15 articles Neurology

Hemorrhagic Pituitary Macroadenoma

Hemorrhagic Pituitary Macroadenoma: Sx: Headache, diplopia (if affects optic chiasm) Consult Neurosurgery for recommendations Medications: Start Dexamethosone (Decadrone) 4mg IV q6hr Start Levothyroxine: Overt disease: 1.6mg/kg Subclinical disease: 1mg/kg If elderly, CAD: Start with lower dose and then titrate up. If hemorrhagic: Control BP to mitigate bleed and likely headache too. Caution: Patient may be…

Vertigo

Vertigo: Meclizine 25mg PO qd. Patient was also given a print out about the Epley Maneuver exercises that he can try at home if his vertigo is positional in nature (presumed BPPV). https://www.google.com/?gws_rd=ssl#q=epley+maneuver&spell=1 http://www.dizziness-and-balance.com/disorders/bppv/bppv.html Semont Maneuver: http://www.dizziness-and-balance.com/disorders/bppv/Semont/semont.html

Stroke

Stroke: (long-term management) Must be on Aspirin 81mg PO qd + Plavix 75mg PO qd [secondary-prevention of stroke] If recurrent Strokes: Change Aspirin to Aggrenox. Aggrenox vs. Plavix. New info suggests that Plavix alone is superior**** Aggrenox: May cause syncope! (Dipyridamole vasodilates à increase orthostatic hypotension) Must also be on a statin. Check bilateral carotid…

Peripheral Neuropathy

Peripheral Neuropathy: Gabapentin (Neurotin) 100mg PO. Can titrate up dose as tolerated. Lyrica (Pregabalin) 150mg PO. Take 1 capsule bid. SNRIs (specifically: venlafaxine and duloxetine = Cymbalta), topical capsaicin, anticonvulsants (specifically carbamazepine), and TCA (specifically: amitriptyline) are more effective than placebo. Pregabalin is less effective than venlafaxine and duloxetine. Ex: Lyrica 200mg – 1 capsule…

Headaches

Migraine headaches: Preventative: Start Propranolol 40mg PO bid (start at 80mg/day and go up to 160mg/day) Propranolol is better than Metoprolol for preventing migraine headaches because Propranolol crosses the blood brain barrier better and has some alpha receptor action (?), which facilitates it dilating cranial vessels. Start Riboflavin (Vitamin B2) 400mg PO qd. Start Magnessium…

Syncope

Syncope: Witnessed? Determine whether patient experienced tonic-clonic activity while unconscious: Consider Seizure. Post-ictal state 20-30 minutes of confusion once regained consciousness: Consider Seizure. Tongue biting and/or diffusely sore muscles, generalized weakness: Consider seizure. San Francisco Syncope Rule: Defines high-risk criteria for patients with syncope. http://www.mdcalc.com/san-francisco-syncope-rule-to-predict-serious-outcomes/ Work up: Telemetry: Assess for arrhythmia. Patient may need to…

Concussion

Concussion: Post-concussion syndrome: complex disorder in which various symptoms (headaches and dizziness) last for weeks and sometimes months after the injury that caused the concussion. Persistent worsening headaches and dizziness (post-concussion syndrome): Due to patient’s symptoms worsening and due to patient chronically being on Warfarin” A head CT without contrast is ordered. Things to look…

Meningitis

Meningitis: Suspect in patients with headache, fever, nuchal (neck) rigidity/stiffness, AMS, nausea. PE: Neck stiffness, Kernig and Brudzinski signs Lumbar Puncture done acutely (may already be done by the ER physician). Start Ceftriaxone along with Vancomycin. Add dexamethasone 10 mg IV q6h. Run complete work-up on the CSF including: Gram stain and culture, cell count,…

Seizures

Seizures: Witnessed? Determine whether patient experienced tonic-clonic activity while unconscious: Consider Seizure. Post-ictal state 20-30 minutes of confusion once regained consciousness: Consider Seizure. Tongue biting and/or diffusely sore muscles, generalized weakness: Consider seizure. Work up: Seizure protocol initiated. CT of the head without contrast – r/o intracranial hemorrhage as etiology Order MRI of brain with…