Flashcards in Neurology Deck (52)
who is at high risk of delirium during hospitalization?
elderly pts with dementia
medical indications for catheter
relieve urinary retention
monitor fluid status in acutely ill pts
pts with stage 3/4 pressure ulcers on butt
- aside of these indications, remove urinary catheter to prevent things like infection and delirium
which sedatives should be avoided in elderly?
benzodiazepines and diphenhydramine
- can precipite delirium
pt post-op presents with acute, fluctuating mental status changes with difficulty focusing or maintaining attention and disorganized thinking
think of delirium
patients with chronic dementia are at great risk of what after surgery with general anesthesia?
recommended therapy for delirium in the ICU when supportive care is insufficient?
antipsychotic agents - haloperidol
pt presents with mental status changes, nystagmus, opthalmoplegia and unsteady gait - what should you consider?
Wernicke encephalopathy - due to thiamine deficiency
conditions assoc with Wernicke encephalopathy
AIDS, alcohol abuse
cognitive impairment with fluctuating lethargy/inattention, hallucinations and asterixis implies..
toxic encephalopathy - ie. medication induced delirium
what types of drugs can provoke delirium in a elderly pts with mild cognitive impairment, early dementia of Parkinson's disease?
anticholinergic drugs (ex. nortriptyline)
migraine with aura consists of..
neurologic abnormalities including visual loss, hallucinations, numbness, tingling, weakness or confusion (diffuse symptoms)
aura associated with partial seizures is characterized by..
feeling of deja vu, rising epigastric sensation or autonomic disturbances; automatisms (lip smacking) can also be suggestive of partial seizure
pt presents with a headache that is dull, bilateral or diffuse described as a pressure or squeezing sensation; the pain is usually not disabling
chronic daily headache
headache is present on > 15 days/month for at least 3 months
disabling headache assoc with tearing or rhinorrhea; typically unilateral and periorbital/temporal
- cluster episodes usually last 6-8 weeks with remission lasting 2-6 months
what is a cluster headache classically assoc with?
common visual symptoms associated with migraine
perceptions of flashes of light
arcs of flashing light that forms zig-zag pattern
area of loss of vision surrounded by normal visual field
work-up order for "thunderclap headache" as in subarachnoid hemorrhage
1. CT scan without contrast - if neg,
2. do lumbar puncture, - if neg,
3. CT or MR angiography
prophylactic tx. of migraine headaches
pt should have 2+ headaches per week
first line - propranolol
- can also use: amitriptyline, valproic acid, topiramate, other BB, petasites hybridus
dementia characterized by prominent memory loss, anomia, constructional apraxia, anosognosia (impaired recognition of illness) and personality change
dementia the progresses over months and startle myoclonus; also: visual/cerebellar disturbance, pyramidal/extrapyramidal dysfunction and akinetic mutism
Creutzfeld Jakob disease
dementia accompanied by Parkinsonism, visual hallucinations and fluctuating symptoms; MC includes impaired learning and attention, psychomotor slowing and visuospatial impairment (vs. memory)
Dementia with Lewy Bodies
pt presents with behavioral and personality changes ranging from apathy to social disinhibition and emotional lability - dementia?
stages of dementia based on MMSE
MMSE 21-25 = mild dementia
MMSE 11-20 = moderate dementia
MMSE 0-10 = severe dementia
first line initial therapy for mild-moderate Alzheimer's dementia
Ach-esterase inhibitors: donepezil, rivastigmine or galantamine
first line tx of moderate to advanced Alzheimer dementia
- better effects when added to donepezil
what types of drugs are implicated in acute dystonic reactions?
neuroleptic, antiemetic and serotonergic agents - dystonic reactions typically occur w/in 5 days of initiating therapy
pt presents with resting tremor, bradykinesia, rigidity and postural instability
upper extremity, high frequency tremor present with both limb movement and sustained posture of the involved extremities and is absent at rest; usually bilateral
- usually improved with alcohol and worsens with stress