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PCM EX 2 > 4a. Approach to Neuro Cases I > Flashcards

4a. Approach to Neuro Cases I Flashcards

1
Q

What are the basic types of primary HA?

A
  • tension-type HA
  • migraine HA
  • cluster HA
  • other, including cold-stimulus HA
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2
Q

What should headache-specific history include?

A
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3
Q

Characteristics:

  • gradual in onset, crescendo pattern
  • pulsating
  • moderate or severe intensity
  • aggravated by routine physical activity

Appearance: pt rests in dark, quiet room

Duration: 4-72 hrs

Assoc. sx: n/v, photophobia/phonophobia, aura

Location: unilater in 60-70% adults, bifrontal/global in 30%; bilateral in children

A

migraines

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4
Q

Characteristics: pressure or tightness which waxes and wanes

Pt appearance: remain active or may need to rest

Duration: 30 min to 7 days

No assoc sx

Location: bilateral

A

tension-type HA

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5
Q

Characteristics:

  • pain begins quickly, reaches crescendo w/in minutes
  • pain is deep, continuous, excruciating, and explosive in quality

Pt appearance: active

Duration: 15 min to 3 hours

Assoc sx: ipsilateral lacrimation and redness of the eye; stuffy nose; rhinorrhea; pallor; sweating; Horner syndrome; restlessness or agitation; focal neurologic symptoms rare; senstivity to alcohol

Location: unilateral always (around eye or temple)

A

cluster HA

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6
Q

What to obtain for headache-specific physical exam?

A
  • Obtain BP and pulse
  • Listen for bruit
  • Check eyes and head for signs of arteriovenous malformation
  • Palpate head, neck, and shoulder regions
  • Check temporal and neck arteries
  • Examine the spine and neck muscles
  • Mental status testing
  • CN examination
  • Fundoscopy and otoscopy
  • Symmetry on motor, reflex, cerebellar, and sensory test
  • Gait: toe walk, heel walk, tandem walk
  • Station: get-up from seated position without support, Romberg test
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7
Q

What does SNOOP stand for?

A
  • S: systemic symptoms, illness, or condxn
  • N: neuro symptoms or abnormal signs
  • O: onset is new
  • O: other associated conditions
  • P: previous HA hx w/ HA progression or change
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8
Q

What indicates need for emergency evaluation?

A
  • sudden “thunderclap” HA
  • acute or subacute neck pain or HA w/ Horner syndrome and/or neuro deficit
  • HA w/ suspected meningitis or encephalitis
  • HA w/ global or focal neurologic deficit or papilledema
  • HA w/ orbital or periorbital sx
  • HA and possible CO exposure
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9
Q

transient triggered episodes of vertigo caused by dislodged canaliths in the semicircular canals

A

BPPV

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10
Q

spontaneous episodes of vertigo caused by inflammation of the vestibular nerve or labyrinthine organs, usually from a viral infection

A

vestbular neuritis

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11
Q

spontaneous episodes of vertigo caused by abnormal bone growth in the middle ear and associated w/ conductive hearing loss

A

osteosclerosis

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12
Q

spontaneous episodes of vertigo associate w/ migraine headaches

A

vestibular migraine

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13
Q

continuous spontaneous episodes of vertigo caused by arterial occlusion or insufficiency, especially affecting the vertebrobasilar system

A

cerebrovascular disease

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14
Q

continuous spontaneous episodes of dizziness caused by vestibular schwanomma, infratentorial ependymoma, brainstem glioma, medulloblastoma, or neurogibromatosis

A

cerebellopontine angle and posterior fossa meningiomas

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15
Q

initially episodic, then often continuous episodes of dizziness w/o another cause and associated with psychiatric condition (e.g. anxiety, depression, bipolar disorder)

A

psychiatric

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16
Q

continuous episodes of dizziness w/o another cause and associate with a possible medication adverse effect

A

medication induced

17
Q

acute episodic symptoms that are not associated with any triggers

A

cardiovascular/metabolic

18
Q

acute episodic symptoms associated with a change in position from supine or sitting to standing

A

orthostatic

19
Q

What history should be included for dizziness?

A
  • hx trauma
  • frequency, intensity, and duration of attack
  • severity (how it affects life NOT on a 0-10 scale)
  • assoc sx: blurry vision, syncope, n/v, hearing loss
  • personal and family hx of similar symptoms
  • thorough review of all meds
20
Q

Where were the previous classifications of dizziness?

A
  • vertigo
  • lightheadedness
  • presyncope
  • dysequilibrium

limited usefulness

21
Q
  • sensation of self-motion when they are not moving or distorted self-motion during normal head movement
  • can be:
    • result of asymmetry w/in vestibular system
    • disorder of peripheral labrynth of its central connections
  • distinction b/w vertigo and dizziness has limited clinical usefulness
A

vertigo

22
Q

TiTrATE

A
  • T: timing of the symptom (onset, duration, and evolution of symptoms)
  • T: triggers that provoke the symptom (actions, movements, or situations)
  • ATE: and a targeted examination
23
Q

Name the 3 clinical scenarios for dizziness.

A
  • episodic triggered symptoms
  • spontaneous episodic symptoms
  • continuous vestibular symptoms
24
Q

What are the basics of targeted exam for CC dizziness?

A
  • HEENT
  • cardiovascular
  • neurologic, including Romberg
  • Dix-Hallpike maneuver to dx BPPV
25
Q

Describe the Dix-Hallpike Maneuver.

A
26
Q
  • occurs when loose canaliths “get stuck” in SC canals
  • affect people at any age but most common b/w 50-70 y/o
    • no obvious cause foud in 50-70% of older individuals
    • head trauma is a consderation in younger individuals
  • tx consists of Epley maneuvers in the office (or can refer to PT for these)
  • home tx w/ Brandt-Daroff exercises
  • unless other comorbidity exists - no need for lab tests or imaging
  • no role for pharmacologic tx
A

BPPV

27
Q
  • vertigo w/ hearing loss; +/- tinnitus
  • any age (most common age 20-60 y/o)
  • vertigo so severe often requires bedrest
  • any accompanying HA and hearing loss can be worsened during an attack
  • exact cause unknown
  • can have BPPV & Meniere Disease so Dix-Hallpike test may be +
A

Meniere Disease

28
Q

What are the classifications of syncope?

A
  • cardiac
  • neurally mediated (reflex)
  • orthostatic hypotension
29
Q

Syncope-specific history should focus on what 3 things?

A
  1. Is LOC attributed to the syncope?
  2. Is there a hx of cardiovascular disease?
  3. Are there clinical features to suggest a specific cause of syncope?

PCM EX 2 (11 decks)

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