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PCMI > 2.4 Neuro Cases 1 > Flashcards

2.4 Neuro Cases 1 Flashcards

1
Q

What is the most frequent headache in population?

A

Tension Headache

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2
Q

What is the most common diagnosis in patients presenting to clinicians with complaint of headache?

A

Migraine

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3
Q

What is a primary headache?

A

Just a headache.

Not CAUSED by something else

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4
Q

What are (3) examples of primary HA?

A

Tension-type HA

Migraine HA

Cluster HA

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5
Q

Migraine

Location:

Characteristics:

Pt. appearance:

Duration:

Associated sxs:

A

Location: Mostly unilateral in adults, bilateral in children/adolescents

Characteristics: Gradual onset, pulsating, aggravated by physical activity

Pt. appearance: Pt. prefers to rest in dark quiet room

Duration: 4 - 72 hrs

Associated sxs: Nausea, vom, photophobia

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6
Q

Tension Type HA

Location:

Characteristics:

Pt. appearance:

Duration:

Associated sxs:

A

Location: Bilateral

Characteristics: Pressure/tightness which waxes and wanes

Pt. appearance: Pt. may remain active OR need to rest (variation)

Duration: 30min-7days

Associated sxs: None

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7
Q

Cluster HA

Location:

Characteristics:

Pt. appearance:

Duration:

Associated sxs:

A

Location: ALWAYS unilateral; usually begins around eye or temple

Characteristics: Pain begins quickly, and explosive in quality

Pt. appearance: Pt. remains active

Duration: 15min-3 hours

Associated sxs: Ipsilateral lacrimation and redness of the eye, stuffy nose, pallor, sweating, horner syndrome

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8
Q

When performing a PE on a pt w/ headache, what is something you should always do?

A

Touch the area that hurts

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9
Q

What are the typical things you would do in a headache focused physical exam?

A
  • Get a BP and pulse
  • Listen for bruit at neck, eyes and head for clinical signs of arteriovenous malformation
  • Palpate the head, neck and shoulder regions
  • Check temporal and neck arteries

-Examine the spine and neck muscles

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10
Q

What should you do in a typical neuro physical exam?

A
  • Mental status testing
  • CN exam
  • Funduscopy and otoscopy
  • Symmetry on motor, reflex, cerebellar and sensation tests
  • Gait : toe walk, heel walk, tandem walk
  • Station: Get up from seated position without support, Romberg test
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11
Q

What is the mnemonic for DANGER signs with a headache?

What would a (+) with anything in the mneumoic potentially indicate?

A

SNOOP

Space-occupying mass, vascular lesion, infection, metabolic disturbance or systemic problem

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12
Q

What does each letter of SNOOP represent?

A

S = Systemic symptoms (fever, wt loss, cancer etc…)

N= Neuro symptoms or abnormal signs (confusion, papilledema etc…)

O= Onset is new (*particularly age over 50)

O= Other associated conditions (head trauma, illicit drug use, etc…)

P=Previous HA hx with HA progression/change

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13
Q

What are some indications for emergency evaluation?

A
  • Sudden “thunderclap” HA
  • Acute/subacute neck pain
  • HA w/ horner syndrome and/or neuro deficit
  • HA w/ suspected meningitis or encephalitis
  • HA w/ global or focal neurologic deficit or papilledema
  • HA with orbital or periorbital sxs
  • HA and CO exposure
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14
Q

How does occipital neuralgia typically present?

A

Unilateral

Starts at the area where the neck meets the skull and moves forward to involve the ear and forehead

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15
Q

What causes the pain seen in occipital neuralgia?

A

Caused by trauma to the nerves

*includes pinching of the nerves by overly tight neck muscles, compression of the nerve as it leaves the spine due to osteoarthritis, or tumors or other types of lesions in the neck

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16
Q

What test can confirm a occipital neuralgia diagnosis?

A

Nerve blocks

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17
Q

What is the treatment for occipital neuralgia?

A

Massage

NSAIDS

Muscle relaxants

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18
Q

Dizziness affects ______% of adults

A

Dizziness affects 15-20% of adults

19
Q

What are some relevant associated symptoms to ask about with a cc of dizziness?

A

Blurry vision

Syncopy

Hearing loss

Nausea/vomiting

20
Q

What is important to remember (clinical pearl) with dizziness that increases with motion?

A

Dizziness that increases with motion is common to both peripheral and central causes

21
Q

Vertigo can be:

A result of?

or

Disorder of?

A

Result of : asymmetry within the vestibular system

Disorder of: peripheral labyrinth of its central connections

22
Q

What is the gold standard method of evaluating dizziness?

A

TiTrATE

Ti = Timing of the symptom (onset, duration and evolution of symptoms)

Tr=Triggers that provoke the symptom (actions, movements or situations)

And a Targeted Examination

23
Q

What are episodic triggered symptoms?

What are common triggers?

A

Brief episodes of intermittent dizziness lasting seconds to hours

Head motion/change in body position

24
Q

If you have (+) episodic triggered symptoms…

you most likely have?

A

Benign paroxysmal positional vertigo

(BPPV)

25
Q

What are spontaneous episodic symptoms?

A

Dizziness WITHOUT triggers that lasts seconds to days

26
Q

What are some potentials you should include in your differential for spontaneous episodic symptoms?

A
27
Q

What are continuous vestibular symptoms?

A

Dizziness lasting days to weeks

Classic symptoms= continuous dizziness or vertigo with N/V, nystagmus, gait instability and head motion intolerance

28
Q

What are the common causes of continuous vestibular symptoms?

A

Exposure to trauma or toxin

Medications are frequently the cause

*If no toxin or tauma exposure…consider vestibular neuritis or central etiologies

29
Q

What are the 4 basic categories of exams that would constitute a targeted exam for cc of dizziness?

A

HEENT

CV

Neurologic, including Romberg

Dix-Hallpike maneuver to diagnos BPPV

30
Q

What is the dix-hallpike maneuver?

What are you testing for?

A

Maneuver to diagnose BBPV

Summary of maneuver:

Pt sits upright, head turned 45 degrees to one side, with head supported by physician, lies back quickly to supine position ending w/ head hanging off table. Stays for 30 seconds. Then returns to upright position and observed. Then, repeat on opposite side.

IF MANEUVER TRIGGERS VERTIGO (+) TEST

31
Q

Anatomically, what causes BPPV?

A

Occurs when loose canaliths “get stuck” in semicircular canals

32
Q

Vestibular Neuritis

Symptoms?

A

Rotatory vertigo

Apparent movement of objects in visual field

Horizontal nystagmus to non affected side

Abnormal gait w/ tendency to fall to affected side

33
Q

GENERALLY what is meniere disease?

What age does it occur?

A

Vertigo w/ hearing loss, +/- tinnitus

Any age, most common 20-60

34
Q

Vestibular Migraine

What would suggest pt has this?

A

Episodic vertigo in pt with hx of migraines

COMMON in kids

35
Q

Patient presents with vertigo/dizziness….

Draw out the flow chart for how you would approach it

A
36
Q

what is a secondary headache?

A

Headache in response to some other problem, an issue that could kill you

37
Q

What is an aura?

A

aura often occurs before a migraine or seizure. It may consist of flashing lights, a gleam of light, blurred vision, an odor, the feeling of a breeze, numbness, weakness, or difficulty in speaking

38
Q

Cluster Headache

  1. location
  2. Characteristics
  3. Pt appearance
  4. Duration
  5. Associated symptoms
A
  1. unilateral, usually around eye/temple
  2. Rapid pain onset; deep, continuous, excruciating pain thats explosive in quality
  3. remains active
  4. 15 min-3 hours
  5. ipsi redness and lacrimation of eye, stuffy nose, pallow, sweating, horner’s syndrome, restless or agitation, sensitivity to alcohol
39
Q

Tension type headache

  1. location
  2. Characteristics
  3. Pt appearance
  4. Duration
  5. Associated symptoms
A
  1. bilateral
  2. pressure/tightness which wax and wane
  3. pt remain active or need to rest
  4. 30 mins - 7 days
  5. none
40
Q

migraine headache

  1. location
  2. Characteristics
  3. Pt appearance
  4. Duration
  5. Associated symptoms
A
  1. Adults: UL (60-70%), Bifrontal or global (30%); child: BL
  2. gradual onset, pulsating, moderate or severe intensity, aggrevated by routine PA
  3. pt prefers to rest in dark, quiet room
  4. 4-72 hours
  5. N/V, photophobia, phonophobia, aura, can cause speech or motor deficits
41
Q

What 3 categories does your TiTrATE evaluation place dizziness in?

A
  1. episodic triggered symptoms
  2. spontaneous episodic symptoms
  3. continuous vestibular symptoms
42
Q

what are 3 classifications of syncope?

A
  1. cardiac
  2. neurally mediated (reflex)
  3. orthostatic hypotension
43
Q

history of syncope should focus on what 3 things?

A
  1. LOC?
  2. hx of CVD?
  3. clinical features to suggest specific cause?

PCMI (15 decks)

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