Neurology Flashcards
- Most prevalent headache type, women affected more than men
- Constant daily bilateral headaches
- Vise-like pressure of tightness that waxes and wanes but does not throb
- Exacerbated by emotional stress, fatigue, noise, glare, but not normal physical activity
- Complaints of poor concentration and other vague non-specific symptoms
- Generalized and often most intense about the neck or back of the head, muscles may be sore
- No focal neurological symptoms
Tension HA
- Middle aged men affected more than women
- Unilateral pain beginning around the eye or temple
- During attacks, patients are often restless and agitated
- Episodes often occur at night and last between 15 min to 3 hours
- May be associated with; ipsilateral nasal congestion or rhinorrhea, lacrimation and redness of the eye
- Horner Syndrome; Ptosis/Miosis/Anhidrosis
- Usually no family history of headache or migraine
- Occur in ““clusters””, that is daily on the same side of the face for several weeks
- Spontaneous remission
- During a bout, PT may report that alcohol, stress, glare, or indigestion of specific foods triggers and attack
Cluster HA
- Gradual buildup of a throbbing headache, often unilateral
- Duration of several hours or longer
- Aura may or may not be present
- Focal disturbances of neurologic function that precedes or accompanies the headache
- Visual disturbances; field deficits or luminous visual hallucinations such as seeing stars, light flashes, zigzags of light or geometric patterns
- Other focal disturbances such as aphasia or numbness, tingling, clumsiness, or weakness in a circumscribed distribution
- Family history is positive for headaches
- Triggers may or may not be known
Migraine
- After head injury, it is common to have headaches
- Symptoms occur within 1-2 days of injury and subside within 7-10 days
- Often accompanied by impaired memory, poor concentration, emotional instability, and increased irritability
Post-traumatic HA
- Present in about 50% of patients with chronic daily headaches
- Typically present with chronic pain or with complaints of headache unresponsive to medication
- History will reveal heavy use of analgesics
Medication Overuse HA
- MOTOR SEIZURES - have motor signs; convulsive jerking, involuntary movements of contralateral side
- SENSORY SEIZURES - have sensory signs; paresthesia, tingling, flashing lights, unusual sounds or odors, indicate involvement of visual/auditory/olfactory/gustatory regions of brain
- AUTONOMIC SEIZURES - have autonomic signs; abnormal epigastric sensations, sweating, flushing, pupillary dilation
- HIGHER CORTICAL SEIZURES - have higher cortical signs; dysphasia, deja vu, affective disturbances, illusions, hallucinations, etc
Partial Seizures
•Arise from both cerebral hemispheres simultaneously
•Have loss of conciousness as hallmark
ABSENCE(PETIT MAL)
•Sudden, brief impairment of conciousness without loss of postural control
•Lasts for only seconds, consciousness returns as suddenly as it was lost and no post-ictal confusion
•Usually accompanied by automatisms
•Can occur hundreds of times per day, but PT may be unaware
•First clue is unexplained ““daydreaming”” and a decline in school performance
Generalized Seizure Absence (Petit mal)
TONIC-CLONIC(GRAND MAL)
•Usually begins abruptly without warning; PT becomes rigid, falls to ground, and respiration is arrested
•Initial phase is TONIC; contractions of muscles throughout the body, after 10-20 seconds, evolves into the CLONIC phase; periods of muscle relaxation and contraction(jerking) lasting about 2-3 minutes, POST-ICTAL phase; unresponsiveness, muscular flaccidity, excessive salivation, stridorous breathing, and bladder/bowel incontinence
•Gradually retain conciousness over minutes to hours and typically have post-ictal confusion, headache, fatigue, and muscle aches
Generalized Seizure Absence (Grand mal)
- Sudden and brief muscle contraction that may involve one part of the body or the entire body
- Sudden jerking movement observed while falling asleep
- Associated with metabolic disorders, degenerative CNS diseases, or anoxic brain injury
- Usually coexist with other forms of generalized seizure disorders; may generalize to tonic-clonic
- If only myoclonic, no LOC typically
Generalized seizure myoclonic
- Often part of a conversion reaction to outside stress
- Difficult to make determination clinically
- Usually females more than males and usually in front of witnesses
Generalized Seizure NON-ELECTRIC (Psychogenic, Non-epileptic, pseudo)
- Continuous seizures >5 min
- After 30-45 minutes, signs become increasingly subtle
- Patients may only have mild clonic movements of fingers or fine, rapid movements of the eyes.
- There may also be paroxysmal episodes of tachycardia, hypertension, and pupillary dilation
Status Epilepticus
- Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction that resolved within 24 hours
- Sudden onset focal neurological deficit
Transient Ischemic Attack (TIA)
- Symptoms depend on the site of bleed
- Intracerebral hemorrhage usually has gradual onset as blood builds
- SAH has maximal impact right away usually with intense ““worse headache of my life”
Hemorrhagic Stroke (ICH and SAH)
- "”creeping, crawling”” sensation or ““pins and needles feeling”” in the limbs, especially in the legs
- Tends to occur during waking and at sleep onset
- Being recumbent increases leg discomfort and leads to difficulty sleeping
Restless Leg Syndrome
- Episodic neurologic symptoms
- PT usually under 55 years old at onset
- Single pathologic lesion cannot explain clinical findings
- Multiple foci best visualized by MRI
- Weakness, numbness, tingling, or unsteadiness in a limb
- Spastic paraparesis
- Retrobulbar optic neuritis
- Diplopia
- Dysequilibrium or a sphincter disturbance such as urinary urgency or hesitancy
- May appear after a few days or weeks, although exam often reveals a residual deficit
Multiple Sclerosis
