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Clin Med - NEURO > Dementia, headaches, head injury - ERIC > Flashcards

Dementia, headaches, head injury - ERIC Flashcards

1
Q

what is delirium

A

acute change
causes confusion and short term memory loss
decreased level of alertness
resolves within one week

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2
Q

what is dementia

A

progressively worsening impairment of intellectual functioning:
language
memory
visuospatial
executive functioning
emotional behavior

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3
Q

what is the PINCHME mneumonic for

A

to help identify potential causes of delirium

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4
Q

what is the PINCHME mneumonic

A

Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment

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5
Q

What is MOCA

A

Montreal Cognitive Assessment

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6
Q

how many area’s are assessed during MOCA

A

8 areas of cognition assessed

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7
Q

what cognitive test do we use when there is concern for cognitive impairment or dementia

A

MOCA

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8
Q

how is Dementia worked up by lab work

A

CBC
CMP
THS
B12, folate, thiamine
Drug screen
Ammonia levels
Syphillis screen
?heavy metal screens

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9
Q

how is dementia worked up with imaging

A

acute mental status change - CT of the brain without contrast
Progressive - MRI w/o contrast

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10
Q

what is alzheimers dementia

A

progressive dementia caused by intracellular neurofibrillary tangles and extracellular plaques

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11
Q

what is the most common type of dementia

A

Alzheimers dementia

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12
Q

what are risk factors for Alzheimers dementia

A

Age and family history
occurs in 3-50% of people at age 80

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13
Q

how is Alzheimers dementia treated

A

Acetylcholinesterase inhibitors
NMDA receptor agonists
Aducanumab - newly FDA approve and controversial

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14
Q

how do Acetylcholinesterase inhibitors treat Alzheimers dementa

A

delays disease progression and may improve memory
Ex. Donepezil, Rivastigmine, Galantamine

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15
Q

how do NMDA receptor agonist treat Alzheimers dementia

A

regulates glutamate. too much glutamate triggers NDMA which increase dementia risk
used in conjunction with acetylcholinesterase inhibitors in mod-severe disease
ex. memantine

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16
Q

how are aducanumab used to treat Alzheimers dementia

A

newly FDA approved and very controversial
only USED ONLY IN MILD DEMENTIA with MOCA
thought to reduce amyloid plaques

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17
Q

what are non-medication treatments for Dementia

A

room-by-room safety (garage, basement, workroom, kitchen, bathroom)
Locks
Alarms
Preventing Falls
Living Partners

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18
Q

what is vascular dementia

A

second most common type of dementia
M>W
ischemia of the brain and lacunar infarcts - occurs both with and without hx of TIA/stroke

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19
Q

what conditions are vascular dementia associated wtih

A

hypertension and high cholesterol

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20
Q

what are the subtypes of vascular dementia

A

cortical vascular dementia
Subcortical vascular dementia

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21
Q

what is cortical vascular dementia

A

speech difficulty, loss of ADLs, confusion, Amnesia and poor executive function

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22
Q

what is subcortical vascular dementia

A

motor deficit, gait changes, urinary incontinence, personality changes

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23
Q

what does the progression of vascular dementia lead to

A

loss of ADLs, decreased concentration, disorientation, social withdrawal

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24
Q

labs on patients with vascular dementia may show

A

underlying hyperlipidemia

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25
Q

what is seen on brain CT or MRI on a patient wtih ascular dementia

A

small vessel infacts

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26
Q

what is the treatment for vascular dementia

A

treat underlying hyperlipidemia and hypertension (consider statins and anti-platelet)
Treat symptoms of insomnia, depression and agitation

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27
Q

what is Lewy Body Demenia caused by

A

deposits in nerve cells known as Lew bodies in the midbrain, brain stem and olfactory bulb

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28
Q

what does Lewy Body Dementia cause

A

delusions and visual hallucinations, anxiety, with or without motor symptoms

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29
Q

what is Histologically similar to Parkinsons diesase

A

Lewy Body Dementia- dementia starts before motor symptoms

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30
Q

what type of medications are used to treat Lewy Body dementia

A

Cholinesterase help with the delirium, but dopamine medications are not effective

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31
Q

what is the cause of frontotemporal dementia

A

caused by degeneration of the frontal and temporal lobes

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32
Q

what does frontotemporal dementia present with

A

euphoria, apathy, disinhibition or compulsions

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33
Q

MRI shows degeneration of frontal lobe on what type of dementia

A

frontotemporal dementia

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34
Q

what is the treatment for frontotemporal dementia

A

no curative treatment

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35
Q

what is pseudodementia

A

perceived memory loss - usually due to uncontrolled depression or anxiety

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36
Q

what condition presents with perceived memory loss with normal MOCA, MRI and labs?

A

psudodementia

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37
Q

how is pseudodementia treated

A

with SSRIs and counseling for uncontrolled depression or anxiety

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38
Q

how are dementia symptoms managed

A

Depression - SSRI or antipsychotics
Hallucinations/agitation - Zyprexia, Seroquel, Risperdal
Weight loss/lack of appetite - antipsychotics, cyproheptadine, Remeron

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39
Q

Acute head trauma exam includes

A

CSF or blood in external acoustic canal, nostril
bruising at base of skull or around the eyes
obvious head/trauma/skull depressions
Hemotympanum
priapism
pupils, Glasgow coma scale, blood glucose, tox screen, CT of brain without contrast

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40
Q

a patient presents with bilateral raccoon eyes what tests needs to be run

A

CT scan

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41
Q

what is priapism

A

erection (can happen s/p brain injury)

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42
Q

What is the glasgow coma scale scoring

A

15 is the best response
8 or less the patient is comatose
3 is totally unresponsive

43
Q

what are the components of Glasgow coma scale

A

Eye opening response
Best verbal response
Best Motor response

44
Q

what responses are assessed in the eye opening response portion of the Glasgow coma scale

A

spontaneously -4
to speech -3
to pain - 2
no response - 1

45
Q

what responses are assessed in the best verbal response portion of the Glasgow coma scale

A

oriented to time, place and person -5
confused - 4
inappropriate words - 3
incomprehensible sounds -2
No response - 1

46
Q

what responses are assessed during the best motor response portion of the Glasgow coma scale

A

obeys commands - 6
moves to localized pain - 5
flexion withdrawal from pain - 4
abnormal flexion (decorticate) - 3
abnormal extension (decerebrate) - 2
no response - 1

47
Q

what is the Glasgow Coma Scale on a deceased patient

A

3

48
Q

what is the cause of a singular pupil dilation

A

brain bleed on the dilated pupils side

49
Q

what duration of loss of consciousness has the worst prognosis

A

> 2 minutes

50
Q

what is a countra-coup injury

A

happen on the opposite site of impact

51
Q

if a child 2 years or older has a GCS of 15 or less what is the plan of care

A

CT scan

52
Q

where do intracerebral hemorrhages occur

A

intraparenchymal space

53
Q

what is the cause of intracerebral hemmorhages?

A

trauma, arterio venous malformation or hypotension

54
Q

what is a key CT finding for Intracerebral hemorrhages

A

bleed will not touch the skull

55
Q

what are the symptoms of intracerebral hemorrhage

A

headache, N/V, hemiplegia, hemiparesis

56
Q

what can a lumbar puncture cause in a patient with a intracerebral hemorrhage

A

herniation of the brain

57
Q

that is the treatment for intracerebral hemorrhage

A

steroids to decrease edema, anti-epileptics and possible surgical intervention

58
Q

what is a subarachnoid hemorrhage

A

arterial bleed in the space between the arachnoid and pia matter

59
Q

what is the cause of subarachnoid hemorrhage

A

caused by trauma, AVN, or chery aneurysm

60
Q

what is a “thunderclap” headache associated with

A

subarachnoid hemorrhage

61
Q

what are the symptoms for subarachnoid hemorrhage

A

thunderclap headache, usually unilateral, N/V
photophobia, confusion, neck stiffness

62
Q

what is the treatment of subarachnoid hemorrhage

A

stool softeners, antieleptic (phenytoin), Nimodipine (BP control)

63
Q

what is the shape of epidural hematoma

A

I or lemon shape

64
Q

what is a epidural hematoma

A

arterial bleed between the skull and dura mater
usually due to skull fracture damaging the middle meningeal artery

65
Q

what is associated with a skull fracture of the middle meningeal artery

A

epidural hematoma

66
Q

what are the common symptoms with epidural hematom

A

loss of consciousness, and regain of consciousness
Headache, N/V, CSF fluid leak, focal neuro changes, coma

67
Q

what is the treatment of epidural hematoma

A

EMERGENT NEUROSURGERY CONSULT

68
Q

what is a subdural hematoma

A

venous bleeding between dura and arachnoid from torn bridging veins
along the skull line but not lemon shaped

69
Q

what is the most common location of damage during subdural hematomas

A

torn bridging

70
Q

what population are at higher risk for subdural hematoma

A

elderly, alcoholics

71
Q

what is damaged during a concussion

A

axonal rupture from shear or tensile forces causing axonal swelling and release of neurotransmitters

72
Q

what should be seen on a concussion CT scan

A

normal - there should be no bleeding

73
Q

what is a patient with a concussions common GCS score

A

15

74
Q

what can make concussion symptoms worse

A

focusing eyes, mental strain and physical strain

75
Q

what are redflags of headaches

A

thunderclap headache
worse headache of life
recent head trauma
anticoagulation use
decreased level of consciousness
suspicion of meningitis

76
Q

what is a Romberg exam

A

balance test with eyes closed and arms up to assess for balance

77
Q

what is a migraine

A

unilateral headache with pulsating/throbbing moderate-severe pain

78
Q

what are the subtypes of migraines

A

migraine with aura and migraine without aura

79
Q

what is likely cause a migraine

A

intracranial vasospasm

80
Q

what are migraine triggers

A

alcohol
caffeine
skipped meals
physical exertion
bright light
excessive noise
smells
lack of sleep
stress
weather

81
Q

what should be avoided in patients with migraine with aura

A

estrogen medications because increase risk of stroke

82
Q

how much Triptan medications can be prescribed at once

A

no more than 10 days a month

83
Q

what types of drug classes are used to prevent migraines

A

Antihypertensives
antidepressant
anticonvulsants
CGRP antagonists

84
Q

What are the common antihypertensives used to prevent migraines

A

propranolol, metropolol, atenolol - beta blockers
Lisinopril - ACEi
Candesartan - ARB

85
Q

what are the common Antidepressant medications used to prevent migraines

A

Amitriptyline - TCA
Venlafazine - SNRI

86
Q

what are the common anticonvulsants used to prevent migraines

A

Topiramate
Valproate
Gabapentin

87
Q

what are the common CGRP antagonists used to prevent Migraines

A

Rimegepant (Nurtec)
Aimovig

88
Q

what are tension headaches thought to be caused by

A

thought to be due to muscle spasms, but more evidence showing it is due to increased neuronal sensitivity

89
Q

what are tension headaches induced by

A

stress, anxiety and minor trauma

90
Q

what is the treatment of tension headaches

A

NSAIDs, acetaminophen
IM/IV Toradol (ketorolac)
Muscle relaxers
migraine abortive medications

91
Q

what is the presentation of cluster headaches

A

severe, unilateral periorbitalpain - conjunctival injection, ptosis, tearing and nasal congestion
very short duration and can occur several times a day

92
Q

what is the first line of treatment for cluster headaches

A

100% O2
other treatment : subcutatneous sumatriptan

93
Q

what medications can prevent cluster headaches

A

verapamil titration or prednisone 60mg taper (only if new onset)

94
Q

what is the cause of sinus headaches

A

due to underling sinusitis (chronic or acute)
these are usually migraines with superimposed sinus symptoms

95
Q

what signs are not indicative of sinus headaches

A

photophobia, phonophobia or nausea

96
Q

what is the cause of exertional headaches

A

thought to be due to intrathoracic/abdominal pressure causing pain in sensitive vascular and meningeal structure

97
Q

what are exertional headaches often associated with

A

past trauma
space occupying lesion
AVM/aneurysm
intracranial hemorrhage

98
Q

how do you rule out vascular anomaly and lesion in exertional headaches

A

MRI and MRA

99
Q

what are the types of sexual activity headaches

A

pre-orgasmic headaches and orgasmic headaches

100
Q

what are the symptoms of pre-orgasmic headaches

A

occurs as a bilateral occipital pain (pressure/aching)

101
Q

what are the symptoms of orgasmic headaches

A

due to increase in blood pressure and HR
sudden onset severe throbbing pain over the whole head

102
Q

what is a menstrual headache

A

fluctuations in estrogen level can trigger both headaches and migraines
menstrual migraines occur from 2 days prior to 2 days after menstruation

103
Q

what can be used to treat migraines without aura

A

OCP to regulate estrogen levels - continuous regimens may decrease further

Clin Med - NEURO (13 decks)

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