Wallenberg syndrome (lateral medullary syndrome)
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Cause: occlusion of PICA
1) Vestibulocerebellar: vertigo, falls to side of lesion, can't sit up, diplopia
and dual nystagmus, limb ataxia
2) Sensory: no pain and temp sensation in ipsi face, contralat trunk and
limbs, abnormal facial sensation or PAIN AS EARLY SX
3) Ipsi bulbar muscle weakness: dysphagia, aspiration, dysarthria,
dysphonia, hoarseness(ipsilateral vocal cord paralysis)
4) Autonomic dysfunction: ipsi Horner's, hiccups, lack of automatic
respiration
Dementia with Lewy bodies (DLB)
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DLB may be diagnosed in the setting of dementia (ie, progressive cognitive
decline that causes functional impairment) when ≥ of the following 4
clinical features are present:
* Fluctuating cognition (eg, alertness, attention)
* Visual hallucinations
* Parkinsonism
* Rapid eye movement sleep behavior disorder (ie, loss of normal rapid eye
movemnt sleep atonia).
- Antipsychotics may be used to treat functionally impairing visual
hallucinations or delusions in pts with DLB; however, physicians should be
aware that pts with DLB are extremely sensitive to antipsychotics. The use
of antipsychotics in DLB may be associated with a significant worsening of
confusion, parkinsonism, or autonomic dysfunction, eg, risperidone.
treatment for bell's palsy
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steroids & supportive eye care
CNS Infections:
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,Bacterial Meningitis:
- the most accurate test is culture and start therapy immediately
- Preliminary analysis of the CSF is useful
- Gram +ve diplococci: Pneumococcus
- Gram _ve diplococci: Neisseria
- Gram -ve pleomorphic, coccobacillary: Hemophilus
- Gram +ve: Listeria
- Tx: IV Rocephin and vanc + steroids (in bacterial meningitis - decreases
mortality)
Cryptococcus:
- HIV-+ve pt with <100 CD4 cells.
- infection is slower than bacterial meningitis and may not give severe
meningeal signs, such as neck stiffness, photophobia, and high fevr, all at
the same time.
- Best initial test: India Ink
- Most accurate test: Cryptococcal antigen
- Tx: Amphotericin and 5-flucytosine (5FC)
Followed by oral fluconazole
Lyme Disease:
- h/o joint pain, 7th cranial nerve palsy, or rash with central clearing (target
lesion)
- Tx: IV cefriaxone or penicillin
RMSF:
- Camper or hiker with a rash that starts in the wrists and ankles and moves
centripetally toward the center.
- Fever, HA, and malaise precede the rash.
- Tx: doxycyline for therapy
Listeria monocytogenes: is a cause of meningitis that is not adequately
treated by any for of cephalosporins. Ampicillin is added to the usual
regimen of ceftriaxone and Vanc to cover Listeria.
- Look for elderly, neonatal, and HIV-positive pts and those who have no
spleen, are on steroids/immunocompromised with leukemia or lymphoma.
Neisseria meningitidis:
- When an adolescent presents with a petechial rash and increased
neutrophils on CSF, it is suggestive of Neisseria meningitidis. These pts
should be placed on respiratory isolation, and close contacts should
receive ppx.
, - Close contacts: start ppx with rifampin, ciprofloxacin, or ceftriaxone for
close contacts, such as household members and those who share utensils,
cups, or kisses.
Amoebic Meningitis:
- Naegleria fowleri and Acanthamoeba - thermophilic amoeba that can
infect swimmers in fresh water.
- Wet mount show mobile amoebae
- Treat with miltefosine
dressing apraxia
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-difficulty wearing clothes
-appear to struggle while attempting to get into a coat or pants
-seen w/bilateral or right-sided (nondominant) parietal lobe lesions
-confusion is seen also
lacunar stroke
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pure motor stroke; limited neurological dysfunction
long-term pharm therapy for relapsing-remitting multiple sclerosis
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Cause: occlusion of PICA
1) Vestibulocerebellar: vertigo, falls to side of lesion, can't sit up, diplopia
and dual nystagmus, limb ataxia
2) Sensory: no pain and temp sensation in ipsi face, contralat trunk and
limbs, abnormal facial sensation or PAIN AS EARLY SX
3) Ipsi bulbar muscle weakness: dysphagia, aspiration, dysarthria,
dysphonia, hoarseness(ipsilateral vocal cord paralysis)
4) Autonomic dysfunction: ipsi Horner's, hiccups, lack of automatic
respiration
Dementia with Lewy bodies (DLB)
,Give this one a try later!
DLB may be diagnosed in the setting of dementia (ie, progressive cognitive
decline that causes functional impairment) when ≥ of the following 4
clinical features are present:
* Fluctuating cognition (eg, alertness, attention)
* Visual hallucinations
* Parkinsonism
* Rapid eye movement sleep behavior disorder (ie, loss of normal rapid eye
movemnt sleep atonia).
- Antipsychotics may be used to treat functionally impairing visual
hallucinations or delusions in pts with DLB; however, physicians should be
aware that pts with DLB are extremely sensitive to antipsychotics. The use
of antipsychotics in DLB may be associated with a significant worsening of
confusion, parkinsonism, or autonomic dysfunction, eg, risperidone.
treatment for bell's palsy
Give this one a try later!
steroids & supportive eye care
CNS Infections:
Give this one a try later!
,Bacterial Meningitis:
- the most accurate test is culture and start therapy immediately
- Preliminary analysis of the CSF is useful
- Gram +ve diplococci: Pneumococcus
- Gram _ve diplococci: Neisseria
- Gram -ve pleomorphic, coccobacillary: Hemophilus
- Gram +ve: Listeria
- Tx: IV Rocephin and vanc + steroids (in bacterial meningitis - decreases
mortality)
Cryptococcus:
- HIV-+ve pt with <100 CD4 cells.
- infection is slower than bacterial meningitis and may not give severe
meningeal signs, such as neck stiffness, photophobia, and high fevr, all at
the same time.
- Best initial test: India Ink
- Most accurate test: Cryptococcal antigen
- Tx: Amphotericin and 5-flucytosine (5FC)
Followed by oral fluconazole
Lyme Disease:
- h/o joint pain, 7th cranial nerve palsy, or rash with central clearing (target
lesion)
- Tx: IV cefriaxone or penicillin
RMSF:
- Camper or hiker with a rash that starts in the wrists and ankles and moves
centripetally toward the center.
- Fever, HA, and malaise precede the rash.
- Tx: doxycyline for therapy
Listeria monocytogenes: is a cause of meningitis that is not adequately
treated by any for of cephalosporins. Ampicillin is added to the usual
regimen of ceftriaxone and Vanc to cover Listeria.
- Look for elderly, neonatal, and HIV-positive pts and those who have no
spleen, are on steroids/immunocompromised with leukemia or lymphoma.
Neisseria meningitidis:
- When an adolescent presents with a petechial rash and increased
neutrophils on CSF, it is suggestive of Neisseria meningitidis. These pts
should be placed on respiratory isolation, and close contacts should
receive ppx.
, - Close contacts: start ppx with rifampin, ciprofloxacin, or ceftriaxone for
close contacts, such as household members and those who share utensils,
cups, or kisses.
Amoebic Meningitis:
- Naegleria fowleri and Acanthamoeba - thermophilic amoeba that can
infect swimmers in fresh water.
- Wet mount show mobile amoebae
- Treat with miltefosine
dressing apraxia
Give this one a try later!
-difficulty wearing clothes
-appear to struggle while attempting to get into a coat or pants
-seen w/bilateral or right-sided (nondominant) parietal lobe lesions
-confusion is seen also
lacunar stroke
Give this one a try later!
pure motor stroke; limited neurological dysfunction
long-term pharm therapy for relapsing-remitting multiple sclerosis
Give this one a try later!
