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neurology > headaches/parkinsons > Flashcards

headaches/parkinsons Flashcards

1
Q

symptoms that can occur with cluster headaches

A 
Along with the headaches
Runny nose
Watery eyes
Drooping eyelid
Blushing
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2
Q

Acute attack tx for cluster HA

avoid what

A

Oxygen!!!
Triptans(IV)
Opioids are just as likely to make things worse

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3
Q

Cluster HA Preventive therapy

A

Calcium channel blockers – Verapamil
Steroids may be used in the first few days.
Lithium

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4
Q

migraine

  • describe HA
  • what occurs in 30% of pts
A

Typically unilateral headache of moderately severe pulsating pain.
Auro occurs in about 30% of patients
Classic migraine = aura
Common migraine = no auro

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5
Q

migraine

  • duration
  • FH?
  • age
A

Usually lasts between 2 and 72 hours
There is often a family history of migraines
Before puberty more boys than girls. After puberty more women than men.

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6
Q

other diseases migraines are associated with

A

seizures, essential tremor, tourette syndrome, depression, anxiety, stroke

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7
Q

aura

  • describe
  • duration
  • location
A

visual changes, field cuts, flashing lights
lasts several minutes to less than 1 hr
throbbing pain is contralateral to aura

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8
Q

Recurrent severe headaches
They become worse if I move at all
Nausea/vomiting
Sensitivity to light and sound

A

migraine

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9
Q

pathophysiology of migraines

A

attributed to intracranial vasospasm followed by extracranial vasodilatation

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10
Q

Prophylactic treatment of migraines

A

Beta blockers – metoprolol, propranolol
Calcium Channel blockers – verapamil
ACE inhibitors
Tricyclic antidepressants

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11
Q

Most common type of headache

A

Most common type of headache making up about 90% of all headaches: Tension

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12
Q 
Causes include
Stress
Lack of sleep
Hunger
Minor head and neck trauma
A

tension HA

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13
Q

Constant pain like my head is in a vice

A

tension HA

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14
Q

tension HA tx

A

Analgesics

first line: NSAIDs and Acetaminophen

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15
Q

Unilateral headache with a runny nose that occurs at 1:30 everyday for the past week?

A

Cluster headache

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16
Q

Oxygen therapy is used in the acute setting of which headache?

A

Cluster headache

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17
Q

Which type of headache is associated with an aura?

A

Migraine

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18
Q

severe, unilateral, periorbital HA that lasts 30-90 minutes and occur several times a day over a period of weeks to months

A

cluster

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19
Q

typical pt with cluster HA

A

middle aged man, often without a FH of migraine and HA

20
Q

cluster HA has a ___ etiology and evidence of serotonergic mechanism

A

vascular

21
Q

pt presentation with a cluster HA that is atypical compared to the usual HA

A

often pace incessantly around the room because pain is severe and not relieved by rest

22
Q

Often called familial tremor because it may follow an autosomal dominant pattern.
Most common movement disorder

A

essential tremor

23
Q

Uncontrollable rhythmic movement typically involving the hands, tongue or head.
The tremor may occur at rest, but is more commonly seen when the patient attempts to use the affected muscles.

A

essential tremor

24
Q

essential tremor gets worse with what

A

The tremors get worse with fatigue, stress, caffeine as well as many other triggers.

25
Q

essential tremor tx

A

Avoidance of fatigue, stress, caffeine etc
First line medical treatment is with Beta blockers
propranolol/ use primidone if BB fails
Second line include anti epileptics
topiramate
gabapentin
Second line also includes benzodiazepines
alprazolam
Patients may self medicate with alcohol as is it provides dramatic relief.

26
Q

essential tremor

  • cause
  • inherited?
  • age
  • enhanced with what
  • disability
A 
unknown cause
often inherited in an autosomal dominant manner
any age
enhanced by emotional stress
minimal disability
27
Q

essential tremor

  • affects what extremities
  • speech
A

usually upper extremities

speech can be affected if laryngeal muscles involved

28
Q

Degenerative disorder of the central nervous system

describe disease

A

Parkinsons
There is an imbalance between acetylcholine and dopamine due to the death of cells in the substantia nigra which normally produce dopamine

29
Q

Parkinsons
age
depression and cognitive impairment

A

45-65

50%

30
Q 
Resting or pill rolling tremor
Bradykinesia
Rigidity – Lead-pipe or cogwheel
Postural Instability
Festination (rapid shuffling gait)
Difficulty getting up from a chair, difficulty with stairs
A

Parkinsons Motor function
Resting or pill rolling tremor – begins in one limb or on one side but will spread
Bradykinesia (slow movements) – reduced arm swing, mask like facies, infrequent blinking
Rigidity – Lead-pipe or cogwheel
Postural Instability
Festination (rapid shuffling gait)
Difficulty getting up from a chair, difficulty with stairs

31
Q 
Psychiatric
Loss of executive function
problem solving
planning
Inhibition of inappropriate actions
Speech disorders
Behavior and mood alterations
Depression
Anxiety
Dementia
A

Parkinsons

32
Q 
Autonomic Nervous System
Urinary Incontinence
Orthostatic Hypotension
Excessive sweating
Constipation or gastric motility
Eye and vision abnormalities
A

Parkinsons

33
Q 
Neuropsychiatric
Loss of executive function
problem solving
planning
Inhibition of inappropriate actions
A

Parkinsons

34
Q

CT or MRI in Parkinson’s

A

CT or MRI are normal in Parkinson’s, but used to rule out other causes of neurologic symptoms

35
Q

Lewy Bodies may be seen on an autopsy of the brain in…

A

Parkinson’s disease
Dementia with Lewy bodies
Multiple system atrophy
Alzheimer’s disease

36
Q

Medications goal in parkinsons

A

Medications (you can either increase dopamine or decrease acetylcholine)

37
Q

most helpful with mild motor symptoms in parkinsons

A

Anticholinergics
Amantadine
Benztropine

38
Q

the number one medication for Parkinson’s disease

A

Levodopa

39
Q

Levodopa MOA and SE

A

Mechanism of action
Levodopa is converted to to dopamine within the body and results in decrease the motor symptoms of Parkinson’s disease.
Side effects
No more than 10% of Levodopa crosses the blood brain barrier
Nausea
Dyskinesia (tics and chorea) Need to reach a balance between rigidity, bradykinesia and dyskinesia

40
Q

Peripheral dopa decarboxylase inhibitors

A

slow the process of levodopa → dopamine outside of the brain
Carbidopa
Benserazide

41
Q

Catechol-O-methyltransferase inhibitor (COMT inhibitors)

Tolcapone

A

– COMT breaks down dopamine

42
Q

Bromocriptine

Pergolide

A

Dopamine agonists work on dopamine receptors

43
Q

MAO-B inhibitors
Selegiline
Rasagiline

A

These block the metabolism of dopamine thereby increasing the concentration in the basal ganglia.
may arrest the progression of the disease

44
Q

Parkinson’s surgical tx

Deep Brain Stimulation
Ablative brain surgery
Pallidotomy

A

Deep Brain Stimulation – involves the implantation of a brain pacemaker, which sends electrical impulses to specific parts of the brain.
Ablative brain surgery
Pallidotomy – A small probe is place into the globus pallidus and then heated to almost 200 degrees.

45
Q

The term pill rolling tremor should make you think of what diagnosis?

A

Parkinson’s

46
Q

Cell death in what area of the brain results in parkinsonism?

A

The substantia nigra

47
Q

rule out what with tension HA in pts over 50 y/o

A

giant cell arteritis, get ESR

neurology (9 decks)

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