Neuro 2 pt4

Question 1

5% of headaches are due to neuro disorders, such as (3)

Answer 1

post-traumatic H/A, cervical spine dz, structural intracranial processes

Question 2

Evaluation for new onset H/A - one big criteria to ask/assess

Answer 2

Change in work or lifestyle (disability)

Question 3

headache that starts btw. childhood and early adulthood (80% starts under age 30)
highly prevalent, largely familial d/o characterized by periodic, usu. unilateral, often pulsatile h/a
majority are genetically linked

Answer 3

Migraine

Question 4

2 types of tx a migraine

Answer 4

Acute attack tx

Preventative tx

Question 5

B-blockers (propanolol, metoprolol)
AEDs (valproic acid, topiramate)
TCAs (amytriptyline)
Ca channel blockers (verapamil, nifedipine)
Indomethacin
these are all _ migraine tx

Answer 5

Preventative

Question 6

What 2 types of headaches are more frequently found in younger ppl?

Answer 6

Cluster and Migraine

Question 7

Migraine patients like to lie down in the dark. but cluster headache patients like to do what?

Answer 7

pace about or sit and rock back and forth

Question 8

SUNCT syndrome stands for:
more common in __ and responds to __

(SUNCT looks very similar to cluster, but it’s different and it has its own tx that works very well.)

Answer 8

Short-lasting Unilateral Neuralgiform H/A c Conjunctival injection and Tearing
women
indomethacin

Question 9

sudden, usu. unilat. severe, brief stabbing or lancinating, recurrent episodes of pain in one or more branches of CNV
Avg age is how old?

Answer 9

*Trigeminal Neuralgia

Avg age in 60s

Question 10

Trigeminal Neuralgia
Usu involves branches (2)
the remaining branch is usually associated with what condition?

Answer 10

V2 and/or V3

V1: herpetic neuralgia

Question 11

Which artery being occluded may cause:
Trigeminal Neuralgia CNV
Hemifacial Spasm CNVII
Glossopharyngeal Neuralgia CNIX/X:

Answer 11

Trigeminal Neuralgia CNV: SCA (superior cerebellar artery)
Hemifacial Spasm CNVII: PICA or AICA/Vert (posterior/anterior inferior cerebellar artery)
Avg age in 40s
Glossopharyngeal Neuralgia CNIX/X: PICA or Vert

Question 12

Provoking features of Vascular Compression Syndromes
Tregiminal Neuralgia:
Hemifacial Spasm:
Glossopharyngeal Neuralgia:

Answer 12

Tregiminal Neuralgia: light wind to face
Hemifacial Spasm: chewing
Glossopharyngeal Neuralgia: swallowing
usu. begins in tonsillar region or base of tongue and may radiate to ipsilateral ear

Question 13

Trigeminal Neuralgia-Tx

If those drugs don’t work, it isn’t Trigeminal Neuralgia!

Answer 13

carbamazepine

oxcarbazepine

Question 14

panarteritis affecting large vessels
Mostly caucasian over age 60
Onset of throbbing H/A is abrupt or insidious

Answer 14

Giant Cell Arteritis(GCA)

Question 15

definitive way to dx temporal arteritis

and the tx

Answer 15

biopsy. 50% shows multinucleated giant cells

tapering steroids

Question 16

what is the most common type of cancer that metastasizes to the brain?
But which is most prevalent?

Answer 16

Melanoma

Lung cancer is much more prevalent

Question 17

Dx and best tx:
most common malignant primary BT
normally fatal
intra-axial – within parenchyma of brain

Answer 17

Glimoas

best tx: gross total rsxn followed by chemo (temodar) and Radiation Tx.

Question 18

Most common primary BT (32%)
extra-axial (start from dura and push into the brain), dural based
usu. partially calcified

Answer 18

Meningiomas

Question 19

Account for 9% of primary brain tumors
Secretory vs. Nonsecretory
Full endocrine w/u
If nonsecretory and large, (>1cm= macroadenomas) require surgery
may need exogenous hormone support

Answer 19

Pituitary Tumors

Question 20

galactorrhea/amenorrhea/infertility are a sign of ____. What’s its tx?

Answer 20

Prolactinomas

tx. dopamine agonist (bromocriptine)

Question 21

multiple, soft, rubbery cutaneous tumors

6 or more cafe au lait spots, axillary freckling

Answer 21

Neurofibromatosis-1

Question 22

NF-1 requires surgery when? (3)

Answer 22

when neurofibroma affects a cranial nerve, spinal root, or cord compression

Question 23

characterized by bilateral vestibular schwannomas (hearing problems)
Dz is progressive, and surgery often indicated

Answer 23

NF-2

Question 24

Brain Tumor Presentations (5)

Answer 24

Seizure(if they are located supratentorial)
Personality changes (frontal lobe)
Focal deficit (dependent on location)
H/A (usually worse in morning b/c they’re lying down), nausea, lethargy(incr. ICP)
Endocrine abnl (Pituitary mass)

Question 25

Brain Tumor initial work up

Answer 25

MRI Brain

Question 26

Brain Tumor initial Tx

what do you not give?

Answer 26

No hypotonic fluids
+/- AEDs (they will need it by time of surgery, so it’s a moot point)
Dexamethasone

Question 27

neurologic deficit from remote effect of cancerous process, usu. Small Cell
Clinical findings resemble primary endocrine (SIADH), metabolic(hypercalcemia), hematologic (anemia), or neuromuscular d/o
Autoantibodies impair Acetylcholine release or cause encephalomyelitis

Answer 27

Paraneoplastic Syndrome

Question 28

transient cranial nerve palsies, upright presyncopal symptoms, proximal muscle weakness with lower extremity predominance, and depressed tendon reflexes

Answer 28

Lambert-Eaton Myasthenic Syndrome

Question 29

Stiff Man Syndrome – too much ___ – trouble moving

Answer 29

acetylcholine