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1
Q

What blood vessels are involved in an Intracranial Aneurysm?

A

Anterior Cerebral A

Middle Cerebral A

Communicating Branches of Circle of Wilis

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2
Q

Signs/ Symptoms of Aneurysm

A
  • Headache (minor= impending or Severe= rupture)
  • Changes in Character
  • CN (Ocular, Diplopia, Squint, Facial pain, Visual Loss, Homonymous Hemianopsia)
  • Neurological Deficits
  • Vomiting, Dizziness, Alterations in pulse, Respiratory rate
  • Seuzure
  • Neck Stiffness

+ Kernigs, and bilateral Babinskis

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3
Q

Ancillary test to check for Aneurysm

A

CT scan (speed)

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4
Q

Treatment for Aneurysm

A

Surgery

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5
Q

Etiology of Benign Paroxysmal Positional Vertigo (BPPV)

A
  • Degenerative depris (otoconia) floating in semicircular canals
  • Causes inappropriate endolymph movement
  • Most common vertigo
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6
Q

Presentation of Benign Paroxysmal Positional Vertigo

A

Vertigo that occurs with certain head positions

Lasts seconds to minutes

Horizontal-rotational nystagmus

Diminished over month without hearing loss

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7
Q

Diagnosis of BPPV

A

Dix Hallpike maneuver (+ve= latency of secs before vertigo and nystagmus begin)

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8
Q

Treatment of BPPV

A

Eply’s Maneuver

Semont’s Maneuver

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9
Q

Etiology of Cervicogenic Headache

A

Referral from Soft Tissue and Articular structures in neck

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10
Q

Signs and symptoms of Cervicogenic headache

A

HA w/o neurological deficits

Reduced neck ROM with pain

Restrictions in C/S usually upper occiput

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11
Q

Treatment for Cervicogenic HA

A

CMT and STM

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12
Q

Signs/Symptoms of Classic Migraine (w/ aura)

A

Often femal presenting with unilateral throbbing HA that preceeded by prodrome (aura)

HA lasts several hours to 1-3 days

PT seeks quiet and dark environment

Associated nausea & vomiting

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13
Q

Treatment for Classic Migraine

A

May respond to SMT

Medical= Ergotamine Derivatives & sumatriptan

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14
Q

Signs and Symptoms of a Cluster HA:

A

Severe, Unilateral, Preorbital or Temporal

Painful orbital HA

Last 30 min, triggered by food or alcohol

Pt Hx of smoking

Pt agitated and animated (suicide)

Some have Horners syndrome (ptosis, miosis, anhydrosis)

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15
Q

Treatment for cluster headache

A

Similar to migraine with mets

Trial SMT

Management set A B or I

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16
Q

S&S of Common Migraine

A

Same as Classic, but w/o aura

Unilateral pulsatile severe HA

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17
Q

Supplemental MGMT of Migraine

A

Bromelain

Cal/Mag

Iron

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18
Q

CN I Lesion & Clinical Observation

A

Ethmoid bone

Olfaction sensation= Anosmia

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19
Q

CN II Lesion & Clinical Observation

A

^ pressure= papilledema

Transaction causes ipsil blindness and loss of light reflex

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20
Q

CN III Lesion & Clinical Observation

A

Oculomotor paralysis: diplopia, ptosis, eye looking down

Aneurysm of carotid & post communicating branch: dilated and fixed pupil

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21
Q

CN IV Lesion & Clinical Observation

A

Extorsion of eye & weakness looking down and in

Head tilting to compensate for extorsion

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22
Q

CN V Lesion & Clinical Observation

A

Loss of sensation to face

Loss of corneal Reflex

Flaccid paralysis of muscle of mastication

Deviation of jaw to weak side

Hypacusis (partial deafness to low pitched sounds) due to tensor tympani

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23
Q

CN VI Lesion & Clinical Observation

A

Inability to abduct eye

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24
Q

CN VII Lesion & Clinical Observation

A

Flaccid paralysis of muscle of facial expression

Loss of corneal blink reflex

Loss of taste anterior 2/3 tongue

Hyperacusis (acuity of sounds) due to stapedius m paralysis

Bells Palsy

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25
CN IX Lesion & Clinical Observation
Loss of gag reflex Loss of carotid sinus reflex loss of taste from post 1/3 of tongue
26
CN VIII Lesion & Clinical Observation
Lesions result in disequilibrium vertigo, and nystagmus
27
CN X Lesion & Clinical Observation
Ipsil paralysis of soft palate leading to hoarsness, dyspnea, dysarthria, and dysphagia Aortic aneurysms and tumors of neck or thorax often compress the vagus nerve
28
CN XI Lesion & Clinical Observation
Paralysis of SCM, Traps, and larynx if root is involved
29
CN XII Lesion & Clinical Observation
Hemiparaysis of tongue causing deviation to weak side
30
Etiology of Facet Syndrome/Joint fixation
Often traumatic onset Facet or capsule may be source of pain Meniscoid may be entrapped Degenerative changes can cause pain from facets
31
S&S of Facet Syndrome
Neck, upper back pain or stiffness Sharp pain with motion possible Scleratogenous referral Tender restrictions upon motion palpation Limited CS active and passive ROM Absent nerve root tension signs MM hypertonicit possible Local pain with Kemp's, Spurlings, and Jacksons
32
Treatment for Facet Syndrome
SMT, Ice, PT mod (Ultrasound, IFC, TENS, Electrotherapy)
33
Eiology of Glaucoma
Intraocular Pressure MC cause of blindness
34
S&S of Glaucoma
No early Sx Once aware of visual field loss, atrophy of nerve is already present Peripheral vision loss 1st, then central
35
Tx of Glaucoma
Medication or laster therapy tried first (stabilize IOP) Meds: Beta blockers Refer to optometrist
36
Sx of Hematoma
Focal neurological deficits or increased intracranial swelling and pressure.
37
Types of Hematomas.
Subarachnoid: - Caused by berry aneurysm - Bleeding into subarachnoid space Subdural: - Caused by venous bleeding between dura and Arachnoid - Gradual signs of cerebral compression occur over days-weeks after head injury Epidural: - Arterial hemorrhage associated with skull fracture and laceration of middle meningeal aa - Short lucid period of consciousness followed by rapid Sx Intracerebral: - MC from hypertension
38
Etiology of Herpes Zooster of Facial Nerve
Invasion of the ganglia of 8th (vestibulocochlear) nerve & Geniculate ganglia of VII (Facial) by herpes zoster
39
S&S of Herpes Zoster of Facial Nerve
Pain often preceeds vsicle eruption by 2-3 days Severe ear pain, hearing loss, vertigo, paralysis of facial nerve, vesicles on pinna & ear canal
40
Diagnosis of Herpes Zoster of Facial Nerve
Elevated Lymphocytes & protein in CSF
41
Treatment of Herpes Zoster of Facial Nerve
Antivirals (Acyclovir) Corticosteroids (Prednisone)
42
Etiology of Hypertension Headache
Benign intracranial hypertension characterized by increased intracranial pressure without evidence of intracranial space occupying lesion.
43
S&S of Hypertension Headache
HA of Varying severity and Papilledema
44
Dx of Hypertension HA
CSF pressure is increased but fluid is normal CT, MRI, EEG are all normal
45
S&S of Intracranial Mass
HA, Personality Changes, Neuro Deficits, Vomiting Drowsiness, Lethargy Changes in temp, BP, pulse are usually just before death
46
S&S of Medication Reaction
Chronic use of OTC at recommended higher doese. Can cause or maintain chronic daily HA Use or overuse of Analgesics
47
Which meningitis is most common in Children? Adults? Immunocompromised?
Children= Meningococcal Meningitis Adults= Pneumococcal Meningitis, especially in alcoholics, chronic otitis, sinusitis, mastoiditis. G- Meningitis due to e.coli in immunocompromised
48
Signs/Symptoms of Acute Bacterial Meningitis
Respiratory ilness or sore throat preceded by fever, HA, Stiff Neck, Vomiting Adults become ill within 24 hours, kids sooner.
49
Dx of Acute Bacterial Meningits
+ve Brudinzinsky's sign, Kernigs Sign Unilateral or bilateral Babinsky Culture CSF +ve for bacteria Lumbar puncture after CT excludes mass lesion
50
Tx for Acute Bacterial Meningitis?
Antibiotics
51
Etiology of Trigger Point of Suboccipital mm
Repetitive traume (postural strains)
52
S&S of Suboccipital Trigger Points?
Tenderness and hypertonicity of suboccipital mm TrPs in Suboccipitals
53
Etiology of Otitis Media
Bacterial or Viral infection of middle ear Organisms migrate from nasopharynx to middle ear via Eustachian tube E.coli & Staph Aureus
54
S&S of Otitis Media
Persistent, Severe earache initially Hearing loss Fever, nausea, vomiting, diarrhea Red, bulging tympanic membrane Acute mastoiditis, periostitis, labyrnthitis, conductive & sensorineural hearing loss
55
Tx of Otitis Media
Antibiotics: Penicillin or Amoxiciin Refer to GP for Tx
56
Etiology of Nerve Root Irritation
MC Herniated disc Osteoarthritis
57
S&S of Nerve Root Irritation
Segmental neurologic Deficits Ventral= motor deficits & atrophy Dorsal= Sensory Deficits in dermatomal distribution Corresponding DTR diminished Pain aggravated by moving spine, coughing, sneezing, or Valsalva Relieved pain by raising arm behind head (Bakodys)
58
Dx of Nerve Root Irritation
Radiographs should include obliques CT/MRI
59
Tx of Nerve Root Irritation
Muscle relaxants, analgesics Surgical Mobs, Traction`
60
Etiology of Sinusitis
Inflammation of paranasal sinuses due to viral, bacterial, or fungal infections or allergic reactions Acute Sinusitis= Strep Pneumonia, Haemophilius Influenza, or staph and is usually precipitated by acute Viral respiratory infection.
61
S&S of Sinusitis
Red, Translucent nasal mucous membrane; yellow or green purulent rhinorrhea Maxillary sinusitis= pain in maxillary area, toothache Frontal Sinusitis= pain in frontal area and HA Sphenoid sinusitis= less well localized Ethmoid Sinusitis causes pain behind and between eyes and "splitting frontal HA"
62
Tx for Sinusitis
Steam inhalation for drainage Antibiotic Therapy
63
Temporal Arteritis Etiology
Primarily in Elderly Concomitant with Polymyalgia Rheumatica (PMR)
64
S&S of Temporal Arteritis
Severe HA, especially temporal & occipital Scalp tenderness, visual disturbances Blindness caused by ischemic optic neuropathy Systemic symptoms similar to PMR PA may reveal swolen and tender nodules in Temporal Arteries
65
Dx for Temporal Arteritis
Increased ESR in active phase Normochromic-Normocytic Anemia Increased s-ALP Biopsy may be required for Dx
66
Tx for Temporal Arteritis "GCA"
Prednisone
67
Sx of Polymyalgia Rheumatica
Pain and stiffness in shoulder and hips in the morning. Is associated with Temporal Arteritis "GCA"
68
S&S of TMJ Dysfunction
Clicking, Popping sound with opening and closing of the jaw Pain when chewing hard foods Musculature may be sore and have TrPs
69
Tx for TMJ Dysfunction
Mild analgesics Reposition splint or mouth guard STT
70
S&S of Tension Headache
Bilateral 30 min to 7 days, no pulsating, mild to moderate severity
71
Trigeminal Neuralgia Etiology
Arterial or venous loops compressing trigeminal nerve root. Disorder of Trigeminal nerve
72
S&S of Trigeminal Neuralgia
Adults, especially elderly Pain is often triggered by touching a trigger point or by activity Bouts of excruciating, lancinating pain, lasting seconds to 2 minutes.
73
Tx for Trigeminal Neuralgia
Carbamazepine meds Peripheral nerve blocks provide temporary relief.

CSA (3 decks)

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