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