Review - Clinical XXXII (Neurology)

[Intro: 128 B.P.M. Two bars kick and bass only. Stab on bar three. Voice already on the first word.] [Chorus] [Lead Vocalist — first block as hook. “4 to 72” counted, not smeared. “Avoid opiods” is the fall.] Migraine; pulsatile, lasting 4 to 72 hours, typically unilateral. Treat analgesic (limited to 15 days), ergotamines, triptans; Rimegepant ; Prochlorperazine, metoclopramide. Avoid opiods. Preventive if above 2, 3 times a month or significant disability. Topiramate, valproate, gepants , amitriptyline, venlafaxine, propranolol, verapamil. [Verse 1] [Lead Vocalist — tighter, male-age line clipped; autonomic list fired as one phrase.] Cluster headache mostly middle-aged men; unilateral periorbital pain and ipsilateral nasal congestion, rhinorrhea, lacrimation, eye redness, Horner. Treat; sumatriptan, oxygen . Prophylactic; verapamil, lithium carbonate, topiramate. Prednisone, ergotamine. [Verse 2] [Lead Vocalist — calendar math on pitch. “N saids” kept as written, three short hits.] Ergotamines, triptans, opioids medication overuse headache when more than 10 days in a month; for acetaminophen, N saids, more than 15. [Verse 3] [Lead Vocalist — “72 hours” held half a beat, then the rash-line runs.] Acyclovir, valacyclovir within 72 hours of rash, reduces the incidence of postherpetic neuralgia. Management of the established complication is analgesics ,if fail Tricyclics. [Verse 4] [Lead Vocalist — almost kind, then cut.] Only when adult have been seizure-free for 2 years, withdrawal of medication considered. [Verse 5] [Lead Vocalist — stacked protocol, each “if fail” a step up. “I.V.” / “I.M.” dotted and punched.] Status epilepticus, airway maintenance and 50 percent dextrose in case hypoglycemia is responsible. If continue, an I.V. lorazepam, I.M. midazolam or rectal diazepam can also be given. Then I.V. fosphenytoin . If fail, phenobarbital, if fail general anesthesia. [Verse 6] [Lead Vocalist — clock-time sung dry. Risk list is one breath.] Transient ischemic attacks focal ischemic cerebral neurologic deficits that last for less than 24 hours (usually < 1–2 hours). C.T./M.R within 24 hours. Treat underlying disorders. Hospitalization if increased risk for early recurrence Anticoagulation if A.F. Dual, clopidogrel and aspirin. [Verse 7] [Lead Vocalist — imaging windows counted like a fuse. “t.P.A.” three even notes.] Stroke; C.T. with or without contrast. Diffusion M.R. for the first 6 to 12 hours. C.T. angio to identify large vessel occlusions. t.P.A. up to 4 point 5 hours from onset. Large vessel occlusion, within 6 hours, embolectomy. Once hemorrhage excluded by C.T., aspirin Dual antiplatelet therapy for 90 days if stenosis, 21 days if mild "after 90, risk of hemorrhage" Anticoagulant for A.F. [Verse 8] [Lead Vocalist — pressure numbers sung flat, no drama. Reversal list is the last run.] Intracerebral Hemorrhage; lower B.P. to 140 with I.V. labetalol or nicardipine . If needed; platelet transfusion. Discontinued anticoagulation and reverse with F.F.P., P.C.C., vitamin K, or specific reversal agents . [Outro] [Lead Vocalist — last line as a two-day clock. Quieter, still on the motorik.] For Sunarachnoid hemorrhage.; within 2 days of the hemorrhage, surgical clipping of the aneurysm or coil embolization. [Chorus] [Lead Vocalist — hook once more, faster breath, same notes.] Migraine; pulsatile, lasting 4 to 72 hours, typically unilateral. Treat analgesic (limited to 15 days), ergotamines, triptans; Rimegepant ; Prochlorperazine, metoclopramide. Avoid opiods. Preventive if above 2-3 times a month or significant disability. Topiramate, valproate, gepants , amitriptyline, venlafaxine, propranolol, verapamil. [Ending: Kick cuts mid-bar. Bass note left hanging. One analog stab. Silence.] [End]