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Boards Basic > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the 3 main categories of primary headaches? ~90% of headaches are one of these

A
  • migraine
  • tension type headache
  • trigeminal autonomic cephalgias
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2
Q

What is the most common headache in clinical practice?

A

Migraine headache

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3
Q

Pneumonic to diagnose Migraine?

A 
POUND
Pulsatile quality
One-day duration (4-72 hrs)
Unilateral in location 
Nausea or vomiting 
Disabling intensity (patient goes to bed)
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4
Q

Migraine with aura description

A

Aura during or within 1 hour of migraine

Visual loss, hallucinations, flashing lights, numbness, tingling, aphasia, confusion

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5
Q

Migraine with brainstem aura

A

Presence of vertigo, ataxia, dysarthria, diplopia, tinnitus, hyperacusis, or alteration in consciousness

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6
Q

Hemiplegic migraine

A

any aura complex that involves some degree of motor weakness

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7
Q

DBT - Primary Headaches

  • 90% of patients with “sinus headache” have ___ headache that will respond to ___ medications
  • ____ is indicated only for atypical headache features or for headaches that do no meet strict definition of migraine
A
  • migraine; triptan

- neuroimaging

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8
Q

Name the differential diagnosis for migraine:

  • 30 min to 7 days
  • typically bilaterally
  • pressure or tight quality
  • does no prohibit activity
  • not associated with nausea
  • treat acute headache with NSAIDS
  • a TCA may be needed for prophylaxis
A

tension type headache

TCAs: amitriptyline, clomipramine, mirtazapine, nortriptyline

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9
Q

Name the differential diagnosis for migraine:

  • brief paroxysms of unilateral lancinating pain in the V2/V3 area of trigeminal nerve, often triggered by light touch
  • what is the imaging to obtain and drug to use for treatment?
A

Trigeminal neuralgia

  • MRI to exclude intracranial lesions and MS
  • carbamazepine for treatment
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10
Q

DDx for migraine:
- chronic headache that occurs >15 days per month in patients using combination analgesics, ergotamine products or triptans >10 days per month

A

Medication overuse headache

Withdraw all meds

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11
Q

DDx for migraine:

  • headache occurring >15 days per month for >3 months
  • headache possesses the features of migraine >8 days per month
  • RFs include migraine headache frequency or acute medication use >10 days per month
A

chronic migraine headache

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12
Q

DBT - Primary headaches

What categories of meds have no role in acute or preventative treatment of tension type headache?

A

muscle relaxants, benzos, botulinum toxin A

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13
Q

____ or ____ are 1st line treatment for acute mild to moderate migraine

A

NSAIDs or aspirin

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14
Q

____ or ____ may be used for severe acute migraine or poor response to 1st line treatment

A

triptan or dihydroergotamine

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15
Q

Migraines present on awakening, associated with vomiting or escalates rapidly, best treated with nasal ____ or subQ _____

A

triptans; sumatriptan

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16
Q

_____ is effective for migraine associated nausea and enhances efficacy of abortive meds

A

metoclopramide

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17
Q

Migraine prophylaxis indications:

A
  • migraines not responding to therapy
  • HA occurs >8 days per month
  • disabling HA occurs >4 days per month
  • use of acute migraine meds >8 days per month
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18
Q

migraine prophylaxis meds:

A

topiramate, valproic acid, metoprolol, propranolol, timolol

19
Q

DBT - primary headaches

  • Don’t choose oral meds for patients with ___ & ___
  • ___ are contraindicated in presence of CAD, cerebrovascular disease, brainstem aura and hemiplegic migraine
  • don’t use acute therapies more than _____ days per week to avoid medication overuse headaches
  • _______ containing contraceptive must be avoided in women experiencing aura with migraine b/c of increased risk of stroke
A
  • nausea; vomiting
  • triptans
  • 2-3 days
  • estrogen
20
Q

Name the Trigeminal Autonomic Cephalgia diagnosis:
Pain usually periorbital, duration 20-60 minutes, several times per day, repeating over weeks then disappearing for months or years, unilateral tearing and nasal congestion or rhinorrhea, ptosis, miosis; treat with ____ or ____ and ____ for long term prevention

A

Cluster headache

triptan; oxygen; verapamil

21
Q

Name the Trigeminal Autonomic Cephalgia diagnosis:

occurs at least 5x daily lasting 3-20 minutes; responds completely to _____

A

chronic paroxysmal hemicrania

indomethacin

22
Q

Name the Trigeminal Autonomic Cephalgia diagnosis:

Dozens to hundreds of headaches a day with duration 1 - 600 seconds; typically resistant to treatment

A

SUNCT = Short lasting unilateral Neuralgiform headaches with conjunctival injection and tearing

23
Q

Name the Trigeminal Autonomic Cephalgia diagnosis:

Persistent strictly unilateral headache that responds to indomethacin

A

Hemicrania continua

24
Q

Red flag signs, typically sign of secondary headache disorders

A
  • first or worst headache
  • abrupt onset or thunderclap
  • progression or change in pattern
  • abnormal exam findings
  • neurologic symptoms > 1 hour
  • new headache in persons <5 or >50
  • new headache in patient with cancer, immunosuppression or pregnancy
  • alteration or LOC
  • triggered by exertion, sexual activity or Valsalva
25
Q

Name the thunderclap headache:

Sudden onset of worst headache of my life; warning sentinel headaches beforehand

A

SAH

Neurosurgery

26
Q

Name the thunderclap headache:

Neck pain and ipsilateral headache, neurologic findings in territory of involved vessel; pulsatile tinnitus

A

Carotid or vertebral dissection

Aspirin, heparin or OAC

27
Q

Name the thunderclap headache:

Exertional headache, papilledema, neurological findings; consider in hypercoagulable states, pregnancy, use of OCPs

A

Thrombosis of cerebral vein or dural sinus

LMWH followed by warfarin

28
Q

Name the thunderclap headache:
Premenopausal women with recurrent thunderclap headaches, imaging with strokes, hemorrhages or cerebral edema, often triggered by exposure to adrenergic or serotonergic drugs

A

Reversible cerebral vasoconstriction syndrome

Normalization of BP and elimination of triggering drugs

29
Q

Increased intracranial HTN without identifiable structural pathology; patient usually female, obese, child bearing age; +papilledema
CSF > 250
MRI with normal or small ventricles
Name the diagnosis and treatment

A

Idiopathic intracranial HTN or pseudotumor cerebri

Tx: acetazolamide

30
Q

Headache and mental status abnormality

A

Epidural or subdural hematoma

31
Q

brief “lucid interval” before subsequent precipitous decline

A

epidural hematoma

32
Q

Protocol for athlete who suffers TBI

A

Immediate removal from play. Sideline evaluation. Prohibition from sports until patient returns to cognitive baseline and asymptomatic without taking meds

33
Q

Persistence of symptoms of mild TBI beyond a typical recovery period of several weeks

A

post concussion syndrome
Repeat imaging for worsening headache, repeated vomiting, drowsiness, persistent confusion, dysarthria or focal neurologic findings

34
Q

Treatment for postconcussion syndrome

A

supportive with rehabilitation

35
Q

Posttraumatic headache treatment

A

NSAIDs and triptans

TCAs, SSRI, SNRIs

36
Q

Clues to identify a partial seizure that progressed to a generalized seizure

A
  • unilateral shaking
  • head turning to one side
  • aura
  • postictal weakness
37
Q

Name the seizure type:
Normal consciousness and awareness with single neurologic modality (sensory, motor, olfactory, visual gustatory) involving single area of the body

A

simple partial seizure

38
Q

Name the seizure type:
Conscious but unresponsive or staring. Automatism (lip smacking, swallowing or manipulating objects). Postictal confusion

A

Complex partial seizure

39
Q

Name the seizure type:

loss of consciousness at onset, no prodromal or localizing symptoms, whole body stiffening and or jerking seizures

A

primary generalized seizure

40
Q

Name the common epilepsy syndrome:

Complex partial seizure preceded by an aura. Medical temporal sclerosis is a characteristic finding on MRI

A

Temporal lobe epilepsy

41
Q

Name the common epilepsy syndrome:

Nocturnal complex seizures that awaken patients from sleep. Often associated with underlying structural pathology

A

Frontal lobe epilepsy

42
Q

Name the common epilepsy syndrome:
any combination of tonic-clonic seizures, absence seizures and myoclonic seizures. MRI typically normal. EEG may show generalized spike-wave abnormality

A

Idiopathic generalized epilepsy

43
Q

Name the common epilepsy syndrome:

a generalized seizure associated with morning onset of brief, lightning like jerks of the arms not associated with LOC

A

Myoclonic seizure

44
Q

DBT - Epilepsy

  • Consider drugs (alcohol & cocaine) as cause of 1st time seizure
  • Diagnostic eval may not be needed for a provoked seizure if ____
  • Seizures that occur within a week of head trauma or ICH may benefit from short course of ____ but do not necessarily require long-term treatment
A
  • normal findings on neurologic exam

- AED

Boards Basic (7 decks)

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