Term
|
Definition
tachycardia
sweating
dilated pupils
sometimes mimics herniation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| signs bacterial meningitis 4 |
|
Definition
headache
fever
brudzinski
kernig |
|
|
Term
| LP signs bacterial meningitis |
|
Definition
CSF gram staim positive
low glucose
increased protein |
|
|
Term
|
Definition
|
|
Term
| signs subarachnoid hemorrhage 5 |
|
Definition
headache
htn
retinal hemorrhage
brudzinski
kernig |
|
|
Term
| labs subarachnoid hemorrhage |
|
Definition
non clearing RBC in CSF
subarachnoid blood/anrueysm
vascular malformation on CT |
|
|
Term
| tx subarachnoid hemorrhage 2 |
|
Definition
surgucal ablation of aneurysm
other vascular malformation surgery |
|
|
Term
| signs traumatic intracranial hemorrhage 3 |
|
Definition
headache
htn
lateralized neurological signs |
|
|
Term
| labs traumatic intracranial hemorrhage 3 |
|
Definition
| epidural, subdural, intracerebral hemorrhage on CT |
|
|
Term
| tx traumatic intracranial hemorrhage |
|
Definition
| surgical evacuation of epidral/subdural hematoma |
|
|
Term
| causes of AA sublexation 6 |
|
Definition
rheumatoid arthritis
down syndrome: absent transverse axis ligament
marfans: lax ligament
elhers danlos: lax ligament
malformation of odontoid
degenerative arthritis |
|
|
Term
| signs of AA sublexation 5 |
|
Definition
decreased motor skills
torticollis
gait disorder
progressive paralysis
pain: C spine, neck, occipital |
|
|
Term
| complications of AA sublexation 1 |
|
Definition
|
|
Term
| stroke: highest rate location, who can have one |
|
Definition
highest in south east US
anyone: risk differs among race and ethnicity |
|
|
Term
| where is stroke in cause of death statistics |
|
Definition
| under heart disease and cancer at #3 |
|
|
Term
| how many neurological disease hospitalizations are due to stroke |
|
Definition
|
|
Term
| how many people have neurological deficits from stroke in us, how many strokes in us a year, how much does it cost |
|
Definition
4 million with deficits
>700,000 a year
43.3 billion |
|
|
Term
| what percent of stroke is preventable |
|
Definition
|
|
Term
| stroke: emergncy?, recovery length, statistic in cause of dissability |
|
Definition
requires emergency tx
recovery is life time
leading cause of long term dissabiity |
|
|
Term
| non-modifiable risk factors of stroke 5 |
|
Definition
age: risk doubles with each decade
gender: higher in males
race: higher in AA, asian, hispanic
family hx
low birth weight |
|
|
Term
| modifable risk factors for stroke 14 |
|
Definition
smoking
drugs
oral contraceptives
post menopause therapy
obesity
physical inactivity
diabetes
elevated BP
elevated LDL
AFib
CHF
CAD
carotid stenosis
peripherial artery disease |
|
|
Term
| what is the percent of TIA that will have a stroke in 5y |
|
Definition
|
|
Term
| clinical signs of a stroke 11 |
|
Definition
sudden onset, gradual resolution
multiple body regions
facial droop
arm drift
sudden weakness/paralysis
numbness: face, arm, leg
speech: slurred, mute
vision: dim, loss (esp one eye)
headache: ipsilateral, non-throbbing, sudden severe
LOC
AMAUROSIS FUGAX |
|
|
Term
| amaurosis fugax: explain MOA, cause, defining characteristics, prognosis statistics |
|
Definition
unilateral loss of vision developing over seconds and remaling 10-20 min
caused by emboli in renal arteru usually due to athlerosclerotic lesion in carotid bifurcation, mitral valve prolapse, or other cardiac source
often indicator of impending stroke (14% in 7y, 50% TIA) |
|
|
Term
|
Definition
aspirin
remove plaque surgically |
|
|
Term
| what are the three types of ischemic stroke |
|
Definition
thrombosis 61%
embolism 24%
TIA |
|
|
Term
| ischmic thrombotic stroke: length of evolution, warning signs |
|
Definition
symptoms evolve in minutes to hours
preceded by TIA in same region as thrombus so causes similar symptoms |
|
|
Term
| ischemic embolic stroke: locations 2, warning signs |
|
Definition
often occludes middle cerebral artery
if posterior it is at apex of basilar
usualy have neurological deficits and signs varying between attacks because they are being thrown to different areas by cardiac source |
|
|
Term
| TIA: defining characterstiics, goals of evaluation |
|
Definition
symptoms and recovery under an hour
eveluation is aimed at finding cause and preventing reoccurrance |
|
|
Term
| categories of causes of ischemic stroke 2 |
|
Definition
vessel occlusion
cardiac events and diseases |
|
|
Term
| vessel occlusions that cause ischemic stroke 5 |
|
Definition
large artery athlerosclerosis: extra or intracranial
small artery occlusion
cardioembolism
hematologic disorder/hypercoaguable state
non-athlerosclerotic vasculoplastics: inflammatory and non |
|
|
Term
| major cardiac diseases at risk for stroke 8 |
|
Definition
AFib
mitral stenosis
mechanical heart valves
recent MI
atrial myxoma
infective endocarditis
dilated cardiomyopathy
marantic endocarditis |
|
|
Term
| minor cardiac diseases at risk for stroke 5 |
|
Definition
mitral valve prolpase
mitral annular calcification
PFO
atrial septal aneurysm
calcified aortic stenosis |
|
|
Term
| symptoms of stroke if in carotid circulation 4 |
|
Definition
pain in trigeminal distribution
IPSILATERAL MONOOCULAR graying, clouding, burning, loss of vision
CONTRALATERAL weakness, clumsiness, numbness
language or articulatory disturbances
visual and neurological symptoms dont normally occur together |
|
|
Term
| symptoms of a stroke if in vertebrobasilar circulation 6 |
|
Definition
pain in occipital area
DOUBLE VISION, BINOCULAR graying, clouding, burning, loss of vision
vertigo
UNILATERAL or bilateral weakness, clumsiness, numbness in limbs
articulatory or swallowing disturbances
lack of coordination or staggering while walking |
|
|
Term
| steps of examinatioon of stroke 6 |
|
Definition
vitals: HTN and arrhythmia check
BP: check for arterial disease, stenosis, occlusion (ESP SUBCLAVIAN)
pulse in neck and temple: extracranial carotid occlusion or stenosis
ascultate subclavian, neck, orbit, skull
neurological exam: usually normal, can help localize |
|
|
Term
| diagnostic studies for stroke 7 |
|
Definition
CT
MRI
CXR
ECG
CBC: differential, platelet, prothrombin, thromboplastin, ESR, CHEM, fasting glucose
TEE/TTE
stress ECG |
|
|
Term
| when should you hospitalize a possible stroke pt |
|
Definition
recent <48h
prolonged or crescendo events
suspected high grade carotid artery disease
posterior circulation TIA |
|
|
Term
| post-emergency stroke management |
|
Definition
IV heparin or aspirin if recurrent or recent (aspirin has immediate platelet effect and is alternate)
corticosteroids and dehydrating agents for cerebral edema |
|
|
Term
| what percent of stroke pt are independent by 6mo |
|
Definition
|
|
Term
| why can't you always just give TIA |
|
Definition
|
|
Term
| signs of hemorrhagic stroke 5 |
|
Definition
severe headache
depression of conciousness
neurological deficits that dont correlate to specific vessel
NAUSEA, VOMITING |
|
|
Term
| causes of hemorrhagic stroke, which is #1 (12) |
|
Definition
#1 HTN
amyloid angiopathy
anti-coagulants
tPA
post-infarction
delayed post trauma
endocarditis
coagulopathy
AVM/aneurysm
tumor
vasculopathy/vasculitis
post-thrombotic |
|
|
Term
| where are the main sites of damage from HTN caused hemorrhage 6, and their prevelance |
|
Definition
putamen 50%
thalamus 15%
lobar 15%
cerebellum 10%
pons 10% |
|
|
Term
| if BP is controlled, what is the rate reoccurrance of a hemorrhagic HTN stroke |
|
Definition
|
|
Term
| where does amyloid angiopathy hemorrhae usually occur 3 |
|
Definition
lobal
multiple bilateral
parieto occipital |
|
|
Term
| causes of amyloid angiopathy hemorrhage 3 |
|
Definition
| dementia, alzheimers, >70yo |
|
|
Term
| warfarin caused hemorrhage: method, statistic, risk reoccurrance |
|
Definition
causes DVT, PE, AF
doubles mortality from hemorrhage
5-15% of hemorrhage cases
risk reoccurrance 10x |
|
|
Term
| how much does tPA increase the rate of hemorrhage, where |
|
Definition
| 6%, 18% at different site than stroke |
|
|
Term
| risk factors for tPA hemorrhage 4 |
|
Definition
>70yo
glucose >300
NIHSS>20
early ischemic changes on CT |
|
|
Term
| what are the 6 outcome predicotrs for hemorrhagic stroke |
|
Definition
hematoma volume and expansion
intraventricular extension
deep ICH location
GCS
age
cerebral edema: midline shift, herniation |
|
|
Term
| what is the risk of mortality for 0-20cm, 30-60cm, >60cm expansion of hemorrhage |
|
Definition
0-20: 19%
39-60: 30-55%
>60: 90% |
|
|
Term
| what is the statistic for how many people have hemorrhage expansion in 1h, 24h, major expansion in 24h |
|
Definition
1h 26%
>33% in 24h 38%
expansion in 24h at all 72% |
|
|
Term
| how is a hemorrhage diagnosed 2 |
|
Definition
CT without contrast: shows hematoma in parenchyma
MRI: shows intraparenchymal blood |
|
|
Term
| supportive care for hemorrhage 6 |
|
Definition
ABCs
BP management systolic <140
cerebral edema reduction
surgery to evacuate clot
fever management
DVT prophylaxis
anti-convulsants- NO ROLE |
|
|
Term
| why do you want to avoid agressive reduction of BP in hemorrhage |
|
Definition
| could compormise flow to brain |
|
|
Term
| signs of subarachnoid hemorrhage 8 |
|
Definition
headache: worst of life
non-focal neuro deficits
vomiting
stiff neck
fever
confusion or stupor
coma
oculomotor nerve palsy due to compression of CN III |
|
|
Term
| cause of subarachnoid hemorrhage 7 |
|
Definition
trauma
AVM/aneurysm
arteritis
drug abuse
coarctation of aorta
family hx pregnancy |
|
|
Term
| diagnosis of subarachnoid hemorrhage 4 |
|
Definition
CT: confirms, hydrocephalus check
MRI: detects smaller bleeds
LP: if CT/MRI not helpful evaluate opening pressure, RBC, xanthochromic
EEG: Deep T waves, short PR, takk U |
|
|
Term
| tx subarachnoid hemorrhage 7 |
|
Definition
bed rest
elevated head
mild sedation
analgesics for headache
NO antiplatelet drugs
reduce BP to 160/100
surgical tx of ruptured vessels as needed |
|
|
Term
|
Definition
|
|
Term
| cause of trigeminal neuralgia with decreased facial sensation 5 |
|
Definition
intracranial aneurysm
giant cell arteritis
intracranial tumors
dental mandibular malignancy
cranial malignancy |
|
|
Term
| cause of trigeminal neurlagia with normal facial sensation 3 |
|
Definition
idiopathic
MS
dental pathology |
|
|
Term
| trigeminal neuralgia: duration, reoccurrance, time of day, between reoccurrance |
|
Definition
2sec - 2 min
jab or clusters
for a few weeks them remits
asymptomatic between attacks
day or night |
|
|
Term
| trigeminal neuralgia symptoms |
|
Definition
intense pain in lips gums, cheek, chin
sudden, intense, sharp, superificial, burning, severe
NO NEUROLOGICAL DEFICITS |
|
|
Term
| what part of the trigeminal nerve is trigeminal neuralgia usually in |
|
Definition
|
|
Term
| what can percipitate a trigeminal neuralgia attack |
|
Definition
spontaneous
motion of mouth
trigger zones: face lips, tongue respond to tactile stimuli
eating, talking, washing fact, cleaning teeth |
|
|
Term
| what is the pathology behind trigeminal neuralgia |
|
Definition
compression where CN 5 enters brainstem causes demyelination of non-pain fibers that become hyperexcited and stimulate poorly/un myelinated pain fibers near by
superior cerebellar artery or tortous vein compresses due to age related brain sagging and increased vascular thickness and tortousity |
|
|
Term
| DDx trigeminal neuralgia 11 |
|
Definition
disease/neoplasm of jaw, teeth, sinuses
vascular malformation of brainstem
post-herpatic pan: antecedent rash, scaring (usually when opthalmic division)
sjogerns syndrome and RA: sensory deficits
migraine/cluster headache: associated with neuraliga (cluster tic), more prolonged
MS: BILATERAL due to demyelination of CH5 at nerve root at pons, will have SENSORY LOSS
aneurysm, acoustic schwannoma, meningioma: sensory loss
temporal arteritis: PAIN ISNT SHOCK LIKE, WILL HAVE ELEVATED ESR |
|
|
Term
| labs done for diagnosis of trigeminal neuralgia 2, why |
|
Definition
ESR: RO temporal arteritis
MRI: RO MS |
|
|
Term
|
Definition
carbamazepime 1 mo
oxycarbamazepime
surgical microvascular decompression
gamma knife radiosurgery
radiofrequence theraml rhizotomy |
|
|
Term
| when do you use EEG to diagnose headache |
|
Definition
altered conciousness
encephalopathy
focal neurological signs
atypical auras |
|
|
Term
| when do you use CT/MRI to diagnose headache |
|
Definition
recent change in headache pattern
new onset of seizures
focal neurological signs |
|
|
Term
| what can MRA and MRV helps us diagnose 8 |
|
Definition
cerebelvascular: arterial dissection (MRA), cerebral venous sinus thrombosis (MRV), CNS vasculitis
herpes encephalitis
trauma: posterior fossa, pituitary, leptomeninges
high and low ICP syndromes |
|
|
Term
| what do you always have to make sure before a LP |
|
Definition
| cranial imaging is normal |
|
|
Term
| when should you do an LP for headache 7 |
|
Definition
thunderclap headache
subacute progressive headache
headache associated with fever, meningisums, confusion, seizure
high or low ICP |
|
|
Term
| when a headache is exercised induced think |
|
Definition
| saggital sinus thrombosis |
|
|
Term
| when a headache causes change in vision think 5 |
|
Definition
temporal arteritis
retroorbital aneurysm
mass lesion
glaucoma
pseudotumor cerebri |
|
|
Term
| when an headache includes increased temp think 3 |
|
Definition
meningitis
encephalitis
sepsis |
|
|
Term
| when a headache includes high BP think 4 |
|
Definition
malignant HTN
pheochromocytoma
intrancranial mass lesion (cushing response)
sepsis |
|
|
Term
| when a leadache includes low BP think |
|
Definition
|
|
Term
| when a headache includes high pulse think 2 |
|
Definition
|
|
Term
| when a headache is in temporal region think |
|
Definition
|
|
Term
| when the headache is associated with trauma behind TM think |
|
Definition
|
|
Term
| when headache includes horner syndrome think |
|
Definition
|
|
Term
| when a headache includes brainstem signs think |
|
Definition
|
|
Term
| when a headache includes focal neurological signs think |
|
Definition
|
|
Term
| general signs of a migraine 13 |
|
Definition
unilateral
pulsatile
nausea
vomiting
photophobia
phonophobia
lassitude
prodrome mood, appetite, cognition. GI, fatigue
>2g but <1d |
|
|
Term
| what are the two types of not-complicated migraine |
|
Definition
with aura - classic
without aura - common |
|
|
Term
| what are visual auras that could precede a classic migraine 3 |
|
Definition
hemianopic field deficits
scotomas (blind spots)
scintillations (flickering) |
|
|
Term
| migraine without aura: length if untreated, signs 5 |
|
Definition
4-72h untreated
occasionally terminated by vomiting
usually bilateral and periorbital
throbbing
cervical muscle contraction
scalp tenderness |
|
|
Term
| things that can percipitate a migraine 6 |
|
Definition
foods: tyramine (cheese, meat, nitrate, chocolate, MSG)
fasting
emotion
menses
drugs: OC, nitro
bright light |
|
|
Term
|
Definition
ergots: cause vasoconstriction
amyl nitrate: cause vasodilation
pressing ipsilateral carotid or superificial temporal artery may reduce severity |
|
|
Term
| types of complicated migraine 4 |
|
Definition
basilar
hemiplegic
opthalmoplegic
migraine equlivanents |
|
|
Term
| basilar migraine: who, symptoms 7 |
|
Definition
young women
bilateral visual
migranous march then spontaneous resolution
dysarthria
vertigo
ataxia
limb parasthesia
even tetraparesis
LOC an ensue or precede |
|
|
Term
| hemiplegic migraine: cause 2, signs 2 |
|
Definition
familial: dominant
idiopathic
aura: unilateral paralysis, persists for days affter headache
stroke like, can often cause stroke |
|
|
Term
| signs of opthalamoplegic migraine |
|
Definition
extraocular nerve palsies: usually 3rd, sometimes 4th
due to dilation of internal carotid stretching CN3 or CN6 in cavernous sinus
dysphagia
memory disturbance
vertigo
hemisensory disturbance
focal neurological disrutbance without headache |
|
|
Term
| signs of migraine equivalents |
|
Definition
migraine without headache (esp >50yo)
lasts 15-20 min
visual disturbance
hemiparesis
hemisensory loss
dysarthria
aphasia |
|
|
Term
| cluster headache: who gets it, ehy |
|
Definition
men>women
20-30yo
genetic predisposition
serum histamine raises dring atack |
|
|
Term
|
Definition
severe unilateral orbital, suborbital, temporal pain
15-180 min
seperated by weeks or months
often wake from sleep
conjunctival infection
lacrimation
congestion
rhinorrhea
swelling and eyelid edema
miosis ptosis |
|
|
Term
| cluster headache percipitation 2 |
|
Definition
|
|
Term
| treatment of cluster headache |
|
Definition
antihistammine: not awesome
ergot methysergide: prophylaxis
lithium: useful
prednisone: in refractory cases |
|
|
Term
| tension headache: who, signs |
|
Definition
20yo woman
chronic recurrant headache with unapparent cause
contraction of neck and scalp muscles
non-throbbing
bilateral occipital
no nausea, vomiting, prodrome |
|
|
Term
|
Definition
migraine meds
aspirin
nsaid
tylanol
ergot
dihydroergotamine
prophylaxis: amitriptyline, imipramine, propranolol (selective SSRI not useful)
psychotherapy: relaxation, PT |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| definition of temporal arteritis, location |
|
Definition
| systemic vasculitis in medium and large erteries (esp external carotid) |
|
|
Term
| 2 pathological findings of temporal arteritis |
|
Definition
subacute granulomatous inflammation: lymphocytes, neutrophils, giant cells
inflammatory of vessl wall |
|
|
Term
| signs of temporal arteritis 9 |
|
Definition
headache: inflammation of artery, severe throbbing
ischemia: arterial stenosis
malaise
weight loss
arthralgia
fever
scalp tenderness: laying down, brushing hair
jaw claudication: pain when clenching due to ischemia of muscles of mastication
visual symptoms |
|
|
Term
| disgnosis of temporal arteritis 5 |
|
Definition
ESR elevatiom
thrombocytosis
elevated CRP
ALK-P
biopsy of artery: thick, non-pulsatile, dilated, tender |
|
|
Term
|
Definition
|
|
