Neuro Cases Flashcards
What is the most frequent HA in population based studies?
Tension HA
What is the most common dx in pts presenting to clinicians with c/o HA?
Migraine
How does the WHO rank HA in terms of causes of disability?
In list of top ten causes for both genders
In list of top five for women
What is some HA-specific history?
Age at onset Presence of absence of aura and prodrome Frequency, intensity, and duration of attack Number of HA days per month Time and mode of onset Quality, site, and radiation of pain Associated sxs and abnormalities Family hx of migraine Precipitating and relieving factors Exacerbation or relief with change in position Effect of activity on pain Relationship with food/alcohol Response to any previous treatment Review of current medications Any recent change in vision Association with recent trauma General health Recent changes in lifestyle Environmental factors
What should be considered in women presenting with HA?
Change in method of birth control
Effects of menstrual cycle and exogenous hormones
What should the physical exam include for HA?
Obtain blood pressure and pulse
Listen for bruit at neck, eyes, and head for clinical signs of arteriovenous malformation
Palpate the head, neck, and shoulder regions
Check temporal and neck arteries
Examine the spine and neck muscles
What are some low risk features for HA complaint?
Age < 50 years Features typical of primary HA Hx of similar HA No abnormal neurologic findings No concerning change in usual HA pattern No high-risk comorbid conditions No new or concerning findings on hx or examination
Should you do a neuro exam for HA complaints?
Ye
What are some danger signs for HA that could represent a space-occupying mass, vascular lesion, infection, metabolic disturbance or systemic problem?
SNOOP
Systemic symptoms, illness, or condition (fever, wt loss, cancer, pregnancy, immunocompromised state)
Neuro sxs or abnormal signs (confusion, papilledema, etc)
Onset is new (particularly for age > years or sudden aka thunderclap)
Other associated conditions (head trauma, illicit drug use, worse with valsalva maneuvers, precipitated by sex, etc)
Previous HA hx with HA progression or change
What are some signs that require emergency evaluation for HA?
Sudden thunderclap HA
Acute or subacute neck pain or HA with Horner syndrome and/or neuro deficit
HA with suspected meningitis or encephalitis
HA with global or focal neurologic deficit or papilledema
HA with orbital or periorbital sxs
HA and possible carbon monoxide exposure
What region is occipital neuralgia usually found in?
Usually unilateral, starts at the area where the neck meets the skull and moves forward to involve the ear and forehead
What causes occipital neuralgia?
Pain caused by trauma to the nerves, including pinching of the nerves by overly tight neck muscles, compression of the nerve as it leaves the spine due to osteoarthritis, or tumors or other types of lesions in the neck
What confirms a diagnosis of occipital neuralgia?
A greater occipital nerve block confirms diagnosis
What is the treatment for occipital neuralgia?
Massage, NSAIDs, and muscle relaxants
What percentage of adults are affected by dizziness in large population studies?
15-20%
What is some dizziness specific history to obtain?
History of trauma
Frequency, intensity, and duration of attack
Severity (how it affects life, NOT on a 0-10 scale)
Associated sxs (blurry vision, syncope, N/V, hearing loss
Personal and family history of similar symptoms
Thorough review of all meds
What kind of dizziness is common to both peripheral and central causes?
Dizziness that increases with motion
Why do we no longer use patient description (vertigo, lightheadedness, presyncope) as classifications for dizziness?
Had limited usefulness– patients had hard time describing these as they have a variety of meanings for each individual. Distinction between vertigo and dizziness has limited clinical usefulness.
