Clinical

Question 1

List disease processes that can present as Generalized neurological Events.

Answer 1

Toxicities: ETOH, Hypoglycemia, organ failure, medications Ischemic- resulting in encephalophathy i.e.-encephalomalacia (atrophy) resulting from hypoxia. Scan with enlarged ventricles and small cortex.

Complex seizure

Encephalitis- Infectious, neoplastic (commonly a small cell lung cancer-tumor), or autoimmune

Question 2

List disease processes that can present as Focal Neurological Events.

Answer 2

Stroke-2 types: ischemic and hemorrhagic. Ischemic can be thrombo-embolic. Usually the result of a heart defect like a patient foramen ovali that allows the clot to bypass pulmonary cirrculation. Occlusive/Vasospastic-atherosclerosis, vasoconstriction (smoking). Hemorrhagic-worst headache of my life. Subarachnoid bleed

Partial seizure

Structural-Tumor, epidural bleed, subdural bleed.** **

Question 3

What does it mean to be obtunded?

When should you order a CT of the brain without contratst?

Answer 3

Less than alert

When someone presents with sudden event and an unknown cause. The lack of contrast is important as it can be confused with blood upon imaging, this could obfuscate a bleed in the brain.

Question 4

How do you distinguish between Generalized and Focal Acute neurologic events?

Answer 4

Systemic effects vs classical signs of strictly neurologic disorders. H&P, lab work, diagnostic studies, etc

Question 5

On the Acute neurologic events scheme what falls under the heading Generalized?

Answer 5

Toxic

Ischemic

Complex seizure

Encephalitis

Question 6

What do you look for in a migrane screening?

What questions do you ask?

Answer 6

Look: Disability, Nausea, Photophobia

Ask: Interfer with work

stable pattern of occurance

Frequency

Efficacy of current treatment

Question 7

Your patient has a headache that has a deep cortical spreading depression (CSD) through the brainstem (BS) with pain and motor problems. What type of headache do they have?

Answer 7

Basilar migrane-primary headache

Question 8

Which characteristics of an Aura are confused with a serious neurologic problem?

Answer 8

Pins and needles, Heavy limbs, hard to speak

**Often confused with stroke or TIA-must r/o **

Stroke will have unilateral eye problems rather than bilateral

also r/o detached retina

Question 9

What are the major catagories of secondary headache?

Name the subcatagories for each

Answer 9

Infections-Meningitis and Encephalitis

Vascular-Stroke, Pseudotumor cerebri, cerebral venous sinus thrombosis, carotid artery dissection

Trauma-Intracranial hematomas: subdural, subarachnoid, epidural

Non-vascular-Tumors

Cranial neuralgias-Occipital, carotidynia, Face pain: TGM, Shingles, MS, CN IX

Question 10

What headache types are associated with medication overuse?

how do you diagnose this condition?

Answer 10

Chronic tension, Chronic daily, Rebound headaches

Diagnosis-obviously worse w/overuse of medication. Specifically using drugs 2-3 days/wk

Headache last half the month.