Neurology #1 Flashcards
Explain the GCS and what the best score is, what the worst score is, and what each component is. What it the MC etiology of a TBI?
3 is the worst score
15 is the best score
Eye Opening: spontaneous = 4, verbal command = 3, response to pain = 2, none = 1
Verbal Response: Oriented = 5, Confused = 4, Bad words = 3, incomprehensible sounds = 2, no verbal = 1
Motor Response: obey commands = 6, localizing response to pain = 5, withdrawal response to pain = 4, flexion to pain = 3, extension to pain = 2, no motor response = 1
MC etiology of a TBI = Falls (especially in elderly). Others are MVA’s
What is a concussion?
Symptoms of a concussion?
What is the diagnostic of choice initially? Next diagnostic?
What is the treatment?
-Mild TBI with or without LOC
-Confusion, amnesia, blurry vision, emotional instability, persistent vomiting, headache, changing levels of consciousness
-CT head without contrast initially. MRI if symptoms > 7-14 days or with worsening symptoms
Cognitive and physical rest. Resume activity after resolution of symptoms.
MC type of headache?
Explain this type.
What is the treatment?
-Tension-type headache
-Bilateral, pressing, tightening band-like nonpulsatile headache that worsens throughout the day. Not worse with routine activity. No nausea, vomiting, photophobia, photophobia, auras.
NSAIDs and other analgesics. Local heat.
Trigeminal Neuralgia
-Pathophysiology
-MC in who?
-Symptoms…worse with…
-Management
-Patho: compression of the trigeminal nerve (Cranial Nerve V) root by the superior cerebellar artery or vein
-MC In middle-aged women.
-Symptoms: brief, episodic stabbing, lancinating or shock-like pain in 2nd or 3rd division of Trigeminal nerve.
-Worse with chewing, touch, brushing teeth, wind, and movements. Often unilateral.
-Carbamazepine (first line). Oxcarbazepine. Surgical decompression for refractory.
First-line medical treatment for Trigeminal Neuralgia (Tic Douloureux)
-Carbazepine
Migraine
-MC type
-Symptoms
-Migraine without aura (MC type)
-Symptoms: Lateralized, pulsatile throbbing headache with nausea, vomiting, photophobia, phonophobia. Worse with routine activity, stress, sleep, alcohol, hormonal, specific foods, dehydration.
-Auras: focal neuro symptoms that last < 60 minutes. Visual is the MC type.
Symptomatic (Abortive) Management for Migraines
-NSAIDs, Acetaminophen, or Aspirin are first-line if mild.
-IVF and place patient in dark room.
-Triptans or Ergotamines if severe or no response.
-Antiemetics (Metoclopramide, Prochlorperazine).
Prophylactic (Preventative) for Migraines
-Anti-hypertensives (BB and CCB)
MED FACTS
-Triptans
–Names
–MOA
–Adv. Effects
–Contraindications
-Names: Sumatriptan, Zolmitriptan
-MOA: Serotonin agonists cause vasoconstriction and block pain pathways in the brainstem.
-Adv: chest tightness from vasoconstriction, nausea, vomiting, cramps, flushing, malaise.
-C/I: ischemic stroke or ischemic heart disease, pregnancy, uncontrolled hypertension
MED FACTS
-Ergotamines
–Names
–MOA
–Adv. Effects
–Contraindications
-Names: Ergotamine, Dihydroergotamine
-MOA: Serotonin agonists cause vasoconstriction and block pain pathways in the brainstem.
-Adv: rebound headache
-C/I: CAD, hypertension, PAD, renal disease, hepatic disease
Cluster Headaches
-Worse at night and with _____
-Symptoms
-Acute Management
-Worse at night and with alcohol, stress, ingestion, specific foods
-Symptoms: severe, unilateral periorbital or temporal pain (sharp, lancinating). Bouts last < 2 hours with spontaneous remission. Bouts occur several times per day.
-Ipsilateral findings: Horner’s syndrome (ptosis, miosis, anhidrosis), nasal congestion, rhinorrhea, conjunctivitis, lacrimation.
-Acute Management: 100% oxygen (first line).
-Prophylaxis: Verapamil (first line)
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
-Risk Factors
-Symptoms
-Ocular Exam Findings
-Diagnostics
-Management
-RF: Obese women of childbearing age. Meds (corticosteroid withdrawal, thyroid replacement, OCP, Vitamin A toxicity)
-Symptoms: Headache (pulsatile, worse with straining), nausea, vomiting, tinnitus, visual changes.
-Ocular hypertension: papilledema (bilateral and symmetric), visual field loss, diplopia due to cranial nerve VI (abducens palsy)
-Diagnostics: CT scan prior to LP to rule out intracranial mass. LP (increased CSF pressure 250 or more + normal CSF). MRI with venography ideal neuroimaging.
-Management: Acetazolamide (First line) decreases CSF production and weight loss reduction.
–Refractory: ventriculoperitoneal shunt
Acute Bacterial Meningitis
-MCC in adults and children < 3 months - 10 years old
-MCC in older children (10-19 years old). Associated with what symptom?
-MCC in neonates < 1 month and infants < 3 months.
-_______ Has increased incidence in neonates, > 50 years old, immunocompromised states, pregnancy, HIV, AIDS, chemotherapy
Strep Pneumoniae: MCC in adults of all ages and children ages > 3 months - 10 years
Neisseria Menigitidis: MCC in older children (10-19 years old). Associated with petechial rash on trunks, legs, conjunctivae.
Group B Strep (Strep agalactiae): MCC in neonates < 1 month and infants < 3 months.
Listeria monocytogenes has increased neonates, > 50, immunocompromised states.
Symptoms of Acute Bacterial Meningitis
Diagnostics
-Symptoms: meningeal symptoms (headache, neck stiffness, photosensitivity, fever, chills, nausea, vomiting)
–Nuchal rigidity, positive Brudzinski (neck flexion produces knee and/or hip flexion)
–Positive Kernig sign (inability to extend the knee/leg with hip flexion)
-Diagnostics: LP + CSF examination
–decreased glucose < 45, increased neutrophils, increased protein, increased pressure.
-Head CT scan PRIOR To LP if needed: if papilledema, seizures, confusion, > 60 years old, immunocompromised, or history of CNS disease.
Treatment for Acute Bacterial Meningitis
-What should be started ASAP after LP?
-What has been shown to reduce mortality of Strep Pneumo (in adults)
-Start ABX along with Dexamethasone ASAP after LP or prior to head CT if LP contraindicated
-Dexamethasone
