Acute migraine treatment options Emergency Setting Sumatriptan 6 mg sq Metoclopramide 10 mg iv Dihydroergotaimne (DHE 45) 1 mg iv Ketorolac 30 mg iv or 60 mg im Dexamethasone: 10-25 mg iv or im to reduce early recurrence NSAID Ketorolac: 30 mg iv or 60 mg im Indomethacin 50...

Beta Blocker: avoid in bradycardia, copd, asthma First trimester exposure did not show increase in major congenital malformations Metoprolol ER: start 50 mg qd available in 50, 100, 200 mg up to 200 mg per day Propronol ER: start 40 mg qd, available in 60, 80, 120, 160 mg...

Relapsing remitting multiple sclerosis (RRMS) initial therapy Very active disease: Natalizumab (Tysabri) 300 mg iv q 4 w Natalizumab: Risk of PML, 4 in 1000. check anti JC virus Ab before and at 1 year, then q 6 months or Ocrelizumab (Ocrevus): 300 mg iv, then 300 mg iv...

Initial treatment Assess ABC, check lab: cmp, cbc, Tox screen, anticonvulsant levels Lorazepam 0.1 mg/kg or 4 mg iv at max of 2 mg/min Glucose + thiamine if indicated May need intubation Anticonvulsant loading Levetiracetam: 60 mg/kg, max 4500 mg over 15 minutes Valproate (Depacon): 30 mg/kg, at 10...

Surveillance for PML anti-JCV antibodies: at baseline and after one year PML is rare in the first year baseline brain MRI scan should be obtained prior to initiating therapy For patients who are negative for JCV antibodies at baseline and at one year, check anti-JCV antibody status and index...

Initial therapy with dopamine agonists Cabergoline 0.25 mg twice weekly; the dose may be increased by 0.25 mg twice weekly up to a maximum of 1 mg twice weekly according to the patient’s serum prolactin level. For woman who wishes to become pregnant, bromocriptine might be better There is...

AKA Posterior reversible encephalopathy syndrome (PRES) Reversible posterior cerebral edema syndrome Posterior leukoencephalopathy syndrome Hyperperfusion encephalopathy Brain capillary leak syndrome Symptoms headache altered consciousness/confusion visual disturbance seizure MRI calcarine and paramedian parts of the occipital lobe are usually spared, helping to distinguish RPLS from bilateral posterior cerebral infarctions Involvement...

Nimodipine 60 mg every four hours is administered to all patients with aneurysmal SAH within four days of SAH. Treatment is continued for 21 days....

Medication induced usually symmetrical take pt off the offending medication can be caused by older neuroleptic and Metoclopropamide (Reglan) May use anticholinergic for treatment Idiopathic: one side is worse than other. For young onset (<65 years old). start with dopamine agonist, such as ropinirole Older patient, use L dopa...

= involved medial aspect of the corticospinal tract on the anterior horn gray matter = weakness is more prominent in arms than legs. = usually no bladder symptoms, but urinary retention may occur. = Loss of pain and temperature sensation in the distribution of one or several adjacent dermatomes...