Neuro NBME
Biggest risk factor for ischemic stroke
ANSWER *HTN*
HASBLED
ANSWER - Hypertension > 160 systolic
- Age > 65
- Stroke history
- Bleeding history/predisposition
- Labile INR
- Enzymes of liver >3x normal, or bilirubin >2x normal
- Dialysis/transplant
- Meds such as aspirin, clopidogrel, NSAIDs
- Renal disease
Score above 2 results in automatic consideration for alternatives to anticoagulation
CHADVASC
ANSWER - CHF
- Hypertension
*- Age >75*/ >65
- Diabetes
- Sex
- Vascular disease
*- Thromboembolism hx*
,Score of 2 or greater warrants anticoagulation
What do you do if you see evidence of parenchymal bleeding in a symptomatic patient?
ANSWER - Control BP and send for Neurosurgery consult
What are some studies that must be done for patients with suspected ischemic stroke?
ANSWER - ECG, Echo, Carotid U/s
ECG allows us to identify Afib/Aflutter, which may warrant what kind of medication if the
patient is found to be symptomatic for a potential stroke?
ANSWER - Warfarin/NOAC without heparin bridging
Echo allows to identify what in a patient with a suspected stroke? What kind of meds does that
warrant if the patient may have a stroke?
ANSWER - Thrombus
- Warfarin/NOAC with heparin bridging
NOACs
ANSWER Direct Xa and PAR-1 antagonists (Vorapaxar)
If a carotid U/S reveals more than 80% occlusion in a patient with a suspected stroke or 70% in
a symptomatic patient, what must be done?
ANSWER - Endarterectomy unless a stent is warranted within 2 weeks
Contraindications to TPA
ANSWER - Recent surgery
- Uncontrolled BP > 180/105
,- Recent hx of bleed
- Any previous ICH
Status Epilepticus (Definition, Go-to treatment)
ANSWER - > 5 minutes of continuous seizure, OR >20 minutes before returning to baseline
- Treated with Benzodiazepines
If Benzos do not work for Status, what do you use?
ANSWER - Fosphenytoin
- Midozolam + Propofol
- Phenobarbital
Go to treatment for generalized seizures
ANSWER - Valproate
- Lamotrigine
- Levetiracetam
Atonic + Myoclonic seizure treatment
ANSWER Valproate
Absence seizure treatment
ANSWER Ethosuximide, valproate, and lamotrigine
Trigeminal neuralgia treatment
ANSWER Carbamazepine
Parkinsons (Symptoms)
, ANSWER - Cogwheel rigidity
- Bradykinesia
- Pill-rolling tremor
- Shuffling gait
- Postural instability
Parkinson's disease (Medication classes)
ANSWER - L-Dopa/Carbidopa
- COMT inhibitors (-capones)
- MAOi-B inhibitors (Selegiline)
- Dopamine agonists (Pramipexole, ropinerole)
- Deep brain stimulation
What is the general pharmacotherapy guidelines for Parkinson's patients?
ANSWER - If patients are under 70 AND not having any functional impairment, give them a
dopamine agonist first
- If patients are over 70 OR having functional impairment, give them L-dopa/Carbidopa, then
COM-T and MAOi-B inhibitors
Essential tremor (Features, Treatments)
ANSWER - Activity tremor that is present with movement but disappears at rest
- Propanolol
Intention tremor (Features, *Treatments*)
ANSWER - Tremor secondary to cerebellar damage, usually occurring with movement and
disappearing with rest; however, it usually gets worse the closer the patient gets to the target
- No treatments
Biggest risk factor for ischemic stroke
ANSWER *HTN*
HASBLED
ANSWER - Hypertension > 160 systolic
- Age > 65
- Stroke history
- Bleeding history/predisposition
- Labile INR
- Enzymes of liver >3x normal, or bilirubin >2x normal
- Dialysis/transplant
- Meds such as aspirin, clopidogrel, NSAIDs
- Renal disease
Score above 2 results in automatic consideration for alternatives to anticoagulation
CHADVASC
ANSWER - CHF
- Hypertension
*- Age >75*/ >65
- Diabetes
- Sex
- Vascular disease
*- Thromboembolism hx*
,Score of 2 or greater warrants anticoagulation
What do you do if you see evidence of parenchymal bleeding in a symptomatic patient?
ANSWER - Control BP and send for Neurosurgery consult
What are some studies that must be done for patients with suspected ischemic stroke?
ANSWER - ECG, Echo, Carotid U/s
ECG allows us to identify Afib/Aflutter, which may warrant what kind of medication if the
patient is found to be symptomatic for a potential stroke?
ANSWER - Warfarin/NOAC without heparin bridging
Echo allows to identify what in a patient with a suspected stroke? What kind of meds does that
warrant if the patient may have a stroke?
ANSWER - Thrombus
- Warfarin/NOAC with heparin bridging
NOACs
ANSWER Direct Xa and PAR-1 antagonists (Vorapaxar)
If a carotid U/S reveals more than 80% occlusion in a patient with a suspected stroke or 70% in
a symptomatic patient, what must be done?
ANSWER - Endarterectomy unless a stent is warranted within 2 weeks
Contraindications to TPA
ANSWER - Recent surgery
- Uncontrolled BP > 180/105
,- Recent hx of bleed
- Any previous ICH
Status Epilepticus (Definition, Go-to treatment)
ANSWER - > 5 minutes of continuous seizure, OR >20 minutes before returning to baseline
- Treated with Benzodiazepines
If Benzos do not work for Status, what do you use?
ANSWER - Fosphenytoin
- Midozolam + Propofol
- Phenobarbital
Go to treatment for generalized seizures
ANSWER - Valproate
- Lamotrigine
- Levetiracetam
Atonic + Myoclonic seizure treatment
ANSWER Valproate
Absence seizure treatment
ANSWER Ethosuximide, valproate, and lamotrigine
Trigeminal neuralgia treatment
ANSWER Carbamazepine
Parkinsons (Symptoms)
, ANSWER - Cogwheel rigidity
- Bradykinesia
- Pill-rolling tremor
- Shuffling gait
- Postural instability
Parkinson's disease (Medication classes)
ANSWER - L-Dopa/Carbidopa
- COMT inhibitors (-capones)
- MAOi-B inhibitors (Selegiline)
- Dopamine agonists (Pramipexole, ropinerole)
- Deep brain stimulation
What is the general pharmacotherapy guidelines for Parkinson's patients?
ANSWER - If patients are under 70 AND not having any functional impairment, give them a
dopamine agonist first
- If patients are over 70 OR having functional impairment, give them L-dopa/Carbidopa, then
COM-T and MAOi-B inhibitors
Essential tremor (Features, Treatments)
ANSWER - Activity tremor that is present with movement but disappears at rest
- Propanolol
Intention tremor (Features, *Treatments*)
ANSWER - Tremor secondary to cerebellar damage, usually occurring with movement and
disappearing with rest; however, it usually gets worse the closer the patient gets to the target
- No treatments
