Level 2 WelComs — Neurology, Psychiatry

Amygdala

- Memory Consolidation

- Limbic system structure

- involved in memory and emotion—esp. fear, aggression.

Cerebellum

- Movement of extremities

- "little brain" at the rear of the brainstem

- sensory input

- coordinating movement output and balance

Hippocampus

- Learning & Memories

- Limbic system structure

- process explicit memories for storage

Hypothalamus

- Temperature Regulation

- neural structure lying below the thalamus

- directs eating, drinking, body temperature

- helps govern the endocrine system via the pituitary gland

- linked to emotions

Nucleus Accumbens

- Role in addiction

- Nicotine causes release of dopamine @ nucleus accumbens

- Varenicline—helps smoking cessation by causing dopamine release @ nucleus accumbens

Nicotine

MOA

release of dopamine @ nucleus accumbens

Varenicline

MOA

- smoking cessation

- release of dopamine @ nucleus accumbens

Thalamus

- relay sensory signals to cerebral cortex

- Sleep-Wake cycle

- the brain's sensory switchboard

- located on top of the brainstem

- directs messages to the sensory receiving areas in the cortex

- transmits replies to the cerebellum and medulla

Alcohol Intoxication

PX

→ Coma

- metabolic depression/coma

- Symmetric nature of neurological deficits

Alcohol Intoxication

MX

- Glucose → Dextrose infusion

- Assess for occult traumatic injuries

Concussion

Red Flags

- Neck pain, tenderness

- Double vision

- Weakness or tingling @ arms or legs

- Severe or increasing headache

- Seizure

- Loss of consciousness

- Deteriorating mental status

- Persistent vomiting

- ↑ restlessness

Concussion

PX

- Develops seconds to days after injury

- Immediate, transient loss of consciousness

- Assc. w/ short period of amensia

- CT scan—normal findings

Concussion

TX

Step-by-step return to play based on symptoms

- 24 hours after symptoms resolve → return to light aerobic activity

- Prevents morbidity

Delirium

MX

Haloperidol

- High potent typical D2 antagonist

- Acts as a major tranquilizer to calm to agitation the patient is exhibiting

⦸ Lorazepam

- Can worsen confusion & mental impairment

- Can further mental impairment

Alzheimer's Disease

- Insidious onset

- Diagnosis of exclusion

- Memory changes

Delirium

PX

- Acute

- Waxing & waning consciousness

- Can be hyper or hypoactive

Anterograde Amensia

- ⦸ store, retain, recall new knowledge

← Wernicke-Korsakoff, Traumatic Brian Injury

Hypoglycemia

Sudden confusion

Lewy Body Dementia

- rapidly progressive form of dementia

- Parkinsonism → Dementia

Amaurosis fugax

PX

← embolic occlusion of the main retinal artery or the upper or lower divisions

- Transient monocular blindness

- Temporary loss of vision in one eye

- "window shade coming down" or grey shading of vision

- Lasts minutes then resolves

Amaurosis fugax

MX

Carotid Duplex Study

- Evaluates for possible sclerotic plaques → microemboli

Post-herpetic Neuralgia

← Herpes Zoster Virus

- Painful, vesicular rash

Post-herpetic Neuralgia

Risk Factors

- > 60 y.o.

- Female

- Presence of prodrome

- Severity of rash

Insomnia

MX

← bad habits affecting sleep

- educate on Sleep Hygiene

- waking up at the same time everyday

Embolic Stroke

Risk Factor

Atrial Fibrillation

#1 type of stroke

Hemorrhagic Stroke

Risk Factor

Poorly controlled HTN

Subarachnoid Hemorrhage

DX

CT scan w/o contrast

LP--> performed if CT (-)

•xanthochromia

Cerebral Angiography (4 vessel)

- usually performed after confirmed SAH to

identify source of bleeding & other aneurysms

Transient Ischemic Stroke (TIA)

PX

- Focal numbness, weakness, speech impairment

< 1-2 hours duration

Transient Ischemic Stroke (TIA)

DX

MRI brain

Syncope

DX

1. EKG

Vasovagal Syncope

- When the body overreacts to certain triggers—intense emotion, pain, &/or orthostatic stress

- Reflexive vasodilation & Bradycardia → syncope

Essential Tremor

Etiology

- Albuterol

- Idiopathic

Essential Tremor

PX

- Bilateral hand tremors

- Worse with voluntary movement

- Improves with alcohol

Essential Tremor

MX

- Primidone—Barbiturate

- Propranolol

Adjustment Disorder

< 12 weeks duration

- Depressed mood

TX—Reassurance

Anorexia Nervosa

- Underweight

- Eating Disorder

Bulimia Nervosa

- Normal or overweight

- Eating Disorder

- episodes > 1x/ week for 3 months

- Recurrent episodes of binge eating

Recurrent inappropriate compensatory behaviors to prevent weight gain

- Vomiting

- Laxative

- Diuretic use

Major Depressive Disorder

PX

5/9 SIGECAPS

- Sleep

- Interest

- Guilt

- Energy

- Concentration

- Appetite

- Psychomotor agitation or retardation

- Suicidal ideation

Major Depressive Disorder

PX—Child

- Irritability

- Agitation

- Poor school performance

- Anger

- Anhedonia—loss of interest & pleasure

Panic Attacks

PX

Panic attack—abrupt surge of intense fear or discomfort

- Reaches a peak within minutes

- Is an anxiety disorder

Panic Attacks

MX

Acute

—Benzodiazepines

Chronic

- Antidepressant

- Cognitive behavioral therapy (CBT)

Suicide Attempt

MX

Immediate Psych Consultation