Neurological Flashcards
Tension headache characteristics
Pressing, NON-PULSATING pain
Mild to moderate intensity
Usually BILATERAL location
0-1 following: nausea, photophobia, photophobia
Female:Male= 5:4
Migraine w/out aura characteristics
Lasts 4-72 hours with >2:
Usually UNILATERAL location, occasionally bilateral
PULSATING quality
Moderate to severe intensity
AGGRAVATED by normal activities
>1: nausea, vomiting, photophobia, phonophobia
Female:Male= 3:1
Migraine with aura characteristics
H/A occurs with or after aura
Feelings of Dread, ANXIETY, unusual fatigue, nervousness or excitement.
Positive family hx in 70-90%
Cluster headache characteristics
Often located BEHIND EYE with a steady, intense “HOT POKER IN THE EYE” intensity. Lasting 15min to 3 hours with most in the range of 30-45 min.
Ipsilateral autonomic signs such as lacramation, conjunctival injection, ptosis, & nasal stuffiness.
Female:Male= ~1:3 or 1:8
Examples of primary headaches
Migraine (with or w/out aura), tension headache, cluster headache
Causes of secondary headaches
Tumor, intracranial bleeding, increased ICP, medications (nitrates), meningitis, accelerated HTN, giant cell arteritis, or viremia.
Red flags with headaches
Systemic symptoms- fever, wt loss, ect.
Neuro sx- confusion, nuchal rigidity, papilledema, cranial nerve dysfunction, or abnormal motor function.
Sudden onset, “thunderclap”, headache with exertion, sexual activity, coughing, sneezing.
Age of onset >50 or
Sx of increased ICP
H/A, nausea/vomiting, increased BP, confusion to time, location, person, double vision, pupils interactive to light.
Medications for migraines
Triptans (selective serotonin receptor agonists), ex- sumatriptan Imitrex
Selected ergot derivatives ex- dihydroergotamine Migranal
Prophylactic medications for migraines
Beta-blockers: metoprolol, propranolol
Tricyclic antidepressants: amitriptyline, nortriptyline
Antiepileptic drugs: divalproex sodium (Depakote), sodium valproate (Depacon), topiramate (Topamax)
Supplements: butterbur, feverfew, coenzyme Q10, mag, riboflavin
Lithium (cluster headaches)
CCB: verapamil
Classic triad for Giant cell arteritis
Fever, normal WBC count, increased sed rate.
Giant cell arteritis etiology
Autoimmune vasculitis that affects medium & large-sized vessels as well as the temporal artery.
Inflammation & swelling of the arteries leads to decreased blood flow & its associated symptoms.
Treatment of giant cell arteritis
Tx aimed to reduce pain & minimize risk of blindness.
High-dose corticosteroids (1-2mg/kg per day prednisone until disease is stabilized). Continue lower dose 6mths-2 years.
ASA to reduce stroke risk.
PPI for GI cytoprotection.
Biphosphonate for bone protection.
Dietary triggers for migraines
Sour cream, pickled, fermented foods, MSG, yeast products, onions, citrus fruits, caffeine, ETOH, aspartame.
Kernigs sign
Flexing pt’s hip 90 degrees, then extending the pts knee-leads to meningeal pain.
Brudzinskis sign
Flex ion of the pts neck causes flexion (involuntary) of pts hips & knees. Meningeal pain.
Bell’s palsy definition
Paralysis or weakness of the muscles on one side of the face. Damage to the facial nerve that controls muscles on one side of the face that causes that side of the face to droop.
CRANIAL NERVE 7 dysfunction.
* most cases thought to be caused by the herpes virus that causes cold sores.
Trigeminal neuralgia definition
Chronic pain condition that affects the trigeminal or 5th CRANIAL NERVE.
Causes extreme sporadic, sudden burning or shock-like facial pain that lasts a few seconds to 2 minutes per episode.
CVA management in primary care
ASA 81mg (325mg if previous CVA), ASA/dipyridamole (Aggrenox) po BID, clopidogrel (Plavix) 75mg qd.
Dizziness etiology
Peripheral- inner ear condition (most common)
Central- brain stem
Red flags with dizziness
Neuro deficits, severe H/A, nausea, central nystagmus, or concern for mass/structural lesion.
Differential dx for dizziness w/ tx
- Benign paroxysmal positional vertigo BPPV. Tx: repositioning maneuvers, Eply maneuver.
- Ménière’s disease. Tx: supportive, meclizine, scopolamine, promethazine, salt restriction.
- Acute vestibular neuropathy (viral cause). Tx: supportive, improved sx with steroids- full recovery can take several weeks.
Multiple sclerosis definition
Chronic, debilitating neurological disease due to an autoimmune process.
Characterized by formation of patches of demyelination (plaques) throughout the brain & spinal cord.
Higher prevalence in Caucasians & women.
Sx of multiple sclerosis
Visual symptoms, possible trigeminal neuralgia, limb weakness, easy fatigability, dysarthria, in coordination of limbs, paresthesias, attention deficits.
Lhermitte’s sign- electric shock-like sensations that run down the back and/or limbs upon flexion of the neck.
Uhtoff’s phenomenon- heat intolerance
Common presentation of Parkinson’s disease
Stiff or weak limb, tremor, asymmetric slowness, shuffling gait, reduced arm swing.
* diagnosis is CLINICAL based on the history & physical exam findings. Conventional imaging studies not helpful.
Management of Parkinson’s disease
Levodopa- biochemical precursor of deficient NT dopamine ( most common tx)
Dopamine agonists- mirapex & requip
Anticholinergic agents- trihexyphenidyl (Artane) & bentropine (Cogentin)
Myasthenia Gravis definition
Autoimmune disorder that affects the neuromuscular junction.
Characterized by fluctuating, fatigable weakness of muscles under voluntary control.
Management of myasthenia Gravis
1st line- Acetylcholinesterase inhibitors (Mestinon- pyridostigmine bromide.
Immunosuppressive tx- steroids, azathioprine, cyclosporine.
Plasmapheresis
IVIG
CN III function
Oculomotor
Pupillary constriction, opening eye (lid elevation), most extra-ocular movements- looking up/down
CN IV function
Trochlear
Downward, internal rotation of the eye, looks downward & laterally
CN V function
Trigeminal
Motor- temporal & masseter muscles (jaw clenching), lateral pterygoids (lateral jaw movement)
Sensory- 3 divisions= ophthalmic, maxillary, mandibular.
corneal reflex
CN VI function
Abducens
Lateral deviation of the eye, looks left/right
CN VII function
Facial
Motor- facial mvmts, facial expressions, closing eye, closing the mouth.
Sensory- taste sweet, salty, sour, bitter on anterior 2/3 of tongue.
CN VIII function
Acoustic
Hearing (cochlear division), balance (vestibular division)
CN IX function
Glossopharyngeal
Motor-pharynx
Sensory- posterior portion of the eardrum & ear canal, the pharynx & posterior tongue, including taste.
CN X function
Vagus
Motor- palate, pharynx/larynx
Sensory- pharynx/larynx
CN XI function
Spinal accessory
Motor- sternomastoid & upper portion of trapezius
CN XII function
Hypoglossal
Motor- tongue
Alzheimer’s disease patho
Neuritic plaques, neurofibrillary tangles
Alzheimer’s management
Mild to moderate- 1st line Cholinesterase inhibitors= donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl).
Moderate to severe- add Namenda
Restless leg syndrome definition & sx?
Neuro sensorimotor disorder, characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations.
Sx- worse at night, relieved by movement, worse at rest-bilateral (can also affect the arms).
Treatment of RLS?
- Dopaminergic agents- Requip, Mirapex
- Alpha2 delta calcium channel ligands- Gabapentin, Lyrica
- Opioids- oxycodone, codeine, methadone, tramadol
- Benzodiazepines- clonazepam
