Neuro Flashcards
What is a Primary Headache?
A headache with no underlying disease.
Tension type is the most common type with migraine being the most diagnosed.
What is a Secondary Headache
A headache with an underlying cause such as brain tumors, subarachnoid hemorrhage, meningitis.
What is Brudzinski Sign?
Clinical Sign in which forced flexion of the neck elicits a relflex flexion of the hips. (FOUND IN MENINGITIS AND SUBARACHNOID HEMORRHAGE)
Kernig’s Sign
A positive Kernig’s sign is when the thigh is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful. (FOUND IN MENINGITIS AND SAH)
Key rule to headaches?
When diagnosing with a headache, RULE OUT BRAIN TUMORS OR UNDERLYING CAUSES.
S/S of Brain Tumor
Papilledema, unilateral weakness sensory loss, aphasia
Papilledema
Optic disk swelling that is caused by an increase in ICP.
Aphasia
Disorder of language function, not of vocalization, as in dysarthria or hoarseness. IT IS A SPECIFIC SIGN OF A LESION IN THE DOMINANT HEMISPHERE. Lesions in the non dominant hemisphere may produce apraxia-Inability to perform purposeful movements.
Two Types of Brain Tumors?
- Glioma
2. Meningioma
Glioma
Most common brain tumor. Has a differing degree of aggressiveness.
Meningioma
Benign, slow growing tumor.
Initial Dx test for Brain Tumor
MRI w/wo contrast
Before waiting for biopsy what medication should be started?
Dexamethosone to reduce swelling and for seizure precautions.
What is a Subarachnoid Bleed?
Bleeding into the subarachnoid space, may occur spontaneously, USUALLY FROM A RUPTURED CERBRAL ANEURYSM OR HEAD INJURY.
S/S of SAH
THUNDERCLAP HEADACHE, N/V, confusion, decreased LOC. + Brudzinski/Kernig
Initial Dx test for SAH
CT scan w/o contrast. Sensitivity is highest within 24 hours.
Treatment of SAH
Prevention of rebleeding by clipping and coiling.
What is Meningitis?
Acute inflammation of the protective membranes covering the brain and spinal cord. May be caused by infection with viruses and bacteria.
S/S of Meningitis
+ brudinski/kernigs. Nuchal rigidity. Fever, confusion, N/V, photophobia.
How to diagnose or exclude Meningitis?
Lumbar Puncture to extract CSF
Increased WBC/Neutrophils
Treatment for Meningitis?
Bacterial Meningitis is treated with antibiotics. CEFTRIAXONE, RIFMPICIN, CIPRO.
Viral Meningitis treatment is mostly supportive-Rest, hydration, antipyretics, pain or anti-inflammatory meds given PRN.
How to spread Meningitis?
Exchange of respiratory and throat secretions.
Most common cause of bacterial Meningitis?
Streptococcus pneumoniae
If CT scan is - for SAH what is the follow up procedure?
Lumbar puncture to assess for Meningitis.
Temporal arteritis
Inflammatory disease of blood vessels, most commonly involving large and medium arteries of the head.
NEVER OCCURS IN INDIVIDUALS YOUNGER THAN 50!!!
S/S of arteritis?
Temporal scalp tenderness, visual disturbances, BLINDNESS!!! JAW CLAUDICATION.
What is Jaw Claudication?
Pain or fatigue of the muscles of mastication: rapid onset after the start of chewing.
Diagnostic Test of Arteritis
Increased ESR+CRP. Temporal artery biopsy.
Treatment of Arteritis?
High dose Prednisone can be initiated before confirming by biopsy.
What is SNOOP?
S-Systemic symptoms, illness, or condition
N-Neurologic symptoms
O-Onset is new (particularly for age 40)
O-Other associated conditions
P-Previous headache history with headache
No SNOOP-NO IMAGING
Migraine
More prevalent in women. Characterized by recurrent moderate to severe headaches that are pulsatile in nature.
Vasodilation to be the rebound of an initial vasoconstriction
neuro-vascular theory several neurotransmitters (dopamine, nitric oxide) and inflammatory markers potentiate irritability of the brain. NEUROGENIC INFLAMMATION IS RESPONSIBLE FOR PAIN.
S/S of Migraines
Unilateral, throbbing or pulsatile headache. N/V photophobia. Recurrent attaches. Genetic. AURA.
Risk of stroke and Migraine
Migraine w/aura= stroke x2
Migraine w/aura+smoking+oral contraceptives=stroke riskx7
What can trigger a Migraine?
STRESS
MENSTRUATION
sleep disturbances
food
Treatment for a Mild-moderate Migraine.
NSAIDS, Acetominophen, +/- antiemetic with caffeine (Excedrin)
with short acting barbiturate (Fioricet).
Treatment for a Moderate-Severe migraines
Triptans (Sumatriptan, zolmitriptan)
Selective agonist for serotonin (causes arterial vasoconstriction)
Ergots (Erotamine, dehydroertamine) weak arterial vasoconstrictor, LESS EFFECTIVE THAN TRIPTANS, but last longer
Prophylactic treatment for migraines
Prophylactic treatment BB: propanolol, metoprolol CCB: verapamil Antidepressants: amitriptyline Anticonvulsants: valproate
Pt w/hx of HTN-BB,CCB
Pt w/hx of arrhythmia-BB,CCB
Pt. w/ depression-antidepressants
Pt. w/ obesity-topiramate
Women childbearing age- DO NOT PRESCRIBE anticonvulsant, esp VALPROATE
MAY TAKE VERAPAMIL
What is a tension headache?
Mild-Moderate intensity
BILATERAL/NON-THROBING/BAND-LIKE
Treatment for tension headache
NSAIDS
ACETAMINOPHEN
What is a cluster headache?
SEVERE UNILATERAL “I HAVE AN ICE PICK STUCK IN MY EYE” \+/- Conjuncitival infection \+/- nasal congestion MORE PREVALENT IN MEN Restless
Treatment for cluster headaches
High flow oxygen (100%) for 15 min
Triptans (Sumatriptan, zolmitriptan) Causes arterial VASOCONSTRICTION
What medications, if overused, can cause headaches?
Highest potential- opioids
intermediate- triptans
lowest- NSAIDs
Trigeminal neuralgia
Neuropathic disorder characterized by episodes of intense pain.
S/S of Trigeminal neuralgia
Unilateral electric shock-like facial pains
Most cases are associated with idiopathic compression of TN root
Other causes: compression by acoustic neurinoama meningioma
Triggered by chewing, talking, brushing teeth, cold air, smiling
How to diagnose Trigeminal neuralgia?
MRI to r/o structural lesion
What is the medical treatment of trigeminal neuralgia?
Carbamazepine
What is the surgical treatment of trigeminal neuralgia?
Microvascular decompression
Insomnia
Difficulty sleeping and staying asleep. Impairs daytime function
Underlying tx for insomnia?
Benzodiazepine (Temazepam)
non-benzo (Ambien, Zaleplon, Lunesta)
melatonin agonists (Ramelteon=Rozerem)
Antidepressants, antipsychotic, diphenhydramine-NOT RECOMMENDED
Sleep onset insomia-Zaleplon, ambient
Sleep maintenance insomnia-ambient ER, RESTORIL, LUNESTA
What is Restless leg syndrome?
Urge to move legs during period of inactivity
Sensation is unpleasant but not painful
Movement provides temporary relief
Treatment
iron supplement (if FERRITIN IS LOW)
Dopamine agonists (Ropinirole) Effect is 120 min
Obstruction sleep apnea
Decrease in muscle tone in upper airways, recurrent collapse of the upper airway during sleep Fragmented sleep/hypercapnea, hypoxemia RISK FACTOR-OBESITY Manifestations: Snoring and day time sleepiness DX-polysomnography Sleep study OSA is a cardiovascular risk factor HTN Ischemic heart disease A-fib Pulmonary HTN
