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Neurology (Seizures (Primary (Partial (simple (no LOC), complex (LOC),…
Neurology
Seizures
Secondary Reasons Mnemonic
V
ascular - AVM, Aneurysm, HTN urgency
I
nfection - meningitis, encephalitis, UTI, PNA
T
rauma, toxin
A
lcohol withdrawl
M
etabolic (Glucose, Na, Mg, Phos), medications
I
diopathic
N
eoplasms
S
troke
Primary
Partial
simple
no LOC
complex
LOC
Treatment
carbamazepine (trileptal), Oxcarbazepine
what do you have to monitor
Na at initiation and in 3 months
Generalized
Nonconvulsive
absence
convulsive
pseudoseizure
definition of epilepsy
two or more seizures
definition of status epilepticus
seizure last more than 5 minutes, or 2 or more and the patient doesn't wake
treatment
fosphentyoin bolus and then 150mg/min
presenting seizure
if going on for 6-10 minutes?
D50, Thiamine; Lorazepam
if going for 10-20 minutes
fosphenytoin 20 mg PE/kg
if going for 20-30 minutes
fosphenytoin 5-10 mg PE/kg, add levitracem (10 mg/kg)
if greater than 30 minutes
phenobarbital 20 mg/kg; intubate
which drip?
propofol drip
MCC SE on phenotyoin
Na-channel blocker - so causes arrythmia
what do you want to avoid in female
valproic acid
lamotrigine and OCP
too much E - then lamotrigine is low, too much lamotrigine - decreases progresterone =
lamotrigine puts you in labor
monitoring AED
obtaining a complete blood count and comprehensive metabolic profile at 6 and 12 months in the first year of therapy is advisable
Dizziness
inner ear
Benign Position Vertigo
Meniere's disease
clincal
not prolonged + hearing loss + tinnitus + vertigo
treatment
Thiazide/Acetazolamide
Vestibular Neuritis
clinical
nonpositiional vertigo, prolonged (hours to weeks), no hearing loss
treatment
meclizine
Brain
sensineural hearing loss - aminoglycide toxicity
Cerebellar stroke
posterior circulation (N, V, N, V) - Nausea/vomiting/nystagmus/vertigo + ataxia
Nystagmus
defined by the direction (the
opposite
side defines the nystagmus) - directional changing nystagmus on both eyes, Vertical as well =
Brain
Headache (ch.1)
Primary
Migraine
clinical characteristics
POUND: 1. unilateral, throbbing, pulsatile, sensitive to light and sound, N/V
type of migraines
classical migraine (aura)
without aura (common migraine)
complicated (paresis, sensory, smells)
basilar (bottom the head location, N/V)
acephalic (no headache)
status migranus (
last more than 72 hours
treatment
Abortive
Triptans
when to avoid
complicated migraine, CVA, history of stroke
uncontrolled BP, pregnancy, with brainstem aura and hemiplegic migraine
butalbital-caffeine related
against the use of opioid- or butalbital-containing compounds as first-line treatments for headache
Preventative when to use
more than 4 headaches a month
types
Anticonvulsant (topiramate)
nephrolithiasis history, history of depression, hepatic impairment, topa will make you "dopa"
Beta blockers
avoid in asthma
CCB
avoid in bradycardia, constipation patient
botox toxin
intracratable
tried 2 meds
Tension
clinical
frontal/temporal, back of the head, stress
Cluster
clinical characteristcs
lacrimation, redness, headache, middle of the night (ALARM CLOCK)
treatment
high flow O2 (7 L or more), triptans
prophylactic
verapamil, lithium, steroids
Autonomic Cephalgia
migraine without the actual headache
post coital/sexual
increased with sexual excitement, benign
treatment
NSAIDs prior to sexual activity
Red Flag signs/mnemonic
Secondary
Primary pseudotumor
clinical
idiopathic intracranial hypertension (higher pressure > 200) - wake up in morning. obese, OCP, steroids, vitamin A overuse
treatment
drain fluid, azetazolamine
if not treated
vision loss
Trauma
Sinus/Dental Diseases
Infection (ch.1 - MKSAP ID)
when to CT before LP
focal neurological deficits, raised ICP signs
broad coverage
ceftriaxone (for pneumococcus - steroid), + vancomcyin + ampicillin (if older than 50 years old, for listeria)
bacteria
pneumoniae was responsible for 71 percent of cases, Neisseria meningitidis for 12 percent, group B Streptococcus for 7 percent, Haemophilus influenzae for 6 percent, and Listeria monocytogen
Giant Cell Arteritis
clinical characteristics
temporal headache + visions, pulsations/nodules/tenderness
in a man old > 50
next step
ESR/CRP
treatment
1 more item...
Hemorrhage
trigeminal neuralgia
clinical
lancing pain in the V (across face)
treatment
carbamazepine
lesion in the brain
pontine lesion
MS
SNOOP
S
ystemic feature
N
eurological Deficits
O
ld age > 50 years
O
nset - sudden "thunderclap"
P
rogression of HA/pattern that has changed
Dementia
(ch. 5)
Reversible causes
Normal Pressure Hydrocephalus (Wet, Wacky, wobbly) Hypothyroidism, B12, Folate
Next step with hydrocephalus
LP
therapeutic and diagnostic
Non-reversible Causes
Alzheimer's
associate condition
Down's syndrome
gene mutation
ApoE4 gene
clinical syndrome
temporal/parietal
affected first (poor short term memory, anoma, aphasia, decrease spatial orientation) and then executive
Pathophysiology
deposition of taub particles
medications
donezapil, mementine
Depression/Pseudodementia
SIGECAPS
Multi-infarct dementia
clinical syndrome
stepwise decline in memory secondary to mini-strokes
what will the scan show
subcortical
white matter lesions, "chronic microangiopathy"
treatment
mementine, control risk factors
Dementia with Lewy Bodies
Parkinsons with production of dementia within 1 year, occipital lobe more affected = hence the visual hallucinations
what if I develops after a year
then its PD dementia
Fronto-temporal dementia
clinical
change in behavior in younger patients
treatment
Donezapil
rapidly-progressive dementia (within 6 months)
CJD (myoclonus, startle)
what to get
14-3-3 protein in the CSF
MRI shows
cortical ribbon sign (white on the outside)
Huntington's Dementia
younger age, chorea,
chromosome 4, trinucleotide repeat
MRI shows
atrophy of caudate