Neuro Flashcards
Thunderclap headache
subarachnoid bleed, especially post partum
Headache associated with pregnancy
Pre-eclampsia. Protein in urine can verify this
Headache associated with HTN, sweats, and heart palpitations
Pheochromocytoma
Headaches associated with cough diagnoses is made when?
headache is brought on and occurs only in association with coughing, straining or a Valsalva manoeuvre and in the absence of any abnormalities on neuro-imaging.
symptomatic cough headache diagnoses is made when?
underlying pathology is identified
Cluster headaches are more common in which people?
men
Cluster headache symptoms, when do they occur, for how long
Wakes patient up at night. Lasts between 15 minutes and 3 hours. Patients usually agitated, No family history of migraines. Will resolve spontaneously, then reoccur. Several episodes per year.
migraines are associated with which symptoms
photophobia, phonophobia, blurring of vision, cognitive impairment, nausea, vomiting
migraine treatment
NSAIDs, Ibuprofen, ASA, triptans, ergotamine/Caffeine (Cafergot)
cluster headache treatment
Prednisone 60 mg for 5 days.Ergotamine and Imitrex not usually effective
Triptans should be avoided in which kinds of patients?
pregnancy, Ischemic disease, diabetes mellitus, coronary artery disease or vascular disease.
Zomigdose
5 mgm at onset, may repeat in 2 hours.
ergotamine/Caffeine (Cafergot) dose
1 mg with 100 mg caffeine
Headache due to Intracranial Mass Lesions symptoms
New onset headache in middle age or later in life, Night sweats, Weight loss, Visual defecits: esotropia, exotropia, Neurological deficits, Papillar edema, Seizure like tremoring or grand mall
medication overuse (withdrawal headache) treatment
Cafergot
most common causes of head injuries in young people are
falls
primary interventions for concussion
Cognitive and physical rest
Zofran is given to help with nausea in concussion patients, what are the side effects of zofran
headaches, drowsiness, and dizziness that may exacerbate other symptoms of concussion. Thus, caregivers should be instructed to stop ondansetron if it makes their child feel worse
concussion patients may have sleep disturbances, what do we do for them?
educate on good sleep habits, can give melatonin
which patients are at risk for prolonged recovery of concussions?
history of prior concussions, female sex, history of migraines, history of learning disabilities, recurrent concussion soon after recovery, or degree of symptoms after a concussion
Second impact syndrome
death or devastating neurological injury attributable to massive swelling of the brain in athletes who sustain a second head injury prior to full recovery from a concussion
Concussion danger symptoms in adults that could signify a blood clot in brain that formed after concussion
Headache that gets worse and does not go away, Weakness, numbness or decreased coordination, Repeated vomiting or nausea, Slurred speech.
Which patients with mild TBI should have a noncontrast head CT scan in the ED?
Level A: Loss of consciousness or posttraumatic amnesia and one or more of the following: • Headache • Vomiting • Age > 60 years old • Drug or alcohol intoxication • Deficits in short-term memory • Physical evidence of trauma above the clavicle • Posttraumatic seizure • GCS score < 15 • Focal neurologic deficit • Coagulopathy
First line therapy for sleep disturbance
other than melatonin
Trazadone 25-50mg
Treatment for Post Concussion Syndrome
Amitryptilline 10-25mg, increase to 50 mgm weekly as necessary. Must have baseline EKG in adults due to possibility of conductive disturbances.
glasco scoring for TBI range and what does it look at?
3-15, eye movement, motor response, verbal response, the lower the score the worse off they are
if patient has a glasco score of 8 after 6 hours what is the likelihood of them dying?
50%
Do older individuals with vasovagal syncope experience a prodrome?
no
carotid sinus syncope is caused by
neck movements
A vagal “surge” immediately upon swallowing can cause
bradycardia and hypotension in predisposed patients
Exertional syncopecan be caused by?
ventricular tachycardia and obstruction from aortic stenosis, hypertrophic cardiomyopathy, hypotension from vagally-mediated vasodepression in patients with hypertrophic cardiomyopathy.
If exertional syncope has occurred and there is no other reason for it, what is the diagnoses?
neurocardiogenic syncope
why is it important to do an EKG with syncope patients?
restore of consciousness is usually quick but even an arrhythmia can still be present with
neurocardiogenic syncope
syncope without a prodrome is more common in which patients?
cardiac syncope
Hyperventilation can be seen with
pulmonary embolism or psychiatric causes of syncope
In-hospital monitoring is recommended in syncope patients with
structural heart disease
Iatrogenic syncope
syncope caused by medications
preferred treatment for syncope due to Supraventricular arrhythmias
radiofrequency ablation
Documented, suspected, or induced ventricular tachycardiasyncope should be treatment with what?
an ICD
typical vertigo symptoms
n/v
is vertigo a diagnoses?
no its a symptom
Tilt illusion
patients feel that they and their environment are tilted with respect to gravity, feels like they are upside down
patients experiencing Tilt illusion have damage to what?
otolithic organs
Drop attacks
feeling like you’re being pushed or pulled to ground
drop attacks are seen with which disorder?
Meniere disease.
Spatial disorientation
A fleeting spatial disorientation with rapid head turns
Oscillopsia
a visual illusion of to-and-fro environmental motion
Impaired balance without vertigois a sign of what
acute simultaneous bilateral vestibular loss
Aminoglycoside toxicity is the most common identified etiology of
bilateral vestibulopathy
bilateral vestibulopathy is a key feature in which problems?
CANVAS (cerebellar ataxia, neuropathy and vestibular areflexia syndrome
