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A comprehensive overview of adult neurology, focusing on common conditions like headaches, seizures, and stroke. It covers various types of headaches, including tension headaches, migraines, and cluster headaches, outlining their causes, symptoms, diagnosis, and treatment. The document also delves into different types of seizures, their classification, management, and long-term treatment options. Additionally, it discusses transient ischemic attacks (tias) and stroke, highlighting their causes, symptoms, diagnosis, and management strategies. A valuable resource for students and professionals seeking to understand and manage these neurological conditions.
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what are the 3 different types of headache? cluster migraine tension if someone says it is the worst headache of their life, what is that a red flag for? subarachnoid hemorrhage what is the most important history item for headaches? chronology what is the most common type of headache, it is what 90% of headaches are, it is vise like or tight in quality, usually generalized, it may be most intense about the neck or back of head, there are no associated focal neurological symptoms, and it usually lasts for several hours? tension what is the managment for a tension headache? OTC analgesics relaxation what are these s/s of: vise like or tight in quality usually generalized may be most intense about the neck or back of head no associated focal neurological symptoms lasts for several hours? tension headache what are the two categories migraine headaches are divided into? classic (migraine with aura)
common (migraine without aura) what headaches have two categories of classic or common, they have been related to dilation and excessive pulsation of branches of the external carotid artery, these headaches typically last 2-72 hours, and they follow the trigeminal nerve pathway? migraine headaches what are these causes/incidence of: usually onset in adolescence or early adult years family history females more affected "triggers" nitate containing food changes in weather? migraines what are these examples of: emotional or physical stress lack or excess sleep missed meals specific foods alcoholic beverages menstruation use of oral contraceptives? migraine triggers what are these findings of:
unilateral lateralized throbbing headache that occurs episodic dull or throbbing build gradually, lasts several hours or days focal neurologic disturbances may precede or accompany them visual disturbances aphasia numbness/tingling clumsiness/weakness n/v photophobia phonophobia appears ill? migraines what are the labs/diagnostics done for migraines? CBC BMP CBC VDRL ESR CT scan of the head what are these labs/diagnostics of: CBC BMP
CT scan of the head? migraine if someone takes NSAIDS every day, they can get rebound headaches + tylenol too? yes what are the prophylactic daily therapy for migraines if attacks occur more than 2 to 3 times per month? anticonvulsants beta blockers botox calcium channel blockers tricyclic antidepressants calcitonin gene related peptide inhibitors NSAIDS triptans what are these drugs for: anticonvulsants beta blockers botox calcium channel blockers tricyclic antidepressants calcitonin gene related peptide inhibitors NSAIDS
triptans? prophylactic migraine treatment what are the abortive drugs for a migaine? NSAIDS triptans what is the management for an acute attack of a migraine? rest in a dark room ASA sumatriptan (Imitrex) what are these management for: rest in a dark room ASA sumatriptan (Imitrex)? acute attack of a migraine what are the anticonvulsant drugs for migraines? topiramate (Topamax) valproic acid (Depakote) what are these examples of for migraines: topiramate (Topamax) valproic acid (Depakote)? anticonvulsants what are the beta blockers for migraine tx? atenolol metoprolol (Lopressor)
nadolol propanolol timolol what are these for migraines: atenolol metoprolol (Lopressor) nadolol propanolol timolol? beta blockers what can be done prophylactically for migraines and it is injecting small amouutns around the face and scalp every 3 months, it is only approved for patients with at least 15 headaches/month? botox what are the calcium channel blockers for migraine tx? diltiazem (Cardizem) verapamil what are these for migraines: diltiazem (Cardizem) verapamil? calcium channel blockers what are the TCAs used for migraine tx? amitryptilline (Elavil) nortriptylline (Aventyl)
what drugs may be used for treating women with migraines that occur in association with the menstrual cycle? NSAIDS (naproxem) triptans what type of headaches are very painful syndromes that are mostly affecting middle aged men, they come and go in cycles? cluster what are these causes/incidence for: no family hx of headache or migraine may be caused by alcohol ingestion severe unilateral periorbital pain occuring daily for weeks occur at night, waking the pt up from sleep last less than 2 hours pain free months or weeks between attacks ipsilateral nasal congestion, rhinorrhea, and eye redness may occur? cluster headaches what is the treatment for cluster headaches? inhalation of 100% O sumatriptan (Imitrex) what are periods of acute cerebral insufficiency usually lasting less than 1 hour without any residual deficits, they are precursors to strokes and time is crucial? transient ischemic attack (TIA) what are these causes of: ischemia from atherosclerosis, thrombus, arterial occlusion, embolis, hemorrhage cardiac embolic event (AFIB, acute MI, endocarditis, valve disease)? TIA
is a TIA often indicative of an impending stroke? yes usually within 3 months or 2 days for a TIA, are the symptoms often resolved by the time the patient arrives to the ED? yes what does FAST stand for, for TIA? F: face drooping A: arm weakness S: speech difficulty T: time to call 911 what are these s/s of: altered vision altered speech motor impairment (paresthesia of contralateral arm, leg, or face) sensory deficits cognitive and behavioral abnormalities dysphagia vertigo nystagmus? TIA what are the two different classifications of a TIA? vertebrobasilar carotid what type of a TIA is as a result of inadequate blood flow from vertebral arteries and has s/s of vertigo, ataxia, dizziness, visual field deficits, weakness, and confusion? vertebrobasilar
what type of TIA is due to carotid stenosis and presentation includes aphasia, dysarthria, altered LOC, weakness, and numbness? carotid what test is the best for distinguising between ischemia,hemorrhage, and tumor for a stroke? CT what test is superior to CT scans in detecting ischemic infarcts for stroke? MRI what are these management for: aspirin clopidogrel (Plavix) assess for hypertension carotid endarterectomy if stenosis? stroke what is the management for stroke? aspirin clopidogrel (Plavix) assess for hypertension carotid endarterectomy if stenosis what drug has been shown to reduce the incidence of stroke and death? aspirin what is the #1 cause of heart failue? hypertension what are a variety of paroxysmal events occuring as a result of abnormal electrical activity, and classification is based on the mode of onset and spread? seizures
what are the different types of seizures? partial (focal, local) -simple partial -complex partial generalized -absense (petit mal) -tonic clonic (grand mal) status epilepticus what are these examples of: partial (focal, local) -simple partial -complex partial generalized -absense (petit mal) -tonic clonic (grand mal) status epilepticus? seizures what are the two different types of partial (focal, local) seizures? simple complex
what are the different types of generalized seizures? absence (petit mal) tonic clonic (grand mal) what type of partial seizure is this: common w cerebral lesions NO loss of consciosness rarely lasts more than 1 minute motor sx start in single muscle group and spread to entire side of body parethesias, flashing lights, vocalizations, hallucinations? simple partial what type of partial seizure is this: any simple partial seizure that is followed by impaired LOC may have aura, staring, or automatisms (lip smacking/picking at clothing)? complex partial what type of generalized seizure is this: sudden arrest of motor activity with blank state commonly discovered in children/adolescents begins and ends suddenly? absence (petit mal) what type of generalized seizure is this:
may have an aura begins w tonic contractions (repetitive involuntary contractions of muscle) loss of consciousness then clonic contractions (maintained involuntary contraction of muscle) lasts 2-5 minutes incontinence may occur followed by a post ictal period? tonic clonic (grand mal) what is a seizure that lasts longer than 5 minutes or having more than 1 seizure within a 5 minute period without returning to normal LOC, it is a medical emergency, it may occur when the patient is awake or asleep but the pt never gains consciosness between attacks, and it is the most uncommon but it is the most life threatening? status epilepticus what is the most important test in determining seizure classification? EEG what test is indicated for all new onset seizures? CT of the head what is this management for: maintain open airway protect pt from injuries administer O do NOT force artificial airways or objects between teeth IV benzodiazepines (to stop seizure activity)? seizures what is the management for seizures? maintain open airway protect pt from injuries
administer O do NOT force artificial airways or objects between teeth IV benzodiazepines (to stop seizure activity) what are the IV benzodiazepines that are given to acutely stop seizure activity? diazepam (Valium) lorazepam (Ativan) does epilepsy need to be managed by neurology? yes what are the drugs given for maintenance as subsequent seizure prevention? anticonvulsants antiepileptic drugs what are these examples of: carbamazepine (tegretol) ethosuximide (zarotin) phenobarbital (luminal) phytoin (dilatin) primidone (mysoline) valproic acid (depekene)? long acting anticonvulsants what are these examples of: gabapentin (neurontin) lacosamide (vimpat)
lamotrigeine (lamictal) levetiracetem (keppra)? antiepileptic drugs what disorder is a dopamine deficiency, it is idiopathic, all ethnic groups are affected, men outnumber women 2:1, and the onset is usually ages 45 to 65 years old? parkinsons disease what are these s/s of: tremor rigidity bradykinesia wooden facies (dont show emotion) impaired swallowing drooling decreased blinging postural instability cogwheeling myersons sign? parkinsons what does TRAP stand for in parkinsons? resting tremor rigid (cogwheeling) akinesia (slow) postural instability what sign in parkinsons is a sustained blink response from tapping over the bridge of the nose and it is the glabellar reflex? myersons sign
what is the treatment for parkinsons? carbidopa/levodopa (Sinemet) Dopamine agonists -Pramipexole -Ropinarole -Rotiogotine MAOB inhibitors -Selegiline -Rasagiline -Safinamide what are these management for: carbidopa/levodopa (Sinemet) Dopamine agonists -Pramipexole -Ropinarole -Rotiogotine MAOB inhibitors -Selegiline -Rasagiline
-Safinamide? parkinsons what drugs mimic dopamine? dopamine agonists what drugs help prevent dopamine breakdown? MAOB inhibitors what is the most common neurocognitive disorder, it has unknown cause, Acetylcholine deficiency is the key Feature, and it affects women more than men? alzheimers disease what are these s/s of: short term memory loss (1st complaint by family) aphasia apraxia agnosia unable to plan, organize, or sequence limb rigidity flexion posture disorientation gait disturbances impaired memory/judgement? alzheimers what is the term for speech difficulty? aphasia what is the term for unable to perform previously learned task? apraxia
what is the term for unable to recognize an object? agnosia what labs are done for alzheimers? CBC electrolytes glucose BUN LFTs B VDRL CT scan to r/o tumors what are the treatment for alzheimers disease? cholinesterase inhibitors -Donepezil (Aricept) -Galatamine -Rivastigmine NMDA antagonist -Memantine what are these treatment for: cholinesterase inhibitors -Donepezil (Aricept) -Galatamine -Rivastigmine
NMDA antagonist -Memantine? alzheimers what are the cholinesterase inhibitors for alzheimers disease? Donepezil (Aricept)- for all stages Galantamine (mild to moderate) Rivastigmine (mild to moderate) what drug for alzhiemers disease is a cholinesterase inhibitor and it can cause bad dreams and dizziness? donepezil what is an autoimmune disorder resulting in the reduction of the number of acetylcholine receptor sites at the neuromuscular junction, weakness is usually worse after exercise and better after rest, there are variable clinical course w remissions and exacerbations, it usually occurs at age 20-40 but can occur at any age, it peaks in the 3rd decade for females and the 5th/6th decade for males, and it is more common in women? myasthenia gravis what are these s/s of: ptosis diplopia dysarthria dysphagia extremity weakness fatigue respiratory difficulty sensory modalities
normal DTRs? myasthenia gravis what are found in the serum in 85% of patients who have myasthenia gravis? antibodies to acetylcholine receptors what is the management for myasthenia gravis? anticholinesterase drugs -Pyriostigmine bromide (Prostigmin) immunosuppressives plasmapharesis ventilator support in crisis what is this managmenet for: anticholinesterase drugs -Pyriostigmine bromide (Prostigmin) immunosuppressives plasmapharesis ventilator support in crisis? myasthenia gravis
what is an autoimmune disease marked by numbness, weakness, loss of muscle coordination, problems with vision, speech, and bladder control, the bodys immune system attacks myelin which is a key substance that serves as a nerve insulator and helps in the transmission of nerve signals, it is a variable clinical course with remissions and exacerbations, greatest incidence is young adults usually betweel 20- 50 years old, and it is more common in people of western european descent living in temperature zones? multiple sclerosis what are these s/s of: weakness/numbness/tingling or unsteadiness in a limb may progress to all limbs ASYMMETRICAL spastic paraparesis diplopia disequilibrium urinary urgency or hesitancy optic atrophy nystagmus? multiple sclerosis what is found on MRI for multiple sclerosis? plaques that affect white matter what tests are done for multiple sclerosis? MRI (brain and spine) CSF analysis (lumbar puncture) blood tests for MS, is there no treatment to prevent progression of the disease and prevent relapses? yes
should you give steroids in between relapses for multiple sclerosis? yes what is the management for multiple sclerosis? antispasmodics interferon therapy immunosuppressive therapy plasmapharesis what is this management for: antispasmodics interferon therapy immunosuppressive therapy plasmapharesis? multiple sclerosis what is characterized by a facial paresis frequently resolving completely without any treatment, it is an inflammatory reaction involving the facial nerve, there might be a relationship to reactivation of herpes simplex, and it involves cranial nerve 7? bells palsy what are these s/s of: abrupt facial paresis pain about eye may accompany the weakness face feels still and pulled to one side unable to move forehead ipsilateral restriction of eye closure difficulty with eating and fine facial movements
may be a disturbance of taste? bells palsy what is the management for bells palsy? prednisone 60 mg over 7-10 days Acyclovir lubricating eye drops refer to neuro what is this management for: prednisone 60 mg over 7-10 days Acyclovir lubricating eye drops refer to neuro? bells palsy what drug is used to treat when facial palsy is caused by the varicella zoster infection aka causing Ramsay Hunt Syndrome? acyclovir what is a skin rash that shows up in the ear? ramsay hunt syndrome what does ipsilateral mean? same side what does contralateral mean? opposite side what is a nerve disorder that causes a stabbing or electric shock like pain in parts of the face, it is caused by multiple sclerosis, and it can also be caused by pressure on the trigeminal nerve from a swollen blood vessel or tumor? trigemninal neuralgia
what are these s/s of: very painful, sharp spasms that last a few seconds or minutes, can become constant pain usually is localized to one side of the face? trigeminal neuralgia what are the labs/diagnostics for trigeminal neuralgia? neuro exam MRI trigeminal reflex testing what is the treatment for trigeminal neuralgia? anti seizure drugs (Tegretol, Carbamazepine) muscle relaxants (Flexeril) tricyclic antidepressants what are these management for: anti seizure drugs (Tegretol, Carbamazepine) muscle relaxants (Flexeril) tricyclic antidepressants? trigeminal neuralgia what are these physiologic changes for: decreases number of neurons/neurotransmitters modifications in cerebral dendrites, glial support cells, synapses compromised thermoregulation decreased sense of touch
increased pain tolerance? elderlyy what are these findings of: diminished muscle strength diminished DTRs slower nerve conduction velocity slowed motor skills deficits in balance/coordination decreased temperature sensitivity blunted or absent fever response? elderly