Neuro diseases/conditions & other info for exam 1

primary headaches

normal, common headaches that are not associated with a pathology that is concerning

migraine, tension, and cluster

Migraine

may have a rapid onset that peaks in 1-2 hours

usually unilateral - does not affect both sides

lasts from 4 hours to several days

pain is a throbbing pain

associated nausea, vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to noise), may have aura (something that precedes this headache such as zig zag lines, tingling of hands arms and face)

stress or menses (menstrual cycle) can provoke

alleviated by quiet, dark room; sleep

recurrent episodes (weekly/monthly)

cluster headache

least common type

more common in men than women

abrupt onset

unilateral (around one side of an eye)

usually lasts less than 3 hours

constant, sharp, intense pain

associated with unilateral autonomic symptoms (lacrimation which is watering of the eye; rhinorrhea which is a runny nose); drooping eyelid; conjunctivitis aka pink eye which is irritation in the white part of their eye)

there is no aggravating or alleviating factors

tension headache

most common type of headache (50% of people)

onset is gradual

usually bilateral or generalized (feels like a band around their head)

may lasts from 30 minutes to 1 week

mild, constant, pressure or tightness (not as severe or debilitating)

associated with scalp tenderness

aggravated by stress, change in sleep or muscle tension

improved with relaxation/massage, tylenol, ibuprofen

Red flags od headache

progressively frequent or severe over a 3-month period

sudden onset

new onset after age 50

aggravated or relieved by change in position - concerning for increased intracranial pressure

precipitated by Valsalva (bearing down) or exertion

presence of cancer (worry about metastasis to the brain), HIV infection, or pregnancy

recent head trauma (could have a bleed to the brain)

change in pattern from past headaches (if they say this is not like their typical migraine)

associated papilledema (buildup of pressure that you can see behind the eyes), neck stiffness (can be concerning for meningitis which is an infection) focal neurologic deficits (can be concerning for a brain bleed or stroke)

secondary headaches

meningitis & subarachnoid hemorrhage

meningitis

viral or bacterial infection of the meninges surrounding the brain and spinal cord

sudden onset

usually generalized, constant throbbing pain

associated fever and neck stiffness

subarachnoid hemorrhage

bleeding commonly caused from a ruptured cerebral aneurysm

sudden onset "Thunderclap" headache

"worst headache of my life"

associated with nausea, vomiting, loss of consciousness

Types of weakness

general, focal, proximal, distal, symmetric, asymmetric

general weakness

affects most areas/muscle groups (may have had a stomach bug, or a pt that has been bedridden after surgery)

focal weakness

affects one particular area or muscle group (arm broken in cast)

proximal weakness

affects muscle groups near the center of the body (i.e shoulders or hips)

distal weakness

affects muscle groups furthest from the center of the body (i.e hands or feet)

symmetric weakness

affects both sides of the body equally

asymmetric weakness

does not affect both sides equally (could be sign of a stroke)

Types of Weakness Conditions

Multiple Sclerosis

Myasthenia Gravis

Guillain-Barre

Stroke

Multiple Sclerosis

immune mediated inflammatory demyelinating disease of the CNS

gradual onset - this started months ago. will not be sudden

symptoms may occur and then improve

may occur in specific limb or be systemic - it is vary variable in how it presents

associated with numbness, tingling, diploplia (double vision), optic neuritis (eye pain), urinary symptoms

symptoms may reoccur after months to years of onset of original symptoms

Myasthenia Gravis

autoimmune neuromuscular disorder characterized by fluctuating weakness involving ocular, bulbar, limb, and/or respiratory muscles

gradual onset

begins in bilateral proximal muscles (i.e shoulders, hips), but may become generalized

worsened by exercise and later in the day (if they are totally worn out by the end of the day)

may be associated with diplopia and ptosis (droopy eyelid)

Guillain-Barre

progressive demyelinating lower motor neuron disease, usually triggered by an immune-response to an infection (need to ask about recent procedures, vaccines, infections)

acute onset following infection, inoculation or procedure

usually begins in the feet and spreads proximally (upwards; can reach the arms)

may experience distal paresthesia (tingling type of pain)

Stroke

may be due to ischemia (clot in brain) or hemorrhage (bleed) in the brain

abrupt onset (happens all of a sudden)

location and associated symptoms depend on the area of the brain affected

may experience unilateral weakness/sensory deficits(numbness, tingling), vision loss, difficulty speaking or swallowing

duration is constant and usually non-progressive (stays consistent)

may have history of similar episodes that resolved (recurrent transient ischemic attack (TIA) is a risk factor for stroke)

Risk Factors for Stroke

high blood pressure

high cholesterol

diabetes

coronary artery disease

afib (heart is beating abnormally which can throw clots up to the brain)

lifestyle such as obesity and exercise

sleep apnea

carotid artery stenosis - plaque buildup

Warning Signs of Stroke (BE FAST)

B: Balance

loss of balance, headaches, dizziness

E: Eyes

sudden loss of vision in one or both eyes

F: Face

does the persons face look uneven

A: Arm

weakness

S: Speech

difficulty

T: Time

to call 911

Numbness/Abnormal Sensation Conditions

Carpal Tunnel Syndrome

Trigeminal Neuralgia

Carpal Tunnel Syndrome

compression of the median nerve between the carpal ligament and other structures within the carpal tunnel

burning/tingling pain in the distribution of the median nerve

aggravated by manual activity (such as typing)

may have associated numbness and weakness

symptoms usually worse at night

Trigeminal Neuralgia

compression of the trigeminal nerve root

brief episodes of stabbing facial pain

usually located in the area of the second and third branches of the trigeminal nerve

unilateral - occurs on one side

worsened by touch or eating

may have recurrent episodes

Seizures history

history depends on the chief concern

if syncope (fainting or passing out), need to rule out other causes

key factors:

age of onset - after age 20 is a red flag

frequency

change in frequency/symptom

medication, alcohol or drug use

history of head trauma

Common and/or Deadly Causes of Seizures

genetics

drugs

brain tumor

head trauma

alcohol withdrawl

high or low blood sugar

Types of Seizures

Focal seizures

Generalized seizures

Focal seizures

limited to one hemisphere of the brain

Generalized seizures

originate within bilaterally distributed networks of the brain including cortical and subcortical structures

Tremors Conditions

Parkinson’s Disease

Benign Essential Tremor

Parkinsons Disease

an adult-onset progressive neurodegenerative disorder that may involve a wide range of nonmotor manifestations that contribute to disability

gradual onset

tremor usually may be confined to one limb for months to years

may have associated rigidity, bradykinesia (slowness of movement) and postural instability, depression, psychosis or dementia

aggravated by emotional stress and resting

improves with action

symptoms worsen over time

Benign Essential Tremor

postural tremor of the hands, head or voice

onset can be at any age

usually present in bilateral hands, head or both

aggravating by emotional stress and action

relieved with rest

typically becomes more noticeable over time (typically affects hands or head)

Syncope History (BEACH)

Before - how the patient felt before (ex. nausea, vomiting, feeling cold, visual changes)

"how did you feel before you passed out?"

"were you nauseous, sweating, dizzy, any blurry vision"

Eyewitness - duration of transient loss of consciousness, movements, description of patient falling

"did anyone see what happened?"

"do you know how long you were passed out for?"

"did you hit your head?"

After - confusion, muscle aches, incontinence, nausea, vomiting, sweating, pallor

"how did you feel once you woke up?"

"any confusion, muscle aches, nausea, vomiting, sweating?"

Circumstances - position (supine, standing), activity (rest, exercise, rising to stand, cough, urination), possible precipitants (fear, pain, prolonged standing)

"were you standing or sitting when this happened?"

"what were you doing when you passed out?"

"was there any reason you passed out such as fear, pain, or prolonged standing?"

History - prior syncopal episodes; known cardiac, neurologic, or metabolic disease; medications, family history of sudden cardiac death

"did you have any prior episodes?"

"any family history of cardiac death?"

"any known cardiac or neurologic disease?"

Vasovagal Syndrome

loss of consciousness due to a reflex response causing vasodilation and/or bradycardia, leading to a systemic hypotension and cerebral hyprofusion (brain is not getting enough blood due to drop in blood pressure)

onset is sudden and may occur due to prolonged standing, fear, or bearing down during defecation

duration is usually one to two minutes

may be associated with lightheadedness, palpitations or nausea/vomiting

could be recurrent depending on the triggers