Hon--Headache, MS, Stroke, Seizures Flashcards
Headache–associated symptoms
- nausea
- vomiting
- anorexia
- photophobia
- phonophobia
headache triggers
- hormones
- diet
- stress
- environmental changes
- sensory stimuli
worrisome signs (NOT benign headache)
- 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
any patient with worrisome history or abnormal exam needs what?
- CT
- if nothing there–do LP! (CT can miss 10% of subarachnoid hemorrhages)
common migraine
- 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
classic migraine
- aura
- 15-30 min
- commonly visual symptoms
tension type HA
- 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
cluster HA
- 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
preventative treatment for chronic migraine?
BOTOX injections (effective 80-90%)
paroxysmal hemicrania–what is it? treatment?
- indomethacin
- similar to cluster headache, but shorter in duration (only minutes)>5 times a day
MS definition
- exacerbations and remissions
- loss of myelin
MS symptoms
- paresthesias
- gait disturbances (transverse myelitis)
- weakness
- visual loss
- urinary difficulty
- dysarthria
- hemiparesis
4 types of MS
- relapsing remitting (50%)
- secondary progressive (25%)
- primary progressive (15%)
- benign (10%)
MS onset, cause, affects who
- 20-30 years of age
- cause unknown, some genetic susceptibility, illness that sensitizes the immune system to attack CNS myelin?
- women, in temporate zones
MS diagnosis
- MRI lesions in periventricular white matter
- LP-oligoclonal bands, IgG
- multiple lesions over space and time
drugs for MS maintenance
(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
MS drugs to treat acute exacerbation
- corticosteorids (solumderol, prednisone taper)
- reduces length of exacerbation
MS different from ADEM how?
-ADEM never recurs!-post infectious or post immunization encephalomyelopathy
other DDs for MS
- 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
treat symptoms of MS spasticity
-Baclofen, tizanadine, diazepam, carbamazepine, Botox, dantrolene
treat symptoms of MS-intention tremor
-propranolol, primidone, clonazepam
treat symptoms of MS–urinary urgency
-oxybutinin
treat symptoms of MS–urinary retention
bethanechol
treat symptoms of MS–painful dysesthesias
-carbamazepine, gapapentin, phenytoin, baclofen
treat symptoms of MS–fatigue
-amantadine, modafinil, fluoxitine
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
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
NIH stroke scale
-score 20–18% risk of hemorrhage
what looks like stroke?
- seizure
- migraine
- hypoglycemia
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
when is warfarin indicated?
- atrial fibrillation
- prosthetic valve
- MI
- atrial septal defect
- hypercoaguable state
- large vessel disease
epilepsy defined as
2 or more unprovoked seizures
% positive findings on 1 EEG
- 90% for petit mal (absence)
- 40% for all types
85% positive finding for epilepsy when?
3 sleep deprived EEG
important to diagnosis for epilepsy?
history–witness!
partial seizures
- simple partial
- complex partial
- secondarily generalized (partial onset)
Generalized seizures
- absence (petit mal)
- tonic clonic
- myoclonic
- tonic
- clonic
- atonic
simple partial seizures
- focal motor or sensory activity
- no LOC
- lasts seconds
- no post ictal state
complex partial
- nonresponsive staring
- possible aura
- automatisms (pick at clothes, lip smacking, chewing)
- LOC
- 1-3 min
- post-ictal state
secondary generalized
- b/l tonic-clonic activity
- LOC
- -1-3 min
- post ictal state
absence (petit mal)
- nonresponsive staring
- rapid blinking, chewing, clonic hand motions
- LOC
- 10-30 sec
- no post ictal state
tonic-clonic
- b/l extension followed by symmetrical jerking of extremities
- LOC
- 1-3 min
- post ictal state
myoclonic
- brief rapid jerking of extremities
- LOC
- lasts few seconds
- minimal post ictal state
drug for absence only
ethosuxamide
drugs used for primary generalized and partial
- valproate
- lamotrigine
- leviteracetam
status epilepticus treatment
- benzodiazepam (lorazepam)
- fosphenytoin
women with epilepsy drugs; avoid? use?
avoid valproic acid
use newer drugs–lamotrigine, leviteracetam
syncope
- pallor, sweating
- lightheadedness
- slow onset
- positionally related
- brief unconsciousness
seizure
- urinary/bowel incontinence
- tongue injury
- tonic/clonic movements
- post ictal state
