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
what is the workup for cluster headaches?
MRI with contrast for all suspected cluster headaches
what medication is used as prophylaxis for tension type headaches?
TCA (eg amitriptyline)
second line: mirtazapine, venlafaxine
what is the most common type of headache?
tension type
what is the definition of medication overuse headache? (frequency of headaches and time period)
Headaches occurs >15 x /month due to overuse of HA rx for >3 months
Medication overuse headaches
What is the definition of overuse?
Regular intake for 10+ days/month for >3 months of ergotamines, triptans, opioids, or combo drugs
Regular intake for 15+ days/month for >3 months of simple analgesics (tylenol, ASA, NSAID)
Medication overuse headaches
What is the goal limit for use of analgesics?
- OTC or triptans: 9 or less days/month
- NSAIDs: 14 or less days/month
- Butalbital: 3 or less days/month
TIA
ABCD2 score - what does each stand for?
age (>60) blood pressure (SBP >140, DBP >90) clinical features duration of symptoms (under or over an hour) diabetes
If score 3+ –> refer to ED for hospitalization
target BP control for TIA?
bonus! what antihypertensive class is recommended?
• Target BP <140/90 in most
○ <130/80 in diabetic or lacunar strokes or hx ICH
ACE-I and thiazide
what is the duration of symptoms to meet definition for TIA?
TIMING has been removed as part of definition of TIA
-can have permanent injury with TIA
however ABCDD score use 10-59 min and 60+ min to stratify risk
what does FAST stand for?
- face drooping
- arm weakness
- speech difficulty
- time to call 911
what is preferred imaging for TIA/CVA?
diffusion-weighted MRI
within 24 hours
which blood vessel is most commonly affected by ischemic strokes?
middle cerebral artery
what is the time frame for giving alteplase for ischemic stroke?
4.5 hours
what is the difference between Broca’s aphasia and Wernicke’s aphasia?
Broca’s aphasia: expressive aphasia (<4 words) - difficulty with speech but can read ok
Wernicke’s aphasia: receptive aphasia - difficulties with comprehensive but can speak ok
RISK FACTORS for carpal tunnel?
- pregnancy
- repetitive motions
- DM
- RA
- obesity
- hypothyroidism
What are the three special tests for carpal tunnel?
Positive = reproduction of symptoms with….
Tinel’s: percussion
Phalen: reverse prayer x 1 min
Durkan’s: manual compression x 30 sec
What diagnostic test should be done for suspected Bell’s palsy?
Lyme disease if in endemic area
Facial nerve palsy is an acute neurologic manifestation and the most common cranial neuropathy associated with Lyme disease. Facial nerve palsy due to Lyme disease may be bilateral and may occur with or without meningitis. Additional findings suggestive of possible Lyme disease include erythema migrans, fatigue, headache, arthralgias, and lymphadenopathy
migraine with aura
how long do auras last for?
max 1 hour
*if longer than one hour then consider alternate diagnosis
At least three of the following six characteristics:
•At least one aura symptom spreads gradually over ≥5 minutes
•Two or more symptoms occur in succession
•Each individual aura symptom lasts 5 to 60 minutes
•At least one aura symptom is unilateral
•At least one aura symptom is positive
•The aura is accompanied, or followed within 60 minutes, by headache
is it more common to have migraines with or without aura?
migraine without aura (80%)
herpes ophthalmicus
affects which cranial nerve?
CN V
Ramsay Hunt syndrome affects which cranial nerve?
CN VIII
