読者です 読者をやめる 読者になる 読者になる

レジデントノート

米国にて内科修行中。何ができるか模索している過程を記録していく

Neurology (memo from NEJM knowledge plus and MKSAP)

・diagnostic test for patient with 1 week constant headache, worse in the morning, no focal sign, with bilateral papilledema, valsalva maneuver increase pain, using tobacco and oral contraceptive, normal brain MRI without contrast

MR venography for possible dural sinus venous thrombosis

(Dx of pseudotumor cerebri requires exclusion of dural sinus venous thrombosis)

 

・the best physical exam to predict the risk of future falls

pull test

 

・Tx for trigeminal neuralgia

carbamazepine

 

・sign more suggestive of atypical parkinson syndrome than parkinson disease

poor response to high-dose levodopa

 

・admission indication for TIA

ABCD2 score 3 or greater within 72 hours of Sx onset

(> 60 yo: 1, BP > 140/90: 1, hemiparesis: 2, duration > 60 min: 2, DM: 1)

 

・tension-type headache

no proved benefit from muscle relaxant, benzodiazepine, or physical therapy 

 

・cause of decreased position and vibratory sensation, macrocytic anemia

copper deficiency and Vit B12 deficiency

 

・verapamil as migraine prevention

evidence is quite limited (effective for preventing cluster headache)

 

・when DVT prophylaxis should be initiated for patient with acute intracranial hemorrhage resulting in paralysis

by hospital day 4 if stable

 

・the most common neurologic presentation of Wilson disease

parkinsonism

 

・Tx for focal dystonia of neck / spasmodic torticollis

botulinum toxin injection

 

・diabetic amyotrophy

lumbar polyradiculopathy affecting primarily muscles of thigh that classically presents with severe pain at onset followed by weakness and numbness over weeks to months,

occur even in undiagnosed diabetes

 

・Tx for multiple sclerosis-related fatigue

amantadine, modafinil

 

・ring-enhancing brain lesion with central necrosis and hemorrhage

glioblastoma multiforme

 

・confirmatory test for patient with physical exam consistent with brain death

apnea test

 

・management of acute intracranial hemorrhage in patient taking aspirin

benefit of platelet transfusion remains unknown -> not indicated

 

・two neurologic conditions which produce rapid deterioration in cognition and behavior in the absence of trauma, infection, fever, intoxication or other systemic signs

Creutzfeldt Jakob disease and paraneoplastic syndrome

 

・anti-epileptic medication for females actively pursing pregnancy

carbamazepine (lamotorigine, levetiracetam, oxcarbazepine)

 

・preferred anti-epileptic medication for asian patient with HLA-B1502

levetiracetam (others increase the risk of Stevens-Johnson syndrome)

 

・diagnostic test for patient with muscle weakness improving with exercise, orthostatic hypotension

nerve conduciton study for suspected Lambert-Eaton myasthenic syndrome

 

・diagnostic test for postpartum female with recurrent thunderclap headache with normal non-contrast head CT

CT angiography / MR angiography for cerebral vasoconstriction syndrome

 

・Dx of young patient with fever, headache, multifocal signs, lymphocytic pleocytosis in CSF, multifocal areas of demyelination in MRI

acute disseminated encephalomyelitis

 

・dementia, visual hallucination and parkinsonism

dementia with Lewy bodies

 

・dementia, parkinsonism, impairment of vertical eye movement, square wave jerks

progressive supranuclear palsy

 

・Tx for patient with recurrent headache with ipsilateral autonomic feature (tearing, rhinorrhea, ptosis, conjunctival injection)

indomethacin for chronic paroxysmal hemicrania

 

・Capgras syndrome

delusional misidentification syndrome, loss of emotional connnection to meaningful person or place

 

・definition of apraxia

inability to perform previously learned skilled motor tasks despite intact motor and sensory systems

 

・indication of Tx for tic disorder

only when impairing social, academic or occupational function

 

・management of cryptogenic embolic stroke with patent foramen ovale

no intervention (procedure of closure didn't reduce the risk of recurrent stroke)

 

・convulsive seizure, provoked by alcohol intake, worse in the morning

juvenile myoclonic epilepsy

 

・Tx for multiple sclerosis-related spasticity

tizanidine (centrally acting alfa-2 adrenergic agonist), baclofen, cyclobenzaprine

 

・adverse effect of natalizumab for multiple sclerosis

nervous system infection with JC virus resulting in progressive multifocal leukoencephalopathy

 

・management of compulsive behavior in patient with parkinson disease 

reduction of dopaminergic medication