neuro pt 1 & 2 Flashcards
GCS
best eye opening -
(spontaneously 4, to verbal 3, to pain 2, no response 1)
best verbal
(oriented 5, confused 4, inappropriate words 3, incomprehensible 2, no response 1)
best motor -
(obeys commands 6, withdrawal 5, flexion 4, decorticate 3, extension 2, no response 1)
epidural vs subdural imaging
epidural - lentiform like a lemon
subdural - sickle-shaped like a banana
imaging recommendations for concussion
GCS <15
focal neurologic deficit
persistent or progressive decline in LOC
seizures
coagulopathy
age >65
skull fracture
persistent headache or vomiting
retrograde amnesia >30 minutes
intoxication
injury to the neck
ED - brain CT imaging of choice
post-traumatic sequelae - brain MRI
when to admit for concussion
GCS <15
abnormal CT
seizures
abnormal coags
elderly
intoxicated
soft tissue injury above clavicle
ataxia
inability to maintain balance
vertigo
sense of the rotational movement of self or surroundings
near syncope
a sense of sinking without loss of consciousness
syncope
loss of consciousness
cardiovascular!!
causes of acquired ataxia
cerebellar insult
ETOH/drug intoxication
infection
metabolic imbalance
malabsorption problems
medications (gabapentin, methotrexate, lithium, amiodarone, cyclosporine)
parkinsons patho
imbalance of dopamine and acetylcholine in the basal ganglia and substantial nigra
parkinsons diagnosis
clinical diagnosis !!!!!
utilize movement disorder society unified Parkinsons disease rating scale
MRI brain - hypointensity and volume loss of the substantial nigra
movement disorder society unified Parkinsons disease rating scale
absolute exclusion criteria (R/O Parkinson’s)
cerebellar signs
supranuclear gaze palsy
established diagnosis of BVFTD
Parkinsonism restricted to the lower limbs only for >3 years
treatment with anti dopamine agents
absence of response to levodopa
sensory-cortical loss
no evidence of dopaminergic deficiency on functional imaging
other Parkinsonism-inducing condition
parkinsons s/s
fatigue
constipation
depression
hypomimia (parkinsonian mask)
shuffling gait
impaired swallowing
rigidity
bradykinesia
tremor
postural instability
parkinsons treatment
symptom modification
PT, OT, SLP
deep brain stimulation
levodopa - first line (if works, confirms dx), take multiple x/day
2nd line - dopamine agonists
dementia DSM criteria
cognitive impairment: learning and memory, language, executive function, complex attention, perceptual-motor function, or social cognition
cognitive deficits interfere with IADLs
no delirium
no other mental disorder that better explains cognitive decline
dementia RF
age
genetics
female>male
mild cognitive impairment
vascular disease
lifestyle & activity
alzheimer’s - Down syndrome
dementia diagnostics
CT/MRI brain for initial evaluation - generalized/focal atrophy and white matter lesions
R/O other causes - syphilis, HIV, B12, thyroid, etc
functional assessment staging tool (FAST) for prognostication
cholinesterase inhibitors
first line for Alzheimer’s and Lewy body dementia
treat cognitive symptoms
dementia meds
treat symptoms!
cholinesterase inhibitors - first line
NDMA receptor antagonist (Memantine)
SSRI - prevent anxiety/agitation
antipsychotics - PRN for agitation
benzodiazepines - PRN
Alzheimer’s symptoms
insidious onset memory loss
progresses to frustration, personality changes, dysphagia, conversation inability
duration 8-10 years
vascular dementia classic presentation
multi-infarct dementia , often mixed w Alzheimer’s
stepwise pattern of progressive cognitive decline following each vascular event
no improvement after each CVA
executive function decline more prominent than memory loss
vascular dementia diagnosis and treatment
stroke s/s
brain CT/MRI - multiple infarcts
prevent new ischemic injury - aspirin, plavix, anti-coagulants, lifestyle modifications
frontotemporal dementia
“picks disease”
behavioral symptoms in early stages
autosomal dominant
preserved memory, behavioral/personality/emotional symptoms predominant
ex. gambling, impulsiveness, sexual activities, aggressive verbal/physically
tx w SSRIs/BDZ/antipsych for behavior symptoms
parkinson’s dementia
RF: advanced age and severity of parkinsons
executive dysfunction, inattention, motor impairment affects language, hallucinations, paranoia
tx: manage motor symptoms, cholinesterase inhibitors, memantine
Lewy body dementia
early psychosis, visual hallucinations, sleep disorders and parkinsonian-like movements
marked fluctuation in cognitive functioning on daily basis
tx: cholinesterase inhibitors, memantine, parkinsons meds, SSRIs/atypical antipsychotics, nonpharm behavior modifications
