Term
| Can seizures be well controlled? |
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Definition
|
|
Term
| Can seizures be well controlled with a single drug? |
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Definition
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Term
| Can seizures be eliminated in epilepsy w/ tx? |
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Definition
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Term
| How often should poorly controlled epileptics have a medical exam? |
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Definition
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Term
| How often should well controlled epileptics have a medical exam? |
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Definition
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Term
| What is the risk of suicide in epileptics? |
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Definition
| 3x greater; greatest risk in 6 months following diagnosis |
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Term
| Are anti-epileptic drugs associated with increased suicide ideation? |
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Definition
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Term
| What is the risk of sudden death in epilepsy? |
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Definition
| Sometimes caused by hypoventilation and arrythmias |
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Term
| What is the increase in risk of drowning with epilepsy? |
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Definition
| 20x greater than the general population |
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Term
| What % of pregnant epileptics will have a normal pregnancy? |
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Definition
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Term
| What is the risk of birth defects in epileptics due to? |
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Definition
| drug treatment, not the dz itself |
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Term
| When can epileptic meds be discontinued? |
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Definition
| Only if seizure free 2-5 years on medications |
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Term
| What is the risk of recurrence for an average epileptic with a normal neurologic exam? |
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Definition
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Term
| What is the time interval to wean epileptics off of their drug regimen? |
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Definition
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Term
| If an epileptic is taken off of meds and then seizures recur, what is the course of action? |
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Definition
| restart meds at previously effective level |
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Term
| When can epileptics be allowed to drive? |
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Definition
| Depends on state. Some require 2 months, some 2 years |
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Term
|
Definition
| sudden unilateral facial paralysis due to block of CN7 |
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Term
| Are men or women more prone to Bell's palsy? |
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Definition
| Niether, both equally affected |
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Term
| How long can it take for Bell's Palsy to reach full paralysis? |
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Definition
| May progress over a few weeks, can be much faster |
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Term
| In Bell's Palsy, is the left or right side more prone? |
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Definition
| Neither, both sides equally affected |
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Term
| What often precedes Bell's Palsy? |
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Definition
| 70% have preceding upper respiratory infection. |
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Term
| What can Bell's Palsy be a precursor to? |
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Definition
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Term
| What is the occurrence of diabetes in Bell's Palsy pts? |
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Definition
| 2x greater than non diabetics |
|
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Term
| What is the nasolabial fold? |
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Definition
| The crease in the face that is relaxed in Bell's Palsy |
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|
Term
| Where is the pathology of Bell's Palsy generally focused? |
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Definition
| The stylomastoid foramen that CN7 passes through compresses the nerve after inflammation of the nerve |
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Term
| If Bell's Palsy presents as just a partial paralysis, what should be considered? |
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Definition
|
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Term
| What are s/sx of Bell's palsy? |
|
Definition
face looks asymmetric
pain behind ear a day or two before palsy
tinnitus possible
ipsilateral lacrimation
decreased taste sensation possible
unilateral facial weakness of both upper and lower muscles* |
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|
Term
| What infection is commonly seen with Bell's Palsy? |
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Definition
| Herpes, both Simplex and Zoster |
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Term
| Why can't Bell's Palsy pt's close their eyes? |
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Definition
| CN7 closes the eye, while CN3 opens it, so eye stays open. Must be treated to prevent or manage dryness keratitis |
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Term
| What should be performed on Bell's Palsy pt's? |
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Definition
Complete screening neurologic exam
Screen for HSV and HZV
Check for Lyme's Dz (erythema migrans)
electroneurography and electomyography
consider syphilis, DM, Lyme, and thyroid deficiencies |
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|
Term
| What is the average time frame for Bell's Palsy onset? |
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Definition
|
|
Term
| What % of Bell's palsy pt's will show some sign of recovery at 3 weeks? |
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Definition
|
|
Term
| When is full recovery expected in Bell's Palsy? |
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Definition
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|
Term
| What % of Bell's Palsy pt's will NOT see any recovery? |
|
Definition
|
|
Term
| What indicates a poor prognosis for Bell's Palsy? |
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Definition
| if severe pain at onset and complete palsy when pt first seen |
|
|
Term
| Are Bell's Palsy recurrences on the same, or opposite side? |
|
Definition
| Can come back on either side |
|
|
Term
| What are meds in Bell's Palsy intended to do? |
|
Definition
| Prevent nerve degeneration |
|
|
Term
| When should Bell's Palsy be treated? |
|
Definition
|
|
Term
| When should Bell's Palsy pt's be re-evaluated after initial dx? |
|
Definition
|
|
Term
| What is used to treat Bell's Palsy? |
|
Definition
prednisone for 3-5 days, taper off over next 7 days
acyclovir regimen for 10 days |
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|
Term
| Cereberovascular dz causes what level of death in the U.S.? |
|
Definition
| 3rd leading cause of death, most common disabling neurologic disordre |
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|
Term
|
Definition
transient neurological attack, often precede cerebrovascular dz.
May be confusion, dizziness, fainting, 'having a spell'. To be considered nonfocal, must be very general. A seizure would be a focal event |
|
|
Term
| What is a focal vs nonfocal neurologic attack? |
|
Definition
non focal are confusion, dizziness, fainting.
Focal would be seizure, or other acute issue |
|
|
Term
| What does focal neurolog loss of function usually follow? |
|
Definition
67% secondary to ischemia
33% secondary to hemorrhage |
|
|
Term
| What are risk factors for cerebrovascular dz? |
|
Definition
| atherosclerosis and HTN, smoking, alcoholism |
|
|
Term
| Even if HTN is controlled in 50s and 60s, can HTN that was uncontrolled in 30s and 40s increase risk of cerebrovascular dz? |
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Definition
|
|
Term
| What are underlying pathologies that can lead to cerebravascular dz? |
|
Definition
congenital aneurysms
vascular inflammations
cardiac and hematological disorders
Anything that inhibits O2 reaching the brain |
|
|
Term
|
Definition
| Transient Ischemic Attack |
|
|
Term
| What is a common ocular SE of a TIA? |
|
Definition
| Loss of vision (hemianopsia, etc), therefore OD's are often first to see pt's after a TIA |
|
|
Term
| How long do TIA's often last? |
|
Definition
| usually a few minutes to an hour. If lasts less than 24 hours, than is a TIA by definition |
|
|
Term
|
Definition
| Just as serious as a stroke. Generally indicates a serious underlying pathology |
|
|
Term
| What % of pt's will suffer a stroke within 3 months of a TIA? |
|
Definition
|
|
Term
| What % of TIA pt's who will progress to a stroke will have the stroke in the week following the TIA? |
|
Definition
|
|
Term
| What % of TiA pt's who will progress to a stroke will have the stroke in the month following the TIA? |
|
Definition
|
|
Term
| How is a TIA-to -stroke prediction made? |
|
Definition
"ABCD^2"
A = age
B = BP
C = Clinical features
D^2 = DM and Duration of TIA |
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|
Term
| In a TIA-to-Stroke prediction, what s/sx indicate worse prognosis? |
|
Definition
unilateral weakness
speech impairment
duration
DM |
|
|
Term
| In the TIA-to-Stroke prediction model, what is considered a high risk for stroke? |
|
Definition
| If the pt displays 6-7 points worth of risk factors |
|
|
Term
| In the TIA-to-Stroke prediction model, what is considered a moderate risk for stroke? |
|
Definition
| If the pt displays 4-5 points worth of risk factors |
|
|
Term
| What are lifestyle TIA tx's? |
|
Definition
Control HTN, DM, and lipids
stop smoking
lose weight and exercise |
|
|
Term
| What are drug tx's for TIA's? |
|
Definition
Aspirin or Aggrenox (ASA and dipyridamole)
ticlopidine or clopidogrel if allergic to ASA
statins |
|
|
Term
| What are Reversible Ischemic Neurological Deficits? |
|
Definition
| If the TIA s/sx last more than 24 hours, but full recovery is seen |
|
|
Term
| What is a completed stroke? |
|
Definition
| sustained ischemic event leading to irreversible neurological dysfunction |
|
|
Term
| What are risk factors for stroke? |
|
Definition
TIA
DM
Migraine w/ aura
Valve dz's (vegetations can break off and throw a blockage into CV system)
HTN
Smoking
Family MHx
Carotid atherosclerosis |
|
|
Term
| Carotid atherosclerosis leads to what % of ischemic strokes? |
|
Definition
|
|
Term
| What kind of stroke does carotid atherosclerosis increase occurrence for? |
|
Definition
| anterior circulation strokes, but not posterior circulation strokes |
|
|
Term
| What level of carotid atherosclerosis will lead to a risk for stroke of 2% per in a given year? |
|
Definition
|
|
Term
| What ocular s/sx can indicate inreased risk of stroke? |
|
Definition
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