Neuro Flashcards
Acute Stroke Tx and Work-Up
- CT head w/o contrast (r/o bleed)
- Ultimately, ECHO, EKG/ telemetry, Holter monitor if no abnormalities while inpatient, carotid duplex US
TX
- If < 3 hrs do tPA
- If > 3 hrs Aspirin
- Can do clot retrieval with catheter up to 8-12 hrs after
STATIN (goal LDL < 70)
What do you do if someone has a stroke while on ASA?
Add dipyridamole OR switch to clopidogrel
When can tPA be used up to 4.5 hrs after presentation?
If pt < 80 yo
If NIH stroke scale < 24
No DM, no previous stroke
Indications for PFO Closure
R to L shunt confirmed w/ bubble study
AND pt < 60
AND stroke appears to be embolic
**Still give them anti-platelet medications
Indications for Carotid Endarterectomy
> 70% stenosis + symptomatic
DEFINITELY DO NOT OPERATE IF < 50% STENOSIS
Tx of Pseudotumor Cerebri
Weight loss
acetazolamide to dec CSF production
VP shunt
Optic nerve fenestration (last resort)
Best Cluster Headache PPX
Verapamil
Tx of Status Epilepticus
1 - benzo (lorazepam or diazepam)
2- fosphenytoin»_space; fenytoin
3 - phenobarbital
4 - general anesthesia (neuromuscular block and propofol with intubation)
When would you start an AED after first seizure?
Family history
Abnormal EEG
CT lesion
Present in status
Focal neuro findings
1 side effect of carbamazepine
SIADH (hyponatremia)
Normal WBC to RBC ratio in CSF
1 WBC for every 500-1000 RBCs
Tx of SAH
Nimodipine (prevent vasospasm)
Phenytoin to prevent seizure
Embolization w/ coil»_space;> surgical clipping
May need VP shunt if hydrocephalus
Tx of Brain Abscess
PCN + metro + ceftriaxone
Use vancomycin instead of PCN if recent neurosurgery
Which 3 migraine drugs worsen Parkinson’s
ANTI-DOPAMINE
Prochlorperazine
Metoclopramide
Chlorpromazine
Shy-Drager Syndrome
parkinsonism + orthostasis
Tx of Restless Leg Syndrome
pramipexole (dopamine agonist)
IRON (if low)
Sequence of Parkinson’s Treatment
1 - anti- cholinergic (benztropine, trihexylphenidyl)
2 - dopamin agonists (pramipexole and ropinirole)
3 - Carbidopa - levodopa (on/off phenomena)
4 - adjuncts (COMT inhibitors like tolcapone or MAO inhibitors like selegiline)
5 - deep brain stimulation
Side effect of natalizumab in MS
Progressive multifocal leukencephalopathy
Presents as worsening neuro deficits and new white matter hypodense lesions
Best 2 drugs for prevention of MS relapse
Beta interferon
glatiramer
ALS Tx + Mechanism
Riluzole (reduces glutamate buildup in neurons)
Charcot-Marie-Tooth
Distal weakness and sensory loss
Wasting in legs
Hyporeflexia
Tremor
High foot arches
Abnormal EMG
NO TREATMENT!
What antibody is associated w/ Miller-Fisher Syndrome?
GQ1b antibody
What is the best initial imaging in myasthenia?
Chest imaging to look for thymoma
What drug is coupled with neostigmine/pyridostigmine in MG?
Glycopyrrolate (anticholinergic to block extra Ach at muscarinic receptors)
