Neuro Flashcards
complex regional pain syndrome
follows an injury to extremity
pain, swelling, color/temp changes. Pain is burning, exacerbated by light tough
severe tenderness to light touch
tx: early intervention is best
saids, steroids, PT/OT, pain management, gabapentin
regional nerve block
peripheral neuropathy
caused by anything
motor, sensory, autonomic
acute: infectious, GB
Motor: weakness, distally and ascent proximal
lower ext: dorosflexion of foot, foot drop
sensory sx; stocking glove distribution, numbness/ pain
Muscle atrophy
PE: diminished DTR
Dx: EMG and nerve conduction
Nerve/ skin bx: for vasculitis
labs; glucose, BUN/Cr, CBC, vitamin b6 /b12 RPR
diabetic neuro
distal symmetric polyneuropahty autonomic: erectile dysfunction no tx control sugars tx: gabapentin, TCA, lyrics, cymbals, lidoderm patch
charcot-marie tooth dz
complain of motor sxs
foot drop
no tx: use ankle foot orthrosese, genetic counseling
trigeminal
shooting pain in the corner the mouth and goes to mandible
worse with chewing
tx: gabapentin
post herceptic neuralgia
tx: acyclovir and steroids
Bell’s Palsy
no clear etiology follow a stress to body ( dm, pregnancy, infection) ipsilateral ear pain loss of motor control of mouth pt recover all the way
start steroids in 5 days
the worst it looks the better it is ( bells palsy vs. stroke)
cluster headaches
men in 40’s
retroorbital, red, tearing of eye, ptosis, myosis
at night and clusters
triggers: similar to migraines
tx: abortive: oxygen, SC triptans, steroids
prophylactic: verapamil
topirmate, lithium
migraine
nervous dysfunction
women ( teen to 30s)
fix
unit, throbbing, n/v, motion worse, photophobia, photophobia
auras( zigzags, flashes of lights)
triggers: stress, foods, smells, bright lights, menstruation
imaging: not warranted
tx: avoid triggers, dark/quite room
abortive: NSAIDs, ASA, APAP
ergotamine with caffeine
triptans
preventing: antileptitus
antihypertensives
tension HA
generalized, constant
gripping, vice-like
triggers: stress, fatigue
tx: reduce stress, improve sleep, ASA, APAP, NSAiDs
caffeine, butabial
amitriptyline for prophylaxis
encephalitis
infection of brain tissue
viral causes
happens with meningitis
herpes simples
west nile
If immunocompromised: HIV, Varicella/ zoster
fever, malaise, n/v, rash,
headache, seizures
lumbar puncture: elevated opening pressure, elevated ptn, and lymphocytes, normal glucose
CT head first if risk for cerebral herniation
MRI, EEG
Tx: acyclovir supportive: ICU, seizure monitor, hydrate, fever anti-emetics west nile: ribavirin weeks to months for recovery
meningitis
infection of arhachoid membrane, pia matter, and css
bacterial and viral
incidence is lower with vaccine
h. flu- children
strep pneuma- adults
neisserira- dorms, barracks, jails
listeria:
presentation: stiff neck, fever, headache,
Kerning/ Brudzinksi signs
petechiae/ ecchyotic rash
seizure, hydrocephalus, CN abxn
lumbar puncture: elevated opening pressure, CSF w/ decreased glucose, grain stain, cx
tx: IV abx and dex
Vanco and 3rd gen cephaosporin
continue to examine-give mannitol for elevated ICP
viral: enterovirus, coxsackie
fever, ha, stiff neck, don’t look as sick
csf: normal glucose, normal protein, run PCP,
tx: supportive tx, fluids,
treated as outpatient
essential tremor
postural tremor of hands, head, and voice
fix
may be being at any age
ETOH relieves sx
no disabling
tx: propanalol
primidone
huntington dz
autosomal dominance
gradual:chorea, dementia, and behavior changes
30- 50 y/o, fatal
no diagnostic tools
genetic test available
tx: sxs:
tetrabenzaine for dyskinesias
parkinson dx
second most common neuro-degenerative
45-65
cardinal: pill rolling tremor, rigidity ( cogwheel), bradykinesia( hard to stand up)
masked faces, reduced to blink
no muscle weakness or reflex changes
tx: levodopa-coveted to dopamine
combine with levodopa
other meds: amantadine, anticholinergics, dopamine agents,
deep brain stimulation
cerebral aneurysm
berry aneurism
anterior circle of willis
asymptomatic until they rupture
RF:
diagnosis : CT or MRA,
angiography ( gold standard)
monitor :
stroke
ischemic- 85%
RF: AA/Hispanic, men, HTN, DM/ smoking , carotid stenosis, A.fib
ishchemic: plaque
emboli-
lacunar: smaller arterioles
TIA 24 hours, brain infarction
Need an accurate timeline
usually painless
exam: focal neuro déficit
MCA- middle cerebral artery( contralateral hemiparesis, arm/face, sensory loss, expressive aphasia)
dx: CT brain
investigate etiology of stroke
cardiac investigation
ABC:
correct glucose
thrombolytic therapy:
3-4 hours– too late
ASA effective for acute ischemia stroke
tPA contraindication:
BP 180/ 110, major surgery or trauma w/in 2 weeks, active GI, recent anti coagulated, evidence of CH,
prevention: ASA, plavix, control lipids, control BP, smoking cessation, anti-coags for a. fib, OT/PT therapy
