NEURO Flashcards
(26 cards)
Abortive therapy for migraine headache?
Prophylactic treatment?
sumatriptan (Imitrex) or ergotamine to abort migraine headache
propranolol (justified when 4+ HA/month) for migrain ppx
Abortive therapy for cluster headache?
Prophylactic treatment?
triptans, 100% oxygen, steriods to abort cluster headache
verapamil (CBBs) for cluster HA ppx
Which headache occurs in men (10 times more likely)
cluster
Name triggers for migraine
Cheese
Caffiene
Menstruation
Oral contraceptive
Vertigo that changes with position. Dx?
**Benign Positional Vertigo **
Will have a postive Dix-Hallpike maneuver
–> tx with meclizine
Vertigo only. No hearing loss or tinnitus. Dx?
Vestibular neuritis
Is inflammation of the vestivular portion (therefore no hearing loss/tinnitus) of 8th cranial nerve. Presumably viral. No tests. Give meclizine.
Vertigo + hearing loss / tinnitus following URI. Dx?
Labyrinthitis
Is inflammation of the cholea. Self limited. Give meclizine.
Vertigo + hearing loss / tinnitus that is remitting and relapsing. Dx? Tx?
Meniere’s Disease
Tx with salt restriction and acetazolamide.
HA + tenderness temporal area + jaw claudication. Dx? Feared complication?
Temporal arteritis
Blindess is the feared complication.
If visual sx –> high dose steroids
If no visual sx, get ESR, do bx
HAs constantly preceded by menstruation.
Dx?, Tx?
Migraine Headache (mentruation is trigger)
Give low dose estrogen (HA caused by estrogen withdrawal)
Patient with migraine. You want to give sumatriptan. What are the major contraindications to triptans?
Ischemic heart disease, Previous MI, Angina, Uncontrolled HTN
SSRIs, MAOIs, lithium
Obese female on OCP with diplopia (6th nerve palsy). Dx? Tx?
Pseodotumor cerebri (Idiopathic Intracranial Hypertension)
Give acetozolamide or lasix –> if no success, recurrent LPs –> if no success, VP shunt
Physical exam clue to differentiate betwen stroke and Bell’s Palsy?
Stroke spares the forhead (will be able to wrinkle forehead).
Bell’s palsy may not
Pt with obvious stroke. Window for TPA?
3 hours
(but MUST do non-con head CT first to r/o hemorrhage –which is 20% of strokes)
What are the absolute contraindications to TPA for stroke?
Previous CVA or head trauma in 3 months
Uncontrolled HTN (>185/110)
Previous intracranial hemorrhage
Intracranial mass
Recent brain or spinal surgery
Bleeding disorder, Active internal bleeding, Already anticoagulated, platelet < 100,000
Indication for carotid endarterectomy?
70% occulusion with symptoms
**BUT **not if it’s 100% occluded. Then risks outweight benefits.
Treatment of trigeminal neuralgia?
carbamazepine
Stroke in a younger patient (<50). What is the cause?
More likely vaculitis or hypercoaguable state
Workup for CVA?
Echo (vegetations)
Carotid dopper/duplex (endarterctomy if 70%)
EKG/holter
Also, if under age 50
Hypercoaguable workup (ANA dsDNA, protein C, S FV leiden def, antiphospholipid, etc)
Vasculitis workup (ESR, VDRL, RPR)
Treatment for Parkinson Disease
Age over 60 = carbidopa/levodopa
Age under 60 = anticholenergics (benztropine)
Treatment for restless leg syndrome?
Pramipexole (dopamine agonist also used in Parkinson Disease)
Most important component of CSF analysis for dx of bacterial meningitis
Cell count: thousands of neutrophils = start IV CTX/Vanc/steroids. (Cx is best, obviously, but results later)
Gram stain
Protein: elevated in all meningitis (if low, not meningitis)
Glucose: low in bacterial meningitis
What is the interpretation of the FENa
< 1% = prerenal
1 - 2% = renal
> 2% = ATN