Neuro Cases 1

Question 1

What are the basic types of primary headaches?

Answer 1

Tension-type, migraine, cluster, or other (cold stimulus) headaches

Question 2

What is the usual location of a migraine headache?

Answer 2

Adults: 60-70% are unilateral; 30% are bifrontal or global

Children/Teens: majority are bilateral

Question 3

What are the characteristics of migraine headaches?

Answer 3

Gradual onset, pulsating, moderate or severe intensity; aggravated by routine physical activity

Question 4

What does the patient like to do when they have a migraine headache?

Answer 4

Patient prefers to rest in a dark, quiet room

Question 5

How long do migraine headaches usually last?

Answer 5

4-72 hours

Question 6

What are the associated symptoms for a migraine headache?

Answer 6

Nausea, vomiting, photophobia; may have aura (usually visual but can involve other senses or cause speech or motor deficits)

Question 7

What is the usual location for tension-type headaches?

Answer 7

Bilateral

Question 8

What are the characteristics for tension-type headaches?

Answer 8

Pressure or tightness which waxes and wanes

Question 9

What does the patient like to do when they have a tension-type headache?

Answer 9

Patient may remain active or may need to rest

Question 10

How long do tension-type headaches usually last?

Answer 10

30 minutes to 7 days

Question 11

What is the usual location for cluster headaches?

Answer 11

Always unilateral, usually begins around the eye or temple

Question 12

What are the characteristics for cluster headaches?

Answer 12

Pain begins quickly, reaches a crescendo within minutes; pain is deep, continuous, excruciating, and explosive in quality

Question 13

What does the patient like to do when they have a cluster headache?

Answer 13

Patient remains active

Question 14

How long do cluster headaches usually last?

Answer 14

15 minutes to 3 hours

Question 15

What are the associated symptoms for a cluster headache?

Answer 15

Ipsilateral lacrimation and redness of the eye; stuffy nose, rhinorrhea, pallor; sweating; Homer syndrome; restlessness or agitation; focal neurologic symptoms are rare; sensitivity to alcohol

Question 16

What does SNOOP stand for?

Answer 16

S: systemic symptoms

N: neuro symptoms or abnormal signs

O: onset is new

O: other associated conditions

P: previous headache history with headache progression or change

Question 17

What could the presence of SNOOP represent?

Answer 17

Could represent a space-occupying mass, vascular lesion, infection, metabolic disturbance, or systemic problem

Question 18

What are some things that signal a need for emergency evaluation?

Answer 18

Sudden “thunderclap” headache; acute or subacute neck pain or headache with Horner syndrome; headache with suspected meningitis/encephalitis; headache with global or focal neurologic deficit or papilledema; headache with orbital or periorbital symptoms; headache with possible carbon monoxide exposure

Question 19

What can vertigo be the result of?

Answer 19

Asymmetry with vestibular system or disorder of peripheral labyrinth of its central connections

Question 20

What does TiTrATE in the evaluation of dizziness consist of?

Answer 20

Timing of the symptom, triggers that provoke the symptom, and a targeted examination

Question 21

What are the 3 possible clinical scenarios of dizziness?

Answer 21

Episodic triggered symptoms, spontaneous episodic symptoms, and continuous vestibular symptoms

Question 22

What is BPPV?

Answer 22

Occurs when loose canaliths “get stuck” in semicircular canals; affect people at any age, but mainly 50-70

Question 23

What is Meniere disease?

Answer 23

Vertigo with hearing loss +/- tinnitus; any age, most common 20-60; vertigo so severe it often requires rest; exact cause unknown

Question 24

What are the classifications of syncope?

Answer 24

Cardiac, neurally mediated (reflex), or orthostatic hypotension