Mod 2 Neuro

Question 1

Mild vs moderate vs major TBI

Answer 1

Mild = concussion = GCS 13-15, LOC <10 minutes
Moderate = GCS 9-13, LOC >10 minutes
Major = GCS <8 / comatose, LOC >10 minutes

Question 2

Criteria to be DC home after TBI

Answer 2

-must be mild TBI with GCS 15
-CT head negative
-Need to have supervision for 24 hours - someone responsible; wake patient up Q2H

Question 3

Criteria to send TBI patient to hospital

Answer 3

-LOC >10 minutes
-Moderate or severe TBI (GCS 9-14)
-No supervision
-Post-trauma seizure
-CT: lesion
-Focal neuro deficit
-GCS <8 –> emergency ASAP with neurosurgery eval

Question 4

Concussion/TBI signs and symptoms

Answer 4

-Personality change
-Unable to control emotions
-HA
-Blurry/double vision
-Slurred/slow speech
-Neuro deficits
-Unsteady gait
-Battle sign (bruising behind ears)
-Raccoon eyes
-dazed look
-Vomiting
-Confusion
-Seizures

Question 5

When is CT head indicated for patient with head trauma

Answer 5

decreased LOC
Open head wound
Penetrating head injury
High risk intracranial injury (ex: blood thinners)
Amnesia
Older patients >60
Patients with major TBI
Patients LOC >5 minutes and GCS <15
Headaches
Seizure
Neuro deficits
Alcohol/substance use

Question 6

Bell palsy onset

Answer 6

<72 hours

Question 7

Bell palsy symptoms

Answer 7

one sided face paralysis
asymmetric smile
unable to close eye
tearing
smooth forehead
drooling
flattened nasolabial fold
tinnitus
altered taste (dysguesia)
post auricular pain

Question 8

Bell palsy etiology

Answer 8

unknown but often caused 2/2 inflammation after viral infection

Question 9

what is bell palsy

Answer 9

acute, unilateral paralysis or weakness of the facial nerve

Question 10

Common history/preceding symptoms of bell palsy

Answer 10

ipsilateral ear pain a few days prior
recent URI/viral illness
recent infection (HIV, varicella)
Lyme disease - tick bite in endemic area, new rash

Question 11

Treatment for bell palsy

Answer 11

glucocorticoids - best to start within 3 days of symptom onset
Eye protection and care - tape shut, artificial tears

severe cases - can also do antivirals with the steroids

Question 12

patient education: bell palsy

Answer 12

-bell palsy causes unilateral face paralysis; usually 2/2 inflammation from virus
-self-limiting - most people make full recovery
-eye protection important
-glucocorticoids treatment of choice
-prognosis - 70% of patients recover spontaneously by 3-6 months; with steroids complete recover 80-85%
-can take up to 6 months to get back to normal - some people do not recover fully - have weakness in face that does not go away

Question 13

peripheral causes of vertigo

Answer 13

benign paroxysmal positional vertigo (BPPV)
acute labyrinthitis - usually viral or bacterial
vestibular neuronitis - inflammation of CN8 usually viral
meunière disease - disorder of inner ear
ototoxicity (due to medication)
head trauma

Question 14

what is vertigo

Answer 14

illusion of movement of self or environment - room spinning, head spinning, head tilting, swaying back and forth

Question 15

what are central causes of vertigo

Answer 15

brainstem hemorrhage
brain tumor/lesion
MS
migrainous syndrome

Question 16

causes of presyncope

Answer 16

cardiac - hypotension, heart block, aortic stenosis, arrhythmias, sick sinus syndrome, mitral valve prolapse
non-cardiac - dehydration, hypotension, valsava-related syncope

*usually cardiac cause

Question 17

what is presyncope

Answer 17

feeling dizzy/woozy/like you are going to faint

actual syncope = fainting

Question 18

what is disequilibrium

Answer 18

sense of insecurity / imbalance / unsteadiness while walking

Question 19

causes of disequilibrium

Answer 19

parkinsons
MSK problem
peripheral neuropathy
CVA