3 Flashcards
Occipital Neuralgia
Side:
D/t:
What can confirm dx:
Tx:
Usually unilateral, starts at the area where the neck meets the skull and
moves => ear and forehead
trauma to nerves; d/t tight paraspinal neck muscles, osteoarthritis pinching of nerves,, tumors in neck
greater occipital nerve block
NSAIDS, muscles, muscle relaxants
what abnormal findings are often seen in occipital neuralgia
- obese
- hold hands to L side of head
- painful
- TTP at L occipitale condyle
- Paraspinal neck musculature are tight,
Dizziness affects ______
of adults in large
population studies.
15-20%
Subjective Data to Obtain w dizziness
- hx
- frequency, intensity and how long does it last
- severity (HOW IT AFFECTS LIFE NOOOOOT a scale from 1-10)
- familal and person hx
- meds
assx sxs with dizziness
- syncope
- blurry vision
- N/V
- hearing loss
Dizziness that increases with motion is common to what?.
PERIPHERAL and CENTRAL causes
what is vertigo
self motion when not moving or distorted self-motion when rotating head normall
Vertigo can be d/t
- asymmetry in vestibular system
2. problem with peripheral labrythin and central connections
Migrains are most common where
adults: 60-70 unilateral
kids: mostly bilateral
migraine characteristic
gradual onset; pulsating; moderate to severe in pain
do migraines get better or worse w activbivty
worse
duration of migraines
4-72 hrs
assx sx of migranins
N/V
photophobia, phonophobia
visual auroas
tension HA are most common where
bilateral
tension HA charactersitics
pression/tesnion that waxes and wanes
do tension HA get better or worse w activbivty
pt can be active but may need rest
duration of tension HA
30 min- 7 days
assx sx of tension HA
none
cluster HA are most common where
always unilateral and begin around ear and temple
cluster HA charactersitics
deep, excruciating, explosive pain begins quickly and reaches peak in minues.
do cluster HA get better or worse w activbivty
pt can stay active
duration of cluster HA
15- 30 minutes
cluster HA assx sx
ipsilateral lacrimination, red eye
SNOOP
DANGER for subarachnoid hemo, vascular disease, metabolic synx
- systemic problem (fever, cancer)
- Neuro problems (confusion)
- Onset is new (esp if under 50 or thunderclap
- Other ASSx sx: head trauma, drugs
- Previous HA that has progressed or changed
how to examine for dizziness
TiTrATE
- Timing (onset, duration and evolution of sx)
- first Q: episodic or continuous - Triggers that provoke the sx
- And a Targeted Exam
what are episodic triggered sxs?
Brief episodes of intermittent dizziness lasting seconds => hours d/t head motion or change in body position
most common cause of episodic triggered sxs is
BPPV
benign paroxsmal positional vertigo
Spontaneous Episodic Symptoms are what
those that have no triggers and dizziness lasts seconds => days
to dx; we need other info from history
pt has dizziness that has NO triggers and lasts seconds -> days and also has unilateral loss of hearing
meniers dz
spontaneous episodic symtoms
pt has dizziness that has NO triggers and lasts seconds -> days and also has assx sx of migraine
vestibular migraine
spontaneous episodic symtoms
pt has dizziness that has NO triggers and lasts seconds -> days that becomes continous and assx with psych disorder (anxiety, bipolar depression)
psych disorder
spontaneous episodic symtoms
what are Continuous Vestibular Symptoms
dizziness that lasts days -> weeks that is ass with N/V, problems with gait, nystagmus, head motion intolerance
Continuous Vestibular Symptoms are often d/t what?
trauma or toxins (in 23% of adults, meds are the cause of dizziness)
• Use of ___ or more meds is associated with increased risk for dizziness
5
If no toxin or trauma exposure, consider
vestibular neuritis or central cause
most common peripheral cause of dizziness
- BPPV
- vestibular neuritis
- Meiners
- ostesclerosis
most common central cause of dizziness
- vestibular migraine
- CerebroV disease
3
other causes of dizzines
- psyciatric
- meds
- CV/metabolic
4.
what is a directed exam for dizzniess
- HEENT
- CV
- Neurologic, including Romberg
- Dix-hallpike maneuar
- Dix-hallpike maneuar is used to dx what?
BPPV
doc rotates pts head to 45 with eyes open while they are sitting up; then; have the pt lay down with head off of the table. stay in position for 30 seconds
pt goes back to upright position for 30 sec and examined
Next, the maneuver is repeated with the patient’s head turned to the left.
A
positive test is indicated if any of these maneuvers trigger vertigo with or without
nystagmus.
BPPV Occurs when loose canaliths ”get stuck” in semicircular canals.
• Affect people at any age, but most common between _____
50-70 YO
tx bPPv
Epley maneuvers in the office; no meds
Vestibular Neuritis
sx
2nd most common cause of vertigo; often d.t a virus; most often in M=F and (20-30)
rotatory vertigo with apparent movement of objects in
visual field; horizontal nystagmus to NON-affected side (pt feels like they are spinning + objects in ivsual field are spinning)
abnormal gait
Meniere Disease
vertigo + tinnitus + hearing loss that is so bad pt needs to sleep
Meniere Disease most common age
20-60 but any age
can pts have MD and BPPV?
yes, causing Dix test to be +
what suggests a Vestibular Migraine
CENTRAL CAUSE: episodic vertigo in a patient with in a patient with vestibular migraines
what is the most common cause of vertigo in kids
vestibular migraine
vestibular migraines are more common in who?
kids
adult women are 2-3x more likely
ages: 20-50
runs in fam
can we use dix test for vestibular neuritis?
no bc it is not positional
pt is in moderate distress, sitting with a large bowl that contains emesis
nystagmus
failed whisper test
Romberg test +
Meiner dz+
Meinerz dz
