Source / episode info

• **Episode:**46
• **Title:**Divine Intervention Episode 46 – Neurology Clerkship Shelf Review Part 3.
• **Published:**2018-08-21
• Source:Episode page

One-liner

This episode provides a comprehensive review of neurological topics including Usseard seizures, the differential diagnosis and management of vestibular disorders, acute intracranial hemorrhage workup, malignant hypothermia/serotonin syndrome pathophysiology, spinal dysraphism classification (e.g., myelomeningocele), and key neurocutaneous syndromes like TSC and NF1.

High-yield summary

• Usseard Seizures: Characterized by 3 Hz spike on EEG; treat with Ethosuximide (a T-type calcium channel blocker); always consider in pediatric patients.
• Ménière's Disease: Classic triad of episodic vertigo, unilateral sensorineural hearing loss, and tinnitus; pathophysiology involves endolymphatic hydrops; definitive treatment is often gentamicin injection (aminoglycoside) or diuretics.
• Intracranial Hemorrhage: Epidural hematomas are typically caused by tearing the middle meningeal artery following temporal bone fracture; acute ICP management includes head elevation, hyperventilation ({CO}_2 reduction), and osmotic agents like mannitol.
• Spinal Dysraphism: Myelomeningocele is the most severe form (meninges + CNS tissue herniation) and is classically associated with a Type 2 Chiari malformation; elevated maternal serum AFP/amniotic fluid {IDCA} are diagnostic markers.
• Tuberous Sclerosis Complex (TSC): Caused by mutations in TSC1 or TSC2; classic findings include hypopigmented macules (Ashlar spots) and renal angiomyolipomas; infantile spasms (West Syndrome) present with hypsarrhythmia on EEG, treated with ACTH/Vigabatrin.
• Neurofibromatosis Type 1 (NF1): Associated with café-au-lait spots, brown pigment in the axilla, and neurofibromas; screening for optic nerve gliomas and acoustic neuromas is critical.

Learning objectives

• Differentiate between various types of peripheral vestibular disorders (BPPV, Ménière's, Vestibular Neuritis).
• Understand the pathophysiology and acute management of intracranial hemorrhage (EDH, SDH).
• Recognize the clinical presentation and genetic basis of major neurocutaneous syndromes (TSC, NF1).
• Master the sequence of hyperkalemia treatment in malignant hypothermia.
• Classify spinal dysraphisms and understand their associated chiari malformations.