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Bilateral loss of pain and temperature
Preservation of proprioception and discriminatory sensation
Where is the lesion
Central spinal cord lesion
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Loss of all modalities on R at one level
Loss of pain and temp on L below level
Loss of proprioception and muscle weakness on R to same level
Half lesion on R at level of loss of sensation
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How do pain and temperature nerves travel
Enter the spinal column synapse and then cross the cord immediately to travel up the Spinothalamic tract
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How do proprioception nerves travel?
Enter the spinal cord and travel up the dorsal column to the lower medulla
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Treatment for infantile spasms
ACTH
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Rx for Sub-Arachnoid Hemorrhage
- Treat HTN
- Reverse anti-coag
- Anti-convulsants
- Clipping or embolization of bleed
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What is Todds paralysis
Focal neurologic deficit for days after Tonic-Clonic seizure
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First line Rx for simple partial seizures
- Phenytoin
- Valproate
- Carbamazepine
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First line Rx for Complex partial Seizures
Phenytoin, Valproate or Carbamazepine
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First line Rx for Absence seizures
Ethosuximide or Valproate
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First line Rx for T-C Seizures
Phenytoin, Valproate or Carbamazepine
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Rx for secondary seizure
diazepam or phenytoin
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First line Rx for Status Epilepticus
Diazepam, Lorazepam, or Phenytoin
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Side effects of Phenytoin
- Gingival hyperplasia
- Androgenic
- Stevens-Johnson syn
- blurred vision
- Confusion
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Side Effects of Carbamazepine
- N/V
- Hyponatremia
- Stevens-Johnson Syn
- Vertigo
- Blurred Vision
- Leukopenia
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Side Effects of Valproate
- Hepatotoxicity
- N/V
- Tremor
- Weight Gain
- Alopecia
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Rx for Parkinsons Disease?
- Levodopa: best but SE
- Carbidopa: Augments Levodopa
- Bromocriptine: Use when levodopa begins to fail
- Selegiline: Early, can delay use of levodopa
- Amantadine: Anti-rigidity and bradykinesia
- Benztropine: Adjuvant therapy
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Rx for M.S.?
Glatiramer Acetate
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Rx for panic disorder?
- Clonazepam
- Alprazolam
- Clomipramine
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Rx for Restless Leg Syn
- Dopaminergic Agonists:
- Pramipexole
- Ropinerole
- Levodopa
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Elderly pt with personality changes, compulsive behavior, impaired memory, and infant reflexes. Dx?
Frontotemporal Dementia
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Alterations in consciousness, Disorganized speech, Visual Hallucinations, Frequent falls and extrapyramidal sx, dementia signs. Dx?
Lewy Body Dementia
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Rx used in subarachnoid hemorrhage? Why?
- Nimodipine
- Prevents vasospasm
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CT findings in alzheimers and frontotemporal dementia?
- 1. Alzheimers: Diffuse cortical and subcortical atrophy
- 2. FTD: atrophy of frontal and temporal cortices
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