Neuro Flashcards
these people are most likely to have a secondary headache
age greater than 40
most common presenting symptoms of brain tumor in adults
headache, seizures
red flags in history for someone with headache
sudden onset, “first or worst headache”, fever, change in LOC
red flags in physical exam for someone with headache
age older than 40, neck stiffness, neuro deficits, papilledema
papilledema is the swelling of the
optic disc
CT is ordered to look at
“hard things” like bone
MRI is ordered to look at
soft tissue
characteristics of migraine headache
POUND: pulsatile One day duration (4-72 hours) unilateral N/V, photophobia Disabling causing interruption in daily activities
characteristics of tension headache
bilateral, tightness/pressure/bandlike, may continue daily activities
characteristics of cluster headache
unilateral, excruciating pain that peaks and lasts 30-90 min, unilateral conjunctiva/tearing or rhinorrhea
s/s of temporal arteritis
jaw claudication, fever, visual loss, pain in temporal area
s/s of pseudotumor cerebrii
transient visual changes, intracranial noise
MOA of triptans
cause cerebral artery constriction
caution when giving triptans in those with
CAD- can cause coronary artery constriction
s/s of migraine with aura
hyperosmia, blurred vision, metallic taste in mouth
common triggers of migraines
stress, menses, skipping meals, weather, sleep, odors, ETOH, smoking, foods
prophylaxis meds for migraines
beta blockers, topiramate, Depakote
migraine with and without aura increases risk of
ischemic stroke
absolute contraindication in women with migraine with aura
oral contraceptive use
Women with migraines can have OCP if they meet these criteria
less than 35 years old, have migraine without aura, no risk factors for stroke.
triptan education
can cause rebound headaches with overuse
s/s of trigeminal neuralgia
sharp, piercing, unilateral facial pain
trigeminal neuralgia involves the
5th cranial nerve
most important risk factor for temporal arteritis
aging (average age is 72)
temporal arteritis is closely linked to
polymyalgia rheumatica
Bell’s palsy affects cranial nerve
7 (facial)
s/s of Bell’s palsy
unilateral droopy eye, facial paralysis or weakness, drooping mouth
duration of bell’s palsy
1-3 weeks
management of bell’s palsy
EYE protection with lubrication and patch
peripheral vertigo involves the
vestibular system
central vertigo involves the
brainstem or cerebellum
s/s of peripheral vertigo
severe vertigo, N/V, lasting less than 1 min; precipitated with positional changes
s/s of central vertigo
severe vertigo that is long lasting, prolonged nystagmus, impaired gait,
most common causes of peripheral vertigo
BPPV, Meniere’s disease, vestibular neuritis
trx of vertigo
antihistamines, benzos
characteristics of parkinson’s
resting tremor, bradykinesia, rigidity
side effects of levodopa
nausea, dizziness, confusion, hallucinations, orthostatic hypotension
s/s of essential tremor
bilateral tremor of hands, arms, head, voice, chin, lip
essential tremor rarely involves
the lower extremities
essential tremor is more apparent with
goal directed movements
patients report that this makes essential tremor better
alcohol
trx for essential tremor
propranolol or primidone
autoimmune disease characterized by weakness in ocular, limb, and respiratory muscles
myasthenia gravis
trx for mild cognitive impairment
No med trx, just exercise
New name for dementia
major neurocognitive disorder
behavior disturbances that accompany dementia
restlessness, wandering, agitation, difficulty concentrating
how to diagnose dementia
no labs or imaging; MMSE test
this score on MMSE indicates dementia
less than 24
differential diagnosis with dementia
meds (anticholinergics, sedatives, analgesics), stroke, depression
labs to order with dementia
CBC, CMP, vitamin B12, folate, TSH
CN I
olfactory- smell
CN II
optic - vision
CN III
occulomotor - eye movements
CN IV
trochlear- downward, internal rotation of the eye
CN V
trigeminal- sensation to face, jaw movement
CN VI
abducens- lateral deviation of eye
CN VII
facial- facial muscle, taste
CN VIII
vestibulocochlear- balance, hearing
CN IX
glossopharyngeal- movement of pharynx
CN X
vagus- gag reflex
CN XI
spinal accessory- sternomastoid and trapezius muscle
CN XII
hypoglossal- movement of tongue
mnemonic for cranial nerve
On Old Olympus’s Towering Tops A Finn and German Viewed Some Hops
Patellar reflex measures
L2-L4
Achilles reflex measures
L5-S2
biceps reflex measures
C5-C6
triceps reflex measures
C6-C7
nuchal rigidity
when the patient cannot touch chest with chin; positive in meningitis
s/s of polymyalgia rheumatica
morning stiffness and aching in shoulders, neck, hips, and torso.
