Neuro Cases 1

Question 1

Most important thing for headache complaint

Answer 1

HPI

Question 2

Migraine Headache

• location
• characteristics
• pt appearance
• duration
• associated symptoms

Answer 2

• location: unilateral 60-70% in adults, bilat in kids
• characteristics: gradual onset, pulsating, moderate to severe intensity, aggravated by physical activity
• pt appearance: prefers dark, quiet room
• duration: 4-72 hours
• associated symptoms: nausea, vomitting, phonophobia

Question 3

Tension Headaches

• location
• characteristics
• pt appearance
• duration
• associated symptoms

Answer 3

• location: bilat
• characteristics: pressure or tightness, comes and goes
• pt appearance: can remain active or may need rest
• duration: 30 mins-7 hours
• associated symptoms: none

Question 4

Cluster Headaches

• location
• characteristics
• pt appearance
• duration
• associated symptoms

Answer 4

• location: unilateral, begins at eye or temple
• characteristics: pain starts fast, reaches crescendo within minutes, pain deep, continuous, excruciating, explosive
• pt appearance: pt remains active
• duration: 15 mins-3 hrs
• associated symptoms: ipsilat lacrimation and redness of eye, stuffy nose, horner syndrome, sweating

Question 5

SNOOP=DANGER

Answer 5

S: systemic symptoms, illness, condition
N: neuro symptoms or abnormal signs
O: onset new
O: other associated symptoms
P: previous HA history with HA progression or change

Question 6

Signs need for emergency eval

Answer 6

• sudden thunderclap HA
• acute or subacute neck pain or HA with Horner or neuro deficit
• HA with suspected meningitis or encephalitis
• HA with global or focal neuro deficit or papilledema
• HA with orbital or periorbital symptoms
• HA and possible CO exposure

Question 7

Common Causes of vertigo

Answer 7

• BPPV, menieres, osteosclerosis
• Vestibular migraine, cerebrovascular disease
• psychiatric, cardiovascular

Question 8

Vertigo

Answer 8

• pt feels they are moving

- can be caused by asymmetry of vestibular system

Question 9

Evaluation for Dizziness (TiTrATE)

Answer 9

Ti: Timing of symptoms
Tr: Triggers of symptoms
And a Targeted Examination
-places dizziness in episodic triggered, spontaneous episodic, or continuous vestibular symptoms

Question 10

Basis of Targeted Exam fo cc Dizziness

Answer 10

• HEENT
• Cardiovascular
• Neurologic
• Dix-Hallpike maneuver to diagnose BPPV

Question 11

Dix-Hallpike Maneuver

Answer 11

-diagnoses BPPV
-turn pt head 45 degrees and have pt lie back quickly with head hanging 20 degrees off table and remain there for 30 seconds
-pt returns to upright position for 30 seconds
+ triggered vertigo

Question 12

BPPV

Answer 12

• loose canaliths stuck in semicircular canals

- treatments: epley maneuvers or home treatments

Question 13

Meniere Disease

Answer 13

• vertigo w/ hearing loss, +/- tinnitus

- accompanying HA can be worsed during attack

Question 14

Classifications of Syncope

Answer 14

• cardiac
• neurally mediated (reflex) (ex. carotid sinus)
• orthostatic hypotension (locking knees and pooling blood)

Question 15

3 things to focus on in history for syncope

Answer 15

1. is LOC attributed?
2. history of cardiovascular?
3. clinical features to suggest specific cause?