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IPAP > Neuro Block 2 Cram > Flashcards

Neuro Block 2 Cram Flashcards

1
Q

What age group is associated with Multiple Sensory Defect Dizziness?

What is it AKA ?

What are the 4 parts that contribute to it?

A

Elderly when walking w/ impaired sensation in feet and poor vision

Benign Disequilibrium of Aging

Age, Dec Sensation, Poor vision, Light headed

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2
Q

What is the Tx for Vaso Vagal Syncope?

What classification of dizziness is always associated with positional changes?

A

Supine position w/ feet elevated, conciousness shoult return

Postural/Orthostatic HOTN that causes abrupt decrease of arterial flow

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3
Q

What are some of the underlying causes for Postural or orthostatic hypotension?

Which syncope classification is secondary to increased pressure on carotid sinus baroreceptors?

A

Chronic Dz or Polypharmaceutics

Carotid sinus hypersenstivity, usually found in Men over 50 w/ tight collar

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4
Q

What classification is associated w/ passing out on the commode while defecating?

What Sx is associated w/ VasoVagal Syncope?

A

Situational reflex syncope

Regains consciousness rapidly

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5
Q

What differentiates Vestibular Neuronitis from Labyrinthitis?

Name a common over the counter medication that can cause of Toxic Vestibulopathies?

A

Pure vestibular neuronitis= preserved auditory function Labyrinthitis= syndrome combined w/ unilateral hearing loss from viral origin

ASA

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6
Q

Name a rare cause of reflex syncope associated w/ sharp repetitive pain precipitated by swallowing/chewing?

How is it Tx?

A

Glossopharyngeal Neuralgia

Carbamazepine (anti-epileptic drug)
Med failure= Microvascualar decompression
Rhizotomy of Glossopharyngeal/Vagal fiber

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7
Q

Exercise induced syncope suggests what type of etiology?

What is the triad for Menier’s Dz?

A

Cardiovascular etiology

Unilateral hearing loss, Vertigo, Unilateral tinnitus w/ N/V

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8
Q

What is the treatment plan for Menier’s Dz?

A 
Avoid salt intake, caffeine, alcohol, nicotine, monosodium glutamate (MSG)
Tx stress/allergic rhinitis
Diuretics: HCTZ/Triamterine
Tx N/V: Meclizine, Scopolomine
Valium (diazepam) 
Hearing Aid
Gentamicin injection 
Surgery
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9
Q

What causes a Perilymphatic fistula?

How is it Tx?

A

Physical injury
Extreme barotrauma
Vigorous valsalva maneuvers Cough/Sneeze
Post-middle ear surgery

Bed rest, head elevation, and avoidance of straining
Surgical patch of the oval or round window

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10
Q

What is the most common cause of acute peripheral vertigo?

Acoustic Neuromas present w/ insidious onset of SNHL and can be associated w/ tinnitus/HA/vertigo. What PT population is it common in?

A

Benign PPV- brief/sudden episodes of vertigo w/ N/V

Middle aged females

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11
Q

Most Acoustic Neuromas are most commonly found on CN ?

What seizure is commonly found in children characterized by staring and lack of awareness?

A

CN8 in the cerebellopontine angle

Absence Seizure

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12
Q

Focal Seizures WITHOUT Dyscogntive features are characterized by what?

Focal Seizures WITH dyscognitive features are characterized by ?

A

No LOC, possible aura and body movement

Loss of awareness. Motor findings. Seizures involve impaired consciousness, responsiveness, and memory

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13
Q

A situation in which the duration of seizure is greater than how may minutes is status epilepticus?

What is the most common cause?

A

5min

Not taking seizure meds
Metabolic disturbance- low sugar
Drug toxicity
CNS Infection/Tumor
Head trauma
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14
Q

What are the 3 types of memory?

How is Working memory tested?

A

Working
Episodic
Lasting

Less than 30 seconds, so Tested w/ “repeat after me… “Neuro. Number. One”

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15
Q

How is Episodic Memory tested?

What is the time course for Delirium?

A

Word recall after 3-5min or,
Asking trivial events of the day

Acute Onset- acute change in mental status

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16
Q

What is the hallmark description of Delirium?

Wernicke’s Encephalopathy is found in ? PT population?

A

Waxing and Waning LoC

Chronic alcoholics*
PTs w/ malnutrition- emesis, starvation, renal dialysis, CA or AIDS

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17
Q

What are the risk factors for the most common form of dementia?

What are the 3 most common reversible causes of Dementia?

A

Alzeihmers
Age

Depression*
Hydrocephalus
Alcohol dependence

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18
Q

What is the single greatest risk factor for cognitive decline?

What abnormal protein is associated with Alzeihmer’s Dz?

A

Age

Extracellular amyloid beta deposits

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19
Q

What abnormal protein is associated with Lewy Body Dementia?

What abnormal protein is associated with Frontotemoral dementia?

A

A-synculein

Tau

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20
Q

Macroscopically (on MRI) what are the findings for AD?

How does this differ from Frontotemoral Dementia?

A

Cortical atrophy leads to compensatory dilation of ventricles

Frontotemporal Dementia is associated with marked atrophy of Temporal and Frontal lobes

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21
Q

Vascular Dementia lacks a uniform set of criteria but what are some findings that are suggestive of the Dx?

A

Cognitive deficit associated w/ Stroke
Abrupt onset w/ stepwise deterioration
Focal neuro findings on exam c/w stroke
Infarcts on MRI/CT

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22
Q

Alzeihmer’s Dz typically has what early sign?

How does this differ from Frontotemporal Dementia?

A

Abnormal Short term memory
Speech hesitant
Score of 24-27 on MMSE

Fronto temporal has early Behavioral changes

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23
Q

What is the triad for Normal Pressure Hydrocephalus?

What pseudomentia d/o is most commonly mistaken for dementia?

A

Cognitive decline
Urinary incontinence/urgency
Gait difficulty

Depression

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24
Q

How is depression Tx?

What are the three inherited forms of Chorea

A

SSRI/SNRI, CBT, Tx comorbidities

Huntington’s, Wilson’s, Benign hereditary chorea

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25
Q

What is unilateral chorea, with sudden, wild, flail-like movements involving proximal muscle groups?

What word is derived from the Greek word for restless and is abnormal movement w/ slow and writhing movements?

A

Hemiballismus

Athetosis, if held as prolonged posture is considered dystonia

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26
Q

What are SUSTAINED muscle contractions, frequently causing twisting, & repetitive movements or abnormal postures?

Name a Focal Dystonia?
Name a Generalized Dystonia?

A

Dystonia

Focal: Torticollis, Blepharospasm

Generalized dystonia: cerebral palsy, acute dystonic reactions

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27
Q

What is involuntary movements of the face and tongue, and very slow in performing voluntary movements?

What drugs can cause Tardive Dyskineisa?

A

Tardive dyskinesia

Long term Tx w/ antipsychotic drugs (dopamine-receptor blockers), Metoclopramide (reglan)

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28
Q

Define Essential Tremor

A

Rhythmic oscillatory movement enhanced by emotional stress and gone during sleep

Relieved by meds and alcohol

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29
Q

What are the 4 core Sxs of Restless Leg Syndrome?

What four items can clinically define Parkinson’s Dz?

A

Urge to move legs w/ or w/out sensations
wWorse w/ rest and at night
Improved w/ activity

Resting tremor
Cogwheel rigidity
Bradykinesia “masked facies”
Gait impairment

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30
Q

What do Pt’s w/ Parkinson’s Dz typically expire from?

What condition is characterized by genetic mutation causing premature apoptosis, atrophy in cerebral cortex and caudate?

A

Choking, pneumonia, falls

Huntingtons
Characterized by chorea and dementia

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31
Q

What autosomal recessive d/o affects copper metabolism that can cause neurologic manifestations?

What is the classic finding on PE?

A

Wilson’s Dz

Kayser-Fleisher rings

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32
Q

What unexplained Sxs are consciously produced?

What unexplained Sxs are unconsciously produced?

A

Factitious d/o (Munchausen’s)
Malingering

Somatoform d/o
Somatization d/o
Hypochondriasis
Conversion d/o- AKA pseudoneurologic syndrome

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33
Q

What are the risk factors for a stroke?

A 
Primary arterial HTN
A-Fib
Smoking
Medical Hx
Previous TIA
Age
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34
Q

What are the potential c/is for thrombolysis?

A 
BP >185/110 mmHg w/ Tx 
Bleeding d/o
Diathesis (plt <100K, HCT <25%)
Head injury/stroke/ hemorrhage (prior 3 months)
 Surgery- past 14 days
GI bleed- past 21 days
Recent MI past 3 months
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35
Q

If PT is not a candidate for thromblytic/tPA therapy, what are they given?

How is BP controlled in ischemic strokes?

A

ASA

Keep BP below 220/120
BB- Esmolol

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36
Q

What is the MOA of Esmolol used in the context of a HTN emergency?

What are the BP goals in a hemorrhagic stroke?

A

Relaxes vessels and slows HR to improve blood flow and decrease BP

150-22= 140
>220= 160
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37
Q

What is the BP goal for a hemorrhagic stroke w/ subarachnoid hemorrhage?

What meds need to be stopped and what is monitored for?

A

Keep SBP below 160

Stop all antiplatelet/anti-coag drugs
Use of IV Nicardipine of Esmolo needs monitoring for cerebral hypoperfusion

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38
Q

Which are more common ischemic strokes or hemorrhagic strokes?

What are the three most predictive examination findings for acute ischemic stroke?

A

80% ischemic

Asymmetric facial paresis
Arm drift/weakness
Dysarthria

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39
Q

What condition is a sudden onset of focal neurologic s/sx that last less than 24 hrs and typically resolve in a single hour?

A

TIA

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40
Q

After working up a TIA, what is typically out pt Tx?

What is the most common medical cause of SAHs?

A

Manage HTN w/ ASA, Ticlopidine, Clopidogrel

Ruptured cerebral aneurysm

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41
Q

What is the classic presentation of pts w/ an aneurysmal SAH?

What is the initial study of choice?

A

Sudden-Onset severe HA “Worst HA of my Life” “Thunderclap HA”

CT w/out contrast

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42
Q

What are relatively compact mass of sinusoidal vessels, typically packed close together?

What are true capillary malformations that often form extensive vascular networks through an otherwise nl brain?

A

Cavernous angiomas

Telangiectasia

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43
Q

What is the typical course of events for an Epidural Hematoma?

What is the most common cause of an Epidural Hematoma?

A

Hard blow to head, brief LOC followed by lucid period, when PT is wake/alert. As hematoma expands, PT experiences HA followed by vomiting/lethargy/hemiparesis, may progress to coma

Trauma to the middle meningeal artery

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44
Q

What type of Fx should be suspected in an Epidural Hematoma?

What is the mortality rate of an Epidural Hematoma that is left untreated?

A

Temporal skull Fx

100% death

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45
Q

Why does a subdural hematoma accumulate slower than an epidural hematoma?

mTBI, AKA concussion has what typical GCS score?

A

SDH is of venous origin whereas the EDH is arterial

13-15

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46
Q

Do Diffuse Axonal Injuries typically show up on CT?

What is the timeline for post-concussion syndrome?

A

Severe TIA lesions that contain substantial blood will show on CT, but more commonly, the CT will be negative

Sx for 7-10 days after injury

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47
Q

What is the timeline for For Post concussion d/o?

Know how to measure a GCS on a PT

A

> 3mon

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48
Q

What are the criterias for pronouncing brain death?

Define the oculocephalic reflex

A

CNS event compatible w/ dx
Exclude all other potentials
No intoxication/drugs/poisons
Core temp >32C/90F

Doll’s eyes
Assess brainstem function in comatose PT w/ intact brainstem
Head is turned, eyes move toward opposite side

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49
Q

The absence of doll’s eye’s movement in a comatose PT is indicative of ?

What is the next test conducted if Doll’s Eyes are absent?

A

Lesion of midbrain/pons

Oculovestibular reflex- ice water into EAC. PT w/ intact brainstem= eyes drift TOWARD the irrigated ear

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50
Q

What is the first stage sign of a central herniation?

With which of the herniations can the increased compression of the anterior cerebral arteries may cause the Pt to have leg weakness?

A

Dec level alertness
Small, reactive pupils
Decorticate posturing
Midposition pupils Decerebate posturing

Transfacial

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51
Q

What are 3 cardinal features of brain death?

A

Coma/unresponsiveness- no response pain
Absence of brainstem reflexes-
pupils, oculocephalic, gag, grimacing
Apnea- no respiratory attempts even with PCO2 > 60mmHg

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52
Q

Most common form of suppurative CNS infection?

What event greatly improves the Dz outcome?

A

Meningitis

Early Dx

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53
Q

Most Common cause for Community acquired Meningits?

What is the triad for meningitis that 2/3rds of PTs will have

A

Streptococcus pneumonia

Fever, HA, nuchal rigidity

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54
Q

What are the special tests for meningitis?

What is the Tx for Viral meningitis?

A

Kernig’s and Brudzinkski

Primarily symptomatic-
Analgesics, Antipyretics, Antiemetics, Fluids/E+ monitored

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55
Q

What factors associated with meningitis are associated w/ a poor prognosis?

What is the time frame goal for Abx on board for a patient suspected of bacterial meningitis?

A 
Age- old/young
Delayed Dx/Tx
Stupor/Coma
Seizure
Focal neurological signs

60min

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56
Q

Most common type of HA & account for more than ½ all HA’s seen in Primary Care

How does this type of HA present?

A

Tension HA

Bilateral, “Band-like” distribution
Tight pain in frontal/occipital regions

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57
Q

Dizziness is a term that describes a variety of feelings that includes ? 3

What are the 3 categories dizziness is broken down into?

A

Vertigo, Disequilibrium, Light headed

Pre/Syncope
Vertigo
Miscellaneous

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58
Q

Define Vertigo

Define Disequilibrium

A

Sense of rotational motion, indicates dysfunction in vestibular system

Describes feeling of uneasiness, about to fall and associated w/ an abnormal gait

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59
Q

What are the two criteria that can lead to a syncope?

What are the 5 categories of causes of syncope?

A

Dec blood or O2 to the brain

Vasovagal (neurally mediated)
Posture/OHOTN
Reflex (Carotid, Situational, Glossopharyngeal)
CV d/o
Cerebrovascular d/o
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60
Q

Vasovagal syncope is the result of what two events?

Define Vasodepressory syndrome

A

SNS withdrawal= dilation
Inc PNS- bradycardia

Associated w/ only sympathetic w/drawal

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61
Q

What is AKA the “common faint”

What are the 4 main S/Sxs

A

Vasovagal/neurally mediated syncope

Diaphoresis, Diuretic, Clonic movement, Retained sphincter

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62
Q

What is the physiology behind glossopharyngeal neuralgia

What is unique about these types of syncopes?

A

Afferent impulse activation in CN8 terminating in nucleus solitarius in the medulla

Less likely to be benign in origin and more likely in elderly PTs

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63
Q

What other neurological issues does glossophyrangeal neuralgia mimic?

What vessels supply the brain stem structures responsible for consciousness?

A

Trigeminal neuralgia

Vertebrobasilar arteries

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64
Q

Most PTs w/ CV presyncopal Sxs also experience ?

Define Basilar Artery Migraine

A

Focal neurological ischemia Sxs: weakness, ataxia, diplopia, dysarthria

Rare d/o causing syncope in adolescents

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65
Q

Syncope when PT is sitting/upright means ?

Syncope when PT is laying down means ?

Syncope when PT was exercising means ?

A

OHOTN

Cardiac event or seizure

CV etiology

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66
Q

What test is the first one conducted when working a PT up for syncope?

A

Head up tilt table test w/ Isoproterenol infusion

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67
Q

If PT had a prodromal light headedness prior to passing out suggests ?

If they had aura Sxs or have postical state, this suggests ?

If PT is clearly thinking upon recovery suggests ?

A

Syncope

Seizure

Faint

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68
Q

Vertigo can be associated with what 4 S/Sxs?

Vertigo can arise from an issue in what 3 systems?

A

Impulsion
Oscillopsia
N/V
Gait ataxia

Vestibular, Visual, Somatosensory

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69
Q

What is vertigo most commonly caused by?

What must it be differentiated from?

A

Asymmetry/imbalance between R/L vestibular systems

Central and Peripheral causes

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70
Q

How does Weber and Rinne tests appear on PE w/ PTs what have vertigo

A

Unilateral conduction
W: hears vibration in Dz ear
R: no AC after BC

Unilateral partial nerve deafness:
W: Vibrations in normal ear
R: hears AC after BC is gone

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71
Q

What are the 3 types of nystagmus?

What can cause physiologic vertigo?

A

Pendulum Saccade (fast), Pursuit (slow)

Intersensory mismatch- car sickness
Unfamiliar movements- sea sickness
Unusual head/neck position
Post-spinning

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72
Q

What can cause pathological vertigo?

A

Vestibular dysfunction- most common
Lesion on stabilizing sensory systems
Visual vertigo
Peripheral neuropathy/myelopathy

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73
Q

What are the difference in Sxs of Peripheral and Central vertigo?

A

Peripheral= short, movement dependent, horizontal, nystagmus

Central= long, not movement dependent, vertical or horizontal nystagmus

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74
Q

What are the peripheral vertigo causing d/os?

What are the central vertigo causing d/os?

A

BP MAG
BPPV, Peripheral vestibulopathy, Meniere’s, Acoustic Neuroma, Gentamycin toxicity

Wernicke’s CAMIS
Intoxication, Wenicke’s, MS, Alchoholic cerebellar degeneration, TIA/stroke, Cerebellar ataxias

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75
Q

What are the characteristics of peripheral vertigo d/os?

What are the 7 types of vertigo?

A

Lesion outside of brain
Sudden, lasting days w/ intense Sxs
Exacerbated by movement
Distress but no neuro PE findings

Vestibular neuronitis, Labrynthitis/Concussion, Meniere’s, Perilymph fistula, Bening positional, Cervical, Vestibular migraine

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76
Q

What is seen on PE of Vestibular Neuronitis in the acute phase?

How is it Tx?

A

Nystagmus and absent response to caloric testing

Supportive
Diazepam, Meclizine, Vestibular therapy
Refer to ENT

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77
Q

How is Labyrinthitis Tx?

What is the most common cause of vertigo after a concussion?

A

ABX if febrile/sign of infection
Diazepam, Meclizine

Labyrinthine Concussion Traumatic Vertigo

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78
Q

What type of injury is Labyrinthine Concussion Traumatic Vertigo associated with?

This form of vertigo can also result from ?

A

Basilar skull fracture causing vertigo, deafness in affected ear

Cupulolithiasis- causes episodic position vertigo

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79
Q

How is Labyrinthine Concussion Traumatic Vertigo Tx?

What is the relation to deafness and vertigo in Meniere’s?

A

Supportive, Vestibular suppressant/therapy

Deafness gets worse vertigo gets better

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80
Q

All Meniere’s suspected PTs get what work up?

What inner ear issue can be seen in PTs w/ BPPV?

A

Audiometry
Vestibular tests
MRI

Otolithic crystals made of calcium carbonate in semi-circular canals

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81
Q

What Sx is always present in BPPV?

How are Sxs reproduced on PE?

A

Positional nystamus

Dix-Hallspike Test/Barany Maneuver

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82
Q

How is BPPV relieved?

What causes cervical vertigo?

A

Epley reposition maneuver
Meclizine
Valium
Scopolomine patch

Neck hyperextension or DJD

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83
Q

How is Cervical vertigo Tx?

How does vestibular migraine present and what is it temporarily related to?

A

Neck exercises, collar, muscle relaxers

Episodic vertigo w/ temporary HA

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84
Q

Vestibular Migraine has a similar presentation to ?

How is it Tx?

A

Meniere’s

Migraine Tx/prophylaxis
Diet change
Anti-emetics

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85
Q

What vestibular orders last the least to the longest w/ auditory Sxs?

A

Seconds- perilymphatic fistula
Hrs- Meniere’s, Syphillis
Days- Labrynthitis/Labyrinthine concussion
Months- acoustic neuroma, ototoxicity

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86
Q

What vestibular orders last the least to the longest w/ NO auditory Sxs?

A

Seconds- Positional vertigo/Cupulolisthiasis, Certebrobasilar insufficiency, Cervical
Hrs- recurrent vestibulopathy, vestibular migraine
Days- vestibular neuronitits
Months- MS, cerebellar degeneration

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87
Q

Central d/os causing vertigo are lesions located where?

What other S/Sxs do they present w/

A

Cerebellum Pons

Ataxia, Nystagmus

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88
Q

What are the 6 common causes of central vertigo?

A 
Vertebrobasilar ischemia/insufficiency
Vertebrobasilar TIA/stroke
Acoustic neuroma
Toxic vestibulopathies
MS
Neurodegeneration involving vestibulocerebellum
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89
Q

What vessel is involved by TIA that causes central vertigo?

What 3 underlying conditions must be r/o when working a PT up for central vertigo?

A

Medial branch of PICA

Anemia, Pregnancy, Glucose derangement

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90
Q

What is the preferred imaging modality for suspected central vertigo?

How is Wernicke’s Tx?
How is MS flare up Tx?

A

MRI

Thiamine replacement
Prednisone burst

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91
Q

What are the S/Sxs of an Acoustic Neuroma

These types of tumors account for 80% of ? tumors

A

Tinnitus, HA, Vertigo, Facial weakness
Unilateral sensorineural hearing loss

Cerebellopontine angle tumors

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92
Q

Acoustic neruomas are made of ? cells that form ?

What is the preferred imaging for these?

A

Uniform spindle cells
Palisades called Verocay bodies

MRI w/ contrast

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93
Q

How are acoustic neuromas Tx?

What 4 drugs can cause toxic vestibulopathies?

A

Sxs, non-compressible and <3cm- stereotactic radio surgery via Gamma knife

Gentamycin
Salicylates
Quinine
Cis-platinum

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94
Q

Balance is maintained by what 3 senses?

Loss of consciousness occurs when ?

A

Vision, Proprioception, Vestibular

Function of both cerebral hemispheres or brain stem RAS are compromised

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95
Q

What are the 3 major causes of LoC?

Define seizure and how it is defined

A

Seizure, Syncope, damage to RAS

Shift in normal balance of excitation and inhibition
Defined by area of brain that’s involved

96
Q

Define Ictus

Define Provoked Seizure

A

Seizure

Seizure in otherwise healthy brain from altered levels of glucose, Na, drugs

97
Q

What types of injuries have high likelihoods of suffering from chronic seizures?

What are the 2 key features of a seizure?

A

Penetrating head wound
Blasts

Aura, Postictal confusion

98
Q

What are 5 causes of seizures that can occur to anyone?

A 
Hypoglycemia
Hyonatremia
Hyperosmolar
Hypocalcemia
Uremia
99
Q

What benefit do EEGs have?

EEGs are conducted under what conditions?

A

Confirm seizures if positive but don’t rule them out if negative

Physiologic stress- sleep deprivation

100
Q

What imaging is better for seizure exploration?

Characteristics of Focal Seizures w/out Dyscognitive features?

A

MRI

No LoC
Aura/smell
Body jerking

101
Q

Characteristics of Focal Seizures w/ Dyscognitive features?

A

Loss of awareness, repetitive movements, smacking, shouting

Olfactory hallucinations or deja vu are common and originate from the temporal love

102
Q

What are the 3 phases and events of a Tonic Clonic/Grand mal seizure?

What type of seizure is considered normal in it’s physiologic form?

A

Tonic- opisthotonus, apnea, tongue biting
Clonic- sphincter relaxation
Recovery- postictal confusion, HA, fatigue

Myoclonic- when falling asleep

103
Q

What is the first step and mainstay of seizure Tx?

When is lab monitoring needed

A

Fist- classify correctly
Mainstay- medication

CBC and LFTs 2wks, 1mon, 3mon, 6mon, Q6mon

104
Q

All anti-convuslant meds can lead to ?

What derm issue can arise?

A

Hematologic/Hepatic toxicity

Stevens-Johnson syndrome

105
Q

What meds are used for acute seizure management?

What meds are used for absence seizure management?

A

Carbamazepine, Phenytoin, Valproic acid

Valproic acid, Ethosuximide (s/e=bone marrow suppression)

106
Q

What meds are used for focal seizure management?

A 
Lamotrigine
Carbamazepine
Oxcarbazepine
Phenytoin
Levetiracetam
107
Q

What are the first line agents used for Tonic-Clonic seizures?

Status epilepticus are a medical emergency due to the potential fo the development of what 3 things?

A

Lamotrigine
Valproic acid

Cardiorespiratory dysfunction
Hyperthermia
Metabolic derangement

108
Q

What labs and studies are done during Status Epilepticus work up?

What drugs are used for medical therapy of Status epilepticus?

A

ABG, CBC, E+, Glucose, BUN, Creatinine, Ca/Mg, Toxicology, Anticonvulsant levels, ECG, LP

Lorazepam/Diazepam
Phenytoin w/ ECG monitoring
Fosphenytoin

109
Q

Referral to neurology is needed if seizures aren’t controlled by meds within ?

If first line drugs achieve partial control fo seizures, what drugs can be added for better control?

A

3mon

Topiramate, Zonisamide, Lacosamide, Tigabine

110
Q

Confusion can be broken down into what 3 issues?

Define Dysarthria

A

Delirium
Dementia
Amnestic d/o

D/o of articulation

111
Q

Define Aphasia

Define Global Aphasia

A

Inability to produce or comprehend language

Global- fluency, repetition, comprehension impaired w/ possible R hemiparesis from lesion in L hemisphere

112
Q

Define Conduction Aphasia

Define Transcortical Motor Aphasia

A

Fluency and Comprehension is preserved, Repetition, naming and writing impaired

Fluency impaired
Repetition, Comprehension preserved
Lesion near Brocas causing R hemiparesis

113
Q

Define Transcortical Sensory Aphasia

Define Subcortical Aphasia

A

Fluency and Repetition preserved
Comprehension impaired
Lesion in Wernickes

Repetition preserved
Fluency, comprehension variable
Hypophonia from lesion in left basal ganglia or thalamus

114
Q

Define Psychogenic Amnesia

Define Organic amnesia

A

Can’t remember emotional events
Can remember facts and events

Can’t remember objective facts

115
Q

Define Retrograde amnesia

Define Anterograde amnesia

A

Loss of memory for events immediately prior to d/o

Inability to store retain or recall knowledge

116
Q

An acutely confused PT will have impaired ? and inability to ?

A demented PT has a normal ? but problems with ?

A

Attention
Learn new material

Normal attention span
Recent memory

117
Q

Executive function is mental activities involved in what 3 things?

What is this also considered as?

A

Planning, Initiating and regulating behavior

Central organization function of the brain

118
Q

What is the “ I WATCH DEATH” acronym for causes of delirium and dementia

A 
Infection
Withdrawal
Acute metabolic
Trauma
CNS pathology
Hypoxia 
Deficiencies
Endocrinopathies
Acute vascular
Toxins
Heavy metals
119
Q

How does an acutely confused PT w/ alcohol intoxication present?

How long does it take for alcohol withdrawal to begin?

A

Nystagmus, dysarthria, limb and gait ataxia

5-10hrs- tremor, tachy, HTN
Day 2- seizure
Day 3-5- DTs

120
Q

What drugs are used during alcohol withdrawals?

How does B12 deficiency induced confusion present?

A

Benzos and Atenolol

Confusion to dementia or psychosis

121
Q

What is the most common cause of Wenicke’s Encephalopathy?

What is the triad?

A

Thiamine deficiency

Ophthalmoplegia/Nystagmus, Gait ataxia, Global confusion

122
Q

All PTs w/ undiagnosed AMS< oculomotor d/os or ataxis should receive?

What learning deficit can occur in Wernicke’s?

A

Thiamine and glucose

Korsakoff psychosis

123
Q

What type of cognitive impairement interferes w/ daily life?

What does this type of impairment usually turn into?

A

Mild cognitive impairment

Frank dementia

124
Q

What are the risk factors for developing Frank Dementia Alzheihmers type?

A

Memorry deficit 1.5 SD from norm
Apolipoprotein E4 allele
Small hippocampal volume

125
Q

What are the 4 types of dementia and the abnormal protein associated with each?

Which one is the most common cause of dimentia?

A

AD- AB42
Fronto Temporal- Tau
Lewy body- A-syncuclein
Prion d/o- CJacob Dz

AD

126
Q

What macro and micro changes are seen in AD?

Define Anosognsia

A

Macro- cortical atrophy
Micro- AB42 plaques, tangles in cytoplasm and amyloid accumulation in vessels

Lack of insight

127
Q

Pathology of AD is localized to what three structures?

What are the key findings?

A

Hippocampus
Lateral termporal cortex
Lateral septum (nucleus basalis of meynert)

Neuritic plaques (not seen on MRI)
Nerofibrillary tangles
128
Q

What will be seen on MRI/CT in late AD while PT is alive?

What test is useful to confirm Dx in an otherwise demented PT?

A

Enlarge ventricles
Widened sulci
Hippocampal atrophy

Apo E genetic test

129
Q

What meds are used in AD Tx?

A

Donepezil
Rivastigmine
Galantamine
NMDA antagonist- Memantine- mod/sev AD, expensive, GI s/e

130
Q

What are the two types of Vascular Dementia

What is the first Sx noticed in Dementia w/ Lewy Bodies?

A

Multi infarct and
Diffuse white matter make up a quarter of cases

Parkinsonian Sxs
Delirium response to L-Dopa
Visual hallucinations

131
Q

What is seen on imaging in PTs w/ normal pressure hydrocephalus?

How is it treated?

A

Large lateral ventricles w/ little or no cortical atrophy

Shunt

132
Q

Where is damage seen in B1 deficiency dementia?

What are the roles of the basal ganglia?

A

Thalamus and midline structures

Central processing center involved in movement, cognition, emotion and learning

133
Q

What 3 chemicals are involved in feedback loops?

What causes resting tremors?

A

Dopamine, glutamate, GABA

Idiopathic
Parkinsons

134
Q

What causes postural tremors

What causes action potentials

A

Physiologic tremor

Cerebellar outflow tract dysfunction

135
Q

Tremors can be described and categorized as what 3?

What is Chorea mean in Greek?

A

Resting
Postural
Action

Dance

136
Q

Define milkmaide grasp and dancing gait

A

Milkmaid- intermittent grip relaxation

Irregular, unsteady gait causing PT to suddenly dip/lurch to tone side

137
Q

Hemiballismus is most often due to ?

How is it Tx?

A

Vascular Dz in contralateral subthalamic nucleus

Dopamine depletion/blocking
Pallidotomy in severe cases

138
Q

What causes dystonia to go away and become worse?

What are the 3 types of focal dystonia?

A

Absent during sleep
Worse w/ voluntary movement

Torticollis
Blepharospasm
Writer’s cramp

139
Q

What are the 2 types of generalized dystonia?

Myoclonus are classified into what 4 categories?

A

Cerebral palsy
Acute dystonic reaction

Generalized
Focal
Mutlifocal
Segmental

140
Q

Pathological myoclonus are associated with ?

Define Coprolalia
Define Echolalia

A

Hypoxemia

Tic of profanity
Tic of repetition

141
Q

Who was Dr Mort Doran

Define Parkinsonian tremor

A

Surgeon w/ Tourettes who had no tic when performing surgery, usually disappears during sleep

4-6Hz tremor usually at rest in hand/foot
Inc w/ stress, improved w/ activity

142
Q

Define Cerebellar Tremor

Define Rubral of Holmes

A

Slow tremor of extremity usually at the end of a purposeful movement

Combo of rest, action and postural tremors associated w/ Cerebellar tremors

143
Q

Psychogenic tremors are usually associated with ?

Define Orthostatic tremor

A

Conversion s/o
Psych issues

High frequency rhythmic contraction after standing, decreases w/ sitting, walking or lifting extremity off ground

144
Q

What type of tremor can follow excessive exercise or sleep deprivation

When is this a common finding

A

Physiologic tremor

Alcoholics/drug abusers during withdrawal
Thyrotoxicosis/poisoning

145
Q

How are physiologic tremors treated?

A

Withdrawal of offending agent and BBs

146
Q

What causes half of essential tremors?

What causes these to worsen and improve?

A

Involuntary 6-10hz oscillation movement worse w/ activity due to ETM1/ETM2 gene mutation w/ dominant transmission

Worse w/ caffeine, nicotine or fatigue
Better w/ alcohol

147
Q

How are essential tremors treated?

A 
Propanolol
Gab/Pregablain
Benzos
High frequency thalamic stimulation
Surgery
148
Q

What drugs can cause dystonic reactions?

A 
Antipsychotic
Phenothiazine anti-emetics
Cocaine/LSD
TCAs
Lithium
Anticonvulsants
149
Q

How are acute cases of dystonia treated?

What causes primary restless leg syndrome?

A

Diphenhydramines
Baclofen

Genetics

150
Q

What can cause secondary restless leg syndrome?

A 
TCAs/SSRIs
Hypoglycemia
Opiate withdrawal
Pregnancy
Animea
Ferritin deficiency
Renal failure
Peripheral neuropathy
151
Q

How are the different stages of restless leg syndrome treated?

A 
mild- sleep hygiene
Mod-sev= dopamine agonist (Pramipexole, Ropinirole)
Opiates
Gabapentin
Analgesics
152
Q

What mental issues are often assicated with the autosomal dominant Gilles de la Tourette Syndrome?

What meds can be used for Tx?

A

OCD and ADD

Halopreidol
Pimozide
Clonidine
Flupheazine
Botulism Toxin A
153
Q

What are the 4 causes of Parkinsonism?

A

Neuroleptic drug exposure
Cerebrovascular dz
MPTP
Von Economos Dz (encephalitis lethargica)

154
Q

Pathology of Parkinson’s shows damage in what area?

How are Sxs revealed?

A

Substantia nigra

No dopamine allows increased amounts of GABA output

155
Q

What are the presenting Sxs of Parkinson’s Dz?

Define the festinating gait?

A 
OH LOOK TRAP
Tremor
Rigidity
Akinesia
Postural instability

PT has to walk quicker to prevent from falling over

156
Q

How is Parinson’s Dx’d?

How are the different types treated?

A

Clinic basis only

Dopamine- bradykinesis and rigidity (Carbidopa/Levodopa)
Anti-Ach- rigidity, tremor (Benztropine)
Dopamine agonist- young PTs or mild cases (Pramipexole, Ropinirole)
Amantadine- dopamine augment
Neuroprotection w/ Selegeline, Coenzyme Q10

157
Q

What are the 3 surgical options for parkinsons?

A 
Thalamotomy
Pallidotomy
Deep brain stimulation of subthalamic nucleus
PT
Speech therapy
158
Q

Why do Sxs of Huntingtons Dz become visible?

A

Autosomal dominant trait causing increased concentration of GABA and ACh in basal ganglia from increased levels of dopamine

159
Q

What test can be done to assess for Huntington’s Dz?

What will be seen on CT or MRI?

A

Tongue protrusion

Atrophy of cerebral cortex and caudate nucleus

160
Q

What meds are used to Tx Huntingtons?

A 
Haloperidol
Reserpine
SSRIs
Benzos
Xenazine- inhibits vesicular monoamine transoporter 2
161
Q

How to PTs w/ Huntingtons usually die?

A

Infection, Fall related injury, suicide

162
Q

Define Stiff Person Syndrome

Where does the stiffness begin?

A

Paraneoplastic- small cell lung/breast cancer

Trunk and legs

163
Q

What spine issue is seen in Stiff Person Syndrome?

What lab results may be seen since CSF is usually normal?

A

Hyperlordosis- causes tin man gait

Abs against Glutamic Acid Decarboxylase

164
Q

How is Stiff Person Syndrome Tx?

Cerebral palsy is a chronic impairment of what 4 things?

A

GCCs
Baclofen
IVIg and plasma exchange

Tone, Strength, Coordination, Movements

165
Q

Why does copper accumulate in Wilson’s?

What is the most sensitive screening test?

A

No conversion to Cerulosplasmin

24hr urine

166
Q

What Dx is considered if a PT answers “bothered a lot” in 3 or more Sxs on a certain screening questionnaire?

What PT population are pseudoseizures more common in?

A

Somatoform d/o

Sexual abuse or trauma

167
Q

What clues suggest pseudoparalysis?

A

Weakness not following anatomic pattern
Give away weakness
Hysterical gait
Pain stimulation causes withdrawal of numb area

168
Q

What are Waddell Signs?

Define Pseudocoma?

A

ID non-organic causes of back pain

PT slumps to floor to prevent hitting head usually w/ observer present

169
Q

What clinical clues suggest pseudocoma?

A

Eyes drift up w/ lid openin
Response to pain stimulus
Hand will just miss face w/ drop test
Caloric test causes nystagmus and N/V

170
Q

Define Pseudotremor

Define Psychogenic Parkinsonism

A

Abrupt onset, disappears w/ distraction

Hysterical gait

171
Q

Define psychogenic myoclonus

Define Psychogenic dystonia

A

Periods of spontaneous remission

Abrupt onset w/ inconsistent exam

172
Q

Define Pseudoneuro-Ophthalmologic Syndrome

What PE clues can suggest this?

A

Sudden blindness w/ diplopia being a common complaint

Normal pupil response
Normal optokinetic nystagmus/mirror response
Normal fundoscopic exam

173
Q

What structures does the anterior/carotid circulation supply?

What does the posterior/vertebro-basilar circulation supply?

A

Cerebral hemispheres except- medial temporal and portion of occipital lobe

Brainstem
Thalami
Cerebellum
Posterior cerebral hemispheres

174
Q

How does the brain get blood supplied to it?

Strokes are the second most common ? and most common ?

A

Internal carotids and vertebral arteries

2nd most common cause of death
Most common disabling neuro d/o

175
Q

What are the steps of events during a brain herniation?

A

Midline shift

Down displacement of cranium

Uncus and hippocampus herniate into tentorial notch

Cerebellar tonsils herniate through foramen magnum causing death

176
Q

Define Neurosis

What structures are involved during an anterior circulation stroke?

A

Mental d/os involving distress but neither delusion or hallucination

L and R cerebral hemisphere

177
Q

What structures are involved in a posterior circulation stroke

A 
Lateral medulla
Bilateral pontine base
Medial tegmentum
Cerevellar infarction
L/R PCA terriotory
Lacunar syndromes
178
Q

What are the results of L cerebral hemisphere involvement from an anterior stroke?

A 
R hemiparesis
R hemisensory loss
Aphasia
Eye deviation
L monocular vision loss
179
Q

What are the results of R cerebral hemisphere involvement of an anterior stroke?

A 
L hemiparesis
L hemisensory
Poor drawing/copying
Neglect of visual field
Eyes deviate to R
R monocular vision loss
180
Q

Stopped on

A

Lect 9 Slide 72

181
Q

Epidural hematomas typically present with what 3 S/Sxs?

What type of injury affects ? artery and how does it appear on CT?

A

Trauma, Progressive coma, Lucid intervals

Middle meningeal artery from temporal skull Fx appearing as convex hyper density brain tissue

182
Q

What causes subdural hematoma?

What causes the bleeding?

A

Blow to front or back of head
Hitting windshield

Veins between dura and arachnoid torn

183
Q

How do subdural hematomas appear on imaging?

What is the most common PT and MOI for young and old individuals?

A

Crescent shaped hyperintensity between brain and skull

MVA
M>W

Falls
W>M

184
Q

What’s the definition of TBI?

A

Alteration in brain function caused by external force characterized by:
Dec/LoC
Loss of memory
Alteration in mental state at time of injury

185
Q

What type of injury is from Coup/Countercoup injuries?

The mechanisms of this injury causes the body to release what two things?

A

Cortical contusion causing a TBI causing a disruption of axon transport causing axon swelling

Neurotransmitters
Free radicals

186
Q

If the brain is ‘slapped against the cranium’ then the PT has a ?

What are the two types of bleeds that can occur?

A

TBI

Vein= subdural
Artery= epidural
187
Q

What is the most recognized and widely used method for grading TBI severity?

What are the 3 parts to the assessment?

A

GCS

Eye Voice Motor

188
Q

How are mild, moderate and severe TBIs scored with GCS?

What type of amnesia is common and bad in TBIs?

A 
Mild= 13-15 AKA Concusion
Mod= 9-12
Sev= 3-8

Retrograde- common
Antegrade- bad

189
Q

What are the worsening signs of a TBI that indicate a bleed?

Diffuse axonal injury is associated with ?

A

Worsening HA
Focal neuro signs
Worsening confusion
Impaired consciousness

4 or more areas of severe axonal injury from trauma

190
Q

What is the first imaging choice for diffuse axonal injury?

Post concussion d/o timeline
Post concussion syndrome time line

A

CT- only shows severe TIA lesions though

7-10days
3mon

191
Q

Post traumatic seizures and epilepsy are divided into what two stages?

What are the 4 herniation syndromes?

A

Early- within 1 wk of trauma
Late- after 1wk of injury

General
Central/Transtentorial
Uncal
Subfalcine

192
Q

What are the 4 components of a General herniation syndrome?

What separates the cranial cavity?

A

Shift in brain contents
Compression of parenchyma
Compression of ventricles
Comprised cerebral blood flow

Foldings of dura

193
Q

What separates the two cerebral hemispheres?

What is the most common form of herniation?

A

Falx
Anterior/Posterior fosae by the tentorium

Central- AKA Transterntorial

194
Q

What causes Central/Transterntorial herniations?

What are the stages of events?

A

Cerebral edema
Large intracranial masses

Herniation of diencephalon into tentorial notch
Dec LoC, Small pupils
Decorticate
Mid-position pupils
Decerebrate
Motionles and death
195
Q

What are the events of Uncal herniation?

A

Anterior medial temporal gyrus impacts into anterior portion of tentorial opening causing medial shift in temporal lobe
Hemiparesis
LoC
Ipsilateal hemiplesia/Kernohan’s Phenomenon

196
Q

What is the first sign of Uncal Herniation?

What causes a transfalcial herniation?

A

3rd Palsy

Herniation of cingulate gyrus beneath the falx and across midline

197
Q

What happens to PTs w/ transfalcial herniations as the anterior cerebral arteries are compressed?

What is the midway point between alert and coma?

A

Leg weakness

Stupor

198
Q

Stupor may be a sign of injury to the ? or ?

Coma is a ? state that leads to ? or ?

A

Injury to RAS
Damage to cerebral hemispheres

Transitional
Recovery, vegetable

199
Q

What’s the difference between Decorticate and Decerebrate posturing?

A

Same: plantar flexion, knee extension, wrist flexion, upper arm adduction

Decorticate- elbow flexion,
Decerebrate- elbow pronation/extension

200
Q

What are the initial management steps for PTs with stupor/coma?

Irreversible loss of brain function can be the result of what 2 processes?

A

IV NS, Thiamine, Naloxone, Dextrose

Hypoxic-ischemic brain
Fulminate hepatic failure

201
Q

What are the 4 pitfalls of Dx Brain Death?

Can PAs pronounce PTs dead?

A

Facial trauma
Papillary abnormalities
Toxic levels of drugs
Sleep apnea/pulmonary Dz

Yes in combat but only in remote locations

202
Q

What documentation must happen if a PA pronounces someone dead?

A

Etiology and irreversibility of condition
Absence of brain stem
Absence of motor response to pain
Absent respiration w/ PCO2 60mm or more
Confirmatory testing
Repeated neuro exams- 2 apnea tests 6hrs apart

203
Q

Posterior circulation comprises of what 4 structures?

1/3 of PTs who survive a TIA will have a full stroke within ?

A

SCA, PICA, AICA, Basilar artery

5yrs

204
Q

What is the most common cause of brain ischemia?

Brain ischemia/stroke material arises ?

A

Atherosclerosis commonly effecting large neck vessels and internal carotids

Proximal- most commonly from heart, aorta, ICA, VA

205
Q

What are the 6 acute HA syndromes?

A 
Glaucoma
Hypersensitive encephalopathy
Meningitis
Encephalitis
Drug rebound HA
Sinusitis
206
Q

Define Meningitis

Define Encephalitis

A

Men- infection of subarachnoid space

Enceph- infection of brain tissue

207
Q

How can meningitis invade the blood stream?

How is it directly spread?

A

Bacteremia, Viremia (aseptic meningitis), Fungemia, Parasitemia

Sinusitis
Otitis media

208
Q

What is the pathognomonic sign of meningeal irritation?

What is the most common form of suppurative CNS infection?

A

Nuchal rigidity

Bacterial meningitis

209
Q

What are the top two most common causes of community acquired bacterial meningitis?

What microbe causes recurrent epidemic outbreaks of meningitis every 8-12yrs and what is the characteristic finding of this microbe

A

Strep pneumo
Niesseria meningitidis

Niersseria meningitidis- purpuric rash that doesn’t blanch w/ pressure

210
Q

What will lab results on CSF w/ bacterial meningitis show?

What does the loss of sulci mean in meningitis?

A

PMNs, Dec Glucose, Inc protein and opening press

Edema + pus

211
Q

What ABX are used for different aged groups of PTs w/ meningitis?

What is the timeframe goal for ABX Tx?

A

1mon-3mon= Amp + Cefotax/Ceftriax
3mon-55y/o= Vanc + C/C/C
+55y/o alcoholic or Dz= Amp + Ceftriax/ Vanc + Ceftriax
Impaired cellular= Amp + Ceftaz + Vanc

W/in 60min

212
Q

What 3 steps are taken when bacterial meningitis is suspected?

What are the top two causes of viral meningitis?

A

Blood cultures, Empiric ABX, Dexamethasone therapy started w/out delay

Enterovirus
Arbovirus

213
Q

What will lab results of CSF w/ viral meningitis show?

Encephalitis is usually viral in origin and caused by ?

A

Inc cell count- Pleocytosis
Normal protein, glucose, opening pressure

Herpes, Enterovirus, Arbovirus

214
Q

What’s the difference between Primary and Secondary Encephalitis

What imaging modality is preferred?

A

Primary- virus infects spine or brain
Secondary- AKA post-infectious encephalitis, virus infects other body tissues

CT w/out contrast done before LP

215
Q

What will CSF lab results show for viral encephalitis?

What are two major components for Tx?

A

Normal protein, glucose
Pos lymphocytes

Head elevation w/ mannitol
Control hyperthermia

216
Q

What two meds can be given during a PTs withdrawal period to treate rebound HAs?

What med is given prophylactically for coitus HAs?

A

Sumatriptan or Dihydroergotamine

Indomethacin

217
Q

What causes Hypertensive Encephalopathy

How is it treated?

A

Secondary to sudden BP increases
Pheo, Sex or MOA/Tyrosine foods (cheddar cheese)

Anti-hypertensive drugs

218
Q

What might be seen on imaging in PTs w/ hypertensive encephalopathy?

What are the 3 recurrent HA syndromes?

A

Posterior white matter changes

Tension, Migraine, Cluster

219
Q

Tension HAs

A

Non-throbbing HA after 20y/o from contraction of scalp/neck muscles and can hint underlying depression/anxiety

Most common type of HA, half of HAs seen in clinic

Bilateral band at temporal/occipital lobes

Tx w/ daily stretches as important FIRST step
TCAs, not SSRIs

220
Q

Migraine HAs

A

Second most common HA in US w/ F>M predominance
Syndrome of HA, N/V, Neuro Sxs w/ onset at 20-30y/o

Can be w/, w/out aura or complicated

Scotomata- common

Usually in the morning w/ gradual/crescendo onset w/ dull/pulsatile progression

221
Q

What is the most frequent type of vascular HA?

What is the POUND acronym mean and what is it’s value?

A

Migraine w/out aura

Pulsatile, Onset (4-72hrs), Unilateral, N/V, Disabling
4/5= 92% probability of migraine

222
Q

What are the steps of migraine Tx?

What NSAIDs can be used for mild migraines?

A

1st- NSAID w/ caffeine
2nd= Serotoning agonist: Tryptan, Ergots, DHE
3rd= antiemetic/dopamine blocker: Prochlorperzine, Metoclopromide

Toradol, Naproxen

223
Q

What meds are used for migraine abortive Tx?

How often can this med be re-administered and where is it c/i?

A

Selective 5HT agonists- Tryptans at onset of pain

Repeat once after 1-2hrs
C/i in pregnancy, cardiac and cerebrovascular Dz

224
Q

What is the MOA of Ergotamine?

Where is the use c/i?

A

Non-selective 5HT agonist, old school constrictor w/ caffeine

Pregnancy, CADz

225
Q

Why is Metoclopramide used for migraines?

What opioid is used?

A

Relieves nausea

Butorphanol nasal

226
Q

What are indications PTs need migraine prophylaxis?

What meds are used?

A

More than one a week or predictable (menses)

Propanolol, Timadol, CCB, ACEI/ARB
Antidepressant: amitriptyline
Anticonvulsant: valproic acid, topiramate, gabapentin

227
Q

How are cluster HAs Tx?

What meds can be used for prophylaxis?

A

100% O2, Sumatriptan, DHE
Prednisone stops cluster attacks

Verapamil, Triptan, DHE

228
Q

Low Pressure HA

A

Tear in dura causes low pressure CSF/subarachnoid space
Pain worse upright, better laying down
Tx: Fluids, Caffeine Sodium Benzoate

229
Q

Idiopathis Intracranial HTN is AKA?

What causes it?

A

Pseudomotor cerebri

Inc ICP causing HA, Papilledema, Pulsatile tinnitus, Visual loss/diplopia
Pain worse in morning and relieved by sitting up
CN6 Palsy

Tx: LP

230
Q

How do brain tumors present?

These present as one of what 3 syndromes?

A

HA w/ pain worse in morning/waking from sleep
Pain worse w/ valsalva/exertion and N/V

Focal neuro deficit
Seizure
Nonfocal neuro d/o (HA, dementia, personality change)

231
Q

How are brain tumors Dx?

What test needs to be avoided?

A

CT/MRI w/ contrast

No LPs

232
Q

What meds are used to Tx post-traumatic HA?

Trigeminal Neuralgia is AKA ?

A

Analgesic
Amytriptyline, Propanolol, Egot derivatives

Tic Douloureux

233
Q

How is Trigeminal Neuralgia Tx?

A

Carbemazepine
Lamotrigene
Phenytoin
Baclofen

234
Q

How does glossopharyngeal neuralgia present?

How is it Dx?

How is it Tx?

A

Pain at tongue/tonsil base or auditory meatus

Reproduction of pain

Carbamazepine

235
Q

What causes the Sxs of a subdural hematoma?

What lab test is done for seizure PTs to tst for syphilis?

A

Stretch= HA
Inc ICP= contralateral weakness

FTA-Abs for Treponema Pallidum

IPAP (212 decks)

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