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CLASS 21025 UNIT 9 NEURO > MDTs > Flashcards

MDTs Flashcards

1
Q

TENSION HEADACHES

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
A
  1. most prevalent type of headache.
    -Women>men.
    -bilateral headaches, vice-like-not throbbing,
    -most intense about the neck or back of the head, muscles may be sore
  2. Reasons for Imaging
    -recent change in patter, frequecy, or severity, progressive worsening despite therapy
    -onset of headache after 40
    -history of trauma, hypertension and fever
  3. Acetaminophen (325-1000mg)
    -NSAID
    - Ibuprofen 400-800mg PO q 4-6 hours, -Naproxen 250-500mg PO q 12 hours, -Meloxicam 7.5-15mg PO daily,
    -Celecoxib 200mg PO daily, -
    Ketorolac -D18mg IV/IM/PO q 6 hours,
    -Indomethacin -mg PO TID
    •Trial of anti-migraine medication if refractory
  4. Retain onboard
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2
Q

CLUSTER HEADACHES

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
A
  1. Middle aged men>women
    - unilateral pain around the eye or temple
    - can last 25mins-3 hours, daily on the same side for weeks
    - During attacks, patients are often restless and agitated. PT may report that alcohol, stress, glare, or indigestion of specific foods triggers and attack
    - ipsilateral nasal congestion or rhinorrhea, lacrimation and redness of the eye. Horner Syndrome (Ptosis/Miosis/Anhidrosis)
  2. Reasons for Imaging
    - recent change in patter, frequecy, or severity, progressive worsening despite therapy
    - onset of headache after 40
    - history of trauma, hypertension and fever
  3. 100% O2 for 15mins.
    - Antimigraine-Sumatriptan SubQ 6mg. May repeat if needed >1 hour after initial dose. max dose 6mg/24hrs
  4. retain onboard
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3
Q

MIGRAINES

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
A

1.Gradual buildup of a throbbing headache, often unilateral for several hours or longer
-Aura may or may not be present
-Visual disturbances; field deficits or luminous visual hallucinations such as seeing stars, light flashes, zigzags of light or geometric patterns, aphasia or numbness, tingling, clumsiness, or weakness in a circumscribed distribution. May have nausea or vomiting.
-Family history is positive for headaches
2. diagnosis is made clinically by HPI
3.-rest in a quiet, darkened room
-Migraine Abortive Treatment:
SIMPLE ANALGESICS - Ibuprofen, Naprosyn, Aspirin, Acetaminophen, Ketorolac(Toradol) 30mg IV/IM once or every 6 hours or 60mg IM once (max 120mg/day)
ANTIMIGRAINE- Sumatriptan 25mg, 50mg, or 100mg taken with fluids. Zolmitriptan 2.5mg, max 10mg/24hrs
-Migraine Prophylaxis (2-3x or more a month)
ANTIHYPERTENSIVES - Propanolol 40mg/BID
ANTICONVULSANTS - Topiramate 100-200mg/day
ANTIDEPRESSANTS - Amitriptyline 20-50mg at bedtime
ANTIEMETICS - Promethazine 12.5-25mg PO/IM/IV/Rectal every 4-6 hours as needed

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4
Q

POST-TRAUMATIC HEADACHE

  1. S/S
  2. TX
A
  1. onset 1-2 days of injury and lasts 7-10 days
    - impaired memory, poor concentration, emotional instability, and increased irritability.
  2. -No special treatment required
    - Simple analgesics are appropriate first line therapy
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5
Q

MEDICATION OVERUSE HEADACHE

  1. S/S
  2. TX
  3. COMPLICATIONS/DISPOTIONS
A
  1. -50% of patients with chronic daily headaches.
    - Present with chronic pain or headache unresponsive to medication
    - History will reveal heavy use of analgesics
  2. Treatment is to withraw medications. Improvement will be in months, not days.
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6
Q

TRANSIENT ISCHEMIC ATTACK

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. MEDEVAC/MEDADVICE
A
  1. -Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction that resolved within 24 hours
    -Sudden onset focal neurological deficit
  2. -Thorough history and physical
    -Exclude other causes; seizures, syncope, migraine, and hypoglycemia
    -Look for sources of emboli; DVT, carotid bruits
    -Fundoscopic examination for papilledema
    -Head should be examined for signs of trauma
    -CT, EKG, CBC, FBG
  3. -Maintain oxygenation and respiratory rate
    -Flat positioning is optimal 0-15 degrees for 24 hours
    -BP may be cause of stroke or spike in response to blockage/stress, DO NOT lower it acutely as it may be the only thing maintaning adequate perfusion UNLESS pressure is above SBP 220 and/or DBP of 120 in which case you should lower pressure by 15%
    Labetalol 10-20mg IV may give same or double dose every 10-20 minutes to max of 150mg
    TIA - if neuro exam reveals no abnormalities, can give Aspirin with MO guidance
    4.MEDEVAC
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7
Q 
HEMORRHAGIC STROKE 
(ICH AND SAH)
1.S/S
2.LABS/RAD/TEST/EXAM
3. TX
4. MEDEVAC/MEDADVIC
A

1.-Symptoms depend on the site of bleed
-Intracerebral hemorrhage usually has gradual onset as blood builds
-SAH has maximal impact right away usually with intense “worse headache of my life”
2. -Thorough history and physical
-Exclude other causes; seizures, syncope, migraine, and hypoglycemia
-Look for sources of emboli; DVT, carotid bruits
-Fundoscopic examination for papilledema
-Head should be examined for signs of trauma
-CT, EKG, CBC, FBG
3. -Maintain oxygenation and respiratory rate
-Flat positioning is optimal 0-15 degrees for 24 hours
-BP may be cause of stroke or spike in response to blockage/stress, DO NOT lower it acutely as it may be the only thing maintaning adequate perfusion UNLESS pressure is above SBP 220 and/or DBP of 120 in which case you should lower pressure by 15%
Labetalol 10-20mg IV may give same or double dose every 10-20 minutes to max of 150mg
4. MEDEVAC

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8
Q

RESTLESS LEG SYNDROME

  1. S/S
  2. TX
  3. COMPLICATIONS/DISPOTIONS
A
  1. -“creeping, crawling”/”pins and needles feeling” in the limbs, especially in the legs
    - Tends to occur during waking and at sleep onset
    - Being recumbent increases leg discomfort and leads to difficulty sleeping
  2. -Correct underlying disorders and if possible discontinue the medications that cause RLS
    - Most treatments reduce either the muscle activity or the sleep disruption
    - DOPAMINERGIC AGENTS - Ropinirole, Pramipexole
    - GABAERGIC AGENTS - Baclofen, Gabapentin, Klonopin
    - OPIOIDS - such as propoxyphene or codeine preparations
    - IRON REPLACEMENT - Ferrous sulfate 325mg three times daily for 3-6 months
  3. -Prognosis depends on the underlying cause, the degree of sleep disruption, and the extent to which treatment complications can be prevented
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9
Q

MULTIPLE SCLEROSIS

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. MEDEVAC/MEDADVIC
A
  1. -Episodic neurologic symptoms
    - PT usually under 55 years old at onset
    - Single pathologic lesion cannot explain clinical findings
    - Multiple foci best visualized by MRI
    - Weakness, numbness, tingling, or unsteadiness in a limb
    - Spastic paraparesis
    - Retrobulbar optic neuritis
    - Diplopia
    - Dysequilibrium or a sphincter disturbance such as urinary urgency or hesitancy
    - May appear after a few days or weeks, although exam often reveals a residual deficit
  2. -MRI of the brain and Cervical cord
    - CSF
  3. -MEDEVAC IF SUSPECTED
  4. MEDEVAC

3.

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10
Q

MULTIPLE SCLEROSIS

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. MEDEVAC/MEDADVIC
A
  1. -Episodic neurologic symptoms
    - PT usually under 55 years old at onset
    - Single pathologic lesion cannot explain clinical findings
    - Multiple foci best visualized by MRI
    - Weakness, numbness, tingling, or unsteadiness in a limb
    - Spastic paraparesis
    - Retrobulbar optic neuritis
    - Diplopia
    - Dysequilibrium or a sphincter disturbance such as urinary urgency or hesitancy
    - May appear after a few days or weeks, although exam often reveals a residual deficit
  2. -MRI of the brain and Cervical cord
    - CSF
  3. -MEDEVAC IF SUSPECTED
  4. MEDEVAC
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11
Q

ALTERED MENTAL STATUS

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
  5. MEDEVAC/MEDADVICE
A
  1. -Level of conciousness is depressed
    - Stuporous PTs only respond to repeated vigorous stimuli
    - Comatose PTs are unarousable and unresponsive
  2. -Physical examination; response to painful stimuli, ocular findings, respiratory patterns
    - Can use Glasgow Coma Scale as an aid in the examination of a PT with AMS
  3. -Treatment depends on the cause and hemodynamic stability
    - OPIOID ANTAGONIST - Narcan 0.4 to 2mg IV/IM/SubQ may need to repeat doses every 2 to 3 minutes
  4. If not quickly reversible, then MEDEVAC
  5. MEDEVAC
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12
Q

CLOSED HEAD INJURY

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
  5. MEDEVAC/MEDADVICE
A

1.•Hallmarks are confusion and amnesia
•May occur with or without loss of conciousness
•May be immediately apparent or delayed by several minutes
•Amnesia almost always includes the traumatic event itself, but may also extend to events before and after trauma
•Clues such as lack of recall or repetitious questioning should be red flags
•Early symptoms - headache, dizziness, vertigo, imbalance, nausea, vomiting
•Delayed Symptoms - mood/cognitive disturbance, light/noise sensitivity, sleep disturbance
•COMMON SIGNS - vacant stare, delayed verbal expression, inability to focus attention, disorientation, slurred or incoherent speech, gross observable incoordination, emotionality out of proportion to circumstances, memory deficits, any period of LOC
•LESS COMMON SIGNS - Seizures, complicated concussion
2. •Complete history and physical (MACE within 24 hours)
•Focus on neuro exam to detail extent of damage
•Mini Mental Status Exam (MMSE)
•Facial fractures are concerning for occult injury
3. FOUR CORNERSTONES OF MANAGEMENT
•Direct observation for 24 hour
•Awaken PT every 2 hours to ensure normal alertness
•Low level of activity for 24 hours after injuy
•No alcohol, sedatives, or pain relievers other than NSAIDs should be given for 48 hours
4.IMMEDIATE REFERRAL/MEDEVAC FOR:
•Inability to awaken the PT
•Severe or worsening headaches
•Somnolence or confusion
•Retlessness, unsteadiness, or seizures
•Difficulties with vision
•Vomiting, fever, or stiff neck
•Urinary or bowel incontinence
•Weakness or numbness involving body part
LONG TERM ISSUES
•Second impact syndrome
•Post-concussion syndrome
•Post-traumatic headaches
•Post-traumatic epilepsy
•Pot-traumatic vertigo
•Cranial nerve injury
•Multiple impact syndrome
•Dementia pugilistica
5.MAYBE

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13
Q

CRANIAL TRAUMA

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. MEDEVAC/MEDADVICE
A

1.-Skull may be depressed, or open
-Thin in several area; temporal region, nasal Sinuses. Scalp will bleed profusely
BASILAR SKULL FRACTURES
-Battle signs, Raccoon eyes, hemotympanum, CSF/rhinorrhea/otorrhea, cranial nerve deficits
2.–Obtain good history and physical
-Check for penetrating trauma, LOC
-Check for soft-tissue swelling, hematoma, palpable fracture, crepitus
CUSHINGS TRIAD (ICP)
-Bradycardia + Hypertension + Respiratory IrregularitY
-Serial neurological exams
–Ultimately needs head CT and Neurosurgery
3.-If open basilar fracture is uspected, use OROGASTRIC TUBE
-Watch for signs of swelling
-O2, C-spine precautions, and MEDEVAC ASAP!
IF SHOWING SIGNS OF ICP OR HERNIATION
-Secure and maintain open airway
-Elevate head of bed 25-30 degrees “Reverse Trendelenburg”
-Ventilate to maintain oxygenation and avoid hypercarbia
-Treat hypotensive shock
-IV Fluids - resuscitate with normal saline or lactated ringers, DO NOT use solutions containing glucose or hypotonic solutions
-Avoid overhydration
-Maintain SBP at 120-140
-Treat hypothermia
MEDICATIONS
-Mannitol 1g/kg IV a 15-20% solution, may repeat 0.25-0.5mg/kg as needed, generally every 6-8 hours
-Osmotic diuretics
-3% Hypertonic NaCl b250cc bolus
-ANTISEIZURES - Diazepam 10mg IV q10min, Phenytoin 18-20mg/kg
-Consider hyperventilation as last resort
-Continually reasses the patients condition and MEDEVAC ASAP
4. MEDEVAC

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14
Q

EPIDURAL HEMMORHGE

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
  5. MEDEVAC/MEDADVICE
A

1.•Usually caused by traffic accidents, falls, and assaults
•75-95% have associated skull fracture
•Immediate LOC after significant head trauma
•”Lucid interval” with recovery of conciousness
•After a period of hours, increasing headache with deteriorating neurologic function
•May also see seizure, coma, anisocoria, respiratory collapse
2.•History and Physical
•Complete and serial neuro exams
•Examination of eyes for papilledema
3.•O2, prepare/initiate intubation if GCS<8
•Immediate neuro consultation
•Closely monitor signs for increased ICP/herniation
•If GCS decreases; intubate, mannitol, hyperventilate
4.•MEDEVAC for immediate neurosurgical consultation and head CT
5. MEDEVAC

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15
Q

SUBDURAL HEMMORHAGE

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
  5. MEDEVAC/MEDADVICE
A

1.•Elderly, ETOH abusers, and anticoagulated at risk
•May occur without impact
•Severe head trauma with ubdural hematoma(SDH) and coma
•Minor head trauma with SDH and LOC
•Minimal head trauma with SDH and mental status exam changes
•Acute SDH presents 1-2 days after onset
•Symptoms of elevated ICP; headache, vomiting, anisocoria, dysphagia, cranial nerve changes
2.•History and Physical
•Complete and serial neuro exams
•Examination of eyes for papilledema
3.•O2, prepare/initiate intubation if GCS<8
•Immediate neuro consultation
•Closely monitor signs for increased ICP/herniation
•If GCS decreases; intubate, mannitol, hyperventilate
4.•MEDEVAC for immediate neurosurgical consultation and head CT
5.MEDEVAC

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16
Q

SUBARACHNOID HEMMORHAGE

  1. S/S
  2. TX
  3. COMPLICATIONS/DISPOTIONS
  4. MEDEVAC/MEDADVICE
A

1.•Sudden, severe headache
•Classically described as the “worst headache of my life”
•May be accompanied by AMS, LOC, seizure, nausea, meningeal signs
•Up to 43% may have a “warning leak” preceding major bleed by 6-20 days
•May be associated with exercise
2.•Bedrest
•Analgesia (Tylenol only)
•Discontinue anticoagulation therapy
•Gradual reduction of BP if severe hypertension is present
•Consult MO
•Avoid Nitroglycerine
3.•MEDEVAC for immediate neurosurgical consultation and head CT
•Will likely get lumbar puncture as it can detect blood breakdown in CSF (Xanthochromia)
4.MEDEVAC

17
Q

SPINL CORD INJURY

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
  5. MEDEVAC/MEDADVICE
A 
1.•Hx of MVA, falls, violence, or sports
•Young, drunk males
•Direct damage to spinal structures
2.NEXUS CRITERIA FOR C-SPINE XRAY
•N - focal Neurological deficit
•S - midline Spinal tenderness
•A - Altered mental status
•I - Intoxicated
•D - Distracting injuries
3.•ABCs, immobilize C-spine with cervical collar ASAP
•Intubation if necessary
•Maintain oxygenation and blood presure
•Insert Foley catheter if bladder paralysis is suspected
•Sedate PT if necessary
•Steroid use controversial, consult MO prior to administration
•Methylprednisolone (Solumedrol) 125mg IM/IV q 4-6 hours PRN
•MEDEVAC ASAP!
4.•MEDEVAC ASAP!
•C-collar and C-spine precautions
•C-spine CT and Neurological consultation
5.MEDEVAC
18
Q

CAUDA EQUINA SYNDROM

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. MEDEVAC/MEDADVICE
A

1.•Pain, numbness, or tingling in the lower back and spreading down 1 or both legs
•Leg weakness or “foot drop”; which is when you cannot seem to hold your foot up
•Problems with bowel or bladder control
•Problems with sex
2.•Will need MRI
3.•Medical Emergency
•Treatment includes treating whatever nerves are causing the symptoms
•Possible surgery
•Radiation to shrink tumor
•Anti-inflammatory or antibiotics
4.MEDEVAC

19
Q

GULLAIN BARRE SYNDROME

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
  5. MEDEVAC/MEDADVICE
A

1.•Acute or subacute progresive polyradiculoneuropathy
•Weakness is more severe than senory disturbances
•Acute dysautonomia may be life-threatening
•Main complaint of weakness that varies widely in severity in different patients and often has a proximal emphasis and symmetric distribution
•Usually begins in the legs, spreading to a variable extent but frequently involving the arms and often one or both ides of the face
•The muscles of respiration and deglutition may also be affected
•Sensory symptoms; distal paresthesia, dysesthesia, neuropathic or radicular pain
•Autonomic disturbances; tachycardia, cardiac irregularities, hypo/hypertension, facial flushing, sweating abnormalities, pulmonary dysfunction, and impaired sphincter control
2.•CSF
•Electrophysiologic studies
3.•Patients should be admitted to ICU if forced vital capacity is declining
•Declining oxygen saturation is a late indicator of neuromuscular respiratory failure
•Marked hypotension may respond to volume replacement or pressor agents
•MEDEVAC to higher level of care
4.•Marked hypotension may respond to volume replacement or pressor agents
•MEDEVAC to higher level of care
5.MEDEVAC

20
Q

CARPAL TUNNEL SYNDROME

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
A

1.•Focal motor or sensory deficit
•Compression of the median nerve between the carpal ligament an other structures within the carpal tunnel
•Pain, burning, and tingling in the distribution of the median nerve
•Most bothersome during sleep
•Late weakness or atrophy of the thenar eminence
•Can be caused by repetitive wrist activities
•Commonly seen during pregnancy and patients with diabetes mellitus or rheumatoid arthritis
•Likely positive Tinel or Phalen’s sign
2.•Ultrasound
•Nerve conduction studies
3.•Treatment directed toward relief of pressure on the median nerve
•Modified hand activitie and the affected wrist should be splinted in neutral poition for up to 3 months
•Oral or injected steroids or NSAIDS can help decrease inflammation and lessen pain
•Carpal tunnel release surgery is definitive treatment
4.•Refer if symptoms persist more than 3 months despite conservative treatment, including the use of a writ splint OR if thenar mucle weaknes or atrophy develops

21
Q

LUMBAR DISK HERNIATION

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. COMPLICATIONS/DISPOTIONS
  5. MEDEVAC/MEDADVICE
A

1.•Pain with back flexion or prolonged sitting
•Radicular pain into the leg due to compresion of neural structures
•Lower extremity numbness and weakness
•L5-S1 disk is affected in 90% of cases
•Can cause cauda equina syndrome
•Discogenic pain of the lower back, sciatica, pain worsened with back flexion such as bending or sitting, numbness, weakness, including weakness with plantar flexion of the foot
2.•Plain radiographs are helpful to assess spinal alignment (scoliosis, lordosis), disk space narrowing, and OA changes
•MRI is the best method to assess the level and morphology of the herniation and is recommended if surgery is planned.
3.•For acute exacerbation of symptoms, bed rest is appropriate for up to 48 hours
•First line treatments include modified activities; NSAIDs and other analgesics; and physical therapy, including core stabilization and McKenzie exercises
•Exercise protocole to centralize or alleviate the pain
4.WHEN TO REFER:
•Cauda equina syndrome
•Progressive worsening of neurologic symptoms
•Loss of motor function
5.MAYBE

22
Q

BELLS PALSY

  1. S/S
  2. TX
  3. COMPLICATIONS/DISPOTIONS
  4. MEDEVAC/MEDADVICE
A

1.•Acute facial palsy (paralysis) of a specific pattern
•Pain about the ear precedes or accompanies the weaknes in many cases but usually lasts only a few days
•Face feels stiff and pulled on one side
•May be ipsilateral restriction of eye closure and difficulty with eating and fine facial movements
•Disturbance of taste, tearing or dryness of the eye, and less frequent blinking on the affected side
•Bell’s phenomenon (upward rolling of eye on attempted lid closure)
•Subjective numbness of the affected side
•Drooling, hyperacusis, viral prodrome
2.RULE OUT STROKE
•In a STROKE, there is NO paralysis of the forehead
•Intact forehead muscle tone suggests STROKE and not Bell’s Palsy
•Look for other abnormalities or neurological deficits
TREATMENT
•CORTICOSTEROID - Prednisone 60mg PO daily x7 days, then 5 day taper, best to start within 5 days of symptoms
•ANTIVIRAL - Acyclovir 400mg PO QID x10 days, Valacyclovir 1000mg TID x1 week also acceptable3.•60% of all cases recover completely without treatment
•10% of all patients remain disfigured
•Corneal ulceration (use artificial tears, lubricating ointment, and possible eye shield)
•Misdiagnosis
•Immediate referral/MEDEVAC, if eye complications or suspicious of alternative diagnosis
•Referral to Neurology/MEDADVICE if mild paresis and no other symptoms to sugget alternative diagnosis
•While onboard, follow symptoms and extent of paralysis
4.MEDEVAC

23
Q

MENINGITIS

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. MEDEVAC/MEDADVICE
A

1.•CLASSIC TRIAD - Fever, nucchal rigidity, and change in mental status
•Headache usually severe and generalized, not easily confused with normal headache
•Photophobia, seizures, focal signs, papilledema
•Petechia and palpable purpura
•Arthritis
•Nuchal rigidity
•Evaluate for Kernig/Brudzinski sign
2.•Routine bloodwork often unrevealing
•Elevated WBC with left shift in bacterial meningitis
•Severe infections may show a low WBC count
•Platelet count may be low
•CSF analyis is mainstay of diagnosis
•Do not delay treatment awaiting lumbar puncture
•Obtain CBC
3.MEDICAL EMERGENCY WITH 100% MORTALITY RATE IF LEFT UNTREATED
•Obtain thorough history and physical; drug allergies, recent exposure, recent infections, recent travel, illegal drug use, rashes, head trauma, immunocompromising conditions
TREATMENT - need antibiotics that cross blood-brain barrier
•CEPHALOSPORIN - Ceftriaxone 2g IV q12 hours
•STEROIDAL ANTI-INFLAMMATORY - Dexamethasone
•If aseptic meningitis due to HSV is suspected, empiric therapy with Acyclovir IV is recommended
PROPHYLAXIS (For exposed crew)
•FLUOROQUINOLONE - Ciprofloxacin 500mg PO x1
4.MEDEVAC

24
Q

ENCEPHALITIS

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
  4. MEDEVAC/MEDADVICE
A

1.•Can be Viral or Post-infectious
•May look like meningitis, but brain function is impaired
•Seizures and post-ictal states can be seen with meningitis or encephalitis
•Symptoms can mimic meningitis
•Typical presentation; nonspecific fevers, headache, nausea, nuchal rigidity
2.•Laboratory studies and other tests are often non-diagnostic
•Definitive diagnosis requires extensive laboratory studies and imaging, may include brain biopsy
3.•Obtain detailed history and physical exam; focus on sexual, travel, and exposures
EMPIRIC THERAPY
•Acyclovir 10mg/kg IV q8 hours (PO okay if no IV form), Ceftriaxone 2g IV q12 hours
•Monitor for seizure/ elevated ICP
4.MEDEVAC

25
Q

CHRONIC PAIN SYNDROME

  1. S/S
  2. TX
A

1.•Chronic complaints of pain
•Symptoms frequently exceed signs
•Minimal relief with standard treatment
•History of having seen many clinicians
2.•Behavioral; comprehensive behavioral program, avoidance of positive reinforcers of pain such as sympathy and attention to pain, biofeedback techniques and hypnosis
•Medical; a single clinician in charge is the highest priority, treatment should be from MO or specialist
•Social; involvement of family members and other significant persons in the patients life
•Psychological; groups of patients can be helpful if properly led, gain patient involvement

26
Q

INSOMNIA

  1. S/S
  2. TX
  3. COMPLICATIONS/DISPOTIONS
A

1.•Difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or any combinations
•Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are coomon factors
•Psychiatric disorders are often associated with persistent insomnia
•Tendency to use alcohol as a means of getting to sleep without realizing it disrupts the normal sleep cycle
•Heavy smoking (more than a pack a day) causes difficulty falling asleep
2.PSYCHOLOGICAL
•Go to bed only when sleepy
•Use the bed and bedroom only for sleeping/sex
•If awake after 20 mins, leave bedroom and return when sleepy
•Get up same time every morning regardless of the amount of sleep during the night
•Discontinue caffeine and nicotine, at least in the evening if not completely
•Exercise, avoid alcohol, limit fluids in the evening, learn relaxation techniques, cognitive behavioral therapy
MEDICAL
•ANTIHISTAMINES - Hydroxyzine, Diphenhydramine 23-50mg PO before bed
•BENZODIAZEPINES
•ANTIDEPRESSANT - Trazadone 50-100mg at bedtime
3.•Prognosis depends on the underlying cause of insomnia as well as the prevention of secondary complications such as substance misuse in the context of self-medication

27
Q

VERTIGO

  1. S/S
  2. LABS/RAD/TEST/EXAM
  3. TX
A

1.•Either a sensation of motion when there is no motion or an exaggerated sense of motion in response to movement
•Duration and association with hearing loss are the key to diagnosis
•PERIPHERAL; onset is sudden, often associated with tinnitus and hearing loss; horizontal nystagmus may be present
CENTRAL; onset is gradual, no associated auditory symptoms
•Cardinal symptom of vestibular disease
•Typically experienced as a distinct “spinning” sensation or a sense of tumbling or of falling forward or backward
2.•Audiogram
•Electronystagmography (ENG)
•Videonystagmography (VNG)
•Head MRI
•Thorough history and physical examination
•Dix-Hallpike testing (quickly lowering the patient to the supine position with the head extending over the edge and placed 30 degrees lower than body, turned either to the left or right) will elicit a delayed onset (-10 sec) fatigable nystagmus
3.•ANTIHISTAMINE - Meclizine 25 to 50mg q 6-12 hours PRN
•ANTICONVULSANT - Diazepam 1mg PO q12 hour as needed for dizziness
•ANTIEMETIC - Ondansetron 4mg PO/IV q8 hours
•ANTIHISTAMINE/ANTI-NAUSEA/ANTI-EMETIC - Promethazine 12.5-25mg PO/IM/IV/Rectal every 4-6 hours as needed
•Recommended vestibular exercises in patients with peripheral vestibular disorders to promote early recovery

28
Q

SEIZURES

  1. EPIDEMIOLOGY
  2. PATHOPHYSIOLOGY
  3. ETIOLOGY OF SEIZURE
A
  1. Epilepsy is characterized by recurrent unprovoked seizures
  2. an abnormal, excessive hypersynchronous discharge from an aggregate of CNS neurons
  3. young adults
    trauma
    metabolic disorders
    CNS infection
    Older Adults
    Cerebrovascular disease
    Brain Tumor
    Metabolic Disorder
    Degenerative Disorders (Alzheimer’s)
    CNS Infection
29
Q

FOCAL SEIZURE WITH RETAINED AWARENESS

  1. FORMERLY KNOWN AS
  2. HOW MANY PARTS OF THE BRAIN IS AFFECTED
  3. PRESENTS
  4. MEDEVAC/MEDADVICE
A
  1. Partial seizures
  2. Only one part of the brain is affected
  3. depends on the focal area involved.
    (ex. seizures starting in the occipital can lead to flashing light sensation)
  4. MEDEVAC
30
Q

FOCAL SEIZURE WITH IMPAIRED AWARENESS

  1. FORMLY KNOWN AS
  2. HOW MANY PARTS OF THE BRAIN IS AFFECTED
  3. PRESENTS
  4. MEDEVAC/MEDADVICE
A
  1. Complex Seizure
  2. Only one part of the brain is affected
  3. Pt appears to be awake but not in contact with others in environment and so not respond normally to instruction or questions. No memory of what occurred
    - may experience facial grimacing, lip smacking, chewing gesturing, repeating words or phrases.
  4. MEDEVAC
31
Q 
GENERALIZED SEIZURES
1. HOW MANY PARTS OF THE BRAIN ARE INVOLVED
2. LOC?
3. MOST COMMON TYPE? 
  A. DESCRIBE
A
  1. The whole brain is involved
  2. May or May not lead to LOC
  3. Tonic-Clonic
    A. Tonic-sudden muscle stiffing, Clonic- rhythmic jerking. Tongue biting is common in the Clonic phase. Episodes last 1-2mins
32
Q

OTHER TYPES OF SEIZURES

A

Absence
Clonic
Atonic

33
Q

PHASES OF SEIZURES

  1. POSTICAL PHASE
  2. MANAGEMENT OF TREATMENT
  3. DIAGNOSIS
A
  1. POSTICAL PHASE-somnolence, confusion or headache that may occur for several hours. no recollection of event. weakness of limbs may occur.
  2. First Aid- maintain airway if needed, IV catheter. blood work ( electrolytes, lft, cbc, finger stick glucose)
    Active Seizures- Diazepam 5mg IV/IM Q5-10mins max 30mg.
  3. Video EEG
34
Q 
COMPLICATIONS OF SEIZURES
STATUS EPILEPTICUS
1. DEFINITION
2. TREATMENT
3. MEDEVAC/MEDADVICE
A
  1. EMERGENCY. Seizure lasting 5mins> or 2 or more seizures with incomplete recovery of consciousness.
  2. Diazepam 5mg IV/IM Q5-10mins, max 30mg
    Valporic Acid 30 kg
    correct any underlying problem that may be contributing to seizure.
    intubation
  3. MEDEVAC
35
Q

PSYCHOGENIC NONEPILEPTIC SEIZURES

  1. NEURONAL ACTIVITY?
  2. DIFFERENCES BETWEEN EPILEPTIC SEIZURES
  3. DIAGNOSIS
  4. TREATMENT
A
  1. No neuronal activity
  2. in PNES seizures…
    last longer than 2 mins, closed eyes, incontinence is less common, and usually no postictal phase
  3. video EEG
    4.Psychotherapy with cognitive behavioral therapy or interpersonal therapy
36
Q 
BLOOS SUPPLY OF THE BRAIN
1. BLOOD SUPPLY OF BRAIN
  A. INTERNAL CAROTID ARTERIES
  B. VERTEBRAL-BASILAR ARTERIES
  C. CIRCLE OF WILLIS
A

A. Internal carotid arteries- branches from the common carotid artery.
Theres two major branches (Anterior Cerebral Artery and Middle Cerebral Artery)
Supplies the ipsilateral cerebral hemisphere
B. two vertebral arteries fuse to become the basilar artery. It then branches into the right and left posterior Cerebral arteries. Supplies cerebellum and brainstem.
C. interconnects the carotid and basilar artery
PCA-connects carotid and vertebral
ACA-connects anterior cerebral arteries
MCA-Direct branch off the internal carotid artery.

CLASS 21025 UNIT 9 NEURO (6 decks)

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