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Neuro Tx 2


Peripheral vertigo tx bedrest, antihistamines, anticholinergics and/or benzo; mild exercise
vertigo tx: 4 Classes of Drugs to Suppress Vestibular System Anticholinergics, Antihistamines, Phenothiazines, Benzodiazepines
Aspirin recommended for 10-yr stroke risk of: 6-10%
Ischemic stroke: Tx tPA (within 4.5 hrs of sx onset); head CT w/o evidence of hemorrhage/complicating lesion
If pt not tPA candidate: Tx: poss endovascular tx; MERCI clot retriever?
Acute stroke mgmt Temperature; Fluids/Glucose; BP; Antithrombotic agents
Acute ischemic stroke: tx BP? No (drop in MAP can drop CBF, make things worse)
Secondary stroke prevention Plt antiaggregants (ASA); Anticoagulants; BP; Lipid lowering; Endarterectomy
Antihypertensives & stroke risk each 10 mmHg drop in BP = 28% decrease stroke risk
tx: ischemic/TIA vs cardioembolic stroke ischemic/TIA: antiplatelet tx; cardioembolic: anticoagulant tx
hemorrhagic stroke tx supportive; mgmt of HTN & edema (mannitol, steroids); poss surg/clipping
TIA tx Ppx antiplatelet tx (ASA, plavix, aggrenox, etc); if cardiogenic: anticoag (IV hep, LT warf)
TIA tx if anterior circulation poss carotid endarterectomy
Non-absence sz tx carbamazapine, phenytoin, or valp; or newer meds (topamax, gapapentin, keppra, lamictal); felbamate for refractory
Absence sz tx Valp or ethosuximide
status epilepticus tx airway mgmt; prevent aspiration; mgmt hyperthermia (cooling, poss neuromx blocker); IV ativan/valium; phenytoin
Tx after single seizure if: structural lesion or recognized abnormal EEG
Pneumococcal meningitis Tx ceftriaxone (if GP diplococci seen, add Vanc, pending cx)
Meningococcal meningitis: nasal carriage eliminated with: Rifampin (alt: cipro or ceftriaxone)
Meningococcal meningitis: DOC Acqueous Pen G
H flu meningitis DOC ceftriaxone
Brain abscess tx prolonged IV Abx, surg drainage; monitor tx w/ serial scans; if <2 cm poss medical tx only
tx most pts w/ clin syndrome of viral encephalitis: empirically for HSV encephalitis
MS: Goals of tx Tx whole dz; slow accumulation of disability; Reduce relapse rate & CNS inflam (lesions) & progression of brain atrophy (shrinkage); improve pt QOL (including cognitive)
MS tx: to slow relapse rate: glatiramer subQ qd & interferon-beta
MS tx: for secondary progressive MS: poss immunosupp (cyclophosphamide, azathioprine) for secondary
MS tx: for acute relapse: corticosteroids (methylprednisolone)
MS tx: to improve fatigue: amantadine & pemoline
MS tx: to improve spasticity: baclofen & diazepam
Seizures: preferred mode of tx monotherapy
Rationale for polytherapy for seizure Consider 2d agent if inadequate control after trials of 2 diff single agents; Diff MOAs, AE, DI’s
Phenytoin & Albumin Low alb (poor renal fn); order Free PHT levels; can adjust PHT conc for low alb if cannot get free PHT level
DOC for new onset partial: most common: CBZ, Lamictal, oxcarb, PHT
DOC for partial, refractory lamictal, oxcarb, Topamax
DOC: adjunct: partial, refractory Gabapentin; Lamotrigine; Keppra; Oxcarb; Topamax; Zonisamide
DOC: Genl Seizures, Absence, Newly Dx Lamotrigine; Ethosuximide; Valpro
DOC: Primary Genl (Tonic-Clonic) Topiramate; Valpro (Alt: Lamotrigine)
Status Epilepticus: Tx: IV Diazepam (slow push x 2 min); IV Lorazepam; Phenobarb injxn if failure of benzo & PHT
Tx for high grade gliomas Primary tx = surg resection, RTx, CTx; most sig prognostic factors: extent of surg resection, age, & performance status
First treatment modality for high grade glioma Surgery
Std tx for WHO III &IV gliomas: Radiation tx (role of RT in WHO II gliomas is controversial)
Brain tumor: Rad Tx Modalities: Whole brain (ltd use now in gliomas); Focal RTx: Conventional high-dose (59.4 Gy x 42 days; 2 cm border around tumor area) or IMRT; Stereotactic (gamma-knife)
Std of care: high grade gliomas Resection; RTx & 42 days temozolomide; then (if stable dz), adjuvant CTx
Brain tumor: CTx: passage across BB depends on: Molecule Size; Lipid solubility; Ionization state
Created by: Adam Barnard Adam Barnard