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Primary Care 1 > Neuro > Flashcards

Neuro Flashcards

1
Q

Prevalence of recurrent, severe headaches

A

25%

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2
Q

Migraine economic burden

A

due to missed work days, costs US economy 31 billion dollars annually

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3
Q

Primary headache

A

90% of all headaches. Idiopathic with NO underlying disease. Recurrent. Most commonly a migraine. Can be tension or cluster

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4
Q

Secondary headache

A

10% of all headaches. FROM an underlying disease. Can be brain tumor, subarachnoid hemorrhage, meningitis, temporal arteritis, close angle glaucoma. Symptoms can be acute onset of unilateral headache and eye pain, n/v, impaired vision or seeing halos with a mid dilated pupil from close angle glaucoma

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5
Q

Brain tumor s/s

A

Chronic nausea. Significant change in prior headache pattern, worsening overtime. Worse with changing position especially bending over, sneezing, coughing, exertion. Early morning headache. Abnormal neuro exam with papilledema, unilateral weakness, sensory loss, aphasia

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6
Q

Most common type of brain tumor

A

Intracranial tumor- gliomas and meningiomas from brain mets. Mets from lung cancer, breast cancer, melanoma, renal cell carcinoma

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7
Q

Dx brain tumor

A

MRI with and with out contrast. Most accurate is biopsy

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8
Q

Subarachnoid hemorrhage mortality rate

A

50%. 25% die within first 24 hours

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9
Q

SAH s/s

A

severe headache, worst headache I have ever had in my life, thunderclap maximum intensity in 1 minute, may have LOC, focal deficits, seizures, nausea or vomiting, meningeal signs

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10
Q

SAH bleeding

A

caused by a ruptured brain aneurysm, looks like bright white areas on ct scan

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11
Q

Test for SAH

A

CT scan with out contrast. Sensitivity highest within 24 hours. If CT negative, need LP follow up

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12
Q

Meningitis

A

headache, fever, nuchal rigidity, photophobia, change in mental status, ill appearance, brudzinski, kernig

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13
Q

Meningitis caused by

A

Strep pneumonae, N meningitis.

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14
Q

Dx Meningitis

A

LP showing increased WBCs and neutrophils, CT may be done first to exclude a mass lesion

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15
Q

Temporal arteritis

A

Giant cell arteritis a vasculitis of cranial branches of the arteries that originate from the aortic arch. Cause is unknown. Mean age is 72, never younger than 50

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16
Q

s/s Temporal arteritis

A

over 50. New onset temple headache. Temple scalp tenderness. Jaw claudication. Visual disturbances. Systemic s/s of fatigue, fever, anorexia, elevated erthrocyte sedimentation rate, c-reactive protein

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17
Q

Diagnose temporal arteritis

A

biopsy

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18
Q

Treatment of temporal arteritis

A

high dose systemic steroids, do not wait for bx to initiate treatment

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19
Q

Danger signs

A

SNOOP. Systemic illness. Neuro symptoms abnormal. Onset is new after age 40 or sudden. Other associated features. Previous headache history with a headache progression or change in severity and frequency. No SNOOP then No imaging.

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20
Q

Less dangerous secondary headaches

A

dental pain - sensitivity to cold, sweets, dental caries is 50% of all orofacial pains. TMJ disorder - localized, dull, exaccerbated by chewing. Sinusitis - purulent nasal discharge, congestion, possible fever, periorbital and frontal pressure and tenderness, pain worse when bending over

21
Q

Migraine = Pound

A

Pulsatile. One day duration. Unilateral. Nausea. Disability

22
Q

Migraine aura

A

20-30% have auras, bright lights, shapes, halos, scotomas

23
Q

Migraine w aura stroke risk

A

doubled. If also smoking, taking oral contraceptives = stroke risk x 7

24
Q

Migraine triggers

A

stress, menstruation, weather changes, sleep disturbances, fasting, wine, chocolate, odors, lights

25
Q

Migraine etiology

A

largely unknown. Vascular theory: local vasodilation as a rebound of vasocontriction. Neuro-vascular possibly from neurotransmitters like dopamine and inflammatory markers cause brain irritability, this inflammation causes the pain.=

26
Q

Dx migraine

A

clinically, no imaging unless changes in the pattern or focal symptoms

27
Q

Abortive treatment of migraines mild-moderate

A

As soon as the headache starts this is most effective. For mild to moderate do NSAIDs, tylenol and or an antiemetic, Excedrin, or Fioricet

28
Q

Moderate-severe migraine treatment

A

As soon as the headache starts. First line is Triptans. these are selective agonist for seratonin on the intracranial blood vessels causing vasoconstriction. Ergots are similar to dopamine and serotonin they are a weak vasocontrictor but last longer. Oral steroids also work.

29
Q

Prophylactic migraine treatment required if

A

Frequent 3-4month with longer episodes, refractory to abortive treatment, significant disability

30
Q

Prophylactic treatment for migraines

A

BB: Propranolol, metoprolol, CCB: verapamil, antidepressants like: amitriptyline (elavil) and effexor, and anticonvulsants: like valproate (valproic acid) and topirmate (topamax)

31
Q

Prophylactic treatment for migraines leads to this reduction of headaches

A

50 percent reduction. If hx of HTN use BB or CCB. If arrythmias use BB or CCB. Depression - anti. Insomnia - amitriptyline (elavil), obesity - topamax. Women child bearing age no anticonvulsant especially valproic acid - they can take verapamil

32
Q

Lifestyle modifications for migraines

A

sleep, routine meal schedules, regular exercise, managing of triggers

33
Q

Tension headache

A

mild to moderate. BILATERAL. NOT throbbing, band like, no other features like aura, n/v, not aggravated by daily activities, does have muscle tenderness in head neck and shoulders. women higher prevalence. precipitated by stress, mental tension. clinically dx

34
Q

Treatment for tension headaches

A

nsaids, acetaminophen

35
Q

Cluster headaches

A

rare. severe UNILATERAL. pain behind eye. May have conjunctival injection. Nasal congestion. Can last minutes to hours. More prevalent in men. Can feel restless. Can be precipitated by alcohol. Clinically diagnosed.

36
Q

Abortive treatment for cluster headache

A

high flow oxygen for 15 minutes. triptans to cause vasoconstriction

37
Q

Medication overuse headache

A

consequence of regular overuse of acute headache medications for more than 2 times a week. highest potential is opiods. intermediate is triptans. lowest is NSAIDs. s/s daily headache, vary in intensity or location. behavior factors: fear of headache, obsessional drug taking behavior, psychological drug dependence

38
Q

dx MOH and tx

A

drug taking hx, including OTC. treatment: stop the overuse of medications, educate on detrimental side effects of these meds, screen for psych conditions

39
Q

Trigeminal neuralgia s/s, triggers

A

unlateral electric shock like facial pain, distribution of the trigeminal nerve, abrupt onset and termination, lasts several seconds, triggered by chewing, talking, brushing teeth, cold air, smiling. Caused by idiopathic compression of of TN root, acoustic neuroma, or meningioma

40
Q

Dx Trigeminal neuralgia

A

clinically. use MRI to rule out a structural lesion

41
Q

Medical tx of TN

A

carbamazepine Tegretol - side effects of dizziness, drowsiness, rare aplastic anemia CYP34 inducer

42
Q

Surgical treatment of TN

A

if medication is ineffective. Microvascular decompression. Botox.

43
Q

Insomnia

A

impaired daytime functioning due to difficulty initiating sleep, difficulting maintaining sleep, 10% population. increases w age.

44
Q

Why treat insomnia

A

low quality of life, poor daily performance, irritable, self medication with alcohol = risk for abuse, insomnia leads to increased mortality and cardiovascular disease, depression, anxiety

45
Q

Types of insomnia

A

short: less than 3 months, a/w stressors. self limited. chronic: 1 - primary: w out comorbidities, existing w out other disorders. 2 - secondary: caused by a comorbid disorder like depression

46
Q

Insomnia underlying conditions

A

depression, anxiety, pulmonary diseases, chronic pain, cancer, HF, substances like stimulants or substance withdrawals, frequently with BPH, GERD, hyperthyroidism, diuretics

47
Q

dx Insomnia

A

sleep study. daily sleep log for 1-2 weeks. like number of awakenings, duration of awakenings, duration of the problem, bedtime, awakening time, sleep environment

48
Q

Treat primary insomnia

A

behavioral counseling regarding good sleep hygiene and stimulus control, cognitive counseling establishing realistic expectations

49
Q

Smells like poop

A

Avery Gardner

Primary Care 1 (6 decks)

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