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179 Cards in this Set
- Front
- Back
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this type of pain has no apparent nociceptive generator |
chronic pain |
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Pathogenesis - disruption or alteration of normal nociceptive pathways of peripheral nerve, SC, brainstem, or cerebrum - plasticity in normal pathways involving sprouting of axons and loss of inhibitory interneurons -strong emotional & psychosomatic components based on prior experience |
chronic pain |
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neurogenic pain caused by lesion anywhere in the nervous system |
neuropathic pain |
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neurogenic pain caused by a lesion in the CNS |
central pain |
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pain related to the growth of a cancer |
cancer pain |
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Presentation - fulminating or downward spiral of pain and suffering unrelated and out of proportion to tissue damage |
chronic pain |
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benign and recurring syndrome of headache, nausea, vomiting |
migraine |
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most common of pediatric headaches |
migraine |
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prevelance of this type of headache is higher in low-income classes |
migraine |
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what nerve are migraines associated with? What is the trigeminovascular system? |
trigeminal nerve - small primary afferents of the trigeminal are associated with blood vessels |
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what can trigger the release of calcitonin gene-related polypeptide from trigeminovascular fibers to initiate the neurogenic inflammatory response in migraines? |
nitric oxide |
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phases of migraine |
1. prodrome 2. aura 3. headache 4. resolution |
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Presentation - u/l in 60%, b/l in 40% - face, jaw, head, or neck affected - neck pain in 75% - throbbing headache in 85% - headaches last 4-72 hours - photophobia in 90% - nausea in 80% and aura in 10-20% |
migraines |
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headaches that last over 72 hours are termed |
status migrainosus |
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frequent use of headache medications leads to ___________ effect |
rebound effect |
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indications for neuroimaging for migraine headaches include |
- unusual, prolonged, or persistent aura - increased frequency, severity - status migrainosus - first or worst headache - crash migraine (sudden/severe intensity) - onset over 50 yrs old - post-traumatic migraine |
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what 3 key pharmaceuticals are used in prevention of migraine headaches |
1. antidepressants 2. beta blockers 3. anticonvulsants |
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dull, non-pulsating, bilateral head pain of mild to moderate severity |
tension type headache (chronic daily headache) |
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most common of adult headaches |
tension-type headache |
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what is the peak prevalence for tension headaches |
4th decade |
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presentation - 30 minutes to 7 days in duration - pressing, non-pulsating pain quality, b/l - not aggravated by physical activity - mild to moderate severity - no nausea/vomiting or photosensitivity |
episodic tension type headache |
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presentation - avg 15 days/month or 180 days/yr for at least 6 months - same pain type as episodic tension type headache - can be associated with analgesic overuse or a transformed migraine |
chronic daily headache |
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pharmacologic treatments for episodic tension type headaches |
aspirin, NSAIDS isometheptene butalbital |
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tx for chronic daily headache |
- titrate off analgesic if appropriate - tapering dose of prednisone - long acting NSAIDs
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the following prophylactic therapy is for the prevention of.... - methysergide - b-blockers - divalproex sodium - tricyclic antidepressants - trizandidine |
tension type headache |
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episodic, explosive, and severe u/l headache focused in the periorbital area or (less commonly) in the temporal area |
cluster headache |
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the following are synonyms for _______ headache - raeder's syndrome - histamine cephalalgia - sphenopalatine neuralgia |
cluster headache |
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onset of cluster headaches, M:F ratio |
30-40 years old M:F ratio of 5:1 |
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which ganglion in activated in cluster headaches via activation of _____ |
sphenopalatine ganglion via activation of trigeminovascular system |
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Presentation (temporal sequence) - 1 to 2 times per year - duration 30-45 minutes but up to 3 hours - remission can be 6 mo to 2 yrs - attacks are time specific |
cluster headache |
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Presentation (Sx) - u/l severe pain, typically retro-orbital, temporal, or infraorbital - constant boring pressure, burning, or stabbing - rapid onset in 5-15 minutes |
cluster headache |
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autonomic symptoms of cluster heads (4) |
- i/l lacrimation - congestion - partial horner's (ptosis and miosis) - erythema of eye |
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Tx for cluster headache |
- O2 inhalation - sumatriptan - IV dihydro-ergotamine - topical lidocaine - butorphanol - capsaicin applied nasally |
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prophylactics therapy options for cluster headaches include |
- verapamil - methysergide - divalproex sodium - lithium carbonate - topiramate - baclofen |
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characterized by periods of excessive, hypersynchronous, uncontrolled neuronal activty |
epilepsy and seizures |
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difference between epilepsy and seizures |
epilepsy - chronic, recurrent, unprovoked seizures seizure - involuntary change in behavior due to synchronous firing of neurons caused by structural, metabolic, or drug-induced changes |
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seizure classifications |
Partial (focal): 1. simple partial sz (consciousness not impaired 2. complex partial sz (consciousness impaired), secondary to generalized sz Nonfocal: Absence, myoclonic jerks/seizures, tonic-clonic (grand mal), tonic seizures, atonic seizures Unclassified: Neonatal seizures and infantile spasms |
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common causes of seizures -Of these, which are the most serious causes? |
-Genetic components -Congenital abnormalities -Inborn errors of metabolism* -Antenatal or perinatal injuries -Post head injury -Toxic injury -CNS infection* -Cerebral tumors* -Vascular causes (strokes)* -Neurodegenerative diseases -Withdrawal states -Iatrogenic drug reactions -Infections, parasites |
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triggers of seizures |
- fever - menstrual period - flashing lights - stress - strong emotions - intense exercise - loud music |
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presentation 1. loss of consciousness or blanking out or spacing out? 2. sustained or repetitive muscle contractions? |
generalized absence seizure generalized seizures |
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presentation - jerky movements without altered consciousness, nausea, lightheadness, vertiginous feelings |
simple partial seizure |
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presentation - alteration in awareness or consciousness, unresponsive to stimuli |
complex partial seizure |
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what body fluids do you test for in seizures |
blood glucose calcium urea nitrogen sodium |
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fertility rate is how many percent lower in women with seizures/epilepsy |
33% |
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seizure events associated with a fever in a child?
classified as ____ or _____ |
febrile seizures simple or complicated |
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most common seizure disorder of children |
febrile seizures |
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age of onset for febrile seizures |
after 9 months, before 5 years old |
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presentation - core temp increases rapidly to 39 degrees C or more - generalized tonic-clonic seizure lasting seconds to minutes - followed by postictal fatigue |
febrile seizures |
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this drug has been used for febrile seizures |
oral diazepam |
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what is the most common cause of neonatal seizures |
hypoxic-ischemic encephalopathy |
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what type of seizure is this? twitching of muscle groups |
focal seizure |
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what type of seizure is this? - many muscle groups effected |
multifocal clonic seizures |
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what type of seizure is this? - rigid posturing of extremities and trunk |
tonic seizure |
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what type of seizure is this? - brief focal jerks |
myoclonic seizures |
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what type of seizure is this? - chewing, salivation, apnea, bicycling motions |
subtle seizure |
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convulsive seizure activity > 30 minutes or 2 consecutive seizures without regaining consciousness inbetween - medical emergency requiring immediate attention |
status epilepticus |
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presentation - tonic-clonic seizures at beginning usually, but can also initiate with complex partial seizures - repetitive seizures lasting less than 2 min each but with no conscious period in between events |
status epilepticus |
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tx for status epilepticus |
medical emergency w/ immediate medical assessment use established protocol for tx |
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complications of status epilepticus (cardiac, pulmonary, metabolic) |
- cardiac: HTN, tachycardia, arrhythmias - pulmonary: apnea, failure, hypoxia - metabolic: hyperkalemia, volume depletion, hyperglycemia followed by hypoglycemia |
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causes of status epilepticus |
- noncompliance with meds - change of meds -withdrawal of meds - recent cerebrovascular events, head trauma, cerebral infection -developing neoplasm - metabolic disorder - alcohol withdrawal - arteritis |
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of the patients with diagnosed epilepsy syndrome, what percentage will progress to status epilepticus? |
1% |
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half of the cases of status epilepticus are _________ |
children |
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common diagnostics for seizures |
EEG CT MRI |
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what type of pain is this: -70,000,000 Americans report it and many are disabled by it |
chronic pain |
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Characteristics of what type of pain: -often refractory to treatment -disrupts sleep and normal living -serves no adaptive purpose |
chronic pain |
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Etiology of _______ pain: -injury -malignancy -non-life threatening conditions -may have no apparent cause -may be a symptom or diagnosis -may be nociceptive, neuropathic, or both |
chronic |
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what are the different classifications of chronic pain? |
-by the region affected (back, head, chest pain) -by the process involved: --neuropathic pain (lesion anywhere in NS) --central pain (lesion in CNS) --inflammatory pain (pain caused by inflammatory process) --cancer pain: pain related to growth of tumor |
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_____ pain: unpleasant sensation one gets with injury but that is proportion to the injury & remits as the injury heals |
Acute pain |
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_____ pain: pain that is generally defined as a pain that persists for arbitrary time (3-6 mo) beyond the time normally expected for healing |
chronic |
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what type of pain is considered a disease process? |
chronic |
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what are 2 main pathophysiologies of hydrocephalous in the infant? |
-overproduction of CSF -impaired drainage of CSF |
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define: hydrocephalous |
an abundance of fluid in the ventricular or subarachnoid compartments of cranium |
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is hydrocephalous a disease? |
NO: it is a finding or complaint |
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is there a difference in the clinical features of different hydrocephalous etiologies? |
no |
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what are 2 etiologies of hydrocephalous in the infant? |
1. Dandy-Walker syndrome or Chiari malformation 2. Obstruction of cerebral aqueduct secondary to masses or viral infxns |
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in what patients would you see this type of hydrocephalous manifestation? -abnormal enlargement of head or accelerated rate of head enlargment |
infant |
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in what patients would you see this type of hydrocephalous manifestation? -brisk tendon reflexes -spasticity -clonus |
young child |
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in what patients would you see this type of hydrocephalous manifestation? -irritability -lethargy -poor appetite -vomiting -HA |
older child w/ closed cranium |
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how many cases occur in status epilepticus where there is no known history of seizure activity? |
2/3 of cases |
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which convulsive seizure activity has high mortality rates (10-50%)? |
status epilepticus |
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what are the complications of hydrocephalous in the infant? |
-developmental delay -memory problems -visual problems -behavioral issues -can also depend on etiology of the hydrocephalous |
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what CNS congenital disease represents a failure of the closure or a reopening of a previously closed caudal portion of the neural tube? |
spina bifida |
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what are the most common congenital abnormalities in the CNS? |
neural tube defects |
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what are the 3 types of spina bifida? |
1. spina bifida occulta 2. meningiocele 3. myelomeningiocele |
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what is spinal dysraphism another name for? |
spina bifida |
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which is the most common form of spina bifida? |
spina bifida occulta |
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75% of myelomeningioceles occur where? |
in lumbar region |
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Presentation of what type of spina bifida: -general asymptomatic -minor changes in skin over dysraphism |
spina bifida occulta |
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Presentation of what type of spina bifida: -fluid filled, cyst-like sac that can extend off the back over the region of the dysraphism -no untoward neurologic sx |
meningiocele |
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Presentation of what type of spina bifida: -multiple organ dysfunctions; specific dysfxns depend on locale of dysraphism -cyst like structure covered by thin layer of epithelized material -lumbar kinds --> LE paralysis & loss of B/B control |
myelomeningiocele |
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what kinds of preventative measures are used for spina bifida? |
folic acid supplements during pregnancy |
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what type of spina bifida: -midline defect in vertebral posterior arch structures w/ NO involvement of neural components |
spina bifida occulta |
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what type of spina bifida: -midline defect in vertebral posterior arch structures w/ herniation of meninges but NO involvement of neural components |
meningiocele |
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what type of spina bifida: -midline defect in vertebral posterior arch structures w/ herniation of meninges & involvement of neural components |
myelomeningiocele |
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is the incidence of neural tube defects increasing or decreasing? |
decreasing |
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what is a dysraphism? |
a defect in the formation of the midline in an embryo |
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name 2 dysraphisms related to the metencephalon |
1. Chiari malformations 2. Dandy Walker syndrome |
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What CNS congenital disease is this: -Agenesis of cerebellar vermis -Cystic dilation of 4th ventricle -Enlargement of posterior cranial fossa -Dysplasia of brainstem |
Dandy Walker syndrome |
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Dandy Walker syndrome accounts for _____ % of hydrocephalous cases |
1-4% |
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Pathogenesis of _______ syndrome: -enlarged posterior cranial fossa -loss of cerebellar vermis -Enlarged midline, fluid-filled ependymal-lined cyst representing expanded 4th ventricle |
Dandy Walker |
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__________ malformations are dysraphisms in which defects in closure of midline structures related to metencephalon result in range of neurological abnormalities involving posterior cranial fossa |
Chiari |
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what is the fundamental abnormality of the Chiari malformations? |
-displacement of cerebellar tonsils and often medulla through the foramen magnum |
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which type of Chiari malformation is the most common cause of serious malformation of posterior cranial fossa? |
Chiari Type II |
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which type of Chiari malformation appears to be more prevalent than originally thought? |
Chiari type I |
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which type of Chiari malformation: -low lying cerebellar tonsils extending thru foramen magnum? |
I |
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which type of Chiari malformation: -possible obstruction of CSF & medullary compression? |
I |
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which type of Chiari malformation: -not typically associated w/ hydrocephalous in the young, but can cause adult onset hydrocephalous |
I |
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which type of Chiari malformation: -strongly associated w/ idiopathic syringomyelia |
I |
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which type of Chiari malformation: -associated w/ occipital dysplasia? |
I |
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which type of Chiari malformation: -bony and dural abnormalities present |
II |
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which type of Chiari malformation: -small posterior cranial fossa -mis-shapened midline cerebellum with displacement of cerebellar vermis |
II |
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which type of Chiari malformation: -brainstem abnormalities -cerebellar vermis going thru foramen magnum |
II |
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which type of Chiari malformation: -almost always accompanied w/ hydrocephalous & myelomeningiocele |
II |
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SX of what type of Chiari malformation: -asymptomatic in infant or child - but can have apneic episodes -sx develop in puberty/adolescence |
I
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SX of what type of Chiari malformation: -HA -neck pain -urinary frequency -progressive cerebellar ataxia -LE spasticity |
I |
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SX of what type of Chiari malformation: -older children can present w/: -scoliosis -weakness -syringomyelia |
I |
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SX of what type of Chiari malformation: -no hydrocephalous present |
I |
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SX of what type of Chiari malformation: -sx develop early in life; infant |
II |
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SX of what type of Chiari malformation: -progressive hydrocephalous/myelomeningiocele |
II |
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SX of what type of Chiari malformation: -respiratory distress, stridor, episodic apnea, weak cry, facial weakness, aspiration in infants |
II |
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SX of what type of Chiari malformation: -B/L abducens palsies |
II |
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SX of what type of Chiari malformation: -syncopal episode -nystagmus -spasticity in older children |
II |
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SX of what type of Chiari malformation: syrinx in cervical or thoracic spine |
II |
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what is this CNS congenital disease: -group of congenital abnormalities that occur either in utero, during birthing process, or in first 2 yrs of life |
cerebral palsy |
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what CNS congenital disease has: -most prominent presentation = motor abnormalities but sensory / cognitive defects are also present |
cerebral palsy |
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what are these synonyms for? -CP -Brain paralysis -static encephalopathy |
cerebral palsy |
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most common form of severe chronic motor disability in children |
cerebral palsy |
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what is the prevalence of cerebral palsy? |
1 million |
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what are the defining feature of cerebral palsy? |
the causative insult occurs prior to complete development of the cerebrum |
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what are the risk factors for cerebral palsy? |
-preterm birth -maternal or fetal infxn -multiple births -chorioamnionitis -antepartum vaginal bleeding -2nd stage of labor lasting >4hrs -untreated hyperbilirubinemia -fetal anoxic events -low birth weight -intrauterine growth retardation |
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______ can be acquired postnatally from traumatic injury (abuse) or infection |
cerebral palsy |
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what can be the initial presenting clinical sx of cerebral palsy? |
milestone delays- especially motor sx |
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what are the major motor abnormalities of cerebral palsy? |
-spasticity (hemiplegia, quadriplegia, diplegia) -dyskinesias (athetosis/rigidity)
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what are other abnormalities besides motor ones in cerebral palsy? |
-intellectual impairment -seizures -sensory impairment |
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what CNS congenital disorder can present w/: -spastic hemiplegia, diplegia, or quadriplegia -athetosis/rigidity -intellectual impairment -seizures -sensory impairment |
cerebral palsy |
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diagnostics for cerebral palsy |
-hx/physical to rule out progressive disorders -US of fetus -MRI -CT |
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what is tx for cerebral palsy? |
-physical therapy -meds: botulinum toxin, antispasmotics, anticonvulsant -surgery: rhizotomies for spasticity -adaptive equipment: orthoses for motor disabilities |
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what are the complications/management for cerebral palsy? both in children and adult survivors |
-hip dislocation secondary to muscle tone imbalance -difficulty eating/breathing -osteopenia, osteoporosis -chronic MSK pain -adult survivors have increased incidence of: -CV disease, cerebrovascular disease, digestive disorders |
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what are some maternal health issues to take care of to prevent cerebral palsy? |
maternal thyroid condition delivery complications |
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premature closing of cranial suture |
craniosynostosis |
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primary or secondary defects of craniosynostosis |
primary: skull development secondary: due to altered brain growth or environmental factors |
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by what month do cranial membranes develop? |
2nd month |
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by what month do cranial bones develop from cranial membranes? |
5th month |
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what is thought to be the cause of craniosynostosis? |
disruption in balanced growth forces |
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what is the boat skull called? premature closure of what suture? |
scaphoencephaly -sagittal suture
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what is the triangular skull called? premature closure of what suture? |
trigonocephaly -metopic suture |
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premature closure of coronal suture U/L is called______ |
frontal plagiocephaly |
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premature closure of coronal suture B/L is called______ |
brachycephaly |
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premature closure of lambdoid suture is called______ |
occipital plagiocephaly |
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when an infant presents w/ flattened head _____ called what? caused by? -bad or good/ need tx? |
positional plagiocephaly -sleeping on their backs for too long -benign/don't need tx
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what is the phakomatosis that involves a vascular abnormality that develops as the primordial vascular supply to head, brain, & face is organizing? |
Sturge-Weber syndrome |
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what is an angiomata? what CNS congenital disease do u see this in? what causes the angiomata? |
a benign tumor of blood vessels in Sturge-Weber syndrome; the vascular angiomata should regress but doesn't
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child presents w/: -port wine stain around eye/forehead -glaucoma -developmental delays/learning problems what disease? |
Sturge-Weber syndrome |
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child presents w/: -seizures in their 1st year -mental retardation; severe learning disabilities -ADHD -mom says has purple birthmark on face |
Sturge-Weber syndrome |
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series of distinctive changes in visual field and optic cup such as optic neuropathy what is this disease? |
glaucoma |
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what are 2 major forms of glaucoma? |
open angle angle closure |
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what are the 2 subtypes of open angle glaucoma? what differentiates them? |
primary: caused by gene mutation secondary: associated w/ other ocular disease |
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what is the 2nd leading cause of blindness in the world? |
glaucoma |
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what is the most common type of glaucoma? |
primary open angle |
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person presents w/: -insidious, slowly progressive painless visual loss -high normal intraocular pressure |
open angle glaucoma |
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person presents w/: -acute onset painful red eye -progressive loss of visual fields -has progressed from periphery to fovea |
angle closure glaucoma |
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what disease is characterized by thickenings or opacities in the crystalline lens of the eye? |
cataracts |
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what progressive visual loss eye disease is strongly associated w/ age? |
cataracts |
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etiology of cataracts? |
-age -trauma -metabolic disease -radiation -inflammatory disease/immune mediated -nutritional defects |
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person presents w/: -slowly progressive painless loss of vision -image blur -seeing multiple images of one item -"better at seeing objects near - used to have to look at only distant objects" what do they have? |
cataracts |
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eye disease: -slowly progressive degeneration of retinal pigment layer leading to detachment of retinal layer & visual loss |
glaucoma |
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what is the most common cause of untreatable blindness in the elderly? |
macular degeneration |
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2 types of macular degeneration |
non-exudative (dry) exudative (wet) |
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person presents w/: -slowly progressive painless loss of vision on PE you find: - drusen: hyaline nodules present in Bruch's membrane -subretinal neovascular changes what may the person have? |
macular degeneration |
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person presents w/: -acute onset of visual loss on PE u find: -retinal hemorrhages |
macular degeneration |
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what is the leading cause of blindness is US? |
diabetic retinopathy |
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pt is: long term diabetic -has slowly progressive visual loss
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diabetic retinopathy |
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structural alterations & proliferative changes in retina leading to visual loss -long term diabetic |
diabetic retinopathy |
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person has 10 year hx of seizures: his seizures characterized by: -rapid onset -it then evolves into period of intense muscle contractions -in postictal period: he is flaccid; takes him 3-5 sec to regain consciousness - what is the type of seizure? |
tonic clonic seizure |
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what type of seizure? -begins abruptly -loss of consciousness -tonic stiffening of muscles followed by rhythmic contractions of large muscle groups -eye deviation, pupillary dilation, pooling of secretions -ANS: diaphoresis, HTN, piloerection -hypoxia |
generalized tonic clonic |
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what type of seizure? -cessation of motor or speech -blank stare -eyelid flickering -usually brief (5-10 s) -no post-ictal period |
absence seizure |
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what type of seizure? -very brief repetitive jerks w/o loss of consciousness -may convert to generalized tonic clonic |
myoclonic seizure |
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what type of seizure? -brief stiffening episodes of body/extremities w / or w/o impairment of consciousness |
tonic |
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what type of seizure? -sudden loss of postural tone w/ or w/o loss of consciousness |
atonic |
