Notes

Neurocutaneous Diseases

Tuberous Sclerosis Autosomal dominant Presentation Skin Adenoma sebaceum (red facial nodules) → Butterfly distribution Shagreen patches (leathery plaques on trunk) Ash leaf spots (hypopigmented) Angiofibromas Neuro Infantile spasm (West Syndrome) Bilateral symmetrical limb jerking NOT generalized, NO fever Treatment ACTH Vigabatrin Seizure Psychomotor retardation Mental abnormality Eye Retinal lesions Heart...

Brain Abscess

Etiology Sinusitis Otitis media Pneumonia Endocarditis Bacteremia Presentation Headache N/V Fever Seizure Focal neurologic signs All signs even fever can be seen with cancer Diagnosis Best initial → Head CT/MRI → Ring, contrast enhancing, edema, mass effect Cancer and abscess are indistinguishable with imaging Most accurate → Brain biopsy...

Spine

Anterior Spinal Artery Infarction Presentation Early Loss of Motor (flaccid paralysis) + Pain/Temp below level of infarction Posterior column spared → Pos/Vib OK ⊖ DTR at level of infarction Late Spastic paraplegia after several weeks Babinski Treatment No specific treatment Subacute Combined Degeneration of the Cord Etiology B12 deficiency...

Hemorrhagic Stroke

Subarachnoid Hemorrhage (SAH) Etiology Aneurysm rupture Anterior circle of Willis 2% of population Risk Factors PCKD Tobacco Hypertension Hyperlipidemia Alcohol Presentation Sudden severe headache Differentiate from meningitis History of a sentinel headache (1/3 of patients) Meningeal irritation Stiff neck Photophobia Fever Blood irritates meninges LOC (50%) Sudden ↑ICP Distinguishes...

Seizure

Etiology Generalized Tonic-Clonic Seizure Metabolic ↓Na ↑Na ↓O2 ↓Glucose ↓Ca ↑Cr (Uremia) Hepatic failure ↓Mg (rare) CNS Infection Encephalitis Meningitis Abscess Anatomic Trauma Stroke Tumor Substance related Withdrawal Alcohol Barbiturate Benzodiazepine Overdose Cocaine Presentation Partial seizure Focal to one part of body Simple → Intact consciousness Complex → Altered...

Postherpetic Neuralgia

Etiology After shingles in 15% Presentation Pain over the area Treatment TCA Amitriptyline Imipramine Nortriptyline Gabapentin Pregabalin Carbamazepine Phenytoin Topical Capsaicin Prevention Treat shingles with antiherpetics → ↓ Incidence of postherpetic neuralgia Acyclovir Famciclovir Valganciclovir Treating shingles with steroids will NOT ↓ Incidence of postherpetic neuralgia Zoster vaccine Prevents shingles...

Trigeminal Neuralgia

Etiology Idiopathic Seizure of the trigeminal nerve Presentation Severe overwhelming face pain Knife stuck into face Triggered by Chewing Touching face Pronouncing some words → Tongue strikes back of front teeth Diagnosis No specific test Treatment Best initial Carbamazepine Oxcarbazepine Other meds Baclofen Lamotrigin If meds fail Gamma knife...

Headache

Ischemic Stroke

Etiology 3rd most common cause of death in the US Ischemic → 85% Hemorrhagic → 15% 🔗 Emboli origin Heart Atrial fibrillation 🔗 Valvular heart disease 🔗 DVT through patent foramen ovale (ASD) Carotid stenosis Risk Factors Hypertension Diabetes Hyperlipidemia Smoking Presentation MCA Contralateral motor/sensory deficit Contralateral homonymous hemianopia Eyes look towards...

Organisms and their treatments

Gram ⨁ Cocci Penicillins Oxacillin Cloxacillin Dicloxacillin Nafcillin 1st Gen cephalosporins Cefazolin Cephalexin Fluoroquinolones Macrolides → Less efficacy Azithromycin Clarithromycin Erythromycin → More toxic → N/V, Diarrhea MRSA Best choice Vancomycin Linezolid → Reversible BM suppression Daptomycin → ↑CPK Tigecycline Ceftaroline Telavancin Minor skin infections TMP/SMX Clindamycin Doxycycline Linezolid Anaerobes Above diaphragm Penicillin...

HIV Drugs

NRTI → BM suppression, Neuropathy Zidovudine (AZT) → Thrombocytopenia, Megaloblastic anemia Didanosine → Peripheral neuropathy, Pancreatitis Abacavir → HLA B5701 → Hypersensitivity/Stevens-Johnson Stavudine → Peripheral neuropathy, Pancreatitis Tenofovir → Renal failure Lamivudine Emtricitabine NNRTI Efavirenz → Vivid dreams, hallucination Teratogenic → Avoid in pregnancy Nevirapine → Hepatic failure Etravirine Rilpivirine PI → Hyperlipidemia, Hyperglycemia, lipodystrophy Indinavir → Crystal nephropathy,...

Tick-Borne Infections

Lyme Disease Etiology Borrelia burgdoferi → Ixodes scapularis tick Northeast camping/hiking Presentation Fever Rash 5-14d after Erythema migrans → Target lesion Joint pain → Knee most common Neurologic Bells palsy → Most common Meningitis/Encephalitis CN palsy Cardiac Myocarditis Transient AV block → Most common Diagnosis Typical lesion does NOT need confirmatory test Serology → IgM,...