Neuro part 1 Flashcards
Altered LOC/coma mnemonic for causes
Alcohol or AAA
Epilepsy, electrolytes, hepatic encephalopathy, endocrine problems
Insulin, intussusception, or inborn errors of metabolism
Opiates or overdose
Uremia
Trauma, temperature, toxemia, (brain) tumor
Infections
Psychogenic, pulmonary embolism, poisoning
Space-occupying lesions, stroke, shock, seizure, shunt
Pathophys of coma
Bilateral cortical disease
Suppression of reticular activating system via:
-Supratentorial pressure
-Infratentorial pressure
-Intrinsic brainstem lesion
-Torque on brainstem from sudden head blow
CNS causes of paresthesia
CVA TIA Brain tumor Head trauma Brain abscess Encephalitis SLE Vit B12 deficiency MS
Metabolic causes of paresthesia
DM Hypothyroidism EtOH abuse Uremia Amyloidosis Porphyria
Entrapment neuropathy causes of paresthesia
Carpal tunnel Ulnar entrapment (cubital tunnel) Thoracic outlet syndrome Lateral femoral cutaneous syndrome Peroneal palsy Tarsal tunnel
Inflammatory causes of paresthesia
Local trauma
Acute idiopathic polyneuritis
Chronic relapsing polyneuropathy
Connective tissue causes of paresthesia
Polyarteritis nodosa Sjogrens syndrome Systemic sclerosis Autoimmune vasculitis RA
Toxin causes of paresthesia
Chemo Heavy metal toxicity Industrial toxin exposure HIV meds Chronic pyridoxine overdosage
Hereditary causes of paresthesia
Charcot-Marie-tooth
Denny-Brown’s syndrome
Familial amyloidotic poyneuropathy
Malignant causes of paresthesia
Tumor compression Paraneoplastic syndrome Lymphoma CA Plasma cell dyscrasias
Infectious causes of paresthesia
HIV
Lyme disease
Leprosy
Miscellaneous causes of paresthesia
Sarcoidosis
Malnutrition
Panic attack
D/os that can cause seizures
Genetic syndromes Chromosomal deletion or duplication syndromes Metabolic d/os Mitochondrial diseases Single-gene mutations
Workup for seizure sx/epilepsy
Prolactin
Serum anti-eleptic drug levels
MRI or CT
EEG
Workup for altered LOC: labs
Immediate: Bedside glucose First-line: CBC CMP Serum osmolality Serum calcium Serum magnesium UA Urine hCG when applicable TSH Tox screen When infection suspected, or unknown cause: BCx Urine culture LP Serum lactic acid Procalcitonin level
Workup for altered LOC: other labs to consider
Ammonia Carboxyhemoglobin level HIV RPR Heavy metal screen Vit B12 Serum cortisol
Workup for altered LOC: other
EKG and cardiac monitor
Workup for altered LOC: imaging
Head CT
C-spine CT if any risk of trauma
CXR
Tx of seizures
Absence, if only type present: ethosuximde
Absence with other seizure present, tonic or atonic, myoclonic, tonic-clonic: valproic acid, lamotrigine, or topiramate
Generalized and unclassified epilepsies: Valproate (pregnancy category X, find alternative)
Focal onset: carbamazepine
Medically refractory: immunotherapy
Which seizure meds decrease the efficacy of OCPs?
Carbamazepine Phenytoin Phenobarbital Primidone Felbamate Lamotrigine Topiramate Oxcarbazepine
Causes of status epilepticus
Poor medication compliance with low anticonvulsant drug levels EtOH withdrawal Drug overdose or toxin ingestion Intracranial infection Cerebral neoplasm Metabolic d/o
Causes of syncope: orthostatic
Orthostatic hypotension Hypovolemia Medication-related syncope Recreational drug use Postural tachycardia syndrome Autonomic failure
Causes of syncope: cardiac
Predisposing cardiac conditions Arrhythmia Valvular d/os Myocardial d/os Vascular d/os
Causes of syncope: acute painful syncope
SAH AAA rupture ACS Aortic dissection PE Ectopic pregnancy
Predisposing conditions for syncope
FHx of sudden cardiac death DM (hypoglycemia) Parkinson's (orthostatic hypotension) Seizure d/o Dehydration or blood loss Psychiatric illness
What is the cause of the syncope likely to be if it occurs with prolonged standing?
Vasovagal syncope
Orthostatic syncope
What is the cause of the syncope likely to be if it occurs immediately on standing?
Orthostatic hypotension
What is the cause of the syncope likely to be if it occurs while lying supine?
Cardiovascular
What is the cause of the syncope likely to be if it occurs with exertion
Exertional syncope Aortic stenosis CAD or coronary artery abnormalities Cardiomyopathy Arrhythmia
What is the cause of the syncope likely to be if it occurs after exertion in an athlete?
Vasovagal syncope
What is the cause of the syncope likely to be if it occurs with Valsalva
Reflex-mediated syncope
What is the cause of the syncope likely to be if it occurs with neck rotation or pressure?
Carotid sinus hypersensitivity
What is the cause of the syncope likely to be if it occurs with use of arms?
Subclavian steal syndrome
What is the cause of the syncope likely to be if it occurs with a stressful event?
Vasovagal syncope
What is the cause of syncope likely to be if the pt has nausea, chills, and sweats?
Vasovagal syncope
What is the cause of syncope likely to be if the pt has aura?
Migraine HA
Seizure d/o
What is the cause of syncope likely to be if the pt has no prodromal sx?
Cardiovascular syncope
What is the cause of syncope likely to be if the pt has slumping?
CAD
Arrhythmia
What is the cause of syncope likely to be if the pt has kneeling?
Orthostatic hypotension
What is the cause of syncope likely to be if the pt has brief loss of consciousness?
Arrhythmia
What is the cause of syncope likely to be if the pt has loss of consciousness >5 mins?
Seizure d/o
Neurologic, metabolic,k or infectious cause
What is the cause of syncope likely to be if the pt has focal neurologic deficits?
TIA or CVA
Todd’s paralysis
What is the cause of syncope likely to be if the pt has severe thunderclap HA?
SAH
What is the cause of syncope likely to be if the pt has CP?
CAD
PE
Aortic dissection
What is the cause of syncope likely to be if the pt has palpitations?
Arrhythmia
What is the cause of syncope likely to be if the pt has severe abdominal pain or back pain?
AAA
Aortic dissection
What is the cause of syncope likely to be if the pt has pelvic pain or vaginal bleeding?
Ectopic pregnancy
Workup of syncope
Target your workup based on hx and exam
