Adult Neuro

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Questions and Answers

What is the primary function of the frontal lobe?

  • Primarily responsible for vision
  • Processing sound, auditory language, and speech comprehension
  • Cognitive function, control of voluntary movement (correct)
  • Processing information about temperature, taste, touch and movement

Which cranial nerve is responsible for vision?

  • CN IV - Trochlear
  • CN III - Oculomotor
  • CN I - Olfactory
  • CN II - Optic (correct)

What is the purpose of the Romberg test?

  • To assess the patient's ability to understand and follow instructions
  • To assess the patient's ability to perceive pain and temperature
  • To test the patient's ability to maintain balance with their eyes open
  • To evaluate proprioception and cerebellar function (correct)

Which cranial nerve is responsible for the gag reflex?

<p>CN IX - Glossopharyngeal (D)</p> Signup and view all the answers

Which of the following is NOT a function of the cerebellum?

<p>Speech production (A)</p> Signup and view all the answers

Which cranial nerve is responsible for lateral eye movement?

<p>CN VI - Abducens (A)</p> Signup and view all the answers

What is the function of the occipital lobe?

<p>Primarily responsible for vision (B)</p> Signup and view all the answers

Which cranial nerve is responsible for the sense of smell?

<p>CN I - Olfactory (D)</p> Signup and view all the answers

What is the most common triggering event associated with Bell’s Palsy?

<p>Upper respiratory infection (URI) (A)</p> Signup and view all the answers

Which of the following statements is true regarding the facial paralysis seen in Bell’s Palsy?

<p>Both the eye and mouth are affected and the forehead cannot move. (A)</p> Signup and view all the answers

What is the recommended management strategy for patients with Bell’s Palsy?

<p>Protect the eye, as it cannot blink. (C)</p> Signup and view all the answers

Which laboratory test is NOT typically ordered for diagnosing Bell’s Palsy?

<p>Magnetic resonance imaging (MRI) (C)</p> Signup and view all the answers

Which of the following is a common symptom preceding the onset of facial paralysis in Bell’s Palsy?

<p>Pain behind the ipsilateral ear (B)</p> Signup and view all the answers

What symptom is commonly associated with unilateral headaches?

<p>Lateralized pounding or throbbing headache (D)</p> Signup and view all the answers

Which of the following is a common trigger for cluster headaches?

<p>Alcohol consumption (D)</p> Signup and view all the answers

What is an effective initial management option for an acute migraine attack?

<p>Taking 6 mg of Sumatriptan subcutaneously (C)</p> Signup and view all the answers

Which of the following diagnostic tools is indicated for evaluating cluster headaches?

<p>MRI of the brain (C)</p> Signup and view all the answers

What factor can lower seizure threshold?

<p>Fever (A)</p> Signup and view all the answers

Which medication is not effective for generalized seizures?

<p>Carbamazepine (B)</p> Signup and view all the answers

What is a characteristic symptom of cluster headaches?

<p>Nasal congestion on the same side as the headache (D)</p> Signup and view all the answers

What is a notable effect of Sinemet after 2 to 5 years of treatment?

<p>Development of motor fluctuations (D)</p> Signup and view all the answers

Which medication should be taken at night due to the risk of orthostatic hypotension?

<p>Ropinirole (D)</p> Signup and view all the answers

What is a common non-pharmacological treatment for migraines?

<p>Resting in a dark room (A)</p> Signup and view all the answers

Which treatment option for Parkinson's disease involves lesions of nuclei that inhibit basal ganglia?

<p>Deep Brain Stimulation (B)</p> Signup and view all the answers

Which type of scan can detect low levels of dopamine in the brain indicative of Parkinson's disease?

<p>PET scan (B)</p> Signup and view all the answers

Which of the following is incorrectly advised to a patient diagnosed with migraines?

<p>Avoid foods with high potassium content (C)</p> Signup and view all the answers

Bell's palsy is characterized by symptoms except which of the following?

<p>Loss of sensation in the arm (B)</p> Signup and view all the answers

What is a primary indication for using anticholinergics in young patients?

<p>Severe tremor and rigidity (A)</p> Signup and view all the answers

Which of the following statements about MRI or CAT scans in Parkinson's disease is true?

<p>Most scans appear normal (B)</p> Signup and view all the answers

What is a symptom that is NOT associated with Bell’s Palsy?

<p>Inability to swallow (A)</p> Signup and view all the answers

What is most characteristic of a partial seizure?

<p>Fluttering eyelids (D)</p> Signup and view all the answers

What best describes the condition of a child showing paralysis on the left side after a seizure?

<p>Postictal paralysis (C)</p> Signup and view all the answers

Which type of seizure is characterized by fluttering eyes and lip smacking in a child?

<p>An absence seizure (A)</p> Signup and view all the answers

What is a potential consequence for a child with frequent seizures as noted on an EEG?

<p>May have severe mental and physical challenges (A)</p> Signup and view all the answers

In the case of a child experiencing status epilepticus, which medication should the nurse prepare for administration?

<p>Diazepam (C)</p> Signup and view all the answers

Which action should NOT be included in the care of a child during status epilepticus?

<p>Turn the patient to the right side (C)</p> Signup and view all the answers

Secondary headaches can arise due to which of the following situations?

<p>Concussions (D)</p> Signup and view all the answers

What is the most common subtype of Parkinson's Disease?

<p>Primary (idiopathic) (A)</p> Signup and view all the answers

How much dopamine loss is typically required before Parkinson's Disease symptoms are noticeable?

<p>60% (A)</p> Signup and view all the answers

What is a common early sign of Parkinson’s Disease that involves muscular rigidity?

<p>Cogwheel rigidity (D)</p> Signup and view all the answers

Which demographic group is 1½ times more likely to be affected by Parkinson's Disease?

<p>Men aged 50 years and over (B)</p> Signup and view all the answers

What is the primary mechanism of action of Selegiline (Eldepryl) in the treatment of Parkinson's Disease?

<p>Inhibits breakdown of dopamine (C)</p> Signup and view all the answers

What does the 'pill rolling' tremor in Parkinson's Disease refer to?

<p>An asymmetrical tremor at rest (B)</p> Signup and view all the answers

Which condition or symptom may appear in advanced stages of Parkinson's Disease?

<p>Hallucinations (C)</p> Signup and view all the answers

What would be the Gold Standard for diagnosing Parkinson's Disease?

<p>Neuro-pathologic examination of the brain post mortem (D)</p> Signup and view all the answers

Which cranial nerve is responsible for shrugging your shoulders?

<p>CNXI Spinal Accessory (D)</p> Signup and view all the answers

Which of the following are associated with classic migraines?

<p>Numbness or tingling (B)</p> Signup and view all the answers

What is the most common type of headache?

<p>Tension Headaches (B)</p> Signup and view all the answers

What is a common trigger for migraine headaches?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a symptom of tension headaches?

<p>Throbbing pain behind one eye (D)</p> Signup and view all the answers

Which over-the-counter medication is commonly used to manage tension headaches?

<p>All of the above (D)</p> Signup and view all the answers

What does the mnemonic "Oh Oh Oh To Touch And Feel A Girl’s Vagina So Happy" refer to?

<p>Functions of the cranial nerves (C)</p> Signup and view all the answers

Which of the following is a characteristic symptom of migraine headaches?

<p>Nausea and vomiting (A)</p> Signup and view all the answers

Which of the following tests is used to evaluate proprioception and cerebellar function?

<p>Romberg Test (A)</p> Signup and view all the answers

Which cranial nerve is responsible for hearing and equilibrium?

<p>CN VIII - Acoustic (A)</p> Signup and view all the answers

What is the primary function of the temporal lobe?

<p>Processing sound, auditory language, and speech comprehension (A)</p> Signup and view all the answers

What is the typical timeframe for maximum paralysis to occur in Bell's Palsy?

<p>Within 48-72 hours (D)</p> Signup and view all the answers

Which of the following is NOT a typical symptom associated with Bell's Palsy?

<p>Difficulty swallowing (B)</p> Signup and view all the answers

What is a characteristic symptom of cluster headaches, often present in affected patients?

<p>Ipsilateral nasal congestion (D)</p> Signup and view all the answers

What is the correct sequence of steps for the heel to shin test?

<p>The patient runs the heel of one foot along the shin of the opposite leg. (E)</p> Signup and view all the answers

Which of the following medications would be most appropriate for acute management of a migraine attack with severe nausea and vomiting?

<p>Sumatriptan (Imitrex) 6 mg SQ (A)</p> Signup and view all the answers

In the context of seizure management, which of the following medications is typically used to treat focal seizures but not generalized seizures?

<p>Carbamazepine (C)</p> Signup and view all the answers

Which cranial nerve is responsible for both motor and sensory function?

<p>CN V - Trigeminal (B)</p> Signup and view all the answers

What is the single most important management goal for patients with Bell's Palsy?

<p>Protecting the eye (B)</p> Signup and view all the answers

What is a common factor that can lower a person's seizure threshold, making them more prone to seizures?

<p>Hypoglycemia (D)</p> Signup and view all the answers

Which of the following statements accurately describes the function of the frontal lobe?

<p>It controls voluntary movement and cognitive function. (A)</p> Signup and view all the answers

A patient reports experiencing a sudden, intense, unilateral headache that feels like an 'ice pick' being jabbed into their head. They mention these episodes occur almost daily for a few weeks, followed by months or weeks of relief. This pattern is most consistent with:

<p>Cluster headaches (A)</p> Signup and view all the answers

Which cranial nerve is involved in the gag reflex?

<p>CN X - Vagus (B)</p> Signup and view all the answers

What diagnostic tool is typically employed to rule out underlying structural abnormalities, such as AVM or aneurysms, in patients experiencing frequent cluster headaches?

<p>MRI (B)</p> Signup and view all the answers

What daily medication is commonly prescribed for cluster headache prophylaxis, aiming to prevent the recurrence of these excruciating headaches?

<p>Verapamil (B)</p> Signup and view all the answers

Which of the following is a common management strategy for a patient experiencing an acute cluster headache?

<p>Inhalation of 100% oxygen (C)</p> Signup and view all the answers

What is the recommended treatment for a patient with a high-risk TIA (ABCD score ≥ 4)?

<p>Hospitalization and dual antiplatelet therapy using aspirin (160-325 mg loading dose, followed by 50-100 mg daily, plus clopidrogel 300-600 mg loading dose, then 75-100 mg daily for the first 21 days) (C)</p> Signup and view all the answers

Which of the following investigations is most suitable for detecting ischemic infarcts?

<p>MRI (A)</p> Signup and view all the answers

Which of the following medications is NOT recommended as a treatment for hypertension in patients with TIA?

<p>Clopidogrel (C)</p> Signup and view all the answers

A patient with an ABCD score of 2 would fall into which risk category?

<p>Low risk (D)</p> Signup and view all the answers

Which of the following is a cardinal feature of Parkinson's Disease?

<p>Tremor (D)</p> Signup and view all the answers

Which of the following is NOT a recommended management strategy for patients with Parkinson's Disease?

<p>Intense statin therapy (D)</p> Signup and view all the answers

What is the significance of a high ESR and CRP in a patient with suspected TIA?

<p>They suggest an underlying inflammatory process (C)</p> Signup and view all the answers

Which of the following is a potential risk factor for developing TIA?

<p>High cholesterol (A)</p> Signup and view all the answers

Based on the cerebrospinal fluid results, which of the following is indicative of bacterial meningitis?

<p>An elevated protein count and a low glucose level. (A)</p> Signup and view all the answers

The nurse practitioner is evaluating a child with a concussion who is still experiencing sleepiness 2 weeks after the injury. What is the MOST appropriate recommendation for this child?

<p>Continuation of physical and cognitive rest (A)</p> Signup and view all the answers

Which of the following actions should the nurse take after receiving results indicating bacterial meningitis from a cerebrospinal fluid test?

<p>Further assess the neurological function of the child and call the doctor with a report. (A)</p> Signup and view all the answers

What is the primary reason for the elevated protein count in the cerebrospinal fluid of a patient with bacterial meningitis?

<p>Increased permeability of the blood-brain barrier, allowing more protein to leak into the cerebrospinal fluid. (D)</p> Signup and view all the answers

Which of the following statements accurately describes the role of the nurse in caring for a child with suspected meningitis?

<p>The nurse's role encompasses all of the above, and includes assessment and reporting of critical findings. (D)</p> Signup and view all the answers

Cerebellar function is responsible for

<p>Balance and coordination (A)</p> Signup and view all the answers

All tests can evaluate cerebellar function except

<p>Vibration Test (D)</p> Signup and view all the answers

The NP will test which CN by having the patient sniff a familiar scent and blocking one nostril at a time?

<p>I (Olfactory) (A)</p> Signup and view all the answers

The NP will test which CN for visual field testing by having the patient stand 2 feet in front of the examiner and covering one eye at a time, test peripheral vision, and stand 20 feet from Snellen chart?

<p>CN II (Optic) (D)</p> Signup and view all the answers

The NP will test which CN for EOM and pupillary reaction?

<p>CN III (Oculomotor) (D)</p> Signup and view all the answers

Which CN get tested together for sight and EOM?

<p>CN III (Oculomotor) (B), CN IV (Trochlear) (C), CN VI (Abducens) (D)</p> Signup and view all the answers

The NP will test which CN to look for downward and inward eye movement?

<p>CN IV (Trochlear) (A)</p> Signup and view all the answers

The NP will test which CN to asses mastication, sensation scalp/face/cornea/nose (lightly brushes face with whisp)

<p>CN V (Trigeminal) (B)</p> Signup and view all the answers

The NP will test which CN to asses for lateral eye movement?

<p>CN VI (Abducens) (A)</p> Signup and view all the answers

The NP will test which CN to see if they can move the face, close mouth, and generate tear & saliva secretion?

<p>CN VII (Facial) (C)</p> Signup and view all the answers

The NP will test which CN for hearing and equilibrium by whispering words and asking if they can hear the words?

<p>CN VIII (Acoustic) (A)</p> Signup and view all the answers

The NP will test which CN for 1/3 phonation, gag reflex, swallowing, taste (posterior) and have them say Ah?

<p>CN IX (Glossopharyngeal) (D)</p> Signup and view all the answers

The NP will test which CN for talking, swallowing, and carotid reflex ?

<p>CN X (Vagus) (B)</p> Signup and view all the answers

The NP will test which CN for shrugging shoulders and head rotation?

<p>CN XI (Spinal accessory) (D)</p> Signup and view all the answers

The NP will test which CN for tongue movement by telling them to stick out their tongue and move it side to side?

<p>CN XII (Hypoglossal) (C)</p> Signup and view all the answers

Flashcards

Cerebral Function

Involves higher brain functions like touch, vision, hearing, speech, reasoning, and emotions.

Frontal Lobe

Responsible for cognitive function and voluntary movement control.

Parietal Lobe

Processes sensory information related to temperature, taste, touch, and movement.

Occipital Lobe

Primarily responsible for processing visual information.

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Temporal Lobe

Processes sound, auditory language, and speech comprehension.

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Cerebellar Function

Responsible for balance and coordination of movements.

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Romberg Test

Evaluates proprioception and cerebellar function by testing balance with eyes closed.

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Cranial Nerves

Twelve pairs of nerves that control senses and muscle movements in the face and head.

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Bell's Palsy

A common condition causing lower facial motor neuron paralysis, often triggered by stress or a virus.

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Cranial Nerve VII

The facial nerve involved in facial expressions, responsible for the symptoms of Bell's Palsy.

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Symptoms of Bell's Palsy

Acute onset of facial paralysis, inability to close eyelid, asymmetric smile, and pain behind the ear.

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Diagnosis of Bell's Palsy

Includes CBC, MRI if CVA is suspected, and considering differential diagnoses like Lyme disease.

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Management of Bell's Palsy

Focus on protecting the eye, using artificial tears due to inability to blink.

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Migraine Symptoms

Unilateral, throbbing headache with nausea, visual disturbances.

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Migraine Diagnostics

Lab tests like CBC, BMP, and CT scan of the head.

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Acute Migraine Management

Rest in dark room, use analgesics, and possibly sumatriptan.

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Cluster Headaches

Severe unilateral headache, often with nasal symptoms.

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Cluster Headache Symptoms

Abrupt onset, periorbital pain, and eye redness.

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Seizure Definition

Transient disturbances of cortical function from neuronal discharge.

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Seizure Causes

Includes congenital issues, metabolic disorders, trauma, and infections.

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Focal Seizures

Originates in one hemisphere with localized EEG abnormalities.

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Sinemet

A combination medication of Levodopa and Carbidopa, used to treat Parkinson's disease.

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Dopamine agonists

Medications like Ropinirole and Pramipexole that mimic dopamine effects.

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Anticholinergics

Medications such as Benztropine used for tremors in young Parkinson's patients.

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Deep Brain Stimulation

Experimental surgery for Parkinson's involving brain lesions to improve motor control.

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MRI/CAT scans

Imaging tests that typically show no abnormalities in Parkinson's patients.

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PET scan

A scan that detects low dopamine levels in the brain.

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Migraine triggers

Factors like foods high in tyramine that can induce migraines.

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Bell’s palsy

A condition causing temporary facial weakness, often not involving swallowing difficulties.

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Parkinson’s Disease (PD)

A neurodegenerative disorder caused by dopamine depletion in the brain's substantia nigra.

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Primary Parkinson’s Disease

The most common form of PD with no known external cause; it is idiopathic.

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Secondary Parkinsonism

PD caused by other stimuli such as drugs, stroke, or trauma.

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Familial Parkinson’s Disease

A genetically linked form of PD, accounting for less than 20% of cases.

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Dopamine Loss Threshold

Clinical diagnosis of PD occurs after approximately 80% dopamine loss in the basal ganglia.

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Symptoms of PD

Early symptoms include tremors, rigidity, bradykinesia, and posture changes.

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Bradykinesia

A symptom of PD characterized by difficulty initiating movement or slowness in movement.

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Levodopa Therapy

A common treatment for PD, acts as a dopamine precursor to improve symptoms.

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Postictal paralysis

Temporary paralysis following a seizure, often on one side of the body.

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Absence seizure

A brief seizure characterized by loss of awareness, often with fluttering eyes and lip smacking.

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EEG

A test that records electrical activity in the brain, used to diagnose seizures.

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Status epilepticus

A condition where a person has prolonged or repeated seizures without recovery in between.

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Secondary headaches

Headaches that are symptoms of other issues, like concussions or infections.

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Kernig's sign

A clinical sign of meningitis where the patient experiences pain when trying to extend the leg with a flexed knee.

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Brudzinski's sign

A clinical sign of meningitis that involves bending the knees when the neck is flexed.

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Diagnostics for Bell's Palsy

Include CBC, MRI if CVA is suspected, and testing for Lyme disease.

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Tension Headaches

Most common headache type, characterized by a tight sensation or dull pain.

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Migraine Headaches

Headaches caused by dilation of carotid artery branches, lasting 2-72 hours.

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Classic Migraine

Migraine with aura; includes visual disturbances and symptoms before onset.

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Common Migraine

Most prevalent migraine type; unilateral throbbing pain, nausea, and light sensitivity.

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Cerebellum

A brain structure responsible for balance and coordination.

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Finger to Nose Test (FNT)

A test assessing vision and perception by pointing to the nose and then examiner's finger.

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Heel to Shin Test

A test where a patient runs their heel down the opposite shin to assess coordination.

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Cranial Nerve I (Olfactory)

Sensory nerve responsible for the sense of smell.

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Cranial Nerve II (Optic)

Sensory nerve responsible for vision, assessed using a Snellen chart.

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Cranial Nerve VII (Facial)

Responsible for facial movement and secreting tears and saliva.

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Cranial Nerve IX (Glossopharyngeal)

Involved in swallowing, taste, and phonation.

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Proprioception

Awareness of body position and movement in space.

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Bacterial Meningitis Indicators

Indicated by elevated protein and low glucose levels in cerebrospinal fluid.

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Concussion Management

Requires physical and cognitive rest until symptoms resolve for safety.

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Neurological Assessment Steps

Includes documenting findings, assessing functions, and reporting to the doctor.

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Lumbar Puncture Preparation

Process of preparing a patient for cerebrospinal fluid testing.

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Post-Concussion Symptoms

Child may experience ongoing sleepiness and needs continued rest and evaluation.

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Cluster Headache Characteristics

Very painful, unilateral headaches with abrupt onset, often affecting middle-aged men.

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Sumatriptan (Imitrex) Uses

Used for acute migraine attacks, can be administered subcutaneously or orally.

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Prophylactic Treatment for Migraines

Daily therapy recommended if migraines occur more than 2-3 times per month.

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MRI vs CT in Stroke Diagnosis

MRI is more effective than CT for detecting ischemic infarcts.

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ABCD Score

A scoring system for assessing stroke risk in TIAs based on criteria like age and symptoms.

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Management of High-Risk TIA

Hospitalization and dual antiplatelet therapy for high-risk TIAs (ABCD Score ≥ 4).

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Carotid Endarterectomy

A procedure that reduces stroke risk in patients with recent TIAs and occluded carotid arteries.

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Stroke Risk at ABCD Scores

Stroke risk increases with ABCD scores: 1-3 points = 1%, 4-5 points = 4.1%, 6-7 points = 8.1%.

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Low-Risk TIA Management

If ABCD Score < 4, manage with aspirin alone (162-325 mg/day).

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Cardinal Features of Parkinson's Disease

Parkinson’s disease features resting tremor, bradykinesia, rigidity, and postural changes.

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Dopamine Loss in PD

Clinical diagnosis of Parkinson's typically occurs after about 80% dopamine loss in basal ganglia.

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Study Notes

Adult Neurological Disorders

  • Adult Neurological Disorders is the subject.
  • The presenter is Dr. Kim Ballone, FNP-BC.
  • The presentation is a review of many neurological disorders.

Cerebral Function

  • The cerebrum performs higher functions like interpreting touch, vision, hearing, speech, reasoning, emotions, learning, and fine motor control.
  • The brain has four lobes:
    • Frontal lobe: controls voluntary movement and cognitive function.
    • Parietal lobe: processes information about temperature, taste, touch, and movement.
    • Occipital lobe: primarily responsible for vision.
    • Temporal lobe: processes sound, auditory language, and speech comprehension.

Cerebellar Function

  • The cerebellum is responsible for balance and coordination.
  • Assessment techniques to evaluate cerebellar function:
    • Romberg Test: assesses proprioception and cerebellar function by having the patient stand with feet together, eyes closed, and arms at their sides.
    • Finger to nose test: evaluates the patient's ability to correctly touch their finger to their nose, assessing visual-motor coordination and proprioception.
    • Heel to shin test: evaluates the patient's ability to run the heel of one foot along the shin of the opposite leg, assessing proprioception and coordination.

Review of 12 Cranial Nerves

  • Cranial nerves are numbered from I to XII.
  • Each nerve has a specific function and can be either sensory, motor, or both. See the list below.
Cranial Nerve Function Type
CNI (Olfactory) Smell Sensory
CNII (Optic) Vision Sensory
CNIII (Oculomotor) Eye movement (EOMs) and pupillary reaction Motor
CNIV (Trochlear) Down and in eye movement Motor
CNV (Trigeminal) Mastication, sensation of scalp, face, cornea, nose Both
CNVI (Abducens) Lateral eye movement Motor
CNVII (Facial) Facial movements, tears, saliva secretion Both
CNVIII (Acoustic) Hearing and equilibrium Sensory
CNIX (Glossopharyngeal) Taste (posterior), phonation, gag, swallowing; Say Ah Both
CNX (Vagus) Talking, swallowing, carotid reflex Both
CNXI (Spinal Accessory) Shrug the shoulders Motor
CNXII (Hypoglossal) Moves the tongue Motor
  • CN III, IV, and VI test extraocular movements together.

Review of Headaches

  • Tension headaches are the most common type of headache (90%).
  • Signs and symptoms of tension headaches include a vise-like or band-like pain around the neck and back of the head, stiffness in the shoulders, and usually lasting several hours.
  • Triggering factors include emotional/physical stress, head and neck movements.
  • Management includes over-the-counter analgesics (Naproxen, Ibuprofen, Aspirin, Tylenol), combinations, and relaxation techniques.

Headaches (Migraines)

  • Migraines are related to dilation and excessive pulsation of the external carotid artery branches.
  • They can last from 2 to 72 hours.
  • Migraines can have an aura (classic) or no aura (common).
  • Common triggers include stress, missed meals, changes in weather, certain foods (nitrates, aspartame), sleep disturbance, alcohol, and menstruation.
  • Diagnosis includes a clinical evaluation, symptom assessment (unilateral, throbbing pain, visual disturbances, nausea, vomiting).
  • Management of acute attacks includes rest in a dark room and simple analgesics (aspirin, etc.), antiemetics (if needed), or triptans (severe cases).
  • Prophylactic therapy is useful for frequent migraines.

Cluster Headaches

  • Cluster headaches are very painful, abrupt, and unilateral.
  • Pain is typically periorbital, but it can occur daily for several weeks.
  • Triggers include alcohol consumption, tobacco use, or head trauma and are more common in men.
  • Signs include nasal congestion, tearing, and redness in the affected eye (Horner's syndrome).
  • Diagnosis is done via MRI for vascular abnormalities.
  • Management includes triptans, 100% oxygen, ergotamine, and preventives (e.g., verapamil).

Review of Seizures

  • A seizure is a transient disturbance of brain function due to abnormal paroxysmal neuronal discharge.

  • Causes include congenital or perinatal injuries, metabolic disorders, trauma, tumors, infectious diseases, and fever.

  • Different seizure types include partial and generalized, and specific classifications can further describe the manifestation:

    • Partial Seizures - Focal origin, usually unilateral
    • Simple Partial - Retained awareness, motor, sensory, or autonomic symptoms
    • Complex Partial Seizures - Impaired awareness
    • Generalized Seizures - Both hemispheres involved
    • Tonic-Clonic or Grand Mal - Loss of consciousness, bilateral jerking, and coma
    • Tonic - Sudden muscle stiffening
    • Clonic - Rhythmic jerking
    • Absence (Petit Mal) - Brief staring episodes, common in children

  • Diagnosis techniques include CBC, electrolytes, testing for infectious agents, and EEG.

Management of Seizures

  • Management actions involve maintaining airway, protecting from injury, oxygen if cyanotic, anticonvulsant medication (e.g., Lorazepam, Keppra, etc.).
  • Broad-spectrum anticonvulsants are used for both focal and generalized seizures (e.g., Keppra).

Bell's Palsy

  • Bell's Palsy is an acute, unilateral facial nerve palsy.
  • It is of unknown etiology possibly triggered by nerve ischemia or a viral infection.
  • This type of palsy can occur within 24 hours, often preceded by pain behind the ear of affected side.
  • Cranial nerve VII is involved.
  • Diagnosis is based on clinical presentation (unilateral facial paralysis, inability to close eye, forehead movement, etc).
  • It is commonly diagnosed as HSV.
  • Management involves protection of the eye/cornea (artificial tears), eye exercises, massage of affected area, antivirals (Valacyclovir or acyclovir), glucocorticoids.
  • It is more common in women of all ages.

Trigeminal Neuralgia

  • Trigeminal neuralgia is a nerve disorder causing unilateral pain in the maxillary or mandibular branches.
  • Triggering factors can include stimulation like chewing, brushing, hot/cold food, or touch.
  • It is characterized by sudden, severe, stabbing pain in the face.
  • Treatment involves medications that suppress nerve activity and may include tricyclic antidepressants.
  • Diagnosis includes an assessment of neurological function and imaging (MRI) to rule out tumors.

Multiple Sclerosis (MS)

  • MS is a chronic autoimmune disease affecting the central nervous system.
  • The immune system attacks the myelin sheath surrounding neurons.
  • Initial and often early symptoms include numbness, trouble with coordination and balance, problems with vision, speech, and bladder control; episodes may subside and return as exacerbations and remissions.
  • Management includes immunomodulatory therapy (IMT) to reduce relapses, including interferons, immunosuppressants, and plasmapheresis.

Myasthenia Gravis

  • Myasthenia gravis is a neuromuscular junction disorder. It causes muscle weakness and fatigability.
  • The disorder results from a reduction in the number of acetylcholine receptors.
  • This commonly affects women in their 30s/40s and 50s/60s and can affect any age.
  • Testing techniques include antibodies to acetylcholine receptors, and/or Edrophonium.
  • Management involves anticholinesterase drugs (pyridostigmine), immunosuppressives, and possibly plasmapheresis.

Acute Cerebral Vascular Syndrome (ACVS)/Transient Ischemic Attack (TIA)

  • A Transient Ischemic Attack (TIA) is a temporary disruption of blood supply to the brain.
  • Symptoms and Signs are sudden changes in vision, speech, strength/movement (numbness), or sensation.
  • Risk factors include older age, hypertension; Diabetes, history of TIA.
  • Diagnosis often involves a CT scan or MRI to rule out bleeding or tumor, followed by a carotid ultrasound to evaluate the blood vessels, and a blood test.
  • The goal is to address the underlying cause of the TIA.

Parkinson's Disease

  • Parkinson's disease is a slowly progressive neurodegenerative disorder.
  • The cardinal signs include tremor, rigidity, and bradykinesia, commonly with postural changes.
  • The disease develops from a depletion of dopamine in the substantia nigra.
  • The disorder may be primary (idiopathic), secondary, or familial. (genetic).

Tips to Remember

  • For suspected cerebral vascular accidents, immediate ED referral is required.

Other Information

  • The ABCD score is used to evaluate acute cerebral vascular syndrome (TIA).
  • Specific foods (high in tyramine) can trigger migraines.
  • Avoiding high potassium foods is not related to migraines.
  • Swallowing is not directly affected by Bell's palsy.

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