Neuro Guests: Dizzy, HA, Seizures, Peri Neuropathy Flashcards
____ vertigo is not triggered by movement and is associated with vertical nystagmus.
Central Vertigo
Pt presents with horizontal nystagmus and vertigo that is triggered by movement.
… Dx?
Peripheral Vertigo
What is the gold standard test for posterior canal BPPV?
Dix-Hallpike Maneuver
True or False: 63 y/o patient with new onset dizziness is typically benign and non-concerning.
False
What test assesses for posterior fossa lesion and looks for misalignment of eye when covering/uncovering the eye?
Skew Test
A negative HINTS exam can rule out ____ better than MRI in the first 24-48 hours.
stroke
A positive HINTS exam is 100% sensitive and 96% specific for presence of _____
central lesion
Dix-Hallpike maneuver would be considered positive if:
- ___
- ___
- symptoms are reproduced
- nystagmus is present
What are some central causes of vertigo
- Strokes
- CNS tumors
- Acoustic neuroma
- Trauma
- Drug intoxication
- Multiple sclerosis
- AV malformations
- vertebrobasilar migraine
etc
Calcitonin is a neuropeptide that signals ___ in the ___ nerve.
- pain
- trigeminal
when can a patient be prescribed CGRP antagonists
- if migraine occurs 15x/month (chronic migraines)
- has tried and failed 3 other types of meds
What are the 4 common rescue medications
- OTC ibuprofen/APAP
- Sumatriptan
- Ergotamines
- Fioricet
Triptans are vasoconstrictors and should not be given to patients with hx of ___ and ____.
An alternative would be ____
- MI and stroke
- Fioricet
what is typically in a migraine cocktail (ER)
- Toradol
- Benadryl
- Compazine
(NSAID, antihistamine, antiemetic)
What are the downsides to Toradol
hard on the kidneys and stomach
what would you Tx a pt with a migraine who prefers natural supplements
- Magnesium
- CoQ10 (esp for statin-induced HA)
- VitB2
- Vit D
Caucasian male presents with excruciatingly severe, unilateral HA esp around the left eye with lacrimation. No N/V. He appears restless.
… Dx?
… Tx?
- Cluster HA
- injectable/nasal triptans
- 100% O2 6L (hard to cover with insurance)
- Verapamil (Ca CH blocker)
Pt, who is obese, presents with pulsatile tinnitus, headaches, blurry vision. LP has an opening pressure >250 mm/H2O.
… Dx?
… Tx?
- idiopathic intracranial hypertension
- drain fluid via LP until pressure normalizes
- diet changes, Diamox
_____ are inflamed neck nerves that can be due to bad posture, whiplash, s/p neck surgeries
Occipital neuralgia
When can botox be used as migraine therapy?
- if migraine is chronic (15x/month)
- failed 3 medications
what is the most common cause of syncope
vasovagal (brain overreacts to a trigger and “shuts down” your heart)
____ is when there is a drop in systolic BP by 20 or a drop in diastolic by 10 after standing for 3 minutes
Postural hypotension
Degree of rotation for Dix-Hallpike
45 degrees
Elderly pt presents with syncope after suddenly turning their head.
What is this and why does this happen?
- carotid sinus syndrome
- pressure to sensitive baroreceptors at the carotid body > slows heart rate > drop in BP > poor brain perfusion > syncope
what are some causes of seizures
- excessive alcohol
- low glucose, mg, and ca
- insomnia
- Meds: tramadol, wellbutrin, Abx
what med is good for seizures and trigeminal neuralgia
Carbamazepine (Tegretol)
what med is good for headaches and seizures, but can make you forget words
Topiramate (topamax)
what med is good for seizures and is fast acting, but makes you cranky and depressed
Keppra
what med is good for mood and IQ, but can cause a rash and is slow acting
Lamotrigine
what med is good for seizures in pregnant women
- Lamictal (lamotrigine)
- Keppra (levetiracetam)
what med is good for seizures, but can cause weight gain and is bad for pregnant women
depakote
what are seizure medications that are not typically strong enough for seizures and can cause LE edema?
… which is cheaper?
… which has fewer S/E?
- Gabapentin (cheaper)
- Lyrica (fewer S/E)
what med is used for status epillepticus and is also a fast acting, but temporary (band-aid effect)
Benzodiazepines
Ativan or valium
