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CPNP Boards > Neurology > Flashcards

Neurology Flashcards

1
Q

Cranial Nerve I

A

Olfactory

Smell

Sensory

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2
Q

Cranial Nerve II

A

Optic

Vision

Sensory

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3
Q

Cranial Nerve III

A

Oculomotor

Most EOMs, opening eyelids, papillary constriction

Motor

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4
Q

Cranial Nerve IV (4)

A

Trochlear

Down and inward eye movement

Motor

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5
Q

Cranial Nerve V (5)

A

Trigeminal

Muscles of mastication; sensation of face, scalp, cornea, mucus membranes and nose

Sensory and Motor

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6
Q

Cranial Nerve VI (6)

A

Abducens

Lateral eye movement

Motor

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7
Q

Cranial Nerve VII (7)

A

Facial

Moves face, closes mouth and eyes; taste (anterior 2/3)’ saliva and tear secretion; Bells palsy

Sensory and Motor

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8
Q

Cranial Nerve VIII (8)

A

Acoustic

Hearing and equilibrium

Sensory

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9
Q

Cranial Nerve IX (9)

A

Glossopharyngeal

Phonation, (1/3), gag reflex, carotid reflex swallowing; taste (posterior 1/3)

Sensory and Motor

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10
Q

Cranial Nerve X (10)

A

Vagus

Talking, swallowing, general sensation from the carotid body, carotid reflex

Sensory and Motor

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11
Q

Cranial Nerve XI (11)

A

Spinal accessory

Movement of trapezius and sternomastoid muscles (shrug shoulders)

Motor

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12
Q

Cranial Nerve XII (12)

A

Hypoglossal

Moves the tongue

Motor

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13
Q

Pneumonic for remembering the type of Cranial Nerve

A

Some Say Marry Money But My Brother Says Big Bras Matter Most

S = sensory
M = motor
B = both
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14
Q

Cranial Nerve responsible for eye movement

A

III, IV, VI

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15
Q

Headache

A

May present for a multitude of reasons and can be difficult to evaluation

Proper evaluation of the history of the HA, and associated symptoms, are essential to making an accurate diagnosis

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16
Q

4 primary mechanisms of headache pain

A
  1. Vascular dilation: Cranial artery distention (ie migraine, fever, vasodilator drugs, metabolic disturbance, systemic infection
  2. Muscular contraction: HA and neck muscle contraction (ie tension or psychogenic HA - stress HAs)
  3. Traction: Space occupying lesions (ie brain tumors, mass lesions, abscess, hematoma, increased ICP)
  4. Inflammation: Infection (meninges, sinuses, and teeth)
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17
Q

Pneumonic for HA evalation

A 
OLDCARTS
Onset
Location
Duration
Characteristics
Aggravating factors
Remedial/alleviating factors
Treatments tried
Severity
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18
Q

HA considerations for the febrile patient

A
  1. Meningits: bacterial, viral, tubercular, ascetic
  2. Brain abscess or other intracranial infection
  3. Encephalitis
  4. Sinusitis
  5. Associated infection: strep throat, influenza, mononucleosis, rubeola
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19
Q

Meningitis

A
  1. Viral meningitis more common in infants
  2. Bacterial meningitis occurs only in up to 2%.
    - T > than 101.8F (38.8C)
    - Causative agents: Group B streptococcus, S. pneumonia, Haemophilus influenza, Salmonella, Nesseria meningitis, Protozoa, and E. coli
    - Infants between 6-12 months are at the highest risk
    - 90% of cases occur in children ages 1 month - 5 years***
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20
Q

S/S of Meningitis

A

Most are behavioral responses

Differ from newborns and older children

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21
Q

S/S of Meningitis in newborns and young infants

A 
Mimic septicemia
T instability
Irritability, lethargy
Poor feeding
Vomiting 
Bulging fontanel
No stiff neck
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22
Q

S/S of Meningitis in older infants and children

A 
N/V
Irritability, confusion
HAs, back pain, nuchal rigidity 
Hyperesthesia, cranial nerve palsy, ataxia
Photophobia
\+ Kernig's and Brudzinski's signs
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23
Q

Kernig’s sign

A

Flexion of the hip at 90 degrees
Pain on extension of leg

*bend knee forward, hurts at head and want to pull head up

starts with Knee = Kernig

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24
Q

Brudzinkski’s sign

A

Involuntary flexion of legs when neck is flexed

*pull head forward, patient pulls knees up

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25
Q

Diagnostic tests for Meningitis

A

Cerebrospinal fluid (CSF) analysis via lumbar puncture

  • CSF is usually clear
  • cloudy b/c WBC are in there
  • WBCs present
  • increased protein
  • decreased glucose

*bugs are eating the sugar = increased protein and decreased glucose

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26
Q

HA considerations in the afebrile patient

A
  1. Subarachnoid hemorrhage
  2. Intraparenchymal hemorrhage
  3. Postictal HA
  4. Cerebral ischemia
  5. Severe hypertension
  6. Space-occupying conditions (ie brain tumor, hydrocephalies)
  7. Acute dental disease
  8. Acute glaucoma, inflammatory disease of the eye/orbit
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27
Q

Brain tumors

A

1 solid tumor in children

Etiology is unknown

Infratentorial, brainstem, tumors predominate: most common ages 4-11 years (these are below the tentorium, herniate quickly)

28
Q

S/S of brain tumors in infants

A
  • increased head circumference, tense bulging fontanel
  • irritability
  • head tilt
  • loss of developmental milestones
29
Q

S/S of brain tumors in older children

A
  • HA: worst in the morning followed by vomiting; usually increases in frequency
  • Abnormal neurologic or ocular findings
  • atatxia, hemiparesis, cranial nerve palsies
  • somnolence
  • seizures
  • head tilt, FTT, diabetes insidious
  • papilledema
  • loss of fine motor control
  • positive Babinski’s sign
  • behavioral changes
30
Q

Diagnostic tests for brain tumors

A
  1. CT scan — then REFER
  2. MRI
  3. LP - only after CT scan has been done to show safety
31
Q

Migraine Headaches (Vascular HAs)

A

d/t dilation and excessive pulsation of branches in the external carotid artery

2 categories:

  1. classic migraine (with aura)
  2. common migraine (w/o aura)
32
Q

Causes/Incidence of Migraine Headaches

A
  1. Common migraine (no aura) < 10 yo at onset
  2. Classic migraine (with aura) > 10 yo
  3. Often, there is a family history
  4. Females > males
  5. A variety of “triggers” are a/w migraine
    - emotional or physical stress
    - lack or excess sleep
    - missed meals
    - nitrate-containing foods
    - alcoholic beverages
    - mensuration
    - use of oral contraceptives
33
Q

S/S Migraine Headaches

A
  • Unilateral, lateralized dull or throbbing HA that occurs episodically
  • Insidious onset
  • Focal neurologic disturbances may precede or accompany classic migraines (field defects, luminous visual hallucinations)
  • Aphasia, numbness, tingling, clumsiness or weakness may occur
  • N/V
  • Photophobia and phonophobia
34
Q

Confusional Migraine

A

Period of confusion and disorientation followed by vomiting and deep sleep, waking feeling well

HA may not be described

More common in younger children

35
Q

Abdominal Migraine

A

Episodic abdominal pain with nausea, vomiting followed or accompanied by HA

Treat with ibuprofen and HA goes away

36
Q

Labs/diagnostics for Migraine HA

A

Baseline studies:

  1. Blood chemistries, BMP
  2. CBC
  3. Venereal disease research laboratory test
  4. ESR
  5. CT scan of head !!!
  6. Other studies as indicated by the history and physical exam
37
Q

Management of Migraine Headaches

A
  1. Avoidance of trigger factors is very important - have the patient keep a HA diary
  2. Improve general health: balanced diet, aerobic exercise, regular sleep
  3. Relaxation/stress management techniques (counseling, biofeedback)
  4. Eliminate monosodium glutamate and nitrates or nitrites from diet
  5. Stabilize or wean caffeine intake
  6. Prophylactic therapy if attacks occur more than 3-4 times per month, or if migraines interfere with daily functioning or school
  7. Manage acute attacks
38
Q

Prophylactic therapy for Migraine Headaches

A
  • If attacks occur more than 3-4 times per month, or if migraines interfere with daily functioning or school
  1. NSAIDs for chronic cases: low doses daily
  2. Propanolol (Inderal)
  3. Amitriptyline (Elavil)
  4. Topiramate (Topamax)
  5. Imipramine (Tofranil): 10-150 mg daily
  6. Verapamil (Calan): 15-30 mg/kg/24 hours PO BID
39
Q

Management of an acute attack of Migraine HAs

A
  1. Rest in a dark, quiet room
  2. A simple analgesic such as Tylenol or ibuprofen (preferred) taken right away may provide some relief.
    * Ibuprofen 7.5mg-10mg/kg dose in younger children
    * May use up to 800 mg/dose in older teens
  3. Antiemetics
  4. When OTC analgesics are not enough, use triptans
40
Q

Triptans for Migrane HAs

A
  • Almotriptan (Axert): 6.25 mg (approved for children 12 and older
  • Rizatriptan (Maxalt): 5mg
  • Sumatriptan (Imitrex): Nasal 5mg; Tablets are less expensive but may not work as well d/t slower absorption
  • Zolmitriptan (Zomig): Nasal 5mg

Most evidence in adolescent: All triptans above

Most evidence age 6-11yo: Maxalt 5mg or Imitrex nasal 5mg

May take at first sign of HA, then repeat in 2 hours if needed

Avoid in children at risk for heart disease

41
Q

Seizure disorder

A

A transient disturbance of cerebral function d/t an abnormal paroxysmal neuronal discharge in the brain

*an electrical disturbance

There are severe types seizures with different presentations, diagnostic findings, and treatments.

The term epilepsy = any disorder characterized by recurrent seizures.

42
Q

Causes/Incidence of Seizures

A
  1. Congential abnormalities and perinatal injuries may result in seizures presenting in infancy and early childhood.
  2. Metabolic disorders: Hypocalcaemic, hypoglycemia, pyridoxine deficiency, renal failure, acidosis, and others.
  3. Trauma is an important cause of seizures in adolescents.
  4. Tumors and other space occupying lesions
  5. Infectious diseases: Bacterial meningitis, herpes encephalitis, neurosyphilis
  6. Seizure threshold is lowered with a fever (aka it is easier for them to have a seizure if febrile
43
Q

Seizure categories

A

Partial seizures: 1 hemisphere

  • Simple partial seizures
  • Complex partial seizures

Generalized seizures: bilateral, involving both hemispheres

  • Absence (petit mal) seizures
  • Tonic seizures
  • Tonic-clonic (grand-mal seizures)
  • Atonic
44
Q

Simple partial seizures

A

No loss of consciousness

A variety of other symptoms (motor, autonomic, and sensory)

45
Q

Complex partial seizures

A

Impaired consciousness: Staring > 20s before, during, or after the symptoms (motor, autonomic, and sensory)

*loses consciousness

46
Q

Absence (petit mal) seizures

A

Brief “staring” episodes (10-20s)

Onset and termination are very brief

Almost always begin in childhood

47
Q

Tonic seizures

A

Sudden increase in muscle tone producing a number of characteristic postures

Consciousness is usually partially or completely lost

Postictal alteration of consciousness is usually brief, may last several minutes

48
Q

Tonic-clonic (grand mal) seizures

A

Sudden loss of consciousness w/ arrested respirations

The clonic phase involves increased muscle tone followed by bilateral rhythmic jerks lasting 2-3 minutes, followed by flaccid coma

Urinary and/or fecal incontinence may occur

The postictal state is characterized by deep sleep for up to an hour, followed by HA, disorientation, muscle discomfort and nausea, which can last minutes to hours

49
Q

Atonic seizures

A

Sudden loss of muscle tone

May result in head drop or falling to the ground

An eyewitness account is extremely helpful

50
Q

Labs/diagnostics for Seizures

A
  1. Investigate the underlying cause.
  2. CBC with differential, glucose, renal function test, liver function test, and a serologic treat for syphilis should be performed.
  3. Other test to rule out suspected etiology as indicated by the history and age of the patient (CT scan, LP, CT or MRI of the head for all new onset seizures)
  4. EEG: most IMPORTANT test to determine seizure classification**
51
Q

Management of acute attack of seizures

A
  1. Initial management is supportive as most seizures are self-limiting.
    - maintain open airway
    - protect patient from injuries
    - administer oxygen if patient is cyanotic
  2. Do NOT force artificial airways or objects between teeth/mouth.
  3. Parenteral anticonvulsants to stop convulsive seizures.
    - Lorazepam (Ativan)
    - Benzodiazepines (Valium)
  4. Refer is needed
  5. Primary care follow-up
52
Q

Consider referral for seizures if

A
  1. Seizures continue despite therapeutic monitoring through anticonvulsant levels
  2. Regression of developmental skills occurs **
  3. Regression of cognitive function occurs **
  4. Side effect profile is unacceptable
53
Q

Febrile Seizures

A

Seizures occurring during the course of and as a result of a fever

5% of children, peak incidence between 1-3 yo

Risk factors: family history of seizure disorder, tobacco use by mother during pregnancy, prematurity, neonatal hospitalization > 28 days, and/or frequent infections in the first year

If seizure occurs > 24 hours after fever onset, it is likely d/t infection

54
Q

S/S Febrile Seizures

A
  • majority are tonic-clonic
  • most episodes last < 5 minutes
  • physical exam to rule out infectious cause of seizure
  • rule out meningitis
55
Q

Labs/diagnostics for Febrile Seizures

A
  1. LP if meningitis is suspected (fever + seizure = rule out meningitis)
  2. EEG, chemistries, and serologies are NOT indicated
56
Q

Management of Febrile Seizures

A
  1. Protect airway, place in side-lying position
  2. Cooling measures
  3. Acetaminophen

***do NOT prophylactically treat with anticonvulsants

57
Q

Neurofibromatosis (von Recklinghausen Disease)

A

A neurocutaneous syndrome characterized by numerous cafe-au-lait (CLS) spots on the body, and nerve tumors on the skin and in the body

A progressive disorder

Does NOT affect intelligence

Severity is highly variable:
NF1 = von Recklinghausen Disease (most common)
NF2
Schwannomatosis (rare)

58
Q

S/S of Neurofibromatosis

A
  1. Multiple CLS

2. Seizures

59
Q

Diagnostic criteria for Neurofibromatosis

A

Must have at least 2:

  • 6 or more CLS > 5 mm in prepubertal child or > 15 mm post pubertal
  • 2 or more cutaneous neurofibromas (fast skin tags)
  • Axillary or inguinal freckling
  • 2 or more iris Lisch nodules (black sports on iris of the eye)
  • Distinctive osseous lesions
  • Autosomal dominant; present in a first-degree relative (parents, aunt/uncle)
60
Q

Management of Neurofibromatosis

A

Refer to neurology

61
Q

Tic Disorders

A

Brief, abrupt, non-purposeful movements or utterances

  • most common: Tourette’s syndrome (only one you refer)

Movements usually involve the face, neck, or shoulders and sometimes, muscles of the limbs or other parts of the body

Other psychobehavorial problems (ie ADHD, obsessive-compulsive behaviors)

62
Q

Etiology/Incidence of Tic Disorders

A
  1. Frequency unrecognized as a movement disorder in children
  2. Onset is between 6-12 yo
  3. Cause is unknown
  4. Family predisposition
  5. Associated with medications (methylphenidate, pemoline, amphetamines)
63
Q

Types of Tic Disorders

A

Simple motor tics

Complex motor tics

64
Q

Clinical manifestations of complex motor tics

A
  1. Copropraxia (obscene gestures) and coprographia (obscene writing)
  2. Vocal tics
    - oropharyngeal, nasopharyngeal, or laryngeal sounds
    - consonants or syllables
    - meaningful or nonsense words or phrases
    - coprolalia (obscene speech)
    - palilalia (repeating one’s own words) and echolalia (repeating another’s words)
65
Q

Management of Tic Disorders

A

Collaboration with neurology

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