Neurology Flashcards
Contraindications to tap
age<18 bp 185/110 inr 1.7 prior ICH within 3 month brain surgery seizure symptoms
3-4.5 age>80 AC and any INR NIh>25 stroke/diabetes
dose of TPA
0.9 mg/kg with 10% as boils and then over 1 hr
Horner Syndrome…think
Stroke!!
seizure pearls hiv-focal elevated glucose brown machines or subcu modules being treated for Tb mexico trip
toxoplasmosis HHN-hyoerosmolar can tumor-von recklinghausen pyridozine (b6)-inh overdose cyatercercosis
treatment for west nile encephalitis
supportive
toxoplasmosis tx
pyrimethamine, sulfadiazine
spiramycin if pregnant
hiv neurocystercercosis
anti-helminthic. seizure often presenting sign
cmv treatment in hiv
hart and gangiclovir and foscarnet
cryptococcus treatment hiv
amphotericin b, fluconazole
side effects of any meds
rifampin INH Pyrazinamide Ethambutol Streptomycin(cns)
orange fluids
neuropathy (b6)
rash-uric acid
can’t see red-green colors
ONUC
AMS Evaluation
DONT
AEIOU-TIPs
Dextrose
Oxygen
Narcan
Thiamine
Acidosis Endocrine/Electrolytes Infection Oxygen/Opioids Uremia
Trauma, Temperature
Insulin
Porphyria
Stroke
GCS
EVM
Eyes
Verbal
Motor
most common location for bone mets
thoracic spine
suspect cord compression/epidural abscess but can’t get MRI
give steroids first (16mg decadron)
meningitis most common and drugs
0-4 weeks -ecoli, gbs (Amp/Gent)
4 w-3m - neonatal plus strep (cef/amp/vanc)
all others it’s strep and cef and vanc until 50 yrs and then add amp again
N. Meningitis close contacts. what abx
ridampin 1 month or cipro
neuronitis vs labrynthitis
manieres triad
perilymph fistula
neuritis-NO loss
triad - tinnitus, vertigo, hearing loss
hearing worse with pneumatic otoscopy
myasthenia gravis cause features definitive test treatment
igg auto abs against ach nicotinic receptors small muscles of face, proximal>distal tensilon test (edrophonium)-inhibits achesterase...more ach available at the synapse treat with pytidostigmine, but if you give too much you will have cholinergic crisis (sludge) - give atropine
GBS
ascending paralysis.eapecially after viral or campylobacter diarrhea
IVIG and plasma exchange
monitor FEV1<15…intubate
Tick paralysis
ascending paralysis like gbs. remove the god damn tick
Optic Neuritis classic eye finding
afferent pupillary defect (it dilates when light is shown in eye)
GBS
progressive bilateral lower extremity ascending in nature
usually proceeding a infection (think campylobacter)
FIV<15 equals intubate
IVIG and plasma exchange
MRI - selective anterior cord enhancement likely
idiopathic intracranial hypertension
young, obese women
look for vitamin A toxicity, OCP, steroids, tetracyclines
diplopia with lateral gaze (CN VI)
only abnormality is increased opening pressure
most common cause of stroke in children
sickle cell
What is factove V leiden
most common cuase of inherited hypercoagulable disorder, mostly europeans
intracranial hemorrhage EKG findings
Cerebral T Waves - Deep, inverted T waves, prolonged QT
Ascending paralysis
Tick paralysis, GBS
descending paralysis
MG, botulism, miller-fischer GBS
most common primary brain tumor
meningioma
most common malignant brain tumor
glioma
most common source of brain mets
lung cancer
headaches from tumors are worse at what time of day
morning…lying flat all night
association with temporal cell (giant) arteritis
polymyalgia rheumatica
carotid artery dissection, whats it look like?
partial horners syndrome, ptosis, miosis, no anhidrosis
look for patient with recent neck manipulation
symptoms of ACA stroke
weakness of leg and sensation loss, ataxia
MCA stroke symptoms
contralateral lower face weakness, hemiplegia, ataxia, speech impairments
brainstem stroke sx
double vision, taste, hearing face weakness, swallowing issues, bp/respiration dysfunction
stroke vessel for homonymous hemianopsia
posterior cerebral artery
Parkinsons Disease
Lewy bodies, dopaminergic neuron loss in substantia nigra
tx with carbidopa
most common cause of death is respiratory failure
demyelination syndromes
multiple sclerosis and GBS
loss of anterior horn cells
ALS, progressive degernerative disease
neurofibrillary tangles
alzheimers
Syringomyelia
cyst in spinal cord, Cape like distribution of loss of PAIN AND TEMPERATURE….preservation of light touch and proprioception
anterior cord syndrome
loss of MOTOR FUNCTION/pinprick/temp
preservation of position/vibration (wiggle big toe)…grandma doesn’t know why you are moving her lil’ piggies
FORCED FLEXION INJURY
Central cord syndrome
HYPEREXTENSION INJURY
upper extremity»lower extremity
grandma hits airbag (hyperextension) - no arm movement, but can move legs!!!
medulloblastoma
most common malignant brain tumor in children
morning headaches, posterior fossa (cerebellum)
ataxia, “setting-sun” sign of eyes,
Direct Factor Xa inhibitors vs
direct thrombin inhibitor
rivaroxaban, apixaban (Xa), dabigatran (thrombin)
Dabigatran has reversal agent (Idacrucizumab 2.5 grams 15 min apart Praxbind) - takes 2.5 hours to work.
INR of FFP
1.6
