Neurology Flashcards
(112 cards)
1
Q
Signs/symptoms of cluster headaches
A
- Severe unilateral periorbital/temporal pain (sharp, lancinating)
- Bouts lasting < 2 hours with spontaneous remission
- Bouts occur several times a day over 6-8 weeks
2
Q
Triggers for cluster headaches
A
Worse at night
EtOH
Stress
Ingestion of specific foods
3
Q
Additional symptoms associated with cluster headaches
A
Ipsilateral horner’s syndrome (ptosis, miosis, anhidrosis), nasal congestion/rhinorrhea, conjunctivitis and lacrimation
4
Q
Management of cluster headaches
A
- 100% oxygen first line
2. Meds: sumatriptan or ergotamines
5
Q
Prophylaxis of cluster headaches
A
Verapamil (first line)
Ergotamines, valproic acid, lithium, cyproheptadine
6
Q
Most common cause of morning headache
A
Migraines
7
Q
Risk factors for migraines
A
Family history (80%)
8
Q
Signs/symptoms for migraines
A
Lateralized, pulsatile/throbbing headache
Associated with N/V
Photophobia/phonophobia
9
Q
Triggers for migraines
A
Physical activity Stress Lack of/excessive sleep EtOH Foods (red wine, chocolate) OCPs Menstruation
10
Q
Auras
A
Seen with migraines (not commonly)
Visual changes most common, aphasia, weakness, numbness
11
Q
Management of migraines
A
- Triptans or Ergotamines
- Dopamine blockers: metoclopramide, promethazine, prochlorperazine
- Mild: NSAIDs/acetaminophen first line
12
Q
S/E of triptans or ergotamines
A
Chest tightness from constriction
N/V
Abdominal cramps
13
Q
Prophylaxis of migraine
A
Anti-HTN meds: BB, CCB, TCA
Anticonvulsants: valproate, topiramate, NSAIDs
14
Q
Most common overall type of headache
A
Tension headaches
15
Q
Bilateral, tight, band-like constant daily headache. Worsened with stress, fatigue, noise or glare (not worsened with activity like migraines). usually not pulsatile
A
Tension headaches
16
Q
Management of tension headaches
A
- NSAIDs, aspirin, acetaminophen
- Anti-migraine medications
- TCAs in severe or recurrent cases
- Can use BB, psychotherapy
17
Q
Signs/symptoms of bacterial meningitis
A
- Fever/chills (95%)
- HA/nuchal rigidity, photosensitivity, N/V
- AMS, seizures
18
Q
Kernig’s sign
A
Inability to straighten knee with hip flexion
Meningitis
19
Q
Brudzinski’s sign
A
Neck flexion produces knee/hip flexion
Meningitis
20
Q
Diagnosis of meningitis
A
- LP - definitive
2. Head CT - done to r/o mass effect before LP if high risk
21
Q
LP results for bacterial meningitis
A
High neutrophils, low glucose, high total protein
22
Q
For bacterial meningitis, do not wait to start
A
Empiric abx
23
Q
Treatment for bacterial meningitis if < 1 month old
A
Ampicillin + Cefotaxime
24
Q
Treatment for bacterial meningitis if 1 mo - 18 years
A
Ceftriaxone + Vancomycin
25
Treatment for bacterial meningitis if 18 y/o - 50 y/o
Ceftriaxone + Vancomycin
26
Treatment for bacterial meningitis if > 50 y/o
Ampicillin + Ceftriaxone
27
Meningitis post exposure prophylaxis
Ciprofloxacin 500 mg PO x 1 dose
28
Diagnosis of viral meningitis
1. CSF - most important to differentiate
2. MRI
3. Serologies, viral cultures
29
Management of viral meningitis
Supportive care
| Antipyretics, IV fluids, antiemetics
30
Viral infection of the brain parenchyma
Encephalitis
31
Most common cause of encephalitis
HSV -1 MC
| Enteroviruses, arboviruses, varicella, toxoplasmosis
32
Signs/symptoms of encephalitis
HA, fever
Profound lethargy, AMS
Focal neurologic deficits
Seizures
33
Diagnosis of encephalitis
1. LP - lymphocytosis, normal glucose, increased protein
| 2. Brain imaging - temporal lobe MC involved
34
Management of encephalitis
1. Supportive care - antipyretics, IV fluids, seizure prophylaxis
2. Valacyclovir
35
TIAs usually last < ____________ but most resolve in __________
24 hours
| 30-60 minutes
36
TIAs are most commonly due to:
Embolus or transient hypotension
37
___% of patients with TIA will have a CVA within first 24-48 hours afterwards (especially if DM, HTN)
50%
38
Amaurosis Fugax
Monocular vision loss - temporary "lamp shade down on own eye"
Seen with internal carotid artery occlusion
39
Symptoms of TIA
```
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
```
40
Symptoms of TIA
```
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
Gait and proprioception difficulties
Dizziness, vertigo
```
41
Diagnosis of TIA
1. CT scan of head - r/o hemorrhage
2. Carotid doppler - carotid endarterectomy recommended if stenosis > 70%
3. CT angiography, MR angiography
4. BG to r/o hypoglycemia
5. Electrolytes
6. Coag studies
7. CBC
8. Echocardiogram
9. ECG - look for Afib
42
ABCD2 score
```
Assesses CVA risk
Age
BP
Clinical features
Duration of symptoms
Diabetes mellitus
```
43
Management of TIA
Aspirin +/- dipyridamole or clopidogrel
Avoid lowering BP (unless > 220/120)
Reduce modifiable risk factors: 1. DM 2. HTN 3. Afib
44
Signs/symptoms of stroke
Abrupt onset of neurological abnormalities
Facial paresis
Arm drift/weakness
Abnormal speech
45
Signs/symptoms of hemorrhagic stroke
Headache
LOC
N/V
46
Diagnostic testing of stroke
1. Non-contrast CT to r/o hemorrhage
2. LP if negative but still suspicious
3. MRI - localize extent of infarction (after 24 hours)
47
Other tests for stroke to r/o other dz:
1. Glucose - r/o hypoglycemia
2. O2 sats
3. EKG - r/o arrhythmia
4. CBC
5. Cardiac enzymes - r/o infarction
6. PT/PTT
48
All ptst who present within ______ hours of ischemic stroke symptom onset should be offered TPA
4.5 hours
49
All patients who present after 4.5 hour window for ischemic stroke should be given
Aspirin
50
Patients who have __________ should not be given TPA
Rapidly improving stroke symptoms
51
In ischemic stroke, blood pressure should be lowered in the case of
1. Malignant hypertension
2. Myocardial ischemia
3. BP > 185/110 and if TPA will be administered
52
Indications for mechanical thrombectomy in ischemic stroke
Occlusion of proximal anterior circulation
No hemorrhage present
Can be done within 6 hours
53
Treatment for hemorrhagic stroke
BP therapy - goal is 160/90
Labetalol and nicardipine are first linen
If pt on anticoagulants, give reversal agent
Surgical removal or hemorrhage should be done if hemorrhage is > 3 cm in diameter or if patient is deteriorating
54
Ischemic stroke interventions
1. ASA within 48 hours
2. Pneumatic compression stockings or heparin for VTE prophylaxis
3. Statin therapy
4. Smoking cessation
55
Long term antiplatelet therapy after ischemic stroke
Aspirin, clopidogrel or aspirin-dipyridamole
| If pt was previously on aspirin, switch to clopidogrel or add dipyridamole
56
After stroke management (diagnostic modalities):
1. Echocardiogram - look for clot
2. EKG/Holter monitor - r/o AFib/arrhythmia
3. Carotid duplex US - r/o stenosis
4. Duplex US, CTA or MRA or head/neck arteries - look for clot
57
Mechanism behind subarachnoid hemorrhage
Berry aneurysm rupture
58
Signs/symptoms of subararchnoid hemorrhage
```
Thunderclap HA (worst of my life)
+/- unilateral, occipital area
+/- LOC, N/V
May have meningeal symptoms: stiff neck, photophobia, delirium
Usually no focal neurological deficits
```
59
Diagnosis of subarachnoid hemorrhage
1. CT first
2. If CT negative, perform LP (looking for blood, increased pressure)
3. 4-vessel angiography after confirmed SAH
60
Management of subarachnoid hemorrhage
1. Supportive, bed rest, stool softeners, lower ICP
2. Surgical coiling or clipping
3. +/- BP lowering (Nicardipine, Nimodipine, Labetalol)
61
Location of intracerebral hemorrhage
Intraparenchymal
62
Mechanisms behind intracerebral hemorrhage
1. HTN
2. Arteriovenous malformation
3. Trauma
4. Amyloid
63
Signs/symptoms of intracerebral hemorrhage
HA, N/V, +/- LOC
Hemiplegia, hemiparesis
Not associated with lucid intervals
64
Diagnosis of intracerebral hemorrhage
1. CT - intraparenchymal bleed
| DO NOT perform LP if suspected- may cause brain herniation
65
Management of intracerebral hemorrhage
Supportive, gradual BP reduction
+/- IV mannitol if increased ICP
+/- hematoma evacuation if mass effect
66
Mild traumatic brain injury leading to alteration in mental status with or without loss consciousness
Head trauma / concussion
67
Signs/symptoms of concussion
1. Confusion
2. Amnesia (retrograde or antegrade)
3. HA, dizziness, visual disturbances (blurred/double vision)
4. Delayed responses and emotional changes
5. Signs of increased ICP: persistent vomiting, worsening headache, increasing disorientation, changing levels of consciousness
68
Diagnosis of concussion
1. CT scan
2. MRI - if symptoms prolonged > 7-14 days
3. PET scan may be done to look at glucose uptake
69
Management of concussion
Cognitive and physical rest is the main management of pts with concussion
70
Mechanism behind subdural hematoma
Tearing of cortical bridging veins
| Seen most commonly in the elderly
71
Most common cause of subdural hematoma
Blunt trauma - often causes contrecoup bleeding
72
Signs/symptoms of subdural hematoma
Varies
| May have focal neurological symptoms
73
Diagnosis of subdural hematoma
CT (concave crescent shaped bleed)
| Bleeding can cross suture lines
74
Management of subdural hematoma
Hematoma evacuation vs. supportive
| Evacuation if massive or > 5 mm midline shift
75
Mechanism behind epidural hematoma
Middle meningeal artery
| Most common after temporal bone fracture
76
Signs/symptoms of epidural hematoma
Brief LOC, lucid interval, coma
HA, N/V, focal neuro sx, rhinorrhea (CSF fluid)
CN III palsy if tentorial herniation
77
Diagnosis of epidural hematoma
1. CT (convex lens shaped bleed)
| Will not cross suture lines, usually in temporal area
78
Management of epidural hematoma
+/- herniation if not evacuated early
Observation if small
If increased ICP: mannitol, hyperventilation, head elevation, +/- shunt
79
80% of all strokes are ___________ and are due to ________, _________ or ________ ________
Ischemic
Thrombus
Emboli
Systemic hypoperfusion
80
Seizures not provoked by stimuli, occurs without clear cause
Epilepsy
81
Generalized seizure which affects entire cortex. Muscle stiffness followed by muscle jerking. Will often have foaming of the mouth, tongue biting and/or urination
Tonic Clonic Seizure
| Grand-mal seizure
82
Seizure that occurs in one part of the cortex with loss of consciousness
Complex partial seizure
83
Seizure that occurs in one part of the cortex without loss of consciousness
Simple partial seizure
84
Postictal symptoms
```
Confusion
Amnesia
HA
Nausea
Difficulty speaking
```
85
Paresis that occurs following a seizure that lasts for hours
Todd's Paralysis
86
Diagnosis for pt with first time seizures
```
CBC
Electrolytes
Glucose
Calcium, magnesium
Renal function, liver function
Toxicology screen
CT or MRI is also done to r/o masses
```
If all come back normal, this is termed epilepsy, and EEG is done
87
Treatment for seizures
```
First time seizures usually do not require medication
Reasons for therapy to be given:
1. Pt with status epilepticus
2. Prior brain insult
3. EEG with epileptiform abnormalities
4. Brain imaging abnormality
5. Nocturnal seizure
```
88
Antiseizure medication with the most evidence for teratogenicity
Valproate
89
Oral contraceptive efficacy may be ________ when start on an epileptic drug, therefore all women of childbearing age should be given __________
Folic acid
90
Treatment of choice for absence seizures
Ethosuximide
91
Discontinuation of seizure medication can be attempted after:
2 year seizure free period
92
Seizure that lasts longer than 5 minutes
Status epilepticus
93
Treatment for status epilepticus
1. Benzodiazepine (Midazolam used if no IV access)
2. After benzo, give fosphenytoin
3. If seizure persists but stable, phenobarbital
4. If not stable, intubate and give propofol or midazolam
94
Clinical syndrome in which transient loss of consciousness is caused by period of inadequate cerebral nutrient flow
Syncope
95
Most often, syncope is the result of cerebral hypoperfusion due to __________________
Transient hypotension
96
4 possible causes of syncope
1. Reflex syncope
2. Orthostatic syncope
3. Cardiac arrhythmias
4. Structural cardiopulmonary disease
97
An ______ should be obtained in all pts with suspected syncope
ECG
98
Acute/subacute acquired inflammatory demyelinating polyradiculopathy of the peripheral nerves
Guillain-Barre Syndrome
99
Guillain-Barre syndrome has an increased incidence with ________________ or other antecedent respiratory or GI infections or other viruses
Campylobacter jejuni (MC)
100
Ascending weakness and paresthesias (usually symmetric), decreased DTRs
Guillain-Barre syndrome
101
Other symptoms of Guillain-Barre syndrome
Autonomic dysfunction: tachycardia, hypotension, breathing difficulties, CN VII palsy
102
Diagnosis of Guillain-Barre syndrome
1. CSF: high protein with normal WBC
| 2. Electrophysiologic studies: decreased motor nerve conduction velocities
103
Management of Guillain-Barre syndrome
1. Plasmapheresis - best if done early - removes harmful circulating autoantibodies that cause demyelination
2. Intravenous Immune Globulin (IVIG): suppresses harmful inflammation/autoantibodies and induces remyelination. Most recover within months.
104
Anterior cord injury
Lower extremity > upper
| Deficits: pain, temperature, light touch
105
Central cord injury
Hyperextension (MVA)
Upper extremity > lower
Deficits: pain, temperature
Shawl distribution
106
Brown Sequard Syndrome
Penetrating trauma
Ipsilateral deficits: motor, vibration and proprioception
Contralateral deficits: pain and temperature
107
Bell palsy has a strong association with
Herpes Simplex virus reactivation
108
Risk factors for bells palsy
1. DM
2. Pregnancy
3. Post URI
4. Dental nerve block
109
Sudden onset of ipsilateral hyperacusis (ear pain) for 24-48 hours - unilateral facial paralysis
Bell palsy
110
Eye on affected side moves laterally and superiorly when eye closure is attempted
Bell phenomenon
111
Differential diagnosis: bell palsy vs stroke
If pt is able to wrinkle both sides of forehead, it is not bell palsy
112
Management of bell palsy
No tx required - most cases resolve within 1 month
1. Prednisone
2. Artificial tears
