Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
66 Cards in this Set
- Front
- Back
|
what is the most common cause of recurrent vertigo?
|
basilar migrane
|
|
|
what is the most common cause of vertigo?
|
benign paroxysmal postitional vertigo
|
|
|
what causes BPPV?
|
canalolithiasis: stimulation of semicircular canal by endolymph debris (loose otoconia)
|
|
|
vertigo for less than 1 minute a few times a day that gets worse with head movement
|
benign paroxysmal postitional vertigo
|
|
|
how do you diagnose BPPV?
|
dix-hallpike maneuver
|
|
|
how do you manage BPPV?
|
epley maneuver or brandt-Daroff exercises
|
|
|
what findings on Dix-Hallpike would suggest BPPV?
|
severe vertigo, rotatory nystagmus, latency, fatigue (response lessens as position is maintained), habituation (response lessens after repeating testing)
|
|
|
what population is affected with meniere disease?
|
40-60s
|
|
|
what causes meniere disease?
|
idiopathic endolymphatic hydrops
|
|
|
episodic vertigo, tinnitus, hearing loss that last 20 minuts to hours typically monthly with progressive hearing loss over time
|
meneire disease
|
|
|
vertigo with prominent N&V lasting hours to days
|
vestibular neuritis
|
|
|
vertigo with prominent N&V lasting hours to days + tinnitus and or hearing loss
|
labryinthitis
|
|
|
how do you treat vestibular neuritis/labrynthitis?
|
BZDs - vestibular suppressant and corticosteroids if hearing loss
|
|
|
vertigo with headache, N&V, photophobia, phonophobia, and identifyable triggers
|
basilar migrane
|
|
|
what is central vertigo associated with?
|
other brainstem symptoms - diploplia, dysarthria, dysphagia, hemisensory or crossed sensory deficit, ataxia
|
|
|
how do you treat herpetic neuralgia?
|
treat virus and pain, if more than 30 days = postherpetic, then just treat the pain
|
|
|
what are 4 types of neuropathic pain?
|
1. herpetic neuralgia, 2. trigeminal neuralgia, 3. chronic polyneuropathy, 4. thalamic pain syndrome (after stroke)
|
|
|
what is the most effective treatment for neuropathic pain?
|
therpaies that alter neuronal activity = anti-depressants, antiepileptics, to quiet the nerves
|
|
|
how do you give neuropathic pain medicine?
|
begin slow, increase every 2-4 weeks as needed; takes 2-4 weeks for each dose change to take effect; titrate to maximize efficacy-toxicity ratio
|
|
|
define primary headache
|
a condition in which headache is a primary manifestation, no underlying disease present (migraine, tension, cluster)
|
|
|
define secondary headache
|
a condition in which headache is secondary to underlying disease = very dangerous!
|
|
|
what do both primary and secondary headaches stimulate?
|
pain receptors on the meninges
|
|
|
define migraine
|
genetic condition where a person is predisposed to suffering recurrent episodes of: headaches, GI dysfunction, neurologic dysfunction, attacks are triggered by stimuli
|
|
|
what are the 4 phase of a migraine?
|
1. prodrome, 2. aura, 3. headache, 4. postdrome
|
|
|
what happens in the prodrome phase of a migraine?
|
mood changes, difficulty concentrating, stiff neck, fatigue, malaise, yawning, autonomic GI symptoms, anorexia or food craving
|
|
|
what happens in the aura phase of a migraine?
|
visual - gray silver clear; or other often migratory and sterotypical signs; MIGRATING = migraine. Usually positive, not negative symptoms
|
|
|
what happens in the headache phase of a migraine?
|
hurting of head, photophobia, phonophobia etc. can cause INCREASED BP or decreased BP or changes in temperature
|
|
|
what happens in the postdrome phase of a migraine?
|
fatigue, malaise, difficulty concentrating, mood changes, msucle aches, scalp tenderness, food craving or anorexia
|
|
|
what may be released due to migraines?
|
neurpeptides - CGRP
|
|
|
what is commonly found in neuroimaging of a migraine?
|
deep white matter unidentified bright objects (UBOs) located at gray/white jxn - common in migraine with aura
|
|
|
what are triptans?
|
migraine specific serotonin agonists - very effective but can cause vasospasm!
|
|
|
when is the only time that you would use a narcotic to treat migraines?
|
in pregnant women and those with vascular disease (elderly) otherwise they are not used
|
|
|
what population is affected by cluster headaches?
|
men - type of trigeminal autonomic cephalagia
|
|
|
what are cluster headaches associated with?
|
stabbing orbital pain, red eye, tearing, runny nose
|
|
|
what suggests a secondary headache?
|
first, worst, persistant or different
|
|
|
what is giant cell arteritis?
|
headache, arthritis, can really hurt the eye. A vasculitis
|
|
|
what is the most common cause of daily chronic headache?
|
medication overuse/analgesic rebound
|
|
|
how does a cingulated herniation present?
|
contralateral hemiparesis due to stroke - a few days later pt is sleep and leg paralysis ipsilateral to herniation
|
|
|
how does a central herniation present?
|
due to cerebral edema - bilateral dilated pupils increasingly get bigger and less responsive, bilateral medial rectus paralysis, decorticate or decerebrate positioning
|
|
|
how does a uncal herniation present?
|
CN3 gets hit = ipsilateral pupil sightly dilated, less responsive, loss of medial rectus; if ipsilateral brainstem = contralateral decerebration; if contralateral brainstem is pushed against skull = false localization = ipsilateral decerebrate + ispsilateral pupilllary dilation, use pupil to localize
|
|
|
what sign is first to arise but not seen clinically in uncal herniation?
|
visual field defect due to PCA occusion - but isn't seen clinically because patient is in a coma
|
|
|
what is a duret herniation?
|
complete uncal herniation = irreversible
|
|
|
how does a tonsilar herniation present?
|
1. progressive lethargy, 2. pinpoint pupils, 3. loss of PPRP = lateral gaze, 4. decerebrate
|
|
|
define seizure
|
clinical manifestation of abnormal and excessive synchornized cortical neuron activity
|
|
|
define epliepsy
|
two or more recurrent seizures unprovoked by any systemic or acute neruoligcal insult
|
|
|
what can provoke an absence seizure?
|
hyperventilation
|
|
|
what is unique about the postictal state of absence seizures?
|
there is no confusion - unlike complex partial seizures = distinguishable
|
|
|
what is todd's paralysis?
|
postictal confusion, somnolence, w/wo transiet focal deficit (can mimic stroke) = secondarily generalized tonic clonic seizure!!
|
|
|
what is west syndrome?
|
in kids <1 yr, seizure, developmental delay and infantile spasm
|
|
|
what is Lennox Gastuat syndrome?
|
multiple seizure types, developmental delay and MR
|
|
|
what hormones are involved in seizure activity?
|
E - proconvulsant; P - anti-convulusant
|
|
|
what metabolic situations can cause seizures?
|
low blood glucose, or high glucose, low sodium, calcium or magnesium
|
|
|
what drugs can cause seizures?
|
IV drug use, cocain, ephedrine, herbal remedies, medication reduction
|
|
|
what type of seizure has 3 htz spikes and waves?
|
absence
|
|
|
what is the first line of therapy for seizures?
|
AEDs
|
|
|
what is a ketogenic diet?
|
a diet indicated for children with medically resistant epilepsy - high fat, low carbs, low protein; must be closely monitored
|
|
|
what does a corpus callostomy prevent?
|
generalization of simple seizures
|
|
|
define status epilepticus
|
a single seizure lasting more than 30 minutes or mutliple seizures without full recovery in between
|
|
|
define convulsive status epilepticus
|
clinical signs of seizures are obvious
|
|
|
define non-convulsive status epilepticus
|
no clinical signs of seizure actiivty - coma like confusion caused by complex partial seizures
|
|
|
what is seen in the blood during status epilepticus?
|
increased leukocytosis without an increase in bands
|
|
|
where is neuronal necrosis due to seizures most prominent?
|
hippocampus, cerebellum, and layers 3, 5 and 6 of the cortex
|
|
|
what are the autonomic complications of status?
|
hyper/hypotension, hyperthermia, inhibition of respiration, arrhythmias
|
|
|
what are the pulmonary complications of status?
|
obstruction, inhibition of respiratory centers, excessive bronchial secretions, aspiration
|
|
|
what are the metabolic complications of status?
|
lactic acidosis, hyperkalemia, hypoglycemia
|
|
|
what are the renal complications of status?
|
myoglobinuria, acute tubular necrosis
|
