Hon--Headache, MS, Stroke, Seizures Flashcards
1
Q
Headache–associated symptoms
A
- nausea
- vomiting
- anorexia
- photophobia
- phonophobia
2
Q
headache triggers
A
- hormones
- diet
- stress
- environmental changes
- sensory stimuli
3
Q
worrisome signs (NOT benign headache)
A
- worst HA
- onset of HA after age 50
- atypical HA for patient
- fever
- progressive worsening
- drowsiness, confusion, memory impairment
- weakness, ataxia, loss of coordination
- paresthesias
- abnormal medial/neuro exam
4
Q
any patient with worrisome history or abnormal exam needs what?
A
- CT
- if nothing there–do LP! (CT can miss 10% of subarachnoid hemorrhages)
5
Q
common migraine
A
- moderate to severe
- no aura
- 35-40 years, female
- 1-4 per month
- 12-24 hours duration
- throbbing, sharp, pressure
- prodrome
- postdrome
- retreat to dark, quiet room
6
Q
classic migraine
A
- aura
- 15-30 min
- commonly visual symptoms
7
Q
tension type HA
A
- mild to moderate
- doesnt prohibit daily activities
- 20-40 years
- females
- episodic 15 days/month, all day, waxing, waning
- bifrontal, bioccipital
- dull aching
- no prodrome or aura
8
Q
cluster HA
A
- severe, excruciating
- prohibits daily activities
- 20-50s, males
- associated with obstructive sleep apnea
- episodic–1 or more attacks/day for 6 weeks
- chronic–several attacks per week
- 30 min to 2 hours
- 100% unilateral! orbitotemporal
- no aura
- pacing, rocking, frenetic
- ptosis, miosis, conjunctival infection, lacrimation, stuffed or runny nose
9
Q
preventative treatment for chronic migraine?
A
BOTOX injections (effective 80-90%)
10
Q
paroxysmal hemicrania–what is it? treatment?
A
- indomethacin
- similar to cluster headache, but shorter in duration (only minutes)>5 times a day
11
Q
MS definition
A
- exacerbations and remissions
- loss of myelin
12
Q
MS symptoms
A
- paresthesias
- gait disturbances (transverse myelitis)
- weakness
- visual loss
- urinary difficulty
- dysarthria
- hemiparesis
13
Q
4 types of MS
A
- relapsing remitting (50%)
- secondary progressive (25%)
- primary progressive (15%)
- benign (10%)
14
Q
MS onset, cause, affects who
A
- 20-30 years of age
- cause unknown, some genetic susceptibility, illness that sensitizes the immune system to attack CNS myelin?
- women, in temporate zones
15
Q
MS diagnosis
A
- MRI lesions in periventricular white matter
- LP-oligoclonal bands, IgG
- multiple lesions over space and time
16
Q
drugs for MS maintenance
A
(decrease frequency and severity of exacerbations and slow progression of disease)
- Avonex, Rebif (interferon beta)
- Betaseron (interferon beta)
- Copaxone (Glatirimer acetate)
- betaseron only approved for chronic progressive MS
17
Q
MS drugs to treat acute exacerbation
A
- corticosteorids (solumderol, prednisone taper)
- reduces length of exacerbation
18
Q
MS different from ADEM how?
A
-ADEM never recurs!-post infectious or post immunization encephalomyelopathy
19
Q
other DDs for MS
A
- ADEM
- autoimmune disease (SLE, CNS vasculitis, polyarteritis nodosa)
- B12 deficiency
- lymphoma or leukemia
- spinocerebellar ataxias
- vascular malformations (AVM)
- infections (HIV, syphilis)
- granulomatous disease (sarcoidosis)
- metachromatic leukodystrophy, adrenomyeloleukodystrophy
20
Q
treat symptoms of MS spasticity
A
-Baclofen, tizanadine, diazepam, carbamazepine, Botox, dantrolene
21
Q
treat symptoms of MS-intention tremor
A
-propranolol, primidone, clonazepam
22
Q
treat symptoms of MS–urinary urgency
A
-oxybutinin
23
Q
treat symptoms of MS–urinary retention
A
bethanechol
24
Q
treat symptoms of MS–painful dysesthesias
A
-carbamazepine, gapapentin, phenytoin, baclofen
25
treat symptoms of MS--fatigue
-amantadine, modafinil, fluoxitine
26
risk factors for stroke
- age
- previous TIA or stroke
- atherosclerosis
- cardiac disorders (valvular heart disease, atrial fibrillation, mural thrombus, endocarditis, atrial myxoma, interatrial septal abnormalities)
- drug abuse
- oral contraceptives
- pregnancy
- fibromuscular dysplasia
- hypercoagulable states
- infl disorders
27
treatment for stroke
-ABCs
-dont treat acute hypertension
-dont give IV glucose
neuro exam
-labs--CBC, PT, PTT, chemistry panel, glucose, UA, X ray
-treat fever
-elevate HOB 30 degrees
28
NIH stroke scale
-score 20--18% risk of hemorrhage
29
what looks like stroke?
- seizure
- migraine
- hypoglycemia
30
when do you use tPA
- within 3 hours of onset of symptoms
- no stoke or head trauma in 3 months
- no major surgery in 2 weeks
- no intracranial hemorrhage
31
when is warfarin indicated?
- atrial fibrillation
- prosthetic valve
- MI
- atrial septal defect
- hypercoaguable state
- large vessel disease
32
epilepsy defined as
2 or more unprovoked seizures
33
% positive findings on 1 EEG
- 90% for petit mal (absence)
| - 40% for all types
34
85% positive finding for epilepsy when?
3 sleep deprived EEG
35
important to diagnosis for epilepsy?
history--witness!
36
partial seizures
- simple partial
- complex partial
- secondarily generalized (partial onset)
37
Generalized seizures
- absence (petit mal)
- tonic clonic
- myoclonic
- tonic
- clonic
- atonic
38
simple partial seizures
- focal motor or sensory activity
- no LOC
- lasts seconds
- no post ictal state
39
complex partial
- nonresponsive staring
- possible aura
- automatisms (pick at clothes, lip smacking, chewing)
- LOC
- 1-3 min
- post-ictal state
40
secondary generalized
- b/l tonic-clonic activity
- LOC
- -1-3 min
- post ictal state
41
absence (petit mal)
- nonresponsive staring
- rapid blinking, chewing, clonic hand motions
- LOC
- 10-30 sec
- no post ictal state
42
tonic-clonic
- b/l extension followed by symmetrical jerking of extremities
- LOC
- 1-3 min
- post ictal state
43
myoclonic
- brief rapid jerking of extremities
- LOC
- lasts few seconds
- minimal post ictal state
44
drug for absence only
ethosuxamide
45
drugs used for primary generalized and partial
- valproate
- lamotrigine
- leviteracetam
46
status epilepticus treatment
- benzodiazepam (lorazepam)
| - fosphenytoin
47
women with epilepsy drugs; avoid? use?
avoid valproic acid
| use newer drugs--lamotrigine, leviteracetam
48
syncope
- pallor, sweating
- lightheadedness
- slow onset
- positionally related
- brief unconsciousness
49
seizure
- urinary/bowel incontinence
- tongue injury
- tonic/clonic movements
- post ictal state
