Episode Details

Primary Headaches

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

Seizure Disorders

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

Restless Legs Syndrome (RLS)

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

Degenerative Neurologic Disorders

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