Neurology CM
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| Most common type of headache | Tension.
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| Dietary triggers of headache | ETOH, Chocolate, Aged Cheeses, MSG, Aspartame, Caffeine, Nuts, Nitrates, wine, cured meat, dark leafy greens, beets, carrots
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| Hx to obtain | age, aura, frequency, intensity, duration, days/month, time and mode of onset, quality, site, radiation of pain, associated sx
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| POUND criteria (5 criteria) | Pulsatile/throbbing headache, hOurs (4-72), Unilateral, Nausea, Disabling
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| Thunderclap headache "the worst HA of my life" | Subarachnoid hemorrhage (or intracranial mass lesion)
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| Ipsilateral tearing and runny nose is associated with | cluster migraines
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| Dangers Signs | Absence of similar HA previously, worsening pattern, focal neurologic s/s, fever (infection), mental status change, rapid onset with strenuous exercise (carotid dissection, intracranial hemorrhage)
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| New headache in a pt with HIV suggests | opportunistic infection
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| New headache in a pt with Lyme dz suggests | meningeal encephalitis
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| Sudden, severe, unilateral vision loss may be | optic neuritis
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| HA, fatigue, genl. aches and pains, night sweats, >55 may suggest | temporal arteritis
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| Intermittent HA with HBP | rare, but may be pheochromocytoma
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| Indications for imaging | warning signs, clinical judgement. If classic headache with normal neurologic exam, don't image
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| MRI or CT? | CT with or without contrast.
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| Indications for LP | Clinical suspicion for Subarachnoid Hemorrhage, or of an infectious or inflammtory etiology
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| Migraines more common in men or women? | Women. (F17%, M6%). Without arua is most common (80%)
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| which hormone has direct action on cranial vasculature? | serotonin
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| _____ is potent vasodilator | Calcitonin gene-related peptide (CGRP). may mediate trigeminovascular pain transmission
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| Right-left cardiac shunt | migraine with aura, patent foramen ovale
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| _____is a neurologic deficit that precedes the migraine | Aura. Migraine aura precedes migraine, with HA onset just after it stops. Actually can develop during or after onset
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| Most common disturbance associated with aura | visual disturbance. Second most common is numbness or tingling or lips, face, fingers of one hand (cheio-oral)
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| Nasal congestion and rhinorrhea are common in | migraine. Sinusitis is different and has fever, purulent discharge
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| Which type of cutaneous allodynia is most common? | cephalic (ipsilateral).
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| Decreased estrogen levels | associated with migraines
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| Repetitive HA | Cluster. Uncommon <1%, men>women, peak age of onset 25-50
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| Features of Cluster HA | unilateral, begins quickly, patient tends to walk around restless (as opposed to migraine patients who lay in a dark room). Begins around the eye. Ipsilateral tearing, stuffy nose, rhinorrhea, sweating, pallor
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| Which type of cluster HA is most common? | Episodic cluster. 1-3 attacks/day for 6-12 weeks, followed by remission for 6-12 weeks. Remission may last years. treatment is difficult.
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| Band-like, squeezing pain across the forehead is a description of | tension headache. No aura, photophobia, phonophobia. food triggers less likely. Can have daily ha for years. analgesic abuse. Psychologic factors common.
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| Do you use Triptan in tension ha? | no, use naproxen/aleeve
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| This is generally in conjunction with fever and purulent discharge | acute sinusitis. uncommon cause of recurrent HA.
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| This type of HA is typically bilat/peri-orbital, pressure-like, dull, a/w nasal obstruction or congestion, lasts days | Sinus HA
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| Risks for Idiopathic intracranial HTN | Women of childbearing age,Overweight/obese,
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| What time of the day is migraine common? | morning
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| Features of Idiopathic intracranial HTN (pseudotumor cerebri) | Daily or near daily generalized HA, fluctuating intensity, +/- nauseaTransient visual obscurations , “graying out”, diplopia - horizontal displacement, dizziness, N/V, tinnitus, headache is diffuse, increased in the morning and with valsalva.
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| Physical exam finding of idiopathic intracranial htn | papilledema. Indistinguishable from papilledema by intracranial space-occupying lesion. Eventually leads to loss of vision
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| Urgent neuroimaging | if BP is normal in idiopathic intracranial HTN. r/o malignant HTN as well
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| Idiopathic Intracranial HTN treatment | weight control, cessation of exogenous agents, use diuretics, acetozolamide, corticosteroids
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| Chronic vasculitis of large and medium sized vessels | Giant cell (temporal) arteritis. Affects elderly. tenderness or decreased pulse of the temporal artery.
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| Biopsy of GCA reveals | giant cells! ESR is elevated also
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| Which population has higher incidence of Giant cell arteritis? | Scandanavian descent.
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| jaw claudication - fatigue and amaurosis fugax (visual sx) are symptoms of | Giant cell arteritis
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| V1 of CN 5 | opthalmic
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| V2 of CN5 | maxillary
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| V3 of CN5 | mandibular
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| Aberrant loop of an artery or vein which leads to compression of the trigemminal nerve route near the entry into the pons which leads to demyelination | Trigeminal Neuralgia Pathophysiology
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| Which branch of CN5 is most commonly affected in postherpetic neuralgia | V1
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| tic douloureux is a facial muscle spasm associated with | trigemminal neuralgia
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| Which dermatomes are affected in postherpetic neuralgia | thoracic, cervical, trigemminal (V1 most often)
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| Daily, persisten facial pain with pain confined at onset to a specific region (usually not in an area involved in mastication), deep, unilateral is called | Persistent idiopathic (atypical) facial pain
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| Paroxysmal pain associated with CN IX and X | Glossopharyngeal neuralgia. Severe, unilateral pain of the ear, larynx, tonsil, or tongue.
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| Sore points in tension HA | Temporalis, masseters, trapezius, splenius muscles (along the neck)
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