70 neuro Flashcards
Majority of concussions resolve spontaneously within ?
if your pt has concussion when would you want them to come back to follow up?
10 days
2-3 days
when to use diagnostic imaging in concussion?
only to rule out traumatic brain injuries, cuz concussion usually is a functional disturbances not structural injuries
when in concussion, why cautious with NSAIDs?
may worsen the potential for intracranial bleeding
4 diff types of s/s in concussion? SCES eg?
Somatic - HA, dizziness, neck pain, foggy, blurred vision, photosensitivity, balance, gait, NV, fatigue low engery
Cognitive - confusion, amnesia, difficulty remembering or concentrating
Emotional - more emotional, irritable, anxious, nervousness, sadness
Sleep disturbances - drowsiness, falling asleep, more or less sleep
do you need to lose LOC to have concussion?
no
Red Flags for concussion? 6, others 6
Headaches worsen Seizures Neck pain Focal neural sign Repeated vomiting slurred speech
cant recognize ppl and place increase confusion, irritability weakness numbness in arms legs unusual behaviour decrease in LOC very drowsy or cannot be wakened
Modifying factors that leads to think imaging for concussion? 7
these pple require more formal evaluation, neuropsych testing, balance testing and management by neurologist
Age - under 18 over 65
SS - symp last more than 10 days, symptoms are more severe. LOC is more than a minute
Amnesia Sequalae - Activities at risk Co/premorbidities Previous concussions
3 types of tremors?
intention/action - using your cerebellum - intentionally moving your hands legs
postural - occur with the body part suspended against gravity.
resting - eg parkinson, pill rolling, hand twitching, when at rest, but with distraction, tremor is less
3 types of action/postural tremors
Essential
Physiologic
Intention
which tremors affect elders more?
which tremor gets better with ETOH? gets worse with caffiene?
essential and parkinson
essential
This tremor is evident with the affected body part supported and completely at rest and temporarily dampens or disappears during voluntary activity
patho?
eg?
resting tremor
Loss of dopamine disrupts function of thalamus
Most commonly caused by Parkinson’s disease
diff btwn essential and parkison tremor
parkinson - at rest, male>female, assymetrical
essential - familial, bilateral
action tremor - descsribe
patho eg?
increases in severity as the hand moves closer to its target, in contrast to postural and action tremors, which either remain constant throughout the range of motion or abruptly increase at terminal fixation.no tremor at rest
Cerebellar disease i.e. MS, brain trauma, stroke, inherited degenerative diseases (Huntington’s, AD)
Ipsilateral involvement to the lesion
tremor, if younger think? older think?
younger - think MS
older - think PD
Cerebellar signs usually involve balance and coordination, and may include: 4
unsteady and clumsy motion of the limbs or torso (ataxia)
inability to coordinate fine motor activities (intention tremor), e.g. “past-pointing” (pointing beyond the finger in the finger-nose test)
inability to perform rapid alternating movements (dysdiadochokinesia), e.g. inability to rapidly flip the hands
involuntary left-right eye movements (nystagmus
4 main causes of vertigo?
benign paroxysmal positional vertigo,
Meniere disease,
vestibular neuritis,
labyrinthitis
test to eval dizziness? 3
evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing
2 tx for for benign paroxysmal positional vertigo
2 tx for Meniere disease
1 tx for vestibular neuritis
Epley maneuver (canalith repositioning) vestibular rehabilitation
intratympanic dexamethasone or gentamicin
steroids
which maneuver should be performed to diagnose BPPV.? look like?
Dix-Hallpike - nystamus after 45 degree and put head down fast, has slow response of nystamus
Vertigo with hearing loss is usually caused by? 2
vertigo without hearing loss is more likely caused by ? 2
Meniere disease or labyrinthitis
BPPV or vestibular neuritis.
define orthostatic hypotension
A systolic blood pressure decrease of 20 mm Hg, diastolic blood pressure decrease of 10 mm Hg, or pulse increase of 30 beats per minute is indicative of orthostatic hypotension.
fast spontaneous nystamus indicates?
Lesions of the labyrinth and cranial nerve VIII -vestibulocochlear
Romberg test is indicative?
vestibular dysfunction in the ipsilateral side.
Ataxia is indicative?
cerebellar dysfunction, and the patient’s gait is usually slow, wide-based, and irregular
treatment for BPPV
Epley maneuver
