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
