Neuro Flashcards
(74 cards)
1
Q
Role of APRN in HA and face pain
A
accurately dx rule out secondary causes recognize red flags provide acute management assist with HA prevention
2
Q
HA
A
most common pain problem seen in family practice
3
Q
Primary HA
A
Benign
Recurrent
NOT associated with underlying patho
The HA is the disease
4
Q
Types of primary HA
A
Migraine with or without aura
Tention type HA
Cluster HA
5
Q
Secondary HA
A
sudden
progressive
associated with pathology
may require immediate action
6
Q
Patho of Secondary HA
A
Aneurysms Subarachnoid hemorrhage Thunder clap HA Meningitis Stroke Carotodynia Temporal Arteritis HTN Sinus TMJ Trigeminal Neuralgia
7
Q
Worrisone Red Flags of HA “SNOOP”
A
S: systemic symptoms or diease N: neurological signs/symptoms O: onset sudden O: onset before 5 or after 50 P: patterns change from prior HA
8
Q
Characteristics of migraine
A
unilateral moderate/severe intensity lasts 4-72 hours throbbing quality associated symptoms females
9
Q
Characteristics of tension-type HA
A
bilateral mild/mod intensity lasts 30 min to 7 days pressure/tightening quality no associated symptoms females
10
Q
Characteristics of cluster HA
A
strictly unilateral severe intensity last 15-90 minutes severe quality associated symptoms males
11
Q
To Dx migraine with an aura
A
must have 2 attacks with the following criteria:
fully reversible visual, sensory, speech deficits
homonymous visual symptoms
aura developing over 5 mintues
each symptom lasts 5-60 minutes
not attributed to another disorder
12
Q
To Dx migraine without aura
A
must have 5 attacks with the following: HA lasting 4-72 hours unilateral, pulsating, mod pain, aggravation by physical activity N/V Photophobia
13
Q
Tension type HA Criteria
A
At least 10 episodes occuring < 1 day/month with: HA lasting 30min-7days Bilateral pressing/tightening quality not aggravated by physical activity No N/V only one of photophobia or phonophobia
14
Q
Cluster HA Criteria
A
Deep pain around eyes or temporal NO throbbing Nightly occurrence 6-12 wks at a time can have facial sweating, eyelid edema, conjunctival injection, ptosis
15
Q
Chronic daily HA in children
A
HA persists >2 h and occurs > 15 days/month
16
Q
Increased intracranial pressure in children
A
chronic or intermittent increasing frequency progressive severity occipital neuro signs (papilledema)
17
Q
Facial pain
A
most adults female unilateral or bilateral paroxysmal remissions or constant may be triggered by slight touch, wind, speaking
18
Q
Reasons for facial pain
A
trigeminal neuralgia postherpetic neuralgia TMJ dental pain sinusitis glaucoma angina pectoris
19
Q
Tx for Migraine
A
NSAIDS Triptans, Ergotamine, Dihydroergotamine rescue medication prophylaxis with amitriptyline, propranolol, timolol avoid hormone fluctuations foods alcohol environmental changes stress, lack of sleep
20
Q
Tx Tension type HA
A
NSAIDS
don’t provide anything addicting
21
Q
Tx Cluster HA acute attack
A
100% O2
SL ergotamine
itranasal lidocaine can be helpful
22
Q
Tx Cluster HA preventive tx
A
verapamil 80mg QID (cardiac monitor) Lithium 300-900 mg Prednisone taper Ergotamine 2mg 2 hours before bedtime Divalproex
23
Q
Refer HA and facial pain
A
uncertainty
tx failsure
unremitting HA
medication overuse or chronic daily HA
24
Q
Episodic loss of consciousness
A
Seizure: temporary neuro signs from abnormal paroxysmal, hypersynchronous electrical activity in cerebral cortex
Syncope: due to a reduced supply of blood to cerebral hemispheres (vasovagal)
25
Symptoms present in both syncope and seizures
LOC or loss of awareness
with or without myoclonus opisthotonus
myoclonus
incontinence may occur
26
Events during a spell
tonic-clonic LOC with tonic stiffening then clonic jerking
hypoperfusion produces flaccid unresponsiveness, stiffening or jerking
LOC from hypoperfusion rarely lasts more than 15 second
27
Posture when LOC occurs
orthostatic hypotension and faints occur in the upright or sitting position
only occur in lying position suggest seizure or cardiac arrhythmia unless phelbotomy
28
Physical exertion with syncope
usually due to cardiac outflow obstruction
29
Postictal state
brief confusion, disorientation or agitation
30
Seizures
transient disturbance of cerebral fx caused by an abnormal neronal discharge
epilepsy is recurrent seizures
aura associated with seizures
postictal confusion
urinary incontinence and jerking doesn't dx
31
Seizures etiology
```
CNS dysfx
genetic
metabolic
systemic disease
drug induced
```
32
Common causes of new onset seizures
```
fever
head trauma
stroke
meningitis
hypoglycemia
hyponatremia
uremia
drug toxicity
eclampsia
```
33
Tonic phase of seizure
```
generalized stiffening of body and limbs
10-30 seconds
flexion then extension
epileptic cry
cyanosis
```
34
Clonic phase of seizure
limb jerking
saliva frothing
jerks of limbs, body and head
35
Postictal phase of seizure
confusion (can last 10-30 minutes)
limp limbs
HA
36
Absence Seizures
last 5-10 seconds
keep posture
may not answer or seem out of it
37
Diff Dx of seizures
```
TIA
Rage
Panic attack
syncope
cardiac dysrhythmias
pseudoseizures
```
38
Eval of seizure
```
EEG
MRI
Serum creatine kinase 3 hrs after event. elevation = tonic clonic
FBS
electrolytes
renal fx
liver fx
```
39
Management of New onset seizure
avoid driving
monitor serum drug levels: treat clinical response rather than blood levels
special considerations before and during pregnancy
40
Risk of seizure reoccurance
75% after second seizure!
41
Febrile Seizures in Children
```
age 3 months to 5 years
non-CNS infection
> 90% are generalized
lasts < 5 minutes
acute respiratory illnesses are most commonly associated
```
42
Febrile seizure work up
WBC > 20,000 could indicated baterial
blood and urine cultures
if younger than 18 months do lumbar puncture
EEG
43
Tx for febrile seizure
hydration
diazepam with fevers in future
no long term consequences
44
Alcohol withdrawl seizures
48 hrs of withdrawl
hopital for 24 hours
benzos are effective ans safe
45
Syncope
LOC with loss of postural tone
| global hypoperfusion of the brain and brain stem
46
Most common causes of syncope
```
vasovagal can reoccur with within 30 minutes of restanding
situational
orthostatic hypotension
decreased cardiac output
arrhythmias
neurologic disease
```
47
Stroke facts
3rd leading cause of death
work force impact
economic impact
48
Stroke risks
age: doubles each decade after 55
gender: male, but more women die from stroke
genetics: african american, family hx
chronic diseases: HTN, Lipids
diet
obesity
smoking
drug use
49
Stroke etiology
intrinsic to the vessel: plaque, inflammation, arterial dissection, malformations, thrombus
inadequate blood flow
rupture of vessel
50
Stroke types
Ischemic
| Hemorrhagic
51
Hemorrhagic Stroke types
subarachnoid
| cerebral hemorrhage
52
Subarachnoid hemorrhage
aneurysm in carotid ruptures and leaks into subarachnoid space
on surface of brain leaking
bleeds into space between brain and skull
53
Cerebral hemorrhage
defective artery in brain bursts
| HTN, trauma, malformation
54
Subarachnoid clinical features
worst HA ever
rapidly LOC
signs of meningeal irritation
nuchal regidity
55
Cerebral hemorrhage clinical features
```
LOC
sudden N/V
focal signs and symptoms
neuro deficit
HA sometimes present
```
56
TIA
transient neruo dysfunction with focal, spinal or retinal ischemia without acute infarction
tissue based
small emboli
offer opportunity to initiate tx prior to perm diasability
57
Delirium
acute, fluctuating disturbance of consciousness with change in cognition
poor clinical outcomes if persists
may be first indication that there is an underlying medical condition
58
Delirium Dx
```
inability to maintain attention
disorganized thinking
develops in short amount of time
fluctuating LOC
caused by medical condition, substance intoxication or medication S/E
reversible!
```
59
Delirium presentation
```
onset acute/abrupt
progression reversible
decreased perception of environment
orientation fluctuates
recent and immediate memory impaired
```
60
Dementia Presentation
```
chronic onset
progression irreversible
clear awareness
increased impairment over time
recent and remote memory impaired
```
61
Depression presentation
Variable onset
progression reversible
clear awareness
patchy memory
62
Delirium risk factors
```
sensory impairment
old age
pre-existing cognitive impairment
substance abuse
social isolation
trauma
pain
```
63
2 parts of delirium assessment
```
1. recognize delirium
history of care givers, MMSE <24
2. uncover the underlying illness
medication review
labs
imaging
```
64
Delirium Differentials
```
D: dehydration, dementia, depression
E: electrolytes, elimination
L: lungs liver, low profusion
I: Infections
R: restraints
I: injury
U: unfamiliar environment
M: medications
```
65
Closed Head injury
injury to the skull, brain or both
| interfere with normal activities
66
Primary causes closed head injuries
```
direct insult
direct trauma
concussion
contusion
epidural hematoma
subdural hematoma
```
67
Secondary causes of closed head injuries
intracranial insults to the brain (ischemia, edema)
| systemic insults to the brain (hypoxia, anemia, hyperglycemia
68
Concussion symptoms
```
HA
feeling in a fog
emotional lability
LOC
amnesia
irritability
slowed reaction times
sleep disturbance
```
69
Second impact syndrome of concussion
can lead to herniation and coma
| someone with concussion goes back in to play prior to concussion resolving and gets reinjured
70
Contusion
bruising of part of the brain with no puncture of the pial covering
follow with CT after 24 hours to ensure no growth
71
Coup injury
with contusion
| direct impact
72
Contrecoup injury
with contusion
| rotational
73
Intracranial hemorrhage
accumulation of blood within cranium
acute or latent
includes epidural and subdural
74
Refer closed head injuries
```
head trauma with altered LOC
paresthesia, paralysis
raccoon or battle sign
hemotympanum
rhinorrhea
otorrhea
```
