Neuro Flashcards
Symptoms of chronic subdural hematoma
hx of head trauma (falls, accidents) with headache and gradual cognitive change (apathy, somnolence, confusion)
risk factors for chronic SDH?
- ETOH
- age (elderly)
- on anticoagulants and ASA
What is Lhermitte sign?
What disease does it occur in?
Lhermitte sign: bending neck forward/flexion causes electric shock-like sensation down back
MS
-can also occur in other conditions eg transverse myelitis, behcet’s, B12 deficiency, spinal cord compression etc
gag reflex is tested with which cranial nerve(s)?
CN IX and X - glossopharyngeal and vagus
which sensory test is the first to be abnormal in early peripheral neuropathy?
(vibration, sharp-dull touch, temperature, stereognosis, graphesthesia)
vibration
Shingles of CN ______ can result in corneal blindness
CN V (trigeminal)
How is mild TBI defined on GCS?
defined as GCS 13-15 measured 30 min after injury
Meningitis
triad of classic symptoms?
fever
altered mentation
nuchal rigidity
“FAN”
Acute bacterial meningitis
What is seen on CSF findings?
- elevated WBC
- low glucose
- elevated protein
- bacteria isolated from CSF
Acute bacterial meningitis
What patients should have CT head done BEFORE LP?
-if at risk for cerebral herniation
Papilledema focal neurologic deficit abnormal LOC new onset seizures (within 1 week) hx of CNS disease immunocompromised (HIV, solid organ/BMT, immunosuppressed)
What 2 organisms are responsible for majority of bacterial meningitis (community acquired)?
S. pneumoniae followed by N. meningitidis
bacterial meningitis
what needs to be done for close contacts to invasive meningococcal disease?
need chemoprophylaxis:
- rifampin
- ceftriaxone
within 24 hours up to 10 days after last contact
What are some non-pharm measures to prevent migraine headaches?
what foods are triggers?
Avoid precipitating foods/meds
• MSG, chocolate, nitrates (hot dogs, lunch meats, sausage), red wine, beer, caffeine
Stress management
Sleep
Odour triggers: smoke, perfumes
Visual triggers: strobe lights, sunlight, glares
What are contraindications to prescribing triptans?
CONTRAINDICATIONS TO VASOCONSTRICTING DRUGS
• Suspected or known CVD (angina, MI, PAD)
• Suspected or known CVA and/or TIAs
• Hyperlipidemia, males > 40, menopausal females
• Uncontrolled HTN
• complex migraines
Common side effects of triptans?
flushing, tingling, chest/neck/sinus/jaw discomfort
Triptan use should be limited to _____ days/month to reduce risk of medication overuse headache
10
watch for serotonin syndrome when triptans are combined with ________
SSRI/SNRI
MAOI
Symptoms of migraine with brainstem aura?
• Rare subset of migraine with aura
• Looks like stroke without hemiplegia
• Aura symptoms: unilateral/bilateral visual disturbance, vertigo, ataxia, dysarthria, bilateral tingling, numbness of face
• Throbbing occipital headache and nausea
25% will have LOC lasting 2-30 min
NO MOTOR symptoms
what medication is part of management of giant cell arteritis?
high dose prednisone 40-60 mg by mouth daily for weeks
amaurosis fugax (transient monocular loss of vision) is associated with _______
giant cell arteritis
signs and symptoms of polymyalgia rheumatica
• Aching and morning stiffness last >30 min, worse with exertion, may be severe
○ “gel phenomenon” - severe morning stiffness that can last until afternoon, stiffness with inactivity
• Neck, shoulder girdle, hip girdle
• At least 1 month
Age 50+, peak age 70-79, F>M
what is the treatment approach for cluster headaches?
O2: 12 L/min via NRB x 15 min do not use if COPD
triptan (usually sumatriptan 6 mg sc)
what medications are used as prophylaxis for cluster headaches?
verapamil (calcium channel blocker) if frequent attacks
*avoid grapefruit juice, ECG if dose >400 mg
prednisone (high dose with taper) if infrequent attacks
how long do cluster headaches last for?
15 min to 3 hours
