Headaches, Dementia, Truama Flashcards
What is the difference between delirium and dementia?
Delirium is acute while dementia is progressively worsening impairment of intellectual functioning
What are some causes of delirium?
Not being able to see light, medications, trauma. Most commonly seen after surgery and inpatient setting.
When is the Montreal Cognitive Assessment (MOCA) used?
To assess cognition when there is a a concern
What is the time that you ask a patient to draw on the MOCA?
10 past 11
What score is considered normal on the MOCA?
> 26 points is normal
What is a moderate cognitive score on the MOCA?
4-11
How do you work up dementia?
Blood work and imaging (CT for acute and MRI w/contrast for progressive)
Who is likely to have low thiamine levels?
Chronic alcohol drinkers
How many states of decline of cognition on mental testing is most often in Alzheimer’s Dementia?
Declines in 2 areas (on MOCA)
What are acetylcholinesterase inhibitors (Donepezil) role in treating Alzheimers dementia?
Does not cure, but delays disease progression and may improve memory
What drug class do you add to acetylcholinesterase inhibitors in the treatment of Alzheimer’s dementia?
NMDA (Memantine)
When do dementia symptoms get worse?
Sundowning (nighttime)- not processing day and nighttime
What is the pathophysiology of vascular dementia?
Lack of blood flow in small areas of the brain leading to ischemia and lacunar infarcts
What are some of the presentation characteristics in the cortical subtype of vascular dementia?
Speech difficulty
Loss of ADLS
Confusion
Amnesia
Poor executive function
What are some of the presentation characteristics in the subcortical subtype of vascular dementia?
Motor deficit
Gait changes
Urinary incontinence
Personality changes
How are you going to treat vascular dementia?
Treat underlying hyperlipidemia and hypertension. If symptoms of insomnia, depression or agitation are present treat as well.
What type of neurological/psychological symptom can lewy body dementia cause?
Hallucinations
Does dopamine medication help with lewy body dementia symptoms (hallucinations, anxiety, delusions)?
No, need to prescribe a cholinesterase
What are symptoms of frontotemporal dementia?
Euphoria, apathy, disinhibition and compulsions (hypersexual)
What is the treatment for frontotemporal dementia?
No curative treatment
What usually causes pseudodementia?
depression or anxiety
What is the treatment for pseudodementia?
SSRI’s and counseling
What are some of the medications used to treat hallucinations/agitation in dementia?
Zyprexa
Seroquel
Risperdal
What are some of the medications used to treat weight loss or lack of appetite in dementia?
Antipsychotics
Cyproheptadine (anti-histamine)
Remeron
What is always the first assessment in a head trauma?
ABCDE
What is priapism and why is this concerning in head trauma?
An erection, abnormal response to head trauma
What is the top score on the Glasgow Coma Scale?
15
What is a score for a comatose patient on the Glasgow Coma Scale?
8 or less
What is a score for someone who is totally unresponsive on the Glasgow Coma Scale?
3 (No response on eye response, verbal response, and motor response)
What is a dead person’s score on the Glasgow Coma Scale?
3
Do you order a head CT with or without contrast in a head trauma?
Without contrast
What is vomiting indicative of in a head trauma?
Brain bleed
What are the reasons you are getting a head CT in a children over the age of 2?
GCS < 15
Signs of Basilar Skull Fracture
AMS (agitation, somnolence, slow response, repetitive questions)
What are the reasons to initiate shared decision making (observation vs. CT) in a head trauma in a child over 2 years?
Vomiting
LOC
Severe HA
Severe MOI (fall > 5 ft)
What are the reasons you are getting a head CT in a child less than 2 years in a head trauma?
GCS < 15
Palpable skull fracture
AMS (agitation, smnolence, slow response, repetitive questioning)
What are the reasons to initiate shared decision making (observation vs. CT) in a head trauma in a child under 2 years of age?
Scalp hematoma (excluding frontal)
LOC > 5 seconds
Not acting normal per parent
Severe MOI (fall > 3 ft)
What are the symptoms of subarachnoid hemorrhage?
Sudden “thunderclap” headache, usually unilateral, nausea, vomiting
What are some of the meningeal signs of subarachnoid hemorrhage?
Photophobia, confusion, neck stiffness
What are the treatments for subarachnoid hemorrhage?
Admit to hospital for observation, stool softeners (phenytoin), and BP control (Nimodipine)
What is mass effect?
Something is pressing one side of the brain to the other
If you have a patient with a epidural hematoma what is the most common blood vessel that was damaged?
Middle meningeal artery
What is the cause of subdural hematoma?
Venous bleeding between dura and arachnoid from torn bridging veins
What symptoms should not be seen in a concussion?
Pupil size change, strength changes, hemiparesis, or visual field deficit
What should be the GCS on a patient with a standalone concussion?
13-15
What is the recommend period of complete rest after a concussion?
24-48 hours (this does not mean return to sports)
How long should a patient use an NSAID for headache symptoms after a concussion?
Only the first few days, after should not use because there is a risk for rebound HA
What is the treatment for prolonged headaches in concussion?
PT
What are the “red flags” descriptions of headaches?
Thunderclap headache
Worst headache of life
Trauma
Anticoagulation use
Decreased level of consciousness
Suspicion of meningitis
What defines a migraine headache?
Unilateral headache with pulsating/throbbing moderate severe pain
What is an aura?
Visual disturbance such as seeing lines, dots, blurring or loss of peripheral vision lasting several minutes
When can you not prescribe birth control in patients with migraine?
Patients with a diagnosis of Migraine with Aura
What do you use for treatment in moderate to severe migraine flares?
Triptan medications (Sumatriptan)
In an emergent situation of migraine, what can you give to prevent recurrence?
Dexamethasone IV
What treatment are used for migraine prophylaxis?
Antihypertensives (Propranolol)
Antidepressant (Amitriptyline)
Anticonvulsants (Topiramate or Gabapentin)
CGRP antagonists (Rimegepant or Amimovig)
What drug class targets the trigeminal nerve in migraine prophylaxis?
CGRP antagonists, a newer drug class of medications
What is the treatment for cluster headaches?
100% O2 is first line
What is the presentation of a cluster headache?
Severe, unilateral periorbital pain (can have congestion, conjunctival injection) and not improved by rest, patient will be pacing
What can an exertional headache secondary to?
Malignancy, intracranial hemorrhage, or aneurysm (need to order an MRI)
