EO 008 - Neuro Flashcards
(112 cards)
1
Q
What is a headache?
ppt EO 008.01(a/b)
A
Pain in the region of the head or neck
Slide 4
2
Q
What are some causes of a headache?
ppt EO 008.01(a/b)
A
- Dehydration
- Fatigue
- Sleep depravation
- Stress
- Medication
- Drugs
- Infections
- Trauma
Slide 4
3
Q
What is the difference between primary and secondary headache?
ppt EO 008.01(a/b)
A
Primary headaches are benign, recurrent headaches with no underlying disease or injury.
Secocndary headaches are caused by underlying disease or injury
Slide 5-6
4
Q
What are red flags of headaches?
ppt EO 008.01(a/b)
A
- Sudden, severe onset
- Fever / immunocompromised
- Progressive
- Multiple patients with similar onset/symptoms.
- Neuro finding
- Pregnant/post partum
- Clotting disorder
- Eye pain/change
- Cervical maniplation
Slide 7-8 - there are more on slide, just put actual red flags
5
Q
What is a migraine?
ppt EO 008.01(a/b)
A
Recurrent headache capable of altering daily function.
Slide 9
6
Q
List and describe the types of migraines.
ppt EO 008.01(a/b)
A
Episodic - less than 15/month
Chronic - 15/month or more, for 6 months in a row
Slide 9
7
Q
What are the 5 phases of a mgiraine?
ppt EO 008.01(a/b)
A
- Promonitory symptoms
- Aura
- Headache
- Headache termination
- Postdrome
Slides 12-14
8
Q
What is a tension headache?
ppt EO 008.01(a/b)
A
Headache typically bilateral with mild to moderate pain. Can be episodic or chronic.
Slide 21
9
Q
What are the timelines for episodic and chronic tension headache?
ppt EO 008.01(a/b)
A
Episodic, infrequent: less than 1 day a month
Episodic, frequent: more than 1 day a month but less than 15 days a months.
Chronic: More than 15 days/month for more than 3 months
10
Q
What is the presentation of tension headache?
ppt EO 008.01(a/b)
A
Headache lasting 30min - 7 days with 2 or more of:
1. Bilateral
2. Pressing/tightening
3. Mild - moderate
4. Not aggravated by routine physical activity
5. Not associated with nausea/vomiting
6. One of but not both: phonophobia or photophobia
Slide 24 - 25
11
Q
What is a cluster headache?
ppt EO 008.01(a/b)
A
Attacks of severe, unilateral headache typically in periorbital area.
Slide 31
12
Q
What is grey matter?
ppt EO 008.01(a/b)
A
Neurological tissue composed of cell bodies with unmyelinated axons.
Slide 36
13
Q
What is white matter?
ppt EO 008.01(a/b)
A
Neurological tissue containing few cell bodies and mostly myelinated axons
Slide 35
14
Q
What is a cavernous sinus?
ppt EO 008.01(a/b)
A
Large channel of venous blood creating a cavity boredered by the sphenous bone and temporal bone.
Slide 36
15
Q
What is the tributary?
ppt EO 008.01(a/b)
A
A vein emptying into a larger vein.
Slide 33
16
Q
What functions is grey matter involved in?
ppt EO 008.01(a/b)
A
- Muscle control
- Sensory perception
- Memory
- Emotions
- Speech
- Decision making
- Self control.
Slide 34
17
Q
What is a subarachnoid hemorrhage?
ppt EO 008.01(a/b)
A
Bleeding into the subarachnoid space of the meninges. Typically into basal cisterns and CSF pathways like ventricles.
Slide 45 - see slide 46 for visual
18
Q
List some risk factors for subarachnoid hemorrhage.
ppt EO 008.01(a/b)
A
- Smoking
- Drugs
- Heavy alcohol use
- Htn
- Genetics
- Kidney disease
- Arteriovenous malformation.
- Coarctation of aorta
- Marfan syndrome
- Ehlers-Danlos syndromes
Slide 47
19
Q
What is Marfan’s syndrome?
ppt EO 008.01(a/b)
A
A genetic disorder of the connective tissue, varying by patient.
Slide 48
20
Q
What is Ehlers-Danlos syndromes?
ppt EO 008.01(a/b)
A
A group of genetic connective tissue disorders characterized by loose joints, stretchy skin, and abnoral scar formation.
Slide 49
21
Q
What are other two other intracranial bleeds?
ppt EO 008.01(a/b)
A
Epidural hematoma and subdural hematoma.
Slide 55-57
22
Q
What is an epidural hematoma?
ppt EO 008.01(a/b)
A
Collection of blood between skull and dura mater. Typically causes by trauma to temporal or temporoparietal region.
Slide 55-57
23
Q
What is a subdural hematoma?
ppt EO 008.01(a/b)
A
Collection of blood between dura mater and arachnoid mater
Slide 55-57
24
Q
What is a Traumatic Brain Injury (TBI)
ppt EO 008.01(a/b)
A
Impairment of brain function from mechanical force. Temp or Perm.
Slide 58
25
List the three classifications of TBIs based on GCS.
## Footnote
ppt EO 008.01(a/b)
Mild: GCS 14-15
Moderate: GCS 9-13
Severe: GCS 3-8
## Footnote
Slide 58
26
What is the difference between primary and secondary brain injury?
## Footnote
ppt EO 008.01(a/b)
Primary: occurs during initial injury, displaced physical structures of brain.
Secondary: Occurs gradually, involves an array of cell processes.
## Footnote
Slide 59
27
Briefly describe the pathophysiology of a mild TBI.
## Footnote
ppt EO 008.01(a/b)
Dysfunction of varying duration without overt hemorrhages. Typically caused by a wave of energy passing through brain tissue leading to ion shifts affecting mitochondrial functions.
## Footnote
Slide 60
28
What is the neurobiologic cascade?
## Footnote
ppt EO 008.01(a/b)
A complex cascade of ionic, metabolic, and physiological reactions involving microscopic axonal dysfunction. Leads to mitochondrial injury dysfunction.
## Footnote
Slide 60-63
29
What occurs with mitochondrial injury dysfunction?
## Footnote
ppt EO 008.01(a/b)
Leads to oxidtive stress, apoptosis, and decreased cellular energy production.
## Footnote
Slide 63
30
What are the three types of symptoms present with mild TBI?
## Footnote
ppt EO 008.01(a/b)
Cognitive, physical, behavioural
## Footnote
Slide 64 - 67
31
List some cognitive symptoms present in mild TBI.
## Footnote
ppt EO 008.01(a/b)
- Attention difficulties
- Concentration problems
- Amnesia
- Memory problems
- Orientation problems
- Altered processing/reaction speed
- Calculation difficulty
## Footnote
Slide 64-67
32
List some phsyical signs/symptoms of a mild TBI.
## Footnote
ppt EO 008.01(a/b)
- Headache
- Dizzyness
- Insomnia
- Fatigue
- Uneven gait
- Nausea/vomting
- Blurred vision
- Seizures
## Footnote
Slide 64-67
33
List some behaviour signs/symptoms of a mild TBI.
## Footnote
ppt EO 008.01(a/b)
- Irritability
- Depression
- Anxiety
- Sleep disturbances
- Emotional liability
- Loss of initiative
- Loneliness/helplessness
- Problems arising in job/relationship/home/school
## Footnote
Slide 64-67
34
What are some management options for mild TBI?
## Footnote
ppt EO 008.01(a/b)
- Maintain ABCs, GCS, C-spine
- Identifty structural damage
- Neuro exam with MACE/SCAT 5
- Tylenol/Advil
## Footnote
Slide 69 (nice)
35
What are red flags of a mild TBI?
## Footnote
ppt EO 008.01(a/b)
- Loss of consciousness
- Severe/worsening headache
- GCS < 15
- Seizures
- Vomiting
- Abnormal speech
- Double vision / pupil asymmetry
- Basal skull fracture
- Weakness / numbness in arms/legs/face
- Amnesia
## Footnote
Slide 69 (nice) - 70
36
What is a cerebral vascular accident (CVA)?
## Footnote
ppt EO 008.01(a/b)
Sudden onset of a focal neurologic deficit resulting from infarction or hemorrhage within the brain.
## Footnote
Slide 72
37
What are the two classifications of CVA?
## Footnote
ppt EO 008.01(a/b)
1. Ischemic, stemming from thrombosis, embolism, or systemic hypoperfusion. (87% of CVAs)
2. Hemorrhagic, stemming from intracerebral/non-traumatic subarachnoid bleed.
## Footnote
Slide 72, ischemic more common at 87%
38
Explain the FAST acronym for CVAs
## Footnote
ppt EO 008.01(a/b)
F - Facial drooping
A - Arm weakness
S - Speech difficulty
T - Time to cal 911
## Footnote
Slide 74
39
What are symptoms of a CVA?
## Footnote
ppt EO 008.01(a/b)
- Numbness/weakness
- Confusion/Aphasia
- Memory deficit
- Spatial orientation/perception difficulties
- Visual deficit/diplopia
- Dizziness/gait disturbance
- Severe headache.
## Footnote
Slide 74-75
40
What is the initial management of CVAs?
## Footnote
ppt EO 008.01(a/b)
ABCs stabilized, transport, neuro exam and IV.
## Footnote
Slide 77 - IV for Tissue Plasminogen Activator, a thrombolytic.
41
What is bacterial meningitis?
## Footnote
ppt EO 008.01(a/b)
Inflammation of pia/arachnoid meninges and CSF form bacteria.
## Footnote
Slide 79. Bacterial mengitis is an emergency.
42
What are the complications from bacterial mengitits?
## Footnote
ppt EO 008.01(a/b)
- Cerebral edema
- Increased ICP
- Hydrocephalus
- Inflammation of cranial nerves
- Subdural empyema (abcess of pus)
- Septic shock if spreading
## Footnote
Slide 80 - 82
43
What are the typical bacteria causing meningitis?
## Footnote
ppt EO 008.01(a/b)
- Neisseria Meningitidis
- Streptococcus Pneumoniae
- Staphylococcus Aureus
- Haemophilus Influenzae
## Footnote
Slide 83 - 87
44
What are S/S of bacterial meningitis?
## Footnote
ppt EO 008.01(a/b)
- Fever
- Nucal rigidity (inability to flex neck forward)
- Headache
- Altered mental status
- Pre-existing URI
- HA/Photophobia
- Seizures/confuision
- Nausea/vomiting
- Rash
## Footnote
Slide 89
45
What types of rash are common with bacterial meningitis?
## Footnote
ppt EO 008.01(a/b)
- Purpura
- Petachia
- Macule
- Papule
## Footnote
Slide 90 - 91
46
What is positive Brudzinski sign?
## Footnote
ppt EO 008.01(a/b)
Flexion of hips and knees in response to passive neck flexion. Indicates meningitis.
## Footnote
Slide 92, 98
47
What is Kernig's sign?
## Footnote
ppt EO 008.01(a/b)
Contraction of hamstrings in respone to knee extension while knee and thigh is flexed. Indicates meningitis.
## Footnote
Slide 92, 98
48
What is viral meningitis?
## Footnote
ppt EO 008.01(a/b)
Inflammation of the meninges or CSF due to a virus. Less severe than bacterial.
## Footnote
Slide 96
49
What three symptoms can indicate viral meningitis?
## Footnote
ppt EO 008.01(a/b)
- Fever
- Neck stiffness
- LOC change
## Footnote
Slide 97
50
What diagnostics can be used for viral meningitis?
## Footnote
ppt EO 008.01(a/b)
- CSF culture
- CBC
- CT or MRI
## Footnote
Page 99
51
What is a seizure?
## Footnote
ppt EO 008.01(a/b)
An episode of abnormal neurologic function caused by inappropriate electrical discharge.
Presents as Generalized Tonic Clonic, General Abscence, and Partial.
## Footnote
Slide 101
52
What is epilepsy?
## Footnote
ppt EO 008.01(a/b)
A fixed condition of recurrent seizures.
## Footnote
Slide 101
53
What are primary and secondary seizures?
## Footnote
ppt EO 008.01(a/b)
Primary: No cause identified
Secondary: Consquence of identified neurologic condition.
## Footnote
Slide 101
54
What is a Generalized Tonic Clonic seizure?
## Footnote
ppt EO 008.01(a/b)
A simultaneous activation of the entire cerebral cortex with involvement of somatic muscles during Tonic and Clonic phases.
## Footnote
Slide 103
55
What are the stages of a Generalized Tonic Clonic seizure?
## Footnote
ppt EO 008.01(a/b)
1. Tonic
2. Clonic
3. Postictal
## Footnote
Slide 103
56
Describe the Tonic stage of a Generalized Tonic Clonic seizure.
## Footnote
ppt EO 008.01(a/b)
- A short, loud cry as chest muscle contract
- Abrupt loss of consciousness with rigidty and jerking extremities
- Often apneic and cyanotic
- Incontinence
## Footnote
Slide 104
57
Describe the Clonic phase of a Generalized Tonic Clonic seizure.
## Footnote
ppt EO 008.01(a/b)
- Extremities jerk and twitch
- Saliva froths at outh
- Irregular breathing patterns
- Slowly regains consciousness
## Footnote
Slide 105
58
Describe the postictal stage of a seizure.
## Footnote
ppt EO 008.01(a/b)
Period after the seizure when individual needs rest. Pt may be fatigued, confused, disoriented lasting up to 2 weeks.
## Footnote
Slide 106
59
What is a Generalized Absence seizure?
## Footnote
ppt EO 008.01(a/b)
Epileptic activity of the entire brain beginning and ending abruptly characterized by unconsciousness without convulsions. Typically lasts 10-30s
## Footnote
Slide 108
60
What is a Partial Focal Seizure?
## Footnote
ppt EO 008.01(a/b)
Electrical discharges beginning in a localized region of cerebral cortex. May spread to nearby regions. Simple or complex.
## Footnote
Slide 111
61
Describe a simple Partial seizure.
## Footnote
ppt EO 008.01(a/b)
Seizure is local, consciousness is not affected. Symptoms present based on brain region involved
## Footnote
Slide 112
62
What are the typical regions associated with simple Partial seizures?
## Footnote
ppt EO 008.01(a/b)
Motor cortex - Convulsive/jerking movements.
Occipital - Visual symptoms
Medial Temporal - Bizarre olfactory/gustatory
## Footnote
Slide 113
63
Describe a complex partial seizure.
## Footnote
ppt EO 008.01(a/b)
Focal seizures involving consciousness without convulsions. Can have blank look/stare and may exhibit automatisms/visceral/affective symptoms.
## Footnote
Slide 114 - 115
64
What are some seizure management options?
## Footnote
ppt EO 008.01(a/b)
- Detailed history of event incl. prescence of aura, progression of motor activity, incontinence, duration.
- Postictal signs
- History of seizures
- Meds/Compliance
## Footnote
Slide 117
65
List the special populations for seizures.
## Footnote
ppt EO 008.01(a/b)
- HIV positive
- Neurocysticercosis
- Pregnacy
- Alcohol abuse
- Status epilepticus
## Footnote
Slide 120
66
Why does HIV positive constitute a special population for seizures
## Footnote
ppt EO 008.01(a/b)
HIV can cause mass lesions, HIV encephalopathy, and meningitis.
## Footnote
Slide 121
67
What is neurocysticercosis?
## Footnote
ppt EO 008.01(a/b)
CNS infection from the larval stage of a tape worm, taenia solium.
## Footnote
Slide 122
68
Why does neurocysticercosis constitute a special population for seizures?
## Footnote
ppt EO 008.01(a/b)
Parasite invades and causes cysts within the parenchyma causing localized edema. Cysts become fibrotic, causing scarring and calcification leading to seizures.
## Footnote
Slide 122
69
Why does pregnancy constitute a special population for seizures?
## Footnote
ppt EO 008.01(a/b)
Non-compliance of anti-epileptic medication can cause harm to fetus.
## Footnote
Slide 123
70
Why is alcohol abuse a special population for seizures?
## Footnote
ppt EO 008.01(a/b)
- Lifestyle associated with non-compliance
- Risk of head injury
- Toxic coingestions
- Electrolyte abnormalities
- Withdrawal.
## Footnote
Slide 124
71
What is status epilepticus?
## Footnote
ppt EO 008.01(a/b)
Continuous or intermittent seizures lasting more than 5 minutes without recovery. After 5min, less likely to stop spontaneously and increased risk of neuronal damage.
## Footnote
Slide 125
72
List and describe the two types of status epilepticus.
## Footnote
ppt EO 008.01(a/b)
Non-convulsive: Comatose/fluctuating abnormal mental status, confusion, with no overt signs. Prolonged postictal period.
Refractory status epilepticus: Presistent seizures after IV anti-convulsant medications.
## Footnote
Slide 126
73
What are cranial nerves?
## Footnote
ppt EO 008.01(c)
12 pairs of nerves emerging from the cranium sending info to and from the CNS. Divided into Sensory, Motor, and Mixed (both).
## Footnote
Slide 4
74
What is Cranial Nerve (CN) I?
## Footnote
ppt EO 008.01(c)
Olfactory, sensory. Responsible for sense of smell.
## Footnote
Slide 5
75
What is anosmia?
## Footnote
ppt EO 008.01(c)
Loss of sense of smell.
## Footnote
Slide 8
76
What is CN II?
## Footnote
ppt EO 008.01(c)
Optic nerve, sensory. Responsible for visual information from the retina to the thalamus.
## Footnote
Slide 9
77
What is anopia?
## Footnote
ppt EO 008.01(c)
Loss of sense of sight in one or both eyes.
## Footnote
Slide 11
78
What is CN III?
Oculomotor, motor. Responsible for:
- Medial, superior, and inferior rectus
- Inferior oblique
- Levator palpebrae superioris
## Footnote
Slide 14
79
What are S/S of a damaged Oculomotor (III) nerve?
## Footnote
ppt EO 008.01(c)
- Strabismus
- Ptosis
- Dilation of pupil
- Down/outward movement
- Loss of accomodation
- Diplopia
## Footnote
Slide 16
80
What is CN IV?
## Footnote
ppt EO 008.01(c)
Trochlear (IV), motor. Innervates superior oblique muscle.
## Footnote
Slide 18
81
What are S/S of Trochlear (IV) damage?
## Footnote
ppt EO 008.01(c)
- Strabismus
- Diplopia
| Slide 20
82
What is CN V?
## Footnote
ppt EO 008.01(c)
Trigeminal (V), mixed.
## Footnote
Slide 21
83
What are the 3 branches of Trigeminal (V) nerve?
## Footnote
ppt EO 008.01(c)
1. Opthalmic
2. Maxillary
3. Mandibular
## Footnote
Slide 21
84
What is the opthalmic tract of Trigeminal (V) responsible for?
## Footnote
ppt EO 008.01(c)
Sensory: upper eyelid, cornea, lacrimal glands, upper nasal cavity, forehead.
## Footnote
Slide 22 - diagram for visual
85
What is the maxillary tract of Trigeminal (V) responsible for?
## Footnote
ppt EO 008.01(c)
Sensory: pharynx, upper teeth, palates, lower eyelid, and upper lip.
## Footnote
Slide 22 - diagram for visuals.
86
What is the mandibular tract of the Trigeminal (V) responsible for?
## Footnote
ppt EO 008.01(c)
Sensory: chin, anterior 2/3 of tongue, cheek, lower teeth
Motor: temporalis and masseter, jaw movements.
## Footnote
Slide 22 - diagram for visual
87
What is often a cause of Trigeminal (V) neuralgia?
## Footnote
ppt EO 008.01(c)
- Multiple sclerosis
- Diabetes
- B12 deficit
## Footnote
Slide 25
88
What are S/S of damaged Trigeminal (V) nerve?
## Footnote
ppt EO 008.01(c)
Paralysis of chewing/jaw muscles, loss of sensation or proprioception of lower face.
## Footnote
Slide 26
89
What is CN VI?
## Footnote
ppt EO 008.01(c)
Abducens, motor. Innervates lateral rectus muscle of eye.
## Footnote
Slide 27
90
How do we test Oculomotor (III), Trochlear (IV), and Abducens (VI) nerves?
## Footnote
ppt EO 008.01(c)
- Visual inspection
- Eye alignment
- Smooth pursuit (H-pattern)
- Saccades
- Accommodation reflex
- Pupil reflex
- Swinging reflex
## Footnote
Slide 15, 19, 28
91
What is CN (VII)?
## Footnote
ppt EO 008.01(c)
Facial, mixed.
Sensory: post-auricular region, external acoustic meatus, efferent limb of cornea
Motor: muscles of facial expression, taste of anterior 2/3 tongue, lacrimation/salivation.
## Footnote
Slide 30
92
How do you test the facial nerve?
## Footnote
ppt EO 008.01(c)
Visual inspection, facial movements.
## Footnote
Slide 31
93
What are signs of Facial (VII) nerve damage?
## Footnote
ppt EO 008.01(c)
Ipsilateral facial paralysis (Bell's Palsy)
Contralateral partial facial paralysis (Upper Motor Neuron lesion)
## Footnote
Slide 33
94
What can cause facial nerve damage?
## Footnote
ppt EO 008.01(c)
- Shingles/other viral
- Bacterial infection
- Trauma
- Tumor
- Stroke
## Footnote
Slide 34
95
What is CN VIII?
## Footnote
ppt EO 008.01(c)
Vestibulocochlear, sensory.
## Footnote
Slide 35
96
What are the two branches of Vestibulocochlear (VIII) nerve
## Footnote
ppt EO 008.01(c)
Vestibular (balance)
Cochlear (hearing)
## Footnote
Slide 35
97
How do you test the vestibulocochlear (VIII) nerve?
## Footnote
ppt EO 008.01(c)
Sensory: Whisper, Rinne, Weber
Vestibular: Romberg, Positional and Gaze nystagmus
## Footnote
Slide 36
98
What are S/S of vestibulocochlear (VIII) nerve damage?
## Footnote
ppt EO 008.01(c)
Vertigo, ataxia, nystagmus, tinnitus, deafness.
## Footnote
Slide 37
99
What is CN IX?
## Footnote
ppt EO 008.01(c)
Glossopharyngeal, mixed.
## Footnote
Slide 39
100
What is glossopharyngeal (IX) responsible for?
## Footnote
ppt EO 008.01(c)
Motor: elevates pharynx, speech, stimulates secretion of saliva.
Sensory: Pharynx, posterior tongue, carotid baro- and chemoreceptors.
## Footnote
Slide 39
101
How do you test Glossopharyngeal (IX) nerve?
## Footnote
ppt EO 008.01(c)
Swallowing, gag reflex, taste.
## Footnote
Slide 41
102
What are S/S of Glossopharyngeal (IX) damage?
## Footnote
ppt EO 008.01(c)
Dysphagia, aptylia, ageusia.
## Footnote
Slide 42
103
What is CN X?
## Footnote
ppt EO 008.01(c)
Vagus (X), mixed
## Footnote
Slide 43
104
What is Vagus (X) responsible for?
## Footnote
ppt EO 008.01(c)
Motor: Swallowing, coughing, speech, GI tract, heart rate
Sensory: Taste, touch, pain, temperature.
## Footnote
Slide 43
105
What is CN XI?
## Footnote
ppt EO 008.01(c)
Accessory, motor
## Footnote
Slide 46
106
What is Accessory XI responsible for?
## Footnote
ppt EO 008.01(c)
Swallowing, movements of head and shoulders.
## Footnote
Slide 46
107
How is Accessory XI tested?
## Footnote
ppt EO 008.01(c)
Shrugging shoulders and rotation of head.
## Footnote
Slide 47
108
What are signs of Accessory XI damage?
## Footnote
ppt EO 008.01(c)
Weakness/paralysis of trapezius or sternocleidomastoid
## Footnote
Slide 48
109
What is CN XII?
## Footnote
ppt EO 008.01(c)
Hypoglossal, motor
## Footnote
Slide 50
110
What is Hypoglossal (XII) responsible for?
## Footnote
ppt EO 008.01(c)
Tongue muscles for speech and swallowing
## Footnote
Slide 50
111
How is Hypoglossal (XII) tested?
## Footnote
ppt EO 008.01(c)
Tongue movements
## Footnote
Slide 51
112
What are signs of Hypoglossal (XII) damage?
## Footnote
ppt EO 008.01(c)
Dysarthria, dysphagia, difficulty chewing.
## Footnote
Slide 52
