Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CM 4 GERI & NEURO > HA, and Concussions > Flashcards

HA, and Concussions Flashcards

1
Q

location of concussion direckt correlated w/ si/sx

Frontal-

Parietal-

Occipital-

Top of the head impacts-

A

Frontal- irritability, inappropriate tearfulness

Parietal- headache, nausea

Occipital- dizziness, disequilibrium, visual symptoms

Top of the head impacts- more likely to cause LOC than front or side impacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pathophys of concussions

A
  • Hyper-acute ionic flux (K+, Ca+)
  • release of excitatory NT
  • Acute hyperglycolysis
  • Sub-acute metabolic depression
  • Inflammation
  • ↓cerebral blood flow for days-weeks

Combination of these metabolic alterations has been proposed to cause the transient and prolonged neurologic deficits that characterize concussions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

dx of concussion

A
  • SCAT-5
  • Balance error scoring system (BESS)
  • Non-healthcare concussions recognition tools 5 (CRT5)
  • Concussion assessment & response (CARE)
  • Sideline assessment of concussion (SAC)
  • Graded Sx checklist (GSC)
  • Glasgow coma scale (GCS)
  • +/- CT (LOC!)
  • fMRI (BOLD contrast)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

tx of concusisons

A

Retest neuro function q30 min

Observe x4 hours

Sx management (ex. analgesics, antiemetics)

  • No opioids

Brain rest x24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define Post-concussive syndrome

A

Si/Sx last beyond the usual recovery period (7-10 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

tx of Post-concussive syndrome

A

Amitriptyline

Antiemetics (dihydroergotamine & metoclopramide)

Occipital blocks

Propranolol

Indomethacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

define second impact syndrome

A

Death or devastating neurological injury attributed to massive brain swelling in athletes who sustain a second head injury before full recovery from the first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

define imPACT testing and its use

A

imPACT TESTING - Most widely used and scientifically validated computerized concussion evaluation system

  • Not a tool to diagnose concussion
  • Not a substitute for medical evaluation and treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

define CTE

accumulation of??

A

Repeated concussions

An accumulation of abnormal hyperphosphorylated tau (p-tau) in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

•Most common type of traumatic intracranial mass lesion

A

Subdural hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

define subdural hematoma & etiology

acute

subacute

chronic

A

Form between the dura and the arachnoid membranes–> T_earing of bridging veins_

Acute (1-2 days)

Subacute (3-14 days)

Chronic (>15 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

si/sx of subdural hematoma vs epidural hematoma

A

SDH- Gradually increasing LOC

  • HA
  • Dizziness
  • Cognitive impairment
  • Seizures

EDH - Lucidity –> rapid deterioration

  • Severe HA
  • Vomiting
  • Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

define EDH and causes

A

Arise in space between the dura and the skull

  • Due to shearing and rotational forces and blows to the side of the head
  • Adolescents and young adults affected most

Shearing of meningeal arteries

  • Trauma (ex. skull fx)
  • Epidural abscess
  • Infection
  • Cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SDH is due to tearing of ___

EDH is due to tearing of ___

A

SDH is due to tearing of bridging veins

EDH is due to tearing of meningeal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

comapre/conrast head CT for SDH vs EDH

A

Head CT

SDH - crescent shaped)

EDH - biconvex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Surgical evacuation (ex. craniotomy, burr) is always indicated in what cases of EDH / SDH

A
  • >30 cm or mls
  • acute EDH with a GCS < 9 and pupillary abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

compare contrast SDH vs EDH

location

arterial vs venous

LOC ??

CT features

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

list examples of primary vs secondar headache

A

Primary

  • Migraine
  • tension-type
  • cluster headache

Secondary

  • sinus headache
  • SAH
  • tumor
  • hydrocephalus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HA red flags

A

RED FLAGS ...SNOOP 5

  • S: Systemic symptoms (fever, weight loss) or Secondary risk Factors (HIV, cancer)
  • N: Neurologic symptoms or abnormal signs
  • O: Onset - abrupt, peak < 1 minute (thunderclap, SAH, CVST, dissection)
  • O: Older - age > 50 years (GCA, glaucoma, cardiac cephalalgia)
  • P: Previous headache history, pattern change, progressive
  • P: Postural (CSF leak/low pressure headache; IIH)
  • P: Precipitated by valsalva, exertion (Chiari malformation, space occupying lesion-tumor/mass)
  • P: Pulsatile tinnitus (diplopia, transient visual changes- IIH)
  • P: Pregnancy or postpartum (pre-eclampsia, eclampsia, apoplexy, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HA RED FLAGS …on exam

A
  • Abnormal vital signs - increased BP/HR or temperature
  • AMS
  • Alteration in LOC
  • meningeal irritation (Brudzinski’s/Kernig’s signs)
  • Papilledema - swelling of optic nerve indicating elevated ICP
  • P_resence of focal neuro signs_ - hemiparesis, hemisensory loss, ataxia, aphasia, dysarthria, signs of brainstem dysfunction, pathological reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) is a primary vs secondsayr HA

A

secondary

22
Q

define IIH

A

A disorder of the of CSF mechanics

  • disease process mimics a space occupying lesion, with none being found

More common in obese women

23
Q

CSF is produced –>

CSF is resorbed –>

A

CSF is produced –> choroid plexus; also

CSF is resorbed –> arachnoid granulation

24
Q

si/sx of IIH

A

Progressive headache- wks to months

Diffuse pain, holocephalic - can be lateralized

postural changes:

  • Worse with lying down
  • better when upright

Pulsatile tenderness

Worsens or triggered by cough, valsalva maneuver

25
Q

Hallmark PE finding in IIH

A

papellidema

26
Q

eye exam fts in IIH

A

Papilledema

Peripheral visual field loss –> occurs before visual acuity loss

6th nerve palsy (Abducens) –> D/t ↑ ICP on 6th nerve It is possible to

27
Q

imaging/ dx of IIH

A

MRI (most likely w/ contrast)

  • Flattening of posterior globe
  • Optic sheath fenestration
  • Empty sella

MRV (w/ contrast) -> No venous obstruction

LP –> Lateral decubitus **Legs extended

  • Opening pressure ** (↑250, 200-250 if other sx present )
  • Closing pressure
  • CSF studies (cell count and diff, glucose, and protein) – Normal
28
Q

tx of IIH

first line

papilledema

A

FIRST LINE: Acetazolamide (Diamox)

  • Carbonic anhydrase inhibitor
  • ↓ CSF production

Weight loss

Other meds used:

  • Methazolamide
  • Topiramate
  • Furosemide
  • Spironolactone
  • Steroids (but not first line)
  • Triamterene

Optic nerve sheath fenestration

  • Only if papilledema; can lead to visual loss
29
Q

normal vs pathologic pressures

A

Normal pressure ≤ 15 mmHg (200 mmH2O)

Pathologic ≥ 20 mmHg

30
Q

meds assoc w/ IIH

A
  • Tetracyclines
  • Vitamin A and retinoids
  • Nalidixic acid, leuprorelin acetate
  • Withdrawal of corticosteroids
31
Q

IIH asssoc conditions

A
  • Obstructive Sleep Apnea (OSA)
  • PCOS
  • Antiphospholipid antibody syndrome
  • HIV infection
  • Cerebral venous thrombosis/stenosis
32
Q

differentiate b/w longer vs shorter duration HA and give examples

A

Longer Duration: > 4 hours

  • Migraine
  • Tension-type headache (generally)
  • New Daily Persistent Headache
  • Hemicrania Continua

Shorter Duration: < 4 hours

  • Cluster headache
  • Paroxysmal Hemicranias
  • Hypnic Headache
  • Idiopathic stabbing headache
33
Q

types of cluster HA

A

Episodic (most common)

  • At least 2 cluster periods lasting from 7 days to 1 year (when untreated) and
  • separated by pain-free remission periods of ≥3 months.
  • Cluster periods usually last between 2 weeks and 3 months.

Chronic

  • without a remission period
  • or with remissions lasting <3 mo for at least 1 yr
34
Q

si/sx of cluster HA

A

Occur in cycles; know the exact time of year that headaches start; often seasonal

  • 1-8 per day, lasting 15 to 180min

Unilateral, periorbital/retro-orbital pain

Stabbing and unbearable - the worst pain you will ever experience in your life;

  • “Hot poker into the eye”

Nicknamed the “suicide headache”

35
Q

cluster HA behavior and autonmic fts

A

HEADACHE BEHAVIOR:

  • pacing, irritated, pounding fists, head against objects or walls

Autonomic features:

  • Conjunctival injection, lacrimation, nasal congestion, rhinorrhea, lid ptosis - A_ll ipsilateral (same side as pain)_
36
Q

when is neuroimaging apprioriate for cluster HA

A

if this is the first time they are being worked up or if this is an initial event.

  • Exclude a cranial lesion - has been found on occasion

MRI with and w/o contrast (preferred)

CT non- contrast

37
Q

tx of cluster HA

acute

preventitive

A

Acute Treatment

  • High Flow O2 non-rebreather
  • Sumatriptan injection –subcut
    • Other triptans - zolmitriptan nasal spray
  • Prednisone taper
  • Occipital nerve blocks
  • Neuromodulation devices - vagal nerve stimulator

Preventive Treatment: CCB - Verapamil - mainstay

  • Long QT assess ECGs
38
Q

Dull, steady ache; band-like in distribution around head

bilateral, mild to moderate intensity

Pressing or tightening in quality

Physical activity does not worsen pain

  • Nausea, photo/phonophobia are not usually present
  • Vomiting never present
A

tension HA

39
Q

Most common abnormal finding in tension HA

A

pericranial tenderness

40
Q

tx of tension HA

acute

chronic

pphx

A

Acute: Acetaminophen, NSAIDs, Aspirin

Chronic: NSAIDs, biofeedback,

  • may use prophylaxis if >15 days per month

Prophylactic : tricyclics (i.e. - amitriptyline at low dose,

41
Q

smoking is greatest RF in what type of HA

A

cluster

42
Q

Calcitonin Gene Related Peptide (CGRP) is assoc w/ what type of HA

A

migriane

43
Q

Headache is Severe, unilateral throbbing

  • Worse w/ activity
  • Nausea
  • Photophobia
A

migraine

44
Q

Physical activity does not worsen pain of ____ HA

Physical activity worsens pain of ___ HA

A

Physical activity does not worsen pain of tension HA

Physical activity worsens pain of migraine HA

45
Q

HA described as the worst pain you will ever experience in your life

“hot poker in eye”

A

cluster - retrobulbar pain

46
Q

HA in ; band-like in distribution around head

A

tension

47
Q

Acute Tx of migraine

specific

nonspecific

A

Nonspecific Treatments: ↓ pain through general pain pathways

  • Acetaminophen, NSAIDs
  • Anti-emetics (dopamine blockers)
  • Opioid/barbiturates
  • Muscle relaxants

Specific Treatments: ↓ pain through direct actions on the trigeminovascular system, including 5HT1B/D/F receptors:

  • Triptans -
  • Dihydroergotamine (DHE)
  • Ergotamines
48
Q

migraine tx alt to triptans

A

Selective Serotonin 1F agonists

  • Reyvow (lasmitidan)
  • Non-vasoconstrictive

Small molecule CGRP antagonists (-gepants)

  • Ubrelvy (ubrogepant)
  • Nurtec (rimegepant)
49
Q

Acute Treatment of migraine in the ED Setting

A
  • Diphenhydramine IV
  • Anti-emetic IV (Zofran, Reglan, or Compazine)
  • Ketorolac IV
  • Can consider i_njectable sumatriptan_
  • Magnesium sulfate
  • Solu-medrol/dexamethasone/steroids IV
  • Consider DHE IV
  • Valproate IV
  • Last resort – opioids
50
Q

Preventive Treatment of migraine

A

Divalproex (Depakote) - CAUTION in women of childbearing age

Propranolol, timolol

Metoprolol is also used

Topiramate (Topamax)

Amitriptyline

CM 4 GERI & NEURO (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions