Neurology #1 (TBI, Concussion, Lower/Upper Neuron, Cranial Nerves)

Question 1

MC etiology of a TBI

Answer 1

Falls (especially in the elderly)
MVAs

Question 2

How do you classify the severity of a TBI?

Answer 2

Glascow Coma Scale

Scored between 3-15 with 3 being the worst and 15 being the best

Question 3

What are the three components of the Glascow Coma Scale?

Answer 3

EVM

Eye opening
Verbal
Motor response

Question 4

What is short-term treatment of TBI?

Answer 4

use antiseizure meds for 1 week to prevent early seizures (Levitiracetam, Fosphenytoin)

Question 5

Symptoms of a concussion

Answer 5

headache
dizziness
psychological symptoms
cognitive impairment
Confusion: confused or blank expression, blunted affect
Amnesia
Delayed responses or emotional changes
Signs of ICP: vomiting, disorientation, changing LOC

Question 6

What is the study of choice for evaluating most acute head injuries?

Answer 6

CT head without contrast

Question 7

However, what is the study of choice when symptoms > 7-14 days or worsening of symptoms not explained by concussion syndrome?

Answer 7

MRI

Question 8

Management of a concussion

Answer 8

Cognitive and physical rest is main management

Some form of observation for 24 hours

Resume activity after resolution of symptoms and recovery of memory and cognitive functions

Neuro consult if CT is abnormal

Question 9

What are symptoms of a LOWER motor neuron injury?

Answer 9

-Muscles are FLABBY

Fasciculations in advanced stage
Flaccid paralysis
Loss of muscle tone and strength
Areflexia (decreased DTR)
Babinski downwards
Young (infantile paralysis)

Question 10

Some causes of lower motor neuron injury

Answer 10

Guillan-barre Syndrome
Botulism
Poliomyelitis (Baby)
Cauda Equina Syndrome (Back)
Bell Palsy

Question 11

Symptoms of an UPPER motor neuron injury

Answer 11

Muscles are SPASTIC

Slight muscle loss (no atrophy)
Positive Babinski (toe up)
Absence of fasciculations
Strong Tone (Spastic paralysis)
Tone Increased
Increased DTR
Clonus

Question 12

What are some conditions that cause upper motor neuron injuries?

Answer 12

Stroke (CVA)
Multiple Sclerosis
Cerebral PalSY
Spinal cord or brain damage (TBI)

Question 13

Name the 12 cranial nerves

Answer 13

Olfactory
Optic
Oculomotor
Trigeminal
Abducens
Facial
Acoustic (Vestibulocochlear)
Glossopharyngeal
Vagus
Accessory
Hypoglossal

Question 14

What is the MC overall cause of primary headache?

Answer 14

Tension type headache

Question 15

Risk factors for tension type headache

Answer 15

-30 years old
-Mental stress
-Sleep deprivation
-Eye strain

Question 16

Symptoms of a tension-type headache

Answer 16

Bilateral, pressing, tightening “band-like” nonpulsatile aching headache (often worsens throughout the day)

Worse with stress, noise, fatigue, glare

Not worsened with routine activity

Not associated with nausea, vomiting, photophobia, phonophobia, or focal neurological symptoms (auras)

Question 17

What does a patient with a tension type headache have on physical exam?

Answer 17

Tenderness to the head, neck, or shoulders

Question 18

Treatment for tension-type headache

Answer 18

NSAIDs and other analgesics (Acetaminophen or Aspirin)
Local heat
Anti-migraine medications

Question 19

What is trigeminal neuralgia?

Answer 19

Compression of the trigeminal nerve (cranial nerve V) by superior cerebellar artery or vein

Question 20

Trigeminal neuralgia is MC in

Answer 20

middle-aged women

Question 21

If trigeminal neuralgia occurs in younger patients, what should you suspect?

Answer 21

Multiple Sclerosis

Question 22

Symptoms of trigeminal neuralgia

Answer 22

-Headache: paroxysmal, brief, episodic, stabbing pain lasting seconds to minutes
-Worse with touch, chewing, brushing teeth, drafts of wind, and movements
-Pain starts near mouth and shoots to eye, ear, and nostril on same side

Question 23

First-line treatment for trigeminal neuralgia

Answer 23

-Carbamazepine

-Oxcarbazepine, Gabapentin, Lamotrigine are other options
-Surgical decompression for severe cases