526 Neuro Flashcards
secondary or primary headaches are most common
primary
trigeminal autonomic cephaligias (TAC) are primary or secondary headaches
primary
what type of headache has a relationship with epilepsy, depression, raynaud, and cardiac shunting
migraines
what is a fortification spectrum
aura that presents as jagged lines like in a stone fortification
cluster headaches are what time of primary headache
TAC (trigeminal autonomic cephalagias)
what type of headache would present with a partial horner sign? what would that look like?
cluter/TAC
ptosis of eyelid
what does the acronym SNOOP stand for
for serious headaches
systemic symptoms
neuro signs
older >50
onset new or progressive
previous history (first or different from others)
why might you do a CBC, ESR or CRP, and TSH in a patient with headach
CBC - to exclude anemia
ESR or CRP - to exclude temporal arteritis
TSH - to exclude thyroid disease
when would you consider preventative therapy for headaches
unable to deal with attacks
have more than 4 a month
headaches are prolonged or refractory to medication
when might you use divalproex or topiramate in headache therapy
as a preventative for migraines
how does metoclopramide aid in headache treatment
treats n/v and aids in absorption of NSAIDs
true or false: if a triptan is ineffective as a headache treatment you should try a different class of medication
false, there are differences across brands so you may try a different triptan
when should you use triptans with caution
cardiac disease patients as they are arterial constrictors
what is 1st line and 2nd line therapy for severe headaches
1st = triptans
2nd = ergots
what should you be aware of when prescribing ergots
high potential for misuse and should premedicate with antiemetics
what is prevenatitive and abortive treatment for cluster headaches
preventatitve = verapamil/CCB or lithium
abortive = oxygen, analgesics, triptansw
what is the difference between primary and secondary trigeminal neuralgia
primary = vascular compression
secondary = neuro cause like MS, tumor, trauma
the pain of trigeminal neuralgia is described as ___ in what location
burning, stabbing, sharp, shocky
in any branch of the trigeminal nerve
when is trigeminal neuralgia more likely to be bilateral
with MS
what is a trigger zone in trigeminal neuralgia
one specific spot that pt can identify as where it sets off an attack
primary or secondary trigeminal neuralgia may have an abnormal corneal reflex
secondary
true or false: trigeminal neuralgia will usually have an unremarkable physical exam
true
when would you get diagnotic investigation for trigeminal neuralgia and what would you get
usually none needed unless considering a secondary cause
then get MRI to check for lesions or compression of CN5
what is first and second line treatment for trigeminal neuralgia
first = anticonvulsants (carbamazepine)
second or add on = baclofen, lamotrigine, phenytoin
what needs to be monitored when patients are put on anticonvulsants
liver
CBC
Na
what medication is used for trigeminal neuralgia for patients with MS
gabapentin or misoprostol
how are acute attacks of trigeminal neuralgia treated
IV fosphenytoin
botox
sumatriptan
intranasal lidocaine
when is surgical management considered for trigeminal neuralgia
not responding to pharmacological
true or false: when initially diagnosing trigeminal neuralgia, referral to neurologist should be done to confirm
true
which cranial nerve is affected in bells palsy
CN VII, the facial nerve
acute unilateral weakness or paralysis of face that resolves in under 72 hours is indicative of what condition
bells palsy
a neurological disorder that specifically spares the forehead muscles has what cause
upper motor neuron or central lesion
a prodrome of pain behind unilateral ear, hyperacusis and dysgeusia is indicative of what condition
bells palsy
what facial findings would you expect in bells palsy
smooth forehead
widened palpabral fissure
inability to close eye
flattened nasolabial fold
asymmetric smile
true or false: bells palsy will only affect the lower portion of one side of the face
false, it will affect the full face both upper and lower, on one side
what is the house-brackmann classification
classification of facial function to determine severity of bells palsy
when would you consider an MRI for a suspected bells palsy
bilateral palsies
central nerve findings instead of peripheral
does not recover in 3 months
what is the most important treatment goal in bells palsy
protecting the eye - eye lubricant, tape shut at night
what medication is used to treat bells palsy
corticosteroids within 72 hours of symptoms onset
what test is used to test sleep overnight
polysomnography
true or false: trazadone, diphenhydramine and melatonin are all good first line options for insomnia
false, new guidelines suggest not to use these agents for sleep
true or false: CPAP is more effective than surgery for managing OSA
true
when might overnight PAP be recommended
for central sleep apnea
what are the primary hypersomnias
narcolepsy
idiopathic
post traumatic
what is the predominant characteristic of CNS hypersomnias
excessive daytime sleepiness not caused by disturbed nocturnal sleep
what would reduced hypocretin levels in CSF indicate? when would you do this test
narcoplepsy
this test is not routinley done
how is narcolepsy diagnosed
presence of sleep-onset REM on MSLT (multiple sleep latency test) after getting a normal polysomnography
what is cataplexy and what condition is it associated with
sudden loss of muscle tone while awake
narcolepsy
what types of medications are used to treat hypersomnias
stimulants
wakeful promoting agents
REM suppressing medication
what REM suppressing agents are used to treat cataplexy
TCAs, SSRIs, SNRIs
modafinil and armodafinil are what kind of medication and used to treat what
wakeful promoting agents
to treat central hypersomnias
dextramphetamine and methylphenidate are what kind of medication and used to treat what
stimulants to treat central hypersomnias
what are the 4 principle diagnostic criteria for RLS
- urge to move legs, usually with uncomfortable sensation
- urge worse during inactivity
- at least partially relieved with activity
- worsened or exclusive to the evening
what blood work should be done for RLS and why
iron panel because low iron is associated with RLS
true or false: first line treatment for RLS if pharmacotherapy
false, should not be used unless severe
what 1st pharmacotherapy may be used for severe RLS
dopamine agonsits
pramipexole, rotigotine, ropinirole
what pharmacotherapy may be used for RLS with concomitant neuropathy
gabapentin, pregabalin
what are parasomnias
undesirable events or experiences related to sleep
what is rem sleep behavior disorder and what type of sleep disorder is it
pt enacts dreams in a possibly dangerous fashion
parasomnia
sleep terrors and sleep walking are what kind of sleep disorder
parasomnias
RBD and nightmare disorder are an NREM or REM disorder
REM
true or false: polysomnography is not needed for RBD
false
what is the pharmacological treatment for RBD
clonazepam or melatonin
