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Flashcards in Neuro Deck (34):
1

ABCD2 Score

  • Age >=60
  • Blood pressure (HTN)
  • Clinical features
    • speech disturbance but no unilateral weakness = 1
    • unilateral weakness = 2
  • Duration
    • >= 10 min = 1
    • >= 60 = 2
  • Diabetes

2

Cutoffs for carotid endarterectomy

  • >= 70% stenosis within 2 weeks
  • some benefit for >= 50 % within 2 weeks
  • with symptoms

3

Miller-Fisher variant of Guillain-Barre Syndrome

Ataxia, eye muscle weakness, areflexia but usually no limb weakness.

4

Classic Findings of Guillain-Barre Syndrome

Symmetric ascending paralysis with areflexia

5

Brachial Plexus arises from which spinal levels?

C4-T1

6

Definition: status epilepticus

  • 5 minutes of either continuous seizure activity or 2 or more sequential seizures without full recovery of consciousness between the seizures

7

Definition: refractory status epilepticus

  • sz continues despite 2 drugs

8

Lorazepam Dose Status Epilepticus

Lorazepam (best IV agent)

  • 0.1 mg/kg, max 4 mg IV/IM, may repeat x 1 in 4 minutes
  • onset 1-5 min (15-30 min IM), duration 12-24 h

9

Midazolam Dose Status Epilepticus

midazolam (best IM agent)

  • 10 mg (0.2 mg/kg) IM x 1, no repeats
    • onset 5-15 min, duration 1-6 h
  • 5-10 mg (0.1-0.2 mg/kg) IV
    • onset 1-5 min, duration 1-6 h
  • 0.2 mg/kg intranasal (max 10 mg)

10

Lab work to differentiate between sz and PNES

  • prolactin within 20 min of event > 2x ULN predictive or true sz but not perfect
  • lactate rises causes WAG acidosis (resolves within 30 min)

11

Approach to sz in known epileptics

  • check drug levels, glucose
    • if low, give loading dose (PO or IV)
  • DC home when stable
    • if therapeutic and sz not more freq than expected, DC home
  • if can't check (keppra) and noncompliant, give usual home dose before DC
  • If compliant and therapeutic and increased freq/duration of seizures, speak with neurology about adding on agents or adjusting dose
  • f/u 1-3 days if changing dose

12

Approach to first-time sz

  • plain CT Head, ext lytes, tox screen, CBC, ECG
  • if no secondary cause, MTO, DC with f/u, no tx
  • children:
    • > 6 months, single afebrile sz not requiring tx = DC home with outpt MRI if back to neuro baseline
    • no routine labs needed in complex febrile or afebrile sz, use clinical picture
  • neonates:
    • full septic workup + extended lytes + abx with any sz
    • lactate, ammonia, amino acids + urine amino acids

13

Parasitic cause of sz in developing world

Neurocysticercosis

  • most common cause sz in developing world
  • CNS infection by larvae of taenia solium taperworm
  • sz from parasite degenerating, leaving fibrosis

14

Baseline rate of aneurysms in gen pop

2-6%

15

Sensitivity of CT (-) for SAH

  • CT (-): 98% sens @ 6 h, 90% @ 24 h, 50% @ 1 wk

16

How long does it take for xanthochromia to develop in SAH?

  • 12h

17

SAH Treatment

  • HOB 30 deg
  • glu, temp control, reverse anticoag
  • SBP < 140
    • labetalol/nicardipine
  • nimodipine 60 mg PO Q4h (start within 96 h of onset)
    • for vasospasm, risk of which is greatest 2 days-3 weeks

18

Autonomic Dysreflexia

  • in patients with spinal lesions/open neural tube defects
  • paroxysmal sympathetic + parasympathetic hyperactivity initiated by stimuli below level of lesion
    • bladder distension, fecal impaction, fracture

  • sweating, flushing, ha, htn, bradycardia, piloerection

  • tx is remove stimuli

19

Symptoms of Myesthenia Gravis

  • prox muscle weakness relieved by rest
  • facial and bulbar muscle weakness
  • ptosis, diplopia, internuclear opthalmoplegia
  • usually no sensory, reflex, or cerebellar deficits

20

Myesthenia Gravis (Read Through)

Evernote "Chronic Neurological Disorders"

21

Optic Neuritis

  • usually monocular, painful vision + colour vision loss over several days
  • often preceded by retrobulbar/extraocular muscle pain reproducible by periorbital palpation
  • often RAPD (Marcus Gunn pupil)
  • hallmark of MS

22

Multiple Sclerosis (Read Through)

"Chronic Neurological Disorders"

23

Lambert-Eaton Syndrome

  • weakness that gets better with exercise
    • hand grip increases in strength over time
  • paraneoplastic syndrome
  • no specific treatment, refer neuro/medicine

24

Parkinson's Disease

  • resting tremor
  • cogwheel rigidity
  • bradykinesias, akindesias
  • impaired postural reflexes
  • sensory deficits, extremity pain
  • cardiac dysrhythmias, orthostatic hypotension, dyskinesias, dystonias from dopaminergic therapy
    • sometimes drug holiday/reduction in dose may help, discuss with neuro

25

GBS Syndrome

  • symmetric ascending paralysis, no sensory deficit

26

Classic GBS CSF Finding

  • cytoalbuminologic dissociation (high protein, low WBC)

27

GBS (Read Through)

"Acute Peripheral Neurologic Disorders"

28

Bell's Palsy

Important physical exam test

Tx

Dispo

  • may be preceded by pain behind ear
  • r/o otitis/mastoiditis
  • test EOM (should be full)
  • prednisone 1 mg/kg daily x 7d
  • no benefit to antivirals
  • patch eye if incomplete closure, f/u urgent optho
  • if can close, artificial tears
  • f/u GP or ENT within 7d

29

Ramsey Hunt Syndrome

  • HZV of geniculate ganglion
  • may also have CN VIII involvement with vertigo, nausea, hearing loss
  • prednisone + valacyclovir 1 g TID x 7d

30

Botulism Clinical Syndrome

  • descending, symmetric paralysis
  • CN + bulbar affected first
    • diplopia, dysarthria, dysphagia, blurred vision
    • pupils often dilated, nonreactive --> important to differentiate from myesthenia which has normal pupils
    • may have anticholinergic syndrome
  • floppy infant with constipation and weak cry
  • no sensory deficit, no pain

31

Botulism (Read Through)

"Acute Peripheral Neurologic Disorders"

32

Vertigo (Read Through)

"Vertigo"

33

Trigeminal Neuralgia

  • tic douloureux
  • severe pains lasting only seconds
  • no pain between episodes
  • tx: carbamazepine 100 mg PO BID --> GP to increase, refer to neurologist

34

Seizure Meds that can be measured

  • phenytoin (Dilantin)
  • carbamazepine (Tegretol)
  • valproic acid (Epival)