Neuro

Neuro #

Stroke #

BP Goals #

  • Hemmoragic
    • SBP < 140-160
  • Ischemic
      • tPA? => <180/<105
      • tPA? => up to 220/120

Dizziness/Lightleadedness #

Three types

  • Vertigo (50%) => Room spinning
  • Disequilibrium (10%) => Wobbly/off balance
  • Presyncope (10%) => Lightheadedness, “faint” feeling

Workup #

Vertigo #

  • Nystagmus
  • Duration of symptoms
    • Seconds => BPPV
    • Minutes => Migraines, Meniere’s, TIA
    • Hours-days => Labrinthitis, vestibular neuritis, vestibular migraine, MS, stroke, anxiety

Vertigo Table

Encephalopathy #

  • First sign (usually) => sleep disturbance

Grades of encephalopathy

  • 0 - none/fine
  • 1 - +asterixis
  • 2 - +lethargy
  • 3 - inbetween
  • 4 - obtunded

Werneke’s #

Treatment #

  • Thiamine
    • 500mg IV TID x 2 days
    • 250mg IV daily x 5 days
    • 100mg PO daily thereafter

Diagnosis #

Asterixsis => flapping of hands when extended

Treatment #

Lactulose + Rifaxamin

Neuropathy Workup #

  • Blood glucose, A1c
  • B12 + MMA
  • TSH
  • SPEP/UPEP => monoclonal gammopathy
  • ESR + ANA => if suspected inflammatory/autoimmune component

Migraine #

Matergia’s Migraine Mixer: (Can be given in ER or clinic, three separate shots though)

  • Phenergan (promethazine) 25mg IM
    • can make pt drowsy, make sure they have ride otherwise:
      • Give two below and have pt take 50mg benadryl at home
  • Toradol 60mg IM
  • Dexamethasone 10mg IM

Pearls #

  • Benzo’s are tx for catatonia