Neurology Flashcards
Opening pressure for diagnosis of intracranial hypertension +
> 250 mm H2O
Absolute contraindications tPA (name 5)
Head trauma /stroke within 3/12
Prev hx ICH
Hx intracranial neoplasm, AVM
BP >185/110
Platelets <100
Anticoagulant is and INR > 1.7
Brain surgery 3/12
GI bleed 21/7
GI malignancy
DOAC within 48 hrs
Relative contraindications tPA (name 5)
Glucose <2.8
Pregnancy
Serious trauma last 14 days
Only minor and isolated neurologic signs or rapidly improving symptoms
Major surgery in the previous 14 days
History of gastrointestinal bleeding (remote) or genitourinary bleeding‡
Seizure at the onset of stroke with postictal neurologic impairments†
Arterial puncture at a noncompressible site in the previous seven days
Large (≥10 mm), untreated, unruptured intracranial aneurysm
Untreated intracranial vascular malformation
Stroke mimics (name 5
Todd’s paralysis
Syncope
Meningitis
Complex migraine
Brain neoplasm
Hypoglycemia
SAH
Hyponatremia
Drug toxicity
Bell’s palsy
MS
non epileptic seizure
Hypertensive encephalopathy
Symptoms of wernicke’s (3)
Ataxia
AMS
Ophthalmoplegia (nystagmus)
GBS Pathophys, presentation, tx
acute polyneuropathy, immune mediated periipheral nerve myselin sheath or axon destruciton
ascending symmetric weakness/paralysis/loss of DTR. can progress to resp failure
supportive care, IVIG, plasmapheresis
Causes provoked seizure (5)
Trauma
ICH
Mass
Infection
Hypoglycemia
Hyponatremia
Toxins
Alcohol withdrawal
Eclampsia
Anoxic injury
Hypocalcemia
Hernia
Cocaine, lidocaine
Hypertensive encephalopathy
Causes peripheral vertigo (5)
BPPV
menieres
Labyrinthitis
Ramsay hunt
Acoustic neuroma
Perilymph fistula
Ototoxicity
Causes central vertogo
Cerebellar CVA / bleed
Vertebral dissection
Vertebrobasilar insufficiency
Brainstorm infarction
myasthenia gravis - pathophys symptoms and treatment
Autoimmune disorder with acetylcholine receptor (AChR) antibody-mediated impaired transmission at neuromuscular junction
Diplopia/ptosis
proximal muscle /neck/facial weaknes
symptoms worsen with fatigue
respiratory failure in crisis
acetylcholinesterase inhibitor (neostigmine), IVIG, plasma exchange
Botulism symptoms and tx - infants and adults
starts with eye complaints, progress to symmetric descending weakness, respiratory insufficiency
trivalent botulism antitoxin, human botulism IG for infants
LP findings bacterial meningitis (4)
gram satin +ve
>1000-200 WBC (L shift, >80% PMN)
glucose <40
protein >200
opening pressure >170
Meningitis treatment
Ceftriaxone 2g
Vancomycin 15 mg/kg
IF age >50, pregnant, immunocompromised, alcoholic
- ampicillin 2 g IV for lysteria coverage
Acyclovir 10 mg/kg if suspect encephalitis
consider dex
treatment epidural abscess
Vancomycin 25-30 mg/kg
Ceftaz 2 g
Gentamicin 5 mg/kg if receent neurosurgical procedure
Risk factors vertebral dissection (3)
- Trauma
- Connective tissue disorders (Ehlers-Danlos syndrome, Marfan syndrome, Fibromuscular dysplasia, etc)
- History of migraine
- Hypertension/atherosclerosis
- Prior dissections
- Pregnancy and post-partum/ OCP use
- Smoking
Name five causes of stroke in the younger population. [5]
- Dissection (carotid/vertebral)
- Drug use (cocaine, methamphetamine)
- Cardioembolic (valvular heart disease, arrhythmia, endocarditis)
- Structural cardiac abnormalities (patent foramen ovale, atrial septal defect, cardiomyopathies)
- Inflammatory conditions ( vasculitis, SLE)
- Inherited hypercoaguable states (protein C, Protein S, antithrombin, Factor V Leiden)
- Acquired hypercoaguable states (pregnancy, OCP, malignancy, DIC, antiphospholipid)
- Hematolologic (polycythemia vera, sickle cell)
- Trauma
- Nonatherosclerotic angiopathies (Fibromuscular dysplasia, migraine-induced)
What are the hallmark symptoms of delirium? [3]
- Fluctuating level of alertness
- Disorientation
- Inattention
- Perceptual disturbance (ie. hallucinations)
- Memory changes
- Sleep/wake cycle disturbance
Strategies for reducing risk of post LP headache (2)
- Reduced size of spinal needle
- Needle bevel parallel to dural fibers
- Replacement of stylet before withdrawal of spinal needle
- Number of LP attempts (never studied but pathophysiologically makes sence)
Suicide risk factors (3)
SAD PERSONS
Sex-male
Age - <24 or >65
Depression
Previous attempt
Ethanol use
Rational thinking loss
Social supports lacking
organized plan
No spouse
Sickness
Myasthenic crisis triggers
- Medication
– infection
– recent surgery/anesthesia
– emotional or physical stress,
– electrolyte imbalance
– temperature extremes
– pregnancy/childbirth
Paralytics to avoid with myasthenia and why
Succ - depolarizing - reduced number acetylcholine receptor density on muscle
