Headaches, Dementia, Truama Flashcards by Heather White

What is the difference between delirium and dementia?

Delirium is acute while dementia is progressively worsening impairment of intellectual functioning

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What are some causes of delirium?

Not being able to see light, medications, trauma. Most commonly seen after surgery and inpatient setting.

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When is the Montreal Cognitive Assessment (MOCA) used?

To assess cognition when there is a a concern

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What is the time that you ask a patient to draw on the MOCA?

10 past 11

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What score is considered normal on the MOCA?

> 26 points is normal

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What is a moderate cognitive score on the MOCA?

4-11

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How do you work up dementia?

Blood work and imaging (CT for acute and MRI w/contrast for progressive)

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Who is likely to have low thiamine levels?

Chronic alcohol drinkers

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How many states of decline of cognition on mental testing is most often in Alzheimer’s Dementia?

Declines in 2 areas (on MOCA)

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What are acetylcholinesterase inhibitors (Donepezil) role in treating Alzheimers dementia?

Does not cure, but delays disease progression and may improve memory

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What drug class do you add to acetylcholinesterase inhibitors in the treatment of Alzheimer’s dementia?

NMDA (Memantine)

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When do dementia symptoms get worse?

Sundowning (nighttime)- not processing day and nighttime

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What is the pathophysiology of vascular dementia?

Lack of blood flow in small areas of the brain leading to ischemia and lacunar infarcts

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What are some of the presentation characteristics in the cortical subtype of vascular dementia?

Speech difficulty
Loss of ADLS
Confusion
Amnesia
Poor executive function

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What are some of the presentation characteristics in the subcortical subtype of vascular dementia?

Motor deficit
Gait changes
Urinary incontinence
Personality changes

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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.

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What type of neurological/psychological symptom can lewy body dementia cause?

Hallucinations

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Does dopamine medication help with lewy body dementia symptoms (hallucinations, anxiety, delusions)?

No, need to prescribe a cholinesterase

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What are symptoms of frontotemporal dementia?

Euphoria, apathy, disinhibition and compulsions (hypersexual)

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What is the treatment for frontotemporal dementia?

No curative treatment

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What usually causes pseudodementia?

depression or anxiety

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What is the treatment for pseudodementia?

SSRI’s and counseling

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What are some of the medications used to treat hallucinations/agitation in dementia?

Zyprexa
Seroquel
Risperdal

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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?

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?

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?

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)