Neurology Flashcards
Characteristics of migraine headaches (7)
Pounding, pulsatile pain Unilateral pain Worse w/ activity Assoc with N/V Phono/photophobia Disabling intensity May be assoc with neck/posterior head pain, often described as "sinus pain" (But NO nasal discharge/congest'n)
Secondary causes of headache (12)
Vascular (SAH, subdural hematoma, CVA, carotid dissection, ateriovenous malformation, temporal arteritis)
Intercranial masses (primary brain tumour, mets)
Infections (meningitis, sinusitis)
Severe HTN
Pseudotumour cerebri
Which primary headache is more common in men than women?
Cluster
Usually presents bet age 30-40
Characteristics of cluster headaches (5)
Unilateral Retro orbital Sharp/knife-like Wakes you up at night Assoc with lacrimation/congestion Pts often restless or agitated
Characteristics of tension headaches (3)
Dull, pressing or tight
Often bilateral
Radiate to neck/occiput
Name 7 headache red flags and what Dx they point to
Worst headache of life => SAH
Thunderclap (sudden and severe) => SAH
First exertional headache => SAH, carotid dissection
New headache after 50 => brain tumour, stroke, temporal arteritis
Assoc with stiff neck/fever => meningitis (also SAH)
Behaviour changes => brain tumour
PMHx cancer => mets
Medications assoc with headache side effect (5)
Beta blockers Nitrates Indomethacin Phosphodiesterase inhibitors Estrogen/OCP
Important things to check on P/E
Blood pressure
Papilledema
Temporal artery tenderness/pain
Focal neurological findings
Best imaging modality for SAH
CT
(Vs. MRI which is better for aneurysms and neoplasms)
LP may show xanthochromia (yellow discolouration of CSF from hemorrhage)
Migraine Tx - OTC and Rx
OTC: acetominophen, aspirin
Rx:
Tx: prochlorperazine, metoclopramide (for nausea), triptans (cerebral vasoconstrict)
Prevention: propranolol (beta blocker), amitriptyline, topiramate (anticonvulsant)
Tension headache Tx
OTC: acetominophen, aspirin, NSAIDs
Also: Neck stetches, warm compresses, exercise
Rx: baclofen, tizanidine (muscle relaxants)
Cluster headache Tx
High flow oxygen
Rx: triptans
Prevention: verapamil
Delirium - definition
State of impaired consciousness and cognition
Develops overs hours-days
Clinical fluctuation
Conditions increasing susceptibility for delirium (5)
Stroke Dementia Parkinson disease Advanced old age Sensory impairment (ex. Hearing or vision loss)
Important things to look for on P/E in pt with delirium
Vitals => oxygenation Mucous membrane/skin turgor => hydration Signs of trauma Cyanosis, jaundice Needle tracks Focal neuro defects Potential sites of infection MMSE
Tx delirium
DC offending drugs
Tx any infections
Supportive care incl hydration, orienting stimuli, reduce distractions, bedside sitters
Rx: benzos (acute), haloperidol, respiridone, olanzapine (neuroleptics for severe agitation) ***BEWARE: extrapyramidal side FX, QT prolongation
Four subtypes of dizziness
Vertigo: peripheral and central
Presyncopal lightheadedness: hypovolemia, vasovagal, Rx
Disequilibrium: Rx, neuromuscular disease, stroke
Other (ex. Psych): hypervent syndrome, hypoglycemia, Rx
Causes of peripheral vertigo (6)
Peripheral: abnormalities in the vestibular end organs Ex. Benign Paroxysmal Positional Vertigo Otitis media Impacted cerumen Labyrinthitis Meniere disease Ototoxic drugs
Usually sudden onset, severe and lasts seconds to minutes, usually assoc with movement and/or tinnitus, hearing loss and full feeling in ear
Causes of central vertigo (3)
Cerebellar ischemia (hemorrhage or stroke)
Brainstem ischemia
Vertebrobasilar insufficiency
(Due to abnormalities in CNS vs. vestibular end organs in peripheral)
Usually more gradual onset with milder intensity, can be chronic lasting weeks to months
Causes of presyncope
Dehydration
Vasovagal
Rx
Objective vs. subjective vertigo
Objective: enviro spinning around them
Subjective: feel they are spinning relative to enviro
Describe the Dix-Hallpike test
Provocative stimulation of the vestibular sys => Dx BPPV
Pt seated on table with head rotated at 45 deg, pt moved from seated to supine, neck is extended slightly off the exam table => REPEAT on other side
Make sure eyes are open => test for nystagmus
POSITIVE = vertigo, mixed torsional and vertical nystagmus beating towards forehead
Diagnostic criteria for dementia
- Memory loss
- One other cognitive dysfunction (ex. Aphasia, apraxia, agnosia, disturbed executive funct’n)
- Affects social funct’n and is a decline from previous funct’n level. (R/O delirium)
Pathologic causes of dementia
ALZHEIMER DISEASE!!! (With neuron loss, extracell beta amyloid plaques, and intracell tau protein neurofibrillary tangles)
Vascular (due to ischemic injury)
Lewy body dementia and Parkinson disease
Fronto-temporal dementia (with pick bodies or ubiquitin)
Normal pressure hydrocephalus (see enlargement of ventricles)
MMSE score for Dx of dementia
Less than 24/30
Bilateral Hippocampal atrophy on MRI is associated with which kind of dementia?
Alzheimer disease
Treatment of dementia
Cholinesterase inhibitors => AD, Lewy Body
NMDA receptor blocker
High dose Vitamin E (in advanced dementia ONLY!)
Trazodone (FTD)
Ventriculoperitoneal shunt (NPH)
Reversible causes of dementia (4)
Normal pressure hydrocephalus
Depression
Hypothyroidism
Vit B12 deficiency
