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NMSP Exam I > Headache, Meningitis & Encephalitis (Hon) > Flashcards

Headache, Meningitis & Encephalitis (Hon) Flashcards

1
Q

Things to inquire about in a patient with a headache complaint?

A

Headache hx - onset and frequency
Pain - intensity, location, duration
Prodrome - do they know when it’s coming? aura?
Associ symptoms - n/v, photophobia/phonophobia
Behavior -paces/rocks/dark quiet room
Triggers -hormone, diet, stress, environmental or sensory stimuli
Meds - used to prevent/treat and others

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2
Q

Physical examination for a patient with a headache complaint?

A

Vitals (**BP/Pulse)
cardiac
Neuro (include ROM of C-spine)

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3
Q

What are some worrisome signs associated with a headache complaint?

A

“Worst HA” - subarachnoid hemorrhage
Onset of HA after age of 50 yrs
Atypical HA for patient
HA with fever - infection (meningitis/encephalitis)
Abrupt onset
HA worsening over time
Neurological symptoms w HA - confusion, weakness, paresthesias

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4
Q

What is the most common cause of bacterial meningitis in adults, infants and young children?

A

Streptococcus pneumoniae

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5
Q

What is the most common cause of bacterial meningitis in teenagers and young adults?

A

Nisseria meningitidis; highly contagious

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6
Q

What is the most common cause of bacterial meningitis in the elderly?

A

Listeria monoctyogenes

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7
Q

Potential complications of bacterial meningitis?

A

hearing loss, memory difficulty, learning disabilities, brain damage, hair problems, seizures, shock and death

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8
Q

What is the most common cause of viral meningitis?

A

enteroviruses, HSV, HIV, West Nile

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9
Q

What is the most common cause of fungal meningitis?

A

cryptococcal; particularly in diabetics and the immunocompromised

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10
Q

Signs and symptoms of meningitis?

A

Sudden high fever
Stiff neck
Severe headache (seems different than the normal HA)
HA w/ n/v
Confusion and seizures

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11
Q

Immediate treatment of bacterial meningitis?

A

Steroids (dexamethasone) and antibiotics; don’t delay treatment and wait for imaging and LP results!

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12
Q

CSF of bacterial meningitis?

A

Elevated pressure
Elevated WBCs (PMNs)
Elevated proteins
Decreased glucose

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13
Q

CSF of viral meningitis?

A

Normal pressure
Low WBCs (lymphocytes)
Normal to elevated proteins
Normal glucose

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14
Q

CSF of fungal meningitis?

A

Variable pressure
Variable WBCs (lymphocytes)
Elevated proteins
Low glucose
**similar to TB

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15
Q

CSF in TB meningitis?

A

Variable pressure
Variable WBCs (lymphocytes)
Elevated proteins
Low glucose
**similar to fungal

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16
Q

Common causes of infectious encephalitis?

A

majority are viruses - HSV1 or 2, HIV, West Nile, Varicella Zoster or Treponema pallidum

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17
Q

Herpes Simplex 1 encephalitis

A

HSV1 infection causing inflammation of the brain; rapidly progressive neurological illness; MRI and EEG abnormalities in the TEMPORAL lobes; treatment is acyclovir; up tp 1/4 of the patients can develop recurrent neuropsychiatric symptoms

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18
Q

Typical MRI or EEG of an HSV1 encephalitis patient?

A

focal abnormalities in the TEMPORAL lobes

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19
Q

Treatment of HSV1 encephalitis?

A

acyclovir

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20
Q

Concerning later complicated of treated and untreated HSV1 encephalitis patients

A

later development of neuropsychiatric symptoms; sometime associated with autoantibodies (NMDA) with secondary autoimmune encephalitis

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21
Q

What are two common known etiologies of autoimmune encephalitis?

A

NMDA encephalitis
LGI 1 encephalitis

22
Q

NMDA encephalitis

A

common in women; presents with 4 out of the 6 symptoms: abnormal psychiatric behavior, speech dysfunction, seizures, movement disorder, decreased level of consciousness, and autonomic dysfunction/hypoventilation; EEG will show extreme delta brush; commonly associated with presence of a teratoma; will improve with treatment (takes a long time - 1 yr)

23
Q

Typical EEG of someone with NMDA encephalitis?

A

extreme delta brush; normal finding in neonates - pathological in adults

24
Q

What is a common associated with NMDA encephalitis?

A

teratoma

25
Q

Treatment of NMDA encephalitis?

A

these patients can be treated, improvement takes a long time - typically 1 yr; high dose steroids

26
Q

LGI1 encephalitis

A

common in men; faciobrachial dystonic seizures; involves one side of the face and the arm on the same side spasms occur frequently (100s of times a day); sleep disturbance in 50% of patients; temporal lobe (hippocampal) area commonly affected; may result in permanent brain damage - memory problems; 1/3rd of patients relapse after treatment

27
Q

Common area of the brain affected in LGI1 encephalitis patients?

A

temporal lobe - hippocampal region - memory problems

28
Q

Treatment of LGI1 encephalitis patients?

A

can be treated; 1/3rd of patients relapse after treatment; high dose steroids

29
Q

If you suspect a patient to have a subarachnoid hemorrhage and the CT comes back negative, what is the next step?

A

Get a lumbar puncture (for blood); CT’s can miss 5-10% of subarachnoid hemorrhages

30
Q

Common Migraine

A

migraine w/o aura; moderate to severe; unilateral or bilateral throbbing/sharp/pressure pain aggravated by activity (interrupts daily activity); peaks between 35-40 yrs; more common in females; lasts 4 - 72 hours and typically followed by a migraine “fog”; typically seen with excessive yawning; patients typically retreat to a dark quiet room

31
Q

Classic Migraine

A

migraine w/ aura - commonly visual (can be sensory or dizziness); lasts 15-30 mins

32
Q

Chronic Migraine

A

patient with a history of consistent migraines; headache 15 or more days per month lasting 4 hours or more; lasting a period of at least 3 months

33
Q

Tension-Type Headache

A

most common type of headache; bifrontal, bioccipital, neck, shoulders, band-like; dull/achy pain; can be episodic or chronic; no aura or prodrome

34
Q

Cluster Headache

A

severe, excruciating headache UNILATERAL (typically the worst type of HA); orbitotemporal region; stops daily activity; lasts 30 mins to 2 hours; typically seen with frenetic pacing and rocking; common in men; associated with obstructive sleep apnea

35
Q

Typical prodrome and behavior of someone with a common migraine complaint?

A

excessive yawning and sluggish; patients typically retreat to a dark quiet room

36
Q

Common associated symptoms of a patient with a common migraine?

A

Nausea (90%)
Vomiting, Photophobia/Phonotobia

37
Q

What is thought to be the cause of migraines?

A

neurogenic inflammation; trigeminal activation - release of neuropeptides causing painful neurogenic inflammation effecting the dural vasculature

38
Q

What is a common association with cluster headaches?

A

obstructive sleep apnea

39
Q

When treating acute migraines with triptans, if one doesn’t work, what is the next step?

A

try another one; also consider nasal sprays and injectables

40
Q

Treatment of n/v with migraines?

A

consider an antiemetic agent

41
Q

When treating insomnia with migraines?

A

consider a sedative/hypnotic or major tranquilizer to help “sleep off” the migraine

42
Q

When do you consider preventative treatment of a migraine?

A

if patient is experiencing one or more headache per week

43
Q

BOTOX injections of preventive treatment of chronic migraines

A

the only FDA-approved treatment for chronic migraines; improvements seen after 1st treatment; multiple treatments are needed (9-12 months); have shown to be life changing in some patients; not approved for HAs so insurance won’t pay for it

44
Q

Preferred treatment for trigeminal neuralgia

A

carbamazepine or oxcarbazepine

45
Q

Trigeminal neuralgia

A

excruciating sharp, shooting, electrical quality pain along the trigeminal nerve distribution (commonly V2) that is frequent through the day

46
Q

Paroxysmal hemicrania

A

one of the Trigeminal Autonomic Cephalgias (TAC’s) characterized by unilateral trigeminal distribution pain; very similar to a cluster headache but is much shorter (lasts mins compared to 30 mins); treated with indomethacin

47
Q

Treatment of Paroxysmal hemicrania?

A

very responsive to indomethacin

48
Q

Shortlisting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT syndrome)

A

one of the Trigeminal Autonomic Cephalgias (TAC’s) characterized by unilateral trigeminal distribution pain; very similar to a cluster headache but is much shorter (few seconds compared to 30 mins); typically seen in men over 50 yrs; treated with lamotrigine

49
Q

Treatment of SUNCT syndrome?

A

very responsive to lamotrigine

50
Q

If Babinski is present, what is the plantar response?

A

extension

51
Q

If Babinski is absent, what is the plantar response?

A

flexion

NMSP Exam I (18 decks)

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