Neuro emergencies Flashcards
test to distinguish peripheral and central vertigo
dix hallpike maneuver
describe positive dix hallpike
dizziness WITH nystagmus during the maneuver
positive hallpike. now what?
- repeat 3x.
- if fatiguable= BPPV
- non-fatiguable suggests central cause
Illusion of self or environmental rotation; usually d/t vestibular lesions
vertigo
5 peripheral causes of vertigo
- BPPV
- vestibular neuritis
- labrynthitis
- menieres dz
- ototoxic meds (loops, aminoglycosides)
exam to help differentiate vestibular neuritis from stroke; used in patients with hours to days of vertigo & nystagmus
HINTS exam
3 parts of HINTS exam
- nyastagmus observed in primary and lateral gaze– bidirectional is worrisome
- vertical skew is worrisome for stroke
- head impulse test– abnormal is good (suggests vestibular neuritis)
when do you get imaging with vertigo? which imaging is preferred?
- if not cooperative with HINTS or dix hallpike
- MRI/MRA head preferred
3 meds used in vertigo treatment that act as a band-aid
- meclizine
- benzos (diazepam)
- anti-nausea meds
thing you do to move otoliths in semicircular cananals
Epley maneuver
5 things that suggest central cause of vertigo?
- older age
- CAD
- focal neuro deficit (diplopia)
- no N/V
- constant for days
most common cause of peripheral vertigo vs central vertigo
peripheral– BPPV
central– vestibular migraine
having no prodrome is associated with what category of syncope?
cardiogenic
when should you admit someone who passed out?
aka CHESS criteria
CHF hx
Hematocrit under 30%
EKG or cardiac abnormality
SOB hx
SBP under 90
admit if they have any of these
all patients with ____ require EKG & cardiac monitoring
syncope or near syncope
most common HA type
tension
- triptans
- metoclopramide
- chlorpromazine
- diphenhydramine
- ketrorolac
NOT EXHAUSTIVE
treats migraine HA
- abrupt onset of retro-orbital, deep, excruciating HA; days-wks of episodes
- associated sx: tearing, nasal congestion, rhinorrhea, diaphoresis
cluster HA
tx: oxygen or SC/IN triptans
- pressure/tightness; waxes and wanes; bitemporal
- no associated sx
- tx: chlorpromazine, metoclopramide, ketorolac, diphenhydramine
tension HA
severe headache that is worse when standing up, and better when lying down
intracranial HYPOtension
- Pressure/HA worse lying down that is relieved when upright
- precipitated by valsava or exertion
- papilloedema
elevated intracranial pressure (ICP)
imaging for IPH, EDH, SDH, SAH
non con CT
imaging for CSVT, vasculitis, dissections
MRI/MRA with contrast
CT WITH contrast if they cant get MRI
imaging for tumors, abscess (2)
CT non con
MRI w/ con
what should you ask about before LP for meningitis or SAH
ask about anti-platelet meds
what should be done for any patient presenting with HA?
thorough neuro exam
if patient has “red flag” HA, what now?
non con CT
seizure disorder diagnosed when a person has had two or more seizures which have not been provoked by specific events like trauma, fever, infections, etc
* chances of recurrence increases after 1st one
epilepsy
what is something that can help differentiate seizures from syncope?
presence of post ictal period
simple vs complex partial seizures
- simple: NO impaired awareness
- comples: altered mental status
- most common type of seizure
- stiff limbs then jerking of limbs & face
tonic clonic seizures
rapid, brief contractions of bodily muscles which usually happen at the same time on both sides of the body (looks like sudden jerks)
myoclonic
produces abrupt loss of muscle tone; head droop to falls
atonic seizures
treament for medical emergency SE seizures
always admit– IV lorazepam
great first line agent for seizures (NOT actively seizing)
keppra/levetiracetam
how long should patients refrain from driving after a seizure
3 months
what should you give to patients with known epilepsy
loading dose of their home AEDs in the ED prior to discharge
