Clin Med Neuro CMDT
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- Tension headache sx
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- poor concentration
- vague nonspecific symptoms
- often vise-like or tight
- stress, fatigue, noise, glare exacerbate
- usually generalized, sometimes intense in neck, back of head
- maybe from chronic anxiety - Tension headache tx
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- analgesics
- antimigrainous agents
- relaxation techniques
- maybe local botulinum toxin type A injx - Depression headache sx
-
- worse in AM
- maybe w/other depression sx
- sometime focus of somatic delusional system - Depression headach tx
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- antidepressants
- psychiatric consult - Migraine Essentials of Dx
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- headache, usually pulsatile
- n/v, photophobia, phonophobia
- maybe transient visual neuro sx, e.g., stars, flashes, scintillating scotomas preceding headache
- maybe no preceding aura - Migraine pathyphys
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- related to serotonin
- release of neuropeptides acting as neurotransmitters at trigeminal nerve branches, leading to inflammation
- maybe activation of dorsal raphe nucleus - Migraine - basilar artery
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- uncommon variant
- blindness or vis disturb accompanied or followed by dysarthria, disequilibrium, tinnitus, perioral and distal paresthesias
- sometimes loss of consciousness or confused state
- throbbing, occipital headache, n/v follow - Migraine - ophthalmoplegic
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- lateralized pain around eye
- n/v, diplopia due to transient ext ophthalmoplegia due to CNIII palsy - myasthenia gravis
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- insidious onset
- autoimmune
- fluctuating muscle weakness -
grand mal seizure
(tonic-clonic) -
- loss of consciousness
- rigidity (tonic)
- resp depression
- jerking of all 4 limbs (clonic)
- urinary incont, tongue bite - carpel tunnel 1st line tx
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- splinting
- NSAIDs
- ergonomic eval - common signs of Parkinson's
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-resting tremor
- often unilateral
- "pill-rolling"
- also cogwheel rigidity
- bradykinesia
- diminished postural reflexes, i.e., diff keeping balance - types of seizures
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- tonic-clonic
- myoclonic
- absence
- tonic
- atonic - myoclonic seizure feature
- - brief jerking of part or all of the body
- TIA manifestations
-
- focal deficits of 5-15 min, w/return to baseline
- heaviness of extremities
- paresthesias
- numbness
- monocular loss of vision - How is viral meningitis treated?
-
- observation at home
- analgesics
- antiemetics - Meniere's syndrome
- a peripheral lesion causing vertigo
- What class of drugs are approved for palliative treatment of Alzheimer's?
- anticholinesterases, e.g., donepezil, selegiline, tacrine (Cognex), psychotropics
- modifiable risk factors for stroke include:
-
- hypercholesterolemia
- a-fib
- HTN
- DM - anti-parkinsonian agent that directly stimulates post-synaptic receptors
- pergolide
- sx of peripheral vertigo
-
- marked vertigo
- tinnitus - what type of vertigo is shows vertical nystagmus?
- central vertigo
- sx of petit mal (absence) seizures
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- sudden onset of brief episodes of consciousness of which pt is unaware
- often described as daydreaming
- eyelid twitching -
what agent is used in managing acute coma?
a. mannitol
b. Cogentin
c. ipratropium bromide -
a. mannitol
The other two are anticholinergics. - CVA
- cerebrovascular accident or stroke syndrome: a condition with sudden onset caused by acute vascular lesions of the brain, such as infarction from hemorrhage, embolism, or thrombosis, or rupturing aneurysm. It may be marked by any of a variety of symptoms reflecting the focus of infarction or hemorrhage, including hemiparesis, vertigo, numbness, aphasia, and dysarthria; it is often followed by permanent neurologic damage.
- T/F? Multifocal epilepsy is caused by a brain injury.
- F. Mulitfocal epilepsy is of unknown etiology, but brain injury is NOT the suspected cause.
-
Which of the following is chronic and genetic?
a. Bell's palsy
b. myasthenia gravis
c. Parkinson's disease
d. muscular dystrophy - d. muscular dystrophy
- antibiotic therapy for bacterial meningitis
- ampicillin, chloramphenicol, ceftriaxone
-
most common type of ischemic event in a pt w/ a prior CVA is:
a. thrombotic
b. embolic
c. hemorrhagic
d. edema
e. subarachnoid hemorrhage - a. thrombotic
- trigeminal neuralgia hallmark
-
trigger zone
- naso-labial fold
- upper, lower lips - glossopharyngeal CN9 neuralgia
- pain in tonsil area, base of tongue, lateral pharyngeal wall; pain triggered by eating
- CRPS - complex regional pain syndrome
- continuous regional dist of pain, in all or part of extremity. Usually follows trauma, tho no direct correlation between severity of injury and intensity of pain
- TENS - trancutaneous electrical nerve stimulation
- elec impulse goes thru skin and desensitizes area to pain
- 4 types of vascular headaches
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1. migraine
2. cluster
3. toxic
4. hypertensive - Brudzinski's sign
- sign of meningitis -- pt. supine; head passively elevated from table; if positive (pain), pt will flex arm, hip, knee
- Kernig's sign
- sign of meningitis -- pain in lower back and resistance to straightening the leg constitute positive sign
- epidural hematoma
- between dura and skull
- intracerebral hematoma sx
- sudden onset, incapacitating h/a, decreased level of consciousness, maybe n/v
- tentorium cerebelli
- separates occipital lobes of cerebral hemispheres from cerebellum
- superior salvitory nucleus
- area of pons that produces parasympathetic fibers that go to the SPG sphenopalatine ganglia
- dyskinesia
- abnormal involuntary movement
- dystonia
- involuntary sustained muscle contraction; painful; fixed postures
- kinetic tremor; goal-oriented tremor
- tremor upon movement, not at rest
- choreoform
- piano-playing movements
- essential tremor
- involuntary fine shaking of the hand, head, face, esp during routine body movement; autosomal dominant
- ictal
- pertaining to a sudden acute onset, e.g., seizure
- reactive seizure
- single seizure caused by fever, etoh, drug, infxn, etc.
- secondary generalized seizure
- starts focal/local; spreads to both hemispheres, becomes generalized
- status epilepticus
- generalized seizure that doesn't stop; by def, > 30 min; can be fatal (from hypoxia?)
- absence seizure
- epileptic seizure characterized by a sudden, momentary loss of consciousness. Usually occurs many times a day w/o warning aura; most frequent in children, esp. at puberty
- clonus
- abnl pattern of neuromuscular activity, rapidly alternating involuntary contraction and relaxation of skeletal muscle
- Todd's paralysis
- postepileptic hemiplegia or monoplegia lasting a few min, hrs, days
- complex partial seizure
-
- focal seizure
- aura
- malaise, nausea
- slow, rep. limb movements w/head, eye and postural rigidity
-autonomic disability
- impaired ability to comprehend, register, or process info during seizure - post-traumatic seizure
- secondary generalized or partial/focal seizure after head trauma
- BEAM, aka quantitative EEG
- brain electrical activity mapping; detects very sudden wave/form changes eye can't pick up
- multiple sclerosis
- immune mediated demyelinating disease w/periods of relapsing or progressive and remitting neurologic symptoms
- amyotropy
- wasting of muscles
- intention tremor
- when moving towards something, tremor starts
- scanning speech
- abnl speech; singing; staccato-like; person pauses between syllables
- Charcot's triad
-
3 hallmark sx of MS multiple sclerosis
1. nystagmus
2. scanning speech
3. intention tremor - decerebrate posture
- position of comatose patient in which arms are extended and internally rotated; legs extended w/feet in forced plantar flexion; usually in pt w/ compress of brainstem at low level (midbrain and pons)
- decorticate posture
- position of comatose patient in which up extremities are rigidly flexed at elbows and wrists; legs may also be flexed; indicates lesion in higher, corticotract mesencephalic region of brain
- internuclear ophtalmoplegia
- lesion in medial longitudinal fasciculus of brainstem causing nystagmus; eyes aBduct; bilateral abducting nystagmus
- trigeminal neuralgia
- hearing loss and vertigo
- neurogenic pain
- usually band-like pain around body or b ack
- light coma
- subgroup of coma; there may be a reflex, primitive response to light
- deep coma
- no response to any painful stimuli
- caloric testing
- cold water in ears, wakeful pt's eyes will develop rotatory nystagmus away from irrigated side
- locked-in syndrome
- looks like coma, but higher mental functions intact; related to infarction of basilar pons region; pt is quadriplegic w/ paralysis of lower cranial nerves -- can't breathe, talk
- ascending reticular activation system
- the part of the brain that controls wakefulness/ arousability
- central herniation
- cerebral hemisphere is caudally displaced in midline fashion
- unilateral uncus herniation
- lesions laterally displaced in temporal lobe, and brain herniates downward (uncus = hooklike anterior end of the hippocampal gyrus on the temporal lobe of the brain)
- Doll's eyes
- transient eye movement opposite the direction of head movement; if eyes move in same direction as head, indicative of severe brainstem damage
- Wernicke's encephalopathy or syndrome
-
inflam, hemorrhagic, degenerative condition of the brain; char by lesions in several parts of the brain; caused by thiamine B12 deficiency and seen in chronic alcoholism
ophthalmoplegia
nystagmus
vomiting
ataxia
mental deterioration - post-hyperventilation apnea
- 3 min hyperventillation followed by >30 sec apnea; indicates diffuse metabolic disease or damage to forebrain
- Cheyne Stokes respiration
- alternating periods of apnea and deep, rapid breathing; cyclical; slow waxing and waning of repiration, then 30 sec apnea; dysfunction of diencephalon or by bilateral hemispheric lesions or early brain stem compression
- central neurogenic hyperventilation
- - regular, rapid breathing; like on ventilator; indicates lesion in midbrain/pons
- apneustic breathing
- pattern char by prolonged inspiratory phase followed by expiration apnea; associated w/pontine lesion
- ataxic breathing
- associated w/lesion in medullary respiratory center and char by series of irregular inspir, expir
- dementia
- adult acquired intellectual deterioration
- memory impairment
- impaired ability to learn something new or to recall previously learned info
- isolated memory impairment (mild cognitive impairment)
- memory prob with NO other cogntiive disturbances
- apolipoprotein B
- lipid transport protein in the brain
- glutamate
- neurotransmitter released during thinking; a major excitatory amino acid of the CNS
- executive function
- ability to plan and sequence events
- aphasia
- absence or impairment of ability to communicate thru speech, writing, or signs because of dysfunction in dominant hemisphere
- apraxia
- inability to perform tasks or activities even tho motor, sensory, and cerebellar functions are preserved; problem is in cortex
- agnosia
- inability to recognize familiar or common environmental stimulie even tho sensory, motor, and cerebellar functions are preserved; can't recognize color, body parts, etc.
- anopsia
- visual field defects
- Wernicke's aphasia; fluent aphasia
-
-affects dominant temporal lobe
-pt cannot follow commands; cannot repeat sentences
-pure aphasia; no associated weakness
-visual field problems: nystagmus, trouble moving eyes