Howell Flashcards
red flags of HA
new or sudden onset
sudden, acute
worsening over minutes
hallmark of a classic migraine
hemicranial pain
preceded by aura
scintillating scotoma
which migraine prophylaxis drugs are given to pts with low BP
Amitriptyline (mild risk)
Effexor +/- Riboflavin
migraine (does/does not) have a familial component
they do! they are familial!
helping a patient with allergies manage their HA
Targeted mgt of the triggers, w/seasonal allergies
proper technique for taking Flonase and Claritin
must be taken daily/prophylactically
important part of HA management
HA journal
common migraine
MC
not preceded by aura
bilateral and periorybital
common migraine relief
compressing ipsilateral carotid and superficial temporal artery
common triggers of migraines
bright lights, PA school, physical stress, alcohol, caging, dehydration, allergies, etc.
ocular migraine
vasospasm of the retinal artery
visual field deficits, stars, geometric patterns, etc.
occurs without HA
TM
inflammatory disorder taht involves complete transverse section of spinal cord
acute partial TM
asymmetric
one or two vertebral segments
acute complete TM
complete or near complete neuro deficits
below level with MRI 1-2 segments
LETM
3+ vertebral segments involved
types of TM
idiopathic
secondary dz
TM has both grey and white matter
medication tx of TM
IV solumedrol
what if IV solumedrol doesn’t work?
plasma exchange
TM s/s
BILATERAL sensory, motor, autonomic disturbance
fecal and urinary retention
lower back
TM is like ___ disease?
cauda equina syndrome
must have mass to be cauda equina
TM diagnosis is confirmed
inflammation in the absence of compression
neuromyelitis optica
immune meditated demyelination of the optic nerves and spinal cord
neuromyelitis optica v MS
demyelination and inflammation of multiple cords + optic nerve
both grey and white matter
necrosis of the cord
hallmarks of neuromyelitis optica
bilateral or rapidly sequential optic neuritis
how is inflammation defined in TM
cerebrospinal fluid pleocytosis
elevated IgG index
gadolinium enhancement
LP of TM
lymphocytosis + proteins
likely TM idiopathic 2/2
Viral,
GI/diarrheal illness prior to the eruption
acute v subacute TM
acute 1-4 days
subacute 1-4 weeks
first presentation of MS
clinically isolated syndrome
CIS s.s
long tract symptoms and signs
optic neuritis
brainstem syndrome
transverse myelitis ‘
ADEM, encephalopathy
tx CIS
consult neuro
steroids/interfueron (immunosuppressive)
biggest side effect of Interferon?
FLS and injection site reactions
what must be assessed prior to starting interferon
No existing autoimmune syndrome- as this can cause it’s expression
Areas of demyelination with reactive gliosis are found scattered in the white matter of the Brain, Spinal cord, and Optic Nerve
MS
what process is the cause of axonal damage in MS
Autoimmune disorder
pt with CIS returns 10 yrs later with similar symptoms - diagnosis
MRI of the brain
tx of MS flare
Solu-Medrol for the next 3 days (Daily); as well as High dose PO Prednisone
Uhthoff Phenomenon
Visual acuity decreases/impairments that appear to be affected by increases in body temperature
Internuclear ophthalmoplegia
Abnormal eye adduction b/l and horizontal nystagmus, not on convergence
Lhermitte’s sign
An electric shock sensation, or vibration, or pain radiating down the back and often the arms and the legs, resulting from flexion of the neck
McDonald’s criteria
criteria for MS diagnosis , on imaging
must have time (different lesions on different scans) or space (2 lesions in the right spot)
infusion therapy of tx MS
better for those with active dz and value effectiveness over convenience
increased risk of multifocal leukoencephalopathy
injection therapy tx of MS
those who value safety over effectiveness
oral therapy tx of MS
value convience over effectiveness
risk of teratogenicity
MS first line tx
interferon B1a (Rebif, Aconex) - weekly IM
interferon B1b - SQ’
glatiramer acetate (SQ)
Glatiramer acetate can’t be used with which medication
mannitol intolerant
relapsing and remitting MS
pt has “flares” of MS but fine between episodes
secondary progressive
gradually progressive MS course
weakness, ataxia, spasticity, impaired vision, optic atrophy, urinary incontinence
primary progressive MS
rapidly progressive, late manifestation
occurs over the course of a year
progressive relapsing
acute relapse that occurs during the course of primary progressive MS disease
primary progressive diagnostic criteria
one year of progressive disease + 2 of 3
- At least one typical brain lesion
- At least two spinal lesions
- Oligoclonal binding in the CSF
Which medications when provided are most linked to causing a zoster reaction?
Fingolimod (Gilenya)
Alemtuzumab (Lemtrada)
trigeminal neuralgia
facial pain syndrome of unknown cause
more women than men
worse with eating
types of trigeminal neuralgia
classic (anatomic cause)
secondary (MS or space lesion)
what branches of trigeminal affected in trigeminal neuralgia
V2 and V3
MC On R side
classic trigeminal neuralgia
anatomic source
compression of the nerve due to neurovascular conflict
common triggers of trigeminal neuralgia
touch
cold
wind
chewing
what to give to treat trigeminal neuralgia
tegretol (carbemezapine)
tegretol in trigeminal neuralgia
diagnostic and therapeutic
if symptoms don’t resolve in 24hrs = MRI
trigeminal neuralgia treatment fails
Surgery– Craniotomy versus Rhizotomy
post LP headache
occurs w/in 3 days
pain with standing, lie down to relieve
2/2 persistent CSF leak
tx of post LP HA
Caffeine Sodium Benzoate 500 mg IV
OR blood patch
pregnancy and migraines
prophylactic migraine medications are category C
can give Riboflavin (3 mo)
pregnancy will improve
riboflavin
takes 3 mo to start to work
prophylactic migraine HA
Cluster HA tx
provide Oxygen
limit alcohol consumption + vasodilators (can cause)
cluster HA signs
moise on R side but dry on L
horners syndrome (mitosis, ptosis, anhidrosis)
basilar migraine
early in child hood or teen years
looks like stroke
diplopia, dusarthria, vertigo, tinnitus, LOC/confusion
basilar migraine workup
tx as stroke
CT + neuro consult
tx of basilar migraine
avoid vasoconstriction (Triptans, Ergots)
global ischemia
reglan, benadryl
what must be accompanied with raglan
Benadryl
bc known to cause itchy skin
pseudotumor cerebrei workup
CT + LP
LP =study of choice, high opening pressure
pseudotumor cerebrei tx
Acetazolamide 250-500 mg PO tid
Giant Cell Arteritis exam
NML Neuro, nodularity or pulselessness along the temple artery
diagnosed with biopsy
Giant Cell Arteritis s/s, tx
jaw claudication
tx- steroids
