more neuro clinical notes

Use SPECT to follow brain pathology

Choline uptake is increased in demyelination

Lactate is increased in stroke

NAA (n-acetylaspartic acid) increased in tumor becuase marker of cell turnover

Sinemet side effect is psychosis, dont stop suddenly because can cause NMS

avoid giving Sinemet with large protein meals (take an hour before or after a meal).

Parkinson 4 multisystem atrophy syndromes

1. nigrostriatal degeneration

2. olivopontocerebellar atrophy

3. Shy-Drager = parkinson's + dysautonomia

4. Parkinson's + LMN atrophy

all four have intracytoplasmic overlap, dont respond to Sinemet

Rounds:

localization related epilepsy is 2/2 trauma, creates a seizure nidus but can be controlled with meds.

EtOH withdrawal seizures are always generalized.

Metallic taste are temporal lobe seizure

Beauty of phenytoin is you can get a quick level, the newer antiepileptic drugs take 3-4 days to get a level.

Tegretol 2x day

Depakote ER can be 1x day

SUDEP - sudden unexplained death in epilepsy patients (very rare), could be as a result of dangerous ictal arrhythmia

sickle cell causes acquired moyamoya disease

What is a potential problem of giving Demerol (meperidine)? metabolized to normoperidine which is epileptogenic and causes seizure in those with renal failure

anterior interosseous nerve - pure motor nerve (makes hand into knuckle ball pose)

posterior interosseous nerve - continuation of radial nerve

peroneal nerve fibers encircle tibial nerve fibers so most external nerve injuries produce peroneal signs

"usual state of health" is not a good term, instead use, "without significant symptoms"

malignant hypertension is diagnosed clinically

penumbra - surrounding the infarct, an area of ischemia, reason for autohypertensing and this ischemic area is what is conserved with tPa treatment,

autoregulation of cerebral blood flow is disturbed in stroke

Endogenous cannabinoid receptor ligand - anandamide (sanskrit for bliss)

A good marker of aphasia to follow in stroke is writing - its the most lagging function of language to recover, so when examining and someone seems all better, have them write

Diffusion weighted imaging

Senstivity 77%

Specificity 90+%

diffuse axonal injury - DAI - usually from head torsion, bad prognosis

Keppra is great because it has no DDI, but it can unmask psychosis

Fat emboli can cause psychosis

Alcohol/tobacco amblyopia - pallor @temporal margins on fundus

Nick sized decreasd sensation on chin in a women? Breast cancer.

SPAF trial - stroke prevention in atrial fibrillation - warfarin outperformed aspirin (aspirin outperformed placebo)

Conus syndrome - UMN syndrome (fecal bladder incontinence only)

Cauda equina - lower motor neurons (compression of cord from mass, central herniated disc, hematoma, inflammation, carcinoma)

Avonex, intramuscular 1x week

Betaseron subq 3x week

Heard in rounds, "placebo is expectation"

Three frontal lobe syndromes

1. lateral convexity - decreased executive functioning,

2. medial frontal - creates abulia

3. orbitofrontal - disinhibited, inappropriate (Phinease Gage)