Neurology #1 Flashcards
What is the study of choice for evaluating most acute head injuries?
CT head without contrast
When is an MRI the study of choice for head injuries?
-If prolonged symptoms, > 7-14 days or with worsening symptoms not explained by concussion syndrome
Management of concussion syndrome
- Cognitive and physical rest is main management
- Observation for 24 hours
- Resume strenuous activity after resolution of symptoms and recovery of memory
Explain symptoms of a lower motor neuron injury
- Muscles are FLABBY
- -Flaccid paralysis
- -Loss of muscle strength and tone
- -Areflexia (decreased DTR)
- -Babinski downwards
- -Young (infantile paralysis)
Conditions that cause lower motor neuron problems (B’s)
- Guillain-Barre Syndrome
- Botulism
- Bell Palsy
- Cauda Equina Syndrome (Back)
Symptoms of upper motor neuron injury
- Muscles are SPASTIC
- -Slight muscle loss (no atrophy)
- -Positive Babinski (upward)
- -Absence of fasciculations
- -Strong tone
- -Tone increased
- -Increased DTR
- -Clonus
Name the 12 cranial nerves
I: Olfactory II: Otic III: Oculomotor IV: Trochlear V: Trigeminal VI: Abducens VII: Facial VIII: Vestibulocochlear (Acoustic) IX: Glossopharyngeal X: Vagus XI: Accessory XII: Hypoglossal
What areas would there be an injury at with the following problems:
1) Loss of triceps jerk
2) Loss of biceps jerk
3) Loss of knee jerk
4) Loss of ankle jerk
1) C7-C8
2) C5-C6
3) L3-L4
4) S1-S2
Which nerve would be injured that would lead to a foot drop?
Peroneal nerve
MC overall cause of primary headache
Tension type headache
Risk factors for a tension headache
- Mental stress
- Eye strain
- Sleep deprivation
Describe a tension type headache
- Bilateral, pressing, tightening “band-like” nonpulsatile steady or aching headache, often worsens throughout the day
- No nausea, vomiting, photophobia, phonophobia, or focal neurological symptoms
Treatment for tension headaches
- NSAIDs and other analgesics
- Local heat
- Anti-migraine medications
What levels provide the following motor functions?
____: shoulder abduction, elbow flexion (palm up)
____: elbow flexion (thumb up), wrist extension
____: elbow extension, wrist flexion
____: finger flexion
____: finger abduction
C5 C6 C7 C8 T1
Pathophysiology of Trigeminal Neuralgia (Tic Douloureux)
Compression of trigeminal nerve (cranial nerve V) root by superior cerebellar artery or vein
Symptoms of trigeminal neuralgia
- Brief, episodic stabbing or shock-like pain in the 2nd or 3rd division of trigeminal nerve
- Worse with chewing, brushing teeth, drafts of wind, and movements
First-line treatment for trigeminal neuralgia
- Carbamazepine or Oxcarbazepine
- Surgical decompression for refractory cases
Symptoms of a migraine headache
- Lateralized, pulsatile, throbbing headache associated with nausea, vomiting, photophobia, phonophobia
- Worsened with physical activity
- Auras last < 60 minutes (visual)
Treatment for migraines
- NSAIDs, Acetominophen, or Aspirin first line if mild
- IVF and placing patient in a dark room are helpful
- Antiemetics (Metoclopramide, Prochlorperazine)
- Triptans or Ergotamines if severe or no response to above treatment
Side effects of Triptans
- Chest tightness from vasoconstriction
- Nausea, vomiting, abdominal cramps
- Flushing, malaise
Antiemetics such as Metoclopramide are ______ receptor antagonists, but have adverse effects such as
Dopamine receptor antagonists
-Exprapyramidal symptoms: Dyskinesias, sustained contractions in face, neck, trunk
What can you give a patient if they are experiencing dystonic reactions with Metoclopramide?
IV Diphenhydramine
What kind of medication can be given as prophylactic migraine therapy?
BB (Propanolol)
Triggers for cluster headaches
- Worse at night
- Alcohol
- Stress
- Ingestion of specific foods
Symptoms of a cluster headache
- Severe, unilateral periorbital or temporal pain (sharp)
- Bouts last < 2 hours with spontaneous remission
- Several times per day
- Horner’s Syndrome: ptosis, miosis, anhidrosis, nasal congestion, rhinorrhea, conjunctivitis, rhinorrhea
What are the three main symptoms of Horner’s Syndrome?
Ptosis, Miosis, Anhidrosis (inability to sweat normally)
Acute management of cluster headache
100% oxygen via non-rebreather mask
-Sumatriptan can help during acute attack
Prophylaxis for cluster headache
Verapamil (CCB) is first line
What is idiopathic intracranial HTN (Pseudotumor Cerebri)
Idiopathic increased intracranial (CSF) pressure with no clear cause evident on neuroimaging
Risk factors for Idiopathic Intracranial HTN
- Obese women of childbearing age
- Meds: growth hormone, OCP, long-term tetracycline use, Vitamin A Toxicity
- Venous sinus thrombosis
Symptoms of Idiopathic Intracranial HTN
- Headache: pulsatile and worse with straining
- Retrobulbar pain worse with eye movements
- Nausea, vomiting, tinnitus
- Visual changes that lead to blindness if not treated
On ocular exam for Idiopathic Intracranial HTN, what is seen?
Papilledema (bilateral and symmetric)
May have visual field loss
Diplopia due to Abducens nerve palsy
Diagnostics for I-I HTN
- CT: performed prior to LP to rule out mass
- LP: increased CSF Pressure (>250) + otherwise normal CSF
- MRI with MR venography is the ideal imaging
First-line treatment for I-I HTN
-Acetazolamide (decreases CSF production) and weight loss recommended
Again, what does the CSF show if the patient is positive for Idiopathic Intracranial HTN?
Increased opening pressure, otherwise normal CSF
MCC of acute bacterial meningitis in adults of all ages and children 3 months - 10 years
Strep Pneumo
MCC of bacterial meningitis in children 10 years - 19 years
Neisseria Menigitidis
What is Neisseria Menigitidis associated with?
Petechial rash on trunk, legs, and conjunctivae
MCC of bacterial meningitis in neonates < 1 month and infants < 3 months and why
Group B Strep (S. agalactiae)
-It is part of the vaginal flora
Symptoms of bacterial meningitis
- Headache
- Neck stiffness
- Photosensitivity
- Fever
What are some physical exam findings of a patient with meningitis?
- Nuchal rigidity
- Positive Brudzinski (neck flexion produces knee flexion
- Positive Kernig sign (inability to extend knee/leg with hip flexion)
Diagnostics for bacterial meningitis include, and the order they should be done in
- Head CT scan (if you need to rule out mass if papilledema, seizures, confusion, > 60 years old, immunocompromised) should be done first
- Otherwise, do LP + CSF exam
What does an LP with CSF exam show if the patient has bacterial meningitis?
- Increased opening pressure
- Increased protein
- Increased neutrophils
- Turbid appearance
- Decreased glucose
True or False: Antibiotics along with Dexamethasone should be started as quickly as possible after LP or prior to head CT if needed
True
_____ has been shown to reduce mortality and sequelae of S. Pneumo in meningitis
Dexamethasone
Treatment for bacterial meningitis for ages > 1 month - 50 years
Vancomycin + Ceftriaxone
For > 50 years old, what is the treatment for meningitis?
Vancomycin + Ceftriaxone + Ampicillin
What bacteria is responsible for increased incidence of meningitis in neonates, > 50 years, immunocompromised states (pregnant, AIDS, chemotherapy)
Listeria Monocytogenes
What medications are options for post-exposure prophylaxis for meningitis if prolonged exposure > 8 hours, or direct exposure to respiratory secretions?
Rifampin or Ciprofloxacin
What medications are options for post-exposure prophylaxis for meningitis if prolonged exposure > 8 hours, or direct exposure to respiratory secretions?
Rifampin or Ciprofloxacin
True or False: Prophylaxis is not recommended for health care workers who have not had direct exposure to respiratory secretions?
True
