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
Seizure—any stereotypical experience or activity arising from hypersynchronous discharges in the cerebral cortex and perhaps some subcortical structures.
Epilepsy—a disorder characterized by two, three, or more seizures that are unprovoked by any known proximate insult.
Status epilepticus—continuous seizures lasting for longer than 30 minutes or repeated seizures lasting a total of 30 minutes from which the patient does not recover awareness between episodes.Stay updated, free articles. Join our Telegram channel
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