Neuro Flashcards
Normal pressure hydrocephalus
Wacky, wet and wobbly
Mental impairment
Urinary incontinence
Gait disturbance
Caused by abnormal accumulation of CSF In ventricular system
ICP always normal, absence of papilledema on ophthalmoscopy
Dx: CSF removal with documentation of gait before and after procedure
Tx for essential tremor
Primidone (first choice in older pts) and propranolol (first choice in younger pts)
Major neuropathologic findings in Parkinson dz
Lewy bodies
Loss of dopaminergic neurons in substantia nigra
Symptoms of Parkinson dz
TRAP Tremor Rigidity Akinesia Postural instability
Best diagnostic test for Parkinson
Positron emission tomography (PET) and single photon emission CT (SPECT)
Uses dye to measure dopamine neurons in substantia nigra
Distinguishing feature between encephalitis and meningitis
Cerebral function is altered in encephalitis
MS treatment
Immunomodulatory therapy
IV steroids for symptom mgmt
Others: IV immunoglobulins, emergent plasmapheresis
Myasthenia gravis
Most common presenting symptom is ptosis
Caused by antibodies binding to ACh receptors and blocking NMJ
Often a/w thymus hyperplasia
First line tx for acute cluster headaches
100% O2 6-12L per minute for 15min via face mask
Progressive multifocal leukoencephalopathy
Rare fatal brain infection caused by JC virus
A/w natalizumab (monoclonal antibody used for treating MS, CD)
Dx: Brain biopsy is gold standard, MRI, JC virus detection in CSF PCR
MS diagnosis
CSF for elevated IgG, oligoclonal bands
MRI for “Dawson’s fingers” and enhancing plauqes
Tx for absence seizures
Ethosuximide
AKA Valproic acid
Most common cause of chronic cerebellar ataxia
Alcoholism
GBS CSF exam
Albuminocytologic dissociation
Guillain Barre Syndrome most commonly caused by
Cytomegalovirus HSV EBV Viral hepatitis Campylobacter jejuni --> severe GBS
Parkinson’s risk factors
\+ve fam hx Head injury Male Rural living Exposure to pesticides Drinking well water
Parkinson’s protective factors
Coffee
Smoking
NSAID use
E replacement in postmenopausal women
Surgical options of parkinson’s treatment
Deep brain stimulation of globus pallidus
Thalamotomy
Parkinson’s pharmaco treatment
Levodopa-carbidopa (Converts to DA) preferred for pt > 65
MAO-B inhibitiors (selegiline, rasagiline) - mild
Amantadine - mild
Dopamine agonist usually preferred for pt =65 (pramipexole)
Anticholinergics usually only used if pt =65 with tremor but no significant bradycardia or gait disturbance (benztropine)
Symptomatic carotid artery stenosis tx
Urgent endarterectomy
Med regimen post-TIA
DAPT (ASA + Clopidogrel)
Statin
Treat HTN,DM
Time limit for tPA for stroke tx
4.5h after onset
Time limit for thrombectomy
6h after onset
Epilepsy syndromes that often start with febrile sz
Dravet syndrome (severe myoclonic epilepsy) Febrile sz tend to be more severe, frequent and come in clusters
Status epilepticus
Prolonged repetitive seizure activity that lasts >5-10min without spontaneous cessation or recurrent sz without full return to consciousness between seizures
Anti-epileptic most dangerous in pregnancy
Valproic acid
Folic acid dose for epilepsy pts in pregnancy
At least 1mg (possibly up to 4mg)
Anti-epileptic drug monitoring during pregnancy
At start of pregnancy
q4wks
6wk post partum
Immediately if pt reports or presents with sz or medication toxicity
GBS treatment
IVIG or plasmapheresis +/- pain mgmt
Myasthenia gravis treatment
Acetylcholinesterase inhibitors (ie. pyridostigmine)
If no response, steroids
Immunosuppression can be used as steroid-sparing therapy
