Headaches
What is the difference between a classic migraine and a common migraine?
classic has an aura and common does not
A 22yo male has seizures during the day where he remains fully aware with the hair on his arms standing up and a feeling of being flushed. What type of seizure is this?
What will you see on an MRI of the brain with MS?
plaques (ring enhancing, ovoid)
black hole lesions
What is the most common type of brain herniation?
herniation of the temporal lobe
What is used to treat tics?
antipsychotic drugs and behavior therapy
What is the most common type of headache and how do you treat it?
tension HA
acute tx: NSAID/acetaminophen, migraine meds, opioids, massage, apply heat or ice
chronic tx: NSAID, amitryptyline, nortriptyline, fluoxetine, muscle relaxant, avoid triggers
A 35yo man w/a hx of epilepsy has seizures beginning w/a few regularly spaced jerks followed by stiffening of all limbs and rhythmic jerking of limbs. What type of seizure is this?
Generalized Tonic-Clonic Seizure
What CSF finding is the hallmark of MS?
detection of oligoclonal bands (OCB)
What disease results in vision disturbances and HA and is common in overweight women?
Pseudotumor cerebri
What is the most common form of a postural tremor and which parts of the body does it affect?
physiological tremor
upper limbs and hands
During a PE of a pt with a HA what should you always do?
Listen for carotid bruits
What type of generalized seizure is more common in children?
Absence (petit mal) more common in children, febrile are only in children
What is the acute tx of MS?
glucocorticoids (3-7 day course of IV methylprednisone or oral prednisone)
Corticotropin injection gel (for those who cannot tolerate the first option)
Plasma exchange (when other tx fails)
What are semantic variant primary progressive aphasia and nonfluent variant primary progressive aphasia seen with?
Frontotemporal Dementia (FTD)
What are the top two tx options for an essential tremor?
Alcohol and Propranolol
If a pt comes in and is experiencing a weird pain sensation in the back of their neck, what should you think of?
Occipital Neuralgia
What should you not do when someone is having a tonic clonic seizure?
put any object in their mouth or restrain them
What IV therapy is used for long term tx of MS?
Natalizumab or Ocrelizumab
What neurocutaneous disorders are from autosomal dominant inheritance?
tuberous sclerosis and neurofibromatosis
What does the acronym TRAP make you think of and how do you treat it?
Parkinson's Dz (tremor, rigidity, akinesia, postural instability)
pt's under 60 do anticholinergic, pt's over 60 do amantadine
plus levodopa/carbidopa as gold standard
How do you treat GCA?
high dose prednisone (IV or PO)
immunosuppressive drugs
For a seizure to be considered status epileptics, how long does it have to last?
5 min or more (single or back to back) w/o returning to baseline
What is the black box warning for progressive multifocal leukoencephalopathy?
Natalizumab and similar risk drugs should not be used in those w/history of PML and impaired immunity
What is important to remember about the tx for Wernicke Encephalopathy?
do not give IV glucose before thiamine because it can make symptoms worse
What are some possible PE findings with Huntington's Disease?
Jerky, involuntary movements of shoulders, hips, and face
Hemiballismus (type of chorea)
Athetosis (abnormal muscle contractions)
Rigidity, bradykinesia, postural instability