Neurology Flashcards
PICA stroke symptoms
Wallenberg syndrome (lateral medullary)
- Ipsilateral face
- Contralateral body
- Vertigo and Horner’s syndrome
Stroke imaging sensitivities
Head CT: >95% sensitivity in 3-5 days
Initial tests in patient’s with memory loss
- Head CT
- VDRL/RPR
- Thyroid function tests
- B12 levels
Alzheimer’s treatment
acetylcholinesterase inhibitors:
- Donepizil (central-acting), rivastigmine, galantamine, memantine
Frontotemporal dementia (Pick’s disease)
- Changes in personality and behavior come first followed by memory changes
- Same treatments as Alzheimer’s disease but with less response
Normal pressure hydrocephalus
WWW (weird, wet, wobbly)
- Dementia, urinary incontinence, wide-based gait/ataxia
Diagnostic tests to order for Normal pressure hydrocephalus
- Head CT and LP
Treatment for Huntington’s disease
Tetrabenazine for movement disorder
Antipsychotics for symptomatic control
Migraine triggers
- OCPs, menstruation, cheese, caffeine
When to order head CT/MRI with CC of headache
- Sudden or severe onset
- onset after 40
- Focal neurologic findings
Migraine treatment
Abortive therapy: sumatriptan or ergotamine
Prophylaxis: propranolol (with >4 headaches/month)
- alternate therapy CCBs, tricyclic antidepressants, SSRIss
Triptans
Work by vasoconstricting cerebral blood vessels
- Migraines are thought to be vasoconstriction followed by vasodilation and pain
- can be dangerous in hypertension and CAD
Cluster headache
exclusively unilateral
Treatment: sumatriptan, 100% oxygen, steroids (abortive)
Verapamil (preventative)
Temporal arteritis
- temporal tenderness and jaw claudication
Diagnosis: ESR and temporal artery biopsy
Treatment: steroids first and fast (blindness)
Pseudotumor cerebri
Headache + sixth nerve palsy, visual field loss, pulsutile tinnitus
- Vitamin A use can cause
Diagnosis of pseudotumor cerebri
LP with elevated opening pressure
Treatment of pseudotumor cerebri
- weight loss, acetazolamide, surgery for failure (VP shunt, optic nerve sheath fenestration)
Benign positional vertigo
no hearing loss or tinnitis or ataxia
-responds modestly to meclizine
Vestibular neuritis
Viral-induced inflammation of the vestibular portion of the eighth cranial nerve
no relation to position changes, no hearing loss, tinnitis
- Treat with meclizine
Labyrinthitis
acute inflammation of the cochlear portion of the inner ear
- hearing loss, tinnitis
- Treatment with meclizine and steroids
Meniere’s disease
hearing loss and tinnitis that is remitting and relapsing
- Treatment with salt restriction and diuretics
Acoustic neuroma
Hearing loss, tinnitus, vertigo, and ataxia
- Seen in neurofibromatosis and von Recklinghausen’s disease
Diagnosis: MRI of the internal auditory canal
Perilymph fistula
Barotrauma lading to rupture of the tympanic membrane
Wernicke-Korsakoff Syndrome
Symptoms: confusion with confabulation, ataxia, memory loss, gaze palsy and opthalmoplegia, nystagmus
Treatment: IV thiamine and then glucose
