nervous system Flashcards
dangerous headaches
thundercalp
sudden
bacterial meningitis
stiff neck, classic purple colored petechial rash. emergency
temporal arteritis (giant cell arteritis)
headache one side of temple
temple has indurated, red, cordlike artery, tender
jaw pain (artery obstruction)
at risk: poymyalgia rheumatica
narrow angle glaucoma
ED
headache/pain behind an eye, n/v
cornea an looks hazy, pupil is dilated midway
stoke
hemorrhagic- uncontrolled HTN, abrust heacha, nuchal rigidity
embolization (afib, immobilzation )
subarchnoid hemmorhage
“worse headache of my life”, stiff neck,
mini mental exam
orientation reigstration (recite 3 unrelated words) attention calculation spell "world" backward or serial 7's look for aphasia (difficulty speaking)
cerebellar system
romberg
romberg- arms/hands staring on each side, close eyes.
positive- swaying
next, tell pt to hold arms straight
tandem gait
walk straight
then walk, toe to toe
sensory tests
vibration - use 128 hz and place distal joint of each thumb
shar/dull
temperature
stereognosis
ability to recognize familiar object through touch
graphesthesia
ability to identify number or letter written on skin
motor exam
gait, pronator drift , pincer grasp, etc
reflexes grading
0= no response 1= low response 2= NORMAL 3= brisk 4=clonus
quadricep reflex ( knee jerk)
tap patellar
reflex center at L2 to L4
achillis reflex
L5 to S2
plantar reflex
L4-S2
test for meningeal irritation
kerning’s sign: resistance to leg straight dt hamstring tightness ( or c/o back pain)
brudzinski’s flexes hips/knee when head is passively flexed
nuchal rigitiy: touch chest with the chin= pain
.
Cranial nerve test for zoster
CN 5 (trigeminal) ophthalmic branch can lead to corneal blindess
cranial nerves
Olfactory Optic Oculomotor Trochlear Trigeminal Abducents Facial Acoustic Glossopharyngeal Vagus- damage causes increase heart rate, difficulty swallowing Spinal accessroy Hypoglossal
bacterial meningitis
acute bacterial infection of the brain/spinal cord (S. pneumonia, N. meningitides, H. influenza
3 main s/s:
fever
nuchal regidity
labs for meningitis and rx
lumbar puncture: CSF (cloudy csf), MRI
Rx: IV cephlasporins plus chloramphenicol
infants: ampicillin
>50: amoxcilllin plus 3rd genertion cephalosprin
Prophylaxis oaf close contact with rifampin or ceftriaxon. REPORTABLE
3 most common bacteria strain for meningitis
Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), and Haemophilus influenzae type b (Hib).
migraine tx
5 HT 1 agonists: sumatriptain (imitrex)
first, r/o cardiovascular disease (MI, angina, CVA, TIA)
do not start within first 2 wks of maoi use
propylactic migraine tx
propranolol (Inderol)
TCA: amitriptyline (elevil) at HS
neurontin
tests and tx for temporal arteritis (giant cell arteritis)
tests: ESR and SED rte
normal rnge ESR 0-22 (men), 0-29 (women)
tx: high dose prednisone
high risk of blindness (refer to ophthalmologist asap for biopsy and tx)
polmyalgia rheumatica
high risk for developing temporal arteritis!
s/s: morning stiffness and aching (shoulders, hips, torso (diffictuly putting on clothes/bra).
trigeminal neuralgia (tic doulourux)
3 divisions; opthalmic, maxi ally, and mandibular
unilateral headache dt compression of nerve root, located near nasal and cheeks ( near nose/chewing area)
tx: high dose anticonvulsants (i.e. carbamezipin/tegretol or phenytoi/dilantin. MRI
bells palsy
unilateral facial paralysis dt dysfunction of CN 7 (facial). tear production on affected side may stop.
viral, autoimmune, pressure from a tumor
rule out: stroke, TIA, mastoid infection, fracture, lyme disease, tumor
corticosteroids at high dose x 10 days
acyclovir if herpes suspected
copmlications- corneal ulceration
cluster headache
SEVERE one sided headache
“ice pick” behind one eye, tearing
several times a day, resolves spontaneously
tx: high dose 02 ( don’t use if COPD)
Sumatriptan (imitrex)
rebound headache
over use of nsaids, aspirin, narcotics. taper the dose
TIA
resembles a stroke but resolves in 24 hours.
test for carpal tunnel syndrome
tinel’s sign (pins and needles when tapping wrist)
phalen’s sign (full flexion of wrist for 1 min causes tingling sensation of media nerve.
bilateral headache
muscle tension ( all others are unilateral )
trigeminal neuralgia (tic douloureux)
pain on ONE side of the face/cheek precipitated by talking, chewing, cold food, cold air
cluster headache
ONLY headache accompanied by TEARING and NASAL CONGESTION. sever pain ONE side of eye.
middle aged males
risk of suicide.
