IM neuro

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Author:
TerryZ
ID:
248101
Filename:
IM neuro
Updated:
2013-11-27 09:40:30
Tags:
internal medicine IM neurology neuro
Folders:
IM
Description:
Internal medicine - neurology
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  1. Seizure - S/Sx
    • lightheaded
    • sweating
    • SOB
    • long sit/stand
    • HoTN
    • warm, N, abd stress, yawn, belch
    • LOC momentary
    • Bladder cntl retained
  2. Syncope - S/Sx
    • deja vu or unfamiliarity
    • don't remember incident
    • muscle pain
    • confusion/disorientation
    • LOC -> fall
    • Abnl motor fn
    • Unintelligible sounds
    • Automatisms
    • Jerking of limbs/trunk
    • vis/aud/gust hallucinations
    • longer LOC
    • Bladder cntl lost
  3. Meningitis - facts
    • Def: inflam mening membrn brain/SC
    • Acute: onset hrs - days
    • Chron: onset wks-mos (mycobact, fungi, Lyme, parasites)
    • Infect: hematogenous, retrograde, contig
    • ~infect: med, SLE, sarc, carcinomatosis 
    • Ascep: ~bact: virus (entero/ HSV), ^
  4. Meningitis - bacteria by pop
    • Neonates: GBS, E.coli, L.monocytogenes
    • >3 mo: N. mening, S. pneumo, H. flu
    • 18-50: S.pneumo, N.mening, H.flu
    • >50: S.pneumo, N.mening, L.monocyt
    • ImmunC: L.monocyt, G- bac, S.pneumo
  5. Meningitis - S/Sx
    • Char triad: acute bacterial mening: F, nuchal rigid, AMS
    • Gen: HA (lying), N/V, malaise, photophob
    • Rash: MacPap w/petechia, palp purpura;
    • >ICP: papilledema, seizures
    • CN: palsies
    • Signs: Kernig (knees), Brudzinski (neck)
    • Ascept: HA, mild meningismus, F, ?AMS
    • Viral: HA! (sit, stand, cough), F, photo, mening, /CSF WBC
  6. Meningitis - Dx
    • CSF Exam
    • Appear: Cloudy<-pyogenic
    • Sent4: Cell cnt, chem, G stain, cx (w/AFB), & crypto AG or india ink
    • Bact: pyo,^WBC(PMN),prot;vGlu,G+80
    • Ascp: ^MNC(L),=/prot, =Glu, =CSF
    • Head CT: b4 LP if focal neuro signs, space-occupying lesion +/ICP
    • Blood cx: b4 abx
  7. Meningitis - CSF findings
    • .       Normal  Bacterial    Asceptic
    • WBC    <5      1K-10K/uL   10-2K/uL
    • %N      0%       > 50%        <50%
    • Glu    50-75   < 40mg/dL       nml
    • Prot    <60    >150mg/dL  <100mg/dL
  8. Meningitis - Tx tree
    • Suspicion for bacterial meningitis?
    • (IC,CNS dz,new seiz,papil,AMS,foc def)
    • N} Blood cx & LP!    Y} Blood cx
    •   Dexamethazone + emp ~microb tx
    •                            Neg Head CT?
    •                CSF bact? <---- LP
    •             +CSF G stain?
    • N} Dexameth +       Y} Dexameth +
    •    emp ~microb tx      targ ~microb tx
  9. Meningitis, bact - vaccination
    • >65: S. pnuemo
    • asplen: S. pnuemo, N. mening, H. flu
    • IC: meningococcus
  10. Meningitis, bact - prophylaxis
    • rifampin or ceftriaxone
    • close contacts 1 dose IM ceftriaxone
  11. Meningitis, bact - Tx
    • Steroids: start b4 abx prevent hear loss
    • < 4wk: cefotaxime + amp + amionogly
    • < 3mo: cefotaxime + amp + vanc
    • 3m-50y: ceftriax/cefotax + vanc
    • > 50yr: ceftriax/cefotax + vanc + amp
    • xImun: ceftaxidime+amp+vanc
  12. Meningitis, aseptic - Tx
    • No specific tx, supportive care, self-lim
    • ?Analgesics & fever reduction
  13. MS - facts
    • Def: selective demyelination of CNS, multifocal zones (plaques); @ angles of lateral ventricles
    • Involves: white matter (brain/spinal cord)
    • MC tracts: pyramidal, cerebellar, medial log fasciculus, optic n., post columns.
    • Occur: W 2-3x M
    • Etiology: Unk; ?env, immun, genes
  14. MS - S/Sx
    • /sens def: sensat'n or paresth in L/UE
    • Fatigue: MC
    • Motor: weak/spast->paresis
    • Vis distub: Optic neuritis; internuc ophthalmoplegia
    • Cerebellar: ataxia, intent trem, dysarthr
    • bladder cntl: ^mot neuron
    • autonom: impot/constip
    • Cerebral: mem, pers chg, emot lability, anx, depress
    • NeuropathP: hyperesth, trigem neuralgia
  15. MS - course
    • MC starts: 20s-30s - local deficit
    • Clin silent: stable/benign, maybe later
    • Relapse/remit: MC
    • 2ndary prog: gradual worse
    • Prim prog: appears later (40+), less vis
    • Attacks: avg 1 year
  16. MS - Dx
    • Clinical: young adults relapsing/remitting
    • MRI: most sens, abnl 90%
    • LP/CSF: oligoclonal bands of IgG 90%
    • Evoked potentials: 90%
    • Clin definite: 2Sx, 2 white matter lesions
    • Lab definite: 2Sx, 1 white on MRI
    • Prob MS: 2Sx, 1 white OR oligoclon bands
  17. MS - Tx
    • Acute: resolve 6-8wks; high-dose IV CS (solumedrol or dexamethasone + D5, taper PO
    • Dz-mod tx: interferon (Avonex, Betaseron, Rebif; flu-like sxs; mon CBC, LFT, TSH); glatimer acetate
    • Sx-atic tx: baclofen/dantrolene (musc spaz); carba/gabby (neuronic P); tx depress
  18. MG - facts
    • Def: AI d/o ~nicotinic ACh receptors of neuromusc jnct -> post-synapt resp -> signif musc fatigue
    • Occ: F>W, F 20-30, M 50-70
  19. MG - S/Sx
    • Skel musc weak: + senses/reflexes;    //by cont musc use, improved by rest;              /sxs by end of day;                                     musc vary: cranial(EOM,lids,face),               limb (proximal, assym)
    • Eyes: ptosis, diplop, blurry
    • Misc: gen wkness, dysarthria, dysphagia
    • Progr: slowly w/periodic exacerbat'ns
    • Crisis: med emerg,15%,diaphr/intercost
  20. MG - exacerbation causes
    • Abx: aminoglycosides, tetracyclines
    • BB: .
    • ~arrhytm: quinidine, procainamide, lido
    • Misc: infct,stress,heat,postpart,<menses
  21. MG - Dx
    • AChR ab test: most specific (80%)
    • EMG:resp to repet stim of motor nerves
    • CT thorax: r/o thymoma (10-15%)
    • Tesilon tst: (edrophonium) - ~cholinesterase meds -> 10-min improvement in sxs
  22. MG - Mgmt
    • ~cholinesterase: pyridostigme - slows ACh breakdown at NMJ -> Sx-atic relief
    • Thymectomy: sx benef, compl remiss'n
    • Immunosuppr: corticosteroids, azathioprine, cyclosporin
    • Plasmapheresis: x ABs to AChR
    • IV Ig tx: sometimes for acute exacerb
    • Mon serial FVC: 15mL/kg (1L)=intub'n

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