Neuro Cases

Pt had sudden severe HA and progressive altered mental status. Then she developed vomiting, neck stiffness, and left-sided weakness. Also reported photophobia. What was the diagnosis?

SAH

what are diagnostic tests for SAH?

-CT of brain

-CT angiography if confirmed

-CBC, CMP

-ECG

what is the treatment for SAH?

nimodipine, bp control, & surgical clipping or endovascular coiling to prevent rebleed

what are other considerations for SAH?

reverse anticoagulants & CSF drainage or craniotomy if elevated ICP

Pt experienced intermittent dizziness x 3 months. Feels that the room is spinning, especially when rolling over and getting out of bed in the morning. Lasts 10-15 seconds on average. What was the diagnosis?

BPPV

what are diagnostic tests for BPPV?

-Dix Hallpike for posterior canal

-orthostatic vitals

what is the treatment for BPPV?

Epley maneuver & vestibular rehab

Pt has worsening headaches, with flashing lights and zigzag lines in both eyes. It is around one eye and temple. Associated N/V. What was the diagnosis?

migraine w/ aura

what are the diagnostic tests for migraines?

-CBC, CMP

-brain MRI

-TFTs

what is the treatment for migraines?

-NSAIDs

-triptans

-CGRP antagonists ex. rimegepant

what are preventative pharm options for migraines?

-BB

-antidepressants ex. amitriptyline

-anticonvulsants ex. topiramate

-CGRP blockers

Pt reports weakness and numbness of left arm and leg. She reports blurry vision. Afferent pupillary defect on exam. What was the diagnosis?

MS

what is Lhermitte's sign?

neck flexion causing lightning shock pain from the spine down the leg

what are diagnostic tests for MS?

-CBC, BMP, ESR/CRP, B12, ANA, HIV, TFTs, lyme titer

-evoked potentials

-LP

-MRI w/ gad

what are diagnostic results for MS?

increased oligoclonal bands on LP & multiple hyperintense white matter plaques on MRI

what is the treatment for MS?

-IV high dose glucocorticoids

-DMT

-symptomatic tx

Pt has sudden onset HA and fever, along with stiff neck and intermittent vomiting. Just came home from summer camp. Positive Brudzinski's and Kernig's sign. What was the diagnosis?

bacterial meningitis

what are diagnostic tests for meningitis?

-CBC, CMP

-tox screen

-LP + C&S

-blood culture

-lactate/procalcitonin

what are diagnostic results for bacterial meningitis?

CSF is turbid w/ increased WBCs (especially neutrophils), increased protein, & decreased glucose

what is the causative organism for bacterial meningitis if <1 month old?

group B strep

what are the causative organisms for bacterial meningitis in older infants and children?

S pneumo & N men

what is the causative organism for bacterial meningitis in adolescents?

N men

what is the treatment for bacterial meningitis if >1 month of age?

IV vanco + ceftriaxone/cefotaxime & IV dexamethasone

what is the treatment for bacterial meningitis if <1 month of age?

IV amp + genta + cefotaxime & IV dexamethasone

when is chemoprophylaxis indicated for bacterial meningitis?

close/household contacts of N men or H flu within 24 hrs

when is the meningococcal conjugate vaccine (MenACWY) given?

11-12 y/o, booster at 16 for children & adults at increased risk

when is the serogroup B meningococcal vaccine (MenB) given?

10 years or older at increased risk

Pt has weakness of upper extremities x 1 month. She reports that her upper arms feel heavy and tired and is exacerbated by daily activities. Also reports intermittent drooping of the right eyelid. What was the diagnosis?

myasthenia gravis

what is a bedside test for myasthenia gravis?

icepack test

what are diagnostic tests for myasthenia gravis?

-Ach receptor Ab

-TFTs

-lyme titer

-B12 levels

-RNS/EMG

-MuSk Ab

-ESR/CRP, ANA

what further imaging should be conducted based on the suspected diagnosis?

chest CT (eval for thymoma)

what is the treatment for myasthenia gravis?

-pyridostigmine

-chronic immunotherapy: glucocorticoids

-short-acting immunomodulating treatment: plasmapheresis

-thymectomy