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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

ICU: pt with continued AMS after anoxic brain injury or head trauma. Think what

Possible non convulsive Status epilepticus. Get EEG