Term
| typically acute onset, responds to at least some stimuli appropriately, level of consciousness may be impaired. Appear sleepy, disoriented, and inattentive. |
|
Definition
|
|
Term
| chronic in onset with worsening over time. Appear normal but confused. Normal level of consciouness |
|
Definition
|
|
Term
|
Definition
|
|
Term
| inability to learn new material |
|
Definition
|
|
Term
| problems with recent memory |
|
Definition
|
|
Term
| Flostein MMSE score less than what required additional testing? |
|
Definition
|
|
Term
| disorder of articulation in which basic language is intact |
|
Definition
|
|
Term
| impaired production and or comprehension of spoken language |
|
Definition
|
|
Term
| "receptive" aphasia, pt doesn't understand what is said or written. |
|
Definition
|
|
Term
| "expressive" aphasia. patients understands what he hears but produces few words with many pauses. |
|
Definition
|
|
Term
| pt is unaware their responses are nonsense |
|
Definition
|
|
Term
| incorporates elements of both receptive and expressive aphasia |
|
Definition
| global aphasia, middle cerebral artery |
|
|
Term
|
Definition
| Wernicke's area, posterior temporal region |
|
|
Term
| can't remember emotionally charged events but can remember objective facts and events |
|
Definition
|
|
Term
| can't remember objective facts |
|
Definition
|
|
Term
| loss of memory for events immediately prior to the disorder |
|
Definition
|
|
Term
| what lobe of teh brain does drawing a clock or intersecting geometric shapes test? |
|
Definition
|
|
Term
|
Definition
| progressively declining LOC/neuro exam, pupillary assymetry, seizures, repeated vomiting, double vision, worsening headache, can't recognize people or places (disorientation), behaves unusually or seems confused or irritable, slurred speech, unsteady on feet, weakness or numbness in arms or legs. |
|
|
Term
| presents with nystagmus, dysarthria, limb and gait ataxia |
|
Definition
|
|
Term
| presents initially with tremulousness, tachycardia, hypertension |
|
Definition
|
|
Term
| tx for alcohol withdrawal |
|
Definition
initial - benzos (diazepam 5-20mg q 4hrs PRN)
day 2 = seizures --> continue benzos
day 3-5 = DT's (agitation, tremulousness, hallucinations, cardiovascular collapse) --> diazepam (10-20 mg IV q 5 min until calm), correct fluids, electrolytes, glucose abnormalities, BB (atenolol 50-100mg PO qd to block adrenergic response) |
|
|
Term
| acutely confused endocrine disorders and treatment |
|
Definition
hypothyroid - levothyroxine
hyperthyroid - antithyroid drugs, BB
hypoglycemia - IV dextrose
hyperglycemia:
DKA - insuline, K+, IVF
HONK - insulin, IVF |
|
|
Term
| acutely confused - elecotrolyte disorders and treatment |
|
Definition
hyponatremia - water restriction and IV hypertonic saline, slowly raise serum Na level to 125-130
hypocalcemia - IV calcium gluconate and seizure precautions |
|
|
Term
| differentiate heat exhaustion and heat stroke |
|
Definition
| heat stoke has CNS involvement (ataxia, coma, confusion, irritability, seizures) |
|
|
Term
| caused by thiamine deficiency in chronic alcoholics. Presents with ophthalmoplegia/nystagmus, gait ataxia |
|
Definition
| Wernicke's Encephalopathy |
|
|
Term
| Treatment for Wernicke's Encephalopathy |
|
Definition
| thiamine replacement (100mg) followed by D50. Ataxia might not be fully reversible. Deficits in learning and memory may follow. |
|
|
Term
|
Definition
| usually due to poor intake, presents with mild confusion to dementia to psychosis |
|
|
Term
| accumulation of ammonia in liver failure, presents with asterixis. |
|
Definition
|
|
Term
| treatment for Hepatic Encephalopathy |
|
Definition
| requires lactulose, correct coagulopathy |
|
|
Term
| treatment for uremia (elevated BUN) |
|
Definition
| dialysis and renal transplant |
|
|
Term
| classic triad: Fever, nuchal rigidity, mental status change |
|
Definition
|
|
Term
| CSF = cloudy, high protein, high lactate, low glucose, many WBCs |
|
Definition
|
|
Term
| causes of bacterial meningitis |
|
Definition
| strep. pneumoniae, Nesseria meningitidis |
|
|
Term
| Most common cause of meningitis |
|
Definition
| viral (enterovirus, HSV, varicella zoster, mumps, HIV) |
|
|
Term
| CSF = low WBC count with lymphocytes not neutrophils, normal protein and glucose |
|
Definition
|
|
Term
|
Definition
Abx ASAP if bacterial is suspected.
IV NS or LR.
Control fever with Tylenol
If viral is suspected give acyclovir 12.5mg/kg/d divided tid x 10 days.
consider steroids (Decadron 0.4mg/kg q 12 hours for 4 doses) with first dose prior to starting antibiotics to reduce inflammation. |
|
|
Term
|
Definition
| viral (enterovirus, HSX, VZV, arboviruses) |
|
|
Term
| Herpangina (hand, foot, mouth disease), enterovirus 71 --> rhombencephalitis, mild sxs except enterovirus 71 |
|
Definition
|
|
Term
| MCC of fatal encephalitis in the US |
|
Definition
|
|
Term
| treatment for herpes encephalitis |
|
Definition
| antiviral treatment ASAP with acyclovir IV x 14-21 days |
|
|
Term
| transmitted by birds and mosquitos |
|
Definition
| West Nile Virus Encephalitis |
|
|
Term
| treatment of West Nile Virus encephalitis |
|
Definition
|
|
Term
| presents with encephalitis or paralysis, invariably fatal unless treatment is administered before sxs arise |
|
Definition
|
|
Term
LP = increased ICP, obstructive hydrocephalus, mass effect. CSF = protein normal-slightly elevated, lymphocytes present, glucose normal.
MRI most likely to show abnormality |
|
Definition
|
|
Term
| infection with Plasmodium species |
|
Definition
|
|
Term
| CSF = increased pressure, slightly elevated protein, monocytes |
|
Definition
|
|
Term
| treatment for hypertensive encephalopathy |
|
Definition
| get BP down with nitroprusside or labetalol |
|
|
Term
| no loss of consciousness, transient confusion <15 minutes |
|
Definition
| Grade 1 concussion, can return to play if cleared. |
|
|
Term
| no loss of consciousness, transient confusion >15 minutes |
|
Definition
| Grade 2 concussion, need head CT/MRI and neuro work up if sxs persist. May return to activities in 1 week if no sxs. |
|
|
Term
| concussion with any loss of consciousness |
|
Definition
| Grade 3, needs emergent CT/MRI and thorough neuro exam. Must stay out of competition for 1-2 weeks. |
|
|
Term
| what type of bleed is a subdural hematoma? |
|
Definition
| venous, lower pressure, will clot off faster. can cause irritation of the cerebrume which may lead to seizures. |
|
|
Term
| concussion with sxs persisting for > 1 year |
|
Definition
| post concussive syndrome. |
|
|
Term
| risk factors for delirium |
|
Definition
| advanced age, preexisting cognitive deficit, prior episode of delirium, polypharmacy, alcohol or other drug dependence, use of psychoactive drugs, deficits in vision or hearing, perioperative complications, immobility, severe comorbidity |
|
|
Term
|
Definition
| drug induced, depression, hypothyroidism, hyperthyroidism, hypoglycemia, Vit B12/folate deficiency, subdural hematoma, liver failure, nromal pressure hydrocephalus, stroke, CNS infections, cerebral neoplasms, renal failure, ehtanol abuse, hypoxia, hypercalcemia, vasculitis, cadiopulmonary disorders, severe anemia |
|
|
Term
| progressive decline in cognitive function beyond what might be expected from normal aging, severe enough to interfere significantly with work or usual social acitivities or relationships with others. |
|
Definition
|
|
Term
| 3 microscopic changes indicative of Alzheimer's disease |
|
Definition
| B-amyloid plaques, neurofibrillary tangles, cortical atrophy |
|
|
Term
| what disease is associated with the genetic transmission of apolipoprotein E4? |
|
Definition
|
|
Term
| gradual development of forgetfulness, speech halting, mobility, behavior, temperament, and conduct begin to decline |
|
Definition
|
|
Term
| grasping and sucking reflexes |
|
Definition
|
|
Term
| tx for mild-moderate Alzheimer's |
|
Definition
Donepezil and galantamine (reversible ACh inhibitors)
SE: elevated LFT, N/V/D, dizziness.
also consider antipsychotics, antidepressants, anxiolytics. |
|
|
Term
| treatment for moderate to severe dementia |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Alzheimer's with Parkinsonian features |
|
Definition
| Dementia with Lewy Bodies |
|
|
Term
| what medications should be avoided in Dementia with Lewy Bodies? |
|
Definition
|
|
Term
| episodic confusion, hallucinations, and paranoid delusions... |
|
Definition
|
|
Term
| step wise progresson until one event tips the patient over the edge |
|
Definition
| Vascular (multi-infarct) Dementia |
|
|
Term
| risk factors for Vascular Dementia |
|
Definition
| hypertension, cardiac disease, diabetes, smoking, alcoholism, hyperlipidemia, male gender, African American ethnicity |
|
|
Term
| small subcortical luciencies (Lacunar Infarcts) |
|
Definition
|
|
Term
| small subcortical luciencies (Lacunar Infarcts) |
|
Definition
|
|
Term
| treatment of Vascular Dementia |
|
Definition
Manange HTN and CVD risk factors.
CCB, anti-platelet meds, regular exercise, healthy diet, cholinesterase inhibitors (donepizil), glutamate receptor agonsits (memantine) |
|
|
Term
| key factors for depression |
|
Definition
| pt is aware of deficits, complains of memory loss, prominant vegitative symptoms, not worse at night, normal neuro exam, normal labs |
|
|
Term
| rhythmic oscillatory movement characterized by its relationship to voluntary motor activity. Enhanced by emotional stress and disappears during sleep. |
|
Definition
|
|
Term
| rapid irregular muscle jerks that occur involuntarily and unpredictably with normal strength. |
|
Definition
|
|
Term
| difficulty manintan muscular contraction for strength testing - hand grip may relax intermittently |
|
Definition
|
|
Term
| unilateral chorea that is especially violent with sudden, wild, flail like movements involving proximal muscle groups. |
|
Definition
|
|
Term
| sustained muscle contractions, frequently causing twisting and reptitive movements or abnormal postures - not present during sleep, enhanced by voluntary activity |
|
Definition
|
|
Term
|
Definition
| anticholinergics, dopamine |
|
|
Term
| difficulty or slowness in performing voluntary movements. May develop after long term treatment with antipsychotics (dopamine receptor blockers) or metaclopramide |
|
Definition
|
|
Term
| sudden, rapid, twitch like muscle contractions. |
|
Definition
|
|
Term
|
Definition
anticonvulsants (valproic acid)
benzodiazepine (clonazepam) |
|
|
Term
| sudden, recurrent, quick, coordinated movements. Typical of Tourette's |
|
Definition
|
|
Term
| abnormal movement present since infancy is probably due to |
|
Definition
| cerebral palsy or kernicterus |
|
|
Term
| abnormal movement developed in childhood, most likely due to |
|
Definition
|
|
Term
| abnormal movement developed in early adulthood, most likely due to |
|
Definition
| benign essential tremor, Huntington's disease |
|
|
Term
| abnormal movement developed in elderly years, most likely due to |
|
Definition
|
|
Term
| drugs that report "Tardive Dyskinesia" or "Extapyramidal Symptoms" |
|
Definition
| Reglan, Phenergan, Haldol |
|
|
Term
| hx of Rheumatic Fever may be indicative of? |
|
Definition
|
|
Term
| treament of a benign/essential tremor |
|
Definition
|
|
Term
| sudden onset of sustained muscle contractions, frequently causing twisting, repetitive movements or abnormal postures |
|
Definition
|
|
Term
| drugs associated with acute dystonic reactions |
|
Definition
| antipsychotic/neuroleptic drugs, phenothiazine anti-emetics, cocaine, "street valium" (Haldol), tricyclic antidepressants, lithium, phenytoin, carbemazepine, anticonvulsants |
|
|
Term
| abnormal movements associated with the treatment of schizophrenia |
|
Definition
| acute dystonia early, followed by Parkinson like effects weeks later, and Tardive Dyskinesia's have a late onset. |
|
|
Term
| treatment of acute dystonia |
|
Definition
d/c offending drug, administer anticholinergic drug (diphenhydramine 50-100mg IV over 2 minutes).
sxs should resolve in 15-30 minutes, can repeat dose in 15-30 mins if sxs persist.
If sxs persist longer than 2 doses consider non-drug induced dystonia |
|
|
Term
| resting tremor, cogwheel rigidity, akinesia/bradykinesia, progressive neurologic disorder. |
|
Definition
|
|
Term
| damage to substantia nigra with cell loss in basal ganglia --> disorder in the balance of GABA and ACh |
|
Definition
|
|
Term
| Pneumonic for symptoms of Parkinson's |
|
Definition
T - tremor (resting)
R - Rigidity
A - Akinesia/Badykinesia
P - Postural Instability |
|
|
Term
|
Definition
Dopamine replacement - carbidopa, levodopa
Anticholinergics - benzotropine
Amantadine: augments dopaminergic activity
Neuroprotection: Selegeline (MAOI), Coenzyme Q10 |
|
|
Term
| non pharmacologic treatment of Parkinson's |
|
Definition
| surgery, deep brain stimulation, physical therapy, speech therapy |
|
|
Term
| genetic mutation causes premature cell death, resulting in atrophy in cerebral cortex and caudate. |
|
Definition
|
|
Term
| Concentrations of GABA and ACh in basal ganglia are reduced, with increased levels of dopamine |
|
Definition
|
|
Term
| appears 2-3 months after rheumatic fever or Group A beta-hemalytic strep. Usually subsides in 4-6 months |
|
Definition
|
|
Term
| abnormal choreiform movements mistaken for fidgitiness, irritability, disobedience, obsessive compulsive symptoms, emotional lability |
|
Definition
|
|
Term
| treatment of Sydenham's Chorea |
|
Definition
| IM PCN or oral PEN until age 20 |
|
|
Term
| treatment of Huntington's Disease |
|
Definition
|
|
Term
| neurologic movement disorder that is often associated with sleep complaints |
|
Definition
|
|
Term
|
Definition
| iron deficiency, neurologic lesions, pregnancy, uremia |
|
|
Term
| diagnostic criteria for RLS |
|
Definition
| irresistable urge to move legs +/- uncomfortable sensations, urge to move is worse during periods of inactivity, urge to move is relieved by movement, urge to move is worse during evening or night. |
|
|
Term
|
Definition
non pharmacologic - stretching, mental alerting activities, avoid aggravating factors.
Dopaminergic agents (pramipexole), gabapentin, benzodiazpepines, opiods |
|
|
Term
| episode of altered consciousness characterized by excessive or over synchronized discharges of cerebral neurons |
|
Definition
|
|
Term
| brief symptoms that may precede the onset of some seizures |
|
Definition
|
|
Term
| group of disorders characterized by recurrent seizures |
|
Definition
|
|
Term
| LOC due to decreased blood supply to the cerebral hemisphere or brainstem |
|
Definition
|
|
Term
| syncope in upright or sitting position suggests |
|
Definition
| orthostatic hypotension or simple faint |
|
|
Term
| syncope in lying position suggests |
|
Definition
|
|
Term
| syncope during exercise suggests |
|
Definition
|
|
Term
| prolonged postictal state |
|
Definition
|
|
Term
| seizures from systemic disorders |
|
Definition
hyperosmolar states: HONK, hypernatremia
hypocalcemia <9.2
uremia
hypoglycemia <30 or drop quickly
hyponatremia <120 or drop quickly |
|
|
Term
|
Definition
| extreme stress, lack of sleep, watching flashing or strobe lights, low bood sugar, excessive intake of alcohol, certain medications, hormonal changes, illness |
|
|
Term
|
Definition
| not taking medication as prescribed |
|
|
Term
| most life threatening conditions having to do with seizures involve |
|
Definition
| hemorrhage, brain swelling, or mass effect |
|
|
Term
| indications for emergent non-contrast CT |
|
Definition
| few focal deficits, persistant AMS, fever, recent trauma, persistant HA, hx of CA, hx of anticoagulation, suspicion of AIDS, first time seizure in pt > 40 |
|
|
Term
| indications for emergency CT in pt with epilepsy |
|
Definition
| all non-epileptic indications PLUS new seizure pattern or type, prolonged postictal confusion |
|
|
Term
| when is MRI indicated with seizures? |
|
Definition
| it is the preferred imaging method but takes longer, so it is indicated once the pt is stabilized |
|
|
Term
| why scan the brain of a seizure pt? |
|
Definition
| rule out CNS hemorrhage/infarct, mass lesions, AVM, aneurysms, abscess, subdural hematoma |
|
|
Term
| when do you perform a LP in a seizure pt? |
|
Definition
| if the CT comes back negative, looking for xanthochromia (yellowing of the CSF, occurs in 4hrs) |
|
|
Term
| causes of secondary epilepsy |
|
Definition
| head injury, hypoglycemia, ETOH intoxication, narcotic withdrawal, encephalitis, stroke, hypoxia, hyponatremia, hypocalcemia, neoplasms, fevers |
|
|
Term
| seizure with maintained consciousness |
|
Definition
|
|
Term
| seizure with motor, sensory, psychic, or autonomic sxs without any LOC and lasts for < 1 min |
|
Definition
|
|
Term
| begin as simple partial seizures but profess to altered consciousness |
|
Definition
| complex partial, medial temporal or inferior frontal lobes |
|
|
Term
| sudden, brief lapses of consciousness without a loss of postural control, lasting only a few seconds. "daydreaming" |
|
Definition
Absence Seizures.
Tx = valproic acid 150mg TID
ethosuximide 250mg BID
check serum levels periodically |
|
|
Term
| LOC with or without preceding aura. extension of body (30 secs) and alternating muscle contraction and relaxation (30-60 secs), tongue biting |
|
Definition
| generalized tonic-clonic seizures |
|
|
Term
| sudden shocklike contractions localized to a few muscles or a limb, tend to be brief |
|
Definition
|
|
Term
| sudden loss of muscle tone with loss of body posture (drop attacks) |
|
Definition
|
|
Term
| slow single, or multiple sharp, repetitive, jerking movements of arms, legs, or torso |
|
Definition
|
|
Term
| sudden increase in muscle tone of face, upper body; flexion of arms and extension of legs |
|
Definition
|
|
Term
| tachycardia, elevated BP, hyperglycemia, elevatet temp, leukocytosis...how long did the seizure last? |
|
Definition
|
|
Term
| hypotension, hypoglycemia, dysrhythmias, pulmonary edema....how long did the seizure last? |
|
Definition
|
|
Term
| hypotension with decreased cerebral blood flow, disruption of BBB leading to cerebral edema... how long did the seizure last? |
|
Definition
|
|
Term
| treatment of tonic clonic seizures |
|
Definition
| recovery position, valproic acid (DOC), phenobarbital (60mg PO bid/tid), phenytoin (100mg PO tid), carbamazepine (200mg PO bid) |
|
|
Term
| partial seizure treatment |
|
Definition
| phenytoin 100mg PO tid, carbamazepine 200mg PO bid |
|
|
Term
| treatment of status epilepticus (prolonged seizure activity > 30 minutes) |
|
Definition
airway patency (OPA), position pt to prevent aspiraton, IV, O2.
r/o hypothermia, hypoglycemia, meningitis, trauma, etc |
|
|
Term
| Rx for status epilepticus |
|
Definition
thiamine 100mg IM, diazepam 0.1-0.2 mg/kg (max 20mg) or lorazepam 0.1 mg/kg IV (max 8mg).
seizures should be controlled in 30-40 minutes if not, intubate, move to secondary treatments while searching for etiology |
|
|
Term
| recurrent seizures already on drug therapy |
|
Definition
if partial control is achieved with one med consider adding:
gabapentin, topiramate, oxcarbazepine, zonisamide |
|
|
Term
| what should you monitor in all seizure pts on drug therapy? |
|
Definition
| CBC and LFT at 2 weeks, 1 month, 3 months, 6 months, and every 6 months |
|
|
Term
| occur in a child with a fever >102, typically benign and last < 5 minutes |
|
Definition
febrile seizures.
tx = reassurance |
|
|
Term
| irresitable sleep attacks and episodic muscular atonia |
|
Definition
|
|
Term
|
Definition
| nap therapy, CNS stimulants: methylphenidate, d-amphetamine |
|
|
Term
| unarousable unresponsiveness |
|
Definition
|
|
Term
| half way between alertness and coma |
|
Definition
|
|
Term
| usually due to an expanding lesion in the temporal lobe or lateral middle fossa cuasing compression of the 3rd nerve --> ipsilateral fixed, dilated pupil |
|
Definition
| uncal transtentorial herniation |
|
|
Term
| waxing and waning hyperpnea with brief episodes of apnea |
|
Definition
| Cheynes-Stokes respirations |
|
|
Term
| which way do the eyes look in caloric testing? |
|
Definition
|
|
Term
| should the Doll's Eye reflex be present in an alert person? |
|
Definition
| No, it should be supressed |
|
|
Term
| initial mangement of the pt with stupor/coma |
|
Definition
| ABC, intubate < 8, IV NS with 15g dextose, 100mg thiamine, 0.4-1.2mg naloxone |
|
|
Term
| irreversible loss of function of the brain including te brainstem, often from severe head injury or aneurysmal SAH |
|
Definition
|
|
Term
| cardinal features of brain death |
|
Definition
coma/unresponsiveness - no response to painful stimuli
absence of brainstem reflexes - fixed pupils, oculocephalic, gag, grimacing
Apnea - no respiratory attempts even with PCO2 >60 mmHg |
|
|
Term
| medical record documentation of brain death |
|
Definition
| etiology and irreversiblity of condition, absence of brainstem reflexes, absence of motor response to pain, absence of respiration with PCO2>60mmHg, confirmatory testing (angriography, EEG, evoked potentials), repated neurologic examination (reasonable to have 2 positive apnea tests 6 hours apart) |
|
|
Term
| worst headache of my life, + kernig's |
|
Definition
|
|
Term
| when is contrast needed with CT in SAH? |
|
Definition
|
|
Term
|
Definition
prevent elevated arterial BP(<140/100), prevent elevated ICP, IV fluids NS only if needed, analgesics PRN, AVOID ASA.
surgery - clipping or coil for rupture aneurysm, ligate/emobolize AVM |
|
|
Term
|
Definition
|
|
Term
| thorbbing, bilateral, occipital, nuchal pain, worse with sitting upright |
|
Definition
|
|
Term
| HA worse in AM, worse with exertion or valsalva, associated with N/V |
|
Definition
|
|
Term
| new onset HA later in life should raise suspicion for.... |
|
Definition
|
|
Term
| what should you avoid if you suspect a bran tumor? |
|
Definition
|
|
Term
| inflammation of carotid artery at the superficial temporal artery, MC after age 50. pain over scalp at temporal artery |
|
Definition
| temporal arteritis (giant cell arteritis) |
|
|
Term
| treatment of giant cell arteritis |
|
Definition
| urgent prednisone to avoid vision loss, burst with taper over several months. |
|
|
Term
|
Definition
| often idiopathic, can be caused by certain drugs (TCN), during corticosteroid withdrawal, and as sign of venous sinus thrombosis |
|
|
Term
| diffuse generalized HA made worse with straining, transient visual disturbances, papilledema, CN 6 palsy |
|
Definition
intracranial hypertension
tx = LP with drainage
consider acetazolamide, or lasix |
|
|
Term
| pain in dermatomal distribution, decreased pinprick sensation, deep gnawing pain with superimposed sharp elements exacerbated by contact |
|
Definition
|
|
Term
| treatment of post herpetic neuralgia |
|
Definition
amitriptyline, gabapentin, lidocaine, capsaicin cream.
prevention = treat shingles with acyclovir at time of outbreak.
Sxs usually resolve in 6-12 months but can persist longer |
|
|
Term
| excrutating, lancinating pain, unilaterally over lower 2/3 of face |
|
Definition
Tic Douloureux aka Trigeminal Neuralgia.
treatment = spontaneous recovery, also carbemazepine, phenytoin, baclofen |
|
|
Term
| pneumonic for sxs of migrain |
|
Definition
P - pulsatile
O - onset 4-72 hours
U - unilateral in location
N - nausea/vomiting
D - disabling in intensity
can occur with/without an aura |
|
|
Term
|
Definition
simple analgesics (acetaminophen, NSAIDs, Midrin, Fioricet)
5-HT agonists - sumatriptan (contraindicated in CVD and pregnancy).
Ergots - contraindicated in CVD and pregnancy.
narcotics - Demerol (10mg IV) avoid if at all possible
consider anti-emetic: metoclopramide, prochlorperazine |
|
|
Term
|
Definition
| BB (propranalol), TCA (amitriptyline), Valproic Acid |
|
|
Term
| HA due to oversue of analgesics and/or caffeine |
|
Definition
rebound HA
Tx - abrupt withdrawal of meds and caffeine containing sources. Consider sumatriptan or dihydroergotamine IV/IM during transition |
|
|
Term
| unilateral HA starts as burning sensation over lateral aspect of nose or prssure behind the eye. Brief, severe, constant, non throbbing attacks, last a few seconds to less than 2 hours |
|
Definition
|
|
Term
| treatment of cluster headaches |
|
Definition
100% O2, sumatriptan (4-6mg SC), dihydroergotamine (1mg), prednisone may stop cluster attacks.
Prophylaxis - Verapamil, Triptans, DHE |
|
|
Term
| chronic HA of unapparent cause that lacks the features of migraine or cluster HA. Contraction of neck and scalp muscles is probably a secondary phenomenon. |
|
Definition
|
|
Term
| frequent HA at least 15 days a month for more than 6 months, non throbbing, like a tight band around the head, typically bilateral forehead, temples or occiput |
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Definition
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Term
|
Definition
simple analgesics, ergots, avoid reboudn HA.
Prophylaxis - TCA, SSRI, psychotherapy, lifestyle mods, reassurance |
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Term
| non specific sxs that may follow a closed head injury. syndrome of HA, impaired concentration, and altered mood |
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Definition
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Term
| HA within 24 hrs of head injury, constant dull ache, worse with head movement, may worsen over several weeks with gradual improvement, N/V common, exam = non focal |
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Definition
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Term
| when is imaging not necessary with a HA |
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Definition
| classical migraine and normal neuro exam, tension type HA with normal exam |
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Term
| treatment of post traumatic HA |
|
Definition
| simple analgesics, amitriptyline, propranalol, ergot derivatives, encouragement |
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Term
| syndrome of acute neurologic deficits that are the result of cerebral infarction |
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Definition
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Term
| death of CNS tissue due to infarction that results from disruption of the blood supply. |
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Definition
| Ischemic (thrombotic or embolic) |
|
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Term
| rupture of abnormal blood vessel(s) that results in local disrupted tissue structure and toxic effects of blood products that leads to cell death. |
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Definition
|
|
Term
| potentially reversible injury to brain tissue resulting from impaired perfusion |
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Definition
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Term
| brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. |
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Definition
| TIA - warning sign of impending stroke. |
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Term
| bleeding within the brain tissue |
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Definition
|
|
Term
| bleeding into the arachnoid space |
|
Definition
|
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Term
|
Definition
| subdural/epidural hemorrhage |
|
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Term
| focal ischemia produces a central zone of death, with surrounding damage that is potentially reversible. |
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Definition
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|
Term
when does cerebral edem reach is max?
when does most death occur due to stroke? |
|
Definition
5 days post infarct.
within one week due to cerebral edema. |
|
|
Term
| abrupt onset of deficits with gradual improvement suggests..... |
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Definition
|
|
Term
| abrupt onset of deficits with gradual progression to maximum deficit over minutes to hours suggests..... |
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Definition
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|
Term
| onset of deficit during sleep or a stepwise progression usually suggests... |
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Definition
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|
Term
| onset of deficit associated with severe headache or alteration in consciousness suggests.... |
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Definition
|
|
Term
| where do the atherosclerotic plaques form in an anterior cerebral infarction? |
|
Definition
| bifurcation of the carotid artery |
|
|
Term
| storke associated with greater weakness in the legs than arms |
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Definition
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|
Term
| stroke with greater weakness of the arms than the legs. Leg typically circumducted outward. |
|
Definition
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|
Term
stroke:
dominant:aphasia, agraphia, acalculia, alexia
non dominant: neglext, apraxia, confusion |
|
Definition
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|
Term
stroke:
dominant: language
non dominant: neglect, confusion |
|
Definition
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|
Term
| stroke associated with Weber Syndrome (midbrain, CN 3 palsy and contralateral hemiplegia) |
|
Definition
| Posterior Cerebral Artery Occlusion |
|
|
Term
| sxs: presyncope, syncope, neurologic deficits, blood pressure differentiation between the arms |
|
Definition
| subclavian steal syndrome |
|
|
Term
| arterial HTN is the major risk factor for.... |
|
Definition
| small vessel disease (lacunar infarcts) |
|
|
Term
| three most predictive finding for acute stroke: |
|
Definition
| asymmetric facial weakness, arm drift/weakness, abnormal speech |
|
|
Term
| what should you always do in a young pt who has a stroke? |
|
Definition
|
|
Term
| appears dark on CT, may take up to 24 hours to show..... |
|
Definition
|
|
Term
|
Definition
|
|
Term
| which test is better for detecting infarction of the brainstem and cerebellum? CT or MRI |
|
Definition
|
|
Term
| good screen for carotid artery aneurysm |
|
Definition
|
|
Term
| ultrasound used in the evaluation of suspected stenosis of the intracranial internal carotid artery, middle cerebral artery, or basilar artery |
|
Definition
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|
Term
| may detect stenosis of large cerebral arteries, aneurysms, and other vascular lesions |
|
Definition
|
|
Term
| gold standard for the detection of AVM or SAH |
|
Definition
|
|
Term
| only approved treatment for stroke, what are the guidlines? |
|
Definition
TPA, must be done within 3 hours of event, preferably within 60 minutes of arriving at the ED.
<10 minutes to Dr
<25 minutes to scan
<20 to read of scan |
|
|
Term
| how should pts who are not a candidate for TPA be treated? |
|
Definition
| with aspirin once a bleeding stroke has been ruled out |
|
|
Term
|
Definition
| elevated BP that can't be controlled, bleed disorder with elevated PT/aPTT, decreased platelets, stroke or head trauma x 3 months, prior hx of intracranial hemorrhage, major surgery x 14 days, GI/GU bleeding x 21 days, MI in the prior 3 months, LP within the past 7 days, evidence of hemorrhage on head CT, sxs suggestive of SAH even if the CT is normal, pregnancy or lactation, active bleeding or acute trauma/fracture |
|
|
Term
| blood pressure control in ischemic stroke |
|
Definition
| should not be treated acutely unless the BP is greater than 220 and/or 120, then consider labetalol |
|
|
Term
| consider hospitalizatino for a pt with a TIA when..... |
|
Definition
| event occured in the past 24-48 hours, sxs that are worsening or last more than one hour, known cartid artery stenosis, afib, or hypercoagulable state. |
|
|
Term
|
Definition
| consider tPA, aspirin (325mg PO qd), ticlopidine (250mg PO bid), Clopidogrel (75mg PO qd), carotid endarterectomy, agnioplasty, stenting |
|
|
Term
| pneumonic for stroke risk x 30 days |
|
Definition
A - age > 60
B - SBP > 140, DBP >90
C - clinical factors (unilateral weakness, speech disturbance without weakness)
D - Duration (sxs > 60 mins, sxs 1-59 minutes).
score <2 no risk. 4 = 8%. 6 = 31% |
|
|
Term
| prevention of stroke and TIA |
|
Definition
| aggressive control of HTN, and other cardiac risk factors. aspirin, anticoagulation |
|
|
Term
| statin therapy provides high levels of protection for all cause mortality and ischemic strokes. true or false? |
|
Definition
|
|
Term
| a fib increases the risk of ischemic stroke by how much? |
|
Definition
|
|
Term
| bleeding sites of hemorrhagic stroke |
|
Definition
| deep cereral (putamen, thalamus), lobal (subcortical), pons, cerebella |
|
|
Term
| what is SAH usually due to? |
|
Definition
| ruptured cerebral artery aneurysm |
|
|
Term
| how does SAH appear on MRI? |
|
Definition
| center of an acute hemorrhage is brighter, with darker periphery which changes as the hematoma ages. |
|
|
Term
| what should you do if non contrast CT is negative? |
|
Definition
| perform an LP looking for xanthochromia (yellowing of the CSF in 4 hours) |
|
|
Term
|
Definition
SBP betweeen 140 and 160, and monitor for signs of cerebral hypoperfusion induced by fall in BP.
Tx = nitroprusside, nicardapine, labetalol |
|
|
Term
|
Definition
keep SBP lower than 140.
Tx = labetalol |
|
|
Term
| when is a stroke pt not a surgical candidate? |
|
Definition
| Grade 5, coma, decerebrate posturing |
|
|
Term
| how can you prevent increased ICP? |
|
Definition
| elevate the head of the bed, consider sedation, consider mannitol, consider hyperventilation |
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