Cranial Nerves:
Mnemonic:
On Old Olympus Towering Tops
A Finn And German Viewed Some Hops
CN 1: Olfactory (sense and smell)CN 2: Optic (vital to vision and visual fields and in conjunction with CN 3, pupillary reaction)CN 3: Occulomotor (pupillary reaction, movement of eye with CN 4 and 6)CN 4: TrochlearCN 5: Trigeminal (sensations-temperature, pain, and tactile) and corneal reflexesCN 6: Abducens (abduction and movement of eyeball)CN 7: facial movementCN 8: hearing and balanceCN 9: Glossopharyngeal (tongue and throat movement)CN 10: VagusCN 11: Accessory and spinal root of the accessoryCN 12: Hypoglossal (movement and protrusion of the tongue)
Bell palsy is?
Acute paralysis of CN 7.
Treatment of Bell palsy?
Corticosteriod therapy can limit length and severity of the paralysis. Supportive therapy to help avoid ocular and oral injury.
Primary Headaches:
1. migraine2. tension-type3. cluster
Tension-type headache:
Lasts 30 minutes to 7 days with more than 2 characteristics:pressing, nonpulsatile painmild to moderate in intensityusually bilateral locationnotation 0-1 of the following (>1 suggests migraines): nausea, photophobia, and phonophobia
Headache with out aura:
Last 30 minutes to 7 days with more than 2 characteristics: usually unilateral location, although occasionally bilateralpulsating quality, moderate to severe in intensityaggravation by normal activityduring headache, greater than 1 of the following: nausea and/or vomiting, photophobia, and phonophobia
Migraine with aura:
Migraine-type headache occurs with or after aurafocal dysfunction of cerebral cortex or brainstem causes greater than 1 aura symptom develops over 4 minutes or greater than 2 symptoms occur in successionno aura symptom should last greater than 1 hour
Cluster Headache:
Tendency of headache to occur daily in groups or clustersClusters usually lasts several weeks to months, then disappear for months to yearsUsually occur at characteristics times of year such as vernal and autumnal equinox, with 1-8 episodes per day, at the same time of day. Common time 1 hour into sleepHeadache location is often located behind one eye with a steady, intense, severe pain in a crescendo pattern lasting 15 mins to 3 hours, with most in the range of 30-45 mins.
Helpful observations in patients with acute headache:
history of previous identical headachesintact cognitionsupple necknormal neurologic examination resultsimprovement in symptoms while under observation and treatment
Headache Red Flags: "SNOOP" SIGNS
Systemic symptoms: fever, weight loss, or secondary headache risk factorsNeurologic signs & symptoms: confusion, impaired alertness or consciousnessOnset: sudden, abrupt, or split-secondOlder: new onset and progressive headache, especially in adult older than 50Previous headache and history: first headache, different headache, change in attack frequency, severity, or clinical features
Treatment options for tension-type headaches:
acetaminophenNSAIDScombination products (butalbital with acetaminophen)prophylactic therapies
Treatment options for cluster headaches:
reduction of triggers (alcohol & tobacco)prophylactic therapyabortive therapy (triptans, high-dose NSAIDS, and high flow oxygen)
Treatment options for migraines:
abortive therapy (oral, parenteral, nasal spray, suppository)
Forms of medications for headaches:
Triptans: selective serotonin receptor agonists and work at the 5-HT1D serotonin receptor site, allowing an increase uptake of serotonin.Ergotamines: act as 5-HT1A and 5 HT1D receptor agonists and do not alter cerebral blood flow.NSAIDS: inhibit prostaglandin and leukotriene synthesis and are most helpful when used at the first sign of headache.Fioricet: caffeine enhances the analgesic properties of acetaminophen, butalbitals barbiturate action enhances select neurotransmitter action.Midrin: multidrug product that includes a vasoconstrictor, analgesic, and relaxant.Excedrin Migraine: aspirin, acetaminophen, and caffeine combination. Can cause rebound headaches.Neuroleptics: may be used as adjuncts in migraine headache therapy, because they help control nausea and vomiting.Opioids: migraine rescue.
Meningitis:
An infection of the meninges, CSF, and ventricles. It can be bacterial (pyogenic) or viral (aseptic).
Bacterial Meningitis:
Occurs via hematogenous spread. Organisms can enter the meninges through the bloodstream from other parts of the body. It also can be from an infection such as otitis media or bacterial rhinosinusitis. It is contagious through droplets.
Signs & Symptoms of Meningitis:
Presence of Kernig signs(lying supine and the hip flexed at 90 degrees; positive sign when extension of knee from this position elicits resistance or pain in the lower back or posterior thigh) and Brudzinki signs (passive neck flexion in a supine; results in flexion of the knees and hips)HeadacheFevernuchal rigiditystiff neckLess common: seizures, vomiting, and altered consciousness
Diagnosis of Meningitis:
Lumbar puncture with CSFCT or MRI of the head before LP
Treatment for people in contact of infected patient more than 4 hours:
Rifampin, ciprofloxacin, and ceftriaxone.
Treatment of Meningitis:
Supportive careAnti-infective agentsCeftriaxone with VancomycinAcyclovir
Multiple Sclerosis:
Focal neurologic dysfunction, with symptoms occurring acutely, worsening over a few days, and lasting weeks, followed by a period of partial to full resolution. MS is characterized by exacerbation and remission.
Common symptoms of MS:
weakness or numbness of limbmonocular visual lossdiplopiavertigofacial weakness or numbnesssphincter disturbancesataxianystagmus
Two forms of MS:
Relapsing-remitting MS-episodes resolve with good neurologic function between exacerbations and minimal to no accumulative defectsChronic progressive MS-episodes do not fully resolve and there are accumulative defects
Treatment of MS:
High-dose corticosteroidsMaintenance-Betaseron or AvonexImmunosuppressive therapy-methotrexate or mitoxantrone
Parkinson Disease:
Slowly progressive movement disorder that is largely caused by an alteration in dopamine-containing neurons of the pars compacta of the substantia nigra.
Diagnosis of Parkinson:
Clinical evaluationSix cardinal signs: tremor at rest, rigidity, bradykinesia, flexed posture, loss of postural reflexes, and masklike facies
Early treatment of Parkinson:
MirapexRequipLevodopa
Seizures:
Absence: blank staring lasting 3-50 seconds accompanied by impaired level of consciounessMyoclonic: awake state or momentary loss of consciousness with abnormal motor behavior lasting seconds to minutes; one or more muscle groups causing brief jerking contractions of the limbs and trunk, occasionally flinging patientTonic-clonic: rigid extension of arms and legs followed by sudden jerking movements with loss of consciousness; bowel and bladder incontinence common with postictal confusionSimple partial or focal: awake state with abnormal motor, sensory, autonomic, or psychic behavior; movement can affect any part of body, localized or generalizedComplex partial: aura characterized by unusual sense of smell or taste, visual or auditory hallucinations, image or sound, stomach upset; followed by vague stare and facial movements, muscle contraction and relaxation, and autonomic signs; can progress to loss of consciousness
Treatment of Seizures:
PhenytoinCarbamazepineClonazepamEthosuximideValproic acidGabapentinLamotrigineTopiramate
TIA:
an acute neurologic even in which all signs and symptoms, including numbness, weakness, and flaccidity, as well as visual changes, ataxia, or dysarthria, resolve usually within minutes but certainly by 24 hours after onset
Delirium:
Condition in which the patient exhibits an acute onset, over hours to a few days, of reduced ability to maintain attention to external stimuli and appropriately shift attention to new stimuli. Resulting in disorganized thinking.
Causes of Delirium:
DrugsEmotionalLow PO2InfectionRetention of urine or fecesIctal or postictal stateUndernutritionMetabolicSubdural hematoma