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
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
- can make pt drowsy, make sure they have ride otherwise:
- Toradol 60mg IM
- Dexamethasone 10mg IM
Pearls #
- Benzo’s are tx for catatonia