neurology Flashcards
a 47 yo IVDU comes in requesting hydromorphone for back pain. His pain is worse w/ valsalva and his L4 vertebra is TTP. His LE have 4-/5 strength bilaterally, his has flaccid rectal tone and plantar response if upgoing… next best step?
if same clinical picture in a patient w/ hx of prostate ca… next best step?
MRI of the spine. 2nd choice is CT myelogram
if the same clinical picture in a patient w/ hx of prostate ca… next best step? IV dexamethasone then MRI then radiation therapy
Pt s/p MCV w/ whiplash has loss of pain/temp on neck and arms + intact sensation
syringomelia. MRI to dx, surgery to tx
Pt w/ high cholesterol presents w/ acute onset flaccid paralysis below the waist, loss of pain/temp w/ preserved vibration of position
anterior spinal artery occlusion
tx- supportive
most common cause of stroke? best 1st step? most accurate test? treatment if w/in 3-4.5 hr? tx if later than 4.5hr? CI ? tx if stroke on aspirin? tx for subarachnoid hemorrhage?
most common cause of stroke- 80% ischemic, 20% hemorrhagic
best 1st step- non contrast CT to r/o hemorrhage
most accurate test- diffusion weighted MRI for ischemic. CT can be neg 1st 48 hrs
treatment if w/in 3-4.5 hr- TPA
tx if later than 4.5hr- aspirin. heparin only for those in a-fib, basilar clot
CI - stroke w/in 3 mo, surg w/in 2 wek, LP w/ 1 wk
tx if stroke on aspirin- add dipyridamole or switch to clopidorgel. do not use ticlopidine
tx for subarachnoid hemorrhage- nimodipine to reduce ischemic stroke from Vasoconstriction (MC cause of M&M)
when to clip an aneurysm?
w/ in days or rupture or when <10mm
when to do endarterectomy?
when occlusion >70% and is symptomatic (>60% if >60 yo)
total paralysis except for vertical eye movements
paramedial branches of basilar artery
Vertigo, vomiting, nystagmus, and clumsiness with the right arm
major R cerebellar arteries
L hemisensory loss + horners + R facial sensory loss
R wallenburg (RCA)
falling to the L + R ptosis + eye deviated to the right and down
R Benedikt’s
L hemiplegia +R ptosis + eye deviated to the right and down
R Webbers
L hemiplegia/hemisensory loss in the leg>arm. confusion, behaviroal disturbance
R ACA stroke
L hemiplegia/hemisensory loss, L homonomous hemianopsia w/eyes deviated towards the R + apraxia
R MCA stroke
status epilepticus tx
loraxepam + LD of phenytoin. then phenobarbital then anesthesia
partial seizures begin focally (arm twitch, de ja vu, burning rubber smell)
tx?
simple if no LOC and complex if LOC (may have lip smacking) both can generalize
tx- carbamazepine or phenytoin. then valporate or lamotrigine
generalized seizures begin from both hemispheres @ once
tx. for kiddos
tx for alduties?
either grand mal or absence (5-10sec unresponsivenss in kiddos),myoclonic, atonic
tx. for kiddos- absence- ethosuximide
tx for alduties- valproic acid, then lamotrigine, carbamezepine, phenytoin
3 hz spike and wave
absence seizures
tx w/ ethosuxamide
triphasic bursts
creutzfeldt Jakob. dementia and myoclonus
Diffuse background slowing
delirium. contrast w/ psychosis that has no EEG changes
Hypsarrhythmia
infantile spasms. tx w/ ACTH
most are associated with mental retardation
worse headache of my life… first step
subarachnoid hemorrhage…noncontrast CT
new onset severe headche + fever and nuchal rigidity… first step
meningitis. abx then CT then LP
new onset severe headche + deep pain that wakes up at night. worse w/ coughing or bending forwards
consideer brain tumor. most important prognostic factor is grade (degree of anaplasia)
new onset severe headche + unilateral pounding headache w/ changes in vision and jaw claudication… what to do?
temporal arteritis… Check EXR + give streoids then do temporal artery biopsy. can lead to blindness
new onset severe headche + fat lady on minocycline ow how takes isotreintoin w/ abducens nerve palsy/diplopia
pseudomoto cerebry. also assoc. w/ OCPs. normal CT, elevated pressure on LP.
Tx- weight loss then acetazolamide then shunt ot optic nerve sheath fenestration
diarrhea 3wks ago, now areflexia and ascending paralysis? most likely bug? best tx?
Guillain-barre- CFS shows albumino-cytolotic dissociation
bug- campylobacter, HHV, CMV, EBV
best tx- IVIG or plasmapheresis. monitor VC for intubation req
nasal voice, ptosis, dysphagia, resp. acidosis… 1st test? Most accurate test?acute tx? chronic tx? meds to avoid?
Myasthenia Gravis
1st test- Ach-ab/
most accurate- EMG:decrease in muscle fibers contraction
acute tx-IVIG or plasmapheresis. monitor VC for intubation req
chronic tx-pyridostigmine, GCs/AZA, thymectomy (<60)
meds to avoid- aminoglycosides and beta blockers
urinary retention, babinski on R. episode of double vision 6mo ago… best dx test? acute tx? chronic tx?
Multiple slcerosis- neuro-deficits separated by time and space
best dx test- MRI of the brain. incr T2 @ periventricular white matter
acute tx- steroids (3 days IV then 4wks oral) plasma exchange is second in line
chronic tx- IFN-beta1b, glatiramer reduces exacerbations
