CC CJM | Chronic Neurological Disorders

Primary Headaches[1]

• Tension (TTH): Bilateral, dull bandlike pressure[1][2]. No nausea[2]. Tx: NSAIDs[3][4]. Prev: Amitriptyline[3][5].
• Migraine: Unilateral throbbing, ± aura[1][6]. Triggers: stress, red wine[6][7]. Acute: Triptans (sumatriptan; contraindicated in CAD, ischemic stroke, uncontrolled HTN)[5]. Prev: Topiramate, β-blockers, Botox[3].
• Cluster: Severe unilateral orbital pain in clusters[1][4]. ptosis, tearing[1][4]. Tx: High-flow 100% O2 (7-12 L/min)[3][8], triptans[8]. Prev: Verapamil[8].
• Medication Overuse (MOH): Daily headache from analgesic overuse. Tx: Stop drug[8].

Seizure Disorders[9]

• Def: ≥2 unprovoked seizures >24h apart[9].
• Classes: Generalized (bilateral hemispheres, e.g., tonic-clonic with LOC[10][11]) vs. Focal (1 hemisphere, aware vs. impaired[10][12]).
• Status Epilepticus (SE): Seizure >5 min or recurrent; emergency[12]. Tx: IV Lorazepam, then fosphenytoin[13].
• Nursing Care: Airway, turn on side, do not restrain, never insert objects in mouth, pad rails, record phases[14][15].

Restless Legs Syndrome (RLS)[16]

• Leg paresthesias, worse at rest/night, relieved by movement[16][17]. Basal ganglia dopamine dysfunction[17]. Tx: Dopamine agonists (ropinirole), gabapentin[17].

Degenerative Neurologic Disorders[1]

• Multiple Sclerosis (MS): Autoimmune T-cell CNS demyelination[18][19]. Signs: optic neuritis, spasticity, ataxia, bladder dysfunction[20][21]. Tx: DMDs (interferons)[22], steroids for relapses[22].
• Parkinson's (PD): Substantia nigra DA neuron loss; DA/ACh imbalance[23]. Key: resting tremor ("pill-rolling"), cogwheel rigidity, bradykinesia (masked facies, shuffling gait), postural instability[23]. Tx: Levodopa/Carbidopa (avoid protein meals[26]), DA agonists, DBS[25].
• Myasthenia Gravis (MG): Autoimmune AChR antibody destruction[29]. Fluctuating weakness (ptosis/diplopia; worsens with activity, improves with rest)[29]. Dx: Edrophonium test (atropine bedside)[30].
  • Myasthenic Crisis: Respiratory failure[30]; Tx: IVIG, plasmapheresis[31].
  • Cholinergic Crisis: Excess anticholinestase[30]; SLUDGE signs[30]; Tx: hold drugs, atropine[30].
  • Tx: Pyridostigmine[30].
• Amyotrophic Lateral Sclerosis (ALS): Upper/lower motor neuron degeneration; cognition spared[32][33]. Wasting, bulbar signs. Death: respiratory failure[32]. Tx: Riluzole[32].
• Huntington's (HD): Autosomal dominant CAG repeats[33]. ACh/GABA deficit, excess DA[33]. Key: chorea, psychiatric decline, dementia[33][34]. Caloric needs: 4000-5000 kcal/day[34]. Tx: Tetrabenazine[34].