Nervous System Flashcards
What are red flags for headache
- thunder headache
- worst headache of my life
- first headache at 50 years or older
- sudden change in LOC
- focal neurological signs (unequal pupil size, hemiparesis, loss of function, poor gag reflex, difficulty swallowing, aphasia, sudden loss of vision, visual field defect)
- Headache with papilledema
Sudden and rapid onset of severe headache described as the worst headache of my life, nausea and vomiting, neck pain or stiffness. Photophobia, and visual changes with rapid decline in LOC
-Subarachnoid hemorrhage
Acute onset of high fever, severe headache, stiff neck (nuchal rigidity), meningismus with alerted mental status. Classical purple petechial rash
Meningitis
Acute onset of headache that is located over 1 temple of an older patient. May experience burning pain over temporal artery. Indurated, cord-like temporal artery.
-Visual issues, blindness in affected eye (amaurosis fugax), elevated ESR/CRP
Temporal arteritis
Acute onset of stuttering/speech disturbances, one-sided facial/arms/leg weakness (hemiparesis)
Stroke
Episodic visual loss or diplopia, problems with balance and walking, numbness, paresthesias on one side of the face. Accompanied by urinary incontinence, bowel dysfunction. Lhermittes sign (bending forward/flexion creates an electric shock)
-MS
The trigeminal nerve has 3 branches
- Ophthalmic (V1)
- Cheek (V2)
- Jaw (V3)
Biceps reflex responds to what spinal cord segment
C5, C6
Triceps reflex responds to what spinal cord segment
C7, C8
Patellar reflex responds to what spinal cord segment
L3, L4
Achilles reflex responds to what spinal cord segment
S1, S2
CN IX (9) innervates
the movements of the soft palate
CN XII (12) innervates the
tongue
What is Kernig’s Sign
- Flex patients hips one at a time then attempt to straighten the leg while keeping the hip flexed at 90 degrees
- If resistance to leg straightening this is +
What is Brudzinski’s
Passively flex/bend the patients neck towards the chest
+ if patient reflexively flexes the hips and knees to relieve pressure and pain
Rash at tip of nose and temple area you must
rule out shingles of the trigeminal nerve
Mild TBI is defined as a GVS score ___ to ___
13-15
Sx of TBI include
- confusion
- headache
- dizziness
- vertigo
- poor balance
- nausea
- comiting
Indications for hospital admission after TBI
- glasgow coma scale <15
- Seizure or other neuro defects
- Recurrent vomiting
- Abnormal head CT
What is the classic presentation of MS
- episodes of visual loss
- diplopia
- nystagmus
- vertigo
- problems with balance and walking
- foot drop
- numbness and paresthesia
- bowel or urinary incontinence
- Lhermittes sign
What is lhermittes sign
Bending neck forward in flexion produces an electric shock like sensation that runs down the back of the neck
What is the treatment of acute bacterial meningitis
-3rd generation cephalosporin IV plus chloramphenicol IV
What is the prophylaxis of close contacts with meningitis
-rifampin PO or Ceftriaxone IM
Scotomas are
blind spots in the visual field
Throbbing unilateral pain, photophobia, phonophobia and nausea/vomiting
Migrane
Intense, brief, sharp stabbing pain, one cheek
Can be aggravated by cold,walking, touch, chewing
Trigeminal neuralgia
Severe ice pick piercing pain behind one eye and temple with tearing, rhinorrhea, ptosis and miosis (horner syndrome)
Cluster headache
How is temporal arteritis treated
High dose prednisone for severe weeks
Bilateral joint stiffness and aching located in the posterior neck, shoulders, upper arms, hips (pelvic girdle)
PMR
What is first line treatment of Trigeminal neuralgia (Tic Douloureux)
High dose anticonvulsants like carbamazepine or tegretol
With trigeminal neuralgia what imaging is indicated and why
-MRI or CT to rule out tumor or artery pressing on nerve
Bells palsy is associated with cranial nerve
VII
What is the treatment plan for bells palsy
High dose glucocorticoids x7 days and wean + valacyclovir or acyclovir
To limit rebound headaches then limit NSAID use to ____ days
<15 days
ABCD2 score for stroke risk after TIA
Age >65 (1) BP >140/90 (1) Clinical features of TIA -unilateral weakness +/- speech impairment (2) -Speech impairment without weakness (1) Duration of TIA ->60 minutes (2) -10-59 mins (1) Diabetes
What are risk factors for stroke
- a.fib
- hypertension
- aneurysm
- trauma
- bleeding abnormalities
- use of anticoagulants
- use of stimulants
- sickle cell disease
- DM
- OCP use
- smoking
- thrombophilia
What are side effects of triptans
- nausea
- dizziness
- vertigo
- drowsiness
- discomfort of throat/nose/tomgie
What are side effects of NSAIDs
- GI pain/bleeding/ulceration
- renal damage
- increased BP
Management of Acute Migraine
- ice pack on forehead
- rest in quiet room
- triptan
- Torodal
- Prochlorperazine for nausea
Prophylaxis for Migraine
- Amitriptyline
- Beta Blocker
- Venlafaxine
- Topiramate
Management of Cluster Headaches
- 100% O2 at 12L/min via mask
- Intranasal 4% lidocaine
What are side effects of tricyclic antidepressants
sedation, dry mouth, confusion
What are contraindications of beta-blockers
- 2nd or 3rd degree AV block
- Asthma
- COPD
- Bradycardia
Butterbar is an alternative remedy for
Headache
Migraines can last
3 to 72 hours
