Bell's Palsy
causes cranial nerve 7 dysfunction
S/S of Bell's Palsy
Has forehead involvement (whereas a stroke does not affect forehead
... [Show More] movement), facial weakness, inability to keep one eye closed
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Treatment for Bell's palsy
Prednisone 60mg x 5 days, Valcyclovir 1000mg TID x 7 days, artificial tears, lacri lube at night
When can I use tPA?
ischemic stroke presenting within <3 hrs and CT head negative
How do you treat high BP with stroke?
Nitroprusside (short half life, easy to titrate) or IV labetalol
What do you use for anticoagulation/antiplatelet therapy in stroke?
ASA (not in hemorrhagic), heparin for thrombosis
What do you do differently to treat hemorrhagic stroke?
Give prophylactic anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy contraindicated
Types of Hemorrhagic Stroke
1. Intracerebral (10%): results from rupture of small arterioles
2. Subarachnoid (3%): rupture of arterial aneurysms (hemorrhage into subarachnoid space)
Causes of Intracerebral hemorrhagic stroke are what?
HTN, amyloidosis, iatrogenic anticoagulation, vascular malformations, cocaine use
Causes of Subarachnoid hemorrhagic stroke are what?
berry aneurysm rupture, vascular malformation rupture
Signs and symptoms of Intracerebral hemorrhagic stroke are what?
ICP rises, vasoconstriction-sweating
Signs and symptoms of Subarachnoid hemorrhagic stroke are what?
may be preceded by warning headache, neck/back pain, "worst headache of my life," thunderclap, may have loss of consciousness
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Treatment of Subarachnoid hemorrhage
surgery, control hypertension, analgesics
What is Complex regional pain syndrome (CRPS)
Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack.
Signs and symptoms of complex regional pain syndrome are what?
Pain out of proportion to injury. ANS sx: swelling, extremity color changes, increased nail and hair growth.
Treatment for complex regional pain syndrome
Amitriptyline, nortriptyline, gabapentin, pregabalin, lamotrigine; NSAIDs; Calcitonin to reduce pain as adjunctive therapy; Bisphosphonates, IVIG, regional nerve blocks, dorsal column stimulation
Vit C prophylaxis after fx
Imaging modality used to diagnose Subarachnoid Hemorrhage?
CT without contrast. If CT negative but still suspect SAH, do LP to look for RBC or xanthochromia (will not develop until 12hrs after onset)
Delirium
transient disorder characterized by impaired attention, perception, memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced alertness, activity levels change rapidly.
Treatment of Delirium
treat underlying cause, Haloperidol 5-10mg for agitation, Lorazepam 0.5-2 mg
Dementia
Loss of mental capacity. Psychosocial level and cognitive abilities deteriorate and behavioral problems develop. Largest categories are Alzheimer dz and vascular dementia. Hallucinations, delusion, depression, repetitive behavior are common.
Treatment of Dementia
Antipsychotics to manage psychosis
Essential tremor does not occur at rest, occurs bilaterally, and has no indication of other neuro signs. How do you treat essential tremor?
Propranolol, Primidone (can combine these 2 if needed)
Guillian Barre Syndrome
Idiopathic polyneuropathy often following minor infections, immunizations or surgical procedures. Most times no cause is identified.
How long does Guillian Barre Syndrome last?
worst at 2-4 weeks after onset, plateaus next 2-4 weeks, remits weeks-moats
Signs and symptoms of Guillian Barre Syndrome
ascending symmetric weakness and loss of DTR's, proximal muscles affected more than distal. Sensory abnormalities, pain, tachycardia, sweating, impaired pulmonary function, paralytic ileus
How do you diagnose Guillian Barre?
no fever at onset, CSF protein >45 and low WBC, MRI shows selective enhancement of anterior spinal nerve roots
Treatment of Guillian Barre Syndrome
IVIG or plasmapheresis, may need intubation. Hospitalized pt with close monitoring. Recovery is slow but approximately 60% make full recovery within 1 year.
What disease is a systemic inflammatory condition of medium and large vessels affecting people over 50 years old, coexists with polymyalgia rheumatica and can cause blindness if not treated appropriately?
Giant cell arteritis
Signs and symptoms of Giant Cell Arteritis
headache, scalp tenderness, jaw claudication, throat pain, diplopia
Symptoms of polymyalgia rheumatica: pain of shoulder/pelvis
Giant Cell Arteritis Treatment
Steroids immediately, do not wait for biopsy results. Give low dose aspirin too.
Describe a Migraine Headache?
unilateral location, pulsatile quality, moderate to severe intensity, aggravated by movement, nausea, vomiting, photophobia, phonophobia
lasting 4-72 hours
Migraine treatment
NSAIDs, Triptans, antiemetics
What is a Cluster Headache?
severe, unilateral headache localized to periorbital/temporal area accompanied by lacrimation, rhinorrhea, ptosis, myosis, nasal congestion, eyelid edema
-Occurs in clusters meaning 1-8 daily attacks lasting 15-90 minutes for 4-6 weeks... followed by pain free interval 3-6 months
Cluster headache treatment
Oxygen, Sumatriptan 6mg SQ, start preventive therapy as soon as headache onset to suppress attacks over expected duration of cluster period
Preventive therapies for cluster headache lasting more than 2 months
Verapamil 240-960mg given in 3 daily doses
What is a Tension Headache?
mild to moderate intensity, located bilateral-frontal areas, dull band like pain, lasting for hours, associated with stress. No nausea, vomiting, neuro deficits.
Tension HA treatment
NSAIDs or ASA combined with caffeine. APAP less effective but preferred in pregnancy. 2nd line therapies are antidepressants (amitriptyline)
Huntington Disease
inherited disorder, develops after 30 years old, progressive chorea and dementia, usually fatal within 15-20 years
Signs and symptoms of Huntington Disease
mental changes, restless, dystonic posturing, severe choreiform movements
Empiric treatment for bacterial meningitis
Ceftriaxone 2g IV and Vancomycin =/- Acyclovifr, Dexamethasone 10 mg IV; spupportive care
Bacterial meningitis opening pressure of LP
>300mm
Viral meningitis opening pressure of LP
<300mm
Bacterial and Viral meningitis WBC in CSF from lumbar puncture
Bacterial: >1000
Viral: <1000
Bacterial and Viral meningitis glucose in CSF from lumbar puncture
Bacterial: <40
Viral: >40
Bacterial and Viral meningitis protein in CSF from lumbar puncture
Bacterial: >200
Viral: <200
What is Myasthenia gravis?
involves muscle weakness and fatigue improves with rest. Common in young women and old men.
Signs and symptoms of Myasthenia gravis?
ptosis, diplopia, difficulty chewing, limb weakness, respiratory difficulties
Parkinson's Disease
nerve cell damage in brain causes dopamine levels to drop leading to sings and symptoms
Essential features of Parkinson's Disease
resting tremor, bradykinesia, rigidity, postural instability
Treatment for Parkinson's Disease
Mainstay of tx are Levodopa and Carbidopa (when using together can reduce Levodopa to reduce AE) [Show Less]