Neurology Flashcards
Treatment of Cluster Headaches
sumatriptan or 100% HFNC
prophylaxis w/ verapamil
TIA - Treatment if extracranial stenosis is present
> 70% treatment recommended
Ischemic Stroke - Types
Thrombotic/large artery atherosclerosis
Cardioembolic
Small subcortical infarcts
Cryptogenic/other
Treatment of Ischemic Strokes
TPA w/in 3 hours
Aspirin
HTN following strokes
for TPA, <185/110
for no TPA, <220/120
for ICH: <160/90
BP for ischemic strokes not treated with TPA
no treatment unless less than 220/120 or end organ dysfunction
Hemorrhagic Strokes - Types
Subarachnoid Hemorrhages
Intracerebral Hemorrhage
Treatment of SAH
surgery if possible
Nimodipine for vasopasm
BP <160/110
reverse anticoagulation
Intracerebral Hemorrhage - Causes
HTN
consider cerebral amyloidosis in older adults (>55)
Primary Prevention for Strokes
- modify RF (HTN, smoking)
- statin
- stenosis or aneurysm treatment if necessary
Arterial Stenosis & Strokes
Immediate Period: Extracranial stenosis > 70%
Symptomatic intracranial >70% for secondary prevention
Secondary Prevention for Strokes
Aspirin
Statin
BP <130/80
Mononeuritis Multiplex
commonly presents as foot or wrist drop
can be sign of EGPA (Churg-Strauss)
POUND
pulsatile, onset less than 24 hours, unilateral, N/V, disabling; 3 predictive
Status Migranosus duration
72 hours
Status migranosus treatment
steroids, DHE/dopamine antagonist
When to start migraine treatment
at least 5 a month
Chronic migraine defined as
15 or more days per month
Contraindications for triptan use
coronary, cerebral or peripheral vascular disease
uncontrolled HTN
migraine w/ brainstem or hemiplegic auras
Duration of Cluster Headaches
15-180 minutes
CPH (chronic paroxysmal hemicrania)
2-30 minutes
Rx w/ indomethacin
SUNCT (short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing)
1-600 seconds, Rx w/ lamotrigine
Trigeminal Neuralgia
V2 (maxillary) and V3 (mandibular) branches of facial nerve
association w/ MS
Rx w/ carbamazepine
Monitoring of pts when on carbamazepine
hyponatremia
agranulocytosis
Medication Overuse Headache Definition
headache >15 days per month with medication use >10 days per month
Cough Variant HA
order mri to r/o chiari malformation
Thunderclap Headache
maximum intensity w/in 1 minute
think SAH
SAH diagnosis
CT then LP
LP - xanthochromia, RBC >10,000
SAH cause
saccular aneurysm
SAH treatments
NS
nimodipine to help prevent later vasospasm
Reversible Cerebral Vasoconstriction Syndrome
thunderclap HA that reoccurs often cause (pregnancy, vasoactive drug)
RCVS Treatment
Nimodipine or Verapamil
Normalize BP, avoid exercise
Concussion Grades
1, no LOC or amnesia, <15 minutes AMS
2, no LOC, amnesia & AMS >15 minutes
3 - LOC
Basilar Fracture Signs
hemotympanum
orbital ecchymoses
mastoid ehhymoses (Battle Sign)
TBI headaches should resolve in
7-10 days
Epidural Hematoma
fracture of temporal bone
laceration of middle meningeal artery
lentiform fashion, between dura mater and skull
Subdural Hematoma
injury to bridging veins between cortex and dura
crescent shape
Primary CNS Lymphoma risk factor
immunodeficiency
Primary CNS Lymphoma and most common type
NHL/diffuse large B cell lymphoma
Primary CNS Lymphoma & Steroids
avoid unless increased ICP, can suppress lymphoma and delay diagnosis/biopsy
GBM imaging
large, space occupying lesion with central necrosis, mass effect, surrounding edema
GBM treatment
resection if possible + chemo + radiation
Meningioma on imaging
dural based lesion, often with smooth round shape a tail that tracks along dura
Meningioma on imaging
dural based lesion, often with smooth round shape a tail that tracks along dura
Most common brain metastases
lung, breast, kidney, melanoma
Cognitive Impairment Required Workup by American Neurological Association
CBC, BMP TSH, Vit B12 RPR CT or MRI Vitamin D
Alzheimer Disease Treatment
Cholinesterase inhibitors (donepezil) Moderate-severe: memantine
Definition of Epilepsy
two unprovoked seizures more than 24 hours apart
one unprovoked seizure with risk of further seizures
Work up for first time seizures
EEG, MRI
AEDs in young women
lamotrigine or levetiracetam
Intractable Epilepsy Definition
without seizure freedom despite 1 year of treatment with TWO appropriately dosed AEDs
Treatment of Status
1- IV benzo
2- AED: Fosphenytoin
3: intubation/anesthetic
ABCD Score & Hospitalization
greater than 3
Antiplatelet/Anticoagulation after strokes
ASA
if A fib - warfarin
if PAD - plavix
Start AEDs after first seizure if
> 65
head trauma
Lamotrigine & OCP
dose needs to be increased
Parkinson Disease - 4 features
resting tremor (unilateral)
bradykinesia
cogwheel rigidity
gait/postural impairemnt
PD treatment (two age groups)
<65: dopamine agonists including pramipexole & ropinirole
>65 levodopa+cardopa
Mild PD treatment
selegiline/MAOI
amantadine
Dopamine Therapy in PD AEs
motor fluctuations (wearing off) and dyskinesia
PD + multiple system atrophy
prominent dysautonomia (diarrhea, urinary incontinence, orthostatic hypotension)
Essential Tremor
BL UE postural and action tremor
better w/ ETOH
Enhanced Physiologic Tremor
due to caffeine, meds, anxiety; resolves with removal of stressor
Essential Tremor diagnosis - labs
Wilson disease, TSH
Essential Tremor treatment
propranolol or primidone
McArdle Disease
glycogen storage disease V
myophophorlyase def
myopathy w/ exercise
Dystonia Rx/Diagnosis
trial of levodopa to screen for dopamine responsive dystonia
screen for Wilson disease
anti-cholinergic agents
Tourette Dx
motor + vocal for at least 1 year
Tic Rx
clonidine, guanfacine, topiramate, keppra
Neuroleptic Malignant Syndrome
caused by dopamine blocking agents fever, rhabdo, AMS, rigidity Rx dantrolene (not great)
Uhthoff phenomenon
transient worsening of MS symptoms due to hot weather, physical exertion or fever
“pseudorelapse”
Tourette Dx
motor + vocal for at least 1 year
ADEM, differentiation from MS
fevers + encephalopathy
MS - lifestyle factors
smoking cessation
Vitamin D supplementation
exercise
vaccines
Uhthoff phenomenon
transient worsening of MS symptoms due to hot weather, physical exertion or fever
“pseudorelapse”
MS - LP findings
oligoclonal bands
elevated IgG
ADEM, differentiation from MS
fevers + encephalopathy
Ocrelizumab
primary progressive MS
MS exacerbation
at least 24 hours
treat w/ steroids
EMG, demyelinating vs axonal
demyelinating: velocity of nerve conduction decreases
axonal: velocity remains unchanged
Natalizumab AE
MS medication, 2nd line
PML
Ocrelizumab
primary progressive MS
Miller Fischer Variant
ataxia, cranial neuropathies
antibodies to GQ1b ganglioside protein
Amyotrophic lateral sclerosis
motor function
degeneration of motor neurons
upper + lower motor neuron symptoms
GBS treatment
plasmapheresis, IVIG
no steroids
Lower Motor Neuron Symptoms
atrophy
fasciculation
Miller Fischer Variant
ataxia, cranial neuropathies
antibodies to GQ1b ganglioside protein
Amyotrophic lateral sclerosis
motor function
degeneration of motor neurons
Myasthenia Gravis Symptoms
ptosis, diplopia
Myasthenia Gravis Rx
pyridostigmine (cholinesterase inhibitory)
steroids, immunosuppression
Myasthenia Gravis Exacerbation Rx
IVIG or plasmapharesis
Lambert Eaton Myasthenic Syndrome
antibodies against voltage gated calcium channel
Mg symptoms but weakness improves with exercise
hyporeflexia + dysautonomia
maliginacy, esp small cell lung cancer
Myasthenia Gravis Symptoms
ptosis, diplopia
Myasthenia Gravis Rx
pyridostigmine (cholinesterase inhibitory)
steroids, immunosuppressions
Myasthenia Gravis Exacerbation Rx
IVIG or plasmapharesis
Lambert Eaton Myasthenic Syndrome
antibodies against voltage gated calcium channel
Mg symptoms but weakness improves with exercise
hyporeflexia + dysautonomia
maliginacy, esp small cell lung cancer
ICH BP treatment
less than 220/120
labetalol or nicardipine
avoid nitrates, potential to increase ICP
Contraindictions for Donepezil
bradycardia, sick sinus syndrome
angle-closure glaucoma
uncontrolled asthma
Bell’s Palsy
facial paralysis involving UPPER and LOWER parts of face
