Neuro Flashcards
ABCD2 score
Age, Blood pressure, Clinical presentation, Duration of symptoms, and the presence of Diabetes mellitus for TIA risk stratification Hospital admission is recommended for all patients with TIAs who have an ABCD2 score of 3 or greater to expedite diagnostic testing and stroke subtyping; admission is also recommended for patients with a score of 0 to 2 if rapid outpatient evaluation cannot be performed.
Symptomatic extracranial internal carotid artery stenosis is the most appropriate next diagnostic test in this patient with a TIA
Carotid ultrasonography most appropriate initial test Patients with greater than 70% extracranial internal carotid artery atherosclerotic stenosis have the highest risk of stroke in the 2 weeks after a TIA. Carotid Duplex ultrasonography is noninvasive and can effectively rule out significant atherosclerotic disease. If the ultrasound suggests greater than 50% stenosis, hospital admission and a confirmatory test with magnetic resonance or CT angiography is appropriate, with plans for early revascularization. Rapid cardiac testing with transthoracic echocardiography and cardiac rhythm evaluation also is advised within 24 hours for all patients with suspected TIA, as is vascular imaging of the extracranial carotid arteries.
mild cognitive impairment
a cognitive state between normal aging and dementia characterized by a decline in cognitive functioning that is greater than what is expected with normal aging but has not resulted in significant functional disability The course may be progressive; 10% to 15% of patients with MCI transition to dementia per year, compared with 1% to 2% per year of the general population. A score lower than 26/30 generally suggests cognitive impairment, especially in patients with 16 years of formal education
Dementia
In order to meet criteria for dementia, a patient’s cognitive deficits must interfere with daily functioning and result in some loss of independence
Standard of care in MS patients
Vitamin D supplementation as an adjunctive treatment in multiple sclerosis (MS) has been shown to be superior to disease-modifying therapy alone and has become a standard of care for patients with MS, especially those who are vitamin D deficient. Natalizumab is the most highly effective drug for MS currently available first drug developed in the class of selective adhesion molecule inhibitors. α4-integrin
Meningiomas
characteristic imaging features, including intense homogeneous contrast enhancement (“lightbulb sign”) and a dural tail. Patients with small, asymptomatic meningiomas without evidence of invasion of other intracranial structures and without surrounding edema are usually followed clinically and radiographically. Meningiomas should be monitored for growth, with a first follow-up scan performed 3 to 6 months after they are identified. Patients with symptomatic tumors, tumors that invade surrounding parenchyma, or tumors that grow over time may be considered for surgery and/or radiation therapy. If intervention is indicated, surgical intervention is usually the first-line therapy, followed by radiation for higher grade tumors or tumors that could not be resected completely. These treatments are not appropriate at this time in this patient who has none of these indications.
dementia with Lewy bodies
parkinsonism,fluctuating cognition, visual hallucinations, rapid eye movement sleep behavior disorder, and autonomic dysfunction, sixth decade of life or later.
MRIs of patients with migraine
White matter signal abnormalities are typically seen on MRIs of patients with migraine, particularly in the posterior circulation and particularly in women; these lesions are benign and unrelated to neurologic examination abnormalities or cognitive anomalies
Pharmacologic prophylaxis of migraine is indicated for headache frequency greater than 2 days per week (or 8 days per month) or use of acute medications, successfully or unsuccessfully, more than 2 days per week.
temporal lobe epilepsy
A rising epigastric sensation is the most common epileptic aura that originates in the temporal lobe; electroencephalographic and MRI findings are often normal.
Brief episodic anxiety with or without autonomic symptoms, such as dry mouth, also is characteristic of a temporal lobe seizure
