EO 008 - Neuro Flashcards
What is a headache?
ppt EO 008.01(a/b)
Pain in the region of the head or neck
Slide 4
What are some causes of a headache?
ppt EO 008.01(a/b)
- Dehydration
- Fatigue
- Sleep depravation
- Stress
- Medication
- Drugs
- Infections
- Trauma
Slide 4
What is the difference between primary and secondary headache?
ppt EO 008.01(a/b)
Primary headaches are benign, recurrent headaches with no underlying disease or injury.
Secocndary headaches are caused by underlying disease or injury
Slide 5-6
What are red flags of headaches?
ppt EO 008.01(a/b)
- Sudden, severe onset
- Fever / immunocompromised
- Progressive
- Multiple patients with similar onset/symptoms.
- Neuro finding
- Pregnant/post partum
- Clotting disorder
- Eye pain/change
- Cervical maniplation
Slide 7-8 - there are more on slide, just put actual red flags
What is a migraine?
ppt EO 008.01(a/b)
Recurrent headache capable of altering daily function.
Slide 9
List and describe the types of migraines.
ppt EO 008.01(a/b)
Episodic - less than 15/month
Chronic - 15/month or more, for 6 months in a row
Slide 9
What are the 5 phases of a mgiraine?
ppt EO 008.01(a/b)
- Promonitory symptoms
- Aura
- Headache
- Headache termination
- Postdrome
Slides 12-14
What is a tension headache?
ppt EO 008.01(a/b)
Headache typically bilateral with mild to moderate pain. Can be episodic or chronic.
Slide 21
What are the timelines for episodic and chronic tension headache?
ppt EO 008.01(a/b)
Episodic, infrequent: less than 1 day a month
Episodic, frequent: more than 1 day a month but less than 15 days a months.
Chronic: More than 15 days/month for more than 3 months
What is the presentation of tension headache?
ppt EO 008.01(a/b)
Headache lasting 30min - 7 days with 2 or more of:
1. Bilateral
2. Pressing/tightening
3. Mild - moderate
4. Not aggravated by routine physical activity
5. Not associated with nausea/vomiting
6. One of but not both: phonophobia or photophobia
Slide 24 - 25
What is a cluster headache?
ppt EO 008.01(a/b)
Attacks of severe, unilateral headache typically in periorbital area.
Slide 31
What is grey matter?
ppt EO 008.01(a/b)
Neurological tissue composed of cell bodies with unmyelinated axons.
Slide 36
What is white matter?
ppt EO 008.01(a/b)
Neurological tissue containing few cell bodies and mostly myelinated axons
Slide 35
What is a cavernous sinus?
ppt EO 008.01(a/b)
Large channel of venous blood creating a cavity boredered by the sphenous bone and temporal bone.
Slide 36
What is the tributary?
ppt EO 008.01(a/b)
A vein emptying into a larger vein.
Slide 33
What functions is grey matter involved in?
ppt EO 008.01(a/b)
- Muscle control
- Sensory perception
- Memory
- Emotions
- Speech
- Decision making
- Self control.
Slide 34
What is a subarachnoid hemorrhage?
ppt EO 008.01(a/b)
Bleeding into the subarachnoid space of the meninges. Typically into basal cisterns and CSF pathways like ventricles.
Slide 45 - see slide 46 for visual
List some risk factors for subarachnoid hemorrhage.
ppt EO 008.01(a/b)
- Smoking
- Drugs
- Heavy alcohol use
- Htn
- Genetics
- Kidney disease
- Arteriovenous malformation.
- Coarctation of aorta
- Marfan syndrome
- Ehlers-Danlos syndromes
Slide 47
What is Marfan’s syndrome?
ppt EO 008.01(a/b)
A genetic disorder of the connective tissue, varying by patient.
Slide 48
What is Ehlers-Danlos syndromes?
ppt EO 008.01(a/b)
A group of genetic connective tissue disorders characterized by loose joints, stretchy skin, and abnoral scar formation.
Slide 49
What are other two other intracranial bleeds?
ppt EO 008.01(a/b)
Epidural hematoma and subdural hematoma.
Slide 55-57
What is an epidural hematoma?
ppt EO 008.01(a/b)
Collection of blood between skull and dura mater. Typically causes by trauma to temporal or temporoparietal region.
Slide 55-57
What is a subdural hematoma?
ppt EO 008.01(a/b)
Collection of blood between dura mater and arachnoid mater
Slide 55-57
What is a Traumatic Brain Injury (TBI)
ppt EO 008.01(a/b)
Impairment of brain function from mechanical force. Temp or Perm.
Slide 58
List the three classifications of TBIs based on GCS.
ppt EO 008.01(a/b)
Mild: GCS 14-15
Moderate: GCS 9-13
Severe: GCS 3-8
Slide 58
What is the difference between primary and secondary brain injury?
ppt EO 008.01(a/b)
Primary: occurs during initial injury, displaced physical structures of brain.
Secondary: Occurs gradually, involves an array of cell processes.
Slide 59
Briefly describe the pathophysiology of a mild TBI.
ppt EO 008.01(a/b)
Dysfunction of varying duration without overt hemorrhages. Typically caused by a wave of energy passing through brain tissue leading to ion shifts affecting mitochondrial functions.
Slide 60
What is the neurobiologic cascade?
ppt EO 008.01(a/b)
A complex cascade of ionic, metabolic, and physiological reactions involving microscopic axonal dysfunction. Leads to mitochondrial injury dysfunction.
Slide 60-63
What occurs with mitochondrial injury dysfunction?
ppt EO 008.01(a/b)
Leads to oxidtive stress, apoptosis, and decreased cellular energy production.
Slide 63
What are the three types of symptoms present with mild TBI?
ppt EO 008.01(a/b)
Cognitive, physical, behavioural
Slide 64 - 67
List some cognitive symptoms present in mild TBI.
ppt EO 008.01(a/b)
- Attention difficulties
- Concentration problems
- Amnesia
- Memory problems
- Orientation problems
- Altered processing/reaction speed
- Calculation difficulty
Slide 64-67
List some phsyical signs/symptoms of a mild TBI.
ppt EO 008.01(a/b)
- Headache
- Dizzyness
- Insomnia
- Fatigue
- Uneven gait
- Nausea/vomting
- Blurred vision
- Seizures
Slide 64-67
List some behaviour signs/symptoms of a mild TBI.
ppt EO 008.01(a/b)
- Irritability
- Depression
- Anxiety
- Sleep disturbances
- Emotional liability
- Loss of initiative
- Loneliness/helplessness
- Problems arising in job/relationship/home/school
Slide 64-67
What are some management options for mild TBI?
ppt EO 008.01(a/b)
- Maintain ABCs, GCS, C-spine
- Identifty structural damage
- Neuro exam with MACE/SCAT 5
- Tylenol/Advil
Slide 69 (nice)
What are red flags of a mild TBI?
ppt EO 008.01(a/b)
- Loss of consciousness
- Severe/worsening headache
- GCS < 15
- Seizures
- Vomiting
- Abnormal speech
- Double vision / pupil asymmetry
- Basal skull fracture
- Weakness / numbness in arms/legs/face
- Amnesia
Slide 69 (nice) - 70
What is a cerebral vascular accident (CVA)?
ppt EO 008.01(a/b)
Sudden onset of a focal neurologic deficit resulting from infarction or hemorrhage within the brain.
Slide 72
What are the two classifications of CVA?
ppt EO 008.01(a/b)
- Ischemic, stemming from thrombosis, embolism, or systemic hypoperfusion. (87% of CVAs)
- Hemorrhagic, stemming from intracerebral/non-traumatic subarachnoid bleed.
Slide 72, ischemic more common at 87%
Explain the FAST acronym for CVAs
ppt EO 008.01(a/b)
F - Facial drooping
A - Arm weakness
S - Speech difficulty
T - Time to cal 911
Slide 74
What are symptoms of a CVA?
ppt EO 008.01(a/b)
- Numbness/weakness
- Confusion/Aphasia
- Memory deficit
- Spatial orientation/perception difficulties
- Visual deficit/diplopia
- Dizziness/gait disturbance
- Severe headache.
Slide 74-75
What is the initial management of CVAs?
ppt EO 008.01(a/b)
ABCs stabilized, transport, neuro exam and IV.
Slide 77 - IV for Tissue Plasminogen Activator, a thrombolytic.
What is bacterial meningitis?
ppt EO 008.01(a/b)
Inflammation of pia/arachnoid meninges and CSF form bacteria.
Slide 79. Bacterial mengitis is an emergency.
What are the complications from bacterial mengitits?
ppt EO 008.01(a/b)
- Cerebral edema
- Increased ICP
- Hydrocephalus
- Inflammation of cranial nerves
- Subdural empyema (abcess of pus)
- Septic shock if spreading
Slide 80 - 82
What are the typical bacteria causing meningitis?
ppt EO 008.01(a/b)
- Neisseria Meningitidis
- Streptococcus Pneumoniae
- Staphylococcus Aureus
- Haemophilus Influenzae
Slide 83 - 87
What are S/S of bacterial meningitis?
ppt EO 008.01(a/b)
- Fever
- Nucal rigidity (inability to flex neck forward)
- Headache
- Altered mental status
- Pre-existing URI
- HA/Photophobia
- Seizures/confuision
- Nausea/vomiting
- Rash
Slide 89