Clinical Care of the Nervous System Flashcards
If a patient complains about a vice like headache and hypertonicity of neck muscles what are you thinking
Tension headache
What is the treatment for tension headaches
NSAIDS
ibuprofen 400-800mg PO q 4-6 hrs
max 2400mg/34hrs
Napoxen 250-500mg PO q12hrs Acetaminophen 325/1000mg PO 4-6 hrs Max 4G/24hrs
Middle ages man comes in agitated complaining of a headache with intense unilateral pain that starts around the temple or eye what are you thinking
Cluster headache
how long do cluster headaches usually last for 15 - 30 min
cluster headaches
if you suspect a cluster headache what should you ask about reassurance about headache
why
when do you have these types of headaches ?
cluster headaches occur seasonally and are grouped together
what other type of symptoms are you looking at if you suspect a cluster headache
ipsilateral congestion or rhinorrhea
Laceration and redness of the eye
Horner syndrome
Ptosis- drooping of the eye
Miosis- excessive pupil constriction
Anhidrosis- No sweating
how should be your first treatment of choice for a cluster headache
100% O2 for 15 min
what is a secondary treatment of choice for a cluster headache
Sumatriptan SubQ -6mg repeat if needed after 1hr max does 12mg/24hrs
or
Oral Zolmitriptan - 2.5mg repeat if needed after 2 hrs max dose 10mg/24hrs
a patient comes in complaining about a gradual build up of throbbing headache what are you thinking
migraine
if you suspect a migraine headache what questions are you asking
do you have a aura, visual disturbances, or hallucinations
Family Hx
Nausea vomiting
how should migraines be treaded
avoidance of precipitating factors, with treatment of Sx and prophylactics treatment
what shroud you do for the PT during an acute attack
have them rest in a quite dark room until Sx subside
what are abortive treatment for migraines
Simple analgesics and NSAIDS
Ketoralac 30mg IV/IM every 6 hrs or single dose of 60mg IM max 120mg/24hrs
what is the dosage of Sumatriptan for migraines
One oral dose of either 25/50/100mg
or
6mg IM
what is prophylaxis for migraines
antihypertensive - such as beta blockers
anticonvulsants
what should be given sx of migraines
antiemetics promethazine
antihistamines for nausea and vomiting
what is common tohave after a head injury
post traumatic headache
within how many days may a patient have a post traumatic headache
within 1-2 days and last for 7 10 days
what is usually accompanied with a post traumatic headache
impaired Memory
emotional Instability
poor Concentration
Emotional instability
what is the treatment for post traumatic headaches
No treatment
Sx management with
patient comes in complaining of headaches unresponsive to medications that use to work for their headaches what are you thinking
medication overuse headache
how do you treat medication overuse headaches
withdraw abused medication
how long should patients expect to recover from medication use headaches
months
what patient population are seizures common with
childhood and late adulthood
what is a seizure
an abnormal, excessive hypersynchronous discharge from an aggregate of CNS neuros
what are the the two types of focal seizures
focal seizure with retained awareness
focal seizure with impaired awareness
focal seizure with retained awareness were formally known as
simple partial seizure
focal seizure with impaired awareness were formally known as
complex partial seizure
how does a focal seizure with retained awareness present
depends on the foal area involved
what type of focal seizure does the patient appear to be awake but not coherent
focal seizure with impaired awareness
what do patients with focal seizure with impaired awareness usually remember
no memory of the event
patients with focal seizure with retained awareness or impaired awareness exhibit what automations
facial grimacing gesturing lip smacking chewing replacing words or phrases
focal seizure with retained awareness or impaired awareness exhibit what automations affect what part of the brain
only one part of the brain
Generalized seizure effect what part of the brain
the entire brain
what is the most common type of generalized seizure
tonic clonic seizure AKA grand mal
the tonic phase of tonic-clonic seizure is characterized by what
sudden muscle stiffening
the clonic phase of tonic-clonic seizure is characterized by what
rhythmic jerking
how long do tonic clonic seizure AKA grand mal last for
1-2 min
what are the other types of generalized seizures
absence seizure
clonic seizure
atonic seizure
what is the the phase called after a seizure
postictal phase
what happens in the postictal phase
somnolence
confusion
headache that last several hrs
in the postictal phase Todd paralysis happens is this
weakness of limbs occur
how are seizures diagnosed
video EEG
how are seizures treated
start IV electrolytes LFT CBC finger stick glucose
During a seizure what can you give
Diazepam 5mg IM/IV Q5-10min max 30mg
what is status epilepticus
single seizure that last 5min or more
or
2 or more seizure before the patient recovers from the last episode
how do you treat status epilepticus
diazepam
valproic acid 30mg/kg
intubate
what type of seizure is not associated with abnormal excessive neuronal activity
psychogenic nonepileptic seizure
psychogenic nonepileptic seizure last how long
more than 2 min
are a patients eyes open or closed during a psychogenic nonepileptic seizure
closed
is there a postictal phase after psychogenic nonepileptic seizure
no
psychogenic nonepileptic seizure are treated how
cognitive behavioral and interpersonal therapy
an acute neurological injury that is a result of the interrupted blood flow to the brain is called
Stroke
what are the two types of strokes
Hemorrhagic stroke
Ischemic stroke
what type of stroke is one that is caused by a rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia
Hemorrhagic stroke
what type of stroke is cause by blockage of a blood vessel causing lack of cerebra blood flow leading to ischemia
Ischemic stroke
what are two subtypes of ischemic strokes
transient ischemic attack (TIA)
cerebral vascular accident (CVA)
what are the mist common kind of strokes
Ischemic 80%
hemorrhagic 20%
thrombotic ischemic stoke
obstruction of an artery die to a blockage from debris that has broken off from a distal area
describe a embolic ischemic stroke
obstruction of an artery due to a blockage from debris that has broken off from a distal area
describe a systemic hypoperfusion ischemic stroke
lack of blood flow to the brain due to lack of blood supply
what kind of stroke is defined a a episode of neurological dysfunction caused by a focal brain, spinal cord, or retinal ischemia WITHOUT acute infarction
Transient ischemic attack
what kind of stroke is defined a a episode of neurological dysfunction caused by a focal brain, spinal cord, or retinal ischemia WITH acute infarction
Cerebral vascular accident
what is the onset of stoke sx
sudden
what are sx for strokes
Face - drooping or numbness on once side
Arms one limb weaker than the other
Stability- steadiness on feet
talking - slurring garbled, nonsensical words, inability to respond normally
eye-visual changes
react - MEDEVAC
intracerebral hemorrhages strokes bleed where
directly into the the brain tissue
subarachnoid hemorrhage strokes bleed where
into the subarachnoid space
what type of hemorrhage stroke is associated with “worse headache of my life”
subarachnoid hemorrhage
what type of hemorrhage stroke has a gradual onset
intercranial hemorrhage
for treatment of ischemic stroke where should o2 be maintained
> 94%
for treatment of ischemic stroke what position should patients be placed in
reverse Trendelenburg
raise head 30 degrees
how should BP of a ischemic patient not be lowered
acutely
may be only thing maintaining profusion
if ischemic stroke patient BP is above 220 systolic and 120 diastolic what should you lower the be by
15%
what type of BP medications should be used for ischemic strokes
non selective beta blocker
if a transient ischemic attack patient shows no neuro exam abnormalities what can be given
aspirin with MO guidance
what do you think if a patient comes ion complaining of “creeping crawling” or pins and needles feeling” in the limbs
Restless leg syndrome
what is a aggravating factor of restless leg syndrome
periods of inactivity
especially at night
what types of medications make Restless leg syndrome worse
antihistamines
dopamine receptor antagonist
antidepressant
what are Restless leg syndrome diagnosis differentials
Volitional movements - foot taping, bouncing leg rocking
Akathisia - intense desire to move
Nocturnal le\g cramps
what labs should be drawn for restless leg syndrome
iron levels
if iron is low in pt diagnosed with restless leg syndrome what should be prescribed
ferrous sulfate
what is type of injury is a mild subset of TBI
closed head injury
what happens in a closed head injury
force is applied to the brain that creates a shear force at the white/grey matter junction
what word is used to describe a injury at the opposite side of the head
Coup-Countercoup
what are hallmarks for closed head injuries
confusion and amnesia
in additon to confusion and amnesia what are common signs of closed head injuries
vacant stare
delayed verbal expression
inability to focus
disorientation
slurred incoherent speech
incoordination
emotional
memory deficits
within how many hours must a MACE exam be administered
48 hours
during a closed head injury facial fractures are concerning for what
occult injury
how are concussions managed
direct observation for 24 hrs
low level of activity for 24 hrs
no alcohol, sedatives or pain relivers other than NSIAD for 48 hrs
what phrase is used to describe an occurrence when a patient is still having sx from the first concussion and suffers a second concussion
second impact syndrome
what are the two types of cranial fractures
linear fractures
Comminuted/stellate
what type of fracture has a less risk for underlying damage
linear fracture
what type of head fracture requires significant force and underlying damage is likely
Comminuted/stellate
what part of the skull are easiest to break
temporal regions
nasal sinuses
what is Cushing triad
bradycardia
hypertension
raspatory irregularity
if do you do if there are are rapid signs of ICP herniation
secure/ maintain airway
reveres Trendelenburg 25-30 degrees
what type of iv solutions do you not use with ICP/ herniation patients
solutions containing glucose or hypotonic
hyperventilation should be used how
last resort
where does epidural hematoma occur
between the dura matter and the skull
where doe subdural hematoma occur
between the dura mater and the arachnoid matter
where does a subarachnoid hematoma occur
between arachnoid matter
what does a epidural hemorrhage usually affect
middle meningeal artery
hw does epidural hemorrhage present
lucid interval with recovery of consciousness
when do you intubate epidural hemorrhage patient
GCS <8
who does a subdermal hemorrhage affect most
elderly
alcohol abusers
anticoagulated at risk
subdural hemorrhage presents in how many days
1-2 days
who as more at risk for subarachnoid hemorrhage
drug users (coke and amphetamines)
smokers
hypertension
alcohol use
what are hallmarks for subarachnoid hemorrhage
thunderclap headache
worse headache of my life
how do you treat subarachnoid hemorrhage
bed rest
analgesia
avoid anticoagulation
all service members diagnosed with their 1st TBI concussion must have a minimum of how many hrs of recovery time
24 hrs
all service members diagnosed with their 2st TBI/concussion within 12 months must have a minimum of how much recovery time
7 days
all service members diagnosed with their 3rd TBI/concussion within 12 months must have a minimum of how much recovery time
until a recurrent concussion evaluation has been completed
