neurology Flashcards
In MS, ensure Vitamin D supplementation.
linked to higher disease activity and more relapses
mild cognitive impairment
score lower than 26/30 without significant functional decline
can get brain CT/MRI to rule out structural cause
TIA eval
ABCD^2 score, =>3: admit
incidental meningioma
lightbulb sign, calcification, dural tail
benign, repeat MRI 3-6 months after initial discovery
if growing/symptomatic->surgery->radiation
first seizure eval
auras: deja vu (simple partial seizure)
changes in awareness, periods of inattention
any aura before seizure=focal
migraine MRI
Migraine frequency/ use of acute medications> 2 days/wk
white matter signal abnormalities
if NSAIDs dont cut it->oral triptan ->subq triptan
timolol for ppx, topimarate also for ppx
Temporal lobe epilepsy
frontal lobe seizures
rising epigastric sensation, fear and anxiety, fidgety
normal EEG and MRI
if refractory to 2 AEDs->surgery (lobectomy)
motor symptoms that awaken from sleep
Myotonic dystrophy
diagnosis
weakness+ fatigue+ waddling gait+ muscle stiffness+ delayed grip relaxation
EMG
Primary progressive aphasia
treatment
progressive loss of language function with other cognitive functioning intact
speech and language therapy
tardive dyskinesia
caused by
chorea and dystonia
dopamine antagonists such as metoclopramide, risperidone
Interferon beta side effects
natalizumab
fingolimod
teriflunomide
LFTs q3-6 months (autoimmune hepatitis)
screen for JC virus (PML)
eye exams
amylase and lipase (pancreatitis)
secondary stroke prevention
aspirin+ dipyridamole
Antiepileptic in woman taking OCPs/preggo
keppra
failure of OCPs otherwise
newly diagnosed stroke admit to
stroke unit, reduces mortality
unknown epilepsy syndrome (gen vs focal) treatment
broad spectrum AED such as topiramate, lamotrigine, keppra, valproic acid, zonisamide
NPH treatment
lumbar puncture to assess response before VP shunt
acute headache+ neck pain+ transient vision loss+ miosis+ ptosis+ anhidrosis
diagnosis
treatment
carotid artery dissection
MRI of soft tissue of neck
aspirin
essential tremor treatment
propranolol->primidone->topiramate (not of kidney stones/glaucoma)->deep brain stim
spinal cord compression 2/2 plasmacytoma/ myeloma
steroids, radiation (if stable spine and minimal neuro deficits)
surgical decompression if unstable/severe neuro deficits
spinal cord compression 2/2 plasmacytoma/ myeloma
steroids, radiation (if stable spine and minimal neuro deficits)
surgical decompression if unstable/severe neuro deficits
GI effects on cholinesterase inhibitor (donepezil, rivastigmine)
stop
small fiber neuropathy
diagnosis
pain and paresthesia with no neuro deficits
glucose tolerance test
psychogenic nonepileptic seizures
diagnosis
long, closed eyes, can be incontinent, >2 AEDs,PTSD (no Keppra)
video EEG monitoring
MS urge incontinence 2/2
treatment
spasms
oxybutynin
seizures in oldies
lamotrigine, Keppra, gabapentin
asymptomatic carotid artery stenosis
statin, no CEA
cerebral vasoconstriction syndrome
treatment
recurring thunderclap headaches, stroke on imaging
normalize BP
CNS lymphoma diagnosis
treatment
surgical biopsy without resection
methotrexate and radiation
Afib in setting of stroke anticoag
wait for 2 weeks
solitary metastatic brain tumor treatment
resection followed by radiation
myasthenic crisis
relapse without crisis
plasmapheresis or IVIG
high dose steroid
Cluster headache treatment
ppx
oxygen, subq sumatriptan
verapamil (can cause heart block, monitor ECG)
cognitive dysfunction in multiple sclerosis
counseling and therapy
med overuse headache
> 10 days/month
persistent facial nerve palsy after 3 months
MRI of brain
first seizure in setting of risk factors (previous head injury, focal brain lesion, postictal Todd’s paralysis
AED
MS diagnosis
MS preventive care
associated with trigeminal neuralgia
MRI of brain
routine vaccinations
Patient with resolving headache a week after trauma
no imaging, restrict contact sports
parkinsonism+ cerebellar ataxia+ early postural instability+ falls
+impairment in vertical eye movements
Parkinson diagnosis
multiple system atrophy
progressive supranuclear palsy
bradykinesia (slowing with repetitive movements)+rigidity/resting tremor/postural instability
active denervation+ muscle weakness and atrophy in carpal tunnel syndrome
decompression surgery
intracranial hemorrhage + SBP >180
lower to 160 with IV labetalol
progressive weakness+ areflexia+ sensorimotor neuropathy for more than 8 weeks
treatment
chronic inflammatory demyelinating polyradiculopathy
steroids
idiopathic intracranial hypotension
treatment
elevated opening pressure with no CNS lesion (headache, papilledema, visual symptoms)
acetazolamide->optic nerve fenestration
cryptogenic stroke with PFO
prolonged cardiac monitoring to detect a fib
meds wearing off in Parkinson’s
increase carbidopa-levo or add entacapone
if can’t be tolerated (dyskinesia, visual hallucinations)->DBS
restless legs syndrome vs spasticity
discomfort, urge to move, periodic limb movements while sleeping vs tonic leg spasms and cramps
parkinsonian-hyperpyrexia syndrome
AMS, hyperthermia, rhabdo, rigidity, dystonia
medication withdrawal, restart levodopa
Refractory migraine (>72 hours)
dihydroergotamine+ prochlorperazine/metoclopramide
MS preggo
no fingolimod, mitoxantrone, teriflunomide
aneurysmal subarachnoid hemorrhage complication
prevent with
treat with
diagnose with
vasospasm (also rebleeding, hydrocephalus)
oral nimodipine (21 days)
IV dopamine
CTA Brain
UMN+ LMN symptoms
treatment
ALS
riluzole
UMN+ LMN symptoms
treatment
ALS
riluzole
Secondary headache
management
Escalation in frequency and intensity, neuro symptoms> 1 hr med overuse headache is milder, no new neuro sx
brain MRI
unruptured intracranial aneurysms
coiling when
smoking cessation, BP control
>12 mm
nimodipine only when there’s hemorrhage
hyperdensity on CT
post TPA neuro changes
infarct
CT without contrast
Tics
suppressible
Seizure treatment in patient with brain tumor
AED that is not cleared by liver (chemo drugs)
valproic acid, lacosamide, lamotrigine, keppra
persistent myopathy on steroids
taper steroid to distinguish between steroid induced myopathy (stable CK) and inflammatory myopathy (elevated CK)
Chronic migraine
treatment
headache >15 days/month for >3 months
topiramate/ onabotilumtoxin A
paraneoplastic limbic encephalitis
diagnosis
treatment
inflammation of emotional and memory structures, subacute, personality change,psychosis, seizures, cancer related
serum/CSF paraneoplastic antibodies
immunotherapy
treatment of fatigue in MS
modafinil->meth
statin related myopathy, which statin to give
hydrophilic: rosuvastatin, pravastatin, fluvastatin
Creutzfeldt-Jakob MRI
hyperintensities in cortex/thalamus/ganglia
subacute, rapidly progressive
persistent AMS after convulsive status epilepticus
continuous EEG monitoring
dalfampridine contraindication
for MS, any kidney disease
