Approach To Neuro Cases Flashcards
What are the basic types of primary HA?
Tension type, migrain, cluster HA, other
What is the duration of a tension HA?
Minutes-days
Where is a tension HA located?
Bilateral
Starts at posterior head and radiates anteriorly
Describe characteristics and pt presentation of tension HA
Pressure that waxes and wanes
More of a nuisance, usually able to remain active
What is the duration and location of a migraine?
4-72 hours Typically unilateral (temporal/frontal) in adults, can occur bilaterally (more common in peds populations)
What are the characteristics and pt presentation of a migraine?
May have aura, gradual onset, with increase in pain sx from onset
Typically pulsatilla and severe
Pt is ill appearing, pt prefers room with no stimulus
Photo/photophobia, vomiting/nausea, vertigo, seizure like activity
What is the duration and location of a cluster HA?
15mins-3 hours
Typically involves eye and/or temple region
Always unilateral
What are characteristics and pt presentation of cluster HAs?
Quick onset, sharp stabbing pain of significant intensity, often see tearing of eye
Ice pick HA
Pt is active but in obvious discomfort
What is the SNOOP mnemonic?
Systemic sx, illness or condition (fever, weight loss, cancer, pregnancy, immunocompromised)
Neuro sx or abnormal signs
Older onset (over 50)
Onset sudden (thunderclap HA)
Papilledema, precipices by valsalva, positional provocation, progression or change in HA history
Could represent a space occupying mass, vascular lesion, infection, metabolic disturbance or systemic problem
Danger
What signs represent need for emergency evaluation?
Sudden thunderclap HA, acute or subacute neck pain or HA with Horner syndrome, HA with suspected meningitis or encephalitis, HA with global or focal neuro deficit or papilledema, HA with orbital or periorbital sx, HA and possible CO exposure
What are examples of peripheral causes of vertigo?
Benign paroxysmal positional vertigo (BPPV), Meniere disease and otosclerosis
What is benign paroxysmal positional vertigo (BPPV)?
Transient sx of vertigo due to canalith movement in the semicircular canals
What is Meniere disease?
Spontaneous vertigo sx associated with unilateral hearing loss*
Caused by increased endolymphatic pressure in the inner ear
What is otosclerosis?
Bony overgrowth of the stapes that results in spontaneous vertigo and conductive hearing loss
What are examples of central causes of vertigo?
Vestibular migraine, cerebrovascular disease, mass at cerebellopontine angle
What is a vestibular migraine?
Vertigo sx associated with migraine HA
What is cerebrovascular disease?
Vertigo sx associated arterial occlusion
What are other causes of vertigo?
Medication induced, psychiatric or orthostatic
How do pts describe vertigo?
A sensation of self motion when they are not moving or a distorted self motion during normal head movement
What is titrate the evaluation of dizziness?
Titrate consists of three distinct components of workup
Timing of the sx (onset, duration and evolution)
Triggers that provoke the sx (actions,movements or situations)
And a targeted examination
What are the classifications of syncope?
Cardiac, orthostatic hypotension and neuro mediated
What is orthostatic hypotension?
Positional changes that result in acute drop in BP
May be exacerbated my medication (beta blockers)
Volume depletion
Autonomic failure from primary (MS, Parkinson’s) or secondary (DM, spinal cord injury)
What are the three causes of neuro mediated syncope?
Carotid sinus syndrome, vasovagal, situational
What is carotid sinus syndrome?
Head rotation accompanied by pressure to the carotid artery resulting in stimulation carotid sinus resulting in reflexive ventricular pause and possible syncope
