Review - Clinical XXXIII (Neurology)

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[Intro: 100 B.P.M. Four bars cello drone. Rhodes enters bar three. Voice already on the first name.]
[Chorus]

[Lead Vocalist — first block as hook. “I.C.P.” three even taps. Cause-list is one falling breath.]

Intracranial venous thrombosis; headache, convulsions, confusion, high I.C.P., and focal deficits.

Treat; anticonvulsants if seizures, anticoagulation with heparin followed by warfarin for 6 months "caused by infections, hypercoagulability, polycythemia, sickle cell, pregnancy"

[Verse 1]

[Lead Vocalist — size and site sung flat; “inadequate” is the cut.]

Symptomatic aneurysms, treat "surgery or endovascular".

For asymptomatic; depends on size, location, risk factors for rupture.

Digital subtraction angiography for definitive evaluation "C.T./M.R. angiography inadequate"
[Verse 2]

[Lead Vocalist — gadolinium named clearly.]

When glial neoplasms suspected, M.R. with gadolinium to detect, biopsy for definitive diagnosis.
[Verse 3]

[Lead Vocalist — “no L.P.” warned, not shouted.]

Brain Abscess; signs of expanding intracranial mass, fever may be absent; M.R./C.T ."no L.P.-herniation"; I.V. antibiotics with drainage.
[Verse 4]

[Lead Vocalist — warmer on tinnitus, then colder on the workup.]

Idiopathic Intracranial Hypertension; headache, diplopia, visual disturbances due to papilledema, abducens dysfunction, pulse-synchronous tinnitus.

Caused by thrombosis, chronic diseases, vitamin A toxicity, tetracycline, contraceptives, withdrawal of corticosteroids, idiopathic.

C.T./M.R. "M.R. venography for venous sinuses thrombosis" then L.P. to confirm .

Treat with acetazolamide, topiramate, furosemide; if fail, shunt.

L.P. as temporizing measure.
[Verse 5]

[Lead Vocalist — hands and head named; legs spared is the fall.]

Essential Tremor, postural, action tremor; begin at any age enhanced by stress "one or both hands, and head, but the legs spared.)

If needed, propranolol if fail, primidone, alprazolam, topiramate
[Verse 6]

[Lead Vocalist — autonomic list kept in time, no extra ornament.]

Multisystem atrophy, autonomic insufficiency  and parkinsonism, Lower motor signs, or cerebellar dysfunction.
[Verse 7]

[Lead Vocalist — eye-movement line slightly held.]

Progressive supranuclear palsy; Supranuclear disorder of eye movements, pseudobulbar palsy, pseudo-emotional lability and parkinsonism.
[Verse 8]

[Lead Vocalist — asymmetric; cortical list fired as one phrase.]

Corticobasal degeneration, asymmetric parkinsonism and cortical dysfunction ‘apraxia, sensory inattention, dementia, aphasia’.
[Verse 9]

[Lead Vocalist — “within 1 year” counted.]

Dementia with Lewy bodies visual hallucinations and cognitive impairment before or within 1 year of parkinsonism.
[Verse 10]

[Lead Vocalist — formulary voice. Contraindications colder than the agonists.]

Parkinson, for mild amantadine , also ameliorates L-dopa dyskinesias.

Levodopa contraindicated in psychotic illness or narrow-angle glaucoma.

Sudden discontinuation can cause neuroleptic malignant syndrome.

Dopamine agonists ‘pramipexole, ropinirole, rotigotine, apomorphine’; less response fluctuations and dyskinesias than levodopa.

For early and advanced stages.

Adverse effects; somnolence, nausea, peripheral edema, dyskinesias, confusion, postural hypotension, irresistible sleep, impulse control.

Rasagiline for early, mild disease in young patients.

Trihexyphenidyl and benztropine for tremor and rigidity (rather than bradykinesia).

Pimavanserin for psychotic symptoms .
[Verse 11]

[Lead Vocalist — genetic word named clean.]

Huntington, mental changes, dementia, abnormal movements, genetic diagnosis.

Treat tetrabenazine, valbenazine
[Verse 12]

[Lead Vocalist — three sites, one instruction.]

Blepharospasm, oromandibular dystonia, cervical dystonia; inject botulinum
[Verse 13]

[Lead Vocalist — bilateral, then the long resolve.]

Drug-induced parkinsonism; usually bilateral, lower incidence of tremor, poorly responsive to levodopa.

With the exception of tardive dyskinesia and dystonia, the movement disorder usually resolves with withdrawal

If severe, for acute dystonia and akathisia; benztropine or diphenhydramine,

For drug-induced parkinsonism, benztropine,

For tardive dyskinesia, deutetrabenazine or valbenazine
[Outro]

[Lead Vocalist — last block quieter, still on the processional. “O.C.D.” and “A.D.H.D.” dotted.]

Tourette Syndrome; multiple motor and phonic tics at least 1 year, associated with O.C.D. and A.D.H.D.

Treat with habit reversal training, clonidine, guanfacine, haloperidol.
[Chorus]

[Lead Vocalist — hook once more, almost private.]

For drug-induced parkinsonism; benztropine.
For tardive dyskinesia, deutetrabenazine or valbenazine
[End]

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[Intro: 100 B.P.M. Four bars cello drone. Rhodes enters bar three. Voice already on the first name.] [Chorus] [Lead Vocalist — first block as hook. “I.C.P.” three even taps. Cause-list is one falling breath.] Intracranial venous thrombosis; headache, convulsions, confusion, high I.C.P., and focal deficits. Treat; anticonvulsants if seizures, anticoagulation with heparin followed by warfarin for 6 months "caused by infections, hypercoagulability, polycythemia, sickle cell, pregnancy" [Verse 1] [Lead Vocalist — size and site sung flat; “inadequate” is the cut.] Symptomatic aneurysms, treat "surgery or endovascular". For asymptomatic; depends on size, location, risk factors for rupture. Digital subtraction angiography for definitive evaluation "C.T./M.R. angiography inadequate" [Verse 2] [Lead Vocalist — gadolinium named clearly.] When glial neoplasms suspected, M.R. with gadolinium to detect, biopsy for definitive diagnosis. [Verse 3] [Lead Vocalist — “no L.P.” warned, not shouted.] Brain Abscess; signs of expanding intracranial mass, fever may be absent; M.R./C.T ."no L.P.-herniation"; I.V. antibiotics with drainage. [Verse 4] [Lead Vocalist — warmer on tinnitus, then colder on the workup.] Idiopathic Intracranial Hypertension; headache, diplopia, visual disturbances due to papilledema, abducens dysfunction, pulse-synchronous tinnitus. Caused by thrombosis, chronic diseases, vitamin A toxicity, tetracycline, contraceptives, withdrawal of corticosteroids, idiopathic. C.T./M.R. "M.R. venography for venous sinuses thrombosis" then L.P. to confirm . Treat with acetazolamide, topiramate, furosemide; if fail, shunt. L.P. as temporizing measure. [Verse 5] [Lead Vocalist — hands and head named; legs spared is the fall.] Essential Tremor, postural, action tremor; begin at any age enhanced by stress "one or both hands, and head, but the legs spared.) If needed, propranolol if fail, primidone, alprazolam, topiramate [Verse 6] [Lead Vocalist — autonomic list kept in time, no extra ornament.] Multisystem atrophy, autonomic insufficiency and parkinsonism, Lower motor signs, or cerebellar dysfunction. [Verse 7] [Lead Vocalist — eye-movement line slightly held.] Progressive supranuclear palsy; Supranuclear disorder of eye movements, pseudobulbar palsy, pseudo-emotional lability and parkinsonism. [Verse 8] [Lead Vocalist — asymmetric; cortical list fired as one phrase.] Corticobasal degeneration, asymmetric parkinsonism and cortical dysfunction ‘apraxia, sensory inattention, dementia, aphasia’. [Verse 9] [Lead Vocalist — “within 1 year” counted.] Dementia with Lewy bodies visual hallucinations and cognitive impairment before or within 1 year of parkinsonism. [Verse 10] [Lead Vocalist — formulary voice. Contraindications colder than the agonists.] Parkinson, for mild amantadine , also ameliorates L-dopa dyskinesias. Levodopa contraindicated in psychotic illness or narrow-angle glaucoma. Sudden discontinuation can cause neuroleptic malignant syndrome. Dopamine agonists ‘pramipexole, ropinirole, rotigotine, apomorphine’; less response fluctuations and dyskinesias than levodopa. For early and advanced stages. Adverse effects; somnolence, nausea, peripheral edema, dyskinesias, confusion, postural hypotension, irresistible sleep, impulse control. Rasagiline for early, mild disease in young patients. Trihexyphenidyl and benztropine for tremor and rigidity (rather than bradykinesia). Pimavanserin for psychotic symptoms . [Verse 11] [Lead Vocalist — genetic word named clean.] Huntington, mental changes, dementia, abnormal movements, genetic diagnosis. Treat tetrabenazine, valbenazine [Verse 12] [Lead Vocalist — three sites, one instruction.] Blepharospasm, oromandibular dystonia, cervical dystonia; inject botulinum [Verse 13] [Lead Vocalist — bilateral, then the long resolve.] Drug-induced parkinsonism; usually bilateral, lower incidence of tremor, poorly responsive to levodopa. With the exception of tardive dyskinesia and dystonia, the movement disorder usually resolves with withdrawal If severe, for acute dystonia and akathisia; benztropine or diphenhydramine, For drug-induced parkinsonism, benztropine, For tardive dyskinesia, deutetrabenazine or valbenazine [Outro] [Lead Vocalist — last block quieter, still on the processional. “O.C.D.” and “A.D.H.D.” dotted.] Tourette Syndrome; multiple motor and phonic tics at least 1 year, associated with O.C.D. and A.D.H.D. Treat with habit reversal training, clonidine, guanfacine, haloperidol. [Chorus] [Lead Vocalist — hook once more, almost private.] For drug-induced parkinsonism; benztropine. For tardive dyskinesia, deutetrabenazine or valbenazine [End]

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