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DNPR
Migraine Headaches Signs and Symptoms
Signs and Symptoms
More Common in Women
Exacerbated by Activity
Unilateral Pulsating Pain
Aura
Photophobia and Phonophobia
Nausea/Vomiting
Duration
4 hours to 3 Days
1 min
Migraine Headache Treatments
Acute Treatment
Avoid Triggers
Sumatriptan
NSAIDs
Preventative Treatment
Beta Blockers
Calcium Channel Blockers
Amitriptyline
Topiramate (Anticonvulsants)
1 min
Tension Headache
Presentation
More Common in Women
Bilateral Band-like Pain
Occipital and Neck region
Exacerbated by Stress
Exacerbated by Fatigue
Duration
> 30 Minutes
Acute Treatment
Relaxation
Caffeine
NSAIDs
Acetaminophen
Preventative Treatment
Amitriptyline
1 min
Cluster Headache
Presentation
More Common in Men
Unilateral Periorbital Headache
Ipsilateral Tearing
Precipitated by Alcohol
Stabbing Pain
Duration
15 min - 3 Hours
Repetitive Attacks in Clusters
Treatment
High Flow 100% O2
Ergots
Sumatriptan
2 mins
Trigeminal Neuralgia (Tic Douloureux)
Tic Douloureux
Cranial Nerve V - Trigeminal Nerve
Characteristics
Stabbing Unilateral Facial Pain
Facial Spasms
Psychological Disturbances
More Common in Women > 60 Years Old
DIAGNOSIS
Diagnosis by Clinical Impression
MRI
Treatment
Carbamazepine
Surgery As Last Resort
3 mins
Alzheimer's Disease Assessment (Early Symptoms)
Risk Factors
Advanced Age
Early Signs and Symptoms
Poor Judgment and Decision-Making
Difficulty Having a Conversation
Inability to Manage a Budget
Losing Track of the Date or Season
Misplacing Things
1 min
5 A's of Alzheimer's Disease
Agnosia
Anomia
Aphasia
Apraxia
Amnesia
1 min
Alzheimer's Disease Interventions
Diagnostic Tests
PET Scan and CT
Mini-Mental State Examination
Interventions
Drug Therapy
Safe Environment
Moderate Exercise
Behavioral Modification
Assistance with Functional Independence
Assistance and Support for Caregiver
2 mins
Alzheimer's Disease Assessment (Late Symptoms)
Late Signs and Symptoms
Memory Impairment
Wandering Behavior
Confabulation
Perseveration
Lack of Abstract Thinking
Severe Cognitive Decline
1 min
Alzheimer Disease
Most common cause of dementia in elderly
Down syndrome patients have an Increased risk of developing Alzheimer
Associated with the following altered proteins:
EARLY ONSET (Familial)
APP (Chr 21)
Presenilin-1
Presenilin-2
LATE ONSET (sporadic)
ApoE4 in Chr 19: Increases risk of sporadic form
ApoE2 in Chr 19: Decreases risk of sporadic form (protective) due to Increase in Ach
Findings
Decrease Acetylcholine (ACh)
Widespread cortical atrophy (Narrowing of gyri and widening of sulci)
Senile plaques (Amyloid Beta plaques)
Neurofibrillary tangles
Can lead to intracranial hemorrhage
Hyperphosphorylated tau protein
The hippocampus is the area of the brain demostrating the greatest degree of atrophy. Hippocampal atrophy in MRI is highly suggestive of the diagnosis.
Multiple Sclerosis Interventions
Drug Therapy
Corticosteroids
Interferon Beta
Dimethyl Fumarate (Tecfidera)
Fingolimod (Gilenya)
Mitoxantrone (Novantrone)
Natalizumab (Tysabri)
Considerations
Increase Exercise
Identify Triggers
2 mins
Multiple Sclerosis Symptoms and Diagnosis
Symptoms
Optic Neuritis
Internuclear Ophthalmoplegia
Scanning Speech
Urinary and Fecal Incontinence
Motor Issues (Intention Tremor, Paresis)
Numbness and Pain
Depression
Relapsing Symptoms
Diagnosis
Gold Standard = Plaques on MRI
Increased CSF Immunoglobulins (IgG)
Oligoclonal Bands
4 mins
Multiple Sclerosis Features and Mechanisms
Features
More Common in Women
Presents in 20's and 30's
Northern Europeans
Mechanism
Unknown mechanism, genetic factor
HLA-DRB1
Autoimmune Demyelination of CNS
White Matter of Brain and Spinal Cord
T Cell Mediated Inflammation
2 mins
Internuclear Ophthalmoplegia
ETIOLOGY
Multiple Sclerosis
Medial Longitudinal Fasciculus
Mechanism
CN VI Nucleus
CN III Nucleus
2 mins
Amyotrophic Lateral Sclerosis (ALS)
Assessment
Progressive Muscle Weakness
Systemic Muscle Wasting
Fasciculations
Spasticity
Fatigue
Considerations
Riluzole (Rilutek)
Stretching
Little to No Cognitive Decline
Respiratory Support
Palliative Care
2 mins
Vitamin B12 (Cobalamin) Mechanism and Deficiency
Mechanism
Cobalamin
Large reserve pool in the liver
Homocysteine to methionine
Methylmalonyl CoA to succinyl CoA
Deficiency Signs and Symptoms
Macrocytic Megaloblastic Anemia
Hypersegmented Neutrophils
Neurologic defects
Posterior column
Lateral corticospinal tract
Spinocerebellar tract
5 mins
Vitamin B12 (Cobalamin) Deficiency Causes
Causes
Vegans
Pernicious Anemia
Gastric Bypass Surgery
Malabsorption
Sprue
Enteritis
Crohn's Disease
Diphyllobothrium latum
4 mins
Myasthenia Gravis
Mechanism
Antibodies to Acetylcholine Receptor
Symptoms
Ptosis
Diplopia
Weakness with Muscle Use
Respiratory Death
Thymus Associated
Treatment
Acetylcholinesterase Inhibitors
Plasmapheresis
Thymectomy
1 min
Glasgow Coma Scale
LOC Assessment
Score of 3 to 15
8 or Less = Coma
Eye Opening
Verbal Response
Motor Response
1 min
Delirium
Mechanism
Rapid Onset
Reversible
Assessment
Hallucinations
Decline in Cognition
Short Attention Span
Rapid Speech
Change in Activity Level
Mood Swings
2 mins
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