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EO 008 - Neuro Flashcards

1
Q

What is a headache?

ppt EO 008.01(a/b)

A

Pain in the region of the head or neck

Slide 4

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2
Q

What are some causes of a headache?

ppt EO 008.01(a/b)

A
  1. Dehydration
  2. Fatigue
  3. Sleep depravation
  4. Stress
  5. Medication
  6. Drugs
  7. Infections
  8. Trauma

Slide 4

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3
Q

What is the difference between primary and secondary headache?

ppt EO 008.01(a/b)

A

Primary headaches are benign, recurrent headaches with no underlying disease or injury.

Secocndary headaches are caused by underlying disease or injury

Slide 5-6

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4
Q

What are red flags of headaches?

ppt EO 008.01(a/b)

A
  1. Sudden, severe onset
  2. Fever / immunocompromised
  3. Progressive
  4. Multiple patients with similar onset/symptoms.
  5. Neuro finding
  6. Pregnant/post partum
  7. Clotting disorder
  8. Eye pain/change
  9. Cervical maniplation

Slide 7-8 - there are more on slide, just put actual red flags

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5
Q

What is a migraine?

ppt EO 008.01(a/b)

A

Recurrent headache capable of altering daily function.

Slide 9

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6
Q

List and describe the types of migraines.

ppt EO 008.01(a/b)

A

Episodic - less than 15/month

Chronic - 15/month or more, for 6 months in a row

Slide 9

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7
Q

What are the 5 phases of a mgiraine?

ppt EO 008.01(a/b)

A
  1. Promonitory symptoms
  2. Aura
  3. Headache
  4. Headache termination
  5. Postdrome

Slides 12-14

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8
Q

What is a tension headache?

ppt EO 008.01(a/b)

A

Headache typically bilateral with mild to moderate pain. Can be episodic or chronic.

Slide 21

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9
Q

What are the timelines for episodic and chronic tension headache?

ppt EO 008.01(a/b)

A

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

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10
Q

What is the presentation of tension headache?

ppt EO 008.01(a/b)

A

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

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11
Q

What is a cluster headache?

ppt EO 008.01(a/b)

A

Attacks of severe, unilateral headache typically in periorbital area.

Slide 31

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12
Q

What is grey matter?

ppt EO 008.01(a/b)

A

Neurological tissue composed of cell bodies with unmyelinated axons.

Slide 36

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13
Q

What is white matter?

ppt EO 008.01(a/b)

A

Neurological tissue containing few cell bodies and mostly myelinated axons

Slide 35

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14
Q

What is a cavernous sinus?

ppt EO 008.01(a/b)

A

Large channel of venous blood creating a cavity boredered by the sphenous bone and temporal bone.

Slide 36

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15
Q

What is the tributary?

ppt EO 008.01(a/b)

A

A vein emptying into a larger vein.

Slide 33

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16
Q

What functions is grey matter involved in?

ppt EO 008.01(a/b)

A
  1. Muscle control
  2. Sensory perception
  3. Memory
  4. Emotions
  5. Speech
  6. Decision making
  7. Self control.

Slide 34

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17
Q

What is a subarachnoid hemorrhage?

ppt EO 008.01(a/b)

A

Bleeding into the subarachnoid space of the meninges. Typically into basal cisterns and CSF pathways like ventricles.

Slide 45 - see slide 46 for visual

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18
Q

List some risk factors for subarachnoid hemorrhage.

ppt EO 008.01(a/b)

A
  1. Smoking
  2. Drugs
  3. Heavy alcohol use
  4. Htn
  5. Genetics
  6. Kidney disease
  7. Arteriovenous malformation.
  8. Coarctation of aorta
  9. Marfan syndrome
  10. Ehlers-Danlos syndromes

Slide 47

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19
Q

What is Marfan’s syndrome?

ppt EO 008.01(a/b)

A

A genetic disorder of the connective tissue, varying by patient.

Slide 48

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20
Q

What is Ehlers-Danlos syndromes?

ppt EO 008.01(a/b)

A

A group of genetic connective tissue disorders characterized by loose joints, stretchy skin, and abnoral scar formation.

Slide 49

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21
Q

What are other two other intracranial bleeds?

ppt EO 008.01(a/b)

A

Epidural hematoma and subdural hematoma.

Slide 55-57

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22
Q

What is an epidural hematoma?

ppt EO 008.01(a/b)

A

Collection of blood between skull and dura mater. Typically causes by trauma to temporal or temporoparietal region.

Slide 55-57

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23
Q

What is a subdural hematoma?

ppt EO 008.01(a/b)

A

Collection of blood between dura mater and arachnoid mater

Slide 55-57

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24
Q

What is a Traumatic Brain Injury (TBI)

ppt EO 008.01(a/b)

A

Impairment of brain function from mechanical force. Temp or Perm.

Slide 58

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25
Q

List the three classifications of TBIs based on GCS.

ppt EO 008.01(a/b)

A

Mild: GCS 14-15
Moderate: GCS 9-13
Severe: GCS 3-8

Slide 58

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26
Q

What is the difference between primary and secondary brain injury?

ppt EO 008.01(a/b)

A

Primary: occurs during initial injury, displaced physical structures of brain.

Secondary: Occurs gradually, involves an array of cell processes.

Slide 59

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27
Q

Briefly describe the pathophysiology of a mild TBI.

ppt EO 008.01(a/b)

A

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

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28
Q

What is the neurobiologic cascade?

ppt EO 008.01(a/b)

A

A complex cascade of ionic, metabolic, and physiological reactions involving microscopic axonal dysfunction. Leads to mitochondrial injury dysfunction.

Slide 60-63

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29
Q

What occurs with mitochondrial injury dysfunction?

ppt EO 008.01(a/b)

A

Leads to oxidtive stress, apoptosis, and decreased cellular energy production.

Slide 63

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30
Q

What are the three types of symptoms present with mild TBI?

ppt EO 008.01(a/b)

A

Cognitive, physical, behavioural

Slide 64 - 67

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31
Q

List some cognitive symptoms present in mild TBI.

ppt EO 008.01(a/b)

A
  • Attention difficulties
  • Concentration problems
  • Amnesia
  • Memory problems
  • Orientation problems
  • Altered processing/reaction speed
  • Calculation difficulty

Slide 64-67

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32
Q

List some phsyical signs/symptoms of a mild TBI.

ppt EO 008.01(a/b)

A
  • Headache
  • Dizzyness
  • Insomnia
  • Fatigue
  • Uneven gait
  • Nausea/vomting
  • Blurred vision
  • Seizures

Slide 64-67

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33
Q

List some behaviour signs/symptoms of a mild TBI.

ppt EO 008.01(a/b)

A
  • Irritability
  • Depression
  • Anxiety
  • Sleep disturbances
  • Emotional liability
  • Loss of initiative
  • Loneliness/helplessness
  • Problems arising in job/relationship/home/school

Slide 64-67

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34
Q

What are some management options for mild TBI?

ppt EO 008.01(a/b)

A
  • Maintain ABCs, GCS, C-spine
  • Identifty structural damage
  • Neuro exam with MACE/SCAT 5
  • Tylenol/Advil

Slide 69 (nice)

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35
Q

What are red flags of a mild TBI?

ppt EO 008.01(a/b)

A
  • 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

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36
Q

What is a cerebral vascular accident (CVA)?

ppt EO 008.01(a/b)

A

Sudden onset of a focal neurologic deficit resulting from infarction or hemorrhage within the brain.

Slide 72

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37
Q

What are the two classifications of CVA?

ppt EO 008.01(a/b)

A
  1. Ischemic, stemming from thrombosis, embolism, or systemic hypoperfusion. (87% of CVAs)
  2. Hemorrhagic, stemming from intracerebral/non-traumatic subarachnoid bleed.

Slide 72, ischemic more common at 87%

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38
Q

Explain the FAST acronym for CVAs

ppt EO 008.01(a/b)

A

F - Facial drooping
A - Arm weakness
S - Speech difficulty
T - Time to cal 911

Slide 74

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39
Q

What are symptoms of a CVA?

ppt EO 008.01(a/b)

A
  • Numbness/weakness
  • Confusion/Aphasia
  • Memory deficit
  • Spatial orientation/perception difficulties
  • Visual deficit/diplopia
  • Dizziness/gait disturbance
  • Severe headache.

Slide 74-75

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40
Q

What is the initial management of CVAs?

ppt EO 008.01(a/b)

A

ABCs stabilized, transport, neuro exam and IV.

Slide 77 - IV for Tissue Plasminogen Activator, a thrombolytic.

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41
Q

What is bacterial meningitis?

ppt EO 008.01(a/b)

A

Inflammation of pia/arachnoid meninges and CSF form bacteria.

Slide 79. Bacterial mengitis is an emergency.

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42
Q

What are the complications from bacterial mengitits?

ppt EO 008.01(a/b)

A
  • Cerebral edema
  • Increased ICP
  • Hydrocephalus
  • Inflammation of cranial nerves
  • Subdural empyema (abcess of pus)
  • Septic shock if spreading

Slide 80 - 82

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43
Q

What are the typical bacteria causing meningitis?

ppt EO 008.01(a/b)

A
  • Neisseria Meningitidis
  • Streptococcus Pneumoniae
  • Staphylococcus Aureus
  • Haemophilus Influenzae

Slide 83 - 87

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44
Q

What are S/S of bacterial meningitis?

ppt EO 008.01(a/b)

A
  • Fever
  • Nucal rigidity (inability to flex neck forward)
  • Headache
  • Altered mental status
  • Pre-existing URI
  • HA/Photophobia
  • Seizures/confuision
  • Nausea/vomiting
  • Rash

Slide 89

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45
Q

What types of rash are common with bacterial meningitis?

ppt EO 008.01(a/b)

A
  • Purpura
  • Petachia
  • Macule
  • Papule

Slide 90 - 91

46
Q

What is positive Brudzinski sign?

ppt EO 008.01(a/b)

A

Flexion of hips and knees in response to passive neck flexion. Indicates meningitis.

Slide 92, 98

47
Q

What is Kernig’s sign?

ppt EO 008.01(a/b)

A

Contraction of hamstrings in respone to knee extension while knee and thigh is flexed. Indicates meningitis.

Slide 92, 98

48
Q

What is viral meningitis?

ppt EO 008.01(a/b)

A

Inflammation of the meninges or CSF due to a virus. Less severe than bacterial.

Slide 96

49
Q

What three symptoms can indicate viral meningitis?

ppt EO 008.01(a/b)

A
  • Fever
  • Neck stiffness
  • LOC change

Slide 97

50
Q

What diagnostics can be used for viral meningitis?

ppt EO 008.01(a/b)

A
  • CSF culture
  • CBC
  • CT or MRI

Page 99

51
Q

What is a seizure?

ppt EO 008.01(a/b)

A

An episode of abnormal neurologic function caused by inappropriate electrical discharge.

Presents as Generalized Tonic Clonic, General Abscence, and Partial.

Slide 101

52
Q

What is epilepsy?

ppt EO 008.01(a/b)

A

A fixed condition of recurrent seizures.

Slide 101

53
Q

What are primary and secondary seizures?

ppt EO 008.01(a/b)

A

Primary: No cause identified
Secondary: Consquence of identified neurologic condition.

Slide 101

54
Q

What is a Generalized Tonic Clonic seizure?

ppt EO 008.01(a/b)

A

A simultaneous activation of the entire cerebral cortex with involvement of somatic muscles during Tonic and Clonic phases.

Slide 103

55
Q

What are the stages of a Generalized Tonic Clonic seizure?

ppt EO 008.01(a/b)

A
  1. Tonic
  2. Clonic
  3. Postictal

Slide 103

56
Q

Describe the Tonic stage of a Generalized Tonic Clonic seizure.

ppt EO 008.01(a/b)

A
  • A short, loud cry as chest muscle contract
  • Abrupt loss of consciousness with rigidty and jerking extremities
  • Often apneic and cyanotic
  • Incontinence

Slide 104

57
Q

Describe the Clonic phase of a Generalized Tonic Clonic seizure.

ppt EO 008.01(a/b)

A
  • Extremities jerk and twitch
  • Saliva froths at outh
  • Irregular breathing patterns
  • Slowly regains consciousness

Slide 105

58
Q

Describe the postictal stage of a seizure.

ppt EO 008.01(a/b)

A

Period after the seizure when individual needs rest. Pt may be fatigued, confused, disoriented lasting up to 2 weeks.

Slide 106

59
Q

What is a Generalized Absence seizure?

ppt EO 008.01(a/b)

A

Epileptic activity of the entire brain beginning and ending abruptly characterized by unconsciousness without convulsions. Typically lasts 10-30s

Slide 108

60
Q

What is a Partial Focal Seizure?

ppt EO 008.01(a/b)

A

Electrical discharges beginning in a localized region of cerebral cortex. May spread to nearby regions. Simple or complex.

Slide 111

61
Q

Describe a simple Partial seizure.

ppt EO 008.01(a/b)

A

Seizure is local, consciousness is not affected. Symptoms present based on brain region involved

Slide 112

62
Q

What are the typical regions associated with simple Partial seizures?

ppt EO 008.01(a/b)

A

Motor cortex - Convulsive/jerking movements.
Occipital - Visual symptoms
Medial Temporal - Bizarre olfactory/gustatory

Slide 113

63
Q

Describe a complex partial seizure.

ppt EO 008.01(a/b)

A

Focal seizures involving consciousness without convulsions. Can have blank look/stare and may exhibit automatisms/visceral/affective symptoms.

Slide 114 - 115

64
Q

What are some seizure management options?

ppt EO 008.01(a/b)

A
  • Detailed history of event incl. prescence of aura, progression of motor activity, incontinence, duration.
  • Postictal signs
  • History of seizures
  • Meds/Compliance

Slide 117

65
Q

List the special populations for seizures.

ppt EO 008.01(a/b)

A
  • HIV positive
  • Neurocysticercosis
  • Pregnacy
  • Alcohol abuse
  • Status epilepticus

Slide 120

66
Q

Why does HIV positive constitute a special population for seizures

ppt EO 008.01(a/b)

A

HIV can cause mass lesions, HIV encephalopathy, and meningitis.

Slide 121

67
Q

What is neurocysticercosis?

ppt EO 008.01(a/b)

A

CNS infection from the larval stage of a tape worm, taenia solium.

Slide 122

68
Q

Why does neurocysticercosis constitute a special population for seizures?

ppt EO 008.01(a/b)

A

Parasite invades and causes cysts within the parenchyma causing localized edema. Cysts become fibrotic, causing scarring and calcification leading to seizures.

Slide 122

69
Q

Why does pregnancy constitute a special population for seizures?

ppt EO 008.01(a/b)

A

Non-compliance of anti-epileptic medication can cause harm to fetus.

Slide 123

70
Q

Why is alcohol abuse a special population for seizures?

ppt EO 008.01(a/b)

A
  • Lifestyle associated with non-compliance
  • Risk of head injury
  • Toxic coingestions
  • Electrolyte abnormalities
  • Withdrawal.

Slide 124

71
Q

What is status epilepticus?

ppt EO 008.01(a/b)

A

Continuous or intermittent seizures lasting more than 5 minutes without recovery. After 5min, less likely to stop spontaneously and increased risk of neuronal damage.

Slide 125

72
Q

List and describe the two types of status epilepticus.

ppt EO 008.01(a/b)

A

Non-convulsive: Comatose/fluctuating abnormal mental status, confusion, with no overt signs. Prolonged postictal period.

Refractory status epilepticus: Presistent seizures after IV anti-convulsant medications.

Slide 126

73
Q

What are cranial nerves?

ppt EO 008.01(c)

A

12 pairs of nerves emerging from the cranium sending info to and from the CNS. Divided into Sensory, Motor, and Mixed (both).

Slide 4

74
Q

What is Cranial Nerve (CN) I?

ppt EO 008.01(c)

A

Olfactory, sensory. Responsible for sense of smell.

Slide 5

75
Q

What is anosmia?

ppt EO 008.01(c)

A

Loss of sense of smell.

Slide 8

76
Q

What is CN II?

ppt EO 008.01(c)

A

Optic nerve, sensory. Responsible for visual information from the retina to the thalamus.

Slide 9

77
Q

What is anopia?

ppt EO 008.01(c)

A

Loss of sense of sight in one or both eyes.

Slide 11

78
Q

What is CN III?

A

Oculomotor, motor. Responsible for:
- Medial, superior, and inferior rectus
- Inferior oblique
- Levator palpebrae superioris

Slide 14

79
Q

What are S/S of a damaged Oculomotor (III) nerve?

ppt EO 008.01(c)

A
  • Strabismus
  • Ptosis
  • Dilation of pupil
  • Down/outward movement
  • Loss of accomodation
  • Diplopia

Slide 16

80
Q

What is CN IV?

ppt EO 008.01(c)

A

Trochlear (IV), motor. Innervates superior oblique muscle.

Slide 18

81
Q

What are S/S of Trochlear (IV) damage?

ppt EO 008.01(c)

A
  • Strabismus
  • Diplopia

Slide 20

82
Q

What is CN V?

ppt EO 008.01(c)

A

Trigeminal (V), mixed.

Slide 21

83
Q

What are the 3 branches of Trigeminal (V) nerve?

ppt EO 008.01(c)

A
  1. Opthalmic
  2. Maxillary
  3. Mandibular

Slide 21

84
Q

What is the opthalmic tract of Trigeminal (V) responsible for?

ppt EO 008.01(c)

A

Sensory: upper eyelid, cornea, lacrimal glands, upper nasal cavity, forehead.

Slide 22 - diagram for visual

85
Q

What is the maxillary tract of Trigeminal (V) responsible for?

ppt EO 008.01(c)

A

Sensory: pharynx, upper teeth, palates, lower eyelid, and upper lip.

Slide 22 - diagram for visuals.

86
Q

What is the mandibular tract of the Trigeminal (V) responsible for?

ppt EO 008.01(c)

A

Sensory: chin, anterior 2/3 of tongue, cheek, lower teeth
Motor: temporalis and masseter, jaw movements.

Slide 22 - diagram for visual

87
Q

What is often a cause of Trigeminal (V) neuralgia?

ppt EO 008.01(c)

A
  • Multiple sclerosis
  • Diabetes
  • B12 deficit

Slide 25

88
Q

What are S/S of damaged Trigeminal (V) nerve?

ppt EO 008.01(c)

A

Paralysis of chewing/jaw muscles, loss of sensation or proprioception of lower face.

Slide 26

89
Q

What is CN VI?

ppt EO 008.01(c)

A

Abducens, motor. Innervates lateral rectus muscle of eye.

Slide 27

90
Q

How do we test Oculomotor (III), Trochlear (IV), and Abducens (VI) nerves?

ppt EO 008.01(c)

A
  • Visual inspection
  • Eye alignment
  • Smooth pursuit (H-pattern)
  • Saccades
  • Accommodation reflex
  • Pupil reflex
  • Swinging reflex

Slide 15, 19, 28

91
Q

What is CN (VII)?

ppt EO 008.01(c)

A

Facial, mixed.
Sensory: post-auricular region, external acoustic meatus, efferent limb of cornea
Motor: muscles of facial expression, taste of anterior 2/3 tongue, lacrimation/salivation.

Slide 30

92
Q

How do you test the facial nerve?

ppt EO 008.01(c)

A

Visual inspection, facial movements.

Slide 31

93
Q

What are signs of Facial (VII) nerve damage?

ppt EO 008.01(c)

A

Ipsilateral facial paralysis (Bell’s Palsy)
Contralateral partial facial paralysis (Upper Motor Neuron lesion)

Slide 33

94
Q

What can cause facial nerve damage?

ppt EO 008.01(c)

A
  • Shingles/other viral
  • Bacterial infection
  • Trauma
  • Tumor
  • Stroke

Slide 34

95
Q

What is CN VIII?

ppt EO 008.01(c)

A

Vestibulocochlear, sensory.

Slide 35

96
Q

What are the two branches of Vestibulocochlear (VIII) nerve

ppt EO 008.01(c)

A

Vestibular (balance)
Cochlear (hearing)

Slide 35

97
Q

How do you test the vestibulocochlear (VIII) nerve?

ppt EO 008.01(c)

A

Sensory: Whisper, Rinne, Weber
Vestibular: Romberg, Positional and Gaze nystagmus

Slide 36

98
Q

What are S/S of vestibulocochlear (VIII) nerve damage?

ppt EO 008.01(c)

A

Vertigo, ataxia, nystagmus, tinnitus, deafness.

Slide 37

99
Q

What is CN IX?

ppt EO 008.01(c)

A

Glossopharyngeal, mixed.

Slide 39

100
Q

What is glossopharyngeal (IX) responsible for?

ppt EO 008.01(c)

A

Motor: elevates pharynx, speech, stimulates secretion of saliva.
Sensory: Pharynx, posterior tongue, carotid baro- and chemoreceptors.

Slide 39

101
Q

How do you test Glossopharyngeal (IX) nerve?

ppt EO 008.01(c)

A

Swallowing, gag reflex, taste.

Slide 41

102
Q

What are S/S of Glossopharyngeal (IX) damage?

ppt EO 008.01(c)

A

Dysphagia, aptylia, ageusia.

Slide 42

103
Q

What is CN X?

ppt EO 008.01(c)

A

Vagus (X), mixed

Slide 43

104
Q

What is Vagus (X) responsible for?

ppt EO 008.01(c)

A

Motor: Swallowing, coughing, speech, GI tract, heart rate

Sensory: Taste, touch, pain, temperature.

Slide 43

105
Q

What is CN XI?

ppt EO 008.01(c)

A

Accessory, motor

Slide 46

106
Q

What is Accessory XI responsible for?

ppt EO 008.01(c)

A

Swallowing, movements of head and shoulders.

Slide 46

107
Q

How is Accessory XI tested?

ppt EO 008.01(c)

A

Shrugging shoulders and rotation of head.

Slide 47

108
Q

What are signs of Accessory XI damage?

ppt EO 008.01(c)

A

Weakness/paralysis of trapezius or sternocleidomastoid

Slide 48

109
Q

What is CN XII?

ppt EO 008.01(c)

A

Hypoglossal, motor

Slide 50

110
Q

What is Hypoglossal (XII) responsible for?

ppt EO 008.01(c)

A

Tongue muscles for speech and swallowing

Slide 50

111
Q

How is Hypoglossal (XII) tested?

ppt EO 008.01(c)

A

Tongue movements

Slide 51

112
Q

What are signs of Hypoglossal (XII) damage?

ppt EO 008.01(c)

A

Dysarthria, dysphagia, difficulty chewing.

Slide 52

QL5 (13 decks)

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