Neurology Falcon Review 2 Flashcards
What are the types of parenchymal injuries
Concussion
contusion
diffuse axonal injury
Define concussion
Clinical syndrome of altered mental status secondary to head injury typically brought about by a change in momentum of the head
What are some of the symptoms of a concussion
Instantaneous onset of transient neurologic dysfunction, including loss of consciousness, temporary respiratory arrest, and loss of reflexes
Define contusion
Direct parenchymal injury to brain
What are the two types of contusions
Coup injury
Contracoup injury
What is a coup injury
Cerebral injury at point of direct contact
What is a Contracoup injury
damage to brain surface opposite to point of impact
What is a diffuse axonal injury
Injury to white matter due to acceleration and deceleration
– generally located in the corpus callosum, periventricular white matter, and hippocampus
– cerebral and cerebellar peduncle
typically associated with axonal swelling of white matter and is associated with a poor prognosis
What is the most common cause of an epidural hematoma
Trauma to skull causing an epidural artery tear (middle meningeal artery)
– patient may experience a lucid interval lasting upto a few hours
What are the deficits associated with an epidural hematoma
– Contralateral hemiparesis
– ipsilateral pupillary dilation
What is the most common cause of a Subdural hematoma
Tearing of bridging veins
– most common intracerebral lesions and dramatic brain injury
greatest risk is involved with:
– brain atrophy
– coagulopathy (alcoholics)
Do epidural hematomas require drainage
Always
– subdural hematomas to not always require drainage
What are the symptoms of a spinal cord transection
– Upper motor neuron signs below the level of the lesion
– complete sensory loss below the level
– bowel and bladder dysfunction
– may see lower motor neuron signs at the level of the lesion
What is a brown-Sequard syndrome
– Ipsilateral-weakness, joint positions sensory loss
– contralateral-pain and temperature loss
– bowel and bladder dysfunction is rare
What are the causes for central cord syndrome
Tumor
syringomyelia
What is syringomyelia
– Fluid filled cavity within the spinal cord
– most commonly occur in the cervical cord
– can occur after trauma
– can occur in conjunction with chiari malformation
What is the symptoms of a central cord syndrome
– Loss of pain and temperature in a cape like distribution
– lower motor neuron signs and arms
– upper motor neuron signs of lower extremities
– generally spares the dorsal columns
Discuss an anterior spinal artery syndrome
– Rear
– infarction of anterior two thirds of cord
–affects spinothalamic and corticospinal tracts, sparing dorsal columns
– results in spastic paralysis and loss of pain and temperature sensation with intact joint position since and vibration
what cranial nerves are associated with pain sensitive fibers
V
IX
X
Does the brain parenchyma have pain fibers
No
What is the most useful symptom regarding clinical approach to headaches
Time course is the most useful
– quality, severity and location have significant overlap between headache etiologies
What are the signs and symptoms of a subarachnoid hemorrhage
– Thunderclap headache - instantaneous onset, with maximal intensity within minutes
– worst headache of my life
– severe nausea and vomiting is common
– altered level of consciousness is frequent
– may have focal neurologic deficits
Discuss intraparenchymal hemorrhage
Acute onset
focal deficits commonly occur simultaneously
altered level of consciousness is related to the location and size of the bleed
how does a headache associated with meningitis typically present
Bacterial meningitis:
– headache is usually diffuse
– fever and meningismus are typical
viral meningitis
– diffuse headache usually has developed over several days
– associated symptoms of fatigue and myalgias are common
How is the headache associated with temporal arteritis
– headache is typically intermittent, unilateral, and temporal at first, then bilateral temporal, then continuous
– Pain is often throbbing in nature, but also described as aching or burning
– tenderness of the scalp
What is the typical patient presentation for a headache associated with temporal arteritis
Usually women over the age of 60
firm and tender superficial temporal artery
elevated ESR
What is the treatment for temporal arteritis
Steroids until biopsy is negative
– may be continued for years to prevent recurrence
how will a patient with a headache due to hypertensive urgency present
Dull, bilateral ache and pain
no focal deficits
usually seen with BP >170/110
What is RPLS
Reversible posterior leukoencephalopathy
– high blood pressure leading to posterior demyelination in the brain
Discuss cluster headaches
Typically abrupt and onset, peeking over 5 to 10 minutes.
Persist for 45 minutes to 2 hours
clusters over days two weeks
consistently unilateral, orbital location
Nausea and vomiting are atypical
Who is generally affected by cluster headaches
Typically young adult men onsets in the third decade
male-female ratio 5:1
What is a treatment for cluster headache
Abortive therapy is often ineffective but can use: – sumatriptan – DHE – oxygen – intranasal lidocaine
Prophylactic therapy
– lithium
– valproic acid
– amitriptyline
Describe the headache that is associated with a venous sinus thrombosis
An abrupt onset headache that lingers
often diffuse, may localize near the vertex
What is the diagnosis and management of venous sinus thrombus
MRI to define
IV heparin followed by oral anticoagulation
What is the major difference between a classic migraine in common migraine
A classic migraine has a preceding neurologic symptom (aura)
common migraines or more likely to be bilateral
What is the treatment for migraine
Abortive therapy – triptans – IV ergotamine (status migrainnosis) – caffeine – NSAIDs
Preventive therapy
– avoid triggers
– treat attacks early
– tricyclic antidepressants
What is the mechanism of triptan’s
Serotonin 5 HT-1D antagonists
– may cause chest pain and facial flushing
What is the pseudotumor cerebi
A.k.a. idiopathic intracranial hypertension
– headache is described as a diffuse, dull, ache or pressure sensation
– onset is gradual but often progressive
– worsened by laying down in my physical activity
– horizontal diplopia is occasionally seen
Discuss the epidemiology of pseudotumor cerebri
75% of patients are female
20 to 40 years of age
majority are obese
can be associated with drugs (steroid, vitamin A toxicity, tetracycline)
How’s a diagnosis pseudotumor cerebri made
Imaging to rule out mass lesion
LP to document opening pressure (elevated)
What is the treatment for pseudotumor cerebri
Lumbar puncture
weight loss
carbonic anhydrase inhibitor
shunts
How do carbonic anhydrase inhibitors (acetazolamide) benefit pseudotumor cerebri
Decreased CSF production
how are headaches associated with brain tumors
No classic headache syndrome defines a tumor
usually insidious onset
worse in the morning or wakens patient at night due to raised ICP
Discuss tension headaches
Most common variant of headaches
– May limits, but not prohibit activities
– usually bilateral, within a occipital-temporal-frontal “band like” distribution
– tenderness in the cervical paraspinals and temporalis muscles
– typically respond to OTC analgesics
Was the prophylactic treatment for tension headaches
Tricyclic antidepressants arefirst line
What is chronic daily headaches
Typically involves out of tension type headaches associated with analgesic abuse
– cessation of analgesic use as first line treatment followed by tricyclic antidepressants
What is trigeminal neuralgia
Tic doulaureaux
– electric, shooting pain lasting seconds
– neuralgia of cranial nerve V
– triggered by non-noxious sensory stimuli to the affected face