Neuro MDT Flashcards
Headache DANGER SIGNS
- Thunderclap
- Absence of prior headache
- Focal neurosigns
- Fever
- Rapid onset with exercise
- Nasal congestion
- Papilledema
Thunderclap headache could be:
SAH
Absence of prior headache danger sign could be:
CNS infection
Focal Neurosigns other than auras could be
stroke or tumor
Fever with headache could be:
Meningitis
Rapid onset headache with exercise could be:
IC Hemmo./ Brain Aneurysm
Headache with nasal congestion could be:
Sinusitis
Headache with papilledema could be:
Increased ICP
Headache reasons to refer for imaging: (8)
change in pattern worsening despite tx neuro. deficit scalp tenderness onset with exertion visual changes 40 years or older hx of trauma/ HTN
Tension Headache characteristics
most prevalent bilat daily "vice-like" stress/fatigue/glare No dx tests*
Tension Headache Tx
NSAIDS: Motrin 400-800mg Q4-6H/2400mg in 24H max
Tension Headache Tx
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
Cluster Headache Sx
- middle aged males
- unilateral px
- restless agitated
- 15 min-3 hours
Cluster Headache Additional sx
- ipsilateral congestion
- lacrimation
- Horner Syndrome
Homer Syndrome (3)
stop sweating
drooped eyelid
small pupil
Cluster Headache tx + MOA and Contraindications
- 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
Migraine characteristics (6)
throbbing unilateral or bilateral aura (maybe) visual disturbances Fam Hx NV
Migraine Dx:
Clinically using HPI
Migraine Tx
avoidance rest analgesics Sumatriptan 25/50/100mg or 6mg SC 50mg works best*
Migraine prophylaxis + contraindications
beta blocker
Propranolol 20mg BID: 40-160mg range
CHF Cardio Hypotension
Migraine secondary treatments
Anti-depressant: Amitriptyline 10mg
Anti-emetic: Promethazine 12.5mg-25mg Q4-6H
Post Trauma Headache characteristics
1-2 days after injury
poor memory and concentration
emotional instability
Post Trauma Headache tx
analgesic
Med Overuse headache characteristics
50% of daily headaches
chronic px
heavy analgesic use
treat with med withdraw
Partial Seizures characteristics
dependent on cortical involvement
preictal phase can have auras
Focal Seizure with Retained Awareness
FKA: Simple Partial Seizure*
only 1 part of brain/sx dependent on this
Focal Seizure with Impaired Awareness
FKA: Complex Partial Seizure*
one part of brain
awake/not responding
no memory
Complex Partial Seizure 4 signs
Grimace
Gesturing
Lip Smack
Repeating
General Seizure
entire brain
altered consciousness
Tonic-Clonic aka Grand Mal
Tonic phase
stiffening
Clonic Phase
rhythmic jerking
Todd Paralysis
weakness of limbs
3 Postictal Phase Sx
somnolence
no recollection
Todd Paralysis
Seizure Dx
EEG
Seizure Tx
secure airway
treat sx
MEDEVAC
Seizure labs
electrolyte
LFT
CBC
Glucose
Active Seizure Med
Diazepam 5mg IV/IM Q5-10min; 30mg Max
binds with GABA
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
Status Epilepticus tx
Diazepam
Valproic Acid 30mg
Intubate
Frontal Lobe Sx
Head and Leg
Jacksonian March
Posturing
Parietal Lobe Sx
Paresthesia
Occipital Lobe Sx
Visual Phenomena
Temporal Lobe
“oh so no head?”
Hallucinations
Epigastric rising
Automatisms
Deja vu
Psychogenic Non Epileptic Seizure
not assoc. with neuronal activity
longer than 2 min
no incontinence
no postictal phase
PNES tx
psychotherapy
Supplies blood to the brain
internal carotid arteries
2 internal carotid branches
Anterior Cerebral Artery
Medial Cerebral Artery
Vertebral artery
Basilar artery
connects cerebral and vertebral arteries
Circle of Willis
Hemorrhagic Stroke
rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia
Ischemic Stroke
blockage of a blood vessel causing lack of blood flow leading to ischemia
Ischemic Stroke 2 subtypes
CVA and TIA
cerebrovascular accident
transient ischemic attack
Thrombotic Ischemic Stroke
obstruction of artery due to blockage in vessel
Embolic Ischemic Stroke
blockage of artery due to debris
Systemic hypoperfusion Ischemic Stroke
lack of blood brain flow due to decreased systemic blood flow
Transient ischemic attack
transient episode of neurologic dysfunction caused by brain, spinal cord, or retinal ischemia, without acute infarction
Only way to differentiate TIA vs CVA
MRI
FASTER mnemonic
Face (drooping numbness) Arms (one limb being weaker) Stability (steadiness on feet) Talking (slurred garbled) Eyes (visual changes) React (MEDEVAC)
ISchemic stroke risk factors
vascular disease A-fib DVT recent MI clotting disorders
Without acute infarction is
TIA
with acute infarction is
CVA
2 hemorrhagic stroke subtypes
ICH
SAH
ICH risk factors
HTN Trauma Bleeding disorders Drug use Aneurisms
Ischemic Stroke tx
> 94% 02
elevate 30 degrees
labs: EKG CBC Glucose O2 sat
Ischemic stroke BP monitoring
do not lower unless 220/120; reduce by 15%
Ischemic Stroke meds + MOA + vitals
Aspirin 325mg
selective beta blocker Labetalol
10-20mg IV
MOA: inhibits B1 to dec HR
BP every 15min
TIA tx
med advice
aspirin
MEDEVAC
states strokes are disqualifying
MANMED 15-106