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Neuro MSK > Head Trauma, Seizures, HA, Vertigo > Flashcards

Head Trauma, Seizures, HA, Vertigo Flashcards

1
Q

what population is TBIs most common in?

A

75+

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2
Q

what is the most common cause of TBI?

A

falls

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3
Q

what are the scores of eye opening on the GCS?

A

4 spontaneous
3 to speech
2 to pain
1 none

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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

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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

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6
Q

GCS of ____ is a mild TBI

A

13-15

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7
Q

most TBI cases (TBI) are what severity?

A

mild

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8
Q

GCS of ____ is a moderate TBI

A

9-12

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9
Q

T/F: imaging can be normal in mild and moderate TBIs

A

T

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10
Q

GCS of ____ is a severe TBI

A

3-8

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11
Q

what is the coup?

A

primary impact on the skull

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12
Q

what is the countercoup?

A

secondary impact on the skull

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13
Q

where is the most common area for a brain contusion?

A

frontal lobe

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14
Q

brain contusions occur near the ____

A

skull

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15
Q

what occurs during the first phase of TBI?

A

direct consequences of trauma
DAI (sheared axons)

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16
Q

what occurs during the second phase of TBI?

A

begins quickly after primary
hypoxia and hypoperfusion
inflammation

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17
Q

what principle relates to volume of the brain, especially during swelling?

A

Monroe Kellie Doctrine

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18
Q

what is common symptom of uncal herniation?

A

CN 3 palsy

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19
Q

where is the brain injury?
pupils small and reactive

A

diencephalic
drugs, metabolic encephalopathy

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20
Q

where is the brain injury?
pupils large, fixed, hippus

A

pretectal

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21
Q

where is the brain injury?
pupil dilated, fixed

A

uncus or midbrain
CN III

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22
Q

where is the brain injury?
pupils mispositioned, fixed

A

midbrain

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23
Q

where is the brain injury?
pupils pinpoint

A

pons

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24
Q

decerebrate posturing indicates damage to the _____

A

brain stem

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25
Q

decorticate posturing indicates damage to the _______

A

corticospinal tract

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26
Q

a subdural hematoma usually follows a ____ injury

A

low-velocity

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27
Q

which hematoma is more dangerous epi or sub dural?

A

epidural

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28
Q

epidural hematomas consists of bleeding from ______, torn by a ______

A

meningeal artery or vein
temporal or parietal fracture

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29
Q

epidural hematomas have a ____-shaped clot

A

lens

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30
Q

which type of hematoma has a lucid interval?

A

epidural

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31
Q

what is the sequelae of head injury?

A

hydrocephalus
CSF leak
subarachnoid hemorrhage
vascular injury
infection

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32
Q

what are the hallmarks of a concussion?

A

confusion and amnesia

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33
Q

concussion lasts up to
post concussion syndrome lasts

A

concussion - 1 month
post concussion - months to years

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34
Q

what sport has the highest risk of concussion in boys? girls?

A

boys - football
girls - soccer

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35
Q

indications for a CT and emergency management of a concussion?

A

GCS <15
deteriorating mental status
potential spinal injury
progressive, worsening of sx or new neuro signs

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36
Q

post concussive syndrome occurs when sx last longer than

A

1 month

37
Q

chronic traumatic encephalopathy is a spectrum of disorders associated with long term consequences of a single or REPETATIVE _____

A

TBIs

38
Q

what is the earliest manifestation of chronic traumatic encephalopathy?

A

behavioral changes

39
Q

motor involvement sx of chronic traumatic encephalopathy

A

dysarthria
spasticity
motor neuron disease
Parkinsonism
ataxia

40
Q

when should you call 911 for a seizure?

A

if it lasts > 5 mins

41
Q

what is the most common cause of a new onset seizure over 50?

A

stroke

42
Q

epilepsy diagnostic criteria

A

2 or more unprovoked seizures separated in time by greater than 24 hours
OR
single seizure with high risk of another

43
Q

seizure definition

A

episode of transient behavioral, sensory, motor, visual symptom, associated with abnormal excessive cortical activity in the brain

44
Q

what is the most common cause of epilepsy worldwide?

A

infection

45
Q

symptoms of focal onset seizure w/o loss of awareness (simple partial seizures)

A

begins on one side of body
DOES NOT IMPAIR CONSCIOUSNESS
motor: clonic or tonic
sensory: parastheias, visual hallucination
EEG with CONTRA focal discharge

46
Q

sx of frontal lobe seizures

A

clusters at night
brief
early posturing
autonomic sx
large amplitude, irregular, complex mvmt

47
Q

what type of seizure is most common in children?

A

absence seizures

48
Q

T/F: Absent seizures have a loss in muscle tone

A

F!!

49
Q

ictal EEG shows ___ discharges for generalized tonic-clonic seizures

A

bilateral

50
Q

generalized tonic-clonic seizures have ___ muscle tone and __ movements

A

rigid muscle tone - tonic phase
convulsive movements - clonic

51
Q

presentation of myoclonic seizures

A

single brief jerks
involve any or all limbs or torso
occur w/ other generalized seizures
EEG spikes and waves

52
Q

atonic seizures presentation

A

head drop
fall backwards

53
Q

most febrile seizure occur between what ages?

A

6mo - 3 years

54
Q

sx of nonepileptic seizures

A

gradual onset
prolonged duration
thrashing, struggling, crying, thrust
motor activity starts and stops
B jerking with retain consciousness

55
Q

T/F: it is impossible to have bilateral jerking with no LOC during an epileptic event

A

T

56
Q

____% of epilepsy pts will have a normal initial EEG

A

40%

57
Q

status epilepticus is generalized seizure activity last

A

> 5 mins

58
Q

what is a major concern with anti-epileptic drugs side effects?

A

black box warning: suicidality

59
Q

what are some common anti-epileptic drugs?

A

valproic acid
phenytoin
topiramate
carbamazepine
levetiracetam (most common)

60
Q

what are primary headaches?

A

migraines
tension HA
cluster HA

61
Q

secondary HA causes

A

brain tumor
increased ICP
meningitis
encephalitis
aneurysm
HTN

62
Q

> 90% of HA are

A

primary

63
Q

what are the red flags for HA?

A

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
Q

Migraine criteria

A

> 5 HAs
4-72 hrs
2/4:
- throbbing, unilateral, mod-sev, worse
with activity
1/2:
- N/V, photophobia/phonophobia

65
Q

what is a classic aura of a migraine?

A

positive scintillating scotomata with fortification spectra

66
Q

what meds are given for migraines >3 days?

A

acute absortive

67
Q

what meds are given for migraines >5 days?

A

prophylaxis
(take everyday)

68
Q

what type of HA is worse in the AM?

A

analgesic rebound/withdrawal HA

69
Q

tx for analgesic rebound/withdrawal HA

A

stop all acute meds and caffeine
start prophylaxis

70
Q

cluster HA sx

A

severe unilateral orbital, supraorbital, or temporal pain lasting 15-180 mins

71
Q

tension HA sx

A

bitemporal, bioccipital, or bifrontal
“tight band”
perceived as continuous months-years

72
Q

what med is useful for chronic daily HAs (tension)?

A

tricyclics

73
Q

trigeminal neuralgia in young patients may be due to _____ or _____

A

MS or brainstem mass

74
Q

meds for trigeminal neuralgia

A

carbamazepine
oxcarbamazepine

75
Q

what is vertigo?

A

sensation that you are moving, spinning

76
Q

what is opscillopsia?

A

the sensation that the world is moving

77
Q

what is the most common cause of recurrent vertigo?

A

Benign Paroxysmal Positional Vertigo
(BPPV)

78
Q

BPPV sx

A

episodic vertigo lasting 10-30 sec
triggered by: tilt head, rolling over, straightening after bending

79
Q

~85% of BPPV is due to involvement of the ___ canal

A

posterior

80
Q

what is used to diagnose BPPV?

A

Dix-Hallpike

81
Q

what is used to treat BPPV?

A

Epley maneuver

82
Q

what is a sudden onset of prolonged vertigo that is constant, lasting days?

A

peripheral vestibulopathy:
viral labyrinthitis & vestibular neuritis

83
Q

Meniere’s disease sx

A

episodic severe vertigo and vomiting
lasts minutes to hours
feeling of fullness in ear
tinnitus
hearing loss, often progressive

84
Q

vertigo due to posterior fossa mass or infarction will have limb ataxia ____ to the lesion

A

ipsilateral

85
Q

brainstem signs of vertigo

A

diplopia
cortical blindness
dysarthria, dysphagia
quadriparesis
tinnitus
hearing loss

86
Q

how does nystagmus present in vertigo due to brainstem lesions?

A

long duration
not fatigable

87
Q

what is the most common chronic vestibular condition?

A

persistent postural-perceptual dizziness

88
Q

med for persistent postural-perceptual dizziness

A

SSRIs

89
Q

what meds can be a short term treatment for vertigo?

A

antihistamines

Neuro MSK (15 decks)

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