Lecture 4: Neuro Cases 1 Flashcards
What are different type of headaches?
Migraine
Tension
Cluster
What is the most common diagnosis in patients presenting to clinicians with c/o headache?
Migraine
Why is history important for headaches?
Imaging doesn’t tell much so its important to pay attention to patient
What is some HA-specific history?
Age at onset Presence of absence of aura and prodrome Frequency, intensity, and duration of attack Number of headache days per month Time and mode of onset Quality, site, and radiation of pain Associated symptoms and abnormalities Family history of migraine Precipitating and relieving factors Exacerbation or relief with change in position Effect of activity on pain Response to any previous treatment Review of current medications Any recent change in vision Association with recent trauma
What should be considered in women presenting with HA?
Change in method of birth control
Effects of menstrual cycle and exogenous hormones
What are important things to do in a physical exam regarding headaches?
BP and pulse Bruits in neck, eyes, head Palpate head, neck, and shoulder regions Check temporal and neck arteries Examine spine and neck Mental Status CN exam Gait and Station
What are some low risk features for HA complaint?
Age < 50 years Features typical of primary HA Hx of similar HA No abnormal neurologic findings No concerning change in usual HA pattern No high-risk comorbid conditions No new or concerning findings on hx or examination
Should you do a neuro exam for HA complaints?
Yes
What are some danger signs for HA that could represent a space-occupying mass, vascular lesion, infection, metabolic disturbance or systemic problem?
SNOOP
- Systemic symptoms, illness, or condition (fever, weight loss, cancer, pregnancy, immunocompromised state)
- Neuro symptoms or abnormal signs
- Onset is new
- Other associated conditions
- Previous headache history with headache progression or change
What are some signs that require emergency evaluation for headache?
- Sudden thunderclap headache
- Acute or subacute neck pain or headache with Horner syndrome and/or neuro deficits
- Headache with suspected meningitis or encephalitis
- Headache with global or focal neurologic deficit or papilledema
- Headache with orbital or periorbital symptoms
- Headache and possible carbon monoxide exposure
What region is occipital neuralgia usually found in?
Usually unilateral, starts at the area where the neck meets the skull and moves forward to involve the ear and forehead
What causes occipital neuralgia?
Pain caused by trauma to the nerves, including pinching of the nerves by overly tight neck muscles, compression of the nerve as it leaves the spine due to osteoarthritis, or tumors or other types of lesions in the neck
*Case 1
What percentage of adults are affected by dizziness in large population studies?
15-20%
What is some dizziness specific history to obtain?
- History of trauma
- Frequency, intensity, and duration of attack
- Severity (how it affects life, NOT on a 0-10 scale)
- Associated symptoms
- Personal and family history of similar symptoms
- Thorough review of all medications
What kind of dizziness is common to both peripheral and central causes?
Dizziness that increases with motion
Why do we no longer use patient description (vertigo, lightheadedness, presyncope) as classifications for dizziness?
Had limited usefulness– patients had hard time describing these as they have a variety of meanings for each individual. Distinction between vertigo and dizziness has limited clinical usefulness.
