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

Dementia, headaches, head injury - ERIC Flashcards

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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
what is seen on brain CT or MRI on a patient wtih ascular dementia
small vessel infacts
26
what is the treatment for vascular dementia
treat underlying hyperlipidemia and hypertension (consider statins and anti-platelet) Treat symptoms of insomnia, depression and agitation
27
what is Lewy Body Demenia caused by
deposits in nerve cells known as Lew bodies in the midbrain, brain stem and olfactory bulb
28
what does Lewy Body Dementia cause
delusions and visual hallucinations, anxiety, with or without motor symptoms
29
what is Histologically similar to Parkinsons diesase
Lewy Body Dementia- dementia starts before motor symptoms
30
what type of medications are used to treat Lewy Body dementia
Cholinesterase help with the delirium, but dopamine medications are not effective
31
what is the cause of frontotemporal dementia
caused by degeneration of the frontal and temporal lobes
32
what does frontotemporal dementia present with
euphoria, apathy, disinhibition or compulsions
33
MRI shows degeneration of frontal lobe on what type of dementia
frontotemporal dementia
34
what is the treatment for frontotemporal dementia
no curative treatment
35
what is pseudodementia
perceived memory loss - usually due to uncontrolled depression or anxiety
36
what condition presents with perceived memory loss with normal MOCA, MRI and labs?
psudodementia
37
how is pseudodementia treated
with SSRIs and counseling for uncontrolled depression or anxiety
38
how are dementia symptoms managed
Depression - SSRI or antipsychotics Hallucinations/agitation - Zyprexia, Seroquel, Risperdal Weight loss/lack of appetite - antipsychotics, cyproheptadine, Remeron
39
Acute head trauma exam includes
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
40
a patient presents with bilateral raccoon eyes what tests needs to be run
CT scan
41
what is priapism
erection (can happen s/p brain injury)
42
What is the glasgow coma scale scoring
15 is the best response 8 or less the patient is comatose 3 is totally unresponsive
43
what are the components of Glasgow coma scale
Eye opening response Best verbal response Best Motor response
44
what responses are assessed in the eye opening response portion of the Glasgow coma scale
spontaneously -4 to speech -3 to pain - 2 no response - 1
45
what responses are assessed in the best verbal response portion of the Glasgow coma scale
oriented to time, place and person -5 confused - 4 inappropriate words - 3 incomprehensible sounds -2 No response - 1
46
what responses are assessed during the best motor response portion of the Glasgow coma scale
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
what is the Glasgow Coma Scale on a deceased patient
3
48
what is the cause of a singular pupil dilation
brain bleed on the dilated pupils side
49
what duration of loss of consciousness has the worst prognosis
>2 minutes
50
what is a countra-coup injury
happen on the opposite site of impact
51
if a child 2 years or older has a GCS of 15 or less what is the plan of care
CT scan
52
where do intracerebral hemorrhages occur
intraparenchymal space
53
what is the cause of intracerebral hemmorhages?
trauma, arterio venous malformation or hypotension
54
what is a key CT finding for Intracerebral hemorrhages
bleed will not touch the skull
55
what are the symptoms of intracerebral hemorrhage
headache, N/V, hemiplegia, hemiparesis
56
what can a lumbar puncture cause in a patient with a intracerebral hemorrhage
herniation of the brain
57
that is the treatment for intracerebral hemorrhage
steroids to decrease edema, anti-epileptics and possible surgical intervention
58
what is a subarachnoid hemorrhage
arterial bleed in the space between the arachnoid and pia matter
59
what is the cause of subarachnoid hemorrhage
caused by trauma, AVN, or chery aneurysm
60
what is a "thunderclap" headache associated with
subarachnoid hemorrhage
61
what are the symptoms for subarachnoid hemorrhage
thunderclap headache, usually unilateral, N/V photophobia, confusion, neck stiffness
62
what is the treatment of subarachnoid hemorrhage
stool softeners, antieleptic (phenytoin), Nimodipine (BP control)
63
what is the shape of epidural hematoma
I or lemon shape
64
what is a epidural hematoma
arterial bleed between the skull and dura mater usually due to skull fracture damaging the middle meningeal artery
65
what is associated with a skull fracture of the middle meningeal artery
epidural hematoma
66
what are the common symptoms with epidural hematom
loss of consciousness, and regain of consciousness Headache, N/V, CSF fluid leak, focal neuro changes, coma
67
what is the treatment of epidural hematoma
EMERGENT NEUROSURGERY CONSULT
68
what is a subdural hematoma
venous bleeding between dura and arachnoid from torn bridging veins along the skull line but not lemon shaped
69
what is the most common location of damage during subdural hematomas
torn bridging
70
what population are at higher risk for subdural hematoma
elderly, alcoholics
71
what is damaged during a concussion
axonal rupture from shear or tensile forces causing axonal swelling and release of neurotransmitters
72
what should be seen on a concussion CT scan
normal - there should be no bleeding
73
what is a patient with a concussions common GCS score
15
74
what can make concussion symptoms worse
focusing eyes, mental strain and physical strain
75
what are redflags of headaches
thunderclap headache worse headache of life recent head trauma anticoagulation use decreased level of consciousness suspicion of meningitis
76
what is a Romberg exam
balance test with eyes closed and arms up to assess for balance
77
what is a migraine
unilateral headache with pulsating/throbbing moderate-severe pain
78
what are the subtypes of migraines
migraine with aura and migraine without aura
79
what is likely cause a migraine
intracranial vasospasm
80
what are migraine triggers
alcohol caffeine skipped meals physical exertion bright light excessive noise smells lack of sleep stress weather
81
what should be avoided in patients with migraine with aura
estrogen medications because increase risk of stroke
82
how much Triptan medications can be prescribed at once
no more than 10 days a month
83
what types of drug classes are used to prevent migraines
Antihypertensives antidepressant anticonvulsants CGRP antagonists
84
What are the common antihypertensives used to prevent migraines
propranolol, metropolol, atenolol - beta blockers Lisinopril - ACEi Candesartan - ARB
85
what are the common Antidepressant medications used to prevent migraines
Amitriptyline - TCA Venlafazine - SNRI
86
what are the common anticonvulsants used to prevent migraines
Topiramate Valproate Gabapentin
87
what are the common CGRP antagonists used to prevent Migraines
Rimegepant (Nurtec) Aimovig
88
what are tension headaches thought to be caused by
thought to be due to muscle spasms, but more evidence showing it is due to increased neuronal sensitivity
89
what are tension headaches induced by
stress, anxiety and minor trauma
90
what is the treatment of tension headaches
NSAIDs, acetaminophen IM/IV Toradol (ketorolac) Muscle relaxers migraine abortive medications
91
what is the presentation of cluster headaches
severe, unilateral periorbitalpain - conjunctival injection, ptosis, tearing and nasal congestion very short duration and can occur several times a day
92
what is the first line of treatment for cluster headaches
100% O2 other treatment : subcutatneous sumatriptan
93
what medications can prevent cluster headaches
verapamil titration or prednisone 60mg taper (only if new onset)
94
what is the cause of sinus headaches
due to underling sinusitis (chronic or acute) these are usually migraines with superimposed sinus symptoms
95
what signs are not indicative of sinus headaches
photophobia, phonophobia or nausea
96
what is the cause of exertional headaches
thought to be due to intrathoracic/abdominal pressure causing pain in sensitive vascular and meningeal structure
97
what are exertional headaches often associated with
past trauma space occupying lesion AVM/aneurysm intracranial hemorrhage
98
how do you rule out vascular anomaly and lesion in exertional headaches
MRI and MRA
99
what are the types of sexual activity headaches
pre-orgasmic headaches and orgasmic headaches
100
what are the symptoms of pre-orgasmic headaches
occurs as a bilateral occipital pain (pressure/aching)
101
what are the symptoms of orgasmic headaches
due to increase in blood pressure and HR sudden onset severe throbbing pain over the whole head
102
what is a menstrual headache
fluctuations in estrogen level can trigger both headaches and migraines menstrual migraines occur from 2 days prior to 2 days after menstruation
103
what can be used to treat migraines without aura
OCP to regulate estrogen levels - continuous regimens may decrease further

Clin Med - NEURO (13 decks)

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