1. Valproic acid: Depakote 2. Phenytoin: Dilantin

1. Prednisone 2. Artificial Tears

1. Beta Blocker, CCB 2. TCA's 3. Anticonvulsants: Topiramate, Valproate

Neuro Flashcards by Morgan LaRoque

Identify the seizure described below:

Consciousness fully maintained
Focal
+/- transient neuro deficit

Simple partial

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Identify the seizure described below:

Consciousness impaired
Aura: Sec-min
Automatisms: lip smacking, manual picking, patting, coordinated motor movements

Complex Partial Seizure

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Identify the seizure described below:

Brief lapse of consciousness: brief staring, eyelid twitching
No post-ictal phase
EEG: B/L symmetric 3hz spike & wave

Absence (Petit mal)

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Based on this EEG, identify the seizure

-Generalize high amplitude rapid spiking

Tonic-Clonic (Grand mal)

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Identify the seizure described below:

Sudden, brief sporadic involuntary twitching. No LOC

Myoclonus

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Identify the seizure described below:

Sudden loss of postural tone= “drop attacks”

Atonic

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Absence (petit mal) treatment

Ethosuximide

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Grand mal treatment

Valproic acid: Depakote

2. Phenytoin: Dilantin

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Myoclonus treatment

Valproic acid: Depakote

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Define Status Epilepticus

Repeated, generalized sz’s w/o reovery= >30 min

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Status Epileptiucs treatment

Benzos: Lorazepam or Diazepam

2. Thiamine + Ampule of D50

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What nerve does Bell’s Palsy effect?

CN VII (7)

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What is Bells Palsy highly associated with?

Herpes Simplex reactivation

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Bellsy Palsy Tx

Prednisone

2. Artificial Tears

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Identify the HA described below:

B/L: Tight, band/vise-like
Worse with stress, fatigue
NO N/V or focal neuro sx’s

Tension HA

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Tension HA treatment

1st line= NSAIDs, ASA, Acetaminophen

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1st line Tx in mild migraine HA

NSAIDs/Acetaminophen

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Symptomatic/Abortive in migraine HA

Triptans or Ergotamines: Serotonin 5HT-1 Agonist

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Triptans or Ergotamines (Serotonin 5HT-1 Agonist) MOA. CI?

Vasoconstriction

CI: CAD or PVD, uncontrolled HTN

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Migraine prophylaxis

Beta Blocker, CCB
TCA’s
Anticonvulsants: Topiramate, Valproate

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Identify the HA described below:

Severe/sharp/lancinating, unilateral periorbital/temporal pain
Ptosis, Miosis, Anhydrosis
Nasal congestion/Rhinorrhea, conjunctivitis, lacrimation

Cluster HA

Cluster HA 1st line treatment

100% O2

Cluster HA prophylaxis tx

Verapamil

MC pathogen in bacterial meningitis in <1 mo

Group B Strep (Strep agalactiae)

Abx treatmen in bacterial meningitis <1 mo

Ampicillin + Cefotaxime

MC pathogen in bacterial meningitis in 1 mos-18 yo

N. Meningitidis

Abx treatmen in bacterial meningitis 1 mos-50 y.o.

Ceftriaxone + Vancomycin

MC pathogen in bacterial meningitis in 18 y.o.->50

S. pneumo

Define TIA

Transient episode of neuro deficits caused by focal brain, SC, or retinal ischemia WITHOUT infarction Lasts <24 hrs (most 30-60 min)

Correctly identify the TIA described below: Temporary monocular vision loss= Amaurosis Fugax Weakness in contralateral hand

Internal Carotid Artery

Correctly identify the TIA described below: Gait & proprioception disturbances Dizziness, vertigo

Brainstem/Cerebellar sx's

TIA treatment

ASA +/- Clopidogrel

What is the MC type of stroke?

Ischemic stroke

List the causes of ischemic stroke

1. Thrombosis 2. Emboli 3. Cerebrovascular occlusion

What part of the brain is the MC site of an ischemic stroke? what artery is MCly involved?

Anterior circulation | Middle cerebral artery=MC

Middle cerebral artery stroke sx's

Face/Arm weakness>leg/foot | Gaze preference toward left side

Correctly identify the type of ischemic stroke described: Purely motor sx's: Hemiparesis, hemiplegia Ataxia, legs>arms Dysarthria

Lacunar infarct

Correctly identify the type of ischemic stroke described: Visual hallucinations Vertigo N/V Nystagmus, Diplopia

Posterior infarct: Posterior cerebral artery, basilar artery, Vertebral artery

initial diagnostic TOC in a stroke

Noncontrast CT to r/o hemorrhage

CI to tPA therapy in ischemic strokes

1. BP > 185/110 2. Recent bleed/trauma 3. Bleeding disorder

When should anti platelet therapy be given in an ischemic stroke?

ASA (or clopidogrel) given after 3 hrs if no thrombolytic tx OR @ least 24 hrs after thrombolytic tx

When is the only time you want to decrease the BP in an ischemic stroke?

1. BP >185/110 for thrombolytic tx | 2. >220/120

What is the MCC of a Hemorrhagic stroke? 2nd?

HTN=MC | AVM=2nd

Hemorrhagic stroke sx's

1. LOC 2. N/V* 3. HA 4. Hemiplegia/hemiparalysis *Gradually increases in intensity

Hemorrhagic stroke treatment

1. Supportive: Head elevation, +/- Mannitol, decrease BP | 2. Hematoma evacuation if increased ICP

Why is an LP CI in a hemorrhagic stroke?

Can cause brain herniation

if the CT scan is negative in a suspected Subarachnoid hemorrhage, what would be the next step? Findings?

LP: Xanthochromia (RBCs)

What is considered Gold Standard Diagnostic TOC in a subarachnoid hemorrhage?

Angiography

Subarachnoid hemorrhage treatment

1. Decrease BP gradually: Nicardipine, Nimodipine | 2. Aneurysm clipping or coiling

Hepatic Encephalopathy si/sx's

1. Vomiting 2. AMS, Coma 3. Seizure 4. Asterixis: Flapping tremor of hand w/ wrist extension 5. Cerebral edema

Pathophysiologyof hepatic encephalopathy?

Increased ammonia levels d/t failure of liver to excrete ammonia and covert ammonia to urea Ammonia=Neurotoxic

Hepatic Encephalopathy treatment

1. Lactulose: converted into lactic acid by bacteria=neutralizes ammonia 2. Abx: Neomycin, Rifaminin=decrease bacteria producing ammonia in GI tract 3. Protein restriction