Neurology Flashcards
What should you consider with the following drugs and a patient with new headaches?
doxycycline, retinoic acid, progesterone/estrogen supplementation.
IIH (Idiopathic intracranial hypertension)
what should BP be after SAH?
<160
what are complications (early and late) after SAH?
early: rebleeding
late: increased ICP, obstructive hydrocephalus, cerebral edema, seizures, cerebral vasospasm
what drug should be used after aneurysmal SAH and why?
Nimodipine, helps improve neuro outcomes. mixed evidence on preventing cerebral vasospasm.
what labs are increased in CJD? which test is the most specific?
CSF 14-3-3 protein, total tau proteins.
most specific and highly sensitive: real-time quaking-induced conversion assay
what drugs are used first and second line in convulsive status? third line?
1st: IV lorazepam max 4 mg can repeat dose once. (IV diazepam, IM midazolam also options.)
(remember check a glucose and give thiamine/dextrose if needed)
2nd: IV fosphenytoin, valproic acid, levetiracetam
3rd: repeat second line or move to midazolam, propofol, pentobarbital, thiopental with continuous EEG monitoring
What is the pattern of symptom development in FTD?
first alterations to behavior , then years later cognitive impairment.
What does a previous football player with emotional dysregulation, behavior change, motor disturbance with Parkinson features likely have?
Traumatic encephalopathy syndrome
what are features of traumatic encephalopathy syndrome?
emotional dysregulation, behavior change, motor disturbance with Parkinson features
what does multiple system atrophy look like?
symmetric parkinsonism, severe dysautonomia (orthostatic hypotension, urinary incontinence), cerebellar ataxia, early falls.
does multiple system atrophy have asymmetric or symmetric parkinsonism? this is different from corticobasal degeneration how?
symmetric. corticobasal degeneration is asymmetric parkinsonism.
is ALS typically symmetric or asymmetric?
asymmetric
what might be neuro findings of ALS?
asymmetric weakness, atrophy, spasticity, hyperreflexia (both UMN and LMN signs)
Corticobasal degeneration
severely asymmetric parkinsonism, fixed dystonia, myoclonus, cortical sensory deficits (can’t identify key in the hand), apraxia (inability to act out common task), cognitive deficits
what do you call it when someone can’t act out slicing a loaf of bread?
apraxia
what condition may present with asymmetric parkinsonism, apraxia, and cognitive deficits (among other symptoms)
Corticobasal degeneration
what condition has maternal inheritance and is associated with fluctuating weakness, ophthalmoplegia, multiorgan symptoms.
mitochondrial myopathy
what condition is associated with asymmetric weakness involving quads, bulbar muscles, and distal upper extremities without affecting EOM?
Inclusion body myositis
what parts of the body are generally affected in inclusion body myositis? disease of the young or old?
quads, bulbar muscles without EOM involvement, distal upper extremities.
onset usually after age 50
Treatment for NPH.
one time high volume CSF removal LP and if good response –> VP shunt
if uncertain response, could do lumbar drain placement with NSGy then assess response
TUG test improvement by 5 seconds.
what diagnosis should you consider with severe HA associated with miosis and ptosis?
cluster headache or carotid artery dissection!
what do you do if levodopa is causing orthostatic hypotension?
Increase carbidopa
what sizes of intracranial aneurysms have a low 5 year risk of rupture and only require serial imaging?
<7 mm posterior circ
<12 mm anterior circ
what is treatment for increased ICP in emergency?
bed head to greater than 30 degrees
hyperventilation to PaCO2 20-25
mannitol or hypertonic saline (works in minutes)
dex if tumor edema
call neurosurgery
what should be in your differential with unreactive dilated pupils?
brain herniation, death
How long is DAPT given for CVA/TIA?
21 days
Is Memantine for early or late dementia?
moderate to severe (not early)
Is Donepezil for mild or severe dementia, what is a contraindication to use?
better for mild to moderate. ACh-E inhibitor so contraindicated in bradycardia or conduction abnormalities
What do you do if you suspect SAH but normal head CT?
LP
What must you exclude in the diagnosis of ALS (UMN/LMN distal extremity weakness asymmetric or bulbar symptoms)
cervical cord compression, B12 or copper deficiency, HIV, Lyme, hyperparathyroid, thyrotoxicosis
what condition presents as symmetric proximal/distal motor and sensory deficits and diffuse areflexia
CIDP
What AED has higher incidence of depression, anxiety, SI than other AEDs?
Keppra
Tx for levodopa-induced dyskinesia
amantadine (NMDA antagonist)
what condition may look similar to MS except may have bilateral optic neuritis and long instead of patchy spinal cord demyelination?
Neuromyelitis optica (NMO)
What antibody should be tested for in suspicion of Neuromyelitis optica?
Aquaporin-4 antibodies in the CSF
If you see Aquaporin-4 antibodies in the CSF, what condition is implicated?
Neuromyelitis optica
What are infectious causes of transverse myelitis?
HSV, VZV, West Nile virus, human T-lymphotropic virus, Lyme, Syphilis,
TB or HIV can cause ITM-like syndrome at time of seroconversion or HIV can also cause chronic degenerative vacuolar myelopathy with chronic low CD4 counts.
Patient presents with a postural HA may be associated with nausea, photophobia, neck pain. What diagnosis should you consider? How do you diagnose this?
Intracranial hypotension (spontaneous or especially after an LP)
dx: could do LP but most do contrast MRI which will have tell tale findings like patchy meningeal enhancement
How do you treat intracranial hypotension?
blind or targeted epidural blood patch
Do dopamine receptor agonists or antagonists cause EPS like tardive dyskinesia?
Antagonists (treatment is to remove agent +/- valbenazine)
what should you avoid using if at all possible if thinking could be CNS lymphoma?
steroids as this can cause false negative biopsy
