neurologydis.

Inflammatoryds.

ADEM

dx

exam

LabCSF

Viralc/s

imaging

EEG

types

brainstem

spine

postencephalitis.

chronic

tumor

rheumatologic

abscess

Leukoodystrophy

Fulminate

Recurrent

steroidtaper

nontaper

steroiddependent

MS

dx

exam

Lab CSF

MRI

tx

fatigue

tonicspasms

INFreaction

encephalitisdx

clinical

lab

types Encephalomyeloradiculneuropathy

vasculitisdx clinical

tx

DDX

Autonomicneuropathy

signs

tmpcontrol

CVS

GI

GU

otherseye horner's

drymoth/eyes

etiology

CNS

PNS

DM glucoseintolerance

Amyloid

autoimmune

clinicaltypespureautonomic

sympathetic

parasympathetic

both

mixed

etiology

autoimmunediseases Sjogren

postviral

paraneoplsticLambertEaton

antiganglionicAchreceptorsabs

Rehab

chronicresp.care

saliva

musclecramps

vertigo

Bldder

spasticity

Subtopic

Neuropathy

pearls

Presentations

Hypotension&fever

septicshock

DIC

autonomicneuropathy

progressiveweaknessetiologies

MG

Myopathies

ALS

symptoms

abnormalpupillaryexam

opticnerve

3thnerve

autonomicdisease

acutedescendingweakness

MG

MillerfisherGBS

Botulism

intermittentnumbnessorfootdrop CIDP

Dissectioncanpresentslikemigraine

fever,rigidity

Malignancyw/u

steroidtx

pretx

supportivetx

sparingtx

MTX

AZA

Cellcept

IVIG/plasmapherisis

thirdline

Cyclosporine

cyclophosphamide

others

NICU

Neuromuscular&respiratoryemergencies

Monitoring

signs

Increasedbreathingrate

decreasedO2

sweatning.weakcough

Respiratoryfailure

nosignsofdyspneainneuromuscularweakness

bedsidecountto30inonebreath

neckflexormusclespredicttherespiratorymuscles.

respiratoryfunctionexpiratorypeakflow

Vitalcapacity

ABG IncreaseCO2

ICUquadriplegiacriticalillnessneuropathy

criticalillnessmyopathy

EEGmonitoringind.

szpoststatus

encephalopathies/ietis

comaNMJblockage

severeNMJandGBS

vascularstroke

ISH

tech artifact succinylcholine

sz statusEpil.tx

versedloading

drip

Dilantin

Arivanloading

drip

propofulloading

drip

pentobarbitalloading

drip

Ketamineloading

maint.

others

VPA

Topamax

Keppra

theopental

paraldehyde

medical HTNpoststatus

stroke

surgery

CVS

tx

tPAHTN

post3hrs

interventional

IAtPA

deviceretreiver

stent/angioplasty

surgery

prevention surgical

Imaging

CTA

CTperfusion

MRI

rehab depression

ICH

prog

volume

IVH

deterioration

CVA

hydrocephalus

NCSE

medical

typecoagulopathy

Trauma

dx angio

IVH

noHTN

lobar

surgery

ICPmonitor

ventriculostomy

Parenchymalprobe

others centralveinoxymetry

evacuationcerebellar

CT

Clinical

IVH tx

medical

BPlowerBP

inc.BP

lowerICP

manitol

Hypertonicsaline

other

hyperventilation

barbiturate

hypothermia

Lasix

SZprophylaxis

NCSEclinical

tx

reversecoagulation

coumadin

FFP

VitK

fVII

PCC

heparin

Lovenox

argatroban

ITP

DVTprophylaxis

intubation

tech

weaning

trachestomy

weaning

dailylabs latelabs

Re-anticoagsdeepICH

LobarICH

FEN

NMJ MG labs AChr-

Muscles

Myotonicdystrophy

Statinsmyopathyclinical

tx

Muscledystrophies Baker's

LimbGirdlemuscledis.

Myositis

dx

tx

typespolymyositis

inclusionbodymyositis

Myalgia

txsupportive

cardiac

resp.

steroids

presentaion

cardiac

contracutres

bulpar

Dementia

types

Alzheimer

vasculardementia

LBDparkinsonism

dementia

fronto-temoral

txcognitive

behavioural

Movementsdis.

symptoms

dystonia

acute

tx

presentationoculogyriccrisis

dystoniastorm

ddx

chronic tx

Botox

medical

DBS

essentialtremor tx

chorealabs

tx

violentactivityBallismus

paroxysmaldyskinesia

diseases

Parkinson

tx

Sinemet

agonistnew

old

MAOb

COMT

anticolintergics

DBS

symptoms

fluctuation

offtime

dyskinesia

tx

etiologies

presentations

Pain

behavioral

psychosis

impulsecontrol

dementia

anxiety

dysautonomia

NMSofparkinson

exam

tests

Huntingtondis

tics tx

RLS

spine

rehab autonomicdysreflexia

symtoms

txacute

prophylaxis

spondolysis

tx

medical

epidurals

PT

surgery

symptoms

exam

etiologies muscoloskeltal facetjoint

transversemyelitis

symptoms

prognosis

testslabs

imaging

imaging MRI

noramlvariants

degenerativedis.

op&trauma

headache

migraine

prophylaxis

ACEi

bblockers

Cachannel

AED

TCA

NSAID

vitamins

PT

botux

sypmtoms

acute

migrainestatus

outptstriptans

fastmetl

Subq

N.spray

others

surgical

Chronicdaily tx

Trigeminalha

clustertx

prophylaxis

paroxysmalhemicrania

loading0.2 mg/kg/

txRiserpine and Tetrabenzine are preferred over neuroleptics as they deplete dopamine and donot causetardive dyskenisia. however only Riserpine is available in US

CNSclosely related to parkinson and LBD.

strokecan predict the post tpa hemorrhage.

steroid taperno risk for MS

ventriculostomydrains IVH monitors hydrocephalus no need for daily csf cultures unless if there's fever. can be left for up to14 ds.

txstart with O2 100% @ 7-15 L/m Triptans and Ergots Lidocaine nasal drop 4-6% Prednisone 60 for daysthen taper off.

facet jointnot all agree on its existence steroid injection into facet joints might help mostly in neck possibleintervention is radio ablation of the innervating branch

NMJ blockageblockage with vecuronium can be reversed with neostigmine succinylcholine is not preferred b/ohyperkalemia. but it's very short acting, few min, compared to 20 min for non depolarizing agents.

acutefrom neuroleptics

acutelike any HTN managments with vasodilators Nitro sublingual or nitro paste 1/2 clonidine 0.1-.02hydralazine 10-20

CSFCSF immune profile: usually normal MBP high unlike MS

psychosisdecrease the dopamine doses Seroquel UTI,or infection must be r/o early sign of behavioral problems ispaucity of speech and history. Psychosis usually underline a dementia remove anti cholinergics,Amantadine, D agonists,

lower BPMAP=130 ; SPB= 180 severe lowering casue ischemia. Nivadipine, Labetolol, esmolol. for renal pts: usedFenoldopam

HTNtreat if > 185/10 ; if no tPA treat only if > 220 Nitropaste labetolol 10mg q 5 min Nicardipine: 5 mg/hr dripcan be increased every 5-10 min

brainstemmimic: Bickerstaff encephalitis; or glioma

surgerycan not anticogaulate after the surgery mostly used in younger pt who b/o lack of atrophy tend to have worseICP

clinicalsystemic ds, arthritis, rash, dis of the heart, kidney, and liver, retinopathy peripheral nerve dis.

FFPFFP 15 mg/kg or 6 packs can cause volume overload; also pulmonary edema from allergic reactionnormalizes INR in 30 hrs

critical illness neuropathyh/o sepsis use differentiated from myopathy by abnormal phrenic nerve conduction axonal type ofneuropathy; differntiated from GBS by normal CSF

SinemetSinemet CR: does not improve the motor fluctuating and has unpredictable absorption and might increasenausea sudden withdraw can causes NMS like syn. however it can stopped in cases of severe dyskinesia

loading

0.1 mg/kg

Ballismuscan be b/l in HIV, non ketotic hyperglycemia,

noraml variantson para sagital : foramen look like upside down pear with the root occupying the third, conjoined nerves:tow nerve roots exiting from same foramen; it can be mistaken with disc fragment or tumor, nerve rootdiverticulum: expansion of the dura around the root make it look like nerve sheet tumor, Tarlov cyst: duraenoculated cysts in the sacrum Schmorl's Node: disk herniation into the vertebral body. can look like tumorinfiltration to the vertebra body, synovial cysts: from facets.

tmp controlnot shivering for cold not sweating for hot socks are not wet when removed excessive sweating

CVAischemia; hematoma expansion; edema

cognitiveACEi like Aricept. indicated for mild to moderate dementia Namenda for mod. to severe dementia. can beadded to Aricept.; it can worsen sz.

HTN post statususually does not need management as the AED meds and the positive pressure ventilation will lower it.

deep ICHanti-caogulation should be resumed in 1-2 weeks

late labsadrenal insufficiency after 1 week. cortisol < 5 once or < 15 twice. presents as low BP,

volumevolume: = largest diameters X number of slices X slices thickness / 2 Critical voulme= 30 ml

cardiacCardiac: Echo, EKG, Holter; tx with ACEi and B blockers can slow progress; later consider earlypacemaker

tx

start prophylaxis tx on month before tapering off analgesics at the end of the taper to prevent reboundheadache can use: dexamethasone 4 mg bid for 3 days; or steroid Medrol pack or sumatripatans 100 mg tidfor 2 days (then prn) for milder pain: NSAID or hydroxyzine 50

oculogyric crisiscan mimics partial sz. with forced eyes deviation, hyperventilation can be from dpaminergic withdrawal orfrom neuroleptics. tx; anticholinergics (diphenhydramin 50 IV or bemztropin 1 mg)

etiologiesspecially if bulbar or mutlifocal. check: MG, Myopathies (LGMD, myositis..), ALS

medicalNSAID muscle relaxants: Flexeril steroids: Medrol pack 21 of 4 mg. start with 6 tabs and taper by one dailyfor total of 6 days. Neurontin TCA: for radicular pain patches: lidocaine, NSAID patches, opiates (Percocet,Oxycodone, Lortab=Vicodin, Tylenol with codein ) or Ultram

pre txDEXA bone scan for osteoporosis CXR for tuberculosis

manitolmannitol 20% ; 0.25 - 1.4 g/kg boluses over 20 min ; can repeat q 3 hrs. check osmolarity frequently, stop if> 320 stop if osmo gap > 15; osmo gap= measured osmolarity - (2Na+ bun/2.8 + gluc/18) risk of ARF,dehydration or rebound ICP

SjogrenSjogren antibodies anti SSA and SSB are only sensitive in 20% the dry mucosa can be part of the Sjogren orpart of the associated autonomic neuropathy.

parkinsonismmostly with no tremor wide fluctuation from day to day associated with REM behavior disorder.

Botoxboth type A and B are immunogenics

muscoloskeltalback pain in the absence of any neurological causes.

txtx; anticholinergics (diphenhydramin 50 IV )

txIntra-ventricular tPA. drianage. incr. risk of bleeding along the drain.cc

depressionSSRI are best so it does not interfere with Warferin Lexapro 10 mg, celexa 20, zoloft 25

triptansTriptans ( or the combo ones with NSAIDS) for refractory cases use large doses: like sumatriptan 100 mgshould be given early in the attack

labsCSF: pleocytosis, IgG index , protein 14-3-3

AChr -if AChR was neg, always check MusK especialy in bulbar weakness and spared ocular. EMG, Endorphintest, thymus scan are likely normal. tx: is less effective

migrainemigraine with aura increase risk of CVD and CVA x 2

IA tPAfor distal clots beyond M2 up to 6 hrs

MRICT myelogram if MRI is not availbale MRI gradient for disks and MRI STIR for spine.

clinicalin encephalitis: fever lasts longer compared to ADEM where it lasts only 1 day.

txPropranolol, Mysolin and Klonopin Topamax works but needs dose >200 and cause side effects

Cyclosporinestart at 3-4 mg/kg/d and gradually inc. to 6 mg/kg/d goal is trough 50-200

EncephalomyeloradiculneuropathyEncephalitis with peripheral involvement. low reflexes. Enterovirus 71, Coxacie

symtoms

sudden HTN and bradycardia with sweating.. triggered by bowel or urinary retention or ulcer

dystoniafor cervical dystonia: check the MRI cervical for cord compression

tumorlymphoma can respond to steroid then relapse with withdrawl

clinicalpain, weakness, ++ CK noticed by lying down aggravated with fasting can happen anytime after thetreatment. symptoms donot always resolves with stopping the meds. biopsy and EMG may be normal. insevere cases, changing the stating to another one will not work; try alternatively: niacin, bile resins.

hyperventilationgoal is Pco2 26-30 intermittent mandatory ventilation (IMV)at a rate of 16 to 20 per second,with tidalpressure of Cox 28 to 32 hg.Avoid severe hypocapnia of 60

txtx: decrease sinemet and add dopamine agonist (in particular Amantadine 100 bid) severe case needadmission for rhabomyolysis causing ARF or CHF or for respiratory dyskenisia

CTAsource images can estimate the infarcted core as accurate as CBV in Perfusion

loading1-4.5 mg/kg given with benzo

labsanti-phospholipids abs, Lupus, Thyroid panel, ASLO, ESR, non ketotic hyperglycemia

MTXfaster than AZA start 7.5 mg/wk , inc. by 5 mg qwk until 20 mg/kw if no reponse, start IV MTX up to 60mg/qwk

fluctuationcan be non motor: like emotional, depression or activity level or even back pain.

angiorequired for: dural-arterial venous fistula vasculitis cortical vein thrombosis small AVM

techTV: 6 ml/kg ; pCO2=35- 40; O sat > 92 in MICU : slight hypercapnia is usually allowed to prevetmechanical lung injury; however this can increase ICP in NICU pats. high PEEP can increase ICP; this cancounterpart by elevating HOB

eyepupilomotor dysfunction; blurry vision

migraine statusdepaken 500 mg IV Ketorolac plus Prochlorperazine short run of IV steroid or Medrol pack

symptoms100% bladder dysfunction and parathesia. band like dysthesia in levels of lesions.

CSFabnormal CSF immune profile

coumadinreverse with either: vit K + PCC vit K + FFP + f VII

clinicalworsening the consciousness level and spasticity

surgicalendarectomy for all stenosis over 70% for some of stenosis 50-69% Angioplasty and stenting only ifendarectomy is not possible for co moribidities

loading12 mg/kg

Alzheimerinsight is usually saved until late.

rehabmaximum recovery is usually reached by the third month,

fatiguestimulants: Provigil, Ritalin, Concerta, Adderall XR, Straterra, or Amantadine Vyvanse: new agent. the best.Also acetyl-carnitine 1-3 gm bid Provigil can be used up to 600 mg/d. preferred to give holidays off themed. exercise: produce paradoxical effect need to pay attention to other factors: sleep disorder from musclejerks or from nocturia from neurogenic bladder.

chronic resp. careFVC q 3 ms vibrator assisted cough machine BiPaP Non invasive ventilator

Lambert EatonAutonomic neorapathy presents in 60%

fast metlprobably works same like regular tab Zomig ZMT, Maxalt MLT

prophylaxisconsider for 2 attacks /weeks. or for fewer if the attacks were disabling. birth control is required for most ofthose meds when other co morbid conditions co exist with migraine: use the best drugs for each and notnecessary the one drug for both placebo effect is 30s%. most drugs are 50s% consider underling depression

coagulopathyfluid-fluid level

cardiaccardiac involvement could be the only presentation can have either CHF or conduction block or arrythemia(Afib, V tach,...)

CT> 3 cm or ischemia of third of cerebellulm hemisphere. effacement of quadrigeminal cistern need daily CTto r/o acute hydrocephalus.

clusterdifferentiate it from migraine: short escalating (10 min) and lasting ( 1.5 hrs) pt is agitated and restless,where in migraine he's calm unilateral with cranial autonomic dysfunction

ACEiACEi and ARI are prophylaxis effective and can be used to decrease CVD and CVA risks in pts with theaura migraine

exam

little sensory abnormality

dxanti Jo-1 see malignancy w/u

succinylcholinecan cause hyperkalemia should be avoided in NM disorders.

glucose intoleranceglucose intolerance can present just as combination of both pain and autonomic neuropathy

new

Requip and Mirapex

exam

remarkable sensory abnormality; specially vibration.

signsin respirtatory compromise from neuromuscular origin, the weakness can progress to failure with no signs ofrespiratory stress.

salivaanti cholinergics.; scopolamin patch for sever cases try botox

prophylaxisverapamil 160 tid ( twice the dose for migraine) lithium 150-300 tid Neurontin , Indomethacine, Ergotamin

resp.Resp: FVC lying and sitting, overnight pulse ox, Pulmonary function test

post 3 hrsIV tPA can be given 3-5 hrs only if there is big mismatch on perfusion scan.

imagingalways consider brain MRI and evoked potentials.

IVHcritical volume is 20 ml

dystonia stormsevere generalized dystonia: need ICU admission and might need genearlized anathesia ( propofol) andmuscle blockers can be triggered from infection or drug chagne tx: try tthe combination of baclofen,depakote, pimozide. and Atrane but might need urgent DBS

behaviouralfor anxiety: Trazodone, Buspirone can help neurolyptics: likely to have no benefits can try : SSRI, AED, forAbulia: try sinemet, stimulants, SSRI

tximmunosuppresant might work better than AED for sz or behavioural.

tonic spasmsresembles tetanus or dystonis. responds to low carbamazepine, acetazolamide also clonazepam for pelvicspasms: Belladonna with opiods suppositories (B&O) intrarectally or vaginally.

Vital capacityICU criteria: bulbar dysfunction or automonic instability > 30% reduction in VC or sat

impulse controlassociated with dopamine tx includes: gambling, shopping, OCD, hyperphagia, self feeling of clinicalworsening tx: decrease dopamine agonist, seroquel? anti depressents?

supportive txAlendronate 70 mg qweek vit D 800 qd Bactrim DS 3x per week Protonix or TUMS tid.

prognosis1/3 recover, 1/3 moderate and 1/3 severe disability

medicalhigh dose of anti-cholinergics Haldol

Topamaxthrough GT loading dose

Hypertonic salinecan be given as : bolus : HTS 23.4% ; 1 ml/kg ; then infusion 2-3 % at 0.1 - 1 ml/kg/hr or : 23.4% as 30-60cc iv bolus q 6 hrs. or 3% bolus 150 cc q 4-6 hrs or 3% infusion 0.5-1 cc/kg/hr side effects: CHF, bleeding

weaninggood strength: FVC > 15 ml/kg; NIF < -30

ICU quadriplegiaMRI cervical and brainstrem: r/o neck injury and brainstem stroke EMG: critical illness myopathy /neuropathy Spinal cord damage: ischemia or trauma

spinelesions extending longer; more in the thoracic . "transverse myelitis". lesions on axial view involves overhalf diameter of spine unlike MS mimic NMO; check NMO antibodies. NMO is relapsing remitting on MRIinfectious etiologies mimics ADEM: lylme, HTLV 1-2

vascular dementiausually presents shortly after CVA. urinary incontinence is early

chroniccan be tremor-like and repetitive or myoclonic pure neck tremor without associated hand tremor is likelydystonia, it's the most common presentation of Wilson dis. especially proximal tremor.

b blockersPropranolol 40-400 mg, Metoprolol,100 -200 Atenolo 50-200

inclusion body myositisasymmetric, and more in flexors muscles. muscle biopsy is neg in 1/3 usually refractory to tx.

drip1 mg/kg/hr

Huntington disacanthocytosis can mimic HD on MRI and chorea findings. there is associated neuropathy and high CK alsoHD like disease , in blacks, is identical to HD but neg genetic test ,

Dilantinactually may not work at all. so if benzo failed go to propofol

heparin1 mg protamine reverse 100 u heparin in the last 4 hrs. 1000 units/hr heparin is reversed by 25 mg protamine

paroxysmal dyskinesiacongenital. responds to klonopin, carbamazepine,

Sub qbest for pts with nausea Imitrex

Malignancy w/uCT chest/pelvic, Mamogram, colono-scope.

labCSF: elevated WBC and immune profile neg viral c/s in 70%

interventionalbetter only for: large vessels occlusion in ICA, MCA no response to Iv tPA beyond 3 hrs

Clinicaldepressed consciousness brainstem compression signs; ispsilateral babenski

tx

same like neuropathy: Neurontin, PT, NSAID. short course of steroids

inc. BPto avoid ischemia start with norepinephrine or phenylephrin; aslo vasopressin dopamine is poor in NICU

device retreiverfor MCA/ICA +/- IA tPA up to 8 hrs

CVSRt stroke: bradycardia Lt stroke: tachycarida

contracutreslimited ROM: joints contractures, spine rigidity and limited ROM are remarkable in Emery -Dreifuss AD. inthe X linked form, contractures precede weakness. Myotonic dystrophy can have limited ROM.

etiologieslikely to result from pt self medicating dysregulation, also might be from infections

ISHpredicting vasospams before they are detected on Doppler by decrease in the A rythem variability.

drip9 mg/hr

sypmtomsthe aura can be dysartheria but not weakness. symptoms should be at least 5 min headache should followwithin 60 min Triggers include: chocolate, ETOH, cheese, sweetners

oldAmantadin or Bromocriptine

prophylaxisclonidine 0.2 bid prazosin 0.5-1 qd

non taperrisk for MS 25% prepubertal; 85% post puberty

post viral+/- AIDP

symptomsexcessive saliva, inability to whistle. SOB

Traumabrain contusion mostly frontals

maint.0.5-2.5 mg/kg

critical illness myopathyh/o steroid ; muscle blockage use elevated CK normal phrneic nerve study; abnormal diaphragm EMGprognosis is worse

txversed drip

drip0.25-0.4 mg/kg/hr as per EEG

PNSoften combined with pain's small fibers involvement as well.

symptomspain can improve by worsening of the diesease unlike neurological symtoms which usually worsen.

cyclophosphamidePO 1 mg/kg/d or IV 1 gm/m2/ q month

AZAslow, takes 6 ms. start 50 mg qd; inc to 2-3 mg/kg within 2 ms can cause sever flu-like symptoms

txsee steroid tx start prednisone ( 1 mg/kg) or 100 qd for 1-2 w then qod if no response by 4-6 ms then stopwhen response plateau then taper off by 5 mg q 2 weeks Cellcept 1 gm bid can be started along steroids or ifthere is relapses

Chronic dailysame is analgesics over use 15 days per month; 8 of them are migraines it's uncertain if NSAID causes thatas NSAID can be given daily to prevent migraine

degenerative dis.once myelomalacia develops " increased spine signal on T2" it's unlikely for symptoms to resolve withsurgery. the endplates changes from degenerative dis. can mimic tumor infiltration; however the hallmark isthe location along the endplates edges only. Signal on T1 or T2 can be anything' facet joint dis. : causesmuscle skeletal pain on its own, or contribute to spinal stenosis. Also it can be associated with synovial cystwhich causes bones erosions. Para articular defect: shortening of the pedicles causing congenitalspodolithisis.

Vit Kvit K IV 10 mg X 3d

othersErgots. (cafergot, ?excedrin migrain? Combos (Fiorinal, Fioricet, Esgic,) all are caffein + ASA + Butalbitalfor sedation. Midrin has vasocnstrictor.. All are less effective to migraine than triptans.

CT perfusionbest triage for new CVA along with CTA CBF and MTT showes penumbra but CBV showes the ischemiccores CBV can be visualized from the source imaging of CTA as oligoemic area

drip0.1-2 mg/kg/hr

CVSorthostatic hypotesnion: can presents as fatigue after prolonged standing or bathing.. resting tachycardia,sinus pauses; abnormal RR variation- fixed HR- , QT prolongation, slow recovery after exercise. sustainedhypertension; paroxysmal hypo- hypertension.

dementiavisual hallucination and good insight that's not real

Lobar ICHanti coagulation risk is high.

txTetrabenzine, Reserpine, Neuroleptics, Klonopine, valproic acids

diseasesconsider other eitologies: Para neuplastic syn. infections: HIV, virals,... heavy metal poisonings

essential tremorin severe cases there is rest tremor and must be recognized from parkinson's tremor a cluse is response toETOH; (myoclonic dystonia also responds to ETOH)

epiduralshelp only the pain for few weeks. effect resolved by 3 ms does not improve outcomes or activities orneurological symptoms.

Viral c/snasal and rectal viral culture. CSF culture is usually neg.

choreadifficulty maintain protruded tongue is pts with Huntington dis.

steroid dependentboys, sz, ON, plaques responds to immunosupprsent

deteriorationdec. glasco scale or incr. NIHS by 2

abscesscan be ring enhancing: mimic abscess or cystecircusis, l

MRIsmall multipile lesions on spine, involving less than cross diameter of spine on axial and less longitudeextension on sagital.

MAO bRasagiline is MAOi b that can be used with SSRI. it's also available as patch

stent / angioplastyfor athersclersis. is inferior to endarectomy except for high risk pts

PTChiropracter: good only for back pain with no radiculopathy, mostly for cervical pain.

INF reactionNaprelan: extended release naproxen, prednisone 10 mg at the day of injection, pentoxifulline, Treximet forha. for site reaction. EMLA-lidocaine topical- ; ethyl chloride cold spray.

autoimmuneany of those illustrated sub types can have the Ach receptors antibodies of the ganglio neuronic cells.

GIBloating, fullness, Nausea severe constipation, less common diarrhea post prandial sym: fatigue, lightheadedness, sleepiness ; hypotension. acalculeus cholecystitis.

Ca channelverapamil (80 tid), nifedipine, dilitazem all results are ambiguous. they work best for hemiplegic migraineor migraine with prolonged aura. Nifidepine is vasodilator and occasionally can worsen

bulparcan be only nasal speech

N. sprayworks faster than tab. Imitrex, Zomig

Lovenoxonly partially neutralized with protamine; use max dose of 50 mg protamine.

DBSin the Globus Palidus. best for generalized dystonia with mutation DYT1

respiratory functionvital capacity: done with max exhalation. normal 40-70 ml/kg Maximal inspiratory pressure: done with maxsuctioning in, Normal > 100, F > 70 Maximal expiratory pressure: done with max blowing out normal > 200, F> 140

MRIcontrast is contradicated in severe renal failure or HD. it can cause Nephrogenic systemic fibrosis. Microbleeds on GRE scan are not contradiction for giving tPA

dementiaAricept and rivastigmine. however they might increase tremor. cognitive test best by mocatest.org

muscle crampsquinine is the best, baclofen, Neurontin, Magnisum

Keppra1-3 gm

Arivanshould not exceed the max amount b/o metabolic acidosis induced by the solvent, propyl glucocol.

Muscle dystrophiesDuchene's or Baker's are tested by DNA mutation for the dystrophin.

surgeryindication for symptomatics 70-99% and may be indicated for symptomatics 50-69%. may be not indicatedfor women. For asymptomatics 60-99% had to be decided on individual bases ASA is recommended perioperative and to 3 ms after surgery is best done within 2 weeks of CVA

hemicrania continuacontinues headache resemble chronic daily ha but unilateral.

trachestomyafter 7 ds. however can wait for 2-3 weeks to see if pt is improving neurologically

f VIInormalized INR in 8 hrs but INR should not be used for monitoring half life is 2.5 hrs; thus it should be usedin conjuction with FFP dose : 1.2 - 4.8 mg

ALSthe pathognomic finding sometimes is hyper reflexia including jaw jerk

hypothermia34 c. side effects: rebound hyperthermia causes mortal ICP pneumonia bradycarida thrombocytopenia

ddxcan mimics focal sz pharyngeal and vocal cords dystonia must be recognized from titanus, cervical dystoniamust have MRI cervical to r/o fxs or arthritis neck rigidity from menengial irritation can mimic dytonia tooalso neck and pharyngeal infections or cellulitis hypocalcemia can presents with titanus like or paroxysmaldystonia MS can have acute tonic spsams: tonic spasms

SZ prophylaxisfor 1 week Dilantin, Keppra

post encephalitis.pt can present first with viral (HSV) encephalitis, recover then relapse when ADEM occur. this must bedistinguished from recurrence of the infection. in encephalitis: fever lasts longer; in ADEM it's only for 1 d.

othersTacrolimus: similar to Cyclosporine Chlorambucil: similar to cyclophosphamide. Remicade: TNF blocker;also Rituximab

op & traumasyringes tetheres cord arachnoiditis

acutetypical acute tx is: vit B2 / Magnesium 400 mg (or feverfew) Inderal LA 60 qam ( or tompamax) ZomigZMT prn (or Maxalt). for vomiting: nasal spray or injections)

presentationsRespiratory dyskenisia can presents as SOB and dyspnea. it can alternate very rapidly with off times. (likeevery 15 min) painful dystonia can present during off times

imaginglesions are one age. Later scans can show new small lesions but actually they were old but not visible then.no black holes. involvement of deep gray matter nucleus. less likely to involve the corpus collusum

Cellceptno hepatic or renal toxicity 1 gm bid

para neoplsticautonomic panel includes : anti P/Q type Ca; Ach receptors; Neuronal nicotine receptors abs; anti CV 2; antipurkinje cellPCA2; Anti Hu positive

Trigeminal hain a subtype of cluster headache, symptoms can e very short, lasting only seconds, and can be triggered withcertain head movements.

exam

postural instability test : evaluates risk for fall. need to pull the pt one step backward. also: feet should be innormal position unlike Romberg where feet should be closed together needs to document the time of lastdose

exam

Spine ROM, palpating the spine, straight leg and head compression

sparing txMethotrexate, Cellcept. Azathioprine, IVIG

fronto-temoralunlike Alzheimer, starts with personality problems; insight is impaired early , speech problem is early memory loss is late, had two types: frontal dominant, with personality changes ; and temporal dominant withprogressive aphasia that's either fluent or non fluent. the fluent subtype has semantic dementia or visualagnosia with loss of words meanings. Primary progressive aphasia is a type of the temporal dominant,

LeukoodystrophyLarge WM lesions mimic leukodystrophies.

hypnic haha in elderly resembles cluster for being nocturnal but no autonomic features.

weaningcan wean regardless of the neurological status if was not neurologically deterioration and if able to coughand suction less than 1 q 2 hrs. can breath and FiO2< 50%.

RLScan be in arms or trunks only 5% have iron deficiency, can be associated with neuropathy or radiculopathy.the best tx then is Neurontin

surgicalclosure of PFO occipital nerve block

theopentalis long acting and fat soluble form of pentobarb

Tigeminal neuralgiathe ha is electrical shocks

Neuropathysymptomatic in only 10% likely to present along retinopathy and nephropathy UE involvement is likely dueto CTS and mono neuritis

preventionASA: decrease risk by 14% with no dose difference. entero coated ASA is less efficient than regular ASA.Ticlopidine; is an old analogue to ASA with same stroke prevention but more side effects (neutropenia)Plavix is slightly better than ASA Aggrenox: the best prevention. can cause headache, so it can be started qdfor few days with ASA then bid. it lacks the cardiac prevention profile unlike ASA or plavix in Afib if pt isunable to take warferin, ASA is given instead at 325 mg all pt should be placed on statins regardless of LDLlevels; however the high doses of statins (lipitor 80) can increase risk of hemorrhage. statins should not bestopped suddenly. ACEi are not unique among HTN meds for stroke prevention anti coagulation in thefollowing cases: Afib, Mitral stenosis, severe CHF

testsfloudri dopa PET scan showes decreased asymmetric uptake. help to recognize psychogenic cases

GUBladder: frequency, urgency, incontinence. impotence

surgeryto preserve the neuro function but likely would not restore it. two parts: decompression and stabilization

propofulcauses hypotension less mortality than barbiturate so if benzo failed, propofol should be tried next

Lasixgiven in combination with the other agents.

AEDonly toapamax (25-100) , valproate ; possibly neurontin

Painfrom axial rigidity. involves back, shoulder, neck.. can fluctuate with on- off motor response. Also can befrom Dystonia can be discomfort from sensory symptoms or RLS usually correlates with off time tryapomorphine. but also dyskinesia.

anxietyfor insomnia: trazodone, Remeron also seroquel, for panic attacks: if routine tx failed, try ampomorphine orextra LD to abort.

argatrobancan not be reversed.

vertigoScopolamine patch Benzos less response is with Meclizine other etiologies are: labrynth fistula, vestibularMigraine. consider ENG

EEGSZ or slowing. lesions of the gray matter.

PCCProthrombin complex concentrate concentrate of 2, 7, 9 and 10 normalize INR in 1- 2 hrs. dose: 15 u/kg forINR < 5 ; or 30 u/kg for INR > 5

Limb Girdle muscle dis.presents as proximal weakness. type I is dominant, type II is recessive. Lamin deficiency can only beconfirmed with DNA testing. Muscle biopsy is neg.

COMTEntacapone and Tolcapone

Fulminateage < 2 yrs. not immunized. edema, bleeding, residual deficits and recurrence

ITPsymptomatic hematoma (not in the brain ) can be reversed : 2 FFP + 20 cryprecipitate + 6 Platelets

pentobarbitalcaused hypotension and decrease cardiac mortality

intractable haconsider MRI with MRV/MRA LP with pressure reading ESR for giant cell arteriits Indomethasine. tx

reverse coagulationhematoma can expand for 7 ds. normal INR does not necessary remove risk of bleeding b/o factor 9 is notmeasured. you need to correct the factors to 30-50% of their normal values

TCAanitryptalin, nortryptalin 10-50 mg; but not SSRI

behavioralfor fatigue see: fatigue in MS

DDXB12 deficiency: mimics MS or ADEM on MRI Sarcoidosis:causes basilar menegitic enhancement, WMlesions and vasculitis. also orbital pseudotumor

Bldderfor nocuria only: can try DDAVP 0.1 - 0.4 mg/d Uninhibited neurogenic bladder : (anticholinergics)Propantheline 15 mg q.i.d.and titrate Oxybutynin (Ditruban) 5mg b.i.d.and titrate CatheterizationNeurogenic bladder (cholinergics) Bethanechol Baclofen Catheterization

DBSperformed in the sub-thalamic neuclus. specially for dyskinesia and prolonged off time must be young andcognitively intact

DVT prophylaxisstrokes induce low grade of DIC; slightly high FDP start with pneumatic compression from day 2: can useheparin 5000 sq TID or lovenox 40 subq if DVT developed: need IVC filer.

NSAIDcan be used, less likely to develop rebound ha. naproxen, Indomethasine,

dysautonomiaincludes: orthostatic hypotension, dysphagia, urinary retention

Myalgiabiopsy only required if there's weakness, elev CK, exercise confined, isolated maylgia could have abnormalbiopsy but it's not specific or diagnostic the finding of non tender points in pt with myalgia supports dx ofFibromyalgia.

Ketaminecan be used for conscious sedation with versed for minor surgery in older kids can cause agitation cause nochange in BP or increase.

Dissection can presents like migrainewith unilateral headache, intermittent numbness or weakness

spasticityBaclofen start at 10 mg qhs and titrate Dantrolene start at 25 mg qd Tizanidine (Zanaflex)Benzodiazepines Botox IM for focal spasticity Baclofen pump for refractory

intubationfor change in mental status. like for GCS < 8 in stroke: it's usually required after few days, during the edemaphase.

SubtopicLocally: lidoderm, capsaicin cr, compound creams: 12% neurontin + 5% lidocaine

vitaminsriboflavin B2, 400 mg Mg 400 mg co enzyme Q 150 - 300 mg, Feverfew petasites hybridus 150mg qdmelatonin 3 mg qhs

NMS of parkinsonhyperpyrexia syn of PD. presents like NMS: fever, rigidity, rhabdomyolysis, DVT/PE results from abruptwithdraw of sinemet. tx with sinemet; also can giveh bromocriptine or Dantroline 10 mg/kg IV ; same likeNMS

fever, rigidityNMS, Serotonin syn, PD like NMS Tetanus also think of Anticholinergics or toxins for fever witout rigidity

PTconsider chirpopractic or acupunctures.

daily labsAnemia: keep Hg > 7 Na: avoid hypo; but hyper is ok if euvolumic. Glucose control ABG: avoid hypoxemia

Re-anticoagsshould be held for 1-2 weeks

botuxif the previous tx failed.

FENNPO for several days including NG. maint. IV are NS with 20 kcl 50-100 cc/hr

Musclesconsider genetic tests in many muscles dis. could avoid doing biopsy. such as : duchene's and Baker's MD95%; Myotonic dystrophies 100%, FSH 98%; Limb- Girdle dis. I is dominant, II is recessive. both only50% go to genetests.org

Movements dis.general w/u for unclear movements dis: Imaging: PET, PET with fludro dopa labs: heavy metals, para-neuplstic panel, rheumatology panel, thyroid, HD genetic, blood smear, wilson panel, HIV para neuoplasticw/u and body scans. blind tx: reserpine, Klonopin +/- anticholinergics. also consider clozapine, or verapamilafter all think of psychogenic