neuro Flashcards
Difference between dementia and delirium
Chronic vs. acute
Delirium cannot shift focus
3 most common causes of dementia
Alzheimer’s disease, vascular dementia (infarcts/HTN/tobacco), Lewy body dementia
Treatment for cluster headaches
Oxygen; prevention with oral glucocorticoids
Treatment for tension headaches
ASA, Tylenol, NSAID, behavioral changes
Danger symptoms with headaches
SNOOP
Systemic symptoms (fever, wt. loss, immunosuppressed, bleed)
Neurologic S/S (impaired LOC, nuchal rigidity, papiledema)
Onset (thunderclap, during exertion i.e. inc ICP)
Onset- age (if 1st HA >50 or < 5 = secondary cause)
Previous HA history
Hyperactive delirium example
delirium tremens
Hypoactive delirium example
opiate intoxication
If suspected seizure, what lab show you draw?
Serum Prolactin - rises 2-3 times above normal for 10-60 minutes following seizure
Medications regimen during Status Epilepticus
Lorazepam .1-.15 mg/kg over 1-2 minutes
Valproate 25 mg/kg (in patients taking valproate who are possibly sub therapeutic)
Fosphenytoin 20 mg/kg over 150 mg/min
Phenytoin 20 mg/kg over 50 mg/min
Phenobarbital 20 mg/kg over 60 mg/min
Last - propofol, midazolam, or pentobarbital
Brudzinski’s sign
Sign for bacterial meningitis
Pt lay supine, flex neck so chin to chest
Positive if knees raise and flex upwards
Kernig’s sign
Sign for bacterial meningitis
Pt lay supine, take one leg, one hand on heel and one on knee. Raise straight up
Positive if causing spasm/pain in hamstring
Guillain barre is most commonly associated with..
Campulobacter jejuni enteritis (water contaminated by animals or unpasterized milk)
Most common manifestation with Myasthenia Gravis
Ptosis (Ocular weakness)
Can do Tensilon test (edrophonium) medication that decreases ocular/facial twitching when lightly tapped around the eye or
ice pack test - motor nerve function increases with cold
Most common cause of delirium in the hospital
Infection
Tension HA definition
Last 30 min-7 days
pressing, nonpulsatile pain
usually bilateral, mild to moderate pain
Female: male 5:4
Migraine without aura
4-72 hours unilateral pulsating, mod to severe pain female: male 3:1 first line abortive therapy is triptans (contraindicated in CAD and uncontrolled HTN)
Cluster HA
usually brief, several times a day and occur several weeks to months then disappear for months to years
Pain behind the eye, lacrimation, conjunctival injection, ptosis and nasal stuffiness
Most important component of an ischemic CVA
Time, >3 hours prior to presentation, patient is unable to receive thrombolytics
Gullain-Barre Syndrome
caused by demyleniation of ascending peripheral nerves resulting in progressive, symmetrical paralysis
Begins in lower extremities and progresses upward
Autonomic dyreflexia
cause: traumatic injury above T6
Symptoms: exaggerated autonomic responses to stimulus; diaphoresis and flushing above the injury, chills and vasoconstriction below injury, HTN, bradycardia, HA, nausea
Brown-Sequard’s Syndrome
Cause: penetrating trauma to spinal cord
Symptoms: ipsalateral motor disturbance and proprioception; contralateral loss of pain and temp appreciation
Central Cord Syndrome
Cause: hyperextension injury of cervical spinal cord
Symptoms: upper and lower extremity weakness (more deficits in uppers) with varying degrees of sensory loss; impaired pain, temp, light touch and position sense below level of injury
Myasthenia Gravis
autoimmune disorder characterized by profound muscle weakness
Edrophium (tensilon) administration shows profound improvement in symptoms and is diagnostic
Cranial Nerve I-IV
I - Olfactory (S) ability to identify familiar aromatic odors, one naris at a time with eyes closed
II - Optic (S) Test vision with Snellen chart and Rosenbaum chart.
III - Oculomotor (M) visual fields
IV - Trochlear (M) Inspect eyelids for drooping
Cranial Nerve V-VIII
V - Trigeminal (B) Inspect face for muscle atrophy and tremors.
Palpate jaw muscles for tone and strength. Test superficial pain and touch sensation in each branch (test temperature sensation if there are unexpected findings to pain or touch). Test corneal reflex.
VI - Abducens (M) Inspect pupils’ size for equality and their direct and consensual response to light and accommodation. Test extraocular eye movements.
VII - Facial (B) Inspect symmetry of facial features with various expressions (e.g., smile, frown, puffed cheeks, wrinkled forehead).
Test ability to identify sweet and salty tastes on each side of tongue.
VIII - Acoustic (S) Test sense of hearing with whisper screening tests or by audiometry. Compare bone and air conduction of sound. Test for lateralization of sound.
Cranial Nerve IX-XII
IX - Glossopharyngeal (B) Test ability to identify sour and bitter tastes. Test gag reflex and ability to swallow.
X - Vagus (B) Inspect palate and uvula for symmetry with speech sounds and gag reflex. Observe for swallowing difficulty. Evaluate quality of guttural speech sounds
XI - Spinal accessory (M) Test trapezius muscle strength (shrug shoulders against resistance). Test sternocleidomastoid muscle strength (turn head to each side against resistance).
XII - Hypoglossal (M) nspect tongue in mouth and while protruded for symmetry, tremors, and atrophy. Inspect tongue movement toward nose and chin. Test tongue strength with index finger when tongue is pressed against cheek. Evaluate quality of lingual speech sounds (l, t, d, n).
Epidural bleed
arterial bleed within inner table of skull and dura (epidural space); typically caused by damage to middle meningeal artery
Mean age 20-30; unusual > 50
loss of consciousness, followed by a lucid interval, then rapid deterioration
Classic late signs: dilated pupil ipsilateral to EDH and contralateral hemiparesis
Rapid, competent decompression of EDH can make significant difference in outcome
Subdural hematome
o Veins coursing through the subdural space can stretch and tear, causing a bleed. Most common type of intracranial bleeding.
o Acute - appears within 14 days of injury
o Subacute - appears within 20 days of injury
o Chronic - after weeks or months of the initial injury. May wall themselves off; occur more often in the elderly
o Mean age is 31-47 and most common cause is MVA for those that initially present comatose
o Overall mortality is 40-60%; this may be high due to the fact that these bleeds are typically associated with other brain injuries.
o Blood itself may also have a toxic effect on the underlying cortex.
Subarachnoid hemorrhage
o Bleeding within the CSF-filled subarachnoid space.
o Trauma is the most common cause of SAH; spontaneous SAH is most commonly cause by ruptured aneurysms
o Is commonly associated with other intracranial injuries; can be a marker for severity of primary injury. Amount of blood can predict the development and progression of intraparenchymal contusions
Cerebral perfusion pressure
• CPP = MAP-ICP
o MAP = 2(Diastolic BP) + SBP /3
• Normal CPP is 60-80 mm Hg
