Neurology Flashcards
Headache characterized by sudden, severe, one-sided pain and associated eye tearing and nasal drainage
Cluster headache
Cluster headache abortive treatment
Triptans such as sumatriptan (Imitrex)
100% high flow oxygen
Cluster headache preventative treatment
Verapamil (calcium channel blocker)
Headache characterized by one-sided throbbing pain in the temporal region, vision changes, and increased ESR/CRP levels
Giant cell arteritis (temporal arteritis)
Temporal arteritis associated condition
Polymyalgia rheumatica
Headache characterized by a throbbing, pulsating nature with nausea/vomiting and sensitivity to lights/noise
Migraine (with or without aura)
What is an aura?
Sensory disturbances (floaters, flashing lights, vision loss) preceding or during headache
Is a migraine typically unilateral or bilateral?
Unilateral
Headache that presents bilaterally with a pressure-like quality, no other significant symptoms
Tension-type headaches
Migraine preventative treatment
- Beta blockers
- TCAs
- Topiramate (Topamax)
- CGRP antagonists
Migraine abortive treatment
Triptans
Triptan prescribing considerations
Avoid in uncontrolled HTN, CAD, serotonin medications (eg SSRIs)
Parkinson disease cardinal symptoms
- Bradykinesia (needed for diagnosis)
- Resting tremors
- Rigidity
Parkinson disease is caused by a depletion of:
Dopamine
Parkinson disease later symptom
Postural instability
Parkinson disease treatment
Carbidopa levodopa (Sinemet)
Essential tremor treatment
Propranolol
Brudzinski sign
When flexing back of head, it causes patients’ hips and knees to flex with it due to meningeal irritation
Think “B” for Back of head
Kernig sign
Patient unable to extend knee past 90 degree angle without pain
Think “K” for Knee and Kernig
Make a K by straightening the leg
Multiple sclerosis
Demyelinated lesions in brain and spinal cord; affects CNS communication to peripheral nerves
Multiple sclerosis symptoms
Muscle weakness, balance issues, sensory loss, persistent fatigue
Optic nerve involvement: optic neuritis
Most common form of dementia
Alzheimer disease
4 As of Alzheimer disease
- Amnesia
- Apraxia
- Agnosia
- Aphasia
Trigeminal neuralgia treatment
Carbamazepine (Tegretol)
What cranial nerve is affected in Trigeminal neuralgia?
CN V (Trigeminal)
What cranial nerve is affected in Bell palsy?
CN VII (Facial)
Agnosia
Inability to recognize familiar faces/people
Apraxia
Inability to carry out purposeful movements or gestures
Amnesia
Memory loss
Aphasia
Loss of speech/inability to comprehend
Which vitamin deficiency usually leads to Wernicke-Korsakoff syndrome?
Vitamin B1 (thiamine)
Aphasia that develops if Wernicke area is impacted
Receptive aphasia
Aphasia that develops if Broca area is impacted
Expressive aphasia
Seizure diagnostic test
EEG
Thunderclap headache diagnostic test
CT scan
Headache abortive therapy
Triptans
To stop acute attack
Headache preventative therapy
Prophylaxis
Temporal arteritis treatment?
Temporal artery biopsy
ED referral if vision changes
Diabetic neuropathy treatment
- SNRI (Duloxetine, Venlafaxine)
- TCA (Amitriptyline)
- Gabapentinoids (Pregabalin, Gabapentin)
Alzheimer disease treatment (mild to moderate)
Cholinesterase Inhibitors (Donepezil)
Initiate EARLY
Alzheimer disease treatment (moderate to severe)
NMDA (Memantine)
Use with cholinesterase inhibitors
Pharmacological treatment of severe, persistent behavioral symptoms in Alzheimer disease
SSRIs: may reduce agitation and paranoia
Olanzapine: consider first
Quetiapine: alternative
What to do if a patient reports “worst headache of their life”?
Immediate ED referral to rule out stroke
What do we need to prescribe to every patient with Bell palsy?
Eye lubricant to prevent corneal abrasion
Trigeminal neuralgia
Severe, stabbing facial pain down one of more of the three branches of trigeminal nerve
Bell palsy treatment
Glucocorticoids
Antivirals
