Common Neuro Diseases Flashcards
T/F
HA’s attributed with blunt force trauma of the head / neck are Primary HA’s,
False
HA’s associated with trauma of the head and or neck are SECONDARY.
Primary HA’s include migraines, tension HA, Trigeminal autonomic cephalgia, etc.
Many tension HA’s are pathophysiologic/ structurally involve what structure within the brain?
Stimulation of the trigeminal nuclei can cause much of the common S/Sx associated with headaches
Most Tx’s for tension HA’s are aimed at reducing the stimulation of the Trigem nerve.
What are some medical Red Flags or warning signs of underlying structural lesions which may accompany a CC of HA in your PTs?
Vomiting precedes HA (rupture) Awaking from sleep Exertional HA Neuro findings (Mental status, CN, DTRs, PMS, etc) MOST SEVERE HA IN LIFE (Aneurysm) Development/change in HA pattern Sudden onset HA Fever History of cancer
What is the mnemonic device to keep in mind when assessing a PT with HA? This will help maintain a wide differential!!
Systemic: (immunosuppressed, pregnancy, cancer, fever)
Neuro Exam / Findings
Onset: AGE, timing (including worsened w/ Valsalva, sex, exertion, cough etc)
Outside influences (trauma, drugs, toxins)
Previous HA Hx: Progression & severity
What is the common “classic” presentation with migraine PTs?
Lateralized or Bilat PHOTOPHOBIA Aura may present before THROBBING N, V. 3rd Nerve palsy (Opthalmoplegic may occur)
A 45 year old male PT presents to your office stating he has a HA that began in the back of his head and spread throughout the rest of his head later. What kind of HA do you think this PT may suffer from?
Basilar artery migraine
Basilar artery provides blood supply to back of head**
What are some clinical features of CLUSTER HEADACHES?
What is a common trigger?
What is the Tx?
MC middle aged men IPSILATERAL nasal congestion Conjunctivitis Rhinorrhea Horner's Syndrome (unequal pupil size, drooping eyelid, etc)
ALCOHOL TRIGGERS ARE COMMON
O2 Therapy
Prednisone
Triptans
Intranasal lidocaine
PT presents with tenderness to palpation and Px around their temporal artery. What is the appropriate Tx protocol for this PT?
BIOPSY the temporal artery
ESR –> Elevated sed rate
Most common in PTs >60
Rx: Prednisone
Describe how a PT with Trigeminal Neuralgia might present in your urgent care clinic?
What would the appropriate therapy/Tx include?
Acute onset
Wincing Px: Starts @ mouth, radiates towards ear
Triggered by chewing, cold, touching
MRI/MRA
If young PT: CONSIDER MS
Rx Tegretol
Phenytoin
Analgesis
Baclofen
What is the common cause of Glossopharyngeal Neuralgia?
What CN is Glossopharyngeal Neuralgia? How do you test it?
What is the appropriate Tx?
Zoster–> immunocompromised
Px in throat; difficulty swallowing or w/ gag reflex
CN #9
Carbamazepine (Tegretol)
If zoster caused –> Acyclovir
35 y/o Female PT presents with HA, diplopia, and papilledema. What condition do you suspect?
Tx?
Pseudotumor cerebri (Benign intracranial HTN)
MRI w/ venography
Tx: Acetazolamide (Diamox)
Shunting
Prednisone
Discontinue oral contraceptives
What is the inheritance pattern of Tuberous sclerosis?
What is Tuberous sclerosis associated with?
Autosomal Dominant
Reddened nodules on face & neck
~~(Adenoma Sebacceum)
Harmartoma’s in mult. organ systems: malformation of cells (benign)
Angiolipoma (kidney w/ possible retroperitoneal bleed)
Status Epilepticus
Astrocytoma w/ hydrocephalus
What is the diagnostic criteria for Huntington’s Disease?
What is the inheritance pattern?
- Gradual onset / progression of chorea and dementia
- Family Hx
- Gene identification
Autosomal DOMINANT (short arm chromosome 4)
What is the Tx for Huntington’s Disease?
Haldol, Tetrabenazine
Amantadine, antidepressants
What are some things to keep in mind when counseling newly diagnosed PTs / families with Huntington’s?
Suicide rate 5x rate of general population
(why we give antidepressants)
What is Lhermitte’s sign? What condition is it associated with? What other S/Sx should you be looking for to r/in?
What is the best imaging modality for this suspected condition?
Bend the neck forward –> + sign is Electrical sensation running through the neck to the back and limbs.
MULTIPLE SCLEROSIS
Weakness / Diplopia / Numbness retro bulbar neuritis / Disequilibrium
MRI and look for IgG bands in CSF
What are some possible causes of Neuropathies?
What about those inherited conditions too??
Diabetes Uremia B12 Deficiency Heavy metal poisoning Alcoholism Paraproteinemias
Inherited: Charcot Marie Tooth, Friedrichs Ataxia, Porphyria
What is the appropriate Tx for MS?
Treat with: Corticosteroids
Interferon Beta
Glatiramir
What will Guillian-Barre Syndrome present with?
Decreased DTRs (i.e. lower motor neuron lesion)
Prev. Respiratory or GI infxn (viral or bacterial)
Breathing difficulties
CN7 palsy
TAP CSF –> Will visualize increased PROTEINS in CSF and ABNORMAL WBC ct
What are some potential causes of 7th nerve palsy?
Lyme Diabetes Sarcoid HIV IDIOPATHIC BELL's
How do you manage a PT recently diagnosed with Guillian-Barre Syndrome via LP-CSF tap with positive WBC ct and increased protein in CSF?
Plasmapheresis
IV-IG
Mechanical ventilation
You have a 40 y/o Female PT present to your clinic w/ complaint of muscle weakness that waxes and wanes with activity. She additionally notes double vision and speech. What do you suspect?
What should your PE search for?
What would you use to Dx and Tx?
Myasthenia gravis
THYMOMA MAY BE PRESENT
Tensilon (edrophonium) Test
Thymectomy
Neostigmine
Prednisone
