Neuro Flashcards
Types of primary headache (3)
Migraine
Tension type
Cluster
Typical quality of migraine
pulsating, throbbing, lateral,
Typical quality of tension head ache
tightness, pressure, band like, worse at end of day
cluster headache quality
Ice pick, same time each day or night
Additional symptoms of migraine (4)
N/V, photophobia, sound and smell sensitivity
treatment of tension headaches
treat anxiety and depression, CBT, relaxation, Massage
Number of migraines to be diagnostic recurrent:
without aura
with aura
without aura: 5
with aura: 2
migraine Treatment (non- pharmacologic)
avoid precipitating factors,
rest in quiet dark room,
simple ananglesic
Pharm treatment of migraine
Ergotamines - cafergot Sumatriptan prochlorperazine (Compazine) Reglan or Zofran Butalbital - habit forming
migraine preventative therapy - when indicated and what
if migraines >2-3 x per month
botulism,
acupuncture, neurostimulation techniques
cluster headache number for diagnosis
5 attacks occurring everyother day - 8x / day
prophylactic cluster headaches treatment (3)
lithium carbonate
verapamil
topiramate
pseudotumor cerebri symptoms (4)
papilledema,
increased ICP,
normal or small ventricle sizes.
Diplopia, blurred vision, transient visual obscuration
Pseudotumor cerebri treatment
repeat LP, Acetazolamide
thiazide diuretics,
steroids
Severe: lumbar peritoneal shunting, optic nerve sheath decompression
Post herpetic neuralgia treatment
anticonvulsants, gabapentin, antispasmodic agents,
Myasthenia gravis Signs and symptoms
extra ocular muscle and skeletal muscles weakness and fatigability d/t decrease in Ach receptors in neuro muscular junction
exacerbations and remissions (non-complete)
non-symmetric proximal muscle weakness
Myasthenia Gravis treatment
acetylcholine esterase inhibitor (pyridostygmine) –>
prednisolone and azathioprine –>
mycophenolate mofetil –>
other immune suppressive drugs
Cerebral Palsy definition and cause
chronic static impairment of muscle tone, strength, coordination and movement
caused by cerebral insult at birth
Tourette’s syndrome onset and resolution
mean onset age 5
Resolves by adulthood usually
tourettes symptoms and sleep
DO NOT disappear with sleep,
awake Pt may be able to suppress or camouflage tics
necessary length of vocal or motor tics for tourettes diagnosis
1 year
tourettes treatment
usually no treatment - CBT is best
neuroleptics - suppress tics
alpha adrenergic agonists - clonidine, guanfacine
DNU - ADHD drugs with Tourette’s - BBW!!
MS definition
destruction of myelin sheaths
MS symptoms (12)
fatigue, depression, memory changes, pain, spasticity, vertigo, tremor, double vision or vision loss, weakness, dizziness, numbness, ataxia
MS diagnostic feature
Must have at least 2 episodes of symptoms that result from involvement of different areas of the CNS
MS treatment
interferon Beta 1- suppresses immune system
Glatiramer acetate - more SE,
Mitoxantrone - Cardio toxic
Steroids - for acute attacks
Guillain barre cause
caused by infection or inocculation
Meningitis causes
usually bacterial
or viral
Meningitis cardinal symptoms (4)
Bonus (5)
HA, Fever, neck stiffness, altered mental status Bonus (N/V, Photophobia, focal neuro deficit, seizures, rash [non-blanching])
Bacteria of meningitis
Strep Pneumo (kids and adults)
H. flu (adults)
N. Meningitidis (kids)
Aseptic meningitis - different from Bacterial
Spring and fall onset
Caregivers - fecal-oral
benign course resolves on own
Meningitis Diagnosis
Lumbar puncture (may need head CT first)
Meningitis -req. Head CT criteria
altered Mental status, seizure w/in 1 week of presentation, Known CNS lesion or disease, focal neuro finding papilledema >60 immunocompromised
Bacterial meningitis tx
Antibiotics AND STEROIDS - if LP is delayed for any reason, Abx first then delay (sterilization may occur within 2-4 hours so get LP ASAP)
antivirals if any suspicion,
If elevated ICP - mannitol, neuro consult
LP with 100-5000 WBC, Decreased glucose and elevated protein
Bacterial meningitis
LP with 10-500 WBC, normal glucose and elevated protein
Viral meningitis
LP with 0-500 WBC, Decreased or normal glucose and elevated protein
Fungal meningitis
Encephalitis symptoms
fever, HA, altered mental status, may be accompanied by seizures or Focal neuro deficit
(May have meningitis too - meningoencephalitis)
Encephalitis - West nile treatment
supportive
Encephalitis - paraneoplastic & auto immune - treatment
IV IG
IV Steroids
resect tumor if applicable
Encephalitis risk factors
children or elderly
Immunocompromised,
Summer/ early fall
General encephalitis treatment
Acyclovir IV
If seizures - Benzos and Anticonvusants
Intracranial epidural abscess - treatment
craniotomy
Vanco +3rd or 4th cephalosporin
Spinal Epidural abscess
early decompression/ debridement,
Antibiotics - Vanco +3rd or 4th cephalosporin
4-6 weeks
Parkinsonism definition
bradykinesia, with rigidity and tremor
Parkinson’s disease symptoms
Bradykinesia,
One of: resting tremors, muscular rigidity, postural instability
dysautonomia causing supine HTN with orthostatic hypotension, dementia, voice and speech disorders,
depression, psychosis
Parkinson’s treatment
Levodopa, w/ dopa decarboxylase inhibitor
Drugs that induce parkinsonism
Bilateral symptoms Haloperidol,
thioridazine, periphenazine, anti-emetic
Huntington’s disease - cause
genetic disorder
Huntington’s symptoms
incoordination, abnormal movement and intellectual decline,
chorea- brisk rhythmic movement,
gait disturbances, dysarthria and dysphagia, Depression, OCD
Essential tremor - age of onset
45
Essential tremor - diagnosis
tremor with fine motor in hands and forearms,
head tremor with no signs of dystonia,
absence of other etiologic factors
(should be bilateral, duration>1 year, affects daily living, family hx, better with ETOH)
Essential tremor treatment
propranolol, or primidone,
Tourette’s diagnostic features
2+ motor symptoms,
1+ vocal tics
Concussion Risk factors
Dehydration Fatigue Malnutrition Illness Illicit drug use
Frontal Concussion signs
irritability
tearfulness
Parietal Concussion signs
headache
nausea
Occipital Concussion signs
dizziness, disequilibrium, visual symptoms
Top of head impact Concussion signs
LOC
High risk concussions (3)
Double hit, Rotational force
second hit - after previous concussion
Concussion Diagnosis
new neuro symptoms post injury = Diagnostic
May take min to hours to develop
Concussion Physical signs (9)
LOC, Headache, N/V, Balance issues, incoordination, dizziness, visual changes, numbness, neck pain
Concussion cognitive signs (6)
confusion, amnesia, disorientation, blank stare, difficulty concentrating, slurred/slow speech,
Concussion emotional signs (4)
irritability, sadness, emotional labiality, nervousness
Concussion sleep signs (3)
drowsiness,
oversleeping
insomnia
Concussion require ED eval (6)
prolonged LOC C-spine injury concern high impact skull fracture concern seizure post trauma deterioration of condition
ED concussion Eval
neuro exam q 30 minutes
Hx
observe for 4 hours
Manage symptoms
Concussion indications for CT
LOC
Abnormal Neuro findings
Deterioration
Concussion treatment
Responsible adult observation 6-8 hours post injury
Brain rest 24-48 hours
Physical rest until symptom free
NSAIDS and Acetaminphen
(NO cognition altering meds - opioids, muscle relaxants, Benzos, ETOH)
Concussion return to school notify
teachers, counselor, nurse, athletic trainer, coach
Return to play post concussion
Successful return to full school day
symptom free off meds
normal neuro exam
Back to base line balance and cognitive performance
Chronic traumatic encephalopathy - cause and diagnosis
Tau proteins due to repeated Concussions
Post mortem diagnosis
Epidural hematoma description
arterial bleed, pocket of blood,
often with skull fracture
Pt usually lucid –> rapid deterioration, severe HA, Vomiting, Seizure
Subdural hematoma description
Venous bleed
Crescent moon shape following skull curvature,
no skull fracture
LOC or coma in acute onset
Chronic - HA, Dizziness, cognitive impairment, seizures
Subdural hematoma timeline Acute, Subacute, Chronic
Acute 1-2 days post trauma
Subacute 3-14 days post trauma
Chronic >15 days post trauma
Acute subdural hematoma (symptomatic) treatment
Neurologic emergency
surgical decompression - craniotomy
Epidural Hematoma treatment
Neurologic emergency,
surgical decompression - craniotomy
Epilepsy definition
> 2 unprovoked seizures
Simple partial seizures - signs and symptoms
preserved consciousness, seconds to minutes in duration
May be motor, sensory, autonomic,
Simple partial seizures - treatment
Anti-epileptic drugs if recurrent
Surgery if medically refractory
Complex partial seizure - sign and symptoms
impaired consciousness 60-90 seconds w/o recollection of seizure
Behavioral arrest followed by staring, automatism, and post ictal confusion
Types of generalized seizure (6)
Absence - staring Myoclonic - rapid jerks atonic - flaccid tonic - 10-20 second rigid extended extremities Clonic - 1-2 min tremors Tonic-clonic
Absence seizures tx
ethosuximide
Generalized seizures (not absence) tx (4)
valproic acid,
Lamotrignine,
topiramate,
levetiracetam
tonic - clonic additional tx (3)
zonisamide,
phenytoin,
carbamazepine
Tonic - clonic post ictal phase
amnesia,
variable consciousness,
stuporous then gradually awakens to confusion/agitation/combative
Causes of seizures
Primary
Secondary - drugs, infections, metabolic, structural
Seizures and ETOH withdrawal
If any concern for ETOH withdrawal - ADMIT PT - will get much worse over next 10 days if untreated
Status Epilepticus
Seizure > 5-10 minutes
2 seizures without lucid interval
Acute seizure management -> status epilepticus
Airway protection,
Benzos,
Induce coma
Stroke in Pregnancy (2)
Urgent Head CT for CVA, and
think Eclampsia
Criteria for febrile seizure
Duration <15 minutes
Fever >100.4
Age 6 months - 5 years
no more than 1 seizure in 24 hours
PNES or Pseudo seizure
Psych diagnosis
conversion disorder
EEG video monitoring for definitive diagnosis
Anti epileptic tx
Treat after 2nd seizure or if significant need
avoid driving for 6 months if 2nd seizure
meds for 1 year
Anti epileptic drugs (9)
valproic acid Phenytoin carbamazepine levetiracetam topiramate lamotrigine zonisamide ethosuximide phenobarb
