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Neurology Topics Flashcards

(3 cards)

1
Q
Epidural Abscess
1- clinical presentation/clues
2- predisposing conditions
3- MCC (pathogens)
4- Dx
5- Management
A

1 - Fever (not always) and back pain +/- leg weakness/loss sensation, bowel/bladder

2 - DM, alcoholism, HIV, spinal trauma/hardware, local or systemic infection

3 - S. aureus 66%. Staph Epi, E coli (UTI spread), Pseudomonas (IVDU). rarely anaerobic.

4- DX: MRI. CBC,cultures, inflamm markers, good H&P. (no routine LP, adds little to dx)

5- emergency decompressive surgery + abx

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2
Q

Carotid Stenosis Diagnosis

  • what tests are appropriate to dx?
  • benefits/limitations of each?
A

Ultrasound - widely available. Only detects bifurcation

MRA - can’d discriminate sub-total from total occlusion. standard MRI C/I and time/cost. Usually no gadolimium needed

CTA - widely available and good resolution of entire tree. Contrast risks.

Catheter angio - best accuracy, but expensive and invasive (0.5-1% risk CVA/MI/vessel injury/retroper bleed)

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3
Q

Carotid Stenosis Management

  • indications?
  • what entails symptomatic?
  • medical vs surgical management?
A

symptomatic = cause of syncope or TIA/CVA

medical management: statins, antiplatelet, HTN tx

  • initiate for symptomatic 50-69% stenosis (men may benefit more than women)
  • continue aspirin after surgical intervention

CEA - symptomatic and some high-grade asymptomatic pts

  • # 1 = symptomatic >70% occlusion
  • CEA preferred over CAS historically

CAS (stenting) - symptomatic and some high-grade asymptomatic pts (especially cases not amenable to CEA)
- recent trial (ACT) studied pts >79yo with asymptomatic 70-99% stenosis. CAS was non-inferior to CEA in terms of stroke and death

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