Neuro Flashcards
arterial bleed s/s and how fast does it appears?
quick, headache
subdural is venous or arterial?
venous
layers of skull starting with outside layer in
dura, arachnoid membrane, pia, subarachnoid space,
primary headache examples
migraine, tension-type, cluster
secondary headache examples
head trauma, medication overuse, infection, bleeding
brain parenchyma, ependymal lining of ventricles and choroid plexuses are brain structures that are sensitive or insensitive to pain?
insensitive
trigeminal neuralgia
quick, severe facial pain
what actions can stimulate trigeminal neuralgia
washing face, chewing, eating foods or fluids that are extreme temperatures
Temporal Arteritis s/s
jaw claudication, fever, weight loss, visual disturbances
Diagnostic test used for temporal arteritis***
increased ESR!!, need to biopsy artery
migraine without aura diagnostic criteria
at least 5 attacks, last 4-72 hrs, at least n/v or photophbia
migraine with aura diagnostic criteria
at least 2 attacks, visual symptoms in one or both eyes, has 1 aura symptom over >5 mins
Tension-Type Headache (TTH) s/s
no n/v and with at least 2 symptoms of : not aggravated by routine activity, mild or moderate intensity, bilateral
how long do tension-type headaches last?
30 minutes to 7 days
how long do migraine with aura last?
4-72 hrs
how long do cluster headaches last?
30-90 mins
location of migraines?
unilateral
location of tension headaches?
bilateral
location of cluster headaches?
strictly unilateral
how frequent are migraines?
2-5/month
how frequent are tension headaches?
<15/month
how frequent are cluster headaches?
1-6/day
when do migraines, tension and cluster headaches occur?
anytime except for cluster headaches. They occur at same time a day
do you have auras with tension and cluster headaches?
no
what does pain feel like for migraines
achy-throbbing
what does pain feel like for tension headaches
pressing-band like mild-moderate
what does pain feel like for cluster headaches?
boring-sharp excruciating
cluster headache s/s
ipsilateral, eye lid edema, forehead and facial swelling
precipitating factors for migraines?
bright lights, sleep loss, hypoglycemia, alcohol
precipitating factors for tension headaches?
stress
precipitating factors for cluster headaches?
alcohol, nitro
stroke
vascular disorder that injures brain tissue
hypoxia examples that can cause ischemic injury to brain
CO2 poisoning, decreased atmospheric pressure, severe anemia
1 modifiable risk factor for stroke
HTN
focal ischemia and an example
stroke, when blood flow is inadequate to meet the metabolic demands of a part of the brain
global ischemia and an example
cardiac arrest, when blood flow is inadequate to meet the metabolic demands of the entire brain
focal vs global ischemia
blood flow affecting part of the brain vs entire brain
aphasia
impaired ability to speak
hemineglect
processing disorder, food tray example
1 risk factor for hemorrhagic stroke?
HTN!!!!
infarction of anterior cerebral artery affects which lobe?
1 lobe of frontal lobe affected
s/s of anterior cerebral artery infarction
paralysis of foot or leg, impaired gait, urinary incontinence
middle cerebral artery infarction affects which lobes?
lateral hemisphere, frontal, parietal and temporal lobes
hemiattention
denial of paralyzed side of limb
alexia
word blindness
finger agnosia
inability to identify fingers
hemiattention, alexia, finger agnosia are all seen with which infarction?
middle cerebral atery
s/s of middle cerebral artery infarction
aphasia, alexia, finger agnosia, left-right confusion, hemiattention
posterior cerebral artery affects which lobes?
occipital lobe, anterior and medial portion of temporal lobe
s/s of posterior cerebral artery infarction
color blindness, memory deficits, loss of central vision,
diplopia
double vision
dystaxia
unsteady gait
dysphagia
inability to swallow
dysphonia
difficulty speaking
TIA
stroke symptoms lasts <24 hrs
near syncope
feeling faintness or light-headedness (cardiac)
vertigo
spinning
non-syncopal, non-vertigo
feeling of imbalance and fear of failing
near syncope vs vertigo vs non-syncopal
faintness, spinning and failing sensation
peripheral causes of dizziness
menieres disease, sinusitis, otitis, benign positional vertigo
central causes of dizziness
brainstem dysfunction, cerebellar dysfunction, MS
systemic causes of dizziness
psychogenic, neurosyphilis, cardiovascular
Benign paroxysmal positional vertigo
vertigo occurs when head is moved (rolling in bed)
menieres disease is characterized by which symptoms?
episodic vertigo, low frequency hearing loss, tinnitus, feeling full
which age group is affected by menieres disease>
30-40 year olds
labyrinthitis s/s
vertigo, vomiting, nystagmus
labyrinthitis
inner ear disorder
neurosyphilis is caused by what?
syphilis
CN VIII disease
hearing loss
acoustic neuroma what is it, which CN is affected and s/s
benign neuroma of 8th CN which causes UNILATERAL hearing loss, pain, headache and tinnitus
primary epilepsy
without apparent structural changes
secondary epilepsy
structural changes
seizure disorder tests
MRI, EEG, Serum chemistries, skull xray
during a seizure, if metabolic demand for oxygen and nutrients doesn’t increase then what can happen?
brain damage
after seizure (post-ictal) s/s
slow return to consciousness, combative, lethargic, confusion headache fatigue
Epileptogenic focus
neurons in brain depolarize (become excitable) causing it to fire more frequently
prodrome
an aura that happens before a seizure
simple partial seizure
begins locally and does not cause alteration of consciousness, sweating, flushing, pupil dilation
complex partial seizures, how long does it last
alter consciousness, amnesia for events that occur during and after seizure, lasts 1-3 minutes
atonic seizure
loss of postural tone and loss of consciousness
tonic-clonic seizures
loud cry–LOC–body falls–body spams, lasts 2-5 mins
myoclonic seizures
involuntary muscle jerks, no LOC
absence (petit mal) seizures
brief change in LOC, lasts 1-10 sec
status epilepticus
continuous seizure state, most life threatening
which seizure types can status epilepticus occur in?
ALL
Parkinsons disease
lack of dopamine
Lewy body is the hallmark of which disease?
Parkinsons
is Parkinsons fatal?
no but usually die from a complication like aspiration pna
5 stages of parkinsons disease
unilateral bilateral impaired balance fully developed severe disease confinement to bed or wheelchair
bradykinesia and what is it seen with?
extreme slowness of movement (seen with parkinsons disease)
what do you have in excess with parkinsons disease
acetylcholine
Multiple sclerosis
degenerative disease of CNS by demyelinization of neurons
MS:what levels are increased when a lumbar puncture tests is preformed and what levels are normal?
gamma globulin levels but serum globulin levels are normal
With MS, what reflex is present
Babinski
MS S/S
blurred vision, tremors, nystagmus, memory changes, fatigue, positive babinski
Elapsing-remitting MS
relapse with full/partial recovery each time
primary progressive MS (uncommon)
gets worse steadily without recovery
secondary progressive MS
relapse with recovery but eventually gets worse over time
what happens to the axons and nerve fibers with MS?
sporadic patches of axon demylelination and nerve fiber loss occur
which is the most debilitating symptom of MS
fatigue
secondary complications of MS
injury from falls, UTIs, constipation
tertiary complications of MS
depression, loss of social support, stree
how long does bells palsy take to recover?
few weeks
bells palsy
paralysis of one side of face
Guillain-Barre Syndrome
acute infectious neuronitis of cranial and peripheral nerves
what gets destroyed with Guillain-Barre Syndrome?
myelin sheath
Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrigs disease affects what system?
motor system
Glutamate becomes increased in which disease?
ALS
Myasthenia Gravis
neuromuscular disease, there is a defect in the transmission of nerve impulses
insufficient secretion of acetylcholine and too much cholinesterase can cause?
Myasthenia gravis
s/s of ALS
dysphagia, weakness, fatigue, dysarthria
s/s of Myasthenia gravis
diplopia, ptosis, hoarse voice
tensilon test, serum AChR antibodies, spirometry and TFTs are tests for?
Myasthenia gravis
Myasthenic Crisis
acute exacerbation of the disease, caused by rapid progrssion of disease
Cholinergic Crisis happens when there is too much of what?
too much acetylcholine, “SLUGG”
