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Step2: Neuro2

Neuro 2

QuestionAnswer
What is the MCC of headaches in adults? Tension headaches
How do you investigate sudden, severe headache or neurological deficit? CT (WITHOUT contrast)to r/o hemorrhage
What causes electric-like pain in face, extremely sensitive to triggering (even by wind)? Trigeminal headache
What's the DOC for a Trigeminal headache? Carbamezapine. (other anti-convulsants can be given too)
Migraines are more comming in [males/females] due to __________. Females; estrogen fluctuations
Alcohol is a precipitating factor for _________ headaches. Cluster
Stress/fatigue causes ___________ headaches. Tension
[Migraine, Cluster, Tension] is usually bilateral. Tension
OCPs, menstruation, and foods containing tyramine/nitrates are precipitating factors of __________ headaches. Migraine
Periorbital pain, unilateral, recurrent: these are KKs of _________ headaches. Cluster
Aura, photophobia are Sx of _________ headaches. Migraines
Never put a females with migraines + aura on _______. OCPs (DVT risk)
Rx of Tension headache? NSAIDs
Rx of Cluster headache? 100% O2 (impt!) + sumatriptan/ergots
Rx of Migraine? Sumaptriptan + ergots +/- antiemetics
What 5 agents can be used as Migraine prophylactics? CCBs (verapamil), B-blockers (esp if comorbid HTN), TCAs (if comorbid depression), NSAIDs (menstrual cause or arthritis comorbidity), anticonvulsants (valproate, topiramate, gabapentin)
What is the likely cause of headache: Obese female with papilledema? Pseudotumor cerebri
What is the likely cause of headache: Jaw muscle pain while chewing? Temporal arteritis
What is the likely cause of headache: Periorbital pain w/ Horner syndrome? Cluster headache
What is the likely cause of headache: Lacrimation and/or rhinorrhea? Cluster headache
What is the likely cause of headache: "Worst headache of my life"? Subarachnoid hemmorrhage (berry aneurysm)
What is the likely cause of headache: raised ESR? Temporal arteritis
What is the likely cause of headache: headache + extraocular muscle palsy? cavernous sinus thrombosis
What is the likely cause of headache: scotomatas prior to h/a? Migraine
What is the likely cause of headache: occurs days after a trauma to the head, persists? Subdural hematoma
Acute focal neuro deficits lasting <24h are ________. TIA (transient ischemic attacks)
What does carotid bruit in a TIA patient suggest? ATH of carotids. Do USG to quantify.
The first line of radiology in TIA patients is __________. CT to r/o bleeding (MRI is for ischemia!)
What is the purpose of ECHO in a TIA patient? To determine septic emboli, AS, or mural thrombus as a cause
Most dangerous outcome of peudotumor cerebri is___________. Blindness
If vomitting PRECEDES headache, and headache worsens over days-weeks, you should suspect ___________. Brain tumor
What is the first line Rx for pseudotumor cerebri? Acetozolamide
Anticoagulant of choice in pt with TIA/Stroke: First TIA? ASA (prophylactic)
Anticoagulant of choice in pt with TIA/Stroke: due to Afib? warfarin
Anticoagulant of choice in pt with TIA/Stroke: w/ coronary artery dz? clopidogrel
Anticoagulant of choice in pt with TIA/Stroke: Repeat TIA/stroke while taking ASA? agronox/clopidogrel
3 scenarios where you do carotid endarterectomy for TIA/stroke patients? 1. symptoms + 70-99% occlusion (strong benefit) 2. symptoms + 50-69% occlusion (moderate benefit) 3. asymptomatic + 80-99% occlusion, and expected to live longer than 5y by a surgeon w/ <3% complication rate
SSx (5) of carotid artery stenosis? Bruit, TIAs, reversible neuro defecits, transient u/l blindness (amaurosis fugax), CVAs
Nonsurgical Rx of carotid stenosis? HTN control, Lipid control, DM control, aspirin
Acute focal neuro defecit lastin >24h is ________. Stroke
What are the 2 types of stroke? Ischemic and hemorrhagic
Most common artery involved in embolism->ischemic stroke is _______________. Middle Cerebral Artery
What is the radiology of choice for stroke? MRI if pt seen w/i 24h of onset, CT w/o contrast after 24h
What is the purpose of ECG in a stroke patient? To determine if Afib or other arrhythmia is a cause of an embolus
Rx of ISCHEMIC stroke? 4 steps 1. Thrombolytic Tx w/i 3h (6h if given IV @ site of thrombus) 2. Antiplatelet Tx w/i 48h 3.+/- LMWH 4. Lipid lowering drugs w/i 3d
You shouldn't treat ______ in a stroke patient unless it is very extreme. HTN (only Rx >220/120). Risk of decreasing cerebral perfusion if you treat moderate HTN
Rx of HEMORRHAGIC stroke? 3 steps 1. Reversal of any anticoagulant + control BP and ICP 2. +/- surgical decompression 3. Antiplatelet drugs restarted 2w later
Never give _______tonic fluid in suspected brain injury. Hypo-tonic
Stroke of what artery causes: c/l lower extremity and trunk weakness? ACA
Stroke of what artery causes: c/l face and arm weakness, aphasia, inability to recall learned actions? MCA
Stroke of what artery causes: c/l visual loss? PCA
What are the 5 lacunar stroke syndromes? Which has cortical signs? Pure motor hemiparesis (Most common), pure sensory, ataxic hemiparesis, sensory + motor, dysarthria (clumsy hand). NONE of these have cortical signs like aphasia, neglect, visual loss.
What radiology is used to determine EXTENT of bleeding in a parenchymal bleed? CT w/o contrast
What radiology is used to determine SITE of bleeding in a parenchymal bleed? MRA or CTA
What Rx do you use in parenchymal bleed that you wouldn't use in stroke? Anticonvulsants
Berry aneurysm is associated with ____________ and ______________. Marfan's, ADPKD
Subarachnoid hemorrhage is bleeding into the space between the arachnoid and __________. Pia
First step in suspected SAH? CT w/o contrast. If clear, do LP for blood.
What systolic BP should you try to target in SAH? What drug would you use? <150 systolic (only treat if cognitive fxns are intact) use LABETALOL
Declining RBCs in serial LPs most likely implies ___________. traumatic LP, rather than SAH (which is usually the case with blood in LP)
MCC of Subarachnoid Hemorrhage vs Epidural Hematoma? SAH: berry aneurysm. Epidural hematoma: middle meningeal artery damage from TRAUMA
Epidural hematoma is blood between the dura and __________. Skull
[Subdural hematoma/Epidural hematoma] can cross the midline in the brain. Epidural hematoma
Which brain bleed has a "lucid interval"? Epidural hematoma
Which brain bleed has a "blown pupil" i.e. fixed and dilated? Epidural hematoma (or very large subdural hemm)
Subdural/Epidural hematoma = concave/convex on CT Epidural = convex (lens shaped). Subdural = concave (crescent moon).
Rx of epidural hematoma? drainage by radio-guidance or burr hole.
Subdural hematoma is collection of blood between the dura and ___________. Arachnoid
Subdural hematoma is caused by damage to which vessels? How are they damaged? Bridging veins, due to trauma
What is the onset/presentation of Subdural hematoma headache? Slowly progressing, like headache of a tumor
Mental status change seen in elderly pt with Hx of falls. You should suspect a possibility of __________ hematoma. Subdural. Do CT w/o contrast to confirm
Why would hydrocephalus occur following SAH? SAH causes fibrosis of arachnoid granulations (impaired CSF absorption)
3 W's of normal pressure hydrocephalus are? wacky (cognitive impairment), wet (incontinence), wobbly (gait disturbance; feet stuck to floor)
Created by: jsad