Neurology Flashcards
(34 cards)
1
Q
CN I
A
Olfactory - sense of smell
2
Q
CN II
A
Optic - vision, visual fields, pupillary rxn
3
Q
CN III
A
Oculomotor - mvnt of eyeball and eyelid
4
Q
CN IV
A
Trochlear - superior oblique muscle of the eye
5
Q
CN V
A
Trigeminal - temperature, pain, and tactile that covers 3 territories of the face
6
Q
CN VI
A
Abducens - eyeball abduct
7
Q
CN VII
A
Facial - dysfunction give findings of Bell’s palsy
8
Q
CN VIII
A
Auditory or vestibulocochlear - hearing and balance
9
Q
CN IX
A
Glossopharyngeal - swallowing, palate elevation, and gustation
10
Q
CN X
A
Vagus - sensing aortic pressure, slowing heart rate, regulating taste and digestive rate
11
Q
CN XI
A
Accessory or spinal root of the accessory - shoulder shrug and lateral neck rotation
12
Q
CN XII
A
Hypoglossal - mvnt and protrusion of tongue
13
Q
Bell’s Palsy (Patho, S/S)
A
- CN VII
- Cause unknown = Inflammation of CN w/in temporal bone
- Often linked to HSV, HZ, EBV, CMV, adenovirus, rubella, mumps
- Mimick = stroke, infection, Lyme dis, tumors
14
Q
Bell’s Palsy (Dx, Trmt)
A
- EMG, antibody for Lyme disease (rare finding during secondary stage Lyme dis)
- S/S usually temporary (few wks-6 mos); poss perm symptoms
- Steroids; antivirals of little benefit
- Ocular involvement - refer, tear substitutes, lubricants, eye protection
15
Q
Tension-type Headache
A
- 30 min- 7 days
- Pressing, nonpulsatile pain; mild to moderate pain
- Usually bilateral
- F:M = 5:4
Trmt = APAP, NSAIDs, combo with butalbital, ASA, caffeine
16
Q
Migraine without Aura
A
- 4-72 hrs
- Usually unilateral location, occ bilateral
- Pulsating; moderate to severe
- N/V, photophobia, phonophobia
- Positive family hx
- F:M = 3:1
17
Q
Migraine with Aura
A
- Focal dysfxn of cerebral cortex or brainstem
- S/S = dread, anxiety, unusual fatigue, nervousness or excitement, GI upset, visual or olfactory alteration
- Positive family hx
18
Q
Cluster Headache
A
- Occur daily in groups or clusters occuring over wks to months and then disappear; seasonal
- Pain may awaken persion
- Often located behind one eye with a steady, intense, severe pain in a crescendo pattern lasting 15 min to 3 hrs
- Asso with lacrimation, conjunctival injection, ptsosis, and nasal stuffiness
- Most common in middle aged men, heavy ETOH and tobacco use
- F:M = 1:3 to 1:8
- Trmt = avoid triggers, prophylactic therapy and abortive therapy (triptans, NSAIDs, high-flow O2)
19
Q
Headache “Red Flags”
A
- Systemic symtoms = fever, wt loss, or secondary HA risk factors such as HIV, malignancy, preg, anticoagulation
- Neurologic s/s = confusion, impaired alertness or consciousness, nuchal rigidity, HTN, papilledema, CN dysfxn, abn motor fxn
- Onset = sudden, abrupt, “thunder-clap”; HA with exertion, sexual activity, coughing, sneezing (suggests subarachnoid hemorrhage, sudden incr ICP)
- Onset = older (>50 yrs) and younger (30 yrs or new onset of diff HA
20
Q
Helpful Observations in Patients with Acute Headache
A
- Hx of previous identical HAs
- Intact cognition
- Supple neck
- Normal neurological exam results
- Improvement in symptoms while under observation and treatment
21
Q
Nonacute Headache s/s that significantly incr odds of finding abnormality on neuroimaging
A
- Rapidly incr HA frequency
- Hx of dizziness or lack of coordination; numbness/tingling; HA causing awakening from sleep; HA worse with Valsalva maneuver; accelerating, new-onset HA
- Abn neuro exam
- Incr age - more likely old infart; atrophy
22
Q
Nonacute Headache s/s that are unlikely to correlate with abn neuroimaging
A
- Neuro exam is normal
- Long-standing hx of similar HA
- “Wost HA of my life”
23
Q
CT
A
- Better at detecting acute hemorrhage and bone abnormalities
24
Q
MRI
A
- Better at detecting small and subtle lesions
25
Triptans
- Selective serotonin receptor agonists allowing for incr reuptake of serotonin
- Potential vasoconstrictor effect
- Contraindicated in pts with Prinzmetal angina or est or high risk for coronary artery disease, in preg women, and in individuals who have recently used ergots
- Caution in those taking MAOIs or high dose SSRIs
- Used for migraines and may also help with tension HA
26
Ergotamines
- Ergot derivatives that act as 5-HT1A and 5-HT1D receptor agonists; potential vasoconstrictor effect
- Avoid in those with CAD and pregnancy
- Used for migraines
27
NSAIDs
- Useful for tension-type HA and migraines
| - Rapid-onset such as ibuprofen in high doses, naproxen sodium rapid
28
Fioricet
- Combo of caffeine, butalbital, and APAP
- Butalbital enhances select neurotransmitter action
- Useful for migraines and tension-type HAs
- Not for freq use
29
Neuroleptics
- Prochlorerazine, promethazine
- Antiemetic
- Use limited to 3 days a wk - risk of extrapyramidal mvnts
- Can also use Zofran or Reglan (not for daily use) for antiemetic
30
Systemic corticosteroids
- For intractable or severe migraine and in cluster HAs
| - Not for more than once a month
31
Prophylactic therapy
- Goal = minimum of 50% reduction in number of HAs in about 2/3rds of all patients, easier-to-control HAs that respond more rapidly to standard therapies and likely require less medications
- Blockade of the 5HT2 receptor sites
- 1-2 months of use before effect is seen
- Before initiation - must stop HA-provoking meds such as estrogen, progesterone, and vasodilators
32
Medications for prophylactic therapy
- Beta-blockers = metoprolol and propranolol (strongest evidence), atenolol, nadolol
- CCB = verapamil (not recommended)
- Antiepileptic drugs = divalproex sodium, sodium valproate, topiramate
- TCA = nortriptyline, amitriptyline
- SSRI = venlafaxine
33
Herbals for prophylactic therapy
- Petasites (butterbur) (strongest evidence)
| - Riboflavin, magnesium, feverfew, and CoQ10 + estrogen during premenstrual week
34
Secondary headaches
- Caused by an underlying disease, usually increased ICP
