Neuro Cases 1 Flashcards
What is broad based DDX based on CC?
migraine dehydration headache increased ICP heat stroke whiplash sinus infection
basic types of primary headache
tension type
migraine
cluster
other (cold stimulus)
secondary headache
something else going on & headache is a response
more likely to be fatal
What is the most important for a headache CC?
HPI will give you 95% to make good DDX
HA-specific history includes
exacerbation or relief w/ change in position
effect of activity on pain
relationship w/ food or alc
response to previous treatment
review of current meds
any recent change in vision
assoc w/ recent trauma
enviro factors, change in method of BC, change in work, state of general health
What is major cause of HA for older individuals?
23% of older individuals had headache due to medication
Historical features for most common causes of HA
headaches are very common & history of headache is most important thing to help you decide what is causing it
PE for HA CC
obtain BP & pulse
listen for bruit @ neck & eyes & head (clinical signs of arteriovenous malformation)
palpate head/neck/shoulder
check temporal & neck arteries
examine spine & neck (paraspinal) muscles
Neuro exam for HA
mental status CN exam funduscopy symmetry on motor reflex gait station
SNOOP
will most likely have a secondary HA
systemic neuro onset is new (50 yo) other assoc conditions previous HA history
why is snoop important?
could represent space-occupying mass, vascular lesion, infection, metabolic disturbance or systemic problem
Need for emergency eval
sudden thunderclap HA
acute or subacute neck pain
HA w/ suspected meningitis
HA w/ global or focal neuro deficit
HA w/ orbital or periorbital symptoms
HA & possible CO exposure
Abnormal findings for case #1
BMI (morbidly obese)
tearful, holding hand to left side of head
hypertensive (high pulse)
AROM restricted in all planes
TPP noted @ left occipital condyle
abnormal structural exam for case #2
OSE: paraspinal neck muscles tight, ropy,
cranial vault has severely diminished CRI
working DDX for pt based on history & exam
most likely a tension headache
atypical migrane
extension SD
what is the plan for case #1?
medication
return to clinic
OMM cranial therapy
Case #2-dizziness DDX
concussion
stroke
low blood sugar
alcohol
for dizziness, what subjective data do you want?
OLDCAARTS
dizzy specific:
history of trauma
frequency, intensity & duration of attack
severity (how is this affecting your life)
assoc symptoms (blurry vision, syncope, N/V, hearing loss)
personal/FH of similar symptoms
review of meds
Vertigo
pt describe sensation of self-motion when they are not moving or distorted self-motion during normal head movement
causes of vertigo
result of asymmetry w/ in vestibular system
disorder of peripheral labyrinth of central connections
TiTrATE (eval of dizziness)
takes symptoms & puts into 3 clinical scenarios:
Timing of symptom
Triggers that provoke
And a Targeted Exam
3 clinical scenarios for dizziness
episodic triggered symptoms
spontaneous episodic symptoms
continuous vestibular symptoms
Basics of targeted exam for cc Dizziness
HEENT
CV
neurologic, (including Romberg)
Dix-Hallpike maneuver (to diagnose BBPV)
Dix-Hallpike maneuver
looking for nystagmus (fast phase)
