neuro10

Question 1

pain sensitiv structures in the brain

Answer 1

meninges (pia mater), the CNs, the arteries that make up the circle of Willis and its proximal branches, meningeal vessels, external carotid artery, the scalp, pericranial muscles, mucosa of the paransal sinues, the teeth, and cervical nerve roots

Question 2

temporal artery tenderness

Answer 2

suggests giant cell arteritis

Question 3

characteristics of migraine headaches

Answer 3

unilateral, throbbnf or pulsating; often assoc with n/v; exacerbated by movement, light or sounds

Question 4

how long do migraines typically last

Answer 4

several to 72 hours

Question 5

classic vs common migraine

Answer 5

classic is migraine w aura; common is migraine without aura

Question 6

scotoma

Answer 6

partial alteration in the field of vision

Question 7

pathophys of migraine

Answer 7

starts with cortical spreading depression, a wave of hyperpolarization followed by wave of depol, that spreads acorss a region of the cortex

Question 8

pain with migraine

Answer 8

CSD leads to the release of chemicals that activate trigeminal nerve afferents, that leads to activation of in the trigeminal nucleus caudalis and brainstem parasymp efferent projections

Question 9

drugs that should be taken early in the course of migraine

Answer 9

triptans; should be used w caution in patients with coronary artery disease

Question 10

abortive therapy in migraines

Answer 10

triptans, ergotamine derivatives, caffeine-containing compounds, and IV antiemetics like metoclopramide and prochlorperazine

Question 11

propylactic treatment for migraines

Answer 11

beta blockers, TCAs and anticonvulsants

Question 12

when is prophylactic therapy used

Answer 12

when headaches occur more freq than once per month

Question 13

characteristics of tension headaches

Answer 13

recurrent attacks of bilateral or holocranial headaches of a pressing, squeezing, or tightening sensation

Question 14

duration of tension headaches

Answer 14

30 min to several days

Question 15

example of a trigeminal autonomic cephalgias

Answer 15

cluster headaches

Question 16

trigeminal autonomic cephalgias

Answer 16

unilateral trigeminal nerve distribution pain, accompanied by prominent ipsilateral autonomic symptoms

Question 17

cluster headache characteristics

Answer 17

periods of several days or weeks or months in which headaches occur with a high freq followed by headache free periods of months or years

Question 18

location of cluster headaches

Answer 18

usually unilateral (but can flip to the other side within a cluster); usually over the orbit or temporal region;

Question 19

cranial autonomic symptoms seen in cluster headaches

Answer 19

lacrimation, conjunctival injection, facial or forehead swelling, eyelid edema, nasal congestion, rhinorrhea, and signs of Horner’s (miosis, ptosis)

Question 20

patients feel the need to get up and move aroudn to relieve the headache

Answer 20

cluster headache

Question 21

abortive agents in cluster headaches

Answer 21

triptans; steroids may shorten the duration

Question 22

long term prophylaxis for cluster headaches

Answer 22

verapamil and lithium

Question 23

another type of trigeminal autonomic cephalgia besides cluster headache

Answer 23

paroxysmal hemicrania

Question 24

characteristics of paroxysmal hemicrania

Answer 24

unilateral headache with accompanying autonomic symptoms; episdoes are typically much shorter than cluster headaches (10-30min) and occur with greater freq

Question 25

best treatment for paroxysmal hemicrania

Answer 25

the NSAID indomethacin

Question 26

worst headache of my life

Answer 26

subarachnoid hemorrhage

Question 27

SAH headache characteristic

Answer 27

begins suddenly and peaks in intensity within seconds of its onset (thunderclap headache)

Question 28

diagnosis of SAH

Answer 28

head CT followed by LP to show presence of blood or blood breakdown products in CSF

Question 29

what is a low pressure HA

Answer 29

low pressure within the subarchnoid space or CSF; symptoms are worse in the upright position and alleviated by recombency; typically bilateral;

Question 30

idiopathic intracranial hypertension

Answer 30

elevated pressure within the subarachnoid space; increasing severity when recombent; may have pulsatile tinnitus and transient visual obscurations;

Question 31

other characteristics of idiopathic intracranial htn

Answer 31

papilledema, unilateral or bilateral sixth nerve palsy;

Question 32

mimic of idiopahtic intracranial hypertension

Answer 32

venos sinus thrombosis

Question 33

treatment of idiopathic intracranial hypertension

Answer 33

carbonic anhydrase inhib like acetazlamide and topiramate; repeated LPs and diuretics, as well as optic nerve fenestration and occasionally lumboperitoneal shunting

Question 34

most important complicaiton of IIH

Answer 34

vsual loss due to a compresive optic neuropathy from persistently elevated CSF pressure;

Question 35

temporal arteritis

Answer 35

also known as giant cell arteritis; systemic granulomatous arteritis that affects med and large arteries, typically in people over age 50

Question 36

headache with giant cell arteritis

Answer 36

may be assoc with tenderness of the scalp as well as thicening, nodulation, and tenderness of the temporal arteries to palpation; may see claudication of the jaw with chewing and systemic sx

Question 37

most feared complication of temporal arteritis

Answer 37

visual loss rom an anterior ischemic neuropathy

Question 38

treatment of temporal arteritis

Answer 38

high dose steroids

Question 39

chronic daily headache def

Answer 39

headache at least 15 days per month

Question 40

dental causes of facial pain

Answer 40

temporomandiular joint disease

Question 41

neurologic causes of facial pain

Answer 41

trigeminal neuralgia, glossopharyngeal neuralgia, and postherpetic neuralgia

Question 42

trigeminal neuralgia

Answer 42

syndrome characterized by paroxysms of severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve; short paroxysms of electrical like painful sensation in the face

Question 43

pathogenesis of trigeminal neuralgia

Answer 43

compression of the trigeminal nerve root at the cerebelopontine angle, most often by an aberrant vascular loop

Question 44

treatment for trigeminal neuralgia

Answer 44

carbamazepine

Question 45

trigeminal neuralgia that is refractory to carbamazepine and other anticonvulsants

Answer 45

percutaneous radiofreqency ablation and microvascular decompression

Question 46

postherpetic neuralgia

Answer 46

neuropathic pain that may accompany and follow an acute attack of varicella zoster (shingles)

Question 47

pain associated with postherpetic neuralgia

Answer 47

burning, itching, and hypersensitivity to light touch

Question 48

management of postherpetic neuralgia

Answer 48

symptomatic with TCAs and gabapentin

Question 49

how do carbonic anhydrase inhib treat IIH

Answer 49

reduce production of CSF