Chronic Neurological Disorders

What are Primary Headaches and What types of headaches are primary.

Primary headaches are that do not have an indentifiable cause and can be treated in primary care. Headaches include stress, tension, and migraines.

What are Secondary Headaches and What causes them.

Secondary headaches are headaches that have an identifiable biological cause. These typically require specialist intervention. These can be caused by tumors, aneurysms, or clots.

What are the symptoms of Tension Headaches and how long can they last.

Symptoms include a bilateral band like pressure along the base of the skull. Along with palpable muscle tension in the neck and shoulders. These can last from 30 minutes to 7 days.

What are the symptoms of a migraine and how long can they last.

Typically a unilateral throbbing pain. They can last from 4-72 hours. Symptoms include nausea and vomiting along with sensitivity to light and sound.

What are the symptoms of a cluster headache and how long can they last.

Tyypically a unilateral pain raidiating from one eye. These are accompanied with severe, bone crushing pain. They can last anywhere from 5 minutes to 3 hours. These can also induce crying of one eye, ptosis, and rhinoitis. Most common in the Spring and Fall in young to middle age adults.

What is the Prodomal stage of a migraine along with symptoms.

This is the initial stage of a migraine that providers an early warning. This can develop hours or days before a migraine. Symptoms can include fatigue, neck pain, and cravings.

What is the Aura stage of a migraine along with symptoms.

This is the stage preceding migraines that develops over minutes to hours. These induce neurological symptoms such as tinglings or numbness. It can also include Scotomas or bright spots in vision.

What is the Second stage of a migraine along with symptoms.

This is the stage that induces dehabilitating pain. Symptoms such as nausea, vertigo, or vomitting start in this stage. It can last anywhere from 5 minutes to an hour.

What is the third stage of a migraine along with the symptoms.

This stage typically lasts 4-72 hours. In this stage symptoms begin to resolve and the headache dulls.

What is a migrainous infarction.

This is a migraine associated with an ischemic stroke. Imaging after resolve will show brain damage associated with lack of blood flow.

What is the cause of a cluster headache.

Typically caused by circadiation and seasonal disorders. Along with activation of CN5 (Trigeminal)

What are the types of medicines used to treat mild headaches.

NSAIDS, Acetaminophen, and OTC for migrains

What are the preventative treatments for migraines.

Botox Injections, NSAIDs w/ Beta blockers, and Antiepileptics.

What is the medicine used to treat Migraines

Triptans

What are the medicines used to treat cluster headaches.

Corticosteroids (to reduce inflamation of CN5). Glucosamine or Osteo Bi-Flex (to treat microinflamation)

What is the preventative treatment for cluster headaches

Melatonin to fix circadian rhythm disorder brought out by seasonal changes.

What type of medicine can induce migraines?

Vasodilators

What is Epilepsy

Chronic and recurring disruption of brain activity that results in 2 or more seizures and stem from unidentifiable causes.

What is the Aural Phase of Seizures.

This is alterations in vision, smell, hearing, and commonly emotions that precede a seizure.

What is the Tonic phase of seizures.

Stiffening of muscles and loss of conciousness.

What is the Clonic Phase of a seizure.

The irregular jerking motion of the body. Accompanied by irregular breathing and possibly lack of breathing.

What is the Postictal Phase of a seizure

This is the recovery phase. Patients will be confused, sleepy, and may take a while to regain conciousness.

What is a myoclonic seizure.

This is a brief jerking that lasts only for a few seconds. Patients tend to not lose conciousness and remain aware.

What is an absent seizure.

This is a loss of conciousness accompanied with lack of motor control. Can present as zoning out except you cannot wake them. Typically lasts 10-30 seconds.

What is an Atonic/Akinetic Seizure.

This is a loss of muscle tone that is followed by a brief period of confusion. Typically lasts a few seconds.

What is a Complex Partial Seizure.

This is a type of focal seizure, that causes behaviors a patient is unaware of. May cause loss of conciousness and confusion. Can also present with amnesia.

What is a simple partial seizure.

These are seizures consiting of unusual sensations, along with some abnormal jerking motion of the extremities.

What is Status Epilepticus.

This is a seizure lasting for longer than 5 minutes, or two consecutive seizures without regaining conciousness in between.

What is the treatment for seizures.

Diazepam or Lorazepam (Benzos), followed by Phenytonin or fosphenytonin (anti convulsant).

How to care for a patient with an active seizure.

Loosen restrictive clothing, protect the body and specifically head from injury. Turn to side to prevent aspiration and be prepared to use suction. Position the airway to remain patent.

What seizures is Carbamazepine used for.

Focal and Tonic-clonic seizures.

What seizure is Gabapentin used for.

Focal seizures

What seizures is Primodine

All seizures. This is a barbiturate, an (less safe) alternative to benzodiazepines.

What side effects are most important to monitor with seizure medications.

Monitor breathing and airway, along with dysrthymias and hypotension.

What organs need to be monitored when treating with Valporic Acid

Liver and Pancreas.

What is Multiple Sclerosis (MS) and what is the etiology.

A chronic autoimmune disorder that degrades the myelin sheath lining of nerves. These sheaths allow for fast transmission of impulses allowing for controlled movement. Plaques can then form entirely preventing repair of these sheaths.

What are the triggers that worsen MS.

Viruses, infections, cold, physical injury, emotional stress, pregnancy, fatigue, overexertion. Particularly temperature extremes such as extreme hot and cold.

What is Parkinson's

This is a chronic neurodegenerative disease resulting from a degradation of dopamine producing neurons in the substansia nigra.

Why does the imbalance of Dopamine and Acetylcholine (ACh) cause Parkinson's.

Dopamine is a inhibitory and exhibitory neurotransmitter while ACh is an excitatory transmitter. Dopamines role is important for smooth muscle movement while ACh is important for the firing. Dopamine is the gunpower while ACh is the bullet. Without enough gunpowder the bullet still fires, but not correctly.

What is the most important part of care for patients with Parkinson's.

Preventining Aspiration as dysphagia is a common symptom.

How long does it take for Parkinson's medication to start taking effect.

Benefits of treatment may not be seen for weeks after starting.

What is the purpose of the medication used to treat Parkinson's and what are important side effects.

The overall purpose is to raise the level of dopamine in the brain. This can be done via activating neurons that make dopamine, preventing breakdown and reuptake, and overactivating receptors. Common side effects are dyskinesia, hypotension, and hallucinations.

Why is COMT generally given with Levodopa.

COMT prevents the breakdown of dopamine, which levodopa stimulates production of.

What is the purpose of Anti-cholinergics in Parkinson's.

These are used to control muscle tremors and rigidity.

What is Myasthenia Gravis

An autoimmune disorders that attacks ACh receptors responsible for voluntary muscle control.

What are the most important symptoms of MG

Dysphagia and Shortness of Breath. (Shortness of breath is a major issue and generally the cause of death in these patients)

Major side effects of medications used to treat MG

Bradycardia, Respiratory failure/distress, infection, and hypotension.

What is Myasthenic Crisis

This is an acute and severe exaceberation of MG causing severe dyskinesia. Typically results from lack of ACh and can cause respiratory failure.

What is a cholinergic crisis?

An acute exaceberation of MG resulting from too much ACh. Typically results after taking anticholesterase (Meds that prevent breakdown of ACh). Can result in respiratory failure, but less common.

What is the SLUDGE Mnemonic for Cholinergic Crisis

Sweating/Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal Cramps/Pain, and Emesis.

What medications are used to treat Cholinergic Crisis and Myasthenic Crisis, respectively.

Atropine and Anticholinesterase

How are daily activities planned in patients with MG

Activities should be planned around times with peak energy along with frequent rest.