Approach to Neuro Cases Flashcards
What are the basic types of primary headaches?
- tension headache
- migraine headache
- cluster headache
- other (i.e. cold stimulus)
tension headache
- duration:
- location:
- characteristics:
- patient presentation:
- other sx:
tension headache
- duration: minutes-days
- location: bilat, starts at posterior head and radiates anteriorly
- characteristics: pressure that waxes and wanes
- patient presentation: nuisance, not debilitating
- other sx: may have cervical pain
migraine headache
- duration:
- location:
- characteristics:
- patient presentation:
- other sx:
migraine headache
- duration: 4-72 hours
- location: unilat (temporal/frontal) in adults, can be bilat (more common in peds)
- characteristics: may have aura, gradual onset, increase in pain sx from onset; pulsatile, severe, debilitating
- patient presentation: ill appearing, prefers room w/ no stimulus
- other sx: aura, photo/phonophobia, nausea/vom, rarer sx (photopsia, vertigo, scalp tenderness, seizure like activity)
cluster headache
- duration:
- location:
- characteristics:
- patient presentation:
- other sx:
cluster headache
- duration: 15 min - 3 hours
- location: typically involves eye and/or temporal region; always unilat
- characteristics: quick onset, sharp stabbing pain of significant intensity, tearing of eye, “ice pick headache”
- patient presentation: active, but in obvious discomfort
- other sx: tearing, rhinorrhea, sweating, irritation
What is the most frequent headache type in population-based studies?
Most common type in patients presenting to clinicians w/ complaint of headache?
- tension headache is the most frequent in pop based studies
- migraine is the most frequent when presenting to clinic
What are possible triggers for headaches?
- recent changes in sleep, exercise, weight, or diet
- state of general health
- change in work or lifestyle
- change in method of birth control (women)
- possible a/w environmental factors
- effects of menstrual cycle and exogenous hormones (women)
What does the SNOOP mnemonic stand for?
(SNOOP mnemonic helps you remember dangerous sx a/w headache that could represent a space-occupying mass, vascular lesion, infection, metabolic disturbance, or systemic problem)
- S: systemic sx, illness, or condition (fever, weight loss, cancer, pregnancy, immunocompromised)
- N: neuro sx or abnormal signs
- O: older onset (age > 50 y/o)
- O: onset sudden (thunderclap headache a/w SAH)
- P: papilledema, precipitated by valsava, positional provocation (tear in dura mater), progression or change in HA hx
What are associated sx of headaches that are indicative of an emergent situation?
- thunderclap HA (SAH)
- 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 carbon monoxide exposure
What areas of the physical exam should you focus on w/ a headache complaint?
- obtain BP and pulse
- listen for bruit at neck, eyes, and head for clinical signs of arteriovenous malform
- check temporal and neck arteries
- palpate head, neck, and shoulder
- examine spine and neck muscles
- neuro exam: mental status, CN exam, fundoscopy/otoscopy, motor/reflex/cerebellar/sensory tests, gait tests, station tests (Romberg)
What are the most common causes of dizziness?
(that we will be tested on :))
- benign paroxysmal positional vertigo (BPPV): transient sx of vertigo due to canalith movement in semicircular canals
- Menier’s dz: spontaneous vertigo sx a/w tinnitus and unilat hearing loss, caused by increased endolymphatic pressure in the inner ear
How do patients usually describe vertigo and what is the underlying cause of this condition?
- patients describe the room spinning around them, a sensation of self-motion when they are not moving or a distorted self-motion during normal head movement
- causes: asymmetry within vestibular sys or disorder of peripheral labyrinth of central connections
What are the 3 associated components you need to know during a dizziness workup?
(remember the mnemonic TiTrATE)
- Timing of sx: onset, duration, evolution of sx
- Triggers that provoke sx: actions, movements, situations
- And a Targeted Exam
(will place dizziness into 1 of 3 categories: episodic triggered, spontaneous episodic, or continuous vestibular)
dizziness chart
most important thing to remember is spontaneous dizziness w/ hearing loss is Meniere’s dz
What parts of the physical exam should you focus on for dizziness complaint?
- HEENT
- cardiovascular
- neurologic, including Romberg
- Dix-Hallpike maneuver to dx BPPV
- physical exam test for BPPV
- patient sits upright while physician rotates patient’s head 45 degrees in each direction
- if this is negative, patient lays supine and physician rotates patient’s head again
- (+) test: dizziness is recreated
Dix-Hallpike maneuver
