Neurology Flashcards
Cranial nerves
On Old Olympuses Towering TOp a Fin and German Viewed Some Hops
- Olfactory 2.Optic 3. Oculomotor 4.Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Auditory 9. Glossopharyngeal 10. Vagus 11. Spinal 12. Hypoglossal
Some say marry money but my brother says big brains matter more
Primary headache
headache is the disease no secondary cause (HTN, head injury, tumor, menstrual cycle, sleep, TMJ, infection, sinusitis, dehydration)
Migraine characteristics
Recurrent 4-72 hours unilateral pulsating mod-severe *aggravated by activity n/v photophobia, phonophobia
Diagnostic criteria for migraine
5 or more headaches
2: unilateral, pulsating, mod-severe, agg. by activity
1: n/v, photo/phono
Migraine with or without aura more common
without
Migraine with aura criteria
One or more aura: visual sensory speech motor brainstem retinal
Two of four: One symptom unilateral One spreads gradually >5 minutes Each symptom lasts 5-40 mins Within 60 minutes of migraine
Chronic migraine definition
> 15 days per month for 3 months
meeting migraine char. at least 8 days
Tension HA char.
bilateral* pressing/tightening mild-mod *not aggravated by activity *no n/v photophobia/phonophobia maybe
Tension HA diagnostic
10 episodes occuring on less than 1 day a month (
Cluster HA char.
severe unilateral 15 minutes - 3 hours Ipsilateral conj. injection or lacrimation Nasal congestion Ipsilateral eye edema Forehead facial sweating Miosis or ptosis restlessness agitation**
Temporal arteritis char.
dx
tx
>50 piercing, throbbing, unilateral scalp tenderness low grade fever anorexia, malaise swollen hands/feet Dx: ESR, biopsy gold standard Tx: high dose oral steroids
HA red flags
worst HA of life thunder clap change in char. abnormal neuro exam altered vision head trauma >50 altered LOC hx cancer stiff neck fever
HA comfort signs
\+ fh menses preceded by typical aura periodic and stable normal physical and neuro
Primary migraine tx
prophylactic
abortive
proph- topamax, propanolol, timolol, CCB
abort- nsaid, excedrin migraine, ergotamine, triptan (1 then 2 hrs after, no more than 2 in 24 hours, no heart disease or pregnancy, SSRI-caution, dec. bp, flushing, throat tightness)
Tension tx
abortive:
other:
prophylactic
abortive: NSAIDS, aspirin
muscle relaxant
prophylactic- amitriptylline, nonspecific bb (propanolol, timolol)
Cluster tx
abortive:
other:
prophylaxis:
abortive triptan ergotamine intranasal lidocaine
prednisone
prophylactic- ccb
Parkinsons Progressive \_\_\_\_ d.o Degeneration of \_\_\_\_\_\_ Development of \_\_\_\_\_\_\_ Decline in \_\_\_\_ and \_\_\_\_\_ fx
progresive neurodegenerative
degeneration of dopaminergic neurons
development of lewy bodies
decline in motor and cognitive fx
Cause parkinsons
unknown
environmental genetic combination
Staging of parkinsons 1. 2. 3. 4. 5.
- one side, inconvenient, tremor limb
- bilateral, gait affected
- slowing, impaired equilibrium
- severe, rigidity, bradykinesia, cant live alone, can kind of walk
- cannot stand or walk, constant nursing
Ergotamines
cant be used within ___ of triptans
contraindicated in______ may cause _____
dont use with _______
can’t be used within 24hrs of triptans,
contraindicated in pregnancy, pvd, heart disease, may case vasospastic events
don’t use with ketoconazole, macrolids (life threatening peripheral ischemia)
Triptans
response
do not use with _____
se:
80% response, various forms,
DO NOT use with known CAD, angina, pregnancy
side effects: flushing, throat tightness, serotonin syndrome with SSRIs
Parkinsons presentation
dx
rigidity
tremor
bradykinesia
postural instability
dx: 2 symptoms, progression, response with levodopa
PARKINSONS
Bradykinesia def./example
slowing of movement
reduced walking speed (reduced arm swing, shuffling gait)
diff. from one motor to another
masked faces, statue like, stooped, drooling, monotonous speech
PARKINSONS
Rigidity def. /example
cogwheeling (more pron. on limb with tremor)
noted during passive ROM
PARKINSONS Tremor first symptom usually: resting: postural tremor worse with:
first symptom: pill rolling
resting: asymmetric
postural worse with anxiety
PARKINSONS
Postural instability
poor balance loss of postural reflexes retropulsion test gait freezing FALL RISK***
Risk factors migraine
family hx
FEMALE birth control
food/ETOH
1st HA in early childhood
Risk factors tension
stress
TMJ/jaw clench
Risk factors cluster HA
MALE
caffeine/nicotine
age>30
suicide HA
Nonmotor symptoms in parkinsons
Neuropsychiatric (mood, dep, anxiety, hallucinations) Sleep disturbance (daytime sleepiness, fragmentation) Autonomic (ortho hypo, ED, incont., const., drooling, dysphagia)
Parkinsons fatigue tx: sleep: ED: Constipation: Drooling: Dysphagia: Depression:
fatigue: provigil ritalin
sleep: meds, dep., motor problems
ED: viagra
constipation: miralax
drooling: botox
dysphagia: thickened liq., soft diet
depression: TCA
Parkinsons Medication
selective MAOI: amantadine
dopamine agonist: pramiprexole, ropinorole, bromocriptine
carbidopa-levodopa
Parkinsons Amantadine early: late treatment: renal: SE:
early monotherapy
late tx: dyskinesia
renal adjustment
SE: confusion, nausea, blurred vision, hallucinations, NMS
Parkinsons
Dopamine agonist:
early _____ or added to _____ for tx of _____
SE:
dopamine agonists: pramiprexole, ropinorole, bromocriptine
early monotherapy or added to levodopa for treatment of motor complications
SE: n/v, ortho hypotension, neuropsych: hallucinations, psychosis, impulse control, excessive daytime sleepiness
Parkinsons carbidopa-levodopa early: late: SE: How to take:
early: smooth sustained
late: dyskinesia “on off”
SE: dyskinesia, dystonia, confusion, psychosis, sedation, n/v, postural hypotension
how to take: empty stomach, 30-60 before meal, if nausea nonprotein like fruit
most effective parkinsons tx
carb-levo
non pharm parkinsons tx
coq10 vitamin c and e
creatinine
deep brain stimulation
good for:
candidates:
good for: poor controlled symptoms desp. tx
candidates: good response to carb-levo, few morbidities, NO cognitive impairment or depression
ALS risk factors
death from:
age, family hx
death from: neuromuscular respiratory failure, dysphagia
ALS progressive ____ d/o causing ____, _____, and ______. No ______
prog. neurogenerative d/o causing muscle weakness, disability and death. no remission
3-5 years dx to death
dx als
upper and lower motor neuron signs
progression
no alt. explanation
no test to rule in or out
ALS history
progressive symptoms over segment
spreads to other segments months to years
involuntary weight loss and muscle wasting
S/S ALS
upper lower motor signs
upper: weak, slow, hyperreflexia, spasticity lower: weak, atrophy, amyotrophy, fasciculation
other: strained voice, weakness of tongue, lips, swallowing problems, inappropriate crying, laughing, yawning, paresthesia, cognitive impariment, delayed eye closure
most common presentation ALS
asymmetric limb weakness (hand, foot dorsiflexion)
pseudobulbar ALS
inappropriate crying, laughing, yawning
tx ALS
interdisciplinary
rilutek- slows progression tracheostomy feeding tube
MS dx
H&P
Mcdonald criteria
MRI
CSF
MS mcdonald criteria
review on slide
MS vision
most common eye problem optic neuritis
acute, unilateral eye pain worse with movement
diplopia decreased acuity
tx: steroids
MS sensory
paresthesia
coldness
radicular pain
intense itching cervical dermatomes
MS neuro
ataxia/gait
tremor
speech
cognitive impairment
MS PE
Eyes:
Sensory:
Eyes: decreased pupillary reaction (marcus gunn); fundoscopic normal or edema, nystagmus
Sensory: impaired vib., position sense, light/touch perceptions, pinprick increase
MS symptoms
gait weakness vision changes neuro (numbness, tingling) bowel bladder dysfunction heat sensitivity (uhthoff) fatigue depression
MS tx
Acute:
steroids
otherwise supportive pain incont. fatigue
Stroke def.
interruption of blood circulating to brain—> neurologic deficit
87% of strokes are
ischemic
TIA def.
risk of stroke?
neuro deficit resolves in a few hours-24 hours
9x more likely
Types of stroke
Ischemic: blockage of blood vessels lack of blood to area
Hemorrhagic: rupture of blood vessels, leakage of blood to area
Risk factors ischemic
Both: HTN, family hx, smoking, drug use
male, race, previous stroke, carotid stenosis, afib, chf, mitral stenosis, prosthetic valve, MI
Risk factors hemorrhagic
Both: HTN, family hx, smoking, drug use
polycystic kidney dx, ehlers-danlos, lupus, neurofibromatosis, tuberous sclerosis, pregnancy, atherosclerosis, alcohol intoxication
Ischemic stroke causes
Atherosclerotic: dislodges
Afib: clot
Lacunar infarct: elderly, diabetic, smaller areas of brain- arterioles
Hemorrhagic stroke are more
typically occurs in
causes
deadly
occurs in adults age 40-60
causes: subarachnoid, AV malformation, trauma
Presentation of stroke diff. b/w TIA and stroke neuro: ischemic and ha: subarachnoid:
diff b/w TIA and stroke: time frame
neuro: varies dep. on area
ischemic and HA: usually not
single attack evolves hours to days
subarachnoid: severe HA, n/vDx stroke
Ischemic
Hemorrhagic
non-contrast head CT
ischemic: may be normal up to 24 hours
hemorrhagic: may need arteriogram
Tx strokes
TPA; ischemic within 3 hours, not if bleeding risk
surgery
antiplatelet: ASA (TIA ischemic prevention) coumadin (afib, artificial valves, LVD with CHF), plavix, xarelto/pradaxa/eliquis
acute: hospitalize
Risk factor modification for strokes
simple 7: active, control cholesterol, eat better, manage bp, lose weight, reduce sugar, stop smoking
Seizures
Generalized types
absence (petit mal) atypical absense myoclonic (jerk) tonic clonic (stiff) tonic, clonic, or stonic
seizures highest incidence
risk factors
children
risk: family hx, previous seizure, brain tumor, hx neuro insult, withdrawal anticonvulsants
