Difference between revisions of "Neurology"
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|+ Primary Headache Disorders | |+ Primary Headache Disorders | ||
|- | |- | ||
| − | ! !! H&P !! Abortive | + | ! !! H&P !! Abortive !! Prophylaxis |
|- | |- | ||
| Migraine || F > M, throbbing, unilateral, aura, nausea, vomiting, photophobia, phonophobia, visual disturbances, family history, hours to days || NSAIDs, SQ triptans, CGRPs || AEDs (topiramate, valproate), Beta blockers (propranolol), Verapamil, low-dose TCAs (amitryptaline), zonisamide, botox, CGRPs | | Migraine || F > M, throbbing, unilateral, aura, nausea, vomiting, photophobia, phonophobia, visual disturbances, family history, hours to days || NSAIDs, SQ triptans, CGRPs || AEDs (topiramate, valproate), Beta blockers (propranolol), Verapamil, low-dose TCAs (amitryptaline), zonisamide, botox, CGRPs | ||
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*Dx: | *Dx: | ||
*Tx: | *Tx: | ||
| + | |||
==Seizure== | ==Seizure== | ||
*H&P: Aura, symmetrical rhythmic convulsions, eyes deviate towards contralateral side, lateral tongue lacerations, bowel/bladder incontinence, post-ictal state, post-seizure myalgias, can have transient weakness that mimics stroke (Todd paralysis) | *H&P: Aura, symmetrical rhythmic convulsions, eyes deviate towards contralateral side, lateral tongue lacerations, bowel/bladder incontinence, post-ictal state, post-seizure myalgias, can have transient weakness that mimics stroke (Todd paralysis) | ||
Revision as of 22:16, 6 January 2023
Brain
Stroke
- H&P: Ischemic stroke has same risk factors same as ASCVD, with addition of afib, endocarditis, mechanical valve, cardiac shunt. BE FAST. NIHSS. Permanent neurological deficits. Hemorrhagic stroke risk factors include hypertension, blood thinner, trauma, smoking, cancer.
- Dx: Ischemic vs. Hemorrhagic. NCCT head, CTA, MRI, TTE, telemetry.
- Tx: tPA within 4.5 hrs of symptom onset, otherwise hep gtt. If large occluding clot in major vessel, can do endovascular thrombectomy within 24 hrs.
Hematoma
- H&P:
- Dx:
- Tx:
Headache
| H&P | Abortive | Prophylaxis | |
|---|---|---|---|
| Migraine | F > M, throbbing, unilateral, aura, nausea, vomiting, photophobia, phonophobia, visual disturbances, family history, hours to days | NSAIDs, SQ triptans, CGRPs | AEDs (topiramate, valproate), Beta blockers (propranolol), Verapamil, low-dose TCAs (amitryptaline), zonisamide, botox, CGRPs |
| Cluster | M > F, sharp/stabbing, unilateral, retro-orbital, occurs at the same time each day, resolves quickly; exam reveals Horner syndrome, ipsilateral nasal congestion, conjunctival injection, lacrimation | 100% O2, SQ triptans | AEDs (topiramate, valproate), Verapamil, lithium, steroids |
| Tension | dull/tight/pressure, bilateral, band-like, can extend into the neck and shoulders, triggered by stress, lasts up to 7 days | NSAIDs/APAP, massage, heat, relaxation | Avoid triggers |
- H&P:
- Dx:
- Tx:
Seizure
- H&P: Aura, symmetrical rhythmic convulsions, eyes deviate towards contralateral side, lateral tongue lacerations, bowel/bladder incontinence, post-ictal state, post-seizure myalgias, can have transient weakness that mimics stroke (Todd paralysis)
- Dx: EEG. Differentiate between focal (simple and complex) and generalized (grand mal, petit mal, myoclonic, atonic). Differential includes metabolic (hepatic encephalopathy, hyponatremia, hypomagnesemia, hypercalcemia, hypoglycemia), infectious (meningitis), intoxication (or drug withdrawal), neoplastic (brain tumor), vascular (aneurysm, stroke, hemorrhage, dissection)
- Tx: AEDs (no first line agent, decide on a case-by-case basis). For status epilepticus, ABCs, give IV lorazepam, fosphenytoin if seizure persists, consider induced coma if all else fails.
Brain Death
Vertigo
- H&P: Differentiate between dizziness and lightheadedness. Peripheral and central vertigo present differently. Peripheral is positional, improves with eye fixation, and
- Dx: BPPV, MS, Meniere disease
- Tx: Treat underlying cause. For BPPV, the Epley maneuver, PT, antihistamines, and benzos can all help.