9-5 Clinical Care of the Nervous System Flashcards
1
Q
What is one of the most common medical complaints?
A
headache
2
Q
How many workdays are lost each year due to headaches?
A
150 million
3
Q
A headache of sudden onset or “thunderclap” headache could be?
A
subarachnoid hemorrhage
4
Q
Absence of prior headache(s) similar to the present one could be?
A
CNS infection
5
Q
Headaches:
focal neurological signs other than auras?
A
stroke or tumor
6
Q
Headaches:
other physical sx like fevers could be?
A
meningitis
7
Q
Headaches:
rapid onset with exercise could be?
A
intercranial hemorrhage associated with brain aneurysm
8
Q
Headache:
associated with congestion could be?
A
sinusitis
9
Q
Headache:
associated with papilledema(optical disc swelling) could be?
A
increased cranial pressure
10
Q
What are some reasons to refer patients for imaging when complaining of a headache?
A
- recent change in sx
- progressively worse
- focal neurological deficits
- scalp tenderness
- onset of headache with exertion, cough, sex
- visual changes, auras
- after age 40
- history of trauma, hypertension, fever
11
Q
What are the 5 types of headaches?
A
- tension
- cluster
- migraine
- post traumatic
- medication overuse headache
12
Q
What is the most prevalent type of headache?
A
tension
13
Q
- bilateral headaches
- occurs daily
- “vice-like”
- exacerbated by emotional stress, fatigue, noise, glare
- hypertonicity of neck muscles
A
tension headache
14
Q
What is the treatment for tension headaches?
A
- NSAIDs
- Tylenol
15
Q
What is the specific NSAID treatment for a tension headache?
A
- Ibuprofen 400-800 mg PO q 4-6 hours
- naproxen 25-500 mg PO q 12 hours
16
Q
What is the specific Tylenol treatment for tension headaches
A
-325-1000 mg PO q 4-6 hours
17
Q
- intense unilateral pain
- starts around the temple or eye
- pt is restless/agitated
- episodes are 15 mins to 3 hours, occur seasonally
- ipsilateral congestion/rhinorrhea
- lacrimation/redness of eye
- horner syndrome
A
cluster headache
17
Q
- intense unilateral pain
- starts around the temple or eye
- pt is restless/agitated
- episodes are 15 mins to 3 hours, occur seasonally
- ipsilateral congestion/rhinorrhea
- lacrimation/redness of eye
- horner syndrome
A
cluster headache
18
Q
What is the initial treatment of choice for cluster headaches?
A
-inhaled 100% O2 for 15 mins
19
Q
What is the medication treatment for cluster headaches?
A
- sumatriptan (subQ 6 mg)
- zolmitriptan (PO 2.5mg)
20
Q
- gradual buildup of a throbbing headache
- unilateral or bilateral
- duration=several hours
- aura may or may not be present
- family hx usually + for headaches
- may have N/V
A
migraine
21
Q
What is the initial management of a migraine?
-during acute attacks?
A
- avoid of precipitating factors
- during acute attacks: rest in a quite, dark room
22
Q
What is the migraine abortive treatment?
A
- simple analgesics/NSAIDs
- sumatriptan
- zolmitriptan
23
Q
Preventative treatment is indicated when migraines occur more than how many times per month?
A
2-3 times per month
24
What is the treatment for migraine prophylaxis for these classes:
- anti hypertensives
- antidepressants
- anticonvulsants
- beta blocksers, propranolol
- amitryptyline
- topiramate
25
What is the treatment for concurring symptoms of migraines?
antiemetics: promethazine
26
- sx occur within 1-2 days of injury
- subside within 7-10 days
- accompanied by impaired memory, poor concentration, emotional instability, increased irritability
post traumatic headaches
27
What is the treatment for post traumatic headaches?
- no special tx
| - simple analgesics
28
- present in about 50% of pt's with chronic daily headaches
- present with chronic px or with complaints of headache unresponsive to medication
- heavy use of analgesics
medication overuse headache
29
What is the treatment for medication overuse headache?
withdrawal medication
| improvement in months not days
30
What is characterized by recurrent unprovoked seizures?
epilepsy
31
An abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons
seizure
32
What are the 3 etiologies of seizures in young adults?
- trauma
- metabolic disorders
- CNS infection
33
What are the 5 etiologies of seizures in older adults (>35)?
- cerebrovascular disease
- brain tumor
- metabolic disorders
- degenerative disorders
- CNS infection
34
- only one part of the brain is affected
- presentation depends on focal area
- formerly known as simple partial seizure
focal seizure with retained awareness
35
- only one part of brain is affected
- patient appears to be awake, not in contact w/ environment, do not normally respond to questions
- often have no memory of what occurred
- may exhibit automatisms
focal seizure with impaired awareness
36
- involves the entire brain
| - may or not may not lead to alteration of consciousness
generalized seizure
37
What is the most common type of generalized seizure?
tonic-clonic
38
Which phase is:
| -characterized by sudden muscle stiffening
tonic phase
39
Which phase is characterized by rhythmic jerking?
-clonic phase
40
Which phase is tongue biting common in?
clonic phase
41
- somnolence, confusion or headache that may occur for several hours
- no recollection of event
- weakness of limbs may occur (todd paralysis)
postictal phase
42
What is the method of diagnosis of a seizure?
video EEG monitoring
43
What are the 4 aspects of first aid for seizures?
- maintain airway
- redirect gently (partial seizures)
- start IV
- blood work
44
What are the labs you should get for patients with seizures?
- electrolytes
- LFT
- CBC
- finger stick glucose
45
What is the treatment for active seizures?
- diazepam 5mg IM/IV q5-10 minutes, no more than 30mg
| - medevac
46
Single seizure lasting more than or equal to 5 minutes or 2 or more seizures between which there is an incomplete recovery of consciousness
status epilepticus
47
What is a complication of a seizure that is considered a medical emergency?
status epilepticus
48
What is the treatment for status epilepticus?
- diazepam 5mg
- valproic acid 30 mg/kg
- correct underlying problem
- intubate
49
- not associated with abnormally excessive neuronal activity
- usually last longer than 2 mins
- eyes are closed during event
- incontinence is less common
- usually no postictal phase
psychogenic nonepileptic seizure
50
What are the two major branches of the internal carotid arteries?
- anterior cerebral artery
| - middle cerebral artery
51
What supplies blood to the cerebellum and brainstem?
-basilar arteries
52
The basilar artery branches to become the?
-left and right posterior cerebral arteries (PCA)
53
What interconnects the internal carotid and vertebral basilar arteries?
circle of willis
54
Which blood vessel connects internal carotid artery and the vertebral basilar arteries?
posterior cerebral arteries
55
Acute neurological injury that occurs as the result of the interrupted blood flow to the brain
stroke
56
Rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia
hemorrhagic stroke
57
Blockage of a blood vessel causing lack of cerebral blood flow leading to ischemia
ischemic stroke
58
What are subtypes of ischemic stroke?
- TIA
| - CVA
59
What are the 3 risk factors of stroke?
- HTN
- age
- atherosclerosis
60
obstruction of an artery due to a blockage that forms in the vessel
-often due to atherosclerosis
thrombotic
61
obstruction of an artery due to a blockage from debris that has broken off from a distal area
embolic
62
lack of brain blood flow to decreased systemic blood flow
systemic hypoperfusion
63
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction
TIA
64
neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia with infarction (tissue death) of central nervous system tissue.
CVA
65
The only way to determine between a TIA and CVA is?
MRI
66
What is the mnemonic for strokes?
```
Face- face drooping/numb on one side
Arms-one limb weaker/numb
Stability-steadiness on feet
Talking-slurring, garbled
Eyes-visual changes
React-MEDEVAC
```
67
These are risk factors for what?
- hx of vascular disease
- a fib
- atrial septal defect
- ventricular septal defect with DVT
- recent MI
- atherosclerosis
- clotting disorder
ischemic stroke
68
What are the two subtypes of hemorrhagic stroke?
- intracerebral hemorrhage
| - subarachnoid hemorrhage
69
Which type of hemorrhagic stroke
| -bleeds directly into the brain tissue
intracerebral hemorrhage
70
Which type of hemorrhagic stroke:
| -bleeds into the subarachnoid space?
subarachnoid hemorrhage
71
Usually has gradual onset as blood builds
intracerebral hemorrhage
72
maximum impact right away usually with intense "worse headache of my life" headache
subarachnoid hemorrhage
73
headache, vomiting, decreased level of consciousness occurs in about of the patients with what type of hemorrhagic stroke?
intracerebral stroke
74
These are risk factors for what?
- HTN
- trauma
- bleeding disorder
- drug use (cocaine, methamphetamines)
- vascular formations (aneurysms)
hemorrhagic stroke
75
Outpouchings and ballooning of artery due to weakness in the vascular wall
aneurysm
76
Differential blood pressure readings between upper extremities may indicate?
an aortic dissection
77
Acute management for strokes:
| -fundoscopic exam for papilledema, which may indicate?
ICP
78
initial interventions for ischemic stroke
- maintain o2 at 94%
- elevate head of bed 30 degrees
- labs
- imaging
- medication
- medevac
