Neurology



Neurology


Seby John

Charles J. Bae



RAPID BOARD REVIEW—KEY POINTS TO REMEMBER:


DISORDERS OF CONSCIOUSNESS



  • Disorders of consciousness are divided into two categories:



    • Disorders of arousal—confusion, drowsiness, stupor, and coma.


    • Disorders of awareness—an abnormal interaction with the environment when the patient is apparently awake.


  • Vegetative state—complete unawareness of the self and environment despite preservation of some brain functions (often cardiovascular and autonomic control).



    • Persistent vegetative state >1 month after initial injury.


    • Permanent vegetative state >6 months of unresponsiveness.


HEADACHE



  • Tension-type or muscle contraction headache is the most common type of primary headache.


  • Migraine headache, the second most common type of primary headache, has four phases:



    • The prodrome—premonitory phenomena occurring hours to days prior to headache onset


    • The aura—focal neurologic symptoms, usually <60 minutes.


    • The headache—unilateral, throbbing pain, moderate to severe intensity, and aggravated by exertion. Other symptoms: nausea, vomiting, sensory excitability, systemic symptoms.


    • The postdrome—feeling tired, washed out, or depressed.


  • Chronic daily headache—any type of headache that occurs ≥15 days per month.



    • Medication overuse headaches, when related to overuse of medications (e.g., nonsteroidal anti-inflammatory drugs).


  • Cluster headache—≥5 attacks of severe, unilateral, orbital, supraorbital, and/or temporal pain lasting 15 to 180 minutes and associated with ipsilateral lacrimation, conjunctival injection, rhinorrhea, nasal congestion, forehead and facial sweating, miosis, ptosis, or eyelid edema.


  • Thunderclap headache—maximal at onset.


  • Hemicrania continua—continuous, daily unilateral headache, associated with autonomic features (miosis, ptosis, lacrimation, rhinorrhea).


DEMENTIA



  • Group of symptoms that include memory impairment affecting social interactions.



    • Recommended neuroimaging study—a noncontrast head CT or a brain MRI.


    • Check vitamin B12 level and a thyroid test.


  • The most common cause of dementia is Alzheimer’s disease (AD).



    • Centrally acting anticholinesterase drugs are indicated in mild to moderate AD to slow the disease progression.


  • Vascular dementia—secondary to multiple cerebral infarcts or chronic cerebral ischemia causing white matter injury (Binswanger’s disease).


  • Normal-pressure hydrocephalus—dementia, gait abnormalities, and urinary incontinence.


DIZZINESS



  • Vertigo—an illusion of movement caused by a disorder of the vestibular system.


  • Near syncope (lightheadedness)—a sensation of almost fainting caused by an inadequate cerebral perfusion pressure.


  • Disequilibrium—a sensation of dizziness caused by a gait disorder.


SEIZURES AND EPILEPSY

Jul 5, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on Neurology

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