Neurology Flashcards
Carbon monoxide poisoning
Symptoms: (CEREBRAL HYPOXIA)
- syncope, seizure, coma
- MI, arrythmia
- headache, confusion, dizziness, N
Dx:
- ABG: carboxyhemoglobin level (Lactic acidosis)
- ECG ± cardiac enzyme
- MRI : bilateral hyper-intensity in glubos palladium
Tx:
- high flow 100% oxygen
- intubation/hyperbaric oxygen (severe)
Initial evaluation of first time seizure in an adult
Approach seizure:
—> steps to rule out metabolic & toxic causes ( hypoglycemia, electrolyte disturbance, amphetamine, BDZ, Alcohol withdrawal) —> follow with MRI/CT of brain ( rule out space-occupying lesion) —> follow with lumbar puncture ( if sign of meningitis presents) —> followed with EEG for risk stratifying
Rule out:
1. Metabolic causes ( hypoglycemia, electrolyte disturbance)
2. Toxic causes ( amphetamine use, BDZ, Alcohol withdrawal)
Laboratory:
1. Serum electrolytes
2. Glucose
3. Calcium
4. Magnesium
5. CBC
6. Renal function test
7. LFT
8. Toxicology screen
9. ECG —> in patient with LOC to evaluate arrhythmia
IMAGING:
2. . After metabolic & electrolytes causes are ruled out —> perform MRI or CT of brain —> to evaluate structural brain abnormality ( tumor, stroke, mesial temporal sclerosis)
3. Lumbar puncture —> reserved for patient with signs of meningitis ( fever, headache, neck rigidity)
4. EEG —> once metablic/toxic causes are ruled out—> perform EEG for risk stratifying
Note:
* avoid valproic acid in young women with childbearing age—> lead to birth defects (neural tube defect)
Myasthenic crisis
- life-threatening complication of Myasthenia Gravis ( MG) —> leading to respiratory failure
Risk factors:
1. Infection
2. Surgery
3. Certain medication ( fluoroquinolone)
Signs/symptoms:
1. Increase oropharyngeal weakness ( difficulty swallowing/choking)
2. Respiratory insufficiency/ dyspnea (SOB)
Treatment:
1. Intubation for deteriorating respiratory status
2. Plasmapheresis or IVIG + corticosteroid
Clinical feature of tremor
- Essential tremor:
- bilateral action tremor of the hand
- head tremor with dystonia
- no other neurologic signs
- improves with alcohol - Parkinson disease:
- resting tremor: decrease with voluntary movement
- pill rolling
- asymmetric: hand & leg - Cerebellar:
- usually associated with ataxia & dysmetria
- increase steadily as hand approach target - Orthostatic:
- leg & trunk
- occurs only when standing - Physiologic:
- low amplitude, not visible under normal conditions
- increase with sympathetic activity ( drugs, hyperthyroidism, anxiety, coffee)
- worse with movement
- most common cause of action tremor
Intracranial hemorrhage ( thalamic bleed)
First line management for excessive bleeding due to warfarin: immediately reverse anticoagulation
- Prothrombin complex concentrate (PCC) ( takes minutes to hours to work)
- Alternatively, FFP
- Iv Vitamin K ( takes 12-24 hours to work)
NOTE:
warfarin- associated Intracranial hemorrhage can be triggered by:
- over the counter medication for common cold:
1. acetaminophen (can cause anti-coagulant effect of warfarin)
2. nasal decongestant/phenylephrine) —> (elevate BP)
NOTE:
1. PCC—> immediately reverse anticoagulation ( to reduce risk of death & disability) ( takes minutes to hours to work, Contain vitamin K dependent clotting factors 2, 7, 9, 10
- IV Vitamin K—> takes 12 -24 hours to work; synthesis clotting factors in the liver
Protamine sulfate
- to reverse the effect of heparin
Prothrombin complex concentrate (PCC)
- To reverse the effect of warfarin ( elevated INR & PTT)
Tranexamic acid
- to control blood loss in:
1. Excessive menstrual bleeding
2. Surgery
CCB & Beta blocker
- lower SBP to < 140 mm Hg ( in patient with hemorrhagic stroke, to reduce risk of hematoma expansion in the first 24 hours)
Platelet transfusion
- if thrombocytopenia occurs due to aspirin or clopidogrel
Central retinal artery occlusion (CRAO)
- caused by: embolized atherosclerotic plaque from the ipsilateral carotid artery
Sign/symptoms:
1. Painless monocular vision loss
2. Persists for several hours
3. Defect in the afferent pupil reflex
4. Fundoscopy shows: whitening of retina due to edema + red cherry macula
Myasthenia Graves
