Podcast
Questions and Answers
What is the primary goal when evaluating a patient presenting with a headache?
What is the primary goal when evaluating a patient presenting with a headache?
- To determine if the patient has a history of chronic migraines.
- To quickly alleviate the patient's pain and discomfort.
- To differentiate harmless headache causes from life-threatening conditions. (correct)
- To identify the specific type of headache to tailor treatment.
When taking a focused headache history, which element would be MOST helpful in differentiating between different types of headaches?
When taking a focused headache history, which element would be MOST helpful in differentiating between different types of headaches?
- Determining the patient's preferred sleeping position.
- Documenting the patient's favorite foods.
- Assessing the patient's current stress levels.
- Inquiring about neurological changes. (correct)
A patient describes their headache as starting suddenly and peaking within seconds. Which of these possibilities should be HIGHLY considered?
A patient describes their headache as starting suddenly and peaking within seconds. Which of these possibilities should be HIGHLY considered?
- Subarachnoid hemorrhage (correct)
- Tension headache
- Migraine
- Cluster headache
A patient reports experiencing visual disturbances preceding their headaches. What type of headache is MOST associated with this symptom?
A patient reports experiencing visual disturbances preceding their headaches. What type of headache is MOST associated with this symptom?
What is the MOST common characteristic of pain associated with migraine headaches?
What is the MOST common characteristic of pain associated with migraine headaches?
Which of the following is a potential trigger for migraine headaches?
Which of the following is a potential trigger for migraine headaches?
A patient describes their headache as a tight band around their head, accompanied by neck stiffness. Which type of headache is MOST likely?
A patient describes their headache as a tight band around their head, accompanied by neck stiffness. Which type of headache is MOST likely?
When managing tension headaches, what is a PRIMARY recommendation for long-term relief?
When managing tension headaches, what is a PRIMARY recommendation for long-term relief?
A patient presents with severe, unilateral periorbital pain, accompanied by ptosis, lacrimation, and nasal congestion. They report these attacks occur multiple times a day for several weeks. What type of headache is MOST likely?
A patient presents with severe, unilateral periorbital pain, accompanied by ptosis, lacrimation, and nasal congestion. They report these attacks occur multiple times a day for several weeks. What type of headache is MOST likely?
What is a KEY treatment for cluster headaches?
What is a KEY treatment for cluster headaches?
Which of the following is a 'red flag' symptom that warrants immediate evacuation/transfer in a patient with a headache?
Which of the following is a 'red flag' symptom that warrants immediate evacuation/transfer in a patient with a headache?
What is a common underlying cause of a traumatic subarachnoid hemorrhage?
What is a common underlying cause of a traumatic subarachnoid hemorrhage?
A patient who experienced head trauma is showing signs suggesting a possible concussion. What tool should be used to evaluate the patient?
A patient who experienced head trauma is showing signs suggesting a possible concussion. What tool should be used to evaluate the patient?
A patient involved in a motor vehicle incident is suspected of having an epidural hematoma. Which symptom is of PRIMARY concern?
A patient involved in a motor vehicle incident is suspected of having an epidural hematoma. Which symptom is of PRIMARY concern?
A patient who has experienced a concussion is being discharged. What is MOST important to emphasize regarding follow-up?
A patient who has experienced a concussion is being discharged. What is MOST important to emphasize regarding follow-up?
In managing a patient with a recent concussion, what recommendation promotes optimal recovery and return to duty?
In managing a patient with a recent concussion, what recommendation promotes optimal recovery and return to duty?
Which type of headache is MOST likely to be accompanied by a loss of consciousness and requires immediate medical attention to rule out potential aneurysm rupture?
Which type of headache is MOST likely to be accompanied by a loss of consciousness and requires immediate medical attention to rule out potential aneurysm rupture?
Which of these is a potential symptom of a subarachnoid hemorrhage?
Which of these is a potential symptom of a subarachnoid hemorrhage?
When assessing a patient with suspected subarachnoid hemorrhage, during the physical exam, what finding is MOST likely?
When assessing a patient with suspected subarachnoid hemorrhage, during the physical exam, what finding is MOST likely?
Which consideration is of PRIMARY importance in the immediate management of a patient diagnosed with a subarachnoid hemorrhage?
Which consideration is of PRIMARY importance in the immediate management of a patient diagnosed with a subarachnoid hemorrhage?
What factor is MOST common among the etiologies of seizures?
What factor is MOST common among the etiologies of seizures?
A patient experiences a seizure, and you are collecting patient history for further analysis. What is MOST important to do in this stage?
A patient experiences a seizure, and you are collecting patient history for further analysis. What is MOST important to do in this stage?
When assessing a patient who experienced a seizure, what tool is MOST useful in identifying underlying causes?
When assessing a patient who experienced a seizure, what tool is MOST useful in identifying underlying causes?
A patient has a seizure and is administered the proper medication to manage the event. What should a care provider consider regarding further support for this patient?
A patient has a seizure and is administered the proper medication to manage the event. What should a care provider consider regarding further support for this patient?
What is the PRIMARY role of supportive care in managing Guillain-Barré syndrome?
What is the PRIMARY role of supportive care in managing Guillain-Barré syndrome?
A patient is suspected of having Guillain-Barré syndrome. What condition is MOST likely to be found as a result of their condition?
A patient is suspected of having Guillain-Barré syndrome. What condition is MOST likely to be found as a result of their condition?
A patient displaying the symptoms of a traumatic brain injury is suspected of having Guillain-Barré syndrome. What condition would be MOST relevant to monitor?
A patient displaying the symptoms of a traumatic brain injury is suspected of having Guillain-Barré syndrome. What condition would be MOST relevant to monitor?
In caring for a patient diagnosed with mononeuropathy, which non-pharmaceutical intervention promotes recovery?
In caring for a patient diagnosed with mononeuropathy, which non-pharmaceutical intervention promotes recovery?
A patient presents with sensory disturbances and weakness in the distribution of a single peripheral nerve. Which additional factor would MOST suggest mononeuropathy?
A patient presents with sensory disturbances and weakness in the distribution of a single peripheral nerve. Which additional factor would MOST suggest mononeuropathy?
During a physical exam for suspected mononeuropathy, what technique is MOST useful in locating the location of the issue?
During a physical exam for suspected mononeuropathy, what technique is MOST useful in locating the location of the issue?
A patient is following up regarding chronic compressive mononeuropathies. What can caregivers recommend?
A patient is following up regarding chronic compressive mononeuropathies. What can caregivers recommend?
What is the PRIMARY cause of Bell's Palsy (Facial Nerve Palsy)?
What is the PRIMARY cause of Bell's Palsy (Facial Nerve Palsy)?
A patient shows signs of Bell's Palsy. Which of these symptoms will most likely be present?
A patient shows signs of Bell's Palsy. Which of these symptoms will most likely be present?
A patient is undergoing a neurological exam. Which indicator would MOST suggest Bell's Palsy (Facial Nerve Palsy)?
A patient is undergoing a neurological exam. Which indicator would MOST suggest Bell's Palsy (Facial Nerve Palsy)?
What is the PRIMARY initial treatment strategy for Bell's Palsy (Facial Nerve Palsy)?
What is the PRIMARY initial treatment strategy for Bell's Palsy (Facial Nerve Palsy)?
Which neurological disorder presents with weakness that varies widely in severity and has a symmetric distribution?
Which neurological disorder presents with weakness that varies widely in severity and has a symmetric distribution?
Which neurological disorder involves the distribution of a single peripheral nerve?
Which neurological disorder involves the distribution of a single peripheral nerve?
Which neurological disorder causes a headache that peaks within seconds due to bleeding?
Which neurological disorder causes a headache that peaks within seconds due to bleeding?
Which neurological disorder may require care to prevent scratches?
Which neurological disorder may require care to prevent scratches?
When assessing a patient complaining of a headache, what aspect of their medical history is MOST likely to reveal potential underlying conditions contributing to their headaches?
When assessing a patient complaining of a headache, what aspect of their medical history is MOST likely to reveal potential underlying conditions contributing to their headaches?
A patient reports experiencing headaches that are significantly relieved after taking over-the-counter pain medication. What additional information is MOST important to gather to assess for potential medication-overuse headaches?
A patient reports experiencing headaches that are significantly relieved after taking over-the-counter pain medication. What additional information is MOST important to gather to assess for potential medication-overuse headaches?
A patient reports a “band-like” headache that is worse with stress and fatigue. How can a health provider differentiate the headache the patient is experiencing from a migraine?
A patient reports a “band-like” headache that is worse with stress and fatigue. How can a health provider differentiate the headache the patient is experiencing from a migraine?
A patient presents with a severe headache, nasal congestion, and drooping of the eyelid on one side of their face. How might a doctor confirm that the patient is experiencing a cluster headache rather than a migraine?
A patient presents with a severe headache, nasal congestion, and drooping of the eyelid on one side of their face. How might a doctor confirm that the patient is experiencing a cluster headache rather than a migraine?
A patient who sustained a minor head injury is being assessed for concussion. What is the MOST appropriate next step in their management?
A patient who sustained a minor head injury is being assessed for concussion. What is the MOST appropriate next step in their management?
What symptoms should a medical provider ensure are improving in a patient after a medical intervention such as a prescription or a procedure in order to avoid red flag symptoms?
What symptoms should a medical provider ensure are improving in a patient after a medical intervention such as a prescription or a procedure in order to avoid red flag symptoms?
A patient experiencing seizures is suspected to have a hereditary or congenital disorder. What tool would be used to confirm diagnosis?
A patient experiencing seizures is suspected to have a hereditary or congenital disorder. What tool would be used to confirm diagnosis?
An individual experiencing a seizure lasting longer than five minutes requires support beyond medication, What option includes MOST relevant support?
An individual experiencing a seizure lasting longer than five minutes requires support beyond medication, What option includes MOST relevant support?
What factor helps a medical provider differentiate between Guillain-Barré syndrome and other conditions presenting with similar weakness?
What factor helps a medical provider differentiate between Guillain-Barré syndrome and other conditions presenting with similar weakness?
A patient comes in with what appears to be Guillain-Barré syndrome. What information is important to know about the patient's pain?
A patient comes in with what appears to be Guillain-Barré syndrome. What information is important to know about the patient's pain?
What should the medical provider recommend to prevent the compression of any nerves, such as the ulnar, median, and radial nerve?
What should the medical provider recommend to prevent the compression of any nerves, such as the ulnar, median, and radial nerve?
In caring for a patient diagnosed with mononeuropathy triggered by work-related activities, what strategy should be recommended to prevent the issue the from advancing?
In caring for a patient diagnosed with mononeuropathy triggered by work-related activities, what strategy should be recommended to prevent the issue the from advancing?
A patient exhibits unilateral facial paralysis, with the forehead not wrinkling. What information is MOST relevant to collect?
A patient exhibits unilateral facial paralysis, with the forehead not wrinkling. What information is MOST relevant to collect?
What intervention is MOST important in addressing the possible complications of Bell’s palsy?
What intervention is MOST important in addressing the possible complications of Bell’s palsy?
A patient is diagnosed with Bell's Palsy and is undergoing treatment. What step should a caregiver take to ensure symptoms experienced by the patient are improving?
A patient is diagnosed with Bell's Palsy and is undergoing treatment. What step should a caregiver take to ensure symptoms experienced by the patient are improving?
A patient exhibits signs and symptoms suggestive of a neurological disorder. What BEST describes the initial approach to diagnosing the disorder?
A patient exhibits signs and symptoms suggestive of a neurological disorder. What BEST describes the initial approach to diagnosing the disorder?
In a patient suspected of having a stroke presenting with facial paralysis, what finding can HELP distinguish a stroke from Bell's palsy?
In a patient suspected of having a stroke presenting with facial paralysis, what finding can HELP distinguish a stroke from Bell's palsy?
A patient's CT scan reveals blood surrounding the brain but does not show evidence of injury. What actions can the medical provider take to ensure the patient remains safe?
A patient's CT scan reveals blood surrounding the brain but does not show evidence of injury. What actions can the medical provider take to ensure the patient remains safe?
What factor is MOST important to know in treating patients who experienced a traumatic brain injury?
What factor is MOST important to know in treating patients who experienced a traumatic brain injury?
A doctor is creating a plan for an individual after receiving a concussion. What action is MOST important in the plan?
A doctor is creating a plan for an individual after receiving a concussion. What action is MOST important in the plan?
A medical provider can suspect a subarachnoid hemorrhage if a patient experiences a sudden headache. How can physicians confirm a diagnosis?
A medical provider can suspect a subarachnoid hemorrhage if a patient experiences a sudden headache. How can physicians confirm a diagnosis?
A patient presents with a severe headache and is found to have a subarachnoid hemorrhage. What factor is MOST important in improving a patient’s outcome?
A patient presents with a severe headache and is found to have a subarachnoid hemorrhage. What factor is MOST important in improving a patient’s outcome?
A patient comes in experiencing the “worst headache of their life”. What actions should a medical provider take?
A patient comes in experiencing the “worst headache of their life”. What actions should a medical provider take?
What is the typical treatment approach for a patient who has an acute compression neuropathy of the radial nerve, otherwise known as Saturday night palsy?
What is the typical treatment approach for a patient who has an acute compression neuropathy of the radial nerve, otherwise known as Saturday night palsy?
Which of the following actions by a patient is likely to trigger a tension headache?
Which of the following actions by a patient is likely to trigger a tension headache?
Other than physical activity, what else is not aggravated by a tension headache?
Other than physical activity, what else is not aggravated by a tension headache?
Which of the following actions is recommended for a patient to get relief from a tension headache?
Which of the following actions is recommended for a patient to get relief from a tension headache?
Your patient is a male between 20-40 years old. What interventions can be recommended to him if he is having severe pain?
Your patient is a male between 20-40 years old. What interventions can be recommended to him if he is having severe pain?
Trauma is the most common cause of brain injury. What is a secondary cause?
Trauma is the most common cause of brain injury. What is a secondary cause?
What intervention should be taken with trauma victims?
What intervention should be taken with trauma victims?
In which situation should the provider administer MACE-2?
In which situation should the provider administer MACE-2?
If a patient is unable to move, presents with incomprehensible speech, and reports none, what is their Glasgow Coma Scale?
If a patient is unable to move, presents with incomprehensible speech, and reports none, what is their Glasgow Coma Scale?
Why are TBI center preferred in a trauma event?
Why are TBI center preferred in a trauma event?
Compared to an epidural bleed, a subdural bleed...
Compared to an epidural bleed, a subdural bleed...
In order to confirm seizure, what must be ruled out?
In order to confirm seizure, what must be ruled out?
Seizures can result in peculiar behavior and automatisms. What initial intervention steps should be prioritized?
Seizures can result in peculiar behavior and automatisms. What initial intervention steps should be prioritized?
If a patient presents with flaccid weakness at a symmetric distribution and has trouble breathing, what diagnosis should be suspected?
If a patient presents with flaccid weakness at a symmetric distribution and has trouble breathing, what diagnosis should be suspected?
It is important to rule out Polio with patients showing tone muscles, however Polio presents with
It is important to rule out Polio with patients showing tone muscles, however Polio presents with
Trauma is the most common cause of subarachnoid hemorrhages. Other than family history, what can be reviewed to know what space the bleeding is happening in?
Trauma is the most common cause of subarachnoid hemorrhages. Other than family history, what can be reviewed to know what space the bleeding is happening in?
What is the typical presentation of someone experiencing Bell's Palsy?
What is the typical presentation of someone experiencing Bell's Palsy?
A patient reports experiencing a "thunderclap" headache. What is the MOST important INITIAL action?
A patient reports experiencing a "thunderclap" headache. What is the MOST important INITIAL action?
What is the MOST LIKELY characteristic of a migraine with aura?
What is the MOST LIKELY characteristic of a migraine with aura?
What is the MOST common symptom reported with a tension headache?
What is the MOST common symptom reported with a tension headache?
How do cluster headaches DIFFER from migraines?
How do cluster headaches DIFFER from migraines?
You suspect a patient has a migraine. To confirm a migraine diagnosis, their headache history should include which element?
You suspect a patient has a migraine. To confirm a migraine diagnosis, their headache history should include which element?
A patient reports a worsening headache and also experiences aphasia. What do these signs indicate?
A patient reports a worsening headache and also experiences aphasia. What do these signs indicate?
What is the MOST appropriate INITIAL treatment for a patient experiencing mild tension headaches?
What is the MOST appropriate INITIAL treatment for a patient experiencing mild tension headaches?
What is the INITIAL step in managing a patient's cluster headache?
What is the INITIAL step in managing a patient's cluster headache?
What is the primary role of CT scanning in the INITIAL assessment of traumatic brain injuries?
What is the primary role of CT scanning in the INITIAL assessment of traumatic brain injuries?
Following a concussion, what recommendation should patients implement to PROMOTE full recovery?
Following a concussion, what recommendation should patients implement to PROMOTE full recovery?
A patient is diagnosed with a subarachnoid hemorrhage. What intervention is MOST indicated?
A patient is diagnosed with a subarachnoid hemorrhage. What intervention is MOST indicated?
What is the significance of a lucid interval followed by a rapid decline in consciousness following a head trauma?
What is the significance of a lucid interval followed by a rapid decline in consciousness following a head trauma?
If a patient presents with a seizure, and is suspected of having a hereditary disorder, what step is MOST indicated?
If a patient presents with a seizure, and is suspected of having a hereditary disorder, what step is MOST indicated?
What is a KEY characteristic of Guillain-Barré syndrome (GBS)?
What is a KEY characteristic of Guillain-Barré syndrome (GBS)?
Why should care providers support the patients who have Guillain-Barré syndrome during their plan of care?
Why should care providers support the patients who have Guillain-Barré syndrome during their plan of care?
A young adult is experiencing sensory disturbances and weakness in their right hand, specifically affecting the median nerve distribution. What information is MOST critical in assessing this patients injury?
A young adult is experiencing sensory disturbances and weakness in their right hand, specifically affecting the median nerve distribution. What information is MOST critical in assessing this patients injury?
To identify a nerve issue in patients experiencing mononeuropathy, what can a healthcare provider perform?
To identify a nerve issue in patients experiencing mononeuropathy, what can a healthcare provider perform?
How can patients prevent compression neuropathies?
How can patients prevent compression neuropathies?
Which factor is thought to cause Bell's Palsy (Facial Nerve Palsy)?
Which factor is thought to cause Bell's Palsy (Facial Nerve Palsy)?
What is MOST relevant about Bell's Palsy (Facial Nerve Palsy)?
What is MOST relevant about Bell's Palsy (Facial Nerve Palsy)?
Flashcards
Motor Homunculus
Motor Homunculus
Mapping of motor cortex to body parts, distorted by representation size.
Sensory Homunculus
Sensory Homunculus
Mapping of sensory cortex to body parts, distorted by sensitivity.
Dura Mater
Dura Mater
Outermost, tough layer with vessels/nerves; allows venous drainage.
Arachnoid Mater
Arachnoid Mater
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Thunderclap Headache
Thunderclap Headache
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Essential Headache Assessment
Essential Headache Assessment
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Focused History
Focused History
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Physical Exam Importance
Physical Exam Importance
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Migraine Auras
Migraine Auras
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Migraine Pathophysiology
Migraine Pathophysiology
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Migraine Symptoms
Migraine Symptoms
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Migraine Differential
Migraine Differential
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Migraine Medication
Migraine Medication
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Tension headaches
Tension headaches
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Tension Headache Signs
Tension Headache Signs
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Tension Headache Treatment
Tension Headache Treatment
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Cluster Headache Definition
Cluster Headache Definition
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Cluster Headache Signs
Cluster Headache Signs
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Cluster Headache Treatment
Cluster Headache Treatment
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Leading Cause of Death
Leading Cause of Death
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Concussion Definition
Concussion Definition
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Epidural Hematoma
Epidural Hematoma
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Subdural Hematoma
Subdural Hematoma
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Head Injuries Transport
Head Injuries Transport
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Concussion Management
Concussion Management
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Subarachnoid Hemorrhage Cause
Subarachnoid Hemorrhage Cause
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Subarachnoid Physical Exam
Subarachnoid Physical Exam
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Subarachnoid Differential
Subarachnoid Differential
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Seizure Definition
Seizure Definition
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Seizure Etiologies
Seizure Etiologies
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Focused History Seizure
Focused History Seizure
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Seizure Treatment
Seizure Treatment
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Guillain-Barré Syndrome
Guillain-Barré Syndrome
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Guillain-Barré Symptoms
Guillain-Barré Symptoms
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Guillain-Barré Treatment
Guillain-Barré Treatment
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Mononeuropathy Cause
Mononeuropathy Cause
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Mononeuropathy Symptoms
Mononeuropathy Symptoms
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Focused History Mononeuropathy
Focused History Mononeuropathy
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Mononeuropathy Management
Mononeuropathy Management
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Bell's Palsy
Bell's Palsy
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Bell's Palsy Signs
Bell's Palsy Signs
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Physical Exam Bells
Physical Exam Bells
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Differential bells
Differential bells
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Bells Treatment
Bells Treatment
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Study Notes
- Unit 9 focuses on neurologic disorders
Terminal Learning Objective
- Determine what exams and questions are needed to accurately identify the correct diagnosis
- Given a patient scenario, formulate treatment plans for common neurological disorders
Enabling Learning Objectives
- With a patient scenario, identify symptoms and treatment for neurological disorders like headache, subarachnoid hemorrhage, seizure, Guillain-Barré, mononeuropathies, Bell's Palsy
- Meninges are 3 layers that protect the brain and spinal cord
- Dura mater is a tough outer covering containing blood vessels and nerves that allows for venous drainage of the brain via dural sinuses
- Subdural hematoma involves bleeding underneath dura mater
- Arachnoid mater is a thin, web-like covering between dura and pia mater
- Arachnoid mater lacks vessels
- Subarachnoid space lies between arachnoid and pia mater
- Subarachnoid hematoma refers to bleeding in this space
- Spinal cord constitutes a continuous column of nervous tissue extending through the vertebral column
- The spinal cord terminates at the level of L1/L2
- Spinal cord consists of 31 segments, each giving rise to a pair of spinal nerves
Headache
- Headache is a common complaint with many possible etiologies
- Complete history and evaluation are essential
- A focused history will help differentiate between different types of headaches and include OPQRST, family history, travel, medication use, headache history, head injuries, neck stiffness, and neurological changes
- A physical exam is crucial to separate harmless headache causes from life-threatening conditions
- Focus on HEENT, neck, and the nervous system, and perform visual acuity on all headache patients
Migraine Headache
- An episodic primary headache disorder with a clinical diagnosis
- Auras occur in about 25% of patients/UpToDate
- Auras usually occur just before the headache, but may start after
- Auras: gradual onset, temporary, neurologic features
- Auras can be positive (adding something like visual, auditory, or motor) and negative (losing something like vision, hearing, or sensation)
- Visual auras are most common
- Most common cause of recurrent moderate to severe headache
- One-year prevalence in men with migraines is 6%
- One-year prevalence for women with migraines is 18%
- Etiology's theory suggests that it is a primary neuronal dysfunction that leads to a sequence of changes intracranially and extracrainially
- Potential migraine triggers include red wine, skipping meals, excessive stimuli, weather changes, sleep deprivation, stress, hormonal factors, and certain foods
- Symptoms include moderate to severe headaches lasting 4 hrs to several days, resolving with sleep, pulsatile or throbbing pain that is usually unilateral Nausea and occasional vomiting
- Migraines often involve sensitivity to light (photophobia), sound (phonophobia), and smells (osmophobia), and possible visual auras
- Focused History inclues personal or family history of migraines, and known personal or familial triggers
- Differential includes tension headache, cluster headache, post-concussive issues, and meningitis
- Medications that require preceptor approval include acetaminophen or NSAIDs for mild headaches, or cafergot or a triptan if ineffective, ondansetron or promethazine for nausea/vomiting, and a "headache cocktail" potentially including 1L of IV fluids, 15-50mg of ketorolac IM or IV, and an antiemetic like metoclopramide (10mg IV)
- Providers should recall the risk for extrapyramidal side effects of metoclopramide, and consider adding 25mg IV diphenhydramine
Tension Headache
- The most prevalent headache in the general population
- Stress and mental tension are reported to be the most common precipitants
- Signs and Symptoms involve mild to moderate, generalized pain usually without incapacitation, nausea or photophobia, pain typically bilateral, and described as band or vise-like, non-throbbing, not aggravated by routine physical activity
- Focused History reviews potential migraine triggers, sleep disturbances, stress, TMJ dysfunction, neck pain, and eye strain
- In exam, is required full neurological exam and assessment of muscle tenderness in the head, neck or shoulders
- Differential involves migraine headache, post-concussive diagnosis and meningitis
- Treat with Acetaminophen or NSAID and Battlefield Acupuncture (BFA) immediately, identify and address triggers like sleep irregularities, poor posture, emotional stressors, TMJ dysfunction, and neck pain/eyestrain
- Reduce stress, regulate sleep cycle, eat regular meals, and hydrate, avoid triggers if possible, increase exercise, avoid tobacco and alcohol
- Follow up after 48 hours if the symptoms improve, with consideration of EVAC/transfer if remains uncontrolled or worsens
Cluster Headache
- Involves Excruciating, unilateral periorbital or temporal pain with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion)
- Often has a episodic nature: patients experience ≥ 1 attack/day for 1-3 months followed by remission for months to years
- Patients are typically agitated, pacing, yelling or thrashing Symptoms include pain always unilateral and occurs on the same side of the head in an orbitotemporal distribution described as sharp or stabbing, attacks are recurrent and often multiple (clusters), peaking within minutes and spontaneously subsiding within 30 minutes to an hour, and may wake patient from sleep
- Primarily affects men from 20-40 years old
- Exam requires full neurological exam, with possible nasal congestion, rhinorrhea, lacrimation, facial flushing and Horner's syndrome (ptosis, miosis, enophthalmos, and anhidrosis) on the ipsilateral side
- The differential includes tension headache, migraine headache, post-concussive pain and meningitis
- Treatment: Subcutaneous or intranasal triptan and 100% oxygen via non-rebreather mask at 12-15 L/min for 15-20 minutes Attacks are so vicious and with a risk of suicide, disease is not diagnosed or managed appropriately
Head Injury
- Trauma is the leading cause of death for individuals up to the age of 45 years, be sure to undertake a field screening
- Symptoms can include headache and other worrisome symptoms like nausea, vomiting, dizziness, blurred vision, weakness, aphasia, balance and coordination issues, and seizure
- There can be also be cognitive issues The Glasgow Coma Scale provides key data and can be accessed at health.mil
- Full neurological exam also provides key data for brainstem dysfunction
- The differential diagnosis includes Concussion, Epidural hematoma, Subdural hematoma, and Diffuse axonal injury
- Contact preceptor ASAP: the patient may need EVAC and referral for focal neurologic deficits, altered consciousness or skull fracture, or late complications of head injury like post-traumatic seizure or post-concussive syndrome
- Management of specific symptoms is key
- Patients should not return to full duty status until asymptomatic and off medication, needing patient support and reassurance for recovery
- The best outcomes are when it is identified correctly
Trauma and Concussion
- Trauma is the most common cause
- Nontraumatic spontaneous hemorrhage frequently results from the rupture of an arterial saccular (“berry”) aneurysm or from an arteriovenous malformation
- SAH is a sudden "thunderclap" headache of a severe intensity, which peaks within second of onset, possibly followed by nausea and vomiting or loss of consciousness
- Loss or impairment of consciousness and sensorium, and/or Irritability, confusion, coma and death as hemorrhage progresses
- CT will show hemorrhage and lumbar puncture may demonstrate red blood cells in the cerebrospinal fluid
- The differential includes meningitis, migraine, and acute hypertensive crisis
- Conduct an EVAC or transfer for all patients and advise conscious patients against any straining or exertion
- The main aim of treatment is to prevent further hemorrhage
Seizures
- Electrical discharge that occurs within the gray matter and transiently interrupts normal brain function
- Uncommon - about 2% of adults have a seizure at some point during their life (2/3 will never have another)
- Etiologies include alcohol and drug withdrawal, metabolic disturbances, Head trauma, Infectious diseases, Hereditary or congenital disorders, and pressure related
- Symptoms include abrupt onset of abnormal muscle activity – focal or generalized, and aura may precede seizure (consisting of confusion, peculiar behavior, automatisms, or other psychic sensations)
Guillain-Barré Syndrome
- Acute, rapidly progressive but self-limited, inflammatory polyneuropathy following infective illness, inoculations, or surgical procedures
- Autoimmune in origin
- Flaccid weakness predominates in most patients and may be most prominent proximally, in ascending paralysis, which usually begins in the legs, spreading involving the arms and one or both sides of the face
- Loss of neurologic function patterns
- Differential: Includes Poliomyelitis, Botulism, Tick paralysis
- Supportive care, prepare for ALS intervention
- Most patients make a good recovery, but this may take many months, About 30% of adults and even more children have some residual weakness at 3 years
Mononeuropathies
- Sensort disturbances and weakness in distribution patterns
- Individual nerve: compressed, angulated or stretched (entrapment neuropathy). Symptoms include, Paresthesias, Feeling of pain and weakness, Nerve root distribution and pure motor nueropath
- Focused History incluide, Lenght of symptoms, Precipitating factor and Provoking emotions and factors
- Physical Exam includes Nurological exam of the extremity: and Percustion of the nerve
- Differential: Periphial nerve tumour, diabetic neuropathy and Postherpetic neuralgia
Bell's Palsy (Facial Nerve Palsy)
- Generally idiopathic hemifacial paresis of the upper and lower face that is attributed to a swelling of the facial nerve due to an immune or viral disorder
- Reactivation of herpes simplex or varicella zoster
- Unilateral facial paresis comes on abruptly but may worsen over a day or more, pain around the ear may precede the weakness, or disturbance of taste may occur
- On the examination, is show Nurologic exam ,Ipsilateral restriction of eye closure and difficulty with fine facial movements
- Differential Incluide, Herpes Zoster, lyme disease, stroke which presnents with facial peralisys from the eyes
- Is nessacary to eye protection and frequent natural tears to prevent and assurance to early treatment with with oral steriods:
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