exam

CSF
Lab
dx

Viral c/s

imaging
EEG

brainstem
spine
post encephalitis.
ADEM
tumor
rheumatologic
chronic
abscess

types

Leukoodystrophy

Fulminate

steroid taper
Recurrent

Inflammatory ds.

non taper
steroid dependent

exam
dx

Lab

CSF

MRI
MS
fatigue
tx

tonic spasms
INF reaction

clinical
dx
encephalitis

lab

types

Encephalomyeloradiculneuropathy

dx

clinical

vasculitis
tx

DDX

tmp control
CVS
GI
signs

GU

eye

horner's

others
dry moth/eyes

CNS

DM

glucose intolerance

Amyloid

Autonomic neuropathy
sympathetic
pure autonomic

parasympathetic

clinical types
both
etiology
PNS

mixed
autoimmune
autoimmune diseases

Sjogren

post viral
etiology
Lambert Eaton
para neoplstic
anti ganglionic Ach receptors abs

chronic resp. care

saliva
muscle cramps

Rehab

vertigo
Bldder
spasticity
Subtopic

Neuropathy

septic shock
Hypotension & fever

DIC
autonomic neuropathy

MG
etiologies

Myopathies

progressive weakness
ALS

symptoms

optic nerve

Presentations
abnormal pupillary exam

3th nerve
autonomic disease

MG
acute descending weakness

Miller fisher GBS

Botulism

pearls
intermittent numbness or foot drop

CIDP

Dissection can presents like migraine

fever, rigidity

Malignancy w/u

pre tx
supportive tx

MTX
AZA
Cellcept

steroid tx

IVIG/ plasmapherisis

sparing tx

Cyclosporine
third line

cyclophosphamide
others

Increased breathing rate

signs

decreased O2
sweatning. weak cough

no signs of dyspnea
in neuromuscular weakness

Monitoring

Respiratory failure

count to 30 in one breath

bedside

Neuromuscular & respiratory emergencies

neck flexor muscles predict the respiratory

muscles.

expiratory peak flow

respiratory function
Vital capacity

ABG

Increase CO2

NICU
critical illness neuropathy
ICU quadriplegia
critical illness myopathy

post status
sz
encephalopathies/ietis

NMJ blockage
ind.

coma

EEG monitoring

severe NMJ and GBS

stroke
vascular
ISH

tech

artifact

succinylcholine

loading
versed
drip

Dilantin

loading
Arivan
drip

loading
propoful
drip

loading

tx

sz

pentobarbital

status Epil.

drip

loading
Ketamine
maint.

VPA
Topamax
others

Keppra
theopental
paraldehyde

medical

HTN post status

surgery
CVS

HTN
tPA
post 3 hrs

IA tPA

tx
interventional

device retreiver

stroke

stent / angioplasty

surgery

prevention

surgical

CTA
Imaging

CT perfusion
MRI

rehab

depression

volume
IVH

CVA
prog
hydrocephalus
deterioration
NCSE
medical

coagulopathy
type
Trauma

neurology dis.
IVH
dx

angio

no HTN
lobar

ventriculostomy
ICP monitor

Parenchymal probe
others

central vein oxymetry

surgery
CT
cerebellar
evacuation

Clinical

IVH

tx

lower BP
BP
inc. BP

manitol
Hypertonic saline

hyperventilation

ICH

lower ICP
barbiturate
other
hypothermia
Lasix

SZ prophylaxis

clinical
NCSE
tx

FFP
Vit K
coumadin
f VII

medical

PCC
reverse coagulation
heparin
Lovenox
argatroban
ITP

DVT prophylaxis

tech
weaning
intubation
trachestomy
weaning

daily labs

late labs

deep ICH
Re-anticoags
Lobar ICH

FEN

NMJ

MG

labs

AChr -

Myotonic dystrophy

clinical
Statins myopathy
tx

Muscle dystrophies

Baker's

Limb Girdle muscle dis.

dx
tx
Myositis
polymyositis
types

Muscles

inclusion body myositis

Myalgia

cardiac
supportive
tx

resp.

steroids

cardiac
presentaion

contracutres
bulpar

Alzheimer
vascular dementia

types

parkinsonism
LBD
dementia

Dementia

fronto-temoral

cognitive
tx
behavioural

tx

oculogyric crisis
acute

presentation
dystonia storm

dystonia

ddx

Botox
chronic

tx

medical

symptoms
DBS

essential tremor

tx

labs
chorea
tx

Ballismus
violent activity
paroxysmal dyskinesia

Sinemet

new
agonist
old
tx

MAO b
COMT

Movements dis.
anti colintergics
DBS

fluctuation
off time

tx
Parkinson

dyskinesia

etiologies
presentations

diseases
Pain
symptoms

psychosis
impulse control
behavioral
dementia
anxiety

dysautonomia
NMS of parkinson

exam
tests

Huntington dis
tics

tx

RLS

symtoms

rehab

autonomic dysreflexia

acute
tx
prophylaxis

medical
epidurals
tx
PT
spondolysis

surgery

symptoms

spine

exam
etiologies

muscoloskeltal

facet joint

symptoms
prognosis
transverse myelitis
labs
tests
imaging

noraml variants
imaging

MRI

degenerative dis.
op & trauma

ACEi
b blockers
Ca channel
AED
prophylaxis

TCA
NSAID
vitamins
PT
botux

migraine
sypmtoms

migraine status

fast metl

headache

acute

triptans

Sub q

out pts
N. spray

others

surgical

Chronic daily

tx

tx
cluster
prophylaxis
Trigeminal ha

paroxysmal hemicrania

loading
0.2 mg/kg/

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

CNS
closely related to parkinson and LBD.

stroke
can predict the post tpa hemorrhage.

steroid taper
no risk for MS

ventriculostomy
drains IVH monitors hydrocephalus no need for daily csf cultures unless if there's fever. can be left for up to
14 ds.

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

facet joint
not all agree on its existence steroid injection into facet joints might help mostly in neck possible
intervention is radio ablation of the innervating branch

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

acute
from neuroleptics

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

CSF
CSF immune profile: usually normal MBP high unlike MS

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

lower BP
MAP=130 ; SPB= 180 severe lowering casue ischemia. Nivadipine, Labetolol, esmolol. for renal pts: used
Fenoldopam

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

brainstem
mimic: Bickerstaff encephalitis; or glioma

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

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

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

critical illness neuropathy

h/o sepsis use differentiated from myopathy by abnormal phrenic nerve conduction axonal type of
neuropathy; differntiated from GBS by normal CSF

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

loading

0.1 mg/kg

Ballismus
can be b/l in HIV, non ketotic hyperglycemia,

noraml variants
on 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 root
diverticulum: expansion of the dura around the root make it look like nerve sheet tumor, Tarlov cyst: dura
enoculated cysts in the sacrum Schmorl's Node: disk herniation into the vertebral body. can look like tumor
infiltration to the vertebra body, synovial cysts: from facets.

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

CVA
ischemia; hematoma expansion; edema

cognitive
ACEi like Aricept. indicated for mild to moderate dementia Namenda for mod. to severe dementia. can be
added to Aricept.; it can worsen sz.

HTN post status

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

deep ICH
anti-caogulation should be resumed in 1-2 weeks

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

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

cardiac
Cardiac: Echo, EKG, Holter; tx with ACEi and B blockers can slow progress; later consider early
pacemaker

tx

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

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

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

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

pre tx
DEXA bone scan for osteoporosis CXR for tuberculosis

manitol
mannitol 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

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

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

Botox
both type A and B are immunogenics

muscoloskeltal
back pain in the absence of any neurological causes.

tx
tx; anticholinergics (diphenhydramin 50 IV )

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

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

triptans
Triptans ( or the combo ones with NSAIDS) for refractory cases use large doses: like sumatriptan 100 mg
should be given early in the attack

labs
CSF: pleocytosis, IgG index , protein 14-3-3

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

migraine
migraine with aura increase risk of CVD and CVA x 2

IA tPA
for distal clots beyond M2 up to 6 hrs

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

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

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

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

Encephalomyeloradiculneuropathy
Encephalitis with peripheral involvement. low reflexes. Enterovirus 71, Coxacie

symtoms

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

dystonia
for cervical dystonia: check the MRI cervical for cord compression

tumor
lymphoma can respond to steroid then relapse with withdrawl

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

hyperventilation
goal is Pco2 26-30 intermittent mandatory ventilation (IMV)at a rate of 16 to 20 per second,with tidal
pressure of Cox 28 to 32 hg.Avoid severe hypocapnia of <25.

post status
20% remain in electrographic sz after the clinical one stopped.

loading
3-5 mg/kg

autonomic dysreflexia
acute discharge of sympathetic nerves in spine cord lesions above T6

ICP monitor
all pt with GCS < 8 should have ICP monitor goal to ICP < 20 and CPP > 60

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

CTA
source images can estimate the infarcted core as accurate as CBV in Perfusion

loading
1-4.5 mg/kg given with benzo

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

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

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

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

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

eye
pupilomotor dysfunction; blurry vision

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

symptoms
100% bladder dysfunction and parathesia. band like dysthesia in levels of lesions.

CSF
abnormal CSF immune profile

coumadin
reverse with either: vit K + PCC vit K + FFP + f VII

clinical
worsening the consciousness level and spasticity

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

loading
12 mg/kg

Alzheimer
insight is usually saved until late.

rehab
maximum recovery is usually reached by the third month,

fatigue
stimulants: 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 the
med. exercise: produce paradoxical effect need to pay attention to other factors: sleep disorder from muscle
jerks or from nocturia from neurogenic bladder.

chronic resp. care

FVC q 3 ms vibrator assisted cough machine BiPaP Non invasive ventilator

Lambert Eaton
Autonomic neorapathy presents in 60%

fast metl
probably works same like regular tab Zomig ZMT, Maxalt MLT

prophylaxis
consider for 2 attacks /weeks. or for fewer if the attacks were disabling. birth control is required for most of
those meds when other co morbid conditions co exist with migraine: use the best drugs for each and not
necessary the one drug for both placebo effect is 30s%. most drugs are 50s% consider underling depression

coagulopathy
fluid-fluid level

cardiac
cardiac 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 CT
to r/o acute hydrocephalus.

cluster
differentiate 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

ACEi
ACEi and ARI are prophylaxis effective and can be used to decrease CVD and CVA risks in pts with the
aura migraine

exam
little sensory abnormality

dx
anti Jo-1 see malignancy w/u

succinylcholine
can cause hyperkalemia should be avoided in NM disorders.

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

new
Requip and Mirapex

exam
remarkable sensory abnormality; specially vibration.

signs
in respirtatory compromise from neuromuscular origin, the weakness can progress to failure with no signs of
respiratory stress.

saliva
anti cholinergics.; scopolamin patch for sever cases try botox

prophylaxis
verapamil 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 hrs
IV tPA can be given 3-5 hrs only if there is big mismatch on perfusion scan.

imaging
always consider brain MRI and evoked potentials.

IVH
critical volume is 20 ml

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

behavioural
for anxiety: Trazodone, Buspirone can help neurolyptics: likely to have no benefits can try : SSRI, AED, for
Abulia: try sinemet, stimulants, SSRI

tx
immunosuppresant might work better than AED for sz or behavioural.

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

Vital capacity
ICU criteria: bulbar dysfunction or automonic instability > 30% reduction in VC or sat <90% VC < 20ml/kg
or PI max < 30 cm h2O or PE max < 40 cm. (20/30/40 rule)

off time
tx: instant release sinemet or apomorphine prolonged off time can cause NMS like syn,

paroxysmal hemicrania
severe headache with very frequentt attacks up to 40 /d. By definition it must responds to Indomehtasine (up
to 300 mg)

lower ICP
in case of increased ICP: elevating the HOB improve cerebral perfusion will not work if pt had systemic
hypotension; in this case head should be placed down.

impulse control
associated with dopamine tx includes: gambling, shopping, OCD, hyperphagia, self feeling of clinical
worsening tx: decrease dopamine agonist, seroquel? anti depressents?

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

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

medical
high dose of anti-cholinergics Haldol

Topamax
through GT loading dose

Hypertonic saline
can 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 30-60
cc 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

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

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

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

vascular dementia
usually presents shortly after CVA. urinary incontinence is early

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

b blockers
Propranolol 40-400 mg, Metoprolol,100 -200 Atenolo 50-200

inclusion body myositis

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

drip
1 mg/kg/hr

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

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

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

paroxysmal dyskinesia
congenital. responds to klonopin, carbamazepine,

Sub q
best for pts with nausea Imitrex

Malignancy w/u
CT chest/pelvic, Mamogram, colono-scope.

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

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

Clinical
depressed consciousness brainstem compression signs; ispsilateral babenski

tx

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

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

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

CVS
Rt stroke: bradycardia Lt stroke: tachycarida

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

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

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

drip
9 mg/hr

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

old
Amantadin or Bromocriptine

prophylaxis
clonidine 0.2 bid prazosin 0.5-1 qd

non taper
risk for MS 25% prepubertal; 85% post puberty

post viral
+/- AIDP

symptoms
excessive saliva, inability to whistle. SOB

Trauma
brain contusion mostly frontals

maint.
0.5-2.5 mg/kg

critical illness myopathy

h/o steroid ; muscle blockage use elevated CK normal phrneic nerve study; abnormal diaphragm EMG
prognosis is worse

tx
versed drip

drip
0.25-0.4 mg/kg/hr as per EEG

PNS
often combined with pain's small fibers involvement as well.

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

cyclophosphamide
PO 1 mg/kg/d or IV 1 gm/m2/ q month

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

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

Chronic daily
same is analgesics over use 15 days per month; 8 of them are migraines it's uncertain if NSAID causes that
as 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 with
surgery. the endplates changes from degenerative dis. can mimic tumor infiltration; however the hallmark is
the location along the endplates edges only. Signal on T1 or T2 can be anything' facet joint dis. : causes
muscle skeletal pain on its own, or contribute to spinal stenosis. Also it can be associated with synovial cyst
which causes bones erosions. Para articular defect: shortening of the pedicles causing congenital
spodolithisis.

Vit K
vit K IV 10 mg X 3d

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

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

drip
0.1-2 mg/kg/hr

CVS
orthostatic 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. sustained
hypertension; paroxysmal hypo- hypertension.

dementia
visual hallucination and good insight that's not real

Lobar ICH
anti coagulation risk is high.

tx
Tetrabenzine, Reserpine, Neuroleptics, Klonopine, valproic acids

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

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

epidurals
help only the pain for few weeks. effect resolved by 3 ms does not improve outcomes or activities or
neurological symptoms.

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

chorea
difficulty maintain protruded tongue is pts with Huntington dis.

steroid dependent
boys, sz, ON, plaques responds to immunosupprsent

deterioration
dec. glasco scale or incr. NIHS by 2

abscess
can be ring enhancing: mimic abscess or cystecircusis, l

MRI
small multipile lesions on spine, involving less than cross diameter of spine on axial and less longitude
extension on sagital.

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

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

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

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

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

GI
Bloating, fullness, Nausea severe constipation, less common diarrhea post prandial sym: fatigue, light
headedness, sleepiness ; hypotension. acalculeus cholecystitis.

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

bulpar
can be only nasal speech

N. spray
works faster than tab. Imitrex, Zomig

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

DBS
in the Globus Palidus. best for generalized dystonia with mutation DYT1

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

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

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

muscle cramps
quinine is the best, baclofen, Neurontin, Magnisum

Keppra
1-3 gm

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

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

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

hemicrania continua
continues headache resemble chronic daily ha but unilateral.

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

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

ALS
the pathognomic finding sometimes is hyper reflexia including jaw jerk

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

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

SZ prophylaxis
for 1 week Dilantin, Keppra

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

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

op & trauma
syringes tetheres cord arachnoiditis

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

presentations
Respiratory dyskenisia can presents as SOB and dyspnea. it can alternate very rapidly with off times. (like
every 15 min) painful dystonia can present during off times

imaging
lesions 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

Cellcept
no hepatic or renal toxicity 1 gm bid

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

Trigeminal ha
in a subtype of cluster headache, symptoms can e very short, lasting only seconds, and can be triggered with
certain head movements.

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

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

sparing tx
Methotrexate, Cellcept. Azathioprine, IVIG

fronto-temoral
unlike 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 with
progressive aphasia that's either fluent or non fluent. the fluent subtype has semantic dementia or visual
agnosia with loss of words meanings. Primary progressive aphasia is a type of the temporal dominant,

Leukoodystrophy
Large WM lesions mimic leukodystrophies.

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

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

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

surgical
closure of PFO occipital nerve block

theopental
is long acting and fat soluble form of pentobarb

Tigeminal neuralgia
the ha is electrical shocks

Neuropathy
symptomatic in only 10% likely to present along retinopathy and nephropathy UE involvement is likely due
to CTS and mono neuritis

prevention
ASA: 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 qd
for few days with ASA then bid. it lacks the cardiac prevention profile unlike ASA or plavix in Afib if pt is
unable to take warferin, ASA is given instead at 325 mg all pt should be placed on statins regardless of LDL
levels; however the high doses of statins (lipitor 80) can increase risk of hemorrhage. statins should not be
stopped suddenly. ACEi are not unique among HTN meds for stroke prevention anti coagulation in the
following cases: Afib, Mitral stenosis, severe CHF

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

GU
Bladder: frequency, urgency, incontinence. impotence

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

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

Lasix
given in combination with the other agents.

AED
only toapamax (25-100) , valproate ; possibly neurontin

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

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

argatroban
can not be reversed.

vertigo
Scopolamine patch Benzos less response is with Meclizine other etiologies are: labrynth fistula, vestibular
Migraine. consider ENG

EEG
SZ or slowing. lesions of the gray matter.

PCC
Prothrombin complex concentrate concentrate of 2, 7, 9 and 10 normalize INR in 1- 2 hrs. dose: 15 u/kg for
INR < 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 be
confirmed with DNA testing. Muscle biopsy is neg.

COMT
Entacapone and Tolcapone

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

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

pentobarbital
caused hypotension and decrease cardiac mortality

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

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

TCA
anitryptalin, nortryptalin 10-50 mg; but not SSRI

behavioral
for fatigue see: fatigue in MS

DDX
B12 deficiency: mimics MS or ADEM on MRI Sarcoidosis:causes basilar menegitic enhancement, WM
lesions and vasculitis. also orbital pseudotumor

Bldder
for 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 Catheterization
Neurogenic bladder (cholinergics) Bethanechol Baclofen Catheterization

DBS
performed in the sub-thalamic neuclus. specially for dyskinesia and prolonged off time must be young and
cognitively intact

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

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

dysautonomia
includes: orthostatic hypotension, dysphagia, urinary retention

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

Ketamine
can be used for conscious sedation with versed for minor surgery in older kids can cause agitation cause no
change in BP or increase.

Dissection can presents like migraine

with unilateral headache, intermittent numbness or weakness

spasticity
Baclofen 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

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

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

vitamins
riboflavin B2, 400 mg Mg 400 mg co enzyme Q 150 - 300 mg, Feverfew petasites hybridus 150mg qd
melatonin 3 mg qhs

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

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

PT
consider chirpopractic or acupunctures.

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

Re-anticoags
should be held for 1-2 weeks

botux
if the previous tx failed.

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

Muscles
consider genetic tests in many muscles dis. could avoid doing biopsy. such as : duchene's and Baker's MD
95%; Myotonic dystrophies 100%, FSH 98%; Limb- Girdle dis. I is dominant, II is recessive. both only
50% go to genetests.org

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