neuro cards Flashcards
pharmacological management of bells palsy
-If onset <72h, Prednisone (60 to 80 mg/day) x 1 week
-If severe, consider addition of Valacyclovir 1g TID x 1 week
For persistent symptoms, consider imaging and ENT referral
if a patient has a TIA, what is the tool use to predict stroke?
ABCD2
does bells palsy spare the forehead?
no (frontalis effected, suggesting peripheral cause)
sparing of the forehead muscles with facial paralysis suggests a ____ cause
central
how should a patient manage the eye symptoms of bells palsy?
-artifical tears during the day, ointment at night
-protective goggles/glasses
a patient who has incomplete recovery of bells palsy at __ months should have be considered for brain imaging (CT, MRI, neuro referral)
3 months
how quickly does bells palsy develop?
hours to a couple days (if longer, another diagnosis should be considered)
what is the common virus that causes bells palsy?
HSV
what is the virus that causes ramsay hunt syndrome?
varicella zoster
do adults or adolescents have a risk for slower recovery from concussion?
adolescents
What are the ADLs and IADLS? DEATH SHAFT
ADLS: Dressing, eating, ambulating, toileting, hygeine, bath/shower
IADLS: shopping, housework, accounting/finances, food prep, transporation, taking medications
what are the core features of lewy body dementia?
-fluctuating cognition, detailed visual hallucinations, REM sleep behaviour disorder, parkinsonism
how to differentiate between parkinsons with dementia, and lewy body dementia?
Parkinsons has the symptoms for at least one year before onset of dementia, whereas LBD gets dementia and parkinsonism within the same year
in which patients should acetylcholine esterase inhibitors be AVOIDED?
Patients with LBBB, 2nd/3rd degree block, sick sinus, HR<50
triad seen in normal pressure hydrocephalus?
-ataxia
-dementia
-urinary incontinence
adverse effects of acetylcholine esterate inhibitors?
-GI (nausea, diarrhea, vomiting)
-bradycardia, hypotension, dizziness, syncope
-insomnia, sleep disturbance
-QT prolongation and torsades de pointes
pharm management of frontotemporal dementia
SSRI, trazadone
in which type of dementia should antipsychotics be AVOIDED
lewy body dementia - due to risk of NMS
TIA vs stroke
Stroke symptoms last > 24 hrs
within what timeframe from symptom onset should tpa be administered?
<4.5 hours
What is the medication used for stroke thrombolysis?
alteplase
Name 6 contraindications to TPA
History of intracranial hemorhage
Head trauma or other stroke within 3 months
Uncontrolled hypertension >185/110
Known AV malformation, neoplasm or aneurysm
Active internal bleeding
Bleeding disorder (platelets <100, DOAC, INR > 1.7)
what MUST you rule out before giving TPA for stroke?
hemorhagic stroke
what is the name of the scale for stroke severity?
NIHSS
first line medication for parkinsons?
levodopa/carbidopa
SE of levodopa-carbidopa?
-impulse control disorders
-dyskinesia
-somnolense
-orthostatic hypotension/dizziness
-nausea/dyspepsia
-psychotic symptoms and hallucinations
what type of drug is pramipexole?
dopamine agonist
what type of drug is amantadine?
NMDA-receptor antagonist
what type of drug is MAOI?
selegiline
should amantadine be used for treatment of patients wtih early PD?
no - insufficient evidence
is deep brain stimulation effective for motor fluctuations and dyskinesia of parkinsons disease?
yes
