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118 Cards in this Set
- Front
- Back
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what are 3 different types of generalized sz
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Tonic clonic
Absence Myoclonic |
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describe tonic clonic sz
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grand mal sz
tonic phase with contractions of muscles-moan, crying, tongue bite clonic phase- int relaxing and tensing |
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what are partial or focal sz
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instead of diffuse genralized brain activity in generalized sz partial involve discrete areas
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what are 3 types of focAL OR PARTIAL SZ
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simple- no loc
complex- with loc partial with secondary generalized |
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WHAT IS THE PNEUMONIC FOR ETIOLOGY OF SZ
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ABCDE
A--ALCOHOL WD, ILLICIT DRUGS, MEDS LIKE B-LACTAMS,MEPERIDINE, CYCLOSPORINE B--BRAIN TUMOR OR TRAUMA C--CVA, SDH D--DEGENRATIVE DZ OF CNS E--ELECTOLYTES DISTURBANE |
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what is the complication of status epilepticus
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Rhabdo
neuronal death lactic acidosis |
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how do you define status epilepticus
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continious tonic clonic activity > 30 min or repeated sz such that there is no resolution of postictal state
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when should yo use antiepileptic drugs
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structural abnormalities or idiopathic sz PLUS one of these
1. status in presentation 2. focal neurological exam 3. post ictal todds 4. abnormal EEG |
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what is the primary antiepiletic agent for abscense sz
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1. Ethosuximide
2. valproic acid |
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what are SE of dilaltin
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gum hyperplasia
Low Ca High K |
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what are SE of tegretol--carbamazapine
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Aplastic anemia
leukopenia Hepatotoxic Hyponatremia |
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what are SE of Depakote/Valproic acid
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Liver toxic
Thrombocytopenia |
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what is the first line agent for status epilepticus
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Ativan
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what is the 2nd line agent for status if Ativan is not able to break sz after 4mg
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Phenytoin
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what is the drug that is used to control status sz if ativan and phenyton failed to stop sz
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Phenobarbital
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breif sharp orbital HA that may awaken from sleep
lacrimation rhinorrhea unilateral horners |
Cluster
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what are drugs used for ppx for Migraines
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TCA
Tylenol Valproic acid topiramite |
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which anitdepresent should be use to avoid weight gain and fewere sexual SE
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Bupropion
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what defecit is seen with ICA or opthalmic artery stroke
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amaurosis fugax
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what do you expect from ACA stroke
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hemiplegia --leg>arm
confusion urinary incontinece primitive reflexes |
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what do you expect from MCA stroke
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Hemiplegia arm>leg
hemianesthesia homonomous hemianopia aphasia |
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what do you expect from verteral artery cva
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wallenberg syndrome
numbness of ipsilateral face and contralateral limbs diplopia dysrthria ipsilateral horners |
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basilar artery stroke
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pinpoint pupils
cranila nerve abnormalities cerebellar dysfunction sensory or motor defecits on one sdie of the face and the opposite side of the body |
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cerebellar stroke
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vertigo
nausea vomiting nystagmus ipsilateral limb ataxia |
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what is the pathology of AD
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deposition of insoluble β-amyloid protein in extracellular parenchymal plaques
Tangled Tau proteins |
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what are the risk factors for AD
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advanced age
genetic predisposition cardiovascular dz postmenopausal women |
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history of failing to meet responsibilities, poor social decision making, inappropriate behavior, and apathy.
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FTD
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accompanying visual hallucinations, fluctuating cognition, and parkinsonism
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Lewy body dementia
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what is the ddx for CJD
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primary angitis
hashimoto encephalitis |
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how can you definitvely establish dx of CJD
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brain bx
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what is hashimoto encephalistis
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antithyroglobulin antibodies and is manifested by seizures, dementia, myoclonus, and ataxia
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In CJD what does EEG shows that brain bx might be avoided for dx
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periodic short waves
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what test may be helpful in dx of cjd in subacute dementia
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14-3-3 in CSF
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what are primary headache
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migraine
menstrual migraine tension chronic daily/reboun/medication overuse cluster |
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what are secondary headaches
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subarachnoid hemorrhage, meningitis
pseudotumor cerebri cerebral mass lesions giant cell arteritis |
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what is a migraine prodrome
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euphoria,
depression, food cravings, fatigue, hypomania, cognitive slowing, dizziness, or asthenia |
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what is the migraine aura
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within 1 hour of or during headache
Aura constitutes neurologic abnormalities, including visual loss, hallucinations, numbness, tingling, weakness, or confusion. |
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what is a complicated migraine
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occurs when aura persists >24 hours
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when should you consider prophylaxis for migraines
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patients who experience 2 or more days of headache per week.
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what meds may be used as ppx against migraine
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bb
CCB topamax valproic acid TCA Neurontin |
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describe presentation of cluster headaches
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typically unilateral and periorbital/temporal
conjunctival irritation/lacrimation, rhinorrhea/nasal congestion, eyelid edema, facial/forehead sweating, miosis/ptosis, and agitation. |
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compare and contrast migraine vs cluster HA
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cluster headache last 15 min to 3 hours, whereas migraine lasts for 4 to 72 hours
movements makes migraine worse and cluster better touching head hurts more with migraine and cluster always tapping their heads |
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what needs to be excluded before making the dx of cluster HA
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sleep disorder
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what are possbile txt for cluster HA
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PREDNISONE
triptans ccb |
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what are exclusion criteria for tpa
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ICH
CVA or head trauma during previous 3 mos GI or GU bleeding in previous 3 weeks major surgery or trauma during previous 14 days glucose >400 Plt <100000 SBP >185 or DBP >110 |
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when do u need to start stain as a secondary prevention for CVA
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begin statin regardless of XOL
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whata re some RF for SAH
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berry aneurysm
AVM arterial dissection coagulopathy cocaine use |
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Sudden severe headache...what do u need to think about
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arterial dissection
venous thrombosis pituitary apoplexy hypertensive emergency ICH |
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what is the role of factor VIIa in ICH
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limits the size of early enlargement of hemorrhage volume
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what antihypertensive agents are used in ICH
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nitroprusside
nicardipine labetalol |
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acute onset of memory dysfunction, inattention, disorganized thinking, altered level of consciousness
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Delerium
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mild parkinsonism, delusions, visual hallucinations
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Lewy body dementia
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prominent personality changes, behaviorial disturbance, onset before age 60
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FRONTOTEMPORAL DEMENTIA
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axial rigidity
bradykinesia retropulsion vertical gaze palsy |
progressive supranuclear palsy
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choreoathetosis and dementia
AD pattern |
Huntington dz
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what drugs can be used to slow down the intellectual decline in pt with AD
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Donepzil
Rivastigmine Galantamine |
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what drug slow down the cognitive decline in AD pt
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Memantine
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what drugs are used to txt depression in AD pt
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SSRI
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how do u treat delerium
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behavioral measures
if fail or ICu pt..Haldol |
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what drugs need to be avoided in pt with dementia and psychosis or behavioral disturbances
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ATYPICAL ANTIPSYCHOTICS SUCH AS ARIPIPRAZOLE, OLANZAPINE, SEROQUEL, RISPREDAL, ZYPREXA
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WHAT ARE POSSIBLE CASUES OF NON COMPRESSIVE MYELOPATHY
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MS
DEVIC DISEASE VITAMIN B12 DEF COPPER DEF SPINAL CORD INFARCTION |
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RECURRENT EPISODES OF MYELITIS AND OPTIC NEURITIS WITHOUT THE BRAIN LESIOSN TYPICAL OF MS
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NEUROMYELITIS OPTICA...DEVIC DISEASE
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PARAESTHESIAS, LE WEAKNESS, GAIT INSTABLITY,
PARAPRESIS VIBRATION AND POSITION SENSE LOSS SENSORY ATAXIA |
VIT B12 DEF
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HOW DO U SEE THE COPPER DEF WHEN IT PRESENTS AS MYELOPATHY
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PRESENTS AS VIT B12 DEF
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HOWS DOES INFACRCTION OF SPINAL CORD PRESENTS
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ACUTE ONSET
ANTERIOR SPINAL CORD ARTERY DISTRIBUTION VIBRATION AND POSITION SENSE INTACT BUT WEAKNESS AND PINPRICK SENSATION LOSS BELOW THE LEVEL |
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WHEN TREATING MS WHEN DO YOU NOT WANT TO GIVE THE INTERFERON
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LIVER DZ
DEPRESSION |
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WHAT ARE SOME 2ND LINE THERPAY FOR MS
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NATALIZUMAB
MITOXANTRONE |
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SE OF NATALIZUMAB
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PML
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SE OF MITOXANTRONE
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CARDIOTOXICITY
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what is the ddx for parkinsons dz
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shy drager syndrome
progressive supranuclear palsy dementia with lewy body medication induced parkinsonism |
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describe shy drager syndrome
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sever orthostatic hypotension
ataxia MRI shows necrosis of the putamen and cerebellar atrophy |
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unexplained falls typically backwards
inability to move eyes vertically parkinsonian features |
progressive supranuclear palsy
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what are drugs assocaited with meds induced parkinsonism
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reglan
haldol lithium alpha methyldopa |
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what drugs are started in early stage PD for younger pt
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pramipexole
Ropinrole |
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how do u treat drug induced dystonia
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stop the offending drug
benadryl benztropine |
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how do u treat restless leg syndrome
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treat iron def anemia
ropinirole pamipexole |
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what is the 1st line drug for partial simple or complex sz
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carbamazepin, dialtin, lamictal
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what is teh 1st line drug for generalized sz
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valproic acid
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pain tingling numbness in great toe and along medial foot
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tarsal tunnel syndrome
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txt for tarsal tunnel syndrome
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local steroid or surgery if severe
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what diseases need to be considered when thinking about multiple non contigous nerve defecits..mononeurtis multiplex
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vascultis
lymphoma amyloid sarcoidosis lyme dz DM |
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whats the txt for guillain barre syndrome
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plasma exchange and IVIG
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progressive proximal motor and sensory neuropathy that develops over months
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chronic inflammatory demyelinating polyneuropathy
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whats the txt for chronic inflammatory demyelenating polyneuropathy
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prednisone
IVIG Plasma exchange |
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flaccid paralysis of distal sensory loss
Cranial nerves spared assocaited with sepsis and organ failure |
critical illness polyneuropathy
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positive antiacetylcholine receptor ab
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MG
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what imaging needs to be obtained with pt with MG
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CT chest o r/o thymoma
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how do u establish the dx of MG
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single fiber electromyography
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what should be included in ddx for MG
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botulinism
eaton lambert syndrome |
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how do u distonguish between boutlinism and MG
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botulinism starts with cranial nerve involvment including diplopia, dysphagia, sluggish or non reactive pupils whereas pupils are normal in MG
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how do u distinguish between eaton lambert vs MG
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with eaton lambert progressive muscle weakness improves with repeptive movement and is casued by antibodes to volatge gated calicum channel
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what is the inital tretment for MG
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pyridostigmine
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what are some SE of pyridostigmin
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increased salivation
increased resp secretions sweating bradycardia |
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for MG who dod not respond to Pyridostigmine what are some other alternative txt
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prednisone
cyclosporine azathioprine |
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for MG pt when do we need to intubate pt
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if VC decrease to 15ml/kg
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if pt goes into respiratory failre with MG what needs to be done
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intubate and start plasmapharesis
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how do u differentiate between BPV and vestibular neuritis
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BPV sx last for seconds occurs multiple times a day
vetibular neuritis is acute and severe casues n/v and imbalance. sx can lasts upto hours. |
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repeated episodess of tinnitus, flctuating hearnign loss, severe vertigo accompanied eventually by a progressive sensorineural hearing loss
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Menere dz
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facial weakness, vertigo, diplopia, dysarthris
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vertebrobasilar insuffciecny
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what 3 thing son dix halpike manuver makes the dx of peripheral vertigo likley
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nystagmus begins 3-40 sec
stops within 30 sec fatgiuebality |
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what findigns on dix halpike mauver make the dx of central vertigo mor elikely
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nystagmus develos immediately
does not stop rapidly no fatiguablity vertical nystagmus |
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when u see asymteric hearing loss,,,what needs to be ordered
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MRi of brain and internal auditory canal
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what group of pt are at increased risk for neisseria meningitis infection
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pt with C5-C9 complemts def
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for what group of pt we need to start dexamethasone with abx in mengitis
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if suspect penumococcal mengitis and a glascow coma 8-11
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what abx for post neurosurgery pt or csf shunt and suspecting bacterial menngitis
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vanco + cefepime or meropenem
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when shoudl anticonvulasnt therapy should be started after sz
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after 2 or more unprovoked sz
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first line drug for AD
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Aricept
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describe tension type headache
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last 30 min to 7 days
B/L location pressure or tight quality does nto prohibit activity no n/v |
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how do u treat tension type headach
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NSAIDs
ppx with TCA |
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describe cluster headache
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last 20 -60 min several times per day
repating over weeks and then dissappear nasal congestion rhinits periorbital pain |
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how do u treat cluster HA
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triptan acutely
steroids to break cycle of headache verapamil for long term prevention O2 also helps |
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brief episdoe fo unilateral lancitaing pain in face,
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trigeminal neuralgia
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what needs to be ordered with some one with trigeminal neuralgia
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MRi to r/o any masses and MS
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daily headaches lastign 4 hours
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CHRONIC TENSION
REBOUND HA CHRONIC MIGRAINE CHECK FOR DEPRESSION OR SLEEP PROBLEM |
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disorder associated with rapidly progressive extremity weakness, paresthesias, and areflexia.
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GUILLEN BARRE
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WHAT DRUGS CAN CAUSE DRUG INDUCED DYSTONIA
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NEUROLEPTICS
ANTIEMETICS SEROTONIERGIC |
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HOW DO U TREAT MEDS RELATED DYSTONIA
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BENADRYL IV
BENZTROPINE |
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HOW DO U TEAT CERVICAL DYSTONIA
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BOTOX OR ANTICHOLENERGIC MEDS
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