Neuro Cases 1

Question 1

Migraine (location, characteristics, appearance, duration, associated symptoms)

Answer 1

unilateral for adults, bilateral for children. gradual onset, pulsating, aggravated by routine physical activity, prefers to rest in dark, quiet room, 4 to 72 hours, nausea, vomiting

Question 2

Tension Headache (location, characteristics, appearance, duration, associated symptoms)

Answer 2

bilateral, pressure or tightness whcih waxes and wanes, patient may remain active, 30 minutes to 7 days, no associated symptoms

Question 3

Cluster (location, characteristics, appearance, duration, associated symptoms)

Answer 3

unilateral (eye or temple) begins quickly, pain is deep, continuous, excruciating and explosive, remains active, lasts 15 minutes to 3 hours, ipsilateral redness of eye, pallor, sweating, horners, sensitivity to alcohol

Question 4

What is SNOOP criteria?

Answer 4

S: systemic symptoms (fever, wt loss, cancer, pregnancy, immunocompromised)
N: NEURO or abnormal signs (confusion)
O: ONSET (over 50 years of sudden or sudden ‘thunderclap’ headache)
O: other associated conditions (trauma, drug use, Valsalva maneuvers, precipitated by sex, etc)
P: previous HA history (progression or change)

Question 5

Why is TitrATE an improvement for clinical evaluation of dizziness

Answer 5

Timing
Triggers
And a Targeted Examination

point: places dizziness into 1/3 clinical scenarios
1) episodic triggered 2) spontaneous 3) continuous vestibular

Question 6

Peripheral causes of dizziness and vertigo

Answer 6

benign paroxysmal positional vertigo
vestibular neuritis
meniere disease
otosclerosis

Question 7

Peripheral causes of dizziness and vertigo

Answer 7

benign paroxysmal positional vertigo (BPPV)
vestibular neuritis
meniere disease
otosclerosis

Question 8

OTHER causes of dizziness and vertigo

Answer 8

psychiatric
medication induced
CV/metabolic
orthostatic

Question 9

What is the dix-hallpike maneuver for

Answer 9

physician turns patients head, supports head as they lie back quickly (sitting to supine), head hangs slightly off table, pt returns to upright for 30 seconds, then to left side.
POSITIVE: Maneuvers trigger vertigo with or without nystagmus

Question 10

What is BPPV (benign paroxysmal positional vertigo )

Answer 10

Loose canaliths ‘get stuck’ in semicircular canals
Most common: 50-70years old or head trauma in younger
TRT: Epley maneuvers, Brandt Daroff exercises

Question 11

Meniere Disease (Sx

Answer 11

Sx: vertigo WITH hearing loss, +/- tinnitus, most common from 20-60

WATCH OUT: can have BPPC and MENIERE’S disease, + Dix-Hallpike test

Question 12

When taking a history for a PT experiencing Syncope what should the history be focused on?

Answer 12

1) loss of consciousness attributed to syncope?
2) History of CV disease?
3) Clinical features to suggest specific cause?