-
MCA stroke
- contralateral sensory and motor
- Homonymous hemianopsia with eyes to lesion
- Aphasia
-
ACA stroke
- Personality
- Cognitive
- Urinary incontinence
- Leg more than arm weakness
-
PCA stroke
- Ipsilateral sensory loss of face, CN9, CN10
- Contralateral sensory loss of limbs
- Ataxia
-
Stroke tx
- Ischemic:
- <3hr - thrombolytics
- >3hr- ASA. If already on it, add dipyridamole or swtich to clopidogrel
- Hemorrhagic: nothing
-
Pseudotumor cerebri
associations
tx
- obesity
- venous sinus thrombosis
- OCP
- Vit A toxicity
- Papilledema wit diplopia from CN6 palsy
- tx with weight loss, acetazolamide, steroids, repeat LP, shunt
-
Cluster HA tx
- Ergotamine or triptan
- 100% O2
- prednisone
- Li
-
Migraine ppx
- if 3+ per month
- Propranolol
- CCB
- TCA
- SSRI
- Botox
-
Trigeminal neuralgia tx
- oxcarbazepine or carbamazepine
- Surgery
-
Sz causes
- HypoNa, HyperNa
- Hypoxia
- HypoCa
- HypoMg
- Hypogly
- CNS infection or lesion
- Uremia
- Hepatic failure
- Withdrawal
- Cocaine
-
Sz tx
- Lorazepam or diazepam IV
- Phenytoin or fosphenytoin (latter has fewer AV block and hypotension)
- Phenobarbital
- Succinylcholine, vecuronium, pancuronium - intubate - midazolam or propafol
-
Absence sx tx
Ethosuximide
-
Subarachnoid hemorrhage risk factors
-
Normal WBC:RBC in CSF
1:500-1000
-
SAH tx
- Nimodipine - CCB to prevent ischemic stroke
- Embolization > clipping
- VP shunt if hydrocephalus
- Sz ppx - phenytoin. does not dec mortality
-
Brain abcess tx
- Pen + metro + ceftriaxone
- Vanc if recent surgery
-
Tuberous sclerosis
- Sz, retardation
- Adenoma sebaceum (red face nodules), shagreen patches (leathery trunk plaques), ash leaf patches
- Retinal lesions
- Cardiac rhabdomomas
-
Neurofibromatosis
- Neurofibromas
- 8th nerve tumors
- Cafe au lait spots
- Meningiomas and gliomas
-
Sturge-Weber
- Port wine stain
- Sz
- Homonymous hemanopsia, hemiparesis, retardation
- Ca angiomas
-
Parkinson tx
- Anticholinergic - benztropine and trihexyphenidyl
- Amantadine - inc dopamine release
- Dopamine agonisits - pramipexole and ropinirole. bromocriptine, cabergoline
- Levodopa/carbidopa - most effective. on/off
- COMT inh - tolcapone, entacapone block metabolism of levodopa
- MAOi - rasagiline, selegiline - block metabolism of dopamine. can retard progression
- Deep brain stimulation
-
Shy-Drager syndrome
Parkinsonism with orthostatis predominant
-
Restless leg syndrome tx
Dopamine agonists such as pramipexole
-
Huntington disorder tx
- Tetrabenazine for dyskinesia
- Haloperidol or quetiapine for psychosis
-
MS tx
- Acute - steroids
- Glatiramer
- bINF
- Natalizumab - inh a4intergrin. can cause PML
- Mitoxantrone
- Azathiprine
- Cyclophosphamide
-
ALS tx
- Riluzole reduces glutamate buildup and may prevent progression
- Baclofen for spasticity
- CPAP and BiPAP
- Trach
-
Charcot-Marie-Tooth disease
- Distal weakness and sensory loss
- Wasting in legs
- Dec DTR
- Tremor
- High arch in foot
- inverted champagne bottle legs
- No tx
-
Hyperacusis
- Loud sounds due to lack of stapedius muslce
- In Bells
-
Myasthenia gravis tests
- Initial: acetylcholine R Ab
- Edrophonium - short acting acetylcholinesterase
- Accurate: EMG
- Chest imaging for thymoma or thymic hyperplasia
-
Myasthemia gravis tx
- Neostigmine or pyridostigmine
- Thymectomy if <60yo
- Prednisone if >60yo
- Crisis - IVIG or plasmapharesis
|
|