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CMN 568 Unit 5 > Neurological Disorders > Flashcards

Neurological Disorders Flashcards

1
Q

Diagnosing an Acute Headache

A
  • Fever, Vision changes, neck stiffness
  • HIV infection
  • Current or past hx of HTN
  • Neuro findings: mental status changes, motor/sensory deficits, +LOC
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2
Q

Careful assessment of 5 areas crucial when acute HA comes in

A
  • Visual acuity
  • Ocular gaze
  • Visual fields
  • Pupillary Defects
  • Optic Discs
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3
Q

Medications to treat Migraines

A
  • NSAIDS (PO, nasal, IM Toradol)
  • Metoclopramide
  • Dihydroergotamine
  • Triptans (PO, nasal, SubQ)

Avoid using Morphine/Hydromorphone as 1st line therapy

  • Subanesthetic ketamine infusions used for Chronic Migraines/New Daily HA when unresponsive to other therapy
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4
Q

All HA types should receive what in the ED

A

High-flow O2

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5
Q

Treatment for SAH, Intracranial mass, Meningitis

A

Admit to hospital and emergent treatment

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6
Q

OTTAWA SAH Clinical Decision Rule (predicting)

A

100% Sensitivity in predicting SAH

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7
Q

OTTAWA SAH Clinical Decision Rule (clinical finding/symptoms)

A
  • 40+ years of age
  • Neck pain/stiffness
  • Witnessed LOC
  • Onset during exertion
  • “Thunderclap” headache
  • Limited Neck flexion
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8
Q

“Thunderclap” HA

A

Rapid onset of severe pain

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9
Q

Tension-type HA

A
  • Dull, band-like or vise-like generalized HA, worse in neck/back of head
  • Not pulsatile or worse with physical activity/position
  • No N/V
  • EITHER photophobia or phonophobia (not both)
  • May occur daily
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10
Q

Treating tension-type HA

A
  • OTC analgesics
  • Avoid narcotics (rebound HA)
  • Stress management
  • muscle relaxation
  • Exercise
  • Diet changes
  • Counseling
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11
Q

Cluster HA

A
  • SEVERE, UNILATERAL episode of periorbital pain
  • Lasts 15 min - 3 hours
  • Ipsilateral nasal congestion
  • Rhinorrhea
  • Lacrimation
  • Eye redness
  • Horner’s Syndrome
  • Cyclic (may occur daily for several weeks and then remit for weeks or months)
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12
Q

Cluster HA Triggers

A
  • Stress
  • Glare
  • ETOH
  • Certain Foods
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13
Q

Cluster HA Treatment

A
  • “Z’s” (Zolmitriptan, Sumatriptan, etc) + 100% O2 via non-rebreather for 15 mins

Preventative: lithium, topiramate, prednisone, volproate, verapamil

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14
Q

Drugs responsible for Medication Overuse HA

A
  • Acetaminophen
  • Ergots
  • Opioids
  • Butalbital (Fioricet, Esgic)
  • NSAIDs
  • Midrin
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15
Q

Treatment for Medication Overuse HA

A
  • Avoid daily use of analgesics

- Early initiation of migraine preventative tx

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16
Q

Essentials of diagnosing Migraines

A
  • UNILATERAL pain
  • N/V
  • Photophobia/Phonophobia
  • Aura (commonly visual)
  • Can occur without aura
17
Q

Symptomatic therapy of Migraines

A
  • Rest in quiet, dark room
  • ASA, Tylenol, Naproxen may help
  • Other prescription meds may be necessary including
    • Ergotamines - 1-2 tabs taken at onset then 1 tab q30 mins, 6 tabs max per episode
    • Triptans - given to patients with prolonged attacks
    • Chlorpromazine
    • Butalbital-containing combo meds (last resort only)
18
Q

Other causes of HA

A
  • Cerebrovascular disease
  • Internal carotid artery occlusion or Carotid dissection after endarterectomy
  • SAH
  • Meningeal infections
  • Pseudomotor Cerebri (IIH - Idiopathic Intracranial HTN)
  • Lumbar puncture
19
Q

Essentials to diagnose trigeminal neuralgia (TN)

A
  • Brief episode of stabbing facial pain
  • Pain is in area of 2nd and 3rd division of trigeminal nerve
  • Pain exacerbated by touch
  • Most common in middle and later life
  • Affects women > men
  • Neuro exam shows no abnormality
  • Bilateral symptoms = further investigation needed
20
Q

TN under the age of 40

A

Suspect possible multiple sclerosis

21
Q

S/S of trigeminal neuralgia

A
  • Momentary episodes of sudden, lacinating facial pain (commonly near one side of mouth) that shoots toward the ear, eye, or nostril on same side
  • Symptoms remain confined to distribution of trigeminal nerve on ONE SIDE ONLY
22
Q

TN triggers

A
  • Touch
  • Movement
  • Drafts
  • Eating
23
Q

Atypical facial pain

A
  • Common in middle-aged women (many are depressed)
  • Facial pain without typical features of TN
  • Constant pain (often described as burning)
  • Pain spreads to entire side of face and can include neck and back of head as well
Treatment:
- Trial of simple analgesics
- Trial of tricyclic antidepressants
- Carbamazepine
- Oxcarbazepine
- Phenytoin 
(response is often disappointing)
24
Q

Diagnosing Postherpetic Neuralgia

A
  • Develops in 15% of patients with shingles (herpes zoster)
  • Most common in elderly or immunocompromised
  • Rash

Primary Prevention:
- Recombinant Zoster vaccine to patients over 50 years old

25
Q

Treatment of Postherpetic Neuralgia

A
  • Acyclovir (5x/day) or Valacyclovir (3x/day) when given w/in 72 hours of rash onset these can reduce incidence of postherpetic neuralgia by 50%
  • Simple analgesics –> tricyclics (amitriptyline or nortriptyline)
  • SYSTEMIC CORTICOSTERIOIDS DO NOT HELP
26
Q

Glossopharyngeal Neuralgia

A
  • Uncommon disorder with no structural abnormalities

- Similar pain to TN, but occurs in throat and sometimes in deep ear/back of tongue

27
Q

Triggers and treatment of Glossopharyngeal Neuralgia

A

Triggers:
- swallowing, chewing, talking, yawning, syncope

Treatment:

  • Oxcarbazepine
  • Carbamazepine
  • Surgery considered if medications fail
  • Surgical intervention is microvascular decompression
28
Q

Other causes of facial pain

A
  • TMJ
  • Sinusitis/Ear infections
  • Glaucoma
  • Pain in jaw (could be angina pectoris)
29
Q

Risk factors for Subarachnoid Hemorrhage (SAH)

A
  • Older age
  • Female
  • Non-white ethnicity
  • HTN
  • Smoking
  • High ETOH consumption
30
Q

S/S of Subarachnoid Hemorrhage (SAH)

A
  • “Thunderclap” HA leading to N/V
  • Signs of meningeal irritation usually present
  • Obtundation common
  • Focal deficits frequently absent
31
Q

Diagnosing of Subarachnoid Hemorrhage (SAH)

A
  • CT scan (performed immediately to confirm hemorrhage has occurred)
  • CT arteriography determines source of bleeding
  • Transcranial doppler - only screens for vasospasms
32
Q

Lab studies of Subarachnoid Hemorrhage (SAH)

A
  • CSF shows elevated RBC count
  • Absolute RBC count (<2,000 RBC is very unlikely due to SAH)
  • WBC (peripheral leukocytosis)
  • UA (transient glycosuria)
  • ECG (arrhythmias or MI)
33
Q

Characteristics of Pseudomotor Cerebri - Idiopathic Intracranial HTN (IIH)

A
  • HA that worsens with straining
  • Visual obscuration or diplopia
  • Papilledema
  • Abducens palsy commonly present
  • CSF fluid is normal
34
Q

Causes of Pseudomotor Cerebri - Idiopathic Intracranial HTN (IIH)

A
  • Can be caused by stopping long-term oral steroids

- Using tetracycline or oral contraceptives can contribute to cause

35
Q

Diagnosing of Pseudomotor Cerebri - Idiopathic Intracranial HTN (IIH)

A
  • MUST SCREEN FOR SPACE-OCCUPYING LESION OF BRAIN!
  • CT or MRI of brain
  • MR Venography - important to screen for thrombosis of IC venous sinuses
36
Q

Treatment of Pseudomotor Cerebri - Idiopathic Intracranial HTN (IIH)

A
  • Acetazolamide (3x/day) - slowly increase dose
  • Topiramate
  • Furosemide
  • Repeated LP (lowers ICP)
  • Surgical placement of VP shunt or optic nerve fenestration if medications fail

ALL PATIENTS SHOULD BE REFERRED!

CMN 568 Unit 5 (5 decks)

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