Lecture 7 (Neuro) - Exam 3 Flashcards

Question 1

Q

Neurological examincludes:
* What are the cortical functions? (7)
* What are the crainial nerve exam and pupils?(5)

Answer

A

Cortical functions – LOC,mental status, arousal, awareness,cognition, function, and behavior.
Cranial nerve exam and pupils -cranial nerve function, brain stem function, reflexes, eye movement and pupil response.

Question 2

Q

Neurological examincludes:
* What are the motor/cerebellar function tests?
* What si the sensory function tests?
* What are the reflexes?

Answer

A

Motor/Cerebellarfunction -strength,movement, coordination, and posture.
Sensory function -tactile,painful stimuli, numbness.
Reflexes -deep tendon, protective(blink, cough, gag), and plantar(movement of toes)

Question 3

Q

Neurological Assessment -
* What is a must? Get from where?
* What should it include?

Answer

A

Good patient history is a must – get from the patient, family, or old medical records.
Should be included -past medical history, current medication list and events leading up to this hospital visit.

Question 4

Q

Neurological Assessment -
* Complete set of what? What does that establish?

Answer

A

Complete set of vital signs -blood pressure, heart rate,respiration rate and pattern, heart rhythm, blood glucose and laboratory work.
* Establishes a baseline

Question 5

Q

*

NeurologicalAssessment – Cortical Function: Levelof consciousness:
* What is fully conscious? Confused? Lethargic?

Answer

A

Fully conscious -awake, alert, oriented x3, and communicating appropriately.
Confused -awake,alert, disoriented, and distractible.
Lethargic -arouses to voice, may/may not be oriented, slow to respond.

Question 6

Q

NeurologicalAssessment – Cortical Function: Levelof consciousness:
* What is obtunded, stupor and coma?

Answer

A

Obtunded -requires tactile stimulation, one-two word responses then “back to sleep”, follows simple commands.
Stupor -noxious stimuli to arouse a purposeful response, follows no commands, very limited vocalization( groaning, moaning)
Coma -no verbal response, no purposeful movement to noxious stimuli, may have some random movement,GCS generally lessthan 8.

Question 7

Q

Neurological Assessment -Cortical Functions: mentation
* How do you test orientation to person, place and time?

Answer

A

Orientation to person, place and time
* What is your name?
* Do you know where you are?
* About what time would you say it is?

Question 8

Q

Neurological Assessment -Cortical Functions: mentation
* How do you test memory both recent and remote?
* How do you test situational appropriateness?

Answer

A

Memory both recent and remote
* Can you tell me why you came to the hospital?
* Who is the president of theUnited States?

Situational appropriateness
* Whatdo you know about your diagnosis?

Question 9

Q

NeurologicalAssessment -Cranial NerveExam andPupils
* What do you need to assess?

Answer

A

Pupil assessment
* Size and shape
* Direct and indirect responses to light i.e, accommodation.
* Eye movements: Follow the”H”

Question 10

Q

Neurological Assessment -Cranial Nerve Exam andPupils
* What is bitemporal hemianospsia?
* What is homonymous hemianopsia?

Answer

A

Bitemporalhemianopsia – partial blindness where vision is missing in the outer half of both the right and left visual field – think tumor of the optic chiasm
Homonymous hemianopsia – singlesided visual loss of both eyes – bump into obstacles on side of the field loss – bruising on arms and legs

Question 11

Q

Neurological Assessment -Cranial Nerve Exam andPupils
* What is miosis?
* What is ptosis?
* What is nystagmus?

Answer

A

Miosis -abnormally constricted pupils can be due to drugs, braintrauma
Ptosis -drooping eye lid
Nystagmus -rapid eye movement that cannot be controlled.

Question 12

Q

What can ptosis be a sign of?
What is horner’s syndrome?

Answer

A

can be sign of Myasthenia gravis – commonly affects eyes, face and swallowing

Horner’s syndrome -damage to sympathetic nervous system supply to one side of the face.
* seenwith constricted pupils (miosis), droopy eyelid (ptosis) and anhydrous (failure to sweat) – pupils do not respond to adjustments with change in lighting.

Question 13

Q

under notes

When there is compression at the optic chiasm, what can happen?

Answer

A

the visual impulse from both nasal retina are affected, leading to inability to see the temporal, or peripheral, field of vision.

Question 14

Q

How will a cut at each one of these places cause changes to vision?

Answer

A

(1)Blind right eye – lesion of the optic nerve and, of course of the eye itself, produces unilateral blindness.
(2)Bitemporal Hemianopsia (optic chiasm) – lesion at the optic chiasm, may involve only fibers crossing over to the opposite side. Since these fibers originate in the nasal half of each retina, visual loss involves the temporal half of each field.
(4)Right homonymous hemianopia - left optic track – lesion of the optic track, interrupts fibers originating on the same side of both eyes. Visual loss in the eyes is, therefore, similar (homonymous) and involves half of each field (hemianopia)

Question 15

Q

NeurologicalAssessment -Cranial Nerve Exam
* What are CN 1-3?

Answer

A

CranialNerveI – Sense of smell. Sensory only, not associated iwth muscle mvt
CranialNerveII -Visual acuity and fields of vision - blindness, loss of color vision, hemianopia, loss of corneal reflex.
Cranial Nerve III -Oculomotor –paralysis of most eye movements. Can leaad to double vision, ptosis, down and out paralysis, pupil dilation and accommodates (focusing on near objects)

Question 16

Q

What are CN 4-6?

Answer

A

Cranial NerveIV -Trochlear -inability to look down-and-in and double vision. Difficulty walking downstairs, reading. Head tilt to compensate
Cranial Nerve V -Trigeminal -loss of sensation on areas of face and in oral cavity served by each division, loss of jaw-jerk reflex.
CranialNerve VI -Abducens -lateral gaze palsy and diplopia.

Question 17

Q

What is CN 7 and 8?

Answer

A

Cranial Nerve VII – FACIAL - weakness/paralysis of facial muscles and loss of blink reflex, decrease in secretions, loss of taste on anterior two thirds of tongue, loss of ear sensation.
CranialNerveVIII -VESTIBULOCOCHLEAR - hearing, balance and equilibrium – loss of hearing, tinnitus, vertigo, unsteady gait, and nystagmus.

Question 18

Q

For CN 8 what are the weber and rinne test? What are the results?

Answer

A

Weber – inner ear vs middle ear hearing loss, good is when the sound is heard equally in both ears
* Normal: sound is heard equally in both ears.
* Sensorineural hearing loss:sound is heard louder on the side of the intact ear.
* Conductive hearing loss: sound is heard louder on the side of the affected ear.

Rinne -comparing air conduction to bone conduction AC>BC is good
* In conductive hearing loss, sound is heard through bone as long as or longer than it is through air.
* in sensorineural hearing loss, sound is heard longer through air

If they fail the whisper test, then you can use the tuning fork which may help to determine if the hearing loss if conductive or neurosensory in origin.

Question 19

Q

For unilateral conductive and sensorineural hearing loss, where is the sound heard?

Answer

A

In unilateral conductive hearing loss, sound is heard (lateralized) to the impaired ear. Otitis media, perforation can be the cause.
In unilateral sensorineural hearing loss, sound is heard in the good ear.

Question 20

Q

What is CN 9 and 10?

Answer

A

CranialNerveIX -GLOSSOHPARYNGEAL – difficulty swallowing and loss of gag reflex, decrease secretory function, loss of taste on posterior third of tongue, possible bradycardia or tachycardia (from carotid sinus).
Cranial Nerve X -VAGUS – autonomic responses, gag reflex.

Question 21

Q

What is CN 11 and 12?

Answer

A

Cranial NerveXI – SPINAL ACCESSORY - sternocleidomastoid, shrug shoulders, movement of head and neck.
Cranial Nerve XII – HYPOGLOSSAL – deviation of tongue on protrusion.

Question 22

Q

Comments on Diplopia – Cranial Nerve Palsies
* With a third nerve palsy, diplopia is greatest when?
* With a fourth nerve palsy, diplopia if greatest when ?
* With a sixth nerve palsy, diplopia is greatest when ?

Answer

A

With a third nerve palsy, diplopia is greatest when looking up and to the opposite side.
With a fourth nerve palsy, diplopia if greatest when looking down and to the opposite side.
With a sixth nerve palsy, diplopia is greatest when looking to the affected side.

Question 23

Q

NeurologicalAssessment -Motor Response: Extremity mvt and strength
* Graded how?
* Range of what?
* What is a special test?

Answer

A

Generally graded from0, flaccid to 5,full range of motion andfull resistance.

Range of motion and tone
* Any limitations to range, how is the tone of their movement, muscles, flaccid, good resistance?

Pronator drift(palms up and eyes closed)

Question 24

Q

NeurologicalAssessment -Coordination
* Posterior columns carry what?
* General principle is that if a patient can perform a task with their eyes open but not with their eyes closed, it is a sign of what?

Answer

A

Posterior columns carry tracts conducting vibratory and position sense up to the higher centers.
General principle is that if a patient can perform a task with their eyes open but not with their eyes closed, it is a sign of impaired proprioception or posterior column disease.

Question 25

Q

NeurologicalAssessment -Coordination
* What is the romberg test?

Answer

A

Stand with feet together and arms at their side.
Stand nearby, not touching the patient but ready to catch them if they fall.
Observe the patient for 20 seconds.
Tell patient to close their eyes, continue the test for another 30 seconds

Question 26

Q

Neurological Assessment -Sensation
* What do you need to do to check pain and temp?

Answer

A

Check both sides of thebody, at same location – to ensure it is consistent

Question 27

Q

Neurological Assessment -Sensation
* What do you need to do for the dull and sharp test?
* What does abnormal results indicate?

Answer

A

Can they detect and separate types of sensations
* Dull object on their palm vs a sharp object
* Remember to tell them what is sharp and dull before doing procedure then perform in different location

Abnormal results canindicate spinal cord lesions

Question 28

Q

NeurologicalAssessment -Coordination
* How should coordination be tested?
* In upper limbs,it is bestassessedusing what?
* In the lower limbs using what?

Answer

A

Coordination should be tested inthe upperandlower limbs.
In upper limbs,it is bestassessedusing the”finger tonose” test.
In the lower limbs using the”heel to shin” test.

Question 29

Q

NeurologicalAssessment -Coordination
* What can abnormal results be due to?

Answer

A

Abnormal resultscanbe due to defects in
* Cerebellar function
* Muscular weakness

Question 30

Q

Neurological Assessment -Reflexes
* What is the corneal/blink reflex?
* What is the babinski/plantar reflex?
* What is the protective reflex?

Answer

A

Corneal/Blink reflex – test with cotton rubbed overcornea
Babinski/Plantar - stroke soleof the foot, positive means toes flareand big toegoes up
Protective – gag, cough, corneal test

Question 31

Q

Neurological Assessment -Reflexes
* What is the oculocephalic reflex? What do the results mean?
* What is the feep tendon reflex?

Answer

A

Oculocephalic -“dolls eyes”,
* Intact brain stem – eyes are fixed on the on the same point in the room as the patient’s head is moved
* Midbrain damage – eyes will continue to start in whatever direction the head is pointed

Deep tendon -biceps,triceps,quadriceps, Achilles

Question 32

Q

Neurological Assessment - Normal Oculocephalic Reflex
* Easiest way to remember is what?
* Reason for conducting the test is what?

Answer

A

Easiest way to remember is that dead people’s eyes do not move.
Reason for conducting the test is to not determine if there is a brain lesion but to check for brain death.

Question 33

Q

What does deep tendon reflex testing tell us:
* Reflexes are what?
* These unconscious movements happen how?
* Reflex actions do not involve what?
* Simple reflexes are controlled by what?

Answer

A

Reflexes are automatic responses to stimulation.
These unconscious movements happen quickly, and we do not have time to consciously register what happened.
Reflex actions do not involve the brain.
Simple reflexes are controlled by certain areas of the spinal cord.

Question 34

Q

Glasgow Coma Scale
* Developed when and why?
* An accurate neurological examination will help to determine what?

Answer

A

Developed in 1974 as an objective and reliable scale to record the level of consciousness of a person, especially after a head injury.
An accurate neurological examination will help to determine the type and position of the pathological process and provide a baseline for comparison with subsequent examinations.

Question 35

Q

Glasgow Coma Scale
* Emphasis on what? (3)

Answer

A

Conscious state
Pupillary size and reaction
Focal neurological signs in the limbs

Question 36

Q

Glasgow Coma Score
* What are factors that can affect the GCS?

Answer

A

Eye/facial trauma
Intubation
Damage to the throat or cords
Drugs (bothones the patient took and what wegave them)
Paralytics
Fearor sleep depervation
Deafnessor blindness
Etohand withdrawal
Electrolyteimbalances

Question 37

Q

NeurologicalExam - Glasgow ComaScore
* Gives a numerical value to the three most important parameters of the level of consciousness?
* Exact response can be represented on what?

Answer

A

Gives a numerical value to the three most important parameters of the level of consciousness:
* Opening of eyes
* Best verbal response
* Bestmotor response

Exact response can be represented on a chart, or the level of consciousness given a numerical score – the sum of the parameters of the Glasgow coma score.

Question 38

Q

For the GCS, what does a score less than 8 mean?

Answer

A

indicates a severe injury

Question 39

Q

Neurological Exam – Conscious State
* First sign of depressed conscious state is what?
* As they deteriorate, they become more what?
* What is coma?

Answer

A

First sign of depressed conscious state is drowsiness – may be easily arousable and oriented to person, place and time.
As they deteriorate, they become more confused and drowsier.
Coma is restricted to patients who show no response to external stimuli.

Question 40

Q

Neurological Exam – Conscious State
* Avoid the terms “semicoma or stuporse” as they convey waht?
* Assessment is more accurate and reproducible if what?

Answer

A

Avoid the terms “semicoma or stuporse” as they convey different meanings to different observers.
Assessment is more accurate and reproducible if either the exact response is described, or the Glasgow coma score is used.

Question 41

Q

Question 42

Q

Glasgow ComaScale: Withdrawal to painful stimuli
* Using only the motor component of the GCS –
* What does purposeful withdrawal indicate?

Answer

A

Using only the motor component of the GCS – if less than 6 is just as predictive for severe injury as using the whole GCS.
Purposeful withdrawal -indicates that the patientis consciously moving towards the source of the pain – suggests higher level of brain function - localizes, crosses the midline

Question 43

Q

Glasgow ComaScale: Withdrawal to painful stimuli
* What does non pueposeful withdrawal mean?
* What is the flexor and extensor response?

Answer

A

Non-purposeful withdrawal -can be indicative of a lowerlevel of consciousness or severe brain injury, where movement is more reflexive and not consciously directed
Flexor response -decorticate-suggests damage to cerebral hemispheres
Extensor response – decerebrate -indicates more severe damage involving the brainstem

Question 44

Q

The AVPU System
* Often used to describe what?
* What does the AVPU stand for?

Answer

A

Often used to describe the patient’s level of consciousness.
* A stands for alert
* V for responds to verbal stimuli
* P for responds to painful stimulus
* U for unresponsive.

Question 45

Q

The AVPU System
* This approach, although simple, fails to provide what?
* Lack’s what?

Answer

A

This approach, although simple, fails to provide information regarding specifically how the patient responds to either verbal or painful stimuli.
Lack’s precision and has fallen out of favor.

Question 46

Q

Location of cranial nerves in the brain, help to identify what?

Answer

A

Location of cranial nerves in the brain, help to identify how they are affected during times oftrauma, strokes.

Question 47

Q

Clinical Understanding – Same Side Cranial Nerve Deficits
* Compression of a brain mass directly on the affected cranial nerve on the same side, produces what?
* This would not produce what?

Answer

A

Compression of a brain mass directly on the affected cranial nerve on the same side, produces a deficit on that SAME side, such as hearing loss.
This would not produce upper or lower extremity weakness.

Question 48

Q

What is going on here?

Answer

A

In this case, brain mass on left, cranial nerve 8 affected, hearing loss.

Question 49

Q

Clinical Understanding – Same Side Cranial Nerve Deficits
* Cranial nerve deficits like loss of vision –
* This would not produce what?
* What is going on with the image?

Answer

A

Cranial nerve deficits like loss of vision –compression by a benign brain mass upon the optic chiasm.
This would not produce upper or lower extremity weakness.
In this case, patient may have loss of vision as the mass presses against the nerve junction.

Question 50

Q

Clinical Understanding – Opposite Side Deficits
* A patientwith a stroke orhead injury can havedeficits where? Why?

Answer

A

A patient with a stroke or head injury can have deficits on the opposite side of the bodydue to the way the brain and spinal cord are organized - a process called decussation.

Question 51

Q

Clinical Understanding – Opposite Side Deficits: Corticospinal tracts
* Primary pathway that carrieswhat?
* They originates where? Where do they go?
* Where do they descussate?
* As a result, the right side of brain controls muscles where?

Answer

A

Primary pathway that carriesmotor signals from the brain to thespinal cord and then to the muscles.
They originates in themotor cortex of the brain and travelsdown throughthe brainstem.
At the level of the medulla/pons region, fibersin the corticospinal tract cross overto theopposite of the body -decussation
As a result, the right side of brain controls muscles on left side of the body, left side of brain controls muscles on the right side.

Question 52

Q

Clinical Understanding - Deficits: Sensory pathways
* How does sensory pathways travel?

Answer

A

Like motor pathways, sensory pathways also cross over to the opposite side of the body. (at level of medulla)

Question 53

Q

Motor Function/CranialNerves
* This helps to see the location ofcranial nerves and how they are affected by what?
* This also helps to understand what?
* Where do they decussate?

Answer

A

This helps tosee the location ofcranial nerves and how they are affected by tumors, bleeding, trauma.
This also helps to understand how one hemisphere can cause deficits on the opposite side of the body.
At brainstem

Question 54

Q

Functions of the Brain ⭐️
* What is the function of the frontal, parietal, temporal and occipital lobe?

Answer

A

Frontal Lobe: Executive/Motor and Expressive Function
Parietal Lobe: Somatosensory/Calculating
Temporal Lobe: Comprehension and memory function
Occipital Lobe: Vision

Question 55

Q

Cortical Syndromes
* Refers to what?
* The term brain lateralization refewhat?
* Each hemisphere has what?

Answer

A

Refers to identifying locations of a CNS event based on clinical symptoms that are absent or a dysfunction that is present.
The term brain lateralization refers to the fact that the two halves of the human brain are not exactly alike.
Each hemisphere has functional specializations: a theory that different areas of the brain are specialized for different functions.

Question 56

Q

Answer

A

Damage or activity in this region on the left hemisphere typically affects the right side of the body

Question 57

Q

High yield facts:
* What is the dominant hemisphere? What is it responsible for?
* What is the nondominant hemisphere? What it is responsible for?

Answer

A

Dominant hemisphere – left hemisphere is dominant for language and cognitive functions.
Nondominant hemisphere – usually the right hemisphere. It is responsible for three-dimensional, or spatial, perception and nonverbal ideation. It also allows for superior recognition of faces.

Question 58

Q

High-Yield Facts
* Knowing a patient’s handedness helps in predicting what?
* If they have a tumor affecting the left hemisphere, or large tumor, can what?
* Most people are right-handed, thus what?
* In left-handed people, 85% still have what?

Answer

A

Knowing a patient’s handedness helps in predicting which hemisphere might be more critical for these functions.
* If they have a tumor affecting the left hemisphere, or large tumor, can affect language.
* Most people are right-handed, thus left side is dominant.
* In left-handed people, 85% still have left side of brain as dominant side.

Question 59

Q

High-Yield Facts
* What is aphasia?
* What is broca’s area?
* What is wenicke area?
* Global due to what?

Answer

A

Aphasia – impaired expression or comprehension of written or spoken language:
Broca’s Area – located in frontal lobe – receptive aphasia - can understand but cannot speak.
Wernicke Area – located in the temporal lobe – expressive aphasia – patient understands but their responses do not make sense.
Global (all aspects of language involved)->Typically, because of a large stroke

Question 60

Q

What is agnosia? What is the injury to?

Question 61

Q

Apraxia:
* What is it? Give an example
* Injury to where?

Question 62

Q

Amnesia:
* What is retrograde?
* What is anterograde?
* What is transient global?

Question 63

Q

Upper Motor Neurons
* Primarily reside where?
* The primary motor cortex, located in the precentral gyrus, is the key area of what?

Answer

A

Primarily reside in the cerebral cortex, specifically within the motor cortex areas such as the precentral gyrus, which is part of the frontal lobe.
The primary motor cortex, located in the precentral gyrus, is the key area where the cell bodies of upper motor neurons are found.

Question 64

Q

Upper motor neurons:
* These neurons then send their axons down through the brainstem and spinal cord, forming what?
* Responsible for what?
* Involved in what?

Answer

A

These neurons then send their axons down through the brainstem and spinal cord, forming the corticospinal and corticobulbar tracts, to synapse on lower motor neurons or interneurons in the spinal cord or brainstem.
Responsible for transmitting motor signals from the brain to the lower motor neurons in the brainstem and spinal cord.
Involved in planning, initiating, and controlling voluntary movements.

Answer 61

A

Disuse atrophy
Weakness
Increased reflexes with deep tendon reflex testing – exaggerated reflexed due to loss of inhibitory signals from the brain.
Clonus – repetitive, rhythmic muscle contractions
Babinski sign – abnormal reflex where the big toe extends upward when the sole of the foot is stimulated.

Answer 62

A

Amyotrophic Lateral Sclerosis (ALS) – progressive neurodegenerative disease that affects both upper and lower motor neurons – muscle weakness, spasticity and atrophy.
Primary Lateral Sclerosis (PLS) – rare motor neuron disease that primarily affects the UMN. Progresses more slowly than ALS – spasticity, muscle stiffness and weakness in legs.

Answer 63

A

Multiple Sclerosis (MS) – autoimmune disease that targets the myelin sheath of neurons in CNS – affecting UMN and other pathways – spasticity, muscle weakness, vision problems.
Spinal cord injury – can damage the UMN running through it – depending on the level of injury, spasticity, paralysis and loss of voluntary control of lower extremities.

Answer 64

A

Located in the anterior portion of the spinal cord and in the brainstem.
Lower motor neuros are the final common pathway for motor signals from the central nervous system to the muscles – directly innervate skeletal muscles.
When these neurons or axons are damaged, it results in lower motor neuron signs which can manifest in any muscle group – including upper extremities.

Answer 65

A

Typically lead to muscle weakness.
Hyporeflexia.
No myelopathy
Flaccid paralysis

Answer 66

A

Spinal Muscular Atrophy (SMA) – genetic disorder, destroys the anterior horn cells in the spinal cord – muscle weakness, reduced reflexes.
Peripheral Neuropathy – damage to multiple peripheral nerves – such as from diabetes, infections, toxins – symmetric muscle weakness, atrophy, sensory disturbances (numbness, hyporeflexia)

Answer 67

A

Myasthenia Gravis (MS) – autoimmune disorder characterized by weakness and rapid fatigue of voluntary muscles – targets neuromuscular junction – muscle weakness that worsens with exertion and improves with rest.

Answer 68

A

CT scan of the head without contrast – most common-initial exam to look for cerebral bleeding, edema, masses.
CT Angiogram of the head and neck – identify source of bleed, aneurysms, arterial venous malformations.
CT Perfusion of the head – generally done for stroke patients, helps to tell if there is a perfusion deficit to parts of the brain such as from a stroke where a clot causes obstruction of cerebral arteries.

Answer 69

A

MRI angiography generally does not use radiation but high frequency waves, and a non-allergictype of contrast if needed - not used as much when speed of identification and direction of treatment is important.Great formeasuringand examining blood vessels of the brain
MRIs are generally ordered after a patient has had a stroke or suspected, will help identify areas damaged by the stroke.
MRIs of the head, with and without contrast, with stealth – used for mapping of a tumor so that it can be surgically removed.

Answer 70

A

Carotid ultrasound – can tell if there is carotid stenosis, generally will tell the percentage of suspected blockage in the carotid arteries – evaluating the speed, of velocity of flow is important, when compared to previous studies can tell if stenosis is developing.
Transcranial Doppler – used to evaluate for increased velocities in the cerebral arteries – vasospasms develop after a subarachnoid bleed – can lead to reduced blood flow and strokes – this helps to identify if that is developing.

Answer 71

A

Cardiac studies: EKG, Cardiac Monitoring, Echocardiogram, TEE

Neurocognitive testing

Electrophysiological studies:
* EEG, Video EEG monitoring for determination if seizure activity is present – difficult to determine when sedated and unconsciousness.
* EMG nerve conduction study

Answer 72

A

Can be caused by a peripheral or central etiology, or both.
It is the cardinal symptom of vestibular disease that affects your sense of balance.
Experienced as a distinct “spinning” sensation or a sense of tumbling or of falling forward or backward.

Answer 73

A

Should be distinguished from light-headedness, and syncope which are nonvestibular in origin.
* may be a cardiac problem

Answer 74

A

Vertigo: false sensation of movement; spinning
* Can either be central or peripheral related

Presyncope: “lightheadedness”
* Often a cardiovascular problem

Answer 75

A

Sudden transient loss of consciousness and postural tone due to decreased cerebral perfusion
Prognosis often benign unless cardiac cause (vasovagal syncope)

Answer 76

A

Disequilibrium: “bad balance”, “poor equilibrium”
* Multifocal causation, loss of motor function, visual
* Signs and symptoms occur w/ standing or walking and abate when seated/supine
* Continuous

Answer 77

A

disease in the vestibular system

Answer 78

A

Peripheral disease (ear related)
* Onset is sudden, often associated with tinnitus and hearing loss

Answer 79

A

Central disease (nervous system related)
* Develops gradually and then becomes progressively more severe and debilitating
* Not associated with auditory symptoms
* Ataxia is associated – such as gait abnormality, speech changes, abnormal eye movements

Answer 80

A

Benign paroxysmal positional vertigo – most common
Ménière’s Disease
Acute Peripheral Vestibulopathy
Vestibular schwannoma (acoustic neuroma)

Answer 81

A

Migraine
Vertebrobasilar Disease
Multiple Sclerosis
Cerebellar infarction or hemorrhage

Answer 82

A

Nystagmus is unidirectional (primarily horizontal)
The fast phase usually beats towards the normal ear.

Answer 83

A

Purely vertical, does not fatigue, keeps going.
May not be present all the time
VERTICAL WITHOUT vertigo always indicates a lesion in the brain.

Answer 84

A

Most common cause of recurrent vertigo.
Rotatory nystagmus is a classic sign.
Caused by crystals trapped in semicircular canals.
Vertigo that lasts 10 to 30 seconds and that recurs every time the patient assumes a particular position, such as rolling to one side while lying in bed.

Answer 85

A

Not associated with hearing loss, tinnitus, aural pressure or headache.
Occur in clusters that persist for several days.
Dix-Hallpike maneuver reveals a delayed onset fatigable nystagmus-> Reproduces symptoms

Answer 86

A

Epley-reposition maneuver of crystals
* The theory behind the Epley Maneuver is that through sequential head movements, crystals are transferred from the posterior semi-circular canal back to the vestibule of the inner ear.

Medications
* (Antivert) meclizine – manages symptoms only

Answer 87

A

Characterized by sensorineural hearing loss, tinnitus, and vertigo.
Results in accumulation of endolymph in the inner ear, with distortion and distention of the membranous, endolymph-containing portions of the labyrinthine system.

Answer 88

A

Two or more episodes of vertigo
Fluctuating aural fullness
Tinnitus
Hearing loss in the affected ear that is not better explained by another disorder
Low to mid frequency hearing loss demonstrated by audiometry

Answer 89

A

Tinnitus is often described as a low frequency roaring.
Aural fullness may be triggered by high salt meals or caffeine – may not have recognized the connection.
Classic tetrad does not always exist at initial presentation.

Answer 90

A

fluctuating hearing loss
episodic vertigo typically lasting up to 5 hours
tinnitus, and aural fullness

Answer 91

A

horizontal nystagmus during vertigo

Dix-Hallpike Maneuver reveals fatigable nystagmus

Romberg test positive during acute attacks – assesses your ability to stay balanced

hearing evaluation by way of the finger rub, Weber, Rinne
* hearing loss is sensorineural, not conductive – its not a blockage in the ear canal

Imaging/ labs unnecessary if history is convincing that it is Meniere’s.

Answer 92

A

Treatment primarily prophylactic
* elimination of alcohol and caffeinated products – including chocolate
* 80% of patients respond to conservative therapy with salt restriction (1-2g/day) and diuretics
* medications are aimed at symptom reduction: Meclizine (Antivert), Diazepam (Valium)
* steroids may reduce endolymphatic pressure – but for more persistent cases

Answer 93

A

Ménière’sdisease, vertigo seems to occur unprovoked
Benign positional vertigo, it tends to be brought on by rolling over in bed, lifting dishes to the top shelf, turning to check traffic

Answer 94

A

Ménière’s disease or benign positional vertigo, room spins fast
Migraines and anxiety, room spins slow

Answer 95

A

Vestibular neuritis – inflammation of the inner ear
Uncertain pathophysiology (could be a post-viral cause)

Answer 96

A

Clinical picture:
* vertigo gradual onset; resolves in 24-48 hours, but may last for weeks
* incapacitating nausea, vomiting and ataxia
* peripheral nystagmus

Treatment:
* supportive care
* Diazepam or Antivert

Answer 97

A

Are those associated with SAH, cerebral hemorrhages.
Consider if persistent vertigo with vascular risk factors (HTN, DM etc.) or in any elderly patient.

Answer 98

A

includes vertebral artery occlusion/dissection, cerebellar hemorrhage/stroke
can have sudden, severe headaches, dizziness
physical examination may review nuchal rigidity, AMS, focal neurological deficits

Answer 99

A

Headache is the subjective feeling of pain referable to a variety of intracranial & extracranial structures
It is the most common reason for neurological consultation.
Tension type headache is the most prevalent type of primary headaches in the general population

Answer 100

A

Tension Type Headache
Cluster Headache
Migraine

Answer 101

A

Medication Overuse Headache (MOH)
Brain Tumor Headache
Sinus Headache
Hangover Headache
Pseudotumor cerebri, also known as idiopathic intracranial hypertension.

Answer 102

A

Systemic symptoms (fever/weight loss/HTN/stiff stiffness, intolerance of light)
Neurologic symptoms (focal or LOC change, thunder-clap)
Onset (sudden)
Older age(without history of prior headaches)
Progression of previous headache – keeps getting worse, medication is not helping reduce symptoms requiring more

Answer 103

A

The attack of a tension headache is mild to moderate intensity bilateral non-throbbing headache without other associated features.
Current theory relates tension headaches to abnormal, heightened sensitivity.
The most important finding in patients with tension headache is increased head, neck and shoulder muscle tenderness.

Answer 104

A

Tension headaches are typified by a band-like pain around the head or generalized head pain without nausea or vomiting.
Tenderness of the temporalis, masseter, posterior/cervical muscles but physical exam is generally normal.

Answer 105

A

Not associated with focal neurological deficits.
Can be episodic or chronic. Stress, sleep deprivation, hunger and eyestrain are typical causes.

Answer 106

A

Requires at least 10 episodes of headache each lasting 30 minutes to 7 days

Fulfill at least two of the following conditions;
* occurs bilaterally
* pressing or tightening
* mild to moderate intensity
* not aggravated by routine physical activities

Fulfill both of the following:
* no nausea or vomiting
* may be associated with sensitivity to bright lights, loud sounds

Answer 107

A

Recommended acute treatment is simple analgesic
* Aspirin, Ibuprofen, Naproxen, Acetaminophen
* Combination of caffeine, acetaminophen and aspirin or ibuprofen (Fioricet)

Answer 108

A

Treatment of comorbid anxiety and depression is important.
Amitriptyline is preferred for preventative therapy as well.
Avoid narcotics. Medication overuse is the major goal for therapy in treating tension type headache.

Answer 109

A

One of the most painful types of headaches, often described as causing excruciating pain on one side of the head, usually around the eye.

Answer 110

A

Hypothalamic dysfunction – regulation of biological clock – maybe why they occur same time each day
Vascular changes – abnormalities in the blood vessels
Neurochemical imbalances – fluctuations in serotonin – brain’s pathways and contribute to severe pain
Genetic predisposition
Environmental triggers – strong smells, bright lights, alcohol
Smoking and alcohol

Answer 111

A

exclusively a clinical diagnosis from the history and physical
attacks are severe, unilateral orbital, and/or temporal that lasts 15 to 180 minutes

Answer 112

A

red or pink colored eyes due to dilated vessels, watery eyes
nasal congestion
eyelid edema
forehead and facial sweating
constricted pupil (miosis) and/or droopy eyelid (ptosis)

Answer 113

A

a sense of restlessness or agitation
frequency of attacks between one every other day and up to eight (8) per day
imaging studies or lumbar puncture is indicated only in specific clinical settings and to rule out other causes of acute headaches.

Answer 114

A

Oxygen 100% at 15L/min for 15 mins should be tried first.

Triptans (Sumatriptan) subcutaneously or intranasally, helps to change how blood circulates in the brain and how the brain processes pain signals.
* serves as first line treatment, does NOT prevent but CAN stop them during an attack

other medications can include Ergotamine
* neurotransmitter that acts like a vasoconstrictor

Answer 115

A

prophylactic therapy of choice for cluster headaches is verapamil. Valproate and oral corticosteroids are other options

Answer 116

A

Migraine headaches more typically present unilateral, with throbbing or pulsating discomfort.
Usually located in the periorbital region and can extend to the cheek and ear.

Answer 117

A

Typical migraine attack progress is through four phases
* the prodrome, the aura, the headache, and the postdrome

Can often identify triggers as chocolate, red wine, hard cheeses, hormonal changes, exertion and dehydration.

Answer 118

A

Patients often relate a family history of migraine headaches. Women are affected more than men; migraines often follow the menstrual cycle pattern.
Pathophysiology of migraines classically has been attributed to intracranial vasospasm followed by extracranial vasodilation.
Migraines can be associated with other diseases such as seizure disorders.

Answer 119

A

Patients also exhibit irritability and fatigue.
Migraine patients often retreat to quiet, dark rooms and prefer to lie quietly

Answer 120

A

migraine with aura (formally called classic migraine) presents with an aura commonly involving visual changes, field cuts, or flashing lights and partial alteration of visual field
can also be auditory, smell, or taste disturbances

Answer 121

A

occur 5-30 minutes before pain onset
visual auras are the most common
sensory auras such as numbness and tingling in a limb are second most common

Answer 122

A

at least 2 attacks with at least 1 of the following aura’s:
* visual, sensory, speech/language, motor

has at least 3 of the following 6 characteristics:
* at least one aura symptom spreads gradually over or equal to 5 minutes,
* 2 or more symptoms occur in succession
* each individual aura symptom lasts 5-60 minutes
* at least one aura symptom is unilateral
* at least one aura symptom is positive
* aura is accompanied or followed by a headache

Answer 123

A

Migraine without aura (formally called common migraine) frequently is accompanied by nausea, vomiting, photophobia.
* can be more disabling to the patient than the actual head pain

Headache lasts 4 to 72 hours

Answer 124

A

at least five attacks

headache attacks last 4-72 hours

headache has at least 2 of the following characteristics:
* unilateral, pulsating, moderate or severe pain, aggravation by or causing avoidance of physical activity

during headache, at least one of the following:
* Nausea, vomiting, or both photophobia and phonophobia

Answer 125

A

Routine laboratory tests are done only to help rule out other concurrent disorders such as infections, stroke, seizures, or toxins.
Imaging studies such as a head CT with and without contrast, or a lumbar puncture is done only in selected clinical settings and then only to rule out causes of acute secondary headache.
simple procedures such as an fundoscopic exam can identify intracranial pathology

Answer 126

A

Initially treat with IV anti-emetics and pain control; NSIAD’s such as Toradol and hydration.

Abortive therapy may include aspirin, acetaminophen, NSAIDs.

Migraine with aura that no longer responds to NSIADs, guidelines recommend the use of Triptans.
* Triptan can shrink swollen blood vessels in the brain and quieting down overactive pain nerves

Answer 127

A

medical prophylaxis for migraine might include beta blockers, tricyclic antidepressants, calcium channel blockers, NSAIDs.
biofeedback therapy is often employed to help reduce number of headaches
botox injections may be helpful for severe, intractable migraines.

Answer 128

A

Migraine – Unilateral, often around the temples, forehead, or eye, intense, throbbing pain, often associated with nausea and sensitivity to light/sound, lasting hours to days, with potential aura.
Cluster –Unilateral, often around the eye or temple, excruciating, short-lived pain around one eye, occurring in clusters, with eye/nasal symptoms and restlessness.
Tension –Bilateral, often around the forehead or temples, mild to moderate, constant pressure or tightness around the head, often related to stress or muscle tension, lasting from 30 minutes to days.

Answer 129

A

may develop from any primary headache
* over-the-counter combination analgesics should be limited to ≤ 9 days a month on average
* Nonsteroidal anti-inflammatory drugs (NSAIDs) should be limited to ≤ 15 days a month

Answer 130

A

Post-traumatic headache
* begins within 3 months of TBI

Subarachnoid Hemorrhage Headache
* sudden onset “worst headache of my life” (80% due to ruptured aneurism)

Answer 131

A

Temporal Arteritis ( AKA giant cell arteritis, inflammation of the temporal arteries)
* UNILATERAL jaw pain, discomfort and scalp tenderness with reduced vision
* ESR is high but biopsy is diagnostic
* treatment (prednisone) should not be delayed until biopsy
* headache patients who are older than 60 yoa, temporal arteritis should be considered

Answer 132

A

Neoplasm Headache: Change in pattern or new onset headache (especially in elderly)
Sinus Headache: Facial distribution with sinus symptoms
Trigeminal Neuralgia : Distribution of CN V; typically, maxillary (V2) and mandibular (V3)

Answer 133

A

Elevated ICP w/o focal lesion or hydrocephalus
Common in young, obese women, poorly understand MOA
Aggravated by Valsalva
Sxs: Papilledema and increased opening pressure on lumbar puncture
Tx: Loop diuretics, conservative treatment

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Lecture 7 (Neuro) - Exam 3 Flashcards

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