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Flashcards in Neurology Deck (280)
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151

Tx of MS

Acute Relapses -
InterNucOph, Optic Neuritis, fxn impairment -> IV methylprednisolone 1g qd x 3-5 days and taper
Active dz or to prevent relapse
IFN B1a-c
Fatigue - amantadine

152

What causes acute relapse in MS

Infections
before high dose steroids always r/o infection
Young women shoudl be on contraception to avoid teratogencity on IFN tx

153

MC presentation of MS

parathesias, tingling sensation, loss of vibration sense (dorsal column)

154

Blurry vision, diplopia

MS

155

Methylprednisolone x 5 days then taper

Acute MS relapse

156

Alpha interferon

NOT Tx for MS

157

B interferon

PPx for relapse

158

Amantadine

Tx for MS fatigue

159

Optic Neuritis

Better prognosis

160

Sensory sx

Better prognosis

161

Relapsing remitting

Better prognosis

162

Progressive relapsing MS

Worse prognosis - d/c B infn

163

Age>40 at dx of MS

worse prognosis

164

32yo with intermittent diplopia - numbness/paraesthesia - attempted adduction affected eye -> horizontal nystagmus - Visual acuity - 20/20

internuclear ophthalmoplegia
etio - Medial longitudinal fasciulus - MS

165

Young woman develops "thick tongue" blurry vision after hot showser - after exc or after hot weather - dx?

Optic neuritis

166

Pt with MS not responding to B interferon

start mitoxantrone

167

Parkinson's dz

Movement d/o 2/2 decrease DOPAMINE from SUBSTANTIA NIGRA
Clinical Dx
Cl Fts RRRR
R esting tremor 4-7 Hz - pill rolling - pronation/supination
R igidity - cog wheel regidity - dec'd arm swing
R etarded movement - bradykinesia and dyskinesia
R eflex lost - postural reflex lost-> frequent falls

168

When to treat Parkinson's

Only start when sx have negative impact on functioning status
1. Replete dopamin in brain -
Levodopa (peripheral effects not needed) so add carbidopa (prevents periopheral effect of levodopa)
2. Dopamine agonist (pt <70yo): pramipexole, ropinirole bromocriptine
3. Inhibitors of dopamin breakdown - selegiline, tolcapone - allows higher doses of L dopa to cross BBB
4. Anti-cholinergics - dec s/e levodopa (trihexyphenidyl, Benztropine)

169

Complications of Treatment

L-Dopa side effects
Involuntary movements - fascial lingual dystonia, chorea, athetosis
Psychiatri symptoms - confusion, depression hallucinations psychosis
on-off phenomenon - alternative hyperkinesia-hypokinesia

170

55yo M p.w slow shuffling gait - resting tremor and brdykinesia - ADL with difficulty - cogwheel rigidity and spacticity of muscles - now would start...

Levodopa and carbidopa

171

Pt started on levodopa-carbidopa c/o nausea wtd?

Take with low protein meal or carbidopa 30 min prior to levodopa

172

Pt with long standing parkinson's dz on L&Carbidopa now c/o wk and bradykinesia dx?

On-off phenomenon - inc dose/frreq +- selegiline (inhibits levodopa breakdown)

173

70yo F parkinson's dz on levodopa and carbidopa did well for several years now with inc'ing sx - > dosage of levo/carbidopa inc'd-> psychsis wtd?

start atypical antipsychotic - quetiapine or clozapine

174

Pt with refractory schizophrenia started on clazapine - 3 weks later develops agranulocytosis WBC 500 wtd?

d/c clozapine and never use again

175

Pt with Parkinson's dz hospitalized with PNA confused, agitated at night -

start lorazepam

176

Parkinson's related dementia

Quetiapine or clazapine

177

Parkinson's related DELIRIUM

Lorazepam or Quetiapine

178

Pt pw bradkinesia, abn gait, inc'd muscle tone and mild dementia - exam reveal erect posture with hyperextension of neck no tremor, vertical ophthalmoplegia; trouble walking downstairs, eating or reading

Progressive Supranuclear palsy
Slow movements, problem with voluntary eye movement, diplopia while reading (hard to get eyes close together
Tx: TCA (amitripline)

179

Essential or Familial/Kinetic Tremor

Autosomal dominant, mainly hands/head
Intention tremor at 7-10hz (physiogic >9)
Aggrevated by anxiety, anteropost flapping hands
Gets better at rest
dec'd with etoh
Tx with propranolol -> primadone

180

Pt with creepy-crawly sensations, itchiness, pain, parestesias, jerky movement every 20-40 s while sleeping - fatigue during day
Sx transiently relieved with movement or walking - can occur with or wihtout Parkinson's
A/W Iron def anemia

Dx: Restless leg syndrome
-established by H&P
If IDA - iron therapy - if not better in 12 wks start dopamin agonist
No iron def - dopamin agonist (perfolide, pramipexole, ropinrole or gabpentin