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Neuromuscular > Head Trauma, Seizures, Headache, Vertigo > Flashcards

Head Trauma, Seizures, Headache, Vertigo Flashcards

1
Q

Traumatic Brain Injury

A

Causes:
-falls
-Struck (children)
-Other (self harm 25-64)
-Cars

Kinds:
-Mild, Moderate, Severe

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2
Q

Mild TBI

A

-Concussion
-75% of TBI
-GCS: 13-15

Define:
-disruption of brain function via
-LOC, memory loss, altered mental status, focal defects, inattention, confusion, vacant stare
-headache, n/v, photophobia, dizziness

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3
Q

Moderate TBI

A

-GCS: 9-12

Defined:
-prolonged LOC
-Prolonged neuro defects
-requires advanced care

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4
Q

Severe TBI

A

-GCS <8

Defined:
-comatose
-significant neuro injury
-brain lesions
-airway protections, intracranial monitoring
-recovery incomplete

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5
Q

Etiology of TBI

A

Penetrating: skull and meninges breached
-mod to severe TBI

Non- Penetrating: closed head injury
-soft tissue forced into skull
-Coup: where the injury is
-Countercoup: where brain meets skull on opposite, can be more severe

Brain Contusion:
-bruise of brain
First Phase: direct consequence, diffuse axonal injury
Second Phase: quickly after primary, hypoxia and hypofusion and inflammation

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6
Q

Monroe Kellie Doctrine

A

-only so much sppace in head with solid and liquids
-if changes in mmt happen, things will be displaced

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7
Q

Uncal Herniation

A

-CN 3 palsy
-fixed and dilated pupils
-impaired consciousness
-PCA infarct
-hemiparesis
-uncal/hippocampus level herniation into BS

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8
Q

Central Herniation

A

-middle of brain comes down

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9
Q

Cingulate/Subfalcine Herniation

A

-cingulatet goes across falx cerebri and contra hemisphere
-ACA pressure
-increased ICP

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10
Q

Transcalvarial Herniation

A

-out of skull due to fracture

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11
Q

Tonsillar Herniation

A

-through foramen magnum
-cerebellar tonsils
-compress 4th ventricle and medulla
-stiff neck to decerebrate posturing

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12
Q

Head Injury Initial Assessment

A

-Secure airway
-Neuro assessment
-Imaging
-Further testing

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13
Q

Localizing Signs of Head Injury

A

-Anisocoria (pupil size diff)
-Diploia
-Absence of gag
-Abnormal breathing

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14
Q

Small and Reactive Pupils

A

-diencephalic
-drugs, metabolic encaphalopathy

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15
Q

Large and Fixed Pupils

A

-Prectal
-not reactive

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16
Q

Uneven, 1 dilated and Fixed

A

-Occulomotor
-Uncal

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17
Q

Mid position and Fixed Pupils

A

-midbrain

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18
Q

Pinpoint Pupils

A

-pons

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19
Q

Decerebrate

A

-extension
-upper brainstem

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20
Q

Decorticate

A

-flexion
-corticospinal tracts

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21
Q

Subdural Hematoma/Hemorrhage

A

-Bleeding btwm arachnoid and dura
-low velocity injury
Acute: 24-48 injury
Chronic: 14 days to months

Imaging: almost entire hemisphere, concave

Treat: surgical evacuation

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22
Q

Epidural Hematoma/Hemorrhage

A

-bleeding from meningeal artery/vein by skull fracture
-has a lucid interval

Imaging: lens shaped, isolated to one corner of brain

Treat: without evacuation, leads to herniation, death 15-45%

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23
Q

Subarachnoid Hemorrhage

A

-bleeding in subarachnoid space
-aneurysm

S/s: worst headache of life, meningeal irritation

Imaging: crescent shaped, along whole hemisphere

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24
Q

Intracerebral Hemorrhage

A

-small vessel
-bleeding in brain

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25
Post Concussion Syndrome
-s/s persisting after 1 month -headache, fatigue, dizziness, concentration, sleep, anxiety -delayed onset of seizures 10-40%
26
Concussion Protocol
-CT not used to diagnose, must exclude more severe brain injury -wait unti asymptomatic
27
Chronic Traumatic Encephalopathy
-CTE -spectrum of disorders associated with long term consequences of TBI Clinical Presentation: -Behavior changes -Cognitive impairment -Motor
28
Seizures Safety Concerns
-lay on side to prevent asperation -protect from injury -dont put anything in mouth -time it -describe event
29
Seizure
-single provoked/unprovoked -transient behavior, sensory, motor, visual s/s -8-10% of pop Classification: -focal vs generalized -Level of awareness -other features
30
Epilepsy
-2+ unprovoked episodes separate by more than 24h -or single seizure with heightend risk of future -must be diagnosed -40% have normal initial EEG Causes: -genetics -Structural (lesion) -Metabolic -Infectious (MC; HIV, malaria, zika, neurocysticercosis parasite) -immune Treatment: -drugs
31
Simple Partial Seizures
-focal onset seizure without loss of awareness/consciousness -begins on one side of the body, contra brain -clonic or tonic -paresthesias and hallucinations -same thing each time
32
Complex Parital Seizures
-focal onset seizure with loss of awareness -auditory and visual hallucinations -psychomotor phenomena (chewing, biting, liking lips, dysphagia)
33
Temporal Lobe Seizures
-most common -consiousness varried, short duration -may have childhood seizures -followed by post ictal confusion and fatigue Sensory Aura: smell, taste, hallucinations Experiential Aura: psychic feeling, deja vu, panic Autonomic Aura: flushing, nausea, pallor Aphasia
34
Frontal Lobe Seizures
-often clusters at night -May have aura "jacksonian march": mmt of paresthesia -early posturing or clonic activity -large amplitude mmt -autonomic features -breif post ictal phase
35
Absense Seizures
-sudden unresponsiveness lasting seconds -no loss of muscle tone or post ictal -MC in children
36
Generalized Tonic-Clonic Seizures
-sudden LOC with rigid muscle tone (phase 1) -rhythmic and convulsive moments (clonic) (phase 2) -post ictal can last mins to hours (Post ictal stupor) -Ictal EEG shows bilat (cannot be bilat and maintain consciousness)
37
Myoclonic Seizures
-single brief jerks -may involve luimbs and torso -not all myoclonus is a seizure
38
Atonic Seizures
-head drop and fall forward -lose tone
39
Febrile Seizures
-2-5% of children -6m to 3yrs -GTC lastting a few mins -good prognosis -do not need medications
40
Non-Epileptic Events
-gradual onset of seizure -porlonged -thrashing -motor that sttops and starts -arrhythmic jerking -retained consciousness
41
Syncope
-light ehaded ness, sweating -grey vision -rapid recovery -incontinence
42
Status Epilepticus
-generalized seizure activity last >5min -GTC -risk increases with time
43
Epilepsy Drugs Side Effects
-black box warning -OA General: sleep, nausea, ataxia, nystagmus, confusion Valporic Acid: weight gain, tremor Phenytoin: gum hyperplasia, ataxia, rash Topiramate: kidney stones, cognitive, weight loss Carbamasepine: dizziness, n/v Levetiracetam: behavioral changes Gabapentin: weight gain, behavior, GI, fatigue
44
Headaches
-95% of adults -MC ER visit -caused by things pressing/affecting on stuff Primary (MC): migraine, tension, cluster Secondary: tumor, hydrocephalus, meningitis, anwueysm, HTN, hemorrhage
45
Migraine
-18% women, 6% men -25% in first decade -Aura: 10% of migranes -Non-Aura Migraines: 90% Criteria: ->5 -4-72hrs -2/4: Throbbing, unilateral, mod to severe, worse with activity -1/2: N/v or Photophobia/phonophobia Treatment: -Lifestyle changes -Quick meds -Preventative drugs (prophylaxis) -Botox
46
SSNOOP4
-Headache red flags -Systemic s/s -Secondary disease: HIV, cancer -Neurologic s/s -Onset -Older -Previous Hx -Positional -Papilledema -Precipitants: cough, valsalva
47
Withdrawl Headaches
-very common -worse in AM Treatment: -withdraw drugs and start prophylaxis
48
Cluster Headaches
-not common -severe oribital/temporal pain lasting 15min-3 hours Signs: -ipsi signs of (congestion, eyelid edema, sweating, flushing, miosis/ptosis
49
Tension Headache
-tight band of pain around head Treatment: -relaxation -NSAIDS -Muscle relaxants
50
Trigeminal Neuralgia
-jabs of pain in V2 and V3 (V1 <5%) -spontaneous or triggered -mid to late life -if young, consider MS or BS mass Treatment: -microvascular decompression of gangia -carbamazepine
51
Vertigo
-sensation of yourself moving -central or peripheral (characteristics, timing, provocation) Central: vestib portion of CNVIII Peripheral: peripheral end organs, utricle, saccule, semicircular canals Treatment: -treat n/v -antihistamines (short term) -vestib rehab and adaptation -repositions methods
52
Opscillopsia
-sensation of the world moving
53
Differential Diagnosis of Vertigo Attacks
-peripheral vestiubulopathy -BPPV -menieres -vertebrobasilar ischemia
54
Differential Diagnosis of Chronic Vertigo
-peripheral vestiubulopathy -tumor -MS -BS infarct
55
BPPV
-Benign Paroxysmal Positional Vertical -MC cause of recurrent -10-30s, triggerd by moveing, rolling, tilting head -85% involved in posterior semicircular canal Treatment: -Dix hallpike
56
Peripheral Vestibulopathy
-Viral labyrinthitis and vestibular neuritis -no neuro signs -younger ppl S/S: -sudden onset that is constant -hearing loss, n/v, tinnitus
57
Meniere's Disease
-episodic vertigo and vom for mins to hour S/s -feeling of fullness in ear and tinnitus -heaing loss -progressive
58
Vertigo: Posterior Fossa Mass/Infarction
-acute (infarction) or progressive (mass) S/s -limb ataxia ipsi to lesion -BS signs -LOC, n/v
59
Vertigo: BS Ischemia
-BS signs (speech, vision, hearing- -long term, non fatiguable nystagmus
60
Vestibular Migraine
->5 episodes -migraine hx -vestib s/s
61
Perisitent Postural Perceptual Dizziness
-MC chronic vestib condition -normal exam S/s: -non room spinning dizziness -persistent over 90 days for hours -caused impairment (not explained by another Dx)

Neuromuscular (36 decks)

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