-
best initial test for tia or stroke
ct w/o contrast
-
contraindications to thrombolytics
- hemorrhagic stroke
- intracranial mass
- brain surgery or cerebral trauma
- bleeding disorder
- surgery within 6 months
- cpr
- stroke in 1 year
- aortic dissection
-
when is asprin given for stroke
- after tpa
- and if its too late for tpa
-
when do you give clopidogrel
dipyrimadole
clopidogrel if pt has a stroke while on aspirin
dipyrimadole is added if patient got stroke on aspirin
-
when is ticlopidine given?
never unless pt is intolerant of aspirin and clopidogrel
-
what is used to visualize the brainstem
mri/mra
-
what studies are done after a stroke or tia
- carotid duplex
- ekg, echo, holter monitor
-
pt is <50 and has a stroke/tia what studies are oreded
- sed rate
- ana, anti-dsdna
- protein c, antithrombin 3, factor 5 mutation, antiphosholopid study
- vrdl/rpr
-
rx for status epilepticus
- benzo
- phenytoin
- phenobarbital
- anesthesia
-
what tests are ordered for a siezue
- urine tox
- head ct
- serum electrolyte--sodium, calcium, bun/cr, glucose, magnesium, oxygen
-
when is eeg done for seizures
- after urine tox
- head ct
- sodium, calcium, mg, oxygen, cr, oxygen have been ordered and are normal
-
when is a neurology consult ordered,
after initial testing
-
long term seizure treatment is not required for a single seizure unless
- eeg is abnormal
- benzo were needed to stop seizure
- family history of seizure
- brain tumor
-
many antie-seizure drugs are associated with what
- steven johnsons
- osteoporosis
-
1st line agents for chronic seizure prophylaxis
- depakote
- phenytoin
- carbamezapine
- leviteracem
- lamotriginebe
-
what anti seizure is not given during pregnancy
when is ethosuxamide given
valproic acid
for absence or petit mal seizures
-
diagnsosis of parkinsons
clinical constellation of symptoms
-
rx for mild parkinsons
severe
- <60--acetylcholine blockers
- >60--- amantadine
severe- carbidope/levidopa or dopamine agonist--carbergoline
-
next step when levidopa gives psychosis
add quiatepine
-
when is deep brain stimulation done for parkinsons
when medical therapy doenst control symptoms
-
entacapone are used when
with levidope
-
what do you use selegiline for
parkinsons
-
rx for resting tremor
tremor of intention
tremor both at rest and intention
- amantadine
- cerebellar
- propranolol
-
when is lumbar tap done for ms
if mri is non diagnostic
-
best initial and accurate tests for ms
mri
-
rx for ms
rx for ms not in acute exacer
rx for fatigue in ms
rx for spasticity in ms
steroids
interferon, glutarimer, natulizumab, mitoxantrone
- fatigue amantadine
- spasticity- baclofen
-
all pts with memory loss get
-
rx for alzheimes
- rivastigmine
- donepezil
- galatamine
-
how does picks present
rx
with personality changes
same as alzheimers
-
most accurate test for cjd
what does lp shows
on ccs what is ordered for cjd
- brain biopsy
- 14-3-3 protein spares pt from biopsy
mri, lp
-
on ccs, what is ordered for normal pressure hydrocephalus
-
what drug causes pml
natalizumab
-
rx for normal pressure hydrocephalus
shunt
-
-
when do you do ct/mri for migraines
- sudden severe onset
- after 40
- neurolgical deficits
-
rx for migraine head
when do you give propranolol or ccb, tca, ssri
sumatriptan or ergotamine
if you have more than 4 headaches permonth
-
rx for cluster headaches
prophylaxis
triptan drugs or 100% oxygen
with verapamil
-
best initial test for temporal arteriris
most acccurate
-
rx for temporal arteriris
steroids
-
most accurate test for pseudotumor cerebri
lumbar puncture with elevated pressures
-
rx for ptc
- weightloos
- acetazolamide
- surgery with vp shunt, optic nerve shearth fenestration
-
all patients with vertigo should have what test done
mri of internal auditory canal
-
what 4 causes give vertigo and tinnintus/hearing loss
- labiryntisi
- meniere
- perilymph fistula
- acoustic neuroma
-
rx for benign positional vertigo
meclizine
-
most cases of vertigo are treated with
meclizine
-
rx for menieres
- salt restriction
- diuretics
-
dx of acoustic neuroma
rx
-
best initial test for meningitis
csf cell count
-
best initial test for cryptocccus
most accurate
- india ink
- cryptococcus antigen test
-
best initial therapy for cryptococcus meningitis
- amphotericin and 5 flucytosine and then oral fluconazole
- c/w fluconazole if cd<100
-
most accurate test for lyme disesae
serology or western blot of csf fluid
-
rmsf presents how,
rash that starts at the hands and feet and proceeds centrally
-
tb meningitis vs regular meningiits
rx for
tb is slow and regular is fast
ripe + steroids for a long time
-
hiv pt with meningitis and high neutrophils, etiology??
listeria--add amoxacillin to ceftriaxone and vanco
-
petechial rash and meningitis
neisseria
-
who needs prophylaxis for niesseria menigitis
people with saliva close type of contact
-
how you prophylax against neisseria
with rifampin, ceftriaxone or cipro
-
best initial test for encehaitis
most accurate
- ct of head
- pcr for dna of csf
-
best initial rx for herpes encephalitis
resistant?
-
brain absecess for hiv neg and hiv pos?
hiv neg- brain biopsy
hiv pos--treat with pyrimethamine and sulfadiazene for 2 weeks and
-
diagnostic test for pmlr
rx
-
best initial test for neurocystisercosis
most accurate
ct with 1cm cystic lesions
serology
-
rx for active neurocystisercosis
albendazole
-
large intracranial hemorrhage rx
- hyperventilate
- mannitol
- intubate
- surgical intervention
-
mx of concussion
contusion
-
best initial for sah
most accurate
-
normal wbc :rbc count in csf
1:500
-
rx for sah
- angiography
- embolize
- shunt if hydrocephalus develops
- nimodipine to prevent stroke
-
-
dx of cord compression
rx
-
-
-
on ccs, best intiial step for carpal tunnel?
if refracotry
-
rx for bells palsy
steroids
-
rx for reflex sympathetic dystrophy
-
rx for restless leg syndrome
pramiprexole or ropinorole
-
what determines respiratory distress in gbs
rx
peak inspiratory pressued
-
best initial test for mg
most accurate
acetylcholine receptor antibodies
clinical presnetation and acra
-
when do you do thymectomy for mg
if pt <60 and neostigmine did not work
-
when are azathioprine and cyclosporine used for mg
between acute exacerbations
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