Neuro Flashcards
What are the signs/symptoms of a tension headache?
Non-pulsating, band-like pain
Tends to worsen over the course of the day
What is the treatment for a tension headache?
NSAIDs
Lifestyle changes
Triptans for refractory/severe symptoms
What are the signs/symptoms of a migraine?
Gradual onset
Periodic, throbbing/pulsatile pain (mod-severe) (typically lateralized)
N/V
Photo/phonophobia
Fatigue
Irritability
What is the treatment for a migraine?
If new, full workup of new acute HA
NSAIDs
Sleep
Vasoconstrictors
Triptans
Avoid triggers
When/how would you give prophylaxis for migraines?
More than 4 HA/month (beta blockers, SSRIs, gabapentin)
Which type of HA is more common in men than women?
Cluster HA
What are the signs/symptoms of a cluster HA?
Sudden, unilateral, transient, very severe/incapacitating pain
Non-throbbing
Not worse w/activity
Pt appears restless
Ipsilateral nasal congestion
Lacrimation/tearing
What is the treatment for a cluster HA?
100% O2
Triptans
Ca+ channel blocker (verapamil)
Prophylaxis (if meets criteria)
What is your suspected diagnosis if a pt presents with complaints of a unilateral HA w/tenderness to palpating temporal artery, and their labs reveal an elevated ESR/CRP?
Temporal arteritis
What is the treatment for temporal arteritis?
Temporal artery biopsy
High dose oral prednisone
Monitor ESR/CRP
What is your suspected diagnosis if a pt presents with pain and paresthesias in thumb, index, middle, and ring finger that gets worse as night and also describes feeling as if their extremity is “weak”?
Carpal tunnel syndrome
What is a test that can be ordered to confirm suspected carpal tunnel syndrome?
Nerve conduction test
What are the treatment options for carpal tunnel syndrome?
Splint
Injections
Surgery
What are the signs/symptoms of diabetic peripheral neuropathy?
Stocking glove distributed numbness
Mild (progressive) weakness of lower legs
Decreased DTRs
Gait abnormalities
Distal hair loss
Muscle wasting
What is the definition of syncope?
Abrupt onset LOC lasting a few seconds to a few mins. w/a full recovery
May be mildly disoriented (no post-ictal state)
What is ataxia?
Loss of muscle control in the arms and legs
May lead to a lack of balance, coordination, and trouble walking
May affect the fingers, hands, arms, legs, body, speech, and even eye movements
What are the signs/symptoms of MS?
Sensory disturbances: weakness, visual disturbances, balance issues, tightness in trunk & chest, diplopia
Relapse Presentation: new or worsening symptoms that develop acutely and last 24 hours w/o fever or infection, visual changes (optic neuritis), unilateral numbness, Lhermitte’s Sign (electrical sensation)
What is the treatment for MS?
Refer to neuro
Manage symptoms
Prevent relapse & disability
Exercise
Injections (copaxone - can use in pregnant pts)
Oral meds for mild cases
Infusions (Ocrevus)
Steroids for relapse IV or PO (IV Solumedrol PO Prednisone)
Plasma exchange if refractory
What is your suspected diagnosis if a pt presents with sudden unilateral paralysis of their face and dryness in the ipsilateral eye?
Bell’s Palsy
What is the treatment for Bell’s Palsy?
Corticosteroids (Prednisone)
Lubricating eye drops
Neuro consult
What are the signs/symptoms of Guillain-Barre Syndrome?
Dysesthesias
Paresthesias of feet and hands that spreads by the hour
Acute symmetric ascending weakness of limbs
Areflexia
Back & leg pain
Cardiac arrhythmias
Respiratory muscle paralysis can cause death
Guillain-Barre Syndrome is commonly preceded by what?
URI (campylobacter Jejuni)
What is the treatment for Guillain-Barre?
Admit to hospital
Pain mgmt
DVT prophylaxis
Plasma exchange
IVIG
What are the signs/symptoms of Myasthenia Gravis?
Insidious onset
May be preceded by infection/illness
Ptosis
Diplopia
Swallowing difficulties
Respiratory difficulties
Limb weakness
Symptoms fluctuate
Increased weakness at the end of the day
What is a diagnostic test specific to Myasthenia Gravis work up?
Tensilon challenge
What is the treatment for Myasthenia Gravis?
Anticholinesterase (pyridostigmine)
Thymectomy
Immunosuppressants
IVIG
Pt education
Refer to neuro
What are signs/symptoms of ALS?
Focal wasting of muscle groups
Limb weakness w/varying symmetry & distribution
Gait disturbance
Dysphagia
Dysphonia
Fasciculations
Cognition typically intact
Is there a treatment for ALS, if so what is?
No curative treatment
Outpatient supportive care
Refer to neuro
What are similar symptoms seen in bacterial and viral meningitis?
HA
Fever
Stiff neck
What are symptoms specific to bacterial and viral meningitis?
Bacterial: N/V, malaise, rash, AMS
Viral: may have viral prodrome, less ill than bacteria
What is the treatment for bacterial meningitis?
Abx (cephalosporin & vanc)
Corticosteroids
What is your suspected diagnosis if a pt presents with facial droop, drowsiness, confusion, focal neurological deficits, and upper extremity weakness?
Ischemic stroke
What is the treatment for an ischemic stroke?
tPA if < 3 hours since onset of symptoms
Allow for higher BP
PT/OT
What are the signs/symptoms of hemorrhagic stroke?
Lacunar infarcts
HA
N/V
LOC
Seizures
Increased ICP
What commonly presents with pts stating they are experiencing “the worst headache of their life”, or describe it as a thunderclap headache?
Subarachnoid hemorrhage
What is the treatment for subarachnoid hemorrhage?
Moderate control of BP
Surgical clipping or endovascular coil of aneurysms
Ca+ channel blocker
More aggressive treatment of HTN at discharge
What is the most common and most aggressive of the primary brain tumors?
Glioblastoma Multiforme
What is the prognosis/treatment options for Glioblastoma Multiforme?
Poor prognosis and rapidly progressing
Radiation and chemo may prolong life
Full surgical resection unlikely
What is the presentation of a seizure?
Usually begin w/arrest of motion & blank stare
May have convulsions
May lose control of bowel/bladder
May have a prodrome
Post-ictal state following event
What are common meds used to treat seizures?
Keppra
Ethosuximid for absence
What are the different types of seizures?
Partial (localized) or generalized (global)
Simple partial: no impairment of consciousness, motor signs
Complex partial: consciousness impaired
Generalized: non focal origin;
Absence seizures (typical - staring/lack of attention or atypical - associated w/movement)
Myoclonic seizures (tonic, clonic, or tonic-clonic)
Atonic seizures
What is status epilepticus?
Active seizure lasting 5 mins or longer, a 2nd seizure w/o recovering from 1st, or repeated seizures for 30 mins or longer
What is the treatment for status epilepticus?
O2
Ativan (IV or rectum)
Anticonvulsants
What are the signs/symptoms of Parkinson’s?
Tremor (pill-rolling that stops w/ purposeful use of hand)
Bradykinesia
Rigidity (cogwheel)
Postural instability
Flat affect
Cognitive dysfunction/maybe psychosis or depression
Seborrheic dermatitis
Fatigue
What is the treatment for Parkinson’s?
Carbidopa/Levodopa
MAO-B inhibitors
Amantadine
Botox
DBS
PT/OT
How do patients get Huntington’s disease?
It is inherited
What are the signs/symptoms of Huntington’s?
Dysarthria
Dysphagia
Apraxia
Involuntary movements
Cognitive decline
Impulsivity, irritability, depression
What diagnosis has been called “mad cow disease”?
Creutzfeld-Jacob Disease (CJD)
What are the signs/symptoms of Creutzfeld-Jacob Disease (CJD)?
Personality changes
Anxiety/depression
Impaired motor coordination
Insomnia
Blurred vision
Speech difficulties
What is your suspected diagnosis if a pt presents with complaints of loud snoring w/gaps in breathing, waking up tired, and daytime sleepiness?
Obstructive sleep apnea
What is the treatment for obstructive sleep apnea?
CPAP
BiPAP
Surgical removal of uvula
Dental device
Weight loss
Tracheotomy (gold standard)
