Neuro Cases 1 & 2 Flashcards

1
Q
For tension-type HA,
Location?
Characteristics?
Duration?
Pt appearance?
Associated sx?
A

Location: bilateral

Characteristics:pressure or tightness, wanes

Duration: 30 minutes-7 days

Pt appearance: pt may remain active or need rest

Associated sx: none

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What specific hx should be taken for HA?

A
–presence of aura and prodrome
–frequency, intensity and duration of attack
–# of HA per month
–time and mode of onset
–quality, site and radiation of pain
–associated sx and abnormalities
–family hx of migraines
–precipitating and relieving factors
–age of onset
–exacerbation or relief with position change
–effect of activity on pain
–relationship w/ for alcohol
–response to previous tx
–review current meds
–recent vision changes
–recent trauma
–changes in sleep, exercise, weight or diet
–state of general health
–change in work or lifestyle
–change in method of birth control
–environmental factors
–menstrual cycle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Discuss vestibular migraines

A

–central cause
–episodic vertigo in pt with hx of migraine
–most common cause of vertigo in kids
–3x more common in women than men
–most common in 20-50YO
–family hx
–tx: stress relief, sleep, exercise, medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of dizziness if common to both peripheral and central causes?

A

Dizziness that increases with motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What specific hx should be taken for dizziness?

A

–hx of trauma
–frequency, intensity, duration of attack
–severity (how it affects life)
–associated sx (blurry vision, syncope, N/V, hearing loss)
–personal and family hx of similar problems
–review of meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
For cluster HA,
Location?
Characteristics?
Duration?
Pt appearance?
Associated sx?
A

Location: unilateral, around eye or temple

Characteristics: begins quickly reaching a crescendo within minutes, deep pain, continuous, excruciating and explosive

Duration: 15 minutes-3 hours

Pt appearance: pt remains active

Associated sx: ipsilateral lacrimation and redness of eye, stuff nose, rhinorrhea, pallor, sweating, Horner’s, facial neuro sx, restlessness or agitation, sensitivity to alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
For migraine HA,
Location?
Characteristics?
Duration?
Pt appearance?
Associated sx?
A

Location: unilateral in most adults, bilateral in most teenagers and kids

Characteristics: gradual onset, crescendo pattern, pulsating, moderate or severe intensity, aggravated by routine PA

Duration: 4-72 hours

Pt appearance: prefers to rest in a dark, quiet room

Associated sx: nausea, vomiting, photophobia, photophobia, aura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differentiate between Parkinson’s tremor and essential tremor: body parts

A

Parkinson’s: hands and legs

Essential: hands, head, voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Discuss continuous vestibular sx and possible dx

A

=dizziness lasting days to weeks
–classic sx: continuos dizziness or vertigo with N/V, nystagmus, gait instability and head motion intolerance
–often related to trauma or toxin
–if not trauma or toxin exposure, consider vestibular neuritis or central etiologies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does TiTrATE stand for?

A

Timing of the sx
Triggers of the sx
And a Targeted Examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Discuss resting tremors

A

–occurs in body part that is relaxed and supported against gravity
–enhanced by central stress or movement of another body part
–diminished voluntary movement of that body part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Discuss essential tremors

A
–most common pathological tremor
–kinetic is most common
–common in hands and wrists but can also effect head, LE and voice
–usually bilateral
–can be inherited
–progresses with age
–can cause social embarrassment and early retirement
–exacerbated by caffeine and fatigue
–lessened by alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What would you include in a targeted exam for CC of dizziness?

A

–HEENT
–CV
–Neuro including Romberg
–Dix-Hallpike maneuver to dx BPPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a tremor?

A

=involuntary, rhythmic, oscillatory movement of a body part; most common movement disorder seen in primary care practices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Discuss vestibular neuritis,
Presentation and sx?
Tx?

A

–Peripheral cause
–2nd most common cause of vertigo
–May be cause by virus
–Most commonly affects 30-50YO
–Sx: rotatory vertigo with movement of objects in the visual field
–Horizontal nystagmus to non affected side
–Abnormal gait with tendency to fall to affected side
–Lasts a few days, less severe sx can linger
–Tx: anti-emetic, anti-histamine, benzos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Discuss enhance physiologic tremors

A

–everyone has an asymptomatic physiological tremor
–low ampliytude, high frequency at rest and during activity
–enhanced by anxiety, stress, certain medications and metabolic conditions
–if pts have tremors that come and go with anxiety, med use, caffeine intake or fatigue, they don’t need further testing

17
Q

Differentiate between Parkinson’s tremor and essential tremor: distribution

A

Parkinson’s: asymmetrical

Essential: symmetrical

18
Q

Discuss psychogenic tremors

A

–can be difficult to differentiate from organic tremor
–some features are consistent incl. abrupt onset, spontaneous remission, changing tremor characteristics, ↑with attention and extinction with distraction
–more frequently seen in patients in allied health progressions

19
Q

What sx of a headache would require an emergency evaluation?

A
–thunderclap HA
–acute or subacute neck pain with Horner syndrome and/or neuro deficit
–suspected meningitis or encephalitis
–neuro deficit or papilledema
–orbital or periorbital sx
–possible CO exposure
20
Q

Discuss cerebellar tremors

A

–low frequency
–slow-intension or postural tremor
–d/t MS with cerebellar plaques, stroke or brainstem tumors

21
Q

Differentiate between Parkinson’s tremor and essential tremor: course

A

Parkinson’s: progressive

Essential: stable or slowly progressive

22
Q

Differentiate between Parkinson’s tremor and essential tremor: writing

A

Parkinson’s: micrographia

Essential: tremulous

23
Q

Discuss resting tremors

A

–most common type of tremor
–occur with voluntary muscle contraction
–postural: maintaining position against gravity (i.e. arm elevation)
–isometric: muscle contraction against right stationary object (i.e. making a fist)
–kinetic: associated with voluntary movements, includes intention tremors (i.e. reaching for a pen)

24
Q

What are some low risk features for HA complaint?

A
–≤50YO
–primary HA
–hx of similar hx
–no abnormal neuro findings
–no concerning changes
–no high-risk comorbid conditions
25
Q

What are the danger signs of a HA?

A

SNOOP
–systemic sx (i.e. fever, weight loss, cancer, pregnancy)
–neuro sx
–onset is new
–other associated conditions
–previous HA hx with progression or change

26
Q

How does occipital neuralgia present? Dx? Tx?

A

Presentation: unilaterally, starts where neck meets skull and moves forward to involve ear and forehead; pain caused by trauma to nerves including pinching of the nerve by overly high neck muscles and compression of the nerve as it leaves the spine

Dx: via occipital nerve block

Tx: massage, NSAIDS, muscle relaxants

27
Q

Differentiate between Parkinson’s tremor and essential tremor: other neuro sx

A

Parkinson’s: bradykinesia, rigidity, loss of postural reflexes

Essential: none

28
Q

Discuss spontaneous episodic sx for dizziness and possible dx

A

=dizziness lasting seconds to days; no triggers

–unilateral hearing loss→Meziere dz
–sx of migration HA→vestibular migraine
–continulus, associated with psych disorder→psych dx

29
Q

What is the most frequent headache? What is the most common dx for pts who present to clinicians with HA complaints?

A

Most frequent: tension HA

Most common dx: migraine

30
Q

Differentiate between Parkinson’s tremor and essential tremor: frequency

A

Parkinson’s: 3-6 Hz

Essential: 5-12 Hz

31
Q

Differentiate between Parkinson’s tremor and essential tremor: family hx

A

Parkinson’s: less common

Essential: often

32
Q

What are the three clinical scenarios for dizziness?

A

–episodic triggered sx
–spontaneous episodic sx
–continuous vestibular sx

33
Q

Differentiate between Parkinson’s tremor and essential tremor: tremor type

A

Parkinson’s: at rest, ↑with walking, ↓with posture holding or action

Essential: posture holding or action

34
Q

Discuss BPPV,
Cause?
Presentation?
Tx?

A

Cause: peripheral cause; loose canaliths get stuck in semicircular canals; no obvious cause in older individuals, head trauma in younger individuals

Presentation: most commonly in individuals 50-70YO

Tx: EPley maneuvers, Brandt-Daroff exercises, no pharm tx

35
Q

Discuss Parkinsonism tremors

A

–various meds cause Parkinsonism by blocking or depleting DA
–most common form is idiopathic PD
–classic tremor starts as a pill-rolling motion of the fingers
–bradykinesia includes difficulty rising from a seated position, ↓arm swing while walking, micrographia
–70% of PD pts have a resting tremor which can get better with action

36
Q

Discuss Meneire dz

A

–peripheral cause
–vertigo with hearing loss
–most common from 20-60YO but can affect any age
–severe vertigo, requires bedrest
–unknown cause
–can have BPPV too so Dix-Hallpike test may be positive

37
Q

What should you do during a PE for a HA CC?

A
–BP and P
–listen for bruit at neck, eyes and head
–palpate head, neck and shoulder regions
–check temporal and neck arteries
–examine spine and neck muscles
–neuro exam (mental status, CN, funduscopy and otoscope, symmetry on motor reflex cerebellar sensory etc., gait, station)
38
Q

Discuss episodic triggered sx for dizziness and possible dx

A

=brief episodes of intermittent dizziness lasting seconds to hours; common triggers include head motion or change in body position

Most likely BPPV

39
Q

What hx should be taken for tremor CC?

A

–family hx of neurologic dz (genetic component especially for essential tremors)
–tremor in older pts with gradual onset is more likely PD or essential tremor
–sudden onset more likely to be psychogenic, related to medications or toxins or in rare cases, a brain tumor