Dementia and head trauma Flashcards
What blood work should be done when working up a patient for dementia
CBC
CMO
TSH
Drug screen
Ammonia levels
Syphilis screen
Heavy metal screen
What is the most common type of dementia
alzheimers dementia
What is Alzheimers dementia
Progressive dementia cause by intracellular neurofibrillary tangles and extracellular plaques
What are some Alzheimers dementia treatments
AChE inhibitors
-Donepezil, Rivastigmine
NMDA agonists
-Memantine
What is the second most common type of dementia
Vascular dementia
Which gender is at higher risk for vascular dementia
Men
What is vascular dementia
Ischemia of the brain & lacunar infarcts
What are some associated causes of vascular dementia
Hypertension
High cholesterol
What are the 2 subtypes of vascular dementia
Cortical
Subcortical
What is cortical vascular dementia
Speech difficulty
Loss of ADL
Confusion
Amnesia
What is subcortical vascular dementia
Motor deficit
gait changes
urinary incontinence
personality changes
What may be seen in labs for vascular dementia
Hyperlipidemia
What may be given as treatment for vascular dementia to manage disease
States and anti platelets for treatment of hyperlipidemia and hypertension
What is Lewey body dementia caused by
Deposits in nerve cells known as Lewy bodies in the midbrain, brain stem, and olfactory bulbs
What are some side effects from Lewy body dementia
Delusions
visual hallucinations
anxiety
What is frontotemporal dementia
Dementia caused by the degeneration of the frontal / temporal lobes
*pick disease
What does frontotemporal dementia cause
Euphoria
apathy
disinhibition
compulsions
What is pseudo dementia
Perceived memory loss with normal MOCA MRI and labs
What generally causes pseudo dementia
Uncontrolled depression and anxiety
How will you treat pseudo dementia
SSRIs and counseling
What does GCS stand for
Glasgow coma scale
What do you measure on a GCS
Eye open response
best verbal response
Best motor response
How do you measure the eye opening response with GCS
4- Spontaneously
3- To speech
2-To pain
1-No response
How do you measure best verbal response on a GCS
5-Oriented to time, place, person
4-Confused
3-Inappropriate words
2-Incomprehensible sounds
1-No response
How do you measure best motor response on a GCS
6- Obeys command
5-Moves to localized pain
4-Flexion withdrawal to pain
3-Abnormal flexion (decorticate)
2-Abnormal extension (decerebrate)
1-No response
If someone is dead, what is their GCS
3
If a patient is comatose, what is their GCS
8 or less
What is the highest score you can get on a GCS
15
What accounts for 50% trauma deaths in children
Head trauma
What are contra-coup injuries
Injuries that happen on the opposite side of impact
Where do intracerebral hemorrhages occur
in the intraparenchymal space (will not touch the skull)
What causes an intracerebral hemorrhage
Trauma
AVM
Hypertension
What are the symptoms of an intracerebral hemorrhage
Headache
N/V
hemiplegia
hemiparesis
How do you treat an intracerebral hemorrhage
steroids to decrease edema
antiepileptics
possible surgical intervention
If you are concerned someone has an intracerebral hemorrhage, would you preform an LP
NO!
Can cause herniation
what are some causes of a subarachnoid hemorrhage
Trauma
AVM
Cherry aneurysm
What are some symptoms of a subarachnoid hemorrhage
Sudden “thunderclap” headache
(usually unilateral)
N/V
What are meningeal signs of a subarachnoid hemorrhage
Photophobia
confusion
Neck stiffness
What treatment can you use for a subarachnoid hemorrhages
Stool softeners
Phenytoin
Nimodipine (BP control)
Where does an epidural hematoma occur
It is an arterial bleed between the skull and the dura
What causes an epidural hematoma
Skull fracture damaging the middle meningeal artery
What are the signs of an epidural hematoma
Headache
N/V
CSF fluid leak
Focal neuro changes
Coma
*will have LOC and then regain it before losing it again
What will an epidural hematoma look like on imaging
Convex bleed that doesn’t cross the line in the temporal area
What is a subdural hematoma
Venous bleed between the dura and the arachnoid from torn bridging veins
What causes a subdural hematoma
Trauma
What symptoms occur with subdural hematoma
Focal neuro symptoms
severity varies
What will be seen on imaging with a subdural hematoma
Concave bleeding that crosses suture lines
What is a concussion
Traumatic brain injury causing alterations in mental status or LOC
*neurons lose their neurotransmitters
What are immediate symptoms of a concussion
amnesia
confusion
decreased coordination
emotional changes
disorientation
What symptoms should never be included with a concussion
change in pupil size
hemiparesis
visual field deficit
What CT findings should be seen with a concussion
none
What do you give someone with mild headache symptoms
NSAID
Excedrin
What do you give someone with moderate headache symptoms
Triptan medications
*target the blood vessels
*cannot use it more than 10 days a month b/c of rebound migraines
What do you give someone who is having severe migraines
Sumatriptan
*can give a warming sensation of the throat
What medication can be given to prevent migraine reoccurrance within three days of the initial migraine
IV Dexamethasone
What is generally helpful in treating cluster headaches
oxygen
prednisone taper
