Neuro Flashcards
Headache History Template
OCD
PQRST
better/worse
Assoc Sx
BMMMCSA
Red Flags
F-AMPLE
So SAD
4P
BMMMCSA Acronymn
HEADACHES
Bleed
Meningitis
Migraine
Med overuse
Cancer
Stroke
Arteritis
Meningitis key symptoms
- FEVER, HEADACHE, NECK STIFF
- N/V/photo & phonophobia
- seizures
- rash
- FND
very similar presentation to migraine w aura
*ask if recent ear/sinus infection
*live in dorm/military barracks
*trauma/skull fracture
*pregnant
*immunocomp
Focused meningitis exam
- general inspection (orientation, alert/discomfort, rashes, palpate LNs)
- GCS
- special tests: neck flex, Bruzinkski, Kernig’s, Jolt (side to side worsens HA)
- mini CN exam
- fundoscopy to r/o papilloedema
- complete full neuro exam & cardio/resp examination
***high ICP: papilloedema, altered mental sattus, FND, do CT head, N/V esp in morning, worse HA bending over/valsalva
Differentials for young person with headache & fever
- meningitis
- SAH
- Intra-cranial mass
- Encephalitis
- Stroke
Investigations & management for meningitis
Investigations:
- full physical exam & vitals WITH PPE
- labs (assessing organ dysfunction) always glucose with altered mental status
- BLOOD CULTURE
- non-con CT to r/o brain bleed
- LP (low glucose, high protein, high WCC)
Mx:
- Admit & isolate, IVFs & pain meds
- hourly obs & monitoring for sepsis signs
- IV antibiotics
- ID & Neuro consult, alert PH & treat close contacts (rifampicin/cipro)
- Vaccinate
Mx for bacterial meningitis
- Admit & isolate, IVFs & pain meds & anti-emetics
- hourly obs & monitoring for sepsis signs
- IV antibiotics (vanc & ceftriaxone & amp) & steroids
- ID & Neuro consult, alert PH & treat close contacts
Signs of elevated ICP
papilloedema, altered mental sattus, FND, do CT head, N/V esp in morning, worse HA bending over/valsalva
Meningitis differentials
Migraine with aura
SAH
Stroke
Most common early symptoms of MS
- optic neuritis (pain, loss of vision & colour, double vision)
- paraesthesias in face or extremity
- weak/clumsy hand or leg
Key MS symptoms & structure of history
- Cognitive - mood, labile, memory, conc
- FATIGUE
- eyes - nystagmus, double, loss of vision, pain
- dysarthria, slurring/stutter, dysphagia
- numb/tingle/burning
- muscle weakness/cramp/spasms/tremor
- loss of balance/falls
- bladder
- bowel
- *seizures & vertigo
**UHTHOFF - HEAT!!!
****LHERMITAGE - electric shock when flex neck
*ASK ABOUT OTHER AI CONDITIONS & FHX!!!!
In order to be a true relapse, sx have to present >24h and must have been normal for 30d (heat related increases not included unless meet this criteria)
Head to toe
MS differentials
Numb/tingling/weakness
- stroke
- neuropathy (B12, DM, alcohol)
- migraine with aura
- mass
- inflammatory (SLE, Lyme, Sarcoid, vasculitis, HIV, Syphilis)
- electrolyte & glucose & thyroid disturbances
MS investigations
- Serology to rule out other possibilities (CBC, electrolytes, BUN & Cr, glucose, b12, folate, TFTs, hba1c, CRP ESR, AI markers (SLE), HIV, VLDR, lyme, ACE)
- if suspecting stroke - non-con CT head
- Brain & spinal MRI
- Visual evoked potentials
- CSF (IgG & oligoclonal bands)
MS Mx
- Consult neurology
- Admit the patient
- Acute flare: IV steroids 3-5 days or plasmapharesis (if not responding to steroids)
- DMARDS - IFN-beta
- Baclofen - spasticity
- gabapentin/TCAs for pain
- Vit D
MS physical exam findings
- optic neuritis, RAPD (swinging test), nystagmus and INO (conj lateral gaze palsy)
- facial weak/paresis
- muscle weakness
- swallowing? slurring speech
- cerebellar signs - nystagmus, dysdia, **intention tremor ** dysarthria
- romberg +
- hypertonic, hyperreflexic, Babinksi + and clonic
**UMN lesion - forehead spared
