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NMSK Exam 2: Neuro > HA > Flashcards

HA Flashcards

1
Q

What are Primary HA (Benign HA disorders)?

A
  1. Common migraine
  2. Classic migraine
  3. Chronic migraine
  4. Tension HA
  5. Cluster HA
  6. Other: drug-rebound HA, trigeminal neuralagie
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2
Q

Secondary headaches are a sign of?

A

Organic disease

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3
Q

What are the 10 worrisome signs which may indicate headache of pathologic origin (secondary HA)?

A
  1. “Worst HA”
  2. Onset of HA after 50 YO
  3. Atypical HA for patient
  4. HA w/ fever
  5. Abrupt onset (max. intensity in sec. to min.)
  6. Subacute HA w/ progressive worsening over time
  7. Drowsiness, confusion, memory impairment
  8. Weakness, ataxia, loss of coordination
  9. Paresthesias/Sensory loss/ Paralysis
  10. ABNL medical/ neuro exam
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4
Q

When taking a HA history, what important topics do you want to ask?

A
  1. HA history
  2. Pain
  3. Prodrome
  4. Assoc’d Symptoms
  5. Triggers
  6. Current and Previous medications tried: for prophylactic and abortive therapy
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5
Q

As a general rule, many physicians (including neurologists) believe that any person with HA should do what?

A

One-time, thorough neuroimaging study (CT head with and w/o contrast or MRI of the head).

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6
Q

Any patient presenting with a headache who has a “worrisome history” or abnormal examination needs what?

A
  1. Urgent CT of the head
  2. If CT is NL = L.P. and possibly arteriogram because CT can miss 5-10% of SAH
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7
Q

When are imaging studies NOT warrent for HA?

A
  1. Adult patients with recurrent HA: migraine, including aura,
  2. No recent change in pattern,
  3. no history of seizures,
  4. no focal neurological signs
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8
Q

Differentiate a common migraine from a classic migraine.

A
  1. Common migrarine = without aura
  2. Classic migraine = with aura
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9
Q

What do you perform for a HA exam?

A
  1. Vitals (esp BP and pulse)
  2. Cardiac status
  3. Extracranial structures
  4. ROM and prescence of pain in C-spine
  5. Neuro exam
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10
Q

Describe the most common cause of bacterial meningitis in an adult and in a child.

A

Most common cause in infants, young children and adults: Strep. pneumoniae

  • Progresses VERY quickly to bcome serious and complications like: hearing loss, memory problems, learning disabilities, brain damage, gait problems, death.
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11
Q

Describe the appropriate initial treatment for suspected bacterial meningitis.

A

If you suspect a bacterial meningitis:

  1. If you can blood cultures and spinal tap STAT => do it.
  2. If not DO NOT DELAY TX: draw blood cultures STAT => then, treat with ABX
    1. IV STEROIDS (dexamethasone= give to decrease complications) +
    2. IV vancomycin
    3. IV 3rd generation cephalosporin (ceftriaxone or rosephine).
    4. If herpes or suspect, give acyclovir.
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12
Q

What drugs do you give someone with bacterial meningitis?

A
  1. IV STEROIDS (dexamethasone= give to decrease complications)
  2. IV vancomycin
  3. IV 3rd generation cephalosporin (ceftriaxone or rosephine)
  4. If herpes, give acyclovir.
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13
Q

_________ used to be the most common cause in children, but vaccine has decreased this substantially.

A

Hemophilus influenza

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14
Q

__________ is a highly contagious cause in teenagers and young adults.

A

Nisseria meningitidis

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15
Q

___________ is a consideration in causing meningitis in elderly.

A

Listeria monocytogenes

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16
Q

Pt with T1DM, over 50, who never had HA before => __________ better be a differential!!!!

A

Cryptococcal meningitis (fungal) = common in pts with T1DM and immunocompromised

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17
Q

Signs/symptoms of meningitis in children over age 2 years

A
  1. –Sudden high fever + HA that seems different than normal ( can have N/V)
  2. –Stiff neck
  3. –Confusion or difficulty concentrating
  4. –Seizures
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18
Q

Common causes of infectious encephalitis?

A
  1. HSV 1 or 2
  2. HIV
  3. West Nile
  4. Varicella Zoster
  5. Treponema pallidum (shypillus)
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19
Q

Herpes Simplex 1 Encephalitis

  1. MRI and EEG show focal abnormalities in ______
  2. Treatment = _____
  3. Complication of HSV1 Encephalitis
A
  1. Temporal lobes
  2. Acyclovir
  3. Secondary NMDA autoimmune encephalitis
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20
Q
  • AI can cause encephalitis: Over the last 10 years, we have learned of AI causes of encephalitis, which can mimic infectious encephalitis. Most of these associated with _________.
A

Seizures

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21
Q

Autoimmune encephalitis should be considered in who?

A
  1. Rapidly progressive (usually < 6weeks) encephalopathy or psychiatric problems
  2. Seizures
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22
Q

If you suspect pt with AI encephalitis, what should you do?

A
  1. Prompt identification of cause + initiation of treatment is important. CSF and serum testing takes weeks,
  2. IF you suspect this in pt => draw blood and spinal fluid => treat !!
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23
Q

2 etiologies of autoimmune encephalitis

A
  1. NMDA Encephalitis (Anti-N-Methyl-D-Aspartate Encephalitis)
  2. LGI1 Encephalitis (Leucine-rich Glioma Inactivated 1 Encephalitis)
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24
Q

NMDA Encephalitis

  1. MC in:
  2. Presentation:
  3. ABNL labs
  4. Commonly associated with:
  5. Response to treatment:
A
  1. Middle-aged women
  2. Rapid onset (less than 3 months) of at least 4/6 symptoms:
    1. ABNL (psychiatric) behavior or cognitive dysfunction
    2. Speech dysfunction (pressured speech, verbal reduction, mutism)
    3. Seizures
    4. Movement disorder
    5. ⬇︎ level of consciousness
    6. Autonomic dysfunction or central hypoventilation
  3. ABNL labs
    1. Extreme delta brush on EEG
    2. CSF: pleocytosis (increase white cells), oligoclonal bands, NMDA-R AB
  4. Teratomas
  5. Present with severe deficits, but many will improve with aggressive treatment, but may take long time
25
[**EEG with\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ with methotrexate neurotoxicity supports NMDA receptor**](https://www.semanticscholar.org/paper/EEG-with-extreme-delta-brush-in-young-female-with-Schmidt-Kj%C3%A6r/f9482031208e0d2c8ff7e6171c71861397e39c1b)[**involvement.**](https://www.semanticscholar.org/paper/EEG-with-extreme-delta-brush-in-young-female-with-Schmidt-Kj%C3%A6r/f9482031208e0d2c8ff7e6171c71861397e39c1b)
[**extreme delta brush in young female**](https://www.semanticscholar.org/paper/EEG-with-extreme-delta-brush-in-young-female-with-Schmidt-Kj%C3%A6r/f9482031208e0d2c8ff7e6171c71861397e39c1b)
26
**NMDA encephalitis** is commonly associated with a \_\_\_\_\_\_\_\_
**teratoma**
27
**_LGI1 Encephalitis_** 1. MC in: 2. Presentation: 3. Complications 4. Commonly associated with: 5. Response to treatment:
1. **Men** 2. **Faciobrachial dystonic seizures**: brief, seizures involving one side of the _face_ and the _arm_ on the same side, often occurring frequently, sometimes hundreds of times per day. Does not respond to epileptic drugs and may require immunotherapy. 3. **Temporal lobe** (esp. hippocampal) **ABNLities: brain damage** 4. **Sleep** disturbances (50% of pts) 5. **1/3 relapse**
28
**Classic HA of ruptured aneurysm**: sx and what do you do?
* 1. Worst HA of life, * 2. Dilated pupil on side of aneurysm; down and out eye * 3. Grab head and fall over/ collapse suddenly , * 4. stiff neck, * 5. HX of seizure**.** **1st thing you do =**\> PUT IN _CT SCANNER IMMEDIATTELY!!!_! =\> LP in case CT scan misses SAH
29
**Common migraines** 1. Intensity: 2. Disability: 3. Age of onset: 4. Gender MC in:
1. Moderate to severe 2. Inhibits or prohibits daily activities; pain aggravated by activity 3. Late teens =\> early 20’s; prevalence peaks between 35-40 years. 4. F
30
**Common migraine** 1. Location: 2. Description of pain: 3. Patient behavior:
1. Unilateral or bilateral 2. Throbbing/sharp/pressure that last _4-72 hrs (usually 12- 24)_ with _NO_ aura; afterwards, fatique, "fog" 3. Retreat to dark, quiet room
31
MC associated symptoms with **Common migrane**
1. **Nausea (90%)** 2. **Vomiting (33%)** 3. **Photophobia/ phonophobia**
32
How long does the **aura** associated with **Classic Migraines** usually last?
**15-30 mins,** but sometimes longer
33
What are the common visual symptoms associated with **Classic Migraines?**
1. **Scintillations**: flashes of light 2. **Scotoma**: blind spots 3. \*Often _hemianopic_
34
To be defined as a **chronic migraine** which criteria must be met?
HA that last 4+ hours for 15 or more days/month for at least 3 months
35
The most widely discussed theory about the **cause of migraines** says that they are caused by?
**Neurogenic inflammation:** trigmeninal nerve is irritated =\> releasing neuropeptides =\> pain in meninges
36
**_Tension HA_** 1. Intensity 2. Disability 3. Age of onset 4. Gender
1. **Mild to Moderate** 2. **May** inhibit, but does not prohibit daily activities 3. Variable; generally peak incidence **20-40 yr.** 4. **F**:M = 3:2
37
**_Tension HA:_** 1. Location: 2. Description: 3. Behavior:
1. Bifrontal, bioccipital =\> radiate to neck, shoulders 2. Dull, aching, squeezing, pressure with _no_ prodrome or aura 3. No affect on behavior
38
Which type of **HA** has an association with **sleep apnea**? THIS WILL BE ON EXAM!
**CLUSTER HA**
39
**Cluster HA** 1. Intensity 2. Disability 3. Age of onset 4. Gender
1. **Severe, excruciating** 2. **Prohibits daily activities** 3. **20’s - 50’s** 4. F:**M** = 1:6
40
**Cluster HA:** 1. Location: 2. Description: 3. Behavior:
1. **100% unilateral**; generally **orbitotemporal** 2. Excruciating, penetrating, sharp, boring, that does NOT throb; prodrome = brief mild burning in ipsilateral inner canthus or internal nares; no aura 3. **Frenetic, pacing, rocking**
41
How long do **cluster HA** last?
**30 minutes - 2 hours**
42
What are some of the associated symptoms of **Cluster HA's**?
1. **Ipsilateral** ptosis 2. **Miosis** 3. Conjunctival injection 4. **Teary-eyed** 5. **Stuffed / runny nose**
43
**_Acute Treatment of Migraines_**
1. OTC analgesics / NSAIDS 2. Isometheptene (Midrin) 3. Butalbital (Fiorinal, Fioricet) 4. Opioids 5. DHE nasal spray 6. Triptans (5HT1 agonists)
44
**CI** for the use of **Triptans** in the acute treatment of **migraines**
1. Ischemic heart disease 2. Cardiovascular, cerebrovascular, or peripheral vascular disease 3. Uncontrolled HTN 4. Severe renal/ hepatic impairment 5. Raynaud's syndrome 6. Hemiplegic or basilar migraine 7. Use within 24 hr. of taking: ergotamines, MAOI’s, or other 5-HT1 agonists.
45
If one triptan doesnt work for migraines, what should we do?
**Try another!** Consider nasal spray or injectable
46
If **nausea/vomiting** are a major feature of **migraine**, consider using an \_\_\_\_\_\_
**Antiemetic** (metoclopramide, prochlorperazine), often _before_ analgesic medication
47
If **insomnia** is a major feature of **migraine**, consider using a ___________ to help the patient “sleep off” the migraine
1. **Sedative/ hypnotic** (e.g. diazepam or temazepam) 2. **Major tranquilizer** (e.g. thorazine)
48
If migraines become **more frequent** or **prolonged** = what can we give?
**Prednisone taper**
49
In general, if the patient is experiencing **one or more HA’s per week**, consider what?
**Preventive medication** to ⬇︎ the frequency/ severity ## Footnote 1. **Antidepressants:** TCAs, SSRIS, SNRIs, MAOIs **2. BBlockers** **3. Ca2+ channel blockers**
50
What is the only FDA approved treatment for **chronic migraines**?
**BOTOX injections**
51
Acute Tx. Of **Cluster HA**
Avoid oral drugs! 1. **DHE** 1 mg. **IM** or **Ergotamine** 2mg **SL** 2. **Sumatriptan 6 mg SQ** 3. **Zolmitriptan Nasal spray** 4. Lidocaine 4% - 1 ml intranasal 5. Narcotics (e.g.meperdine, morphine) 6. Oxygen 100% 8L/min. by mask
52
What's **Trigeminal Neuralgia?** Treatment?
1. **Excruciating** **sharp**, **shooting**, **electric** pain occuring in **paroxysms** in one or more distributions of the trigeminal nerve, often **freqent** **through the day** 2. Treatment is usually **carbamazepine** or **oxcarbamazepine**
53
A group of headache disorders characterized by **unilateral trigeminal distribution pain** that occurs with **prominent ipsilateral cranial autonomic features**
**TAC’s (Trigeminal Autonomic Cephalgias)**
54
What 5 types of headache disorders are classified as **Trigeminal Autonomic Cephalgias (TAC's)?**
* 1. Cluster HA * 2. Paroxysmal hemicrania * 3. Hemicrania continua * 4. SUNCT syndrome * 5. SUNA syndrome (similar to SUNCT, but with autonomic sx's
55
* Symptoms of **SUNCT syndrome** are the same as Cluster. **What is the difference?**
SUNCT = **s**hortlasting, **u**nilateral **n**euralgiform HA with **c**onjunctival injection and **t**earing 1. Lasts seconds =\> few mins, occuring frequently throughout the day 2. Onset typically **over 50** in **men**
56
Symptoms of **Paraxysmal Hemicrania** are the same as Cluster. What is the difference?
* **Shorter duration** (often only minutes) and ⬆︎ **frequency** (usually \> 5 times per day).
57
**Paroxysmal Hemicrania (HA)** is exquisitely reponsive to which drug?
**Indomethacin**
58
What's a **good oral preventative tx** for someone experiencing _multiple_ cluster HA's in a year?
**Verapamil (Ca2+ channel blocker)**
59
What is the treatment for **SUNCT syndrome?**
- Usually **anticonvulsants** = particularly _lamotrigine_

NMSK Exam 2: Neuro (15 decks)

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