neuro infections, normal neuro, stroke, degenerative neuro Flashcards
What is the ddx for priapism?
- Neurologic injury: cauda equina, spinal cord injury
- Medication side effect- trazadone, prazosin
- Perineal/genital trauma leading to laceration of the cavernous artery
- sickle cell or leukemia
What is spinal artery syndrome?
affects the anterior cord- corticospinal tract, spinothalamic tract, ventral horn, lateral grey matter. dorsal columns are spared. pts have bilateral loss of pain and temperature, bilateral spastic paresis below the level of the lesion, bilateral flaccid paresis at the level of the lesion
What is the prophylactic treatment for close contacts of patients with bacterial meningitis?
rifampin or ciprofloxacin for Neisseria infection. rifampin for for H. influenzae infection in kids without prior vaccination
What kinds of viruses cause meningitis?
enterovirus, echovirus, HSV, lymphocytic choriomenigitis virus, mumps virus.
How is TB meningitis treated?
isoniazid, ethambutol, pyrazinamide, rifampin
How can you differentiate btw TB meningitis and bacterial meningitis based on LP findings?
typically, bacterial meningitis shows incr. WBCs with a preponderance of PMNs, while TB meningitis has incr. WBCs with a lymphocytic prepronderance. both have elevated opening pressures and protein levels, and decreased glucose
What viruses most often cause viral encephalitis?
VZV, HSV, mumps, polio, rhabdovirus, coxsachie virus arbovirus, flavivirus (japanese encephalitis, West Nile), measles
or, immunologic response to viral infection
What are characteristic sx of West Nile encephalitis?
flaccid paralysis with maculopapular rash
What are key s/sx of rabies infection?
malaise, HA, restlessness, fear of water ingestion, CNS excitability, painful laryngeal spasms, alternating mania and stupor. On pathologic exam, there will be rabies virus and negri bodies (round eosinophilic inclusions found in neurons)
What is the tx of TIA? Include info about when to do carotid endarterectomy or angioplasty
- If d/t atherosclerosis, give ASA and statin
- Carotid endarterctomy or angioplasty for carotid narrowing >60% in asymptomatic men, >50% in symptomatic men, and >70% in symptomatic women
- BB, valvuloplasty, valve replacement for AS
- anticoagulation for arrhtymias
When do you anticoagulate after ischemic stroke? When can antiplatelet meds be restarted after hemorrhagic stroke?
- anticoagulate within 48 hrs of ischemic stroke; may give LMWH if suspected evolving stroke
- antiplatelet drugs may be started 2 wks after hemorrhagic stroke if pt is stable
What systemic conditions are associated with berry aneurysms?
adult polycystic kidney disease and Marfan syndrome
What drug can induce a syndrome that is similar to parkinson’s disease?
1-methyl1-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), a side product of illicit opioid production
What enzyme is inhibited by carbidopa?
dopamine decarboxylase
What is benztropine? What symptoms of parkinson disease are helped by benztropine?
anticholinergic used as adjuvant tx for Parkinson disease. helpful for tremor and rigidity but not bradykinesia
What symptoms of parkinson disease are helped by amantadine?
rigidity and bradykinesia. this drug also used against infulenza A and rubella. toxicity can cause ataxia
What are the DA receptor agonists?
bromocriptine (ergot), pramipexole, ropinirole (both non-ergot). Non-ergots are preferred
What is the medical treatment for ALS? What is required for clinical dx of ALS?
riluzole. dx requires LMN signs in at least 2 extremities and UMN signs in one region. sensation usually not involved.
Where is the gene for Huntington’s disease located and how many repeats are needed for the disease to manifest?
found on chromosome 4; if 40 or more CAG repeats, disease is inevitable
What are tx options for MS?
steroids, methotrexate in acute exacerbation; interferon beta, glatiramer acetate (copaxone), natalizumab to decrease frequency of exacerbations.
What is the mechanism of memantine?
NMDA receptor antagonist to prevent excitotoxicity
What are contraindications and MOA of triptans for HA?
5-HT1b/1d agonist. however, may induce vasoconstriction, so is contraindicated in pts with CAD or Prinzmetal angina
