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LDCU Neuro Rotation (Reading Assignments) Feb 1 - 15, 2022
LDCU Neuro Rotation (Reading Assignments) Feb 1 - 15, 2022
GROUP 4 ROTATORS
Definition:
○ Acute, frequently severe, and
fulminant polyradiculoneuropathy
that is autoimmune in nature
○ Occurs year-round at a rate of
between 1 and 4 cases per 100,000
annually
○ Males > Females
○ Adults > Children
Clinical Manifestation:
○ A rapidly evolving areflexic motor
paralysis
○ With or without sensory disturbance.
○ AscendingParalysis - Legs > Arms
○ Facial diparesis - 50%
○ Lower cranial nerves - bulbar Immunopathogenesis:
weakness ○ T cell activation - elevated levels of
○ 30% - ventilatory assistance cytokines and cytokine receptors are
○ Fever (-) at onset present in serum (interleukin [IL] 2,
○ DTR - attenuate or (-) soluble IL-2 receptor) and in
○ Cutaneous sensory deficit - usually
cerebrospinal fluid (CSF) (IL-6, tumor
relatively mild
○ Bladder Dysfunction - in severe cases necrosis factor a, interferon y)
but usually transient ○ complex glycosphingolipids that
○ Plateau - 4 weeks contain one or more sialic acid
○ Autonomic - BP, Cardiac Arrhythmia residues
○ Pain — deep aching, dysesthetic ■ cell-cell interactions
(including those between
Antecedent Events:
○ 1-3 weeks after infection axons and glia)
○ Vaccines ■ modulation of receptors
■ Respiratory or Gastrointestinal ■ regulation of growth
■ Campylobacter jejuni ○ AIDP - induction of tissue damage >
■ Human herpes virus early step: complement deposition
■ Mycoplasma pneumoniae along the outer surface of the
○ Lymphoma
Schwann cell.
○ HIV
○ SLE ○ AMAN/AMSAN - complement is
○ Zika virus deposited along with IgG at the nodes
of Ranvier along large motor axons
As a result,
cerebral edema,
elevated ICP and
CSF volume and
pressure may be
reduced.
Primary
Increased
gradient across
BBB
Rapid reduction
of ICP
Duration of effect:
up to 6 hrs.
Secondary
Cerebral
vasoconstriction
Decreased blood
SAH management mnemonic: viscosity
Increased
cerebral blood
S - Sedation
flow
A - Analgesic
B - bed rest with head of bed at 30 degrees ASPIRIN
A - antiemetics
D - dexamethasone MECHANISMS EFFECT INDICATION
O - oxygenation
→ Blocks → Relieving → Secondary
prostaglandin pain. Reducing prevention of
● DRUGS USED IN NCCU synthesis pain thrombotic
○ Mannitol → Nonselective → Lowering cerebrovascul
○ Furosemide for COX-1 and inflammation ar disease
○ Acetazolamide COX-2 enzymes in higher doses
Inhibition of
platelet
MECHANISMS, EFFECT, INDICATION OF MANNITOL,
aggregation for
ASPIRIN AND DEXAMETHASONE about 7-10 days
→ Acetyl group
MANNITOL of aspirin binds
with a serine
MECHANISMS EFFECT INDICATION residue of COX-1
enzyme, leading
Osmotic diuretic Transient Reduction of to irreversible
elevates blood expansion of ICP and brain inhibition
plasma intravascular mass → Prevents
osmolality and volume Reduce IOP if production of
● Stroke
pain causing
prostaglandin.
→ Also, steps the Steps to diagnose Stroke
conversion of 1. CVD
arachidonic acid 2. Territory (MCA, PCA, ACA, ICA, Basillar,
to thromboxane Vertebral)
A2, which is a 3. Etiology/ Mechanism
potent inducer of
a. Hemorrhagic
platelet
aggregation b. Infarct
→ Result in clots i. Thrombose
and harmful 1. Athero
venous and 2. Embolic -
arterial thrombo- heart/cardioembolic,
embolism, lead to
carotid/artery to artery,
pulmonary
embolism/stroke pulmonary via fistula,
extremities/paradoxic
DEXAMETHASONE embolism
Risk factors:
MECHANISMS EFFECT INDICATION ○ Modifiable
■ Hypertension
→ Long acting →Persistent → Reduce
corticosteroid headache water content ● Primary Hypertension -
with minimal ➔ There and local no cause/etiology
sodium-retaining maybe tissue ● Secondary
potential. increasi pressure Hypertension - usually
→ Decreases ng in → subtly renal, cardiac,
inflammation by swelling increases endocrine, neurologic,
suppression of of the perfusion in
metabolic, or adrenal
neutrophil brain the
migration, edematous cause (e.g.
decreased brain. pheochromocytoma)
production of ■ Lifestyle
inflammatory ○ Non-modifiable - age, gender (<60
mediators; years old)
suppress normal
immune response
● FAST HUG BID - mnemonics for proper
Induce apoptosis
in multiple monitoring and management of stroke
myeloma cells. patients
F - feeding
A - analgesia
S - sedation
T - thromboembolism
B - bowel movement
I - indwelling catheter
D - descalation