Neuro Cases 1 Flashcards
how many meds is associated with increased risk of dizziness?
5
Central causes of vertigo? (3)
peripheral (4)
other? (3)
Vestibular migraine, cerebrovascular disease, meningioma of the cerebellopontine angle
BPPV, vestibular neuritis, meunière, otosclerosis
med induced, psychiatric, CV/metabolic
Migraine patient appearance? Tension HA? Cluster?
prefers to be in a dark, quiet room
may be active or may want to rest
REMAINS ACTIVE
Occipital Neuralgia is what?
what causes it?
what confirms it?
what is the tx?
unilateral, starting at the area where the neck meets the skull and moving forward to involve the ear and forehead
caused by trauma to the nerves, including pinching by tight neck muscles, compression of the nerve, or tumors.
greater occipital nerve block
massage, NSAIDS, muscle relaxants
Meniere disease?
1) what is it?
2) what ages?
3) how severe is the vertigo in this case?
vertigo + hearing loss +/- tinnitus
any age, 20-60 most likely
extremely severe, often needs bedrest
What causes vertigo?
result of asymmetry within the vestibular system
disorder of peripheral labyrinth of its central connection
If someone has brief episodes of intermittent dizziness that last from seconds to hours, what is it most likely? (episodic)
Benign Paroxysmal Positional Vertigo
What are associated symptoms with migraines? tension HAs? cluster HAs?
nausea, vomiting, photophobia, phonophobia
NONE
ipsilateral lacrimation and redness of the eye, stuffy nose, pallor, etc
Where are migraines located? (adults vs children)
tension type?
cluster? where does it begin?
unilateral in most adults, bilateral in most kids
bilateral
always UNILATERAL, begins around the eye or temple.
What is the most frequent headache type in population studies?
what about the most common diagnosis in patients presenting to clinicians?
tension HA
migraine
Vestibular Migraine?
1) what causes it?
2) what about if it’s in kids?
3) who’s more likely to have it, man or woman?
4) classic treatment?
Episodic vertigo in patient with Hx of migraine
most common form of vertigo in kids
women, 3x more likely
stress relief, adequate sleep/exercise, etc.
if someone has continuous vestibular symptoms but has no history of toxin or trauma, what should you consider?
vestibular neuritis or central etiologies
Spontaneous episodic symptoms for dizziness means what?
unilateral hearing loss?
sx of migraine HA?
what if the symptoms are episodic and BECOME continuous.. what should you consider?
no triggers, so other elements of the history help determine the Dx
consider meniere
consider vestibular migraine
psychiatric diagnosis
Continuous vestibular symptoms? how does this differ with episodic?
classic symptoms? (5)
what is it mostly related to? (2 things)
23% of older adults with dizziness. what is it usually related to?
usually last days to week… episodic dizziness lasts hours to days
dizziness or vertigo w/ N/V, nystagmus, gait instability, head motion intolerance
trauma or toxin
their medications
left nystagmus on EOM testing
failed whisper test on R
Romberg +
dix-hallpike +
Meniere disease
BPPV
1) what’s causing it?
2) what age is it most likely hitting people at?
3) treatment in office?
4) home treatment?
5) meds?
loose canaliths get stuck in semicircular canals
most common at ages 50-70, if earlier consider head trauma
Epley Maneuvers in office
Brandt-Daroff exercises
no need for meds
Dizziness that increases with motion is common in what cause?
both central and peripheral
Migraine Characteristics?
Tension HA characteristics?
Cluster HA characteristics?
Gradual in onset –> crescendo and pulsating
pressure or tightness which waxes and wanes
pain begins quickly reaching crescendo within minutes, deep, and continuous, excruciating
What are the 4 types of primary HA?
tension-type
Migraine
Cluster
Other
Duration of Migraines? tension HAs? Cluster HAs?
4-72 hours
30 minutes to 7 days
15 minutes to 3 hours
Vestibular Neuritis
1) what is this ranking on vertigo
2) what causes it?
3) ages?
4) 4 major symptoms?
5) what is NOT useful in this case?
2nd most common cause
virus
30-50, male or female
rotatory vertigo with movements of objects moving in the periphery of their vision… falling to affected side, horizontal nystagmus to non-affected side.
Dix-Hallpike because symptoms aren’t positional
Morbidly obese.. tearful, holding hand to left side of head
TTP noted at left occipital condyle
Paraspinal neck musculature tight, ropy, TTP. cranial vault has severely diminished CRI
Occipital neuralgia
Tension headache (if unilateral)
headache secondary to obstructive sleep apnea
Danger signs of a headache?
SNOOP
systemic symptoms
neuro symptoms or abnormal signs
Onset is new (particularly for age over 50 years and sudden –> thunderclap
Other associated conditions –> head trauma, worse with valsalva, worse with sex
Previous HA history with HA progression or change
How do we evaluate dizziness? mnemonic?
TiTrATE
Timing of the symptom
Triggers that provoke the sympom
And a Targeted Examination
Targeted exam.. what test do you do?
what is it confirming the dx of?
Dix-Hallpike –> turn patients head to right or left 45 degrees, then the person lays down with their head off the table while you hold the head like that. same with the other side.
you’re looking for return of signals of nystagmus
then its confirmatory for BPPV
Vertigo is considered what?
sensation of self-motion when they are not moving or a distorted self-motion during normal head movement
What are common triggers of episodic dizziness?
head motion or change in body position
Need for emergency is what signs?
thunderclap
acute or subacute neck pain or HA with Horner syndrome
meningitis/encephalitis
papilledema
