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Adult Outpatient > Neuro > Flashcards

Neuro Flashcards

1
Q

Migraine Presentation

A
  • unilateral
  • throbbing
  • +/- aura
  • menstrual (2 days b/f and last day)
  • photophobia
  • N&V
  • aggravated by movement

-brought on by hormones, stress, lack of sleep, alcohol,
smoking, weather changes

  • 4 to 72 hours

PUNT (photophobia, unilateral, nausea, throbbing)

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2
Q

Migraine Tx

A

ACUTE - Excedrin (acetaminophen + ASA+ caffeine), NSAIDs, triptans (oral, nasal, IV, injection), DHE (dihydroergotamine)

**Do not use oral if associated w/ N&V

PPX - amitryptiline, propranolol, valproate, topiramate, verapamil

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3
Q

Cluster Headache Presentation

A
  • unilateral
  • orbital, supraorbital, temporal
  • deep, excruciating pain (15 min - 3 hr)
  • ipsilateral autonomic signs (lacrimation, d/c and facial flushing)
  • more common in men
  • Tend to pace/ cannot get comfortable
  • Episodic (2-3 months then remission for mo to yrs) OR chronic (1-2 yrs w/o remission)
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4
Q

Cluster Headache Tx

A

1st line ACUTE -100% O2 at 6L and triptans

PPX - verapamil (first line), lithium, ergotamine, prednisone

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5
Q

Tension Headache Presentation

A

MOST COMMON

  • band/ bilat w/ muscle tenderness
  • no nausea, vomiting, aggravation w/ movement
  • Associated w/ stress, depression, anxiety
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6
Q

Tension Headache Tx

A

Try ASA, acetaminophen and NSAIDs

Then combine w/ caffeine

Try to limit med use to 2-3 days / wk otherwise get med overuse headaches

If chronic … stress mgt, antidep, amitriptyline is first line (also venlafaxine, Ca blockers, beta blockers)

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7
Q

Secondary Causes of Headache

A

VOMIT

  • V - vascular (hemorrhage, hematoma, temporal arteritis)
  • O - other (malignant HTN, pseudo tumor cerebri, post LP, pheochromocytoma)
  • M - meds (analgesic abuse, alcohol withdrawal, nitrates)
  • I - infection (meningitis, encephalitis, sinusitis, cerebral abscess, zoster, fever)
  • T - tumor
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8
Q

Contradictions to Migraine Meds

A
  • Dihydroergotamine (DHE) - serotonin agonist; do not use if CAD, pregnancy, hx TIAs, PAD, sepsis
  • Sumatriptan - more selective serotonin agonist; do not use if CAD, pregnancy, uncontrolled HTN, basilar artery migraine, hemiplegic migraine, if on MAOIs, SSRI or lithium
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9
Q

Approach to Coma

A
  • 1- ABC’s
  • 2- rapid neuro exam (asymmetry suggests mass lesion)
  • 3- brainstem reflexes
    • Pupil light reflex - if intact then brainstem okay; asymmetric may mean uncle herniation
    • Eye movements - if turn head and eyes move to opposite side then brainstem okay
    • Breathing on own? then brainstem okay
  • 4- Labs - CBC, CMP, glucose, plasma Osm, blood gas
  • 5- ECG
  • 6- Toxicology analysis of blood and urine
  • 7- CT / MRI of brain
  • 8- LP if meningitis suspected
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10
Q

Glasgow Coma Scale

A
  • Eye Opening
    • 1- do not open
    • 2- open to painful stim
    • 3- open to voice
    • 4- open spont
  • Motor
    • 1- no movement
    • 2- decerebrate
    • 3- decorticate
    • 4- withdraws from pain
    • 5- localizes pain stimulus
    • 6- obeys commands
  • Verbal
    • 1- no sounds
    • 2- incomprehensible sounds
    • 3- inappropriate words
    • 4- appropriate but confused
    • 5- appropriate and oriented
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11
Q

Bilateral Fixed Dilated Pupils

A

severe anoxia

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12
Q

Unilateral Fixed Dilated Pupils

A

uncal herniation (CN III compressed)

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13
Q

Pinpoint Pupils

A

Narcotics

ICH

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14
Q

Locked In Syndrome

A

completely paralyzed except respiration, blinking and vertical eye movements

fully aware and feel pain

ventral pons damage

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15
Q

Reversible Causes of Dementia (8)

A
  • Hypothyroid
  • Neurosyphilis
  • B12/folate/thiamine def
  • Niacin def
  • Meds
  • Normal pressure hydrocephalus
  • Depression
  • Subdural hematoma
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16
Q

Normal Pressure Hydrocephalus

A
  • dementia, gait problems, incontinence

normal CSF - dilated ventricles

17
Q

Vascular Dementia

A

stepwise progression (not continuous) b/c new deficits w/ ea infarct

18
Q

AZ Tx

A
  • cholinesterase inhibitors (donepezil, galantamine, rivastigmine)
  • Vit E megadose (2000 units / day)
19
Q

Features of Delirium (v. dementia)

A
  • Rapid fluctuation in attention/awareness, disoriented (v. dementia where consciousness is always preserved)
  • Hallucinations, tremor, asterixis
  • Rapid onset, waxing and waning
  • “Sundowning” - worse at night
  • Almost always reversible
  • Blunted responses
  • Agitation

Adult Outpatient (11 decks)

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