Neurological Emergencies Flashcards
- Assists in distinguishing between peripheral and central vertigo
- a dizzy sensation during the maneuver without nystagmus is not considered diagnositic for BPPV
- if nystagmus is seen, repeat the dix-hallpike manuever x 3 to determine whether it fatigues
- fatiguability is consistent w/ BPPV
- lack of fatiguability suggests a central cause
Dix hallpike maneuver
can help differentiate vestibular neuritis from stroke (typically used in patients with hours to day of vertigo and nystagmus)
Three components
- Nystagmus- observe in primary gaze and lateral gaze (unidirectional nystagmus= reassuring; bidirectional= worrisome for stroke)
- test of vertical skew: presence of vertical skew= worrisome for stroke
- head impulse test: abnormal test= GOOD because suggests vestibular nerve problem
HINTS exam
peripheral causes of vertigo?
- BPPV
- vestibular neuritis
- labrynthitis
- meniere’s disease
- ototoxic medication (e.g, loop diuretics, aminoglycosides)
Central causes of vertigo?
- vestibular migraine
- posterior fossa stroke (ischemic or hemorrhagic)
- vertebrobasilar insufficiency
- multiple sclerosis
- acoustic neuroma
Most comon cause of central vertigo
vestibular migraine
most common cause of peripheral vertigo
BPPV
- No structural or metabolic abnormality
- Tension HA
- Cluster HA
- migraines
- other headaches
primary headaches
Structural or metabolic abnormality
- Intracranial: SAH, stroke, hemorrhage, hydrocephalus, meningitis, CSVT, tumor, decreased ICP, vascular dissection
- extracranial: GCA, sinusitis, otitis media, glaucoma, TMJ disorder, trigeminal neuralgia
- metabolic abnormality: CO poisoning, CO2 retention
secondary headaches
- throbbing/pulsating, unilateral
- moderate to severe; worse with exertion
- +/- aura, nausea/vomiting
- photophobia/phonophobia
- neurlogic symptoms (complesx migraine)
- tx: triptans, metoclopramide, chlorpromazine, diphenhydramine, ketorlac, acetaminophen
Migraine
- abrupt onset, retro-orbital, “deep” cont./ exruciating days-wks of “clusters”
- tearing, nasal congestion, rhinorrhea, diaphoresis
- tx: oxygen via NRB, triptans (SC or IN)
cluster
- pressure/tightness
- waxes and wanes
- bitemporal
- associated symptoms: none
- tx: chlorpromazine, metoclopramide, ketorolac, diphenhydramine
tension
a sudden surge of electrical activity in the brain, which may cause changes in behavior, movements or feeling and in levels of consciousness
Seizure
a seizure disorder diagnosed when a person has had two or more seizures which may not have been provoked by specific events such as trauma, infection, fever or chemical change
- if a first seizure is “unprovoked”, 30-50% will recur
- after a second unprovoked seizuer, 70-80% will recur
Epilepsy
- abnormal electrical activity localized to one area of the brain
- simple partial seizures without impaired awareness
- complex partial seizures with altered mental status
partial seizure
abnormal electrical actvity whihc spread to all areas of the brain
-numerous different types
Generalized seizure
