Flashcards in Neurology 2 Deck (58):
What types of stroke have no Tx to reverse them?
Surgical drainage will NOT help where?
outside of the Posterior Fossa
If patient is already on Aspirin at the time of stroke, after 3 hours what would you give for Tx?
- Add Dipyridamole
- Switch to Clopidogrel
Most common type of headache?
(though it is a dx of exclusion)
Type of Headache?
Visual disturbance, systemic symptoms such as muscle pain, fatigue, & weakness
Giant Cell Arteritis
- also includes Jaw Claudication
Type of Headache?
Ass'd w/ obesity, venous sinus thrombosis, oral contraceptives, & vitamin A toxicity
- Mimics a brain tumor w/ nausea vomiting, & visual disturbance
Type of Headache?
Mimics a brain tumor w/ nausea vomiting, & visual disturbance
- Ass'd w/ obesity, venous sinus thrombosis, oral contraceptives, & vitamin A toxicity
PE findings in Tension headaches?
PE findings in Migraine?
Usually none, but rare cases have aphasia, numbness, dyarthria, or weakness
PE findings in Cluster headache?
- Red, tearing eye w/ rhinorrhea
- Horner syndrome occasionally
PE findings in Giant Cell Arteritis?
- Visual loss
- Tenderness of the Temporal area
PE findings in Pseudotumor Cerebri?
- Papilledema w/ diplopia from 6th cranial nerve (abducens) palsy
What does Pseudotumor Cerebri show on LP?
Increased pressure only.
CSF itself is normal
Most accurate Dx test for Giant Cell Arteritis?
Also ass'd w/ markedly elevated ESR
NSAIDS & other analgesics
Triptans or Ergotamine as abortive therapy
Triptans, Ergotamine, or 100% Oxygen as abortive therapy
Giant Cell (Temporal) Arteritis
- Acetazolamide - to dec CSF prod
- Steroids help
- Repeated LP rapidly lowers ICP
- Place V-P shunt or fenestrate (cut into) the Optic Nerve if medical therapy doesn't control
Prophylaxis Tx for Cluster headaches?
Prophylaxis Tx for Migraines? When do you give proph Tx?
- Give this if having 3 or more migraines per month
others include CC-blockers, TCAs, SSRIs, Topiramate, Botulinum toxin injections
Trigeminal Neuralgia Tx?
Oxcarbazepine or Carbamazepine
- Baclofen & Lamotrigine also have been effective
- Gamma knife surgery if meds ineffective
Postherpetic Neuralgia Tx?
TCAs, Gabapentin, Pregabalin, Carbamazepine, or Phenytoin
- Topical Capsaicin helpful
- Most antiepileptic meds are effective, but none of them in more than 50-70% of patients
Indication for Zoster vaccine?
All persons >60 yrs.
Status Epilepticus Tx?
1st = Benzodiazepine
- if persists, give Fosphenytoin or Phenytoin
- if still persists, give Phenobarbitol
- if still, give neuromuscular blocking agent such as Succinylcholine, Vecuronium, or Pancuronium to allow intubation & anesthesia such as Midazolam or Propofol
IV Phenytoin adverse effects?
Hypotension & AV block (Class 1b anti-arrhythmic)
(Fosphenytoin has fewer SEs & same efficacy)
Can neuromuscular blocking agents stop seizure?
No, they just stop muscular contraction or the external manifestation of the seizure
What is a partial seizure?
Seizure focal to one part of the body
Can be simple (intact consciousness) or complex (loss or alteration of consciousness)
Opioids used for diarrhea?
Loperamide & Diphenoxylate
Opioid used for cough suppression?
- Very weak opioid agonist
- Also inhibits 5HT & NE reuptake
Initial Tx for MS?
- Steroids during exacerbations
- B-interferons or glatiramer Acetate (Copaxone) for proph
How long should a patient be seizure-free for you to D/C antiepileptics?
Sudden onset severe headache w/ meningeal irritation (stiff neck, photophobia), & fever
(ruptured aneurysm of ant. circle of Willis)
- LOC in 50% due to inc'd ICP
How does SAH differ from meningitis?
SAH is very sudden in onset & is ass'd w/ LOC
SAH: best initial test?
CT w/out contrast (95% sensitive)
SAH: most accurate test?
Lumbar Puncture showing bleed
Normal WBC:RBC ratio in CSF?
WBC:RBC = 1:500 - 1:1000
In general, when do you use contrast on CT?
When looking for mass lesions like cancer or abscess.
Do NOT use contrast when looking for blood!
After SAH dx, how do you determine which vessel ruptured?
CT angiography, standard angiography w/ catheter, or MRA
Best initial Tx for bacterial meningitis?
Vancomycin, Metronidazole, & Ceftriaxone
Pseudotumor Cerebri: ass'd w/ what 4 things?
- Venous Sinus Thrombosis
- Oral Contraceptives
- Vitamin A toxicity
4 primary presenting symptoms of meningitis?
- Neck stiffness (nuchal rigidity)
Meningitis: best initial test?
Meningitis: most accurate test?
When would a head CT be necessary prior to LP?
Only if there is a possibility of a space-occupying lesion. I.e. if there is:
- Focal neurological abnormalities
- Confusion interfering w/ neuro exam
Papilledema - what's it look like on fundoscopic exam?
Blurred, fuzzy disc margin
(from increased ICP)
When do you give ABX prior to LP in suspected meningitis?
If there is a c/i to IMMEDIATE LP, then give ABX as first step
What test is indicated if patient has received ABX prior to LP in suspected meningitis?
Bacterial Antigen Detection (Latex Agglutination Test)
-- necessary b/c of ABX, culture may be falsely negative
-- extremely specific
-- not sensitive enough to exclude if negative
Decorticate posturing consists of what?
Upper-extremity adduction and flexion at the elbows, wrists, and fingers, together with lower-extremity extension, which includes extension and adduction at the hip, extension at the knee, and plantar flexion and inversion at the ankle
Decerebrate posturing consists of what?
Upper-extremity extension, adduction, and pronation together with lower-extremity extension
Decorticate posturing means what?
This occurs with dysfunction at the cerebral cortical level or below and may reflect a "release" of other spinal pathways
Decerebrate posturing means what?
Traditionally implies dysfunction below the red nucleus, allowing the vestibulospinal tract to predominate
Which response to pain has better prognosis -- decorticate or decerebrate?
Major cause of morbidity in the first 24 hrs after SAH?
Major cause of morbidity 3-10 days after SAH?
(likely caused by arterial narrowing @ base of brain due to degradation of blood & its metabolites leading to cerebral infarction)
How to prevent vasospasm following SAH?
Initiate tx w/ Nimodipine