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WI18 Neuro > Howell > Flashcards

Howell Flashcards

1
Q

red flags of HA

A

new or sudden onset
sudden, acute
worsening over minutes

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2
Q

hallmark of a classic migraine

A

hemicranial pain

preceded by aura

scintillating scotoma

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3
Q

which migraine prophylaxis drugs are given to pts with low BP

A

Amitriptyline (mild risk)

Effexor +/- Riboflavin

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4
Q

migraine (does/does not) have a familial component

A

they do! they are familial!

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5
Q

helping a patient with allergies manage their HA

A

Targeted mgt of the triggers, w/seasonal allergies

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6
Q

proper technique for taking Flonase and Claritin

A

must be taken daily/prophylactically

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7
Q

important part of HA management

A

HA journal

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8
Q

common migraine

A

MC
not preceded by aura
bilateral and periorybital

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9
Q

common migraine relief

A

compressing ipsilateral carotid and superficial temporal artery

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10
Q

common triggers of migraines

A

bright lights, PA school, physical stress, alcohol, caging, dehydration, allergies, etc.

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11
Q

ocular migraine

A

vasospasm of the retinal artery

visual field deficits, stars, geometric patterns, etc.

occurs without HA

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12
Q

TM

A

inflammatory disorder taht involves complete transverse section of spinal cord

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13
Q

acute partial TM

A

asymmetric

one or two vertebral segments

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14
Q

acute complete TM

A

complete or near complete neuro deficits

below level with MRI 1-2 segments

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15
Q

LETM

A

3+ vertebral segments involved

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16
Q

types of TM

A

idiopathic
secondary dz

TM has both grey and white matter

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17
Q

medication tx of TM

A

IV solumedrol

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18
Q

what if IV solumedrol doesn’t work?

A

plasma exchange

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19
Q

TM s/s

A

BILATERAL sensory, motor, autonomic disturbance

fecal and urinary retention

lower back

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20
Q

TM is like ___ disease?

A

cauda equina syndrome

must have mass to be cauda equina

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21
Q

TM diagnosis is confirmed

A

inflammation in the absence of compression

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22
Q

neuromyelitis optica

A

immune meditated demyelination of the optic nerves and spinal cord

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23
Q

neuromyelitis optica v MS

A

demyelination and inflammation of multiple cords + optic nerve

both grey and white matter

necrosis of the cord

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24
Q

hallmarks of neuromyelitis optica

A

bilateral or rapidly sequential optic neuritis

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25
Q

how is inflammation defined in TM

A

cerebrospinal fluid pleocytosis
elevated IgG index
gadolinium enhancement

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26
Q

LP of TM

A

lymphocytosis + proteins

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27
Q

likely TM idiopathic 2/2

A

Viral,

GI/diarrheal illness prior to the eruption

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28
Q

acute v subacute TM

A

acute 1-4 days

subacute 1-4 weeks

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29
Q

first presentation of MS

A

clinically isolated syndrome

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30
Q

CIS s.s

A

long tract symptoms and signs

optic neuritis
brainstem syndrome
transverse myelitis ‘

ADEM, encephalopathy

31
Q

tx CIS

A

consult neuro

steroids/interfueron (immunosuppressive)

32
Q

biggest side effect of Interferon?

A

FLS and injection site reactions

33
Q

what must be assessed prior to starting interferon

A

No existing autoimmune syndrome- as this can cause it’s expression

34
Q

Areas of demyelination with reactive gliosis are found scattered in the white matter of the Brain, Spinal cord, and Optic Nerve

A

MS

35
Q

what process is the cause of axonal damage in MS

A

Autoimmune disorder

36
Q

pt with CIS returns 10 yrs later with similar symptoms - diagnosis

A

MRI of the brain

37
Q

tx of MS flare

A

Solu-Medrol for the next 3 days (Daily); as well as High dose PO Prednisone

38
Q

Uhthoff Phenomenon

A

Visual acuity decreases/impairments that appear to be affected by increases in body temperature

39
Q

Internuclear ophthalmoplegia

A

Abnormal eye adduction b/l and horizontal nystagmus, not on convergence

40
Q

Lhermitte’s sign

A

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

41
Q

McDonald’s criteria

A

criteria for MS diagnosis , on imaging

must have time (different lesions on different scans) or space (2 lesions in the right spot)

42
Q

infusion therapy of tx MS

A

better for those with active dz and value effectiveness over convenience

increased risk of multifocal leukoencephalopathy

43
Q

injection therapy tx of MS

A

those who value safety over effectiveness

44
Q

oral therapy tx of MS

A

value convience over effectiveness

risk of teratogenicity

45
Q

MS first line tx

A

interferon B1a (Rebif, Aconex) - weekly IM

interferon B1b - SQ’

glatiramer acetate (SQ)

46
Q

Glatiramer acetate can’t be used with which medication

A

mannitol intolerant

47
Q

relapsing and remitting MS

A

pt has “flares” of MS but fine between episodes

48
Q

secondary progressive

A

gradually progressive MS course

weakness, ataxia, spasticity, impaired vision, optic atrophy, urinary incontinence

49
Q

primary progressive MS

A

rapidly progressive, late manifestation

occurs over the course of a year

50
Q

progressive relapsing

A

acute relapse that occurs during the course of primary progressive MS disease

51
Q

primary progressive diagnostic criteria

A

one year of progressive disease + 2 of 3

  1. At least one typical brain lesion
  2. At least two spinal lesions
  3. Oligoclonal binding in the CSF
52
Q

Which medications when provided are most linked to causing a zoster reaction?

A

Fingolimod (Gilenya)

Alemtuzumab (Lemtrada)

53
Q

trigeminal neuralgia

A

facial pain syndrome of unknown cause

more women than men

worse with eating

54
Q

types of trigeminal neuralgia

A

classic (anatomic cause)

secondary (MS or space lesion)

55
Q

what branches of trigeminal affected in trigeminal neuralgia

A

V2 and V3

MC On R side

56
Q

classic trigeminal neuralgia

A

anatomic source

compression of the nerve due to neurovascular conflict

57
Q

common triggers of trigeminal neuralgia

A

touch
cold
wind
chewing

58
Q

what to give to treat trigeminal neuralgia

A

tegretol (carbemezapine)

59
Q

tegretol in trigeminal neuralgia

A

diagnostic and therapeutic

if symptoms don’t resolve in 24hrs = MRI

60
Q

trigeminal neuralgia treatment fails

A

Surgery– Craniotomy versus Rhizotomy

61
Q

post LP headache

A

occurs w/in 3 days

pain with standing, lie down to relieve

2/2 persistent CSF leak

62
Q

tx of post LP HA

A

Caffeine Sodium Benzoate 500 mg IV

OR blood patch

63
Q

pregnancy and migraines

A

prophylactic migraine medications are category C

can give Riboflavin (3 mo)

pregnancy will improve

64
Q

riboflavin

A

takes 3 mo to start to work

prophylactic migraine HA

65
Q

Cluster HA tx

A

provide Oxygen

limit alcohol consumption + vasodilators (can cause)

66
Q

cluster HA signs

A

moise on R side but dry on L

horners syndrome (mitosis, ptosis, anhidrosis)

67
Q

basilar migraine

A

early in child hood or teen years

looks like stroke

diplopia, dusarthria, vertigo, tinnitus, LOC/confusion

68
Q

basilar migraine workup

A

tx as stroke

CT + neuro consult

69
Q

tx of basilar migraine

A

avoid vasoconstriction (Triptans, Ergots)

global ischemia

reglan, benadryl

70
Q

what must be accompanied with raglan

A

Benadryl

bc known to cause itchy skin

71
Q

pseudotumor cerebrei workup

A

CT + LP

LP =study of choice, high opening pressure

72
Q

pseudotumor cerebrei tx

A

Acetazolamide 250-500 mg PO tid

73
Q

Giant Cell Arteritis exam

A

NML Neuro, nodularity or pulselessness along the temple artery

diagnosed with biopsy

74
Q

Giant Cell Arteritis s/s, tx

A

jaw claudication

tx- steroids

WI18 Neuro (16 decks)

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