0071643192.pdf

DIAGNOSIS ■ CT scan is notthe imaging of choice (is often normal). ■ Obtain angiography (CT angiogram has not been fully evaluat ...

Migraine PATHOPHYSIOLOGY ■ Slowly spreading wave of neuronal depolorization across the brain →ion dysfunction and vasoconstricti ...

NEUROLOGY ■ Steroids: Controversial; may work in refractory migraines ■ Opiates should be used as last resort. ■ Prophylactic th ...

ALTERED MENTAL STATUS Confusional states can be broadly divided into delirium,dementia,andpsy- chosis(see Table 15.8). Delirium ...

■ Waxing and waningsymptoms ■ Hallucinations, if present, are visual and/or auditory. DIFFERENTIAL Dementia, psychosis DIAGNOSIS ...

DIAGNOSIS ■ Diagnosis is primarily based on history of slow, progressive change in behavior. All patients warrant neuroimaging, ...

CAUSES Causes are myriad and include: ■ Encephalopathy—metabolic, hypertensive, hypoxic, Wernicke’s ■ Toxins (see Table 15.9) ■ ...

ATA X IA Ataxia is the failure to make smooth, intentional movements. Ataxia and gait disturbances are symptoms of particular di ...

Sensory ataxia: ■ Failure of transmission of proprioception to the CNS via peripheral nerves, dorsal columns or cerebellar input ...

The direction of nystagmus is named by the fast(cortical) component. Vertigo with anyCNS symptoms or findings? Assume central ca ...

CRANIAL NERVE DISORDERS Trigeminal Neuralgia The trigeminal nerve (CN V) has three anatomic divisions, V 1 -ophthalmic, V 2 - ma ...

TREATMENT ■ Initiate carbamazepineand analgesics in ED. ■ Outpatient referral to follow carbamazepine levels, CBC and liver func ...

TREATMENT ■ Pharmacologic therapy should be initiated if patient presents within 1 week of symptom onset. ■ Corticosteroids ■ An ...

■3 = Able to move against gravity ■2 = Able to move when gravity eliminated ■1 = Muscle fires, but no movement is generated ■0 = ...

TREATMENT Immediate correction of coagulopathy (when present) and surgical decompression Spinal Epidural Abscess Typically resul ...

DIAGNOSIS/TREATMENT ■ ESRis almost always elevated. ■ Obtain immediate MRI to confirm diagnosis. ■ If MRI unavailable, a CT myel ...

DIFFERENTIAL ■ Spinal cord tumors, Guillain-Barre ́ syndrome DIAGNOSIS/TREATMENT ■ MRI to exclude compressive lesion ■ Steroids ...

PATHOPHYSIOLOGY ■ Antecedent illness (viral or Campylobacter jejunigastroenteritis, URI) → autoimmune response →damage to myelin ...

TREATMENT ■ Supportive therapy ■ Close observation of respiratory function with forced expiratory volume (FEV 1 ) monitoring ■ P ...

SYMPTOMS/EXAM ■ Distal, symmetric, stocking glove distribution of sensory and motor dys- function ■ Pain and paresthesias ■ Loss ...