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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
how is inflammation defined in TM
cerebrospinal fluid pleocytosis elevated IgG index gadolinium enhancement
26
LP of TM
lymphocytosis + proteins
27
likely TM idiopathic 2/2
Viral, GI/diarrheal illness prior to the eruption
28
acute v subacute TM
acute 1-4 days | subacute 1-4 weeks
29
first presentation of MS
clinically isolated syndrome
30
CIS s.s
long tract symptoms and signs optic neuritis brainstem syndrome transverse myelitis ' ADEM, encephalopathy
31
tx CIS
consult neuro | steroids/interfueron (immunosuppressive)
32
biggest side effect of Interferon?
FLS and injection site reactions
33
what must be assessed prior to starting interferon
No existing autoimmune syndrome- as this can cause it’s expression
34
Areas of demyelination with reactive gliosis are found scattered in the white matter of the Brain, Spinal cord, and Optic Nerve
MS
35
what process is the cause of axonal damage in MS
Autoimmune disorder
36
pt with CIS returns 10 yrs later with similar symptoms - diagnosis
MRI of the brain
37
tx of MS flare
Solu-Medrol for the next 3 days (Daily); as well as High dose PO Prednisone
38
Uhthoff Phenomenon
Visual acuity decreases/impairments that appear to be affected by increases in body temperature
39
Internuclear ophthalmoplegia
Abnormal eye adduction b/l and horizontal nystagmus, not on convergence
40
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
41
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)
42
infusion therapy of tx MS
better for those with active dz and value effectiveness over convenience increased risk of multifocal leukoencephalopathy
43
injection therapy tx of MS
those who value safety over effectiveness
44
oral therapy tx of MS
value convience over effectiveness risk of teratogenicity
45
MS first line tx
interferon B1a (Rebif, Aconex) - weekly IM interferon B1b - SQ' glatiramer acetate (SQ)
46
Glatiramer acetate can't be used with which medication
mannitol intolerant
47
relapsing and remitting MS
pt has "flares" of MS but fine between episodes
48
secondary progressive
gradually progressive MS course weakness, ataxia, spasticity, impaired vision, optic atrophy, urinary incontinence
49
primary progressive MS
rapidly progressive, late manifestation occurs over the course of a year
50
progressive relapsing
acute relapse that occurs during the course of primary progressive MS disease
51
primary progressive diagnostic criteria
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
Which medications when provided are most linked to causing a zoster reaction?
Fingolimod (Gilenya) Alemtuzumab (Lemtrada)
53
trigeminal neuralgia
facial pain syndrome of unknown cause more women than men worse with eating
54
types of trigeminal neuralgia
classic (anatomic cause) secondary (MS or space lesion)
55
what branches of trigeminal affected in trigeminal neuralgia
V2 and V3 MC On R side
56
classic trigeminal neuralgia
anatomic source compression of the nerve due to neurovascular conflict
57
common triggers of trigeminal neuralgia
touch cold wind chewing
58
what to give to treat trigeminal neuralgia
tegretol (carbemezapine)
59
tegretol in trigeminal neuralgia
diagnostic and therapeutic if symptoms don't resolve in 24hrs = MRI
60
trigeminal neuralgia treatment fails
Surgery– Craniotomy versus Rhizotomy
61
post LP headache
occurs w/in 3 days pain with standing, lie down to relieve 2/2 persistent CSF leak
62
tx of post LP HA
Caffeine Sodium Benzoate 500 mg IV OR blood patch
63
pregnancy and migraines
prophylactic migraine medications are category C can give Riboflavin (3 mo) pregnancy will improve
64
riboflavin
takes 3 mo to start to work prophylactic migraine HA
65
Cluster HA tx
provide Oxygen limit alcohol consumption + vasodilators (can cause)
66
cluster HA signs
moise on R side but dry on L horners syndrome (mitosis, ptosis, anhidrosis)
67
basilar migraine
early in child hood or teen years looks like stroke diplopia, dusarthria, vertigo, tinnitus, LOC/confusion
68
basilar migraine workup
tx as stroke CT + neuro consult
69
tx of basilar migraine
avoid vasoconstriction (Triptans, Ergots) global ischemia reglan, benadryl
70
what must be accompanied with raglan
Benadryl bc known to cause itchy skin
71
pseudotumor cerebrei workup
CT + LP LP =study of choice, high opening pressure
72
pseudotumor cerebrei tx
Acetazolamide 250-500 mg PO tid
73
Giant Cell Arteritis exam
NML Neuro, nodularity or pulselessness along the temple artery diagnosed with biopsy
74
Giant Cell Arteritis s/s, tx
jaw claudication tx- steroids

WI18 Neuro (16 decks)

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