Head Trauma, Seizures, HA, Vertigo Flashcards
1
Q
what population is TBIs most common in?
A
75+
2
Q
what is the most common cause of TBI?
A
falls
3
Q
what are the scores of eye opening on the GCS?
A
4 spontaneous
3 to speech
2 to pain
1 none
4
Q
what are the scores of verbal response on the GCS?
A
5 oriented
4 confused
3 inappropriate words
2 incomprehensible words
1 none
5
Q
what are the scores of best motor response on the GCS?
A
6 obeys
5 localizes
4 withdraws
3 abnormal flexion (decorticate)
2 abnormal extension (decerebrate)
1 none
6
Q
GCS of ____ is a mild TBI
A
13-15
7
Q
most TBI cases (TBI) are what severity?
A
mild
8
Q
GCS of ____ is a moderate TBI
A
9-12
9
Q
T/F: imaging can be normal in mild and moderate TBIs
A
T
10
Q
GCS of ____ is a severe TBI
A
3-8
11
Q
what is the coup?
A
primary impact on the skull
12
Q
what is the countercoup?
A
secondary impact on the skull
13
Q
where is the most common area for a brain contusion?
A
frontal lobe
14
Q
brain contusions occur near the ____
A
skull
15
Q
what occurs during the first phase of TBI?
A
direct consequences of trauma
DAI (sheared axons)
16
Q
what occurs during the second phase of TBI?
A
begins quickly after primary
hypoxia and hypoperfusion
inflammation
17
Q
what principle relates to volume of the brain, especially during swelling?
A
Monroe Kellie Doctrine
18
Q
what is common symptom of uncal herniation?
A
CN 3 palsy
19
Q
where is the brain injury?
pupils small and reactive
A
diencephalic
drugs, metabolic encephalopathy
20
Q
where is the brain injury?
pupils large, fixed, hippus
A
pretectal
21
Q
where is the brain injury?
pupil dilated, fixed
A
uncus or midbrain
CN III
22
Q
where is the brain injury?
pupils mispositioned, fixed
A
midbrain
23
Q
where is the brain injury?
pupils pinpoint
A
pons
24
Q
decerebrate posturing indicates damage to the _____
A
brain stem
25
decorticate posturing indicates damage to the _______
corticospinal tract
26
a subdural hematoma usually follows a ____ injury
low-velocity
27
which hematoma is more dangerous epi or sub dural?
epidural
28
epidural hematomas consists of bleeding from ______, torn by a ______
meningeal artery or vein
temporal or parietal fracture
29
epidural hematomas have a ____-shaped clot
lens
30
which type of hematoma has a lucid interval?
epidural
31
what is the sequelae of head injury?
hydrocephalus
CSF leak
subarachnoid hemorrhage
vascular injury
infection
32
what are the hallmarks of a concussion?
confusion and amnesia
33
concussion lasts up to
post concussion syndrome lasts
concussion - 1 month
post concussion - months to years
34
what sport has the highest risk of concussion in boys? girls?
boys - football
girls - soccer
35
indications for a CT and emergency management of a concussion?
GCS <15
deteriorating mental status
potential spinal injury
progressive, worsening of sx or new neuro signs
36
post concussive syndrome occurs when sx last longer than
1 month
37
chronic traumatic encephalopathy is a spectrum of disorders associated with long term consequences of a single or REPETATIVE _____
TBIs
38
what is the earliest manifestation of chronic traumatic encephalopathy?
behavioral changes
39
motor involvement sx of chronic traumatic encephalopathy
dysarthria
spasticity
motor neuron disease
Parkinsonism
ataxia
40
when should you call 911 for a seizure?
if it lasts > 5 mins
41
what is the most common cause of a new onset seizure over 50?
stroke
42
epilepsy diagnostic criteria
2 or more unprovoked seizures separated in time by greater than 24 hours
OR
single seizure with high risk of another
43
seizure definition
episode of transient behavioral, sensory, motor, visual symptom, associated with abnormal excessive cortical activity in the brain
44
what is the most common cause of epilepsy worldwide?
infection
45
symptoms of focal onset seizure w/o loss of awareness (simple partial seizures)
begins on one side of body
DOES NOT IMPAIR CONSCIOUSNESS
motor: clonic or tonic
sensory: parastheias, visual hallucination
EEG with CONTRA focal discharge
46
sx of frontal lobe seizures
clusters at night
brief
early posturing
autonomic sx
large amplitude, irregular, complex mvmt
47
what type of seizure is most common in children?
absence seizures
48
T/F: Absent seizures have a loss in muscle tone
F!!
49
ictal EEG shows ___ discharges for generalized tonic-clonic seizures
bilateral
50
generalized tonic-clonic seizures have ___ muscle tone and __ movements
rigid muscle tone - tonic phase
convulsive movements - clonic
51
presentation of myoclonic seizures
single brief jerks
involve any or all limbs or torso
occur w/ other generalized seizures
EEG spikes and waves
52
atonic seizures presentation
head drop
fall backwards
53
most febrile seizure occur between what ages?
6mo - 3 years
54
sx of nonepileptic seizures
gradual onset
prolonged duration
thrashing, struggling, crying, thrust
motor activity starts and stops
B jerking with retain consciousness
55
T/F: it is impossible to have bilateral jerking with no LOC during an epileptic event
T
56
____% of epilepsy pts will have a normal initial EEG
40%
57
status epilepticus is generalized seizure activity last
> 5 mins
58
what is a major concern with anti-epileptic drugs side effects?
black box warning: suicidality
59
what are some common anti-epileptic drugs?
valproic acid
phenytoin
topiramate
carbamazepine
levetiracetam (most common)
60
what are primary headaches?
migraines
tension HA
cluster HA
61
secondary HA causes
brain tumor
increased ICP
meningitis
encephalitis
aneurysm
HTN
62
>90% of HA are
primary
63
what are the red flags for HA?
SSNOOP4:
Systemic sxs
Secondary disease
Neurologic sxs
Onset - suddent, abrupt
Older - new onset after 50
Previous HA hx - different than normal
Positional
Papilledema
Precipitants - cough, Valsalva
64
Migraine criteria
>5 HAs
4-72 hrs
2/4:
- throbbing, unilateral, mod-sev, worse
with activity
1/2:
- N/V, photophobia/phonophobia
65
what is a classic aura of a migraine?
positive scintillating scotomata with fortification spectra
66
what meds are given for migraines >3 days?
acute absortive
67
what meds are given for migraines >5 days?
prophylaxis
(take everyday)
68
what type of HA is worse in the AM?
analgesic rebound/withdrawal HA
69
tx for analgesic rebound/withdrawal HA
stop all acute meds and caffeine
start prophylaxis
70
cluster HA sx
severe unilateral orbital, supraorbital, or temporal pain lasting 15-180 mins
71
tension HA sx
bitemporal, bioccipital, or bifrontal
"tight band"
perceived as continuous months-years
72
what med is useful for chronic daily HAs (tension)?
tricyclics
73
trigeminal neuralgia in young patients may be due to _____ or _____
MS or brainstem mass
74
meds for trigeminal neuralgia
carbamazepine
oxcarbamazepine
75
what is vertigo?
sensation that you are moving, spinning
76
what is opscillopsia?
the sensation that the world is moving
77
what is the most common cause of recurrent vertigo?
Benign Paroxysmal Positional Vertigo
(BPPV)
78
BPPV sx
episodic vertigo lasting 10-30 sec
triggered by: tilt head, rolling over, straightening after bending
79
~85% of BPPV is due to involvement of the ___ canal
posterior
80
what is used to diagnose BPPV?
Dix-Hallpike
81
what is used to treat BPPV?
Epley maneuver
82
what is a sudden onset of prolonged vertigo that is constant, lasting days?
peripheral vestibulopathy:
viral labyrinthitis & vestibular neuritis
83
Meniere's disease sx
episodic severe vertigo and vomiting
lasts minutes to hours
feeling of fullness in ear
tinnitus
hearing loss, often progressive
84
vertigo due to posterior fossa mass or infarction will have limb ataxia ____ to the lesion
ipsilateral
85
brainstem signs of vertigo
diplopia
cortical blindness
dysarthria, dysphagia
quadriparesis
tinnitus
hearing loss
86
how does nystagmus present in vertigo due to brainstem lesions?
long duration
not fatigable
87
what is the most common chronic vestibular condition?
persistent postural-perceptual dizziness
88
med for persistent postural-perceptual dizziness
SSRIs
89
what meds can be a short term treatment for vertigo?
antihistamines
