501. Headaches, hearing loss and vertigo Flashcards
What are the differentials for a rapiud onset headache?
Subarachnoid
Meningitis
Encephalitis
Post-coital headache
What are the differentials of a subactue gradual onset headache?
Venous sinus thrombosis
Sinusitis
Tropical illness- malaria, typhus, flu
Intracranial hypotension
What are the signs of raised ICP?
Worse on walking
Lying, bending down, coughing makes worse
Seizures, focal neurological deficits, funny behaviour
Headache
What are the symptoms of acute glacoma?
What inital treatment is given?
Typically occurs in elderly, long sighted people. Pain around one eye, Radiates to forehead. Casues reduced vision, visual haloes and red congested eye
Pilocarpine and acetazolamide
What medications cause migraine induced headaches?
Paracetamol and codeine/opiates
Ergotramine
Triptans
What is the treatment for a cluster headache?
Keep calm,carry oxygen
Sumatriptan
What are the causes of trigeminal neuralgia?
Idiopathic
Intracranial vessels
Tumour
Meningeal inflammation
MS
Zoster
What are the triggers of a mirgraine?
C hocolate H angovers O rgasms C heese/affeine L ie-ins A lcohol T ravel E xercise
What are the contraindications of triptans?
IHD
Coronary spasm
Uncontrolled blood pressure
BP
Recent lithium
SSRI’s
What is a vasovagal syncope?
Reflex bradycardia and peripheral vasodiation
Only occurs when standing up
pre-syncopal symtpoms following. sometimes seizures
What are two exaples of situation syncope?
Effort syncope(usually cardiac)
and micturation syncope (usually men)
What is carotid sinus syncope?
Hypersensitive baroreceptors cause excessive reflex bradycardia on minimal stimulation e.g. head turning or shaving.
What is a stokes adams attack?
Transient arrythmias cause blackout.
Recovery is in seconds usually patient flushes, pulse speeds up and conciousness is regained.
What examinations should be done on all that pass out?
Cardio,
neuro
Measure BP lying and standing
What investiations should be done in those that present with a faint?
Cardiac assessment if recurrent
ECG and 24 hour ECG
U&E, FBC, Mg, Ca and glucose
Table tilt test
ECHO
ABG
If someone as vertigo and hearing loss/tinnitus what does this indicate?
Labyrinth or CN8 involvement
What manouvers are assocaited in benign positional vertigo?
Hallpike- used for diagnosis, induces nystagmus (turn head and lie down)
Epley- used to clear debris (turn head to right, put head back, lie onto bed)
How do you treat severe vertigo?
Reassure
Benzos
Prochlorperazine
What causes menieres disease?
What are symptoms
How do you treat
Increased pressure of the lymphatic system.
Comes with sensorineural hearing loss and tinntitus
Antihistamine if prolonged
What drugs can cause deafness and vertigo?
Aminoglycosides
Loop diuretics
Cisplatin
What condition predisposes you to vestibular schwannomas?
Neurofibrmatomas Type 2
What are the differentials of conductive deafness?
Wax (olive oil, warm water syringe)
Otoscleoriss
Ottits media
Glue ear
What is presbyacusis?
Form of chornic sensorinueral deafness
Loss of high frequency before 30, not notice until hearing or speech is affected
Hearing is most affected in presence of background noise
What are the differentials of sudde sensorineural hearing loss?
NEED URGENT ENT OPINION
Noise
Gent
Mumps
Accoustic neuroma
MS
Stroke
Vasculitis
What are the causes of tinnitus?
Wax, XS noise, head injury, menieries, anaemia
if pulsatile consider carotid dissection
Aspirin, loop diuretics, aminoglycasides
What are the treatments of tinnitus?
Cognitive therapy- help cope
Drugs- shit
Hearing aids that play white noise
