Neurology JB Flashcards
Acute delirium tx
antipsychotic meds (risperidone, olanzapine, quetiapine)
benzo for alcohol and Benz withdrawal states (lorazepam) + thiamine and B12
akathisia tx
antihistamine
maybe BB
alzheimer dx
dx of exclusion
r/o other causes
cognitive testing
Amyotrophic lateral sclerosis (ALS) sx
instability, upper extremity weakness
sensation, urinary sphincter, and voluntary eye movements spared
cannot control motor movements
mixed upper and lower motor neuron signs
Bells palsy tx
prednisone- start 72h of sx onset
artificial tears
acyclovir- severe cases
C5 nerve root function
deltoids and biceps
dermatome: outer part of upper arm down to elbow
CN3 disorder
oculomotor nerve
inferior rectus, ciliary body
dilated pupil
complex regional pain syndrome sx
pain out of proportion to exam w/ skin changes (raynauds)
psychologic hx
complex regional pain syndrome tx
early mobilization after injury, NSAID, PT/OT
Pain: amitriptyline, gabapentin, calcitonin adjunct
tx failure: bisphosphonates, IVIG, nerve block
VitC prophylaxis after fx may decrease incidence
drugs to avoid when having dementia
avoid anticholinergic, opiates and benzos
what is Bovine spongiform encephalopathy
mad cow disease- from eating infected cattle meat
rapid mental deterioration within few months –> coma
epidural hematoma CT
convex (lens shaped) bleed
doesn’t cross suture line
gonococcal meningitis maintenance
vacine >55yo and high risk
tx close contacts w/ ciprofloxacin or rifampin
Guillain barre syndrome sx
ground to brain syndrome
preceding respiratory or GI infx
decreased DTR (LMN lesion), breathing difficulty
Guillain barre syndrome caused by
campylobacter jejuni
Guillain barre syndrome tx
plasmapheresis
IVIG
mechanical ventilation if respiratory failure
prednisone CI
huntington dz dx
CT scan: cerebral and caudate nucleus atrophy
genetic testing
PET scan: decrease glucose metabolism in caudate nucleus and putamen
huntington dz tx
no cure
chorea: antidopaminergics
antipsychotics, tetrabenazine
sleep and chorea: benzo
Lateral medullary (Wallenberg) syndrome sx/dx
head impulsive, nystagmus, test of skew exam
CT/MRI
basal ganglion lesion sx
problems w/ speech, movement, and posture
“parkinsonianism”
cerebellum lesion sx
dyssynergia, dysmetria, dysarthria, ataxia
ipsilateral
cerebral meningioma dx
CT/MRI: intensely enhancing well defined lesion attached to dura
brain bx guided by imaging studies
meningococcal meningitis sx
positive kernig
positive brudzinski
Multiple sclerosis sx
uhthoffs phenomenon
Lhermittes sign
optic neuritis, vision loss
Marcus gunn pupil
UMN= spasticity, + upward babinski
multiple sclerosis dx
clinical dx - at least 2 discrete episodes
MRI w/ gadolinium TOC= white matter plaques, hyper densities (hallmark)
LP: increased IgG in CSF
multiple sclerosis tx
acute exacerbation: IV high dose CS 1st line. plasmapheresis if refractory
relapsing-remitting/progressive: beta interferon or glatiramer acetate
fatigue: amantidine
spasticity: baclofen and diazepam
Myesthinia gravis sx
strongest in morning, weakest in evening
Myesthinia gravis labs
AChr-ab
MuSK ab assays
edrophonium (tensilon) test
ice pack test
Myesthinia gravis tx
pyridostigmine/neostigmine 1st line
plasmaphoresis/IVIG
thymectomy if thyoma
avoid FQ or aminoglycosides
MC brain neoplasm
glioblastoma- most aggressive and MC
neoplasm in frontal lobe sx
dementia, personality changes, gait, expressive aphasia, seizures
neoplasm in temporal lobe sx
partial complex and generalized seizures
neoplasm in parietal lobe sx
receptive aphasia
contralateral sensory loss
hemianopsia
spacial disorientation
neoplasm in occipital lobe sx
contralateral homonymous hemianopsia
neoplasm in thalamus sx
contralateral sensory loss
neoplasm in brainstem sx
papillary changes
nystagmus
hemiparesis
peroneal nerve injury sx
provides sensation to lateral leg
innervates peroneous longus, peroneus brevis, and short head of biceps
injuries can lead to foot drop
neurogenic shock sx
decreased CO, warm dry skin, normal/decreased HR, wide pulse pressure
decreased SVR, bradycardia
decreased PCWP
due to acute spinal cord injury or regional anesthesia
ulnar nerve neuropathy sx
+ tinels sign
+ froments sign
vagus nerve normal fx
CN 10
motor: voice, soft palate, gag reflex
sensory: information about organs
parkinsons dz tx
levodopa/carbidopa most effective
DA agonist: bromocriptine, pramipexole, ropinirole (to delay use of levodopa)
Ach: benztropine (<70yo w/ tremor predominance)
restless leg syndrome tx
DA agonist TOC (pramipexole, ropinirole
gabapentin, pregabalin
benzo adjunct (clonazepam)
opioids in disease resistant cases
iron supplement w/ ferritin <75
can’t give to patients with seizure disorder
Cant drive for 2 yrs, need to balance meds
buproprion lowers seizure threshold
Tdap cannot give
subarachnoid hemorrhage (SAH) sx
sudden onset HA
thunderclap
worse HA of my life
subarachnoid hemorrhage dx
CT first line –> LP (looking for blood or xanthochromia) –>
4 vessel angiography after confirm SAH
subarachnoid hemorrhage tx
refer to interventional radiology for surgery
nimodipine, nicardipine, labetalol to lower BP
supportive tx
decrease ICP: mannitol, hyperventilation, head elevation
subdural hematoma CT
concave (crescent shaped) bleed
can cross suture line
tardive dyskinesia tx
clonazepam, valbenazine, deutetrabenazine
clozapine good if pt needs antipsychotic tx
TIA dx
CT head BIT
carotid doppler, CTA, MRA
ABCD2 score to assess CVA risk
trigeminal neuralgia (tic douloureux) tx
carbamazepine 1st line
oxcarbazepine
gabapentin, baclofen
trigeminal neuralgia CN
CN5
tumor lysis syndrome labs
hyperuricemia
hypocalcemia
kyperkalemia
hyperphosphatemia
acute renal failure
