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Emergency EOR > Neurology > Flashcards

Neurology Flashcards

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1
Q

Signs/symptoms of cluster headaches

A
  1. Severe unilateral periorbital/temporal pain (sharp, lancinating)
  2. Bouts lasting < 2 hours with spontaneous remission
  3. Bouts occur several times a day over 6-8 weeks
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2
Q

Triggers for cluster headaches

A

Worse at night
EtOH
Stress
Ingestion of specific foods

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3
Q

Additional symptoms associated with cluster headaches

A

Ipsilateral horner’s syndrome (ptosis, miosis, anhidrosis), nasal congestion/rhinorrhea, conjunctivitis and lacrimation

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4
Q

Management of cluster headaches

A
  1. 100% oxygen first line

2. Meds: sumatriptan or ergotamines

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5
Q

Prophylaxis of cluster headaches

A

Verapamil (first line)

Ergotamines, valproic acid, lithium, cyproheptadine

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6
Q

Most common cause of morning headache

A

Migraines

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7
Q

Risk factors for migraines

A

Family history (80%)

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8
Q

Signs/symptoms for migraines

A

Lateralized, pulsatile/throbbing headache
Associated with N/V
Photophobia/phonophobia

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9
Q

Triggers for migraines

A 
Physical activity
Stress
Lack of/excessive sleep
EtOH
Foods (red wine, chocolate)
OCPs
Menstruation
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10
Q

Auras

A

Seen with migraines (not commonly)

Visual changes most common, aphasia, weakness, numbness

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11
Q

Management of migraines

A
  1. Triptans or Ergotamines
  2. Dopamine blockers: metoclopramide, promethazine, prochlorperazine
  3. Mild: NSAIDs/acetaminophen first line
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12
Q

S/E of triptans or ergotamines

A

Chest tightness from constriction
N/V
Abdominal cramps

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13
Q

Prophylaxis of migraine

A

Anti-HTN meds: BB, CCB, TCA

Anticonvulsants: valproate, topiramate, NSAIDs

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14
Q

Most common overall type of headache

A

Tension headaches

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15
Q

Bilateral, tight, band-like constant daily headache. Worsened with stress, fatigue, noise or glare (not worsened with activity like migraines). usually not pulsatile

A

Tension headaches

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16
Q

Management of tension headaches

A
  1. NSAIDs, aspirin, acetaminophen
  2. Anti-migraine medications
  3. TCAs in severe or recurrent cases
  4. Can use BB, psychotherapy
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17
Q

Signs/symptoms of bacterial meningitis

A
  1. Fever/chills (95%)
  2. HA/nuchal rigidity, photosensitivity, N/V
  3. AMS, seizures
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18
Q

Kernig’s sign

A

Inability to straighten knee with hip flexion

Meningitis

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19
Q

Brudzinski’s sign

A

Neck flexion produces knee/hip flexion

Meningitis

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20
Q

Diagnosis of meningitis

A
  1. LP - definitive

2. Head CT - done to r/o mass effect before LP if high risk

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21
Q

LP results for bacterial meningitis

A

High neutrophils, low glucose, high total protein

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22
Q

For bacterial meningitis, do not wait to start

A

Empiric abx

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23
Q

Treatment for bacterial meningitis if < 1 month old

A

Ampicillin + Cefotaxime

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24
Q

Treatment for bacterial meningitis if 1 mo - 18 years

A

Ceftriaxone + Vancomycin

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25
Q

Treatment for bacterial meningitis if 18 y/o - 50 y/o

A

Ceftriaxone + Vancomycin

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26
Q

Treatment for bacterial meningitis if > 50 y/o

A

Ampicillin + Ceftriaxone

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27
Q

Meningitis post exposure prophylaxis

A

Ciprofloxacin 500 mg PO x 1 dose

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28
Q

Diagnosis of viral meningitis

A
  1. CSF - most important to differentiate
  2. MRI
  3. Serologies, viral cultures
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29
Q

Management of viral meningitis

A

Supportive care

Antipyretics, IV fluids, antiemetics

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30
Q

Viral infection of the brain parenchyma

A

Encephalitis

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31
Q

Most common cause of encephalitis

A

HSV -1 MC

Enteroviruses, arboviruses, varicella, toxoplasmosis

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32
Q

Signs/symptoms of encephalitis

A

HA, fever
Profound lethargy, AMS
Focal neurologic deficits
Seizures

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33
Q

Diagnosis of encephalitis

A
  1. LP - lymphocytosis, normal glucose, increased protein

2. Brain imaging - temporal lobe MC involved

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34
Q

Management of encephalitis

A
  1. Supportive care - antipyretics, IV fluids, seizure prophylaxis
  2. Valacyclovir
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35
Q

TIAs usually last < ____________ but most resolve in __________

A

24 hours

30-60 minutes

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36
Q

TIAs are most commonly due to:

A

Embolus or transient hypotension

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37
Q

___% of patients with TIA will have a CVA within first 24-48 hours afterwards (especially if DM, HTN)

A

50%

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38
Q

Amaurosis Fugax

A

Monocular vision loss - temporary “lamp shade down on own eye”
Seen with internal carotid artery occlusion

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39
Q

Symptoms of TIA

A 
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
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40
Q

Symptoms of TIA

A 
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
Gait and proprioception difficulties
Dizziness, vertigo
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41
Q

Diagnosis of TIA

A
  1. CT scan of head - r/o hemorrhage
  2. Carotid doppler - carotid endarterectomy recommended if stenosis > 70%
  3. CT angiography, MR angiography
  4. BG to r/o hypoglycemia
  5. Electrolytes
  6. Coag studies
  7. CBC
  8. Echocardiogram
  9. ECG - look for Afib
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42
Q

ABCD2 score

A 
Assesses CVA risk
Age
BP
Clinical features
Duration of symptoms
Diabetes mellitus
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43
Q

Management of TIA

A

Aspirin +/- dipyridamole or clopidogrel
Avoid lowering BP (unless > 220/120)
Reduce modifiable risk factors: 1. DM 2. HTN 3. Afib

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44
Q

Signs/symptoms of stroke

A

Abrupt onset of neurological abnormalities
Facial paresis
Arm drift/weakness
Abnormal speech

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45
Q

Signs/symptoms of hemorrhagic stroke

A

Headache
LOC
N/V

46
Q

Diagnostic testing of stroke

A
  1. Non-contrast CT to r/o hemorrhage
  2. LP if negative but still suspicious
  3. MRI - localize extent of infarction (after 24 hours)
47
Q

Other tests for stroke to r/o other dz:

A
  1. Glucose - r/o hypoglycemia
  2. O2 sats
  3. EKG - r/o arrhythmia
  4. CBC
  5. Cardiac enzymes - r/o infarction
  6. PT/PTT
48
Q

All ptst who present within ______ hours of ischemic stroke symptom onset should be offered TPA

A

4.5 hours

49
Q

All patients who present after 4.5 hour window for ischemic stroke should be given

A

Aspirin

50
Q

Patients who have __________ should not be given TPA

A

Rapidly improving stroke symptoms

51
Q

In ischemic stroke, blood pressure should be lowered in the case of

A
  1. Malignant hypertension
  2. Myocardial ischemia
  3. BP > 185/110 and if TPA will be administered
52
Q

Indications for mechanical thrombectomy in ischemic stroke

A

Occlusion of proximal anterior circulation
No hemorrhage present
Can be done within 6 hours

53
Q

Treatment for hemorrhagic stroke

A

BP therapy - goal is 160/90
Labetalol and nicardipine are first linen
If pt on anticoagulants, give reversal agent
Surgical removal or hemorrhage should be done if hemorrhage is > 3 cm in diameter or if patient is deteriorating

54
Q

Ischemic stroke interventions

A
  1. ASA within 48 hours
  2. Pneumatic compression stockings or heparin for VTE prophylaxis
  3. Statin therapy
  4. Smoking cessation
55
Q

Long term antiplatelet therapy after ischemic stroke

A

Aspirin, clopidogrel or aspirin-dipyridamole

If pt was previously on aspirin, switch to clopidogrel or add dipyridamole

56
Q

After stroke management (diagnostic modalities):

A
  1. Echocardiogram - look for clot
  2. EKG/Holter monitor - r/o AFib/arrhythmia
  3. Carotid duplex US - r/o stenosis
  4. Duplex US, CTA or MRA or head/neck arteries - look for clot
57
Q

Mechanism behind subarachnoid hemorrhage

A

Berry aneurysm rupture

58
Q

Signs/symptoms of subararchnoid hemorrhage

A 
Thunderclap HA (worst of my life)
\+/- unilateral, occipital area
\+/- LOC, N/V
May have meningeal symptoms: stiff neck, photophobia, delirium
Usually no focal neurological deficits
59
Q

Diagnosis of subarachnoid hemorrhage

A
  1. CT first
  2. If CT negative, perform LP (looking for blood, increased pressure)
  3. 4-vessel angiography after confirmed SAH
60
Q

Management of subarachnoid hemorrhage

A
  1. Supportive, bed rest, stool softeners, lower ICP
  2. Surgical coiling or clipping
  3. +/- BP lowering (Nicardipine, Nimodipine, Labetalol)
61
Q

Location of intracerebral hemorrhage

A

Intraparenchymal

62
Q

Mechanisms behind intracerebral hemorrhage

A
  1. HTN
  2. Arteriovenous malformation
  3. Trauma
  4. Amyloid
63
Q

Signs/symptoms of intracerebral hemorrhage

A

HA, N/V, +/- LOC
Hemiplegia, hemiparesis
Not associated with lucid intervals

64
Q

Diagnosis of intracerebral hemorrhage

A
  1. CT - intraparenchymal bleed

DO NOT perform LP if suspected- may cause brain herniation

65
Q

Management of intracerebral hemorrhage

A

Supportive, gradual BP reduction
+/- IV mannitol if increased ICP
+/- hematoma evacuation if mass effect

66
Q

Mild traumatic brain injury leading to alteration in mental status with or without loss consciousness

A

Head trauma / concussion

67
Q

Signs/symptoms of concussion

A
  1. Confusion
  2. Amnesia (retrograde or antegrade)
  3. HA, dizziness, visual disturbances (blurred/double vision)
  4. Delayed responses and emotional changes
  5. Signs of increased ICP: persistent vomiting, worsening headache, increasing disorientation, changing levels of consciousness
68
Q

Diagnosis of concussion

A
  1. CT scan
  2. MRI - if symptoms prolonged > 7-14 days
  3. PET scan may be done to look at glucose uptake
69
Q

Management of concussion

A

Cognitive and physical rest is the main management of pts with concussion

70
Q

Mechanism behind subdural hematoma

A

Tearing of cortical bridging veins

Seen most commonly in the elderly

71
Q

Most common cause of subdural hematoma

A

Blunt trauma - often causes contrecoup bleeding

72
Q

Signs/symptoms of subdural hematoma

A

Varies

May have focal neurological symptoms

73
Q

Diagnosis of subdural hematoma

A

CT (concave crescent shaped bleed)

Bleeding can cross suture lines

74
Q

Management of subdural hematoma

A

Hematoma evacuation vs. supportive

Evacuation if massive or > 5 mm midline shift

75
Q

Mechanism behind epidural hematoma

A

Middle meningeal artery

Most common after temporal bone fracture

76
Q

Signs/symptoms of epidural hematoma

A

Brief LOC, lucid interval, coma
HA, N/V, focal neuro sx, rhinorrhea (CSF fluid)
CN III palsy if tentorial herniation

77
Q

Diagnosis of epidural hematoma

A
  1. CT (convex lens shaped bleed)

Will not cross suture lines, usually in temporal area

78
Q

Management of epidural hematoma

A

+/- herniation if not evacuated early
Observation if small
If increased ICP: mannitol, hyperventilation, head elevation, +/- shunt

79
Q

80% of all strokes are ___________ and are due to ________, _________ or ________ ________

A

Ischemic
Thrombus
Emboli
Systemic hypoperfusion

80
Q

Seizures not provoked by stimuli, occurs without clear cause

A

Epilepsy

81
Q

Generalized seizure which affects entire cortex. Muscle stiffness followed by muscle jerking. Will often have foaming of the mouth, tongue biting and/or urination

A

Tonic Clonic Seizure

Grand-mal seizure

82
Q

Seizure that occurs in one part of the cortex with loss of consciousness

A

Complex partial seizure

83
Q

Seizure that occurs in one part of the cortex without loss of consciousness

A

Simple partial seizure

84
Q

Postictal symptoms

A 
Confusion 
Amnesia
HA
Nausea
Difficulty speaking
85
Q

Paresis that occurs following a seizure that lasts for hours

A

Todd’s Paralysis

86
Q

Diagnosis for pt with first time seizures

A 
CBC
Electrolytes
Glucose
Calcium, magnesium
Renal function, liver function
Toxicology screen
CT or MRI is also done to r/o masses

If all come back normal, this is termed epilepsy, and EEG is done

87
Q

Treatment for seizures

A 
First time seizures usually do not require medication
Reasons for therapy to be given:
1. Pt with status epilepticus
2. Prior brain insult
3. EEG with epileptiform abnormalities
4. Brain imaging abnormality
5. Nocturnal seizure
88
Q

Antiseizure medication with the most evidence for teratogenicity

A

Valproate

89
Q

Oral contraceptive efficacy may be ________ when start on an epileptic drug, therefore all women of childbearing age should be given __________

A

Folic acid

90
Q

Treatment of choice for absence seizures

A

Ethosuximide

91
Q

Discontinuation of seizure medication can be attempted after:

A

2 year seizure free period

92
Q

Seizure that lasts longer than 5 minutes

A

Status epilepticus

93
Q

Treatment for status epilepticus

A
  1. Benzodiazepine (Midazolam used if no IV access)
  2. After benzo, give fosphenytoin
  3. If seizure persists but stable, phenobarbital
  4. If not stable, intubate and give propofol or midazolam
94
Q

Clinical syndrome in which transient loss of consciousness is caused by period of inadequate cerebral nutrient flow

A

Syncope

95
Q

Most often, syncope is the result of cerebral hypoperfusion due to __________________

A

Transient hypotension

96
Q

4 possible causes of syncope

A
  1. Reflex syncope
  2. Orthostatic syncope
  3. Cardiac arrhythmias
  4. Structural cardiopulmonary disease
97
Q

An ______ should be obtained in all pts with suspected syncope

A

ECG

98
Q

Acute/subacute acquired inflammatory demyelinating polyradiculopathy of the peripheral nerves

A

Guillain-Barre Syndrome

99
Q

Guillain-Barre syndrome has an increased incidence with ________________ or other antecedent respiratory or GI infections or other viruses

A

Campylobacter jejuni (MC)

100
Q

Ascending weakness and paresthesias (usually symmetric), decreased DTRs

A

Guillain-Barre syndrome

101
Q

Other symptoms of Guillain-Barre syndrome

A

Autonomic dysfunction: tachycardia, hypotension, breathing difficulties, CN VII palsy

102
Q

Diagnosis of Guillain-Barre syndrome

A
  1. CSF: high protein with normal WBC

2. Electrophysiologic studies: decreased motor nerve conduction velocities

103
Q

Management of Guillain-Barre syndrome

A
  1. Plasmapheresis - best if done early - removes harmful circulating autoantibodies that cause demyelination
  2. Intravenous Immune Globulin (IVIG): suppresses harmful inflammation/autoantibodies and induces remyelination. Most recover within months.
104
Q

Anterior cord injury

A

Lower extremity > upper

Deficits: pain, temperature, light touch

105
Q

Central cord injury

A

Hyperextension (MVA)
Upper extremity > lower
Deficits: pain, temperature
Shawl distribution

106
Q

Brown Sequard Syndrome

A

Penetrating trauma
Ipsilateral deficits: motor, vibration and proprioception
Contralateral deficits: pain and temperature

107
Q

Bell palsy has a strong association with

A

Herpes Simplex virus reactivation

108
Q

Risk factors for bells palsy

A
  1. DM
  2. Pregnancy
  3. Post URI
  4. Dental nerve block
109
Q

Sudden onset of ipsilateral hyperacusis (ear pain) for 24-48 hours - unilateral facial paralysis

A

Bell palsy

110
Q

Eye on affected side moves laterally and superiorly when eye closure is attempted

A

Bell phenomenon

111
Q

Differential diagnosis: bell palsy vs stroke

A

If pt is able to wrinkle both sides of forehead, it is not bell palsy

112
Q

Management of bell palsy

A

No tx required - most cases resolve within 1 month

  1. Prednisone
  2. Artificial tears

Emergency EOR (12 decks)

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