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64 Cards in this Set
- Front
- Back
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Risk Factors of Stroke
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Smoking. Hypertension. Hyperlipidema. Family history. Diabetes.
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Types of Strokes
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Hemorrhagic. Ischemic.
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Mechanisms of Stroke
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Thrombus. Emboli
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Emboli Sources of Stroke
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A. fib. Valvular heart disease. DVT paradoxical embolism. Carotid Stenosis.
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MCA Stroke and Presentation
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Weakness or sensory loss on contralateral side of vessel. Contralateral homonymous heminopsia. Aphasia if same side as language center left in right handed
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ACA Stroke and Presentation
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Presents with leg weakness. Personality changes. Urinary incontenance.
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PCA Stroke and Presentation
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Ipsilateral sensory loss of face. 9th and 10th Cranial nerves. Contralateral sensory loss of limbs. Limb ataxia.
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Diagnostic Tests and Stroke
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CT done first to rule out hemorrhagic stroke. MRI is most accurate, becoming 95% sensitive at 24 hrs, versus 5 days for CT scan.
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Treatment of Stroke
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If three to 4.5 hrs then thrombolytics. If greater than aspirin. If hemorrhagic no treatment.
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If On Aspirin at Time of Stroke
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Add dipryidamole. Or switch to clopedigrel.
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Evaluation of Cause of Stroke
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Echocardiogram. EKG. Halter Monitor. Carotid doppler.
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A. Fib and Stroke Prevention
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Give warfarin, with out bridging, INR 2 to 3.
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Treatment of Carotid Stenosis
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Endarterectomy only for those patients of greater than 70% stenosis.
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Control Risk Factors for Stroke
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HgbA1C below 7%. 140/90 for hypertension. LDL below 100 if carotid stenosis.
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Migraine Most Likely Diagnosis
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Associated with schitoma, visual disterubances, nausea, vomiting, related to menses. On sided headache with photophobia. Triggers like chocolate and cheese.
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Cluster Headache Most LIkely Diagnosis
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Occur one time of year, usually occur at night. Is sharp stabbing pain high intensity. Rhinorrhea.
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Giant Cell Temporal Arteritis Most Likely Diagnosis
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Unilateral headache with point tenderness with visual disturbances. Systemic symptoms such as jaw pain.
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Pseudotumor Cerebri Most Likely Diagnosis
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Risk factors include obesity, oral contraceptives, venous sinus thrombis, and vitamin A toxicity. Mimics brain tumor with nausea and vomiting. Papilledema with diplopia form sixth cranial nervy palsy.
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Imagining and Headache
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MRI only done if new onset or tumor symptoms are high suspicion.
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Pseudotumor Cerbri Work Up
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MRI to rule out tumor. LP will have increased pressure.
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Tension Headache Treatment
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NSAIDs
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Migraine Treatment
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Triptans. Ergotamine as abortive therapy.
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Cluster Headache Treatment
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Triptans. Ergotamine. 100% Oxygen as abortive treatment.
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Pseudotumor cerbri Treatment
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Acetazolamide decrease CSF production. Steroids. Lose weight. Rapid LP. Shunt placement.
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Prophylactic Treatment for Migraines
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If patient is experiencing greater than 3 migraines a month place on propanolol. Alternatively calcium channel blockers, TCA, SSRI, and Botulinum toxin.
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Trigeminal Neuralgia Presentation and Treatment
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Presentation is stabbing pain in the cheek when touched or tounge hitting teeth. Treated with carbamazepine.
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Postherpatic Neuralgia Treatment
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Is due to reactivation of herpes zoster. If acyclovir given early can reduce incidence of pain after rash. Pain can be treated with carbamezipine, or phenytoin, gabapentin, and pregabalin.
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Zoster Vacine
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Given to patients over 60.
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Generalized Seizure Causes
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Hypo/hypernatremia. Hyperuricemia. Hypocalcemia. Hypoglycemia. Hypomagnesia. Hypoxia. CNS infections. CNS tumors. Alcohol withdraw. Cocaine toxicity.
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EEG and Seizure
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Have to rule out all other causes prior to doing EEG.
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Confusion and Seziure
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Confusion is the preceeding symptom to coma and seizure.
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Treatment of Status Epilpeticus
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Treat first with diazepam and lorazepam. If that fails then fosphenytoin, as it is less associated with AV block and hypotension. If this fails then phenobarbital. If this fails then neumuscular junction blockers to protect muscles.
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Single Seizure and Treatment
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Do not need seizure treatment if first seizure, unless presenting status eplepticus, family history of seizures, or abnormal EEG.
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Best Initial Treatment of Absence Seizures
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Ethosuximide.
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Best Treatment of Tonic-clonic Seizure
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No best initial. Try one, if fails try another. Add a second one if two fail.
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Discontinuing Seizure Medications
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Seizure free for 2 years. Can due EEG sleep depervation study.
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Driving and Epilepsy
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Can not hold patient in office, can only recommend another form of transportation.
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Risk Factors for Subarrachnoid Hemorrhage
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Polycystic Kidney Disease. Smoking. Hypertension. Hyperlipidemia. High Alcohol consumption.
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Subarrachnoid Hemorrhage Most Likely Diagnosis
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Look for severe headache, neck stiffness, and fever due to meningeal irritation. May lose consiousness and have neurological deficits due to increased intercranial pressure.
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Subarrachnoid Hemorrhage vs. Mengingitis
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SAH sudden onset and loss of consciousness.
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Best Initial Test for SAH
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CT Scan
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Most Accurate Test for SAH
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Lumbar puncture with blood.
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LP and SAH
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Xanthochromia is the yellow discolarization in CSF from blood. WBC might be elevated, but the ratio is normal to RBC (500 to 1000). If WBC greater ratio then think meningitis.
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Contrast CT and SAH
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Only helpful with abscess or cancer. Does not help look for blood.
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Determining Vessel Rupture
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CT-angiography, Catheter angiography. MRA.
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Treatment of SAH
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Nothing can reverse the bleeding. Nimodipine to prevent cerebral ischemia. Emoblization with platinum coil, if not a choice then surgical clipping. Seziure prophylaxis with phenytoin.
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Anterior Spinal Artery Infarction
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Loss of everything except posterior column. Flaccid paralysis. Loss of pain and temperature. Postive babinsky.
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Subacute Combined Degeneration of Cord
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Occurs due Vit B12 deficiency. Loss of position and vibratory sense.
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Brown Sequard Syndrome
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Transection of half of the spinal cord. Ipsilateral posterior touch, pressure, proprioception, vibration, ipsilateral spastic paralysis, and contralateral pain and temperature.
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Syringomyelia Presenation and Treatment
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Caused by dilatation of the spinal canal due to truma or tumor. Results in cape like distribution of loss of pain and temperature on back and arms. MRI is best initial test. Treated surgically.
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Causes of Brain Abcess
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Direct dissemination from mastoid cells, otitis media, and sinuses. Anything that leads to bacteremia can cause seeding in brain like pneumonia and endocarditis.
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Presentation of Brain Abscess
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Nausea. Vomiting. headache, fever, seizures, and focal neurological deficit. Can not tell the difference between cancer and abscess with out biopsy.
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Best Initial Test for Brain Abscess
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CT or MRI. Findings are a ring or contrast enhancing lesion that will have surrounding edema.
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Most Accurate Test for Brain Abscess
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Biopsy.
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Empiric Treatment for Brain Abscess
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Penicillin, metronidazole, and ceftriaxone. If risk of staphylcocci, such as brain surgery, then vancomycin.
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Tuberus Sclerosis Treatment
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CNS pathology of seizures, psychomotor retardation, and mental deterioation. Skin adenoma sbaceum, shagreen patches (leathery plaques on trunk), and Ash leaf patches. Retinal lesions. Cardiac rhabdomyomas.
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NF1
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Neurofibromas. Cafe au lait spots. Menigiomas and gliomas. Eighth cranial nerve tumors.
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Sturge Weber Syndrome
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Port Wine stain of the face, seizures, CNS homonymous hemianopsia, hemiparesis, and mental subnormality. Xray shows calcified angiomas.
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Essential Tremor
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Occurs at rest and intention. Improved with alcohol. Caffiene makes it worse. Treated with propanolol.
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Risk Factors for Parkinsons
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Boxer. Antipsychotic treatment. encephalitis, reserpine, and metoclopromide.
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Diagnosis of Parkinsons
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All clinical.
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Presenation of Parkinsons
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Bradykinesia. musclar rigidty, resting tremor, and shuffling gait. Facial expression limited. Orthostatic hypotension
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Mild Disease Treatment of Parkinsons
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Antichoinergic helps tremor and ridgidy.
Amantadine - above 60 and intolerant of anticholinergic |
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Severe Disease Treatment of Parkinsons
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Levdopa/carbidopa. Dopamine agonists. COMT inhibitors. MAO inhibitor.
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