1
Q
ABCD2 Score
A
- Age >=60
- Blood pressure (HTN)
- Clinical features
- speech disturbance but no unilateral weakness = 1
- unilateral weakness = 2
- Duration
- >= 10 min = 1
- >= 60 = 2
- Diabetes
2
Q
Cutoffs for carotid endarterectomy
A
- >= 70% stenosis within 2 weeks
- some benefit for >= 50 % within 2 weeks
- with symptoms
3
Q
Miller-Fisher variant of Guillain-Barre Syndrome
A
Ataxia, eye muscle weakness, areflexia but usually no limb weakness.
4
Q
Classic Findings of Guillain-Barre Syndrome
A
Symmetric ascending paralysis with areflexia
5
Q
Brachial Plexus arises from which spinal levels?
A
C4-T1
6
Q
Definition: status epilepticus
A
- 5 minutes of either continuous seizure activity or 2 or more sequential seizures without full recovery of consciousness between the seizures
7
Q
Definition: refractory status epilepticus
A
- sz continues despite 2 drugs
8
Q
Lorazepam Dose Status Epilepticus
A
Lorazepam (best IV agent)
- 0.1 mg/kg, max 4 mg IV/IM, may repeat x 1 in 4 minutes
- onset 1-5 min (15-30 min IM), duration 12-24 h
9
Q
Midazolam Dose Status Epilepticus
A
midazolam (best IM agent)
- 10 mg (0.2 mg/kg) IM x 1, no repeats
- onset 5-15 min, duration 1-6 h
- 5-10 mg (0.1-0.2 mg/kg) IV
- onset 1-5 min, duration 1-6 h
- 0.2 mg/kg intranasal (max 10 mg)
10
Q
Lab work to differentiate between sz and PNES
A
- prolactin within 20 min of event > 2x ULN predictive or true sz but not perfect
- lactate rises causes WAG acidosis (resolves within 30 min)
11
Q
Approach to sz in known epileptics
A
- check drug levels, glucose
- if low, give loading dose (PO or IV)
- DC home when stable
- if therapeutic and sz not more freq than expected, DC home
- if can’t check (keppra) and noncompliant, give usual home dose before DC
- If compliant and therapeutic and increased freq/duration of seizures, speak with neurology about adding on agents or adjusting dose
- f/u 1-3 days if changing dose
12
Q
Approach to first-time sz
A
- plain CT Head, ext lytes, tox screen, CBC, ECG
- if no secondary cause, MTO, DC with f/u, no tx
- children:
- > 6 months, single afebrile sz not requiring tx = DC home with outpt MRI if back to neuro baseline
- no routine labs needed in complex febrile or afebrile sz, use clinical picture
- neonates:
- full septic workup + extended lytes + abx with any sz
- lactate, ammonia, amino acids + urine amino acids
13
Q
Parasitic cause of sz in developing world
A
Neurocysticercosis
- most common cause sz in developing world
- CNS infection by larvae of taenia solium taperworm
- sz from parasite degenerating, leaving fibrosis
14
Q
Baseline rate of aneurysms in gen pop
A
2-6%
15
Q
Sensitivity of CT (-) for SAH
A
- CT (-): 98% sens @ 6 h, 90% @ 24 h, 50% @ 1 wk
16
Q
How long does it take for xanthochromia to develop in SAH?
A
- 12h
17
Q
SAH Treatment
A
- HOB 30 deg
- glu, temp control, reverse anticoag
- SBP < 140
- labetalol/nicardipine
- nimodipine 60 mg PO Q4h (start within 96 h of onset)
- for vasospasm, risk of which is greatest 2 days-3 weeks
18
Q
Autonomic Dysreflexia
A
- in patients with spinal lesions/open neural tube defects
- paroxysmal sympathetic + parasympathetic hyperactivity initiated by stimuli below level of lesion
- bladder distension, fecal impaction, fracture
- sweating, flushing, ha, htn, bradycardia, piloerection
- tx is remove stimuli
19
Q
Symptoms of Myesthenia Gravis
A
- prox muscle weakness relieved by rest
- facial and bulbar muscle weakness
- ptosis, diplopia, internuclear opthalmoplegia
- usually no sensory, reflex, or cerebellar deficits
20
Q
Myesthenia Gravis (Read Through)
A
Evernote “Chronic Neurological Disorders”
21
Q
Optic Neuritis
A
- usually monocular, painful vision + colour vision loss over several days
- often preceded by retrobulbar/extraocular muscle pain reproducible by periorbital palpation
- often RAPD (Marcus Gunn pupil)
- hallmark of MS
22
Q
Multiple Sclerosis (Read Through)
A
“Chronic Neurological Disorders”
23
Q
Lambert-Eaton Syndrome
A
- weakness that gets better with exercise
- hand grip increases in strength over time
- paraneoplastic syndrome
- no specific treatment, refer neuro/medicine
24
Q
Parkinson’s Disease
A
- resting tremor
- cogwheel rigidity
- bradykinesias, akindesias
- impaired postural reflexes
- sensory deficits, extremity pain
- cardiac dysrhythmias, orthostatic hypotension, dyskinesias, dystonias from dopaminergic therapy
- sometimes drug holiday/reduction in dose may help, discuss with neuro
25
GBS Syndrome
* symmetric ascending paralysis, no sensory deficit
26
Classic GBS CSF Finding
* cytoalbuminologic dissociation (high protein, low WBC)
27
GBS (Read Through)
"Acute Peripheral Neurologic Disorders"
28
Bell's Palsy
Important physical exam test
Tx
Dispo
* may be preceded by pain behind ear
* r/o otitis/mastoiditis
* test EOM (should be full)
* prednisone 1 mg/kg daily x 7d
* no benefit to antivirals
* patch eye if incomplete closure, f/u urgent optho
* if can close, artificial tears
* f/u GP or ENT within 7d
29
Ramsey Hunt Syndrome
* HZV of geniculate ganglion
* may also have CN VIII involvement with vertigo, nausea, hearing loss
* prednisone + valacyclovir 1 g TID x 7d
30
Botulism Clinical Syndrome
* descending, symmetric paralysis
* CN + bulbar affected first
* diplopia, dysarthria, dysphagia, blurred vision
* pupils often dilated, nonreactive --\> important to differentiate from myesthenia which has normal pupils
* may have anticholinergic syndrome
* floppy infant with constipation and weak cry
* no sensory deficit, no pain
31
Botulism (Read Through)
"Acute Peripheral Neurologic Disorders"
32
Vertigo (Read Through)
"Vertigo"
33
Trigeminal Neuralgia
* *tic douloureux*
* severe pains lasting only seconds
* no pain between episodes
* ***tx:*** carbamazepine 100 mg PO BID --\> GP to increase, refer to neurologist
34
Seizure Meds that can be measured
* phenytoin (Dilantin)
* carbamazepine (Tegretol)
* valproic acid (Epival)
EM
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