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I am built like a neuroglia > Neuro MDT > Flashcards

Neuro MDT Flashcards

1
Q

Headache DANGER SIGNS

A
  • Thunderclap
  • Absence of prior headache
  • Focal neurosigns
  • Fever
  • Rapid onset with exercise
  • Nasal congestion
  • Papilledema
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2
Q

Thunderclap headache could be:

A

SAH

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3
Q

Absence of prior headache danger sign could be:

A

CNS infection

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4
Q

Focal Neurosigns other than auras could be

A

stroke or tumor

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5
Q

Fever with headache could be:

A

Meningitis

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6
Q

Rapid onset headache with exercise could be:

A

IC Hemmo./ Brain Aneurysm

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7
Q

Headache with nasal congestion could be:

A

Sinusitis

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8
Q

Headache with papilledema could be:

A

Increased ICP

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9
Q

Headache reasons to refer for imaging: (8)

A 
change in pattern
worsening despite tx
neuro. deficit
scalp tenderness
onset with exertion
visual changes
40 years or older
hx of trauma/ HTN
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10
Q

Tension Headache characteristics

A 
most prevalent
bilat
daily
"vice-like"
stress/fatigue/glare
No dx tests*
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11
Q

Tension Headache Tx

A

NSAIDS: Motrin 400-800mg Q4-6H/2400mg in 24H max

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12
Q

Tension Headache Tx

A

NSAIDS: Motrin 400-800mg Q4-6H/2400mg in 24H max
Naproxen 250-500mg PO Q12
Non-Sal: Tylenol 325-1000mg PO Q4-6H/ 4G in 24H max

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13
Q

Cluster Headache Sx

A
  • middle aged males
  • unilateral px
  • restless agitated
  • 15 min-3 hours
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14
Q

Cluster Headache Additional sx

A
  • ipsilateral congestion
  • lacrimation
  • Horner Syndrome
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15
Q

Homer Syndrome (3)

A

stop sweating
drooped eyelid
small pupil

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16
Q

Cluster Headache tx + MOA and Contraindications

A
  • O2 100% 15 min*
  • Sumatriptan SC 6mg/24h max 12mg
  • Zolmitriptan 2.5mg PO/ 10mg 24h max

MOA: Vasoconstriction/Trigeminal assistance
Contra: Cardiac/Bleeding issues

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17
Q

Migraine characteristics (6)

A 
throbbing 
unilateral or bilateral
aura (maybe)
visual disturbances
Fam Hx
NV
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18
Q

Migraine Dx:

A

Clinically using HPI

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19
Q

Migraine Tx

A 
avoidance
rest
analgesics 
Sumatriptan 25/50/100mg or 6mg SC
50mg works best*
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20
Q

Migraine prophylaxis + contraindications

A

beta blocker
Propranolol 20mg BID: 40-160mg range

CHF Cardio Hypotension

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21
Q

Migraine secondary treatments

A

Anti-depressant: Amitriptyline 10mg

Anti-emetic: Promethazine 12.5mg-25mg Q4-6H

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22
Q

Post Trauma Headache characteristics

A

1-2 days after injury
poor memory and concentration
emotional instability

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23
Q

Post Trauma Headache tx

A

analgesic

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24
Q

Med Overuse headache characteristics

A

50% of daily headaches
chronic px
heavy analgesic use

treat with med withdraw

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25
Partial Seizures characteristics
dependent on cortical involvement | preictal phase can have auras
26
Focal Seizure with Retained Awareness
FKA: Simple Partial Seizure* | only 1 part of brain/sx dependent on this
27
Focal Seizure with Impaired Awareness
FKA: Complex Partial Seizure* one part of brain awake/not responding no memory
28
Complex Partial Seizure 4 signs
Grimace Gesturing Lip Smack Repeating
29
General Seizure
entire brain altered consciousness Tonic-Clonic aka Grand Mal
30
Tonic phase
stiffening
31
Clonic Phase
rhythmic jerking
32
Todd Paralysis
weakness of limbs
33
3 Postictal Phase Sx
somnolence no recollection Todd Paralysis
34
Seizure Dx
EEG
35
Seizure Tx
secure airway treat sx MEDEVAC
36
Seizure labs
electrolyte LFT CBC Glucose
37
Active Seizure Med
Diazepam 5mg IV/IM Q5-10min; 30mg Max | binds with GABA
38
Status Epilepticus
seizure that lasts longer than 5 min, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes
39
Status Epilepticus tx
Diazepam Valproic Acid 30mg Intubate
40
Frontal Lobe Sx
Head and Leg Jacksonian March Posturing
41
Parietal Lobe Sx
Paresthesia
42
Occipital Lobe Sx
Visual Phenomena
43
Temporal Lobe | "oh so no head?"
Hallucinations Epigastric rising Automatisms Deja vu
44
Psychogenic Non Epileptic Seizure
not assoc. with neuronal activity longer than 2 min no incontinence no postictal phase
45
PNES tx
psychotherapy
46
Supplies blood to the brain
internal carotid arteries
47
2 internal carotid branches
Anterior Cerebral Artery | Medial Cerebral Artery
48
Vertebral artery
Basilar artery
49
connects cerebral and vertebral arteries
Circle of Willis
50
Hemorrhagic Stroke
rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia
51
Ischemic Stroke
blockage of a blood vessel causing lack of blood flow leading to ischemia
52
Ischemic Stroke 2 subtypes
CVA and TIA cerebrovascular accident transient ischemic attack
53
Thrombotic Ischemic Stroke
obstruction of artery due to blockage in vessel
54
Embolic Ischemic Stroke
blockage of artery due to debris
55
Systemic hypoperfusion Ischemic Stroke
lack of blood brain flow due to decreased systemic blood flow
56
Transient ischemic attack
transient episode of neurologic dysfunction caused by brain, spinal cord, or retinal ischemia, without acute infarction
57
Only way to differentiate TIA vs CVA
MRI
58
FASTER mnemonic
``` Face (drooping numbness) Arms (one limb being weaker) Stability (steadiness on feet) Talking (slurred garbled) Eyes (visual changes) React (MEDEVAC) ```
59
ISchemic stroke risk factors
``` vascular disease A-fib DVT recent MI clotting disorders ```
60
Without acute infarction is
TIA
61
with acute infarction is
CVA
62
2 hemorrhagic stroke subtypes
ICH | SAH
63
ICH risk factors
``` HTN Trauma Bleeding disorders Drug use Aneurisms ```
64
Ischemic Stroke tx
>94% 02 elevate 30 degrees labs: EKG CBC Glucose O2 sat
65
Ischemic stroke BP monitoring
do not lower unless 220/120; reduce by 15%
66
Ischemic Stroke meds + MOA + vitals
Aspirin 325mg selective beta blocker Labetalol 10-20mg IV MOA: inhibits B1 to dec HR BP every 15min
67
TIA tx
med advice aspirin MEDEVAC
68
states strokes are disqualifying
MANMED 15-106
69
Stuporous patients respond to
vigorous stimuli
70
Coma can result from
``` Seizures Hypothermia Metabolic disturbances Structural lesions Disturbance of circulation Mass causing compression of brain stem ```
71
Abrupt onset of coma could suggest
SAH ICH stroke
72
Decorticate
flexion
73
Decerebrate
extension
74
Coma ancillary study
NON CONTRAST* CT
75
Other name for dilated pupils
mydriasis; associated with brainstem compression or drug use
76
Other name for constricted pupils
miosis; could suggest drug overdose with opiates
77
GCS scores
Mx 15 Low 3 Intubate 8 or less
78
Naloxone dose
0.4-2mg
79
Coup-countercoup
injury at impact as well as opposite side from rebound
80
Concussion hallmarks*
amnesia | lack of recall
81
early concussion symptoms
``` headache dizziness vertigo imbalance nausea vomiting ```
82
delayed concussion symptoms
mood/cognitive disturbance light/noise sensitivity sleep disturbance
83
MACE within how long?
48 hours
84
Direct observation of suspected concussion time
24 hours
85
Second impact syndrome
diffuse cerebral swelling can develop with 2nd concussion (2 concussions back to back) rare but potentially fatal
86
Post concussion syndrome
headache dizziness cognitive impairment resolves in weeks to months
87
CTE
chronic traumatic encephalopathy
88
CTE sx
behavior changes Parkinson's speech and gait abnormalities
89
thin areas of skull
temporal | nasal sinus
90
Basilar skull fracture
``` Battle sign “Raccoon” eyes Hemotympanum CSF rhinorrhea/otorrhea Cranial nerve deficits ```
91
ICP tx
elevate head 25-30 degrees secure airway ventilate NS or LR
92
Mannitol dose
1g/kg IV initial | .25-.5 g/kg IV Q6-8
93
hypertonic saline dose
7.5% NS 250cc bolus
94
Epidural hematoma layers
in-between dura mater and skull
95
Subdural Hematoma layers
between dura mater and arachnoid
96
Subarachnoid hematoma layers *in the JEA
between subarachnoid mater and pia mater | *high association with aneurysms and AV malformations
97
3 ICH type
Epidural hematoma Subdural hematoma Subarachnoid Hematoma
98
Most commonly affected with Epidural Hemmorhage
MMA | middle meningeal artery
99
Epidural hemorrhage presentation (2)
immediate LOC Lucid Interval with consciousness deteriorating neuro function Seizure/Coma
100
Epidural hemorrhage acute management
oxygen/intubate neuro consult monitor for ICP MEDEVAC
101
Subdural Hemorrhage
more common elderly/EOTH abuse may occur without impact likely to die
102
Subdural Hematoma physiology
venous flow into sinus spaces | may tamponade causing inc flow
103
Subdural hematoma clinical manifestations
1-2 days after onset chronic could be 15 days headaches/light headed/cognitive impairment/somnolence
104
Subdural Hematoma acute management
Same as epidural hematoma | non-contrast CT to determine
105
Subarachnoid hemorrhage epidemiology
usually aneurysm | high pressure bleed with CSF
106
SAH hallmarks
Thunder Clap aka worst headache of my life | sudden/may have meningeal irritation from blood
107
SAH risk factors
drug use, smoking, HTN, alcohol use
108
SAH tx
rest Tylenol MEDEVAC
109
Complications of SAH
``` death rebleeding ischemia ICP seizures ```
110
MACE: HEADS
``` Headache or vomiting? Ear ringing? Amnesia, altered consciousness? Double vision? Something feels wrong? ```
111
Recurrent concussion
3 concussions within 1 year. needs neurologist
112
Recurrent Concussion Evaluation
Comprehensive Neurological Eval neuroimaging functional assessment duty status determination
113
Spinal cord injury presentation
flaccid paralysis loss of bowel or bladder control anesthesia loss of reflex activity
114
C3,4 &5...
keep the lungs alive
115
Spinal cord injury tx
``` ABC C-collar O2/BP Foley Cath Sedate if necessary MEDEVAC ASAP ```
116
Spinal cord injury Med
Methylprednisone 125mg IV Q4-6
117
Nexus criteria for C-spine
``` N neuro deficit S spinal tenderness A altered mental status I intoxicated D distracted injuries ```
118
Common radiculopathy discs
L5-S1
119
Radiculopathy
lumbar disk herniation usually due to heavy lifting
120
Radiculopathy clinical presentation
px with sitting radiating to leg lower extremity numbness
121
L1 radiculopathy
pain, paresthesia, inguinal sensory loss
122
L2-L4 radiculopathy
acute back px radiates to anterior thigh/knee | weak hips
123
L5 radiculopathy
most common back pain radiating down lateral aspect of leg into foot
124
S1 radiculopathy
back pain radiates posterior to foot
125
Straight leg testing
Lay patient supine and raise patient’s extended leg on the symptomatic side with foot dorsiflexed.
126
Lasegue’s sign
presence or worsening of radicular pain with straight leg maneuver.
127
Radiculopathy imaging
radiograph and MRI
128
Radiculopathy tx
NSAIDs and analgesics | muscle relaxers
129
Radiculopathy Med
Cyclobenzaprine 5mg PO Q8
130
Radiculopathy reevaluation
4-6 weeks after 1. PT should be considered 2. Consult to px management
131
Cauda Equina
bundle of nerves that spread out from te bottom of the spinal cord
132
Cauda equina syndrome
cauda equina is squeezed or damaged
133
Cauda Equine pathophysiology
herniated disc infection/inflammation cancer spinal stenosis
134
Spinal Stenosis
vertebrae bumps called bone spurs; can compress nerves.
135
Cauda Equina Clinical Presentation
pain/numb/tingling in lowerback and/or legs foot drop bowel problems or incontinence problems with sex
136
Cauda Equina tx
MEDEVAC MRI treat cause of sx (surgery or meds)
137
Carpal Tunnel Syndrome
entrapment neuropathy of the median nerve of carpal ligament caused by repetitive wrist activities
138
3 predispositions for carpal tunnel
preg DM arthritis
139
Carpal Tunnel presentation
pain burning tingling bothersome during sleep late sx: atrophy
140
Carpel tunnel test
Tinel or Phalen
141
Carpal Tunnel Tx
splint up to 3 months Thumb Spica* NSAIDS/Steroids
142
Restless Leg Syndrome
Creepy Crawling or Pins and needles in the Limbs | worse at evening or night
143
hyperalgesia
low px tolerance
144
akathisia
intense desire to move
145
Restless Leg Syndrome differential
Volitional movements | Nocturnal Leg Cramp
146
Class of meds that worsen Restless Leg Syndrome
Antihistamines Anti-nausea Antidepressants
147
Lab for Restless leg syndrome
Iron (serum ferritin)
148
Restless Leg Syndrome Med
Ferrous Sulfate 325mg with laxative
149
Bell's Palsy CN and part of brain
CN 7 (along the pons)
150
Bell's Palsy associated diseases
HSV HIV Lyme
151
Bell's Palsy clinical presentation
``` unilateral facial paralysis px around ear facial stiffness inability to close eyelid* skin does not wrinkle* ```
152
Bell's phenomenon
upward rolling of the eye on attempted lid closure
153
Bell's Palsy vs Stroke
no paralysis of forehead in stroke | intact forehead suggest stroke
154
Bell's Palsy tx
protect the affected eye Prednisone 60mg x7 days Valacyclovir 1000mg
155
Bell's Palsy differentials
HSV Otitis Media Lyme Guillain-Barre Syndrome
156
Meningitis signs and symptoms
fever nuchal rigidity (neck stiffness) altered mental status
157
Bell's Palsy hallmarks
forehead paralysis | cannot close eye
158
Meningitis lab test
Lumbar Puncture
159
Meningitis tests
Brudzinksi | Kerning
160
Meningitis med
Ceftriaxone 2g IV
161
Meningitis Prophylaxis
Ciprofloxacin 500mg
162
Meningitis associated vaccinations
MGC S. Pneumonia FLU
163
3 classes of chronic px
noncaptive neuropathic centralized
164
Chronic px time
greater than 6-12 weeks
165
nociceptive pain
caused by stimuli
166
neuropathic pain
resulting from damage or pathology
167
centralized pain
reduced ability of the CNS to diminish responses to peripheral stimuli
168
Chronic pain syndrome tx
Acupuncture | spinal manipulation
169
Insomnia risk factors
EOTH stimulant tobacco psychiatric
170
Benign paroxysmal positioning vertigo test
Dix-Hallpike
171
Peripheral Vertigo presentation
sudden horizontal nystagmus tinnitus

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