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Clin Med Neuro CMDT


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Tension headache sx
- 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
- 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
- antidepressants
- psychiatric consult
Migraine Essentials of Dx
- 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
- 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
- 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
- lateralized pain around eye
- n/v, diplopia due to transient ext ophthalmoplegia due to CNIII palsy
myasthenia gravis
- insidious onset
- autoimmune
- fluctuating muscle weakness
grand mal seizure
- loss of consciousness
- rigidity (tonic)
- resp depression
- jerking of all 4 limbs (clonic)
- urinary incont, tongue bite
carpel tunnel 1st line tx
- splinting
- ergonomic eval
common signs of Parkinson's
-resting tremor
- often unilateral
- "pill-rolling"
- also cogwheel rigidity
- bradykinesia
- diminished postural reflexes, i.e., diff keeping balance
types of seizures
- 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
- DM
anti-parkinsonian agent that directly stimulates post-synaptic receptors
sx of peripheral vertigo
- marked vertigo
- tinnitus
what type of vertigo is shows vertical nystagmus?
central vertigo
sx of petit mal (absence) seizures
- 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.
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
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
abnormal involuntary movement
involuntary sustained muscle contraction; painful; fixed postures
kinetic tremor; goal-oriented tremor
tremor upon movement, not at rest
piano-playing movements
essential tremor
involuntary fine shaking of the hand, head, face, esp during routine body movement; autosomal dominant
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
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
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
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
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
neurotransmitter released during thinking; a major excitatory amino acid of the CNS
executive function
ability to plan and sequence events
absence or impairment of ability to communicate thru speech, writing, or signs because of dysfunction in dominant hemisphere
inability to perform tasks or activities even tho motor, sensory, and cerebellar functions are preserved; problem is in cortex
inability to recognize familiar or common environmental stimulie even tho sensory, motor, and cerebellar functions are preserved; can't recognize color, body parts, etc.
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

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