Flashcards in 6 Neuro Deck (21):
1
Acute ischemic stroke, first day after admitted.
Carotid U/S or CTA. what looking for?
If >70% stenosis with sxs, do carotid endartectomy
If <70% or no sxs, medical management
2
Pt with acute ischemic stroke, not getting TPA. When does not get ASA? (3)
do no give with TPA
1. allergy--Plavix
2. GI bleed--plavix
3. stroke while on ASA--do ASA and dipyridamole
3
BP Goals in acute ischemic stroke
TPA
no TPA
TPA: must be 185/110 before TPA. then, keep <180/105.
no TPA: <220/120
4
seizure differential
VITAMINS
vascular
infxn
trauma
autoimmune
metabolic (glu, electrolyes)
idiopathic
neoplastic
'sychiatric'
5
sz types, general terms
1. generalized
-absence
-myoclonic
-clonic
-tonic
-atonic
2. partial (aka focal)
-simple partial
-complex partial
6
tremor types (3)
1. intention--cerebellar
2. postural--genetic/essential
3. resting--parkinsons
7
Parkinson's sxs
TRAPS
tremor
rigidity, cogwheel
akinesia
postural instability
shuffling gait
8
Parkinson's meds
-when to use each
1. >65, functional: amantadine
2. <65, functional: bromocriptine/pramipexole/ropirinole
3. older, nonfunctional: carbidopa-levodopa
9
Disk herniation tx:
surgery vs conservative
same outcome at 1 year, but surgery better earlier at 6 mo.
10
Elderly male with sciatica sxs, but no heavy lifting hx. Think what
Osteophyte (similar presentaion as herniated disk)
-get XR then MRI to r/u compression fx. May need surgery
11
spinal stenosis
-what sxs
-what dx and tx
leg/butt 'claudication' but posttional (shopping cart sign)
-XR is normal, MRI shows
-laminectomy
12
Delirium: how to assess
CAM--confusion assessment method: (AIDA)
-Acute onset, fluctuating course
-Inattention
-Disorganized
-Altered LOC
1st 2 must be present, + #3 or #4.
13
Normal pressure hydrocephalus: sxs
wet, wobbly, wacky
14
Peripheral vertigo DDx (4 main ones), and their tx
short duration:
BPPV--epley
Meniere's--also hearing loss. Low salt and diuretics
long duration:
vestibular neuritis
labyrinthitis--also hearing loss
(these get steroids if dx'ed early)
15
States of coma/brain function (3), what is difference
Tests: EEG (cortex), Reflexes (brainstem)
Coma: decreased EEG, reflexes good
PVS: No EEG, yes reflexes
Brain dead: No EEG, no reflexes
16
Brain death reflexes (3)
1. corneal
2. cold water caloric stim
3. VOR (dolls eyes)
17
myasthenia gravis
-crisis tx
-chronic tx--first line, refractory
acute myasthenic crisis: IVIG or plasmapheresis
-pyridostigmine first line (cholinergics)
-refractory--AZT, prednisone
-also thymectomy
18
What autoimmune dz you don't give steroids? (2)
-Guillain barre
- MS 'pseudorelapse'-- when sxs worsen from a reversible inflammation (eg UTI infection). Always r/u infection!
19
Guillan Barre
-tx
IVIG or plasmapheresis
NEVER steroids
20
MS: When NOT to give steroids in a flare?
When the 'flare' is a pseudorelapse. caused by reversible infection or other inflammation.
21