diplopia, Vertigo, Emsesis
- Phenytoin
- Carbamazepine
- Topiramate
- Levetiracetam
- Valproic acid
- Lamotrigene
- Locasamide
What is the BP parameters to RX for Ischemic Stoke?
What is the BP parameter for tpA ?
- > 220/120 mm Hg
- > 185/110 mm Hg
