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Neuro Day 1/5

Francis: Anat/Phys, Imaging, Headache

Bone that encloses and supports brain Cranium
What are the Meninges Dura mater, arachnoid, pia mater
Controls sensory impulses, initiation of voluntary movement, site of reasoning ability and emotional function Cerebrum
Site of coordination of skeletal muscles Cerebellum
What portion of the brain contains nuclei for cranial nerves and vital autonomic functions Medulla Oblongata
This is the portion of the CNS that extends beyond the head. It controls reflexes and impulses Spinal cord
This is a layer of gray matter that covers the surface of each cerebral hemisphere Cortex
Known as the "gatekeeper" this feature of the brain is made up of a wall of capillaries, connective tissue and nerve cells (astrocytes) Blood Brain Barrier
What is the function of the Blood Brain Barrier Determines which substances can move from plasma to extracellular fluid of the brain.
This imaging study may or may not require the use of contrast dye CT
This imaging study is most helpful in evaluating the brain, lung, mediastinum, and liver CT
Procedure of choice for imaging of the brain and spinal cord CT
Used in cases of spinal trauma or stroke to differentiate between infarct or hemorrhage CT
____is superior to ____ for imaging of the brain and spinal cord MRI; CT
This study has an excellent display of vascular anatomy MRI
This study has better visualization of linear structures MRI
This study is based on 3D reconstruction of the brain sections PET (Positron Emission Tomography)
Shows alterations in blood flow, blood volume, O2 metabolism...useful in epilepsy PET
Records exlectrical activity of the brain with electrodes placed on the scalp EEG
MOST useful in evaluating patients with suspected epilepsy and coma EEG (Electroencephalography)
Records pattern of electroactivity in muscle, both at rest and during activity. Needle is inserted into muscle EMG (Electromyography)
Used to obtain sample of CSF from subarachnoid space between L4 and l5 LP (Lumbar Puncture)
Name a contraindication to LP Increased ICP (papilledema, mass lesion), infection near puncture site, coagulation disorder
Rapid series of films obtained after a bolus of contrast via percutaneous catheter, used to image major arteries Angiography
The 3 portions of the history she emphasized for questioning about Headaches Quality, Location, Timing
Common causes of Headache Umm. there's a lot LOL! they're on the slide at the top left corner of page 7-first packet :)
Benign recurring HA with pain-free periods that is often provoked by stereotyped stimuli Migraine Headache
What is the pathophysiology behind a migraine HA INTRAcranial vasoSPASM followed by EXTRAcranial vasoDILATION
What are the three classes of Migraine? Classic, Common, Complicated
This type of migraine presents with an aura Classic Migraine
This type of migraine is most frequent, and does not present with an aura Common Migraine
This type of migraine presents with focal neruological features Complicated Migraine
Name 3 triggers for migraines Alcohol, lack of sleep, OCP, stress, missed meals, chocolate, cheese, caffeine, nitrites(lunch meat)
How does a migraine present? How is the pain distributed? (Quality) UNILATERALIZED, or generalized DULL, THROBBING headache, frontal-temporal
Common associated symptoms of migraines Nausea, vomiting, PHOTOPHOBIA, PHONOPHOBIA, blurred vision.
Describe the onset of a migraine headache builds gradually
How long does the typical migraine last? What makes the pain worse? 4-72 hours; physical activity
Nonpharmacologic management of migraines avoid triggers, rest in a dark quiet room
Prophylactic treatment for migraines ASA, Amitriptyline, Propanolol, Imipramine
What subQ autoinjection is available for migraine headache patients? Sumatriptan
Treatment for mild attacks of migraine HA pain Acetaminophen, NSAIDS
Treatment for moderate pain of migraine HA Butalbital with caffeine and ASA, Ergotamine, Sumatriptain (Except in HTN and CAD)
Treatment for severe pain of migraine HA Dihydroergotamine, Merperidine
This HA is usually bilateral, occipital-nuchal, generalized; MC type of primary HA Tension HA
This headache is described as "fullness, tightness, tight band, waves of aching pain" Tension HA
How long does a tension HA last minutes to days
Tension HA treatment acetaminophen & NSAIDS, anti-migraine agents, and reduce stress. May require TCA's if chronic
Cluster Headache Recurrent episodes of frequent HA separated by pain free periods
This HA is characterized by 1-3 short lived attacks per day of PERIORBITAL, SUPRAORBITAL, or TEMPORAL pain over a 4-8 week period. Cluster HA
How long do Cluster HA last? 15min-3hours
Cluster HA are typically ___-lateral uni-
This HA has no warning and the pain crescendos within 5 min Cluster
This HA tends to recur at about the SAME HOUR EACH DAY for the duration of a bout and may be nocturnal and AWAKE PATIENT Cluster
Management of cluster HA includes High flow O2, ergotamine, and SQ sumatriptan or tartrate aerosol or lithium carbonate
This condition is common in elderly people age 50-85, but the average onset is 70. Giant Cell Arteritis
This is an inflammatory process of the cranial arteries Giant Cell Arteritis
If GCA isn't treated with _______, 50% of patients will go blind high dose glucocorticoids
GCA is diagnosed via a ________ biopsy Temporal artery biopsy
This condition frequently coexists with GCA but does not cause blindness on it's own. Polymyalgia rheumatica
What condition is described as a progressive impairment of intellectual functioning with compromise in multiple cognitive domains, 1 of which is memory? Dementia
What are the two D's that are usually associated with Dementia? Depression and delirium
What are the four subtypes of dementia? 1. DAT (dementia of Alzheimer's) 2. MID (Multi-Infarct Dementia) 3. Subcortical Dementia 4. Secondary Dementia
What is the most common type of dementia? DAT
DAT is a relentless deterioration of __________ __________ functioning (language, perception, calculation) at a variable rate higher cortical
What is MID usually due to? Cerebral infarcts secondary to atherosclerosis
Movement and gait disoders and disturbance of motivation, mood and arousal are usu associated with what type of dementia? Subcortical dementia; Parkinsonism, Huntington's for example
Which type of dementia is reversible if you treat the underlying dz? Secondary dementia: Ex. hypothyroidism, Vit B def., normal pressure hydrocephalus, AIDS, syphillus, neoplasms, meds
What are some risk factors associated with dementia? Inc. age, family hx, head injury, CNS infection, HTN, cholesterol, low education, female, smoking, DM
What is the simplistic pathophys behind dementia? Widespread neuonal degenerations or multifocal disorders
What is the historical hallmark of DAT? Prescence of numerous NEUROFIBILLARY TANGLES and SENILE PLAQUES, microvascular amyloid
When can the historical hallmark of DAT be seen? Autopsy/Post-death
What happens to the brain in DAT (cortical tissue, gyri, and ventricles)? There is a loss of cortical tissue and inc. space between gyri enlargement of the ventricles
What are the four A's associated with dementia? Aphasia (imparied ability to comprehend or use language), apraxia (imparied ability to do previously learned motor skills despite intact motor function), agnosia (cant identify objects despite intact sensory function), anomia (inability to name objects)
What are some other clinical manifestations of Dementia? *Imparied short therm/long term memory, abstract thinking and judegement *personality change, emotional outbursts, wandering, restlessness, hyper *sleep and mood disturbances *urinary/fecal incontinance *ridgidity, tremor *hallucinations, delusions,
What are some pathological findings of DAT? Granuloveicular degeneration, neurofibrillary tangles, senile neuritic plaques, microvascular amyloid
What are some pathological findings of MID Old infarcts, atheroscelrotic dz
What are some patho findings for cortical dementia Degeneration of NIGROSTRIATAL neurons
How is dementia diagnosed? Usu clinically (Hx and phys very important)
What other tests can we use for dementia? EEG- for altered conciousness or seizures: CT of head to rule out mass: MRI- detects small infarcts, mass lesions, atrophy:
When is the diagnosis of dementia confirmed? During autopsy
Which drugs may make the dementia patient more confused? Psychotropic drugs
What are the RX treatments for sundowning/aggressive behavior? Haldol or Risperidol
What are the RX treatments for Depression? Nortirptyline, Sertaline, Fluoxeine, Paroxetine
What are the rx treatments for sleep disturbane Zolpidem
What are the Rx treatments for Mild-Moderate DAT Donepezil
Mecanical destruction of brainstem or cerebral cortex describes a _____________ coma anatomic
Global disruption of brain metabolic processes describe a ________________ coma metabolic
What are some causes of a metabolic coma? Hypoxia, ischemia, hypoglycemia, drug/ ETOH induced intoxication, epilepsy
Some evident causes of a coma include: Trauma, cardiac arrest, known drug ingestion
What are some other causes of coma? Seizures, hypothermia, metabolic disturbances, structural lesions, mass lesion
For physical exam of a comatose patient what are the steps? 1. Observe without intereferece 2. Arouse with stimulus 3. Check for brain stem reflexes
What are some brain stem reflex tests? Pupillary light response (fixed and dilated poor prog): Eye movements (deviation could mean a lesion): Respiratory pattern (irregular or hyperventilation could mean lesion
What are the four most important Labs and/or imaging techniques Urine/Blood Chem tox: (for exogenous drugs) CT/MRI: (anatomic lesions, infarcts, CHI, encephalitis, subdural hematoma) EEG: (more prognostic than diagnostic) CSF exam (for infection or hge)
What is an alpha coma? Determined from EEG which notes poor prognosis in Comatose pt
What is important in coma management? 1. Prevention of further CNS damage 2. Correct metabolic abnormalities 3. Maintain airway, inubate/ventilate if necessary; 4. LP to rule out meningitis
What medication do you give to prevent herniation in a comatose patient? Mannitol
what IV meds do we give to comatose patients who may have had a narcotic overdose? Naloxone
If the comatose pt is hypoglycemic what do we give them? Dextrose
What scale do we use to determine coma prognosis? Glascow Coma Scale
The glascow scale measures three areas: __________, ____ ________ _______, and ______ ______ _________ eyes, best motor response, best verbal response
Is cerebral palsy progressive or non progressive? Non-progressive
A motor function disorder caused by a permanent nonprogressive brain defect or lesion present at _____ or during the first _____ years of life birth, 3
In cerebral palsy, there is a chronic impairment of ________ ________, strength, __________ or movements muscle tone, coordination
Since 70% of causes are idiopathic (of cerebral palsy), what are some causes that we do know? Intrauteral INFECTION, malformations, chromosomal abnormalities, strokes. 20% OB mishaps
What are some risk factors of cerebral palsy? Premature birth, birth asphysia, intrauterine growth retardation, infection, trauma
What are some other risk factors for cerebral palsy? Hypoxic ischemia, encephalopathy in perinatal period, seizures in perinatl period, interventricular hge in perinatal period, meningitis/encephalitis postnatal, child abuse
What are the 4 subtypes of cerebral palsy? Spastic, Athetoic, Ataxic, Spastic Diplegia
What is the most common type of cerebral palsy? Spastic Diplegia
What are some clinical features of Spastic cerebral palsy? Diplegia, Quadriplegia, Hemiplegia, Bilateral Hemiplegia, Involuntary muscle contraction of sudden onset., hyperreflexia, mental retardation, aphonia, seizures
What is another name for spastic cerebral palsy? Pyramidal
What are some clinical features of Atheotic CP Slow writhing continuous and involuntary movement of EXTREMITIES, Usu normal intelligence; Choreiform movement (like a dance)
what are the clinical features of Ataxic CP? Clumsy disposition, normal intelligence, highly talkative
What are some clinical features of Spastic Diplegia CP? Affecting legs but spares upper extremities, SCISSOR gait, Normal intelligence
What are some symptoms babies/ toddlers may have with CP? Abnormalities in breathing, sucking, swallowing, and responsiveness, walking delayed
In CP, deep tendon reflexes are usually ___________ Exaggerated
What is Quadraplegia usually caused by in CP? Cysts, tumors, malformations. (usu produced in infants by fractures-dislocation of cervical spine during breech delivery)
What are some diagnostic studies for CP? CT & MRI: may show cyst, cerebral atrophy, calcifications, tumors, malformations, stroke
What are the Labs that should be run for Cp? Urine screening, IgG, IgM, Blood amino acids, lactate, pyruvate, amonia
What is another test that also be run for CP? EEG
How is CP diagnosed? Clinically
PT, OT, speech therapy and braces are all some techniques in managing ______- cerebral palsy
Are oral meds successful for managing CP? No, Side effects occur before benefits
Injection of _______ ______ into abnormal muscles decreases spacicity botulism toxin
What is a rhizotomy? Surgical resection of dorsal root of spinal nerve (management for CP)
What is intrathecal baclofen? An Antispasmatic agent
What are some medications that may be cnsidereed in CP management? Diazepam, Dantolene sodium, muscle relaxers
Created by: pastudygroup