Best initial Test for stroke
Head CT without contrast
profound upper extremity weakness
Aphasia
Apraxia/neglect
Eyes deviate toward the side of the lesion
Middle cerebral artery stroke
Profound lower extremity weakness
Mild upper extremity weakness
Personality changes or psychiatric disturbance
urinary incontinence
Anterior cerebral artery stroke
Inability to recognize faces(Prosopagnosia)
Posterior cerebral artery
vertigo nausea Loss of consciousness vertical nystagmus ataxia bilateral findings
Vertebrobasilar artery stroke
Absolute contraindications for thrombolytics
Always withing 3 hours.
- History of hemorrhagic stroke
- Presence of intracranial mass/neoplasm
- Active bleeding or surgery within 6 weeks
- Presence of bleeding disorder
- CPR within 3 weeks that was traumatic
- Suspicion of aortic dissection
- Stroke within 1 year
- Cerebral trauma or brain surgery within 6 months
Best initial therapy for those coming too late for thrombolytics
ASA
Acute treatment for Seizures
1-.Benzodiazepines
2-.add Phosphenytoin
3-.Add Phenobarbital
4-.Add general anesthesia(pentobarbital,thiopental,midazolam or propofol)
Best initial therapy for seizures
- Valproic acid
- Carbamazepine
- Phenytoin
- Levetiracepam
Treatment for levodopa psycosis
Quetiapine
Treatment for Parkinsons´s< age 60
Anticholinergics
- Benztropine
- Hydroxyzine
Treatment for Parkinson´s> age 60
Amantadine very good for resting tremor
Treatment for Parkinson´s with severe symptoms
- Carvidopa,Levodopa
- (pramipexole,ropinirole,cabergoline)
Besti initial test for MS
MRI
Best initial therapy:STEROIDS
Dementia workup
- Head CT
- B12 level
- T4/TSH
- RPR or VDRL
Alzheimer Treatment
Anticholinesterase Medications
- Donepezilo
- Rivastigmine
- Galantamine
Creutzfeldt-Jakob disease
Most accurate test:
CSF findings:
Most accurate test: Brain biopsy
CSF findings:14-3-3 protein
Indications for CT or MRI for migraine
- Sudden or severe
- Onset after age 40
- Nuerological findings
Indications for CT before LP in CNS infections
- History of central nervous system disease
- Focal neurologic deficit
- Papilledema
- Seizures
- Altered consciousness
- Significant delay in the ability to perform an LP
Treatment for lyme disease
IV ceftriaxone or penicillin
Rocky mountain spotted fever treatmetn
Doxycycline
Most acurate diagnosis for TB meningintis
PCR of CSF
Treatment of listeria meningitis
Neutrophils in CNS
Gram stain may be normal
Ceftriaxone,vanco Add Ampicillin
-pCO goal in intracraneal Hemorrhage hyperventilation
-pCO2 to 28-32
