Neurology Flashcards
what movement often precipitates benign positional vertigo?
turning over in bed
diagnostic test for benign positional vertigo?
Hallpike manoeuvre-nystagmus on performing (2 beats normal)
features of meniere’s disease?
tinnitus
vertigo
sensorineural deafness
why should unilateral rather than bilateral tinnitus be investigated fully?
in order to exclude an acoustic neuroma
2 systems responsible for balance?
vestibular system
cerebellum
most common headache?
tension headache- usual cause of bilateral, non-pulsatile headache with or without scalp muscle tenderness, but without vomiting or sensitivity to head movement.
stress relief e.g. massage or antidepressants, may be of help.
differentials for acute single episode of headache?
meningitis-fever, purpuric rash-non-blanching with glass tumbler test, photophobia, stiff neck, coma
encephalitis-odd behaviour, fits, fever, reduced consciousness
SA haemorrhage-sudden onset ‘thunder-clap’ headache, often occipital, stiff neck, focal signs, reduced consciousness, worst ever headache
these 3 causes produce meningism signs-neck stiffness and photophobia. need immediate admission for urgent CT head
head injury-headache for around 2 weeks, often resistant to analgesia, do CT to exclude SD or ED haemorrhage if drowsiness with or without lucid interval, or focal signs.
venous sinus thrombosis-sub acute or sudden onset headache, papilloedema-swollen optic disc
sinusitis-dull, constant aching pain over frontal or maxillary sinus, with tender overlying skin with or without postnasal drip. pain worse on bending over. 1-2 weeks of pain.
tropical illness e.g. malaria-travel history? flu-like illness?
acute glaucoma-constant aching pain rapid development around 1 eye, radiating to forehead, markedly reduced vision, visual haloes, N/V, red congested eye with cloudy cornea and non-responsive pupil, need expert help but if delay in tment likely more than 1hr, start the carbonic anhydrase inhibitor acetazolamide IV 500mg over several mins
causes of recurrent acute headache attacks?
migraine
cluster headache-rapid onset severe pain around 1 eye, which may become watery and bloodshot with lid swelling, lacrimation, facial flushing, rhinorhhoea, miosis and/and not ptosis, pain UNILATERAL and almost always affects same side. occurs once or twice a day, can be for a few hrs, often nocturnal. cause possibly STA smooth muscle hyperactivity to 5-HT
trigeminal neuralgia-paroxysms of intense stabbing pan lasting seconds, unilateral, face screws up in pain, treat with anti-epileptics e.g. carbamazepine, and gabapentin.
recurrent (Mollaret’s) meningitis
causes of headaches of subacute onset?
GCA-exclude in all over 50 with a headache that has lasted a few weeks. scalp tenderness, temporal artery tenderness, thickening and pulseless, jaw claudication, features of PMR with proximal symmetrical muscle pain and stiffness over a few weeks which improves with movement or as day goes on, and may be assoc with malaise, weight loss, appetite loss, fever, depression and tiredness.
causes of chronic headaches?
tension headache-often described as feeling like a band or across the forehead, usually worsen as day goes on, but unlikely to interfere with sleep and pt should be able to carry on with work and other daily activities, may be a bit sensitive to light and noise, can be result of tightness in muscle over back of neck and scalp, which may be result of stress or poor posture
raised IC pressure-headache worse on lying down, waking, bending forward and coughing, assoc. vomiting, papilloedema, fits, false localising signs, or behavioural change, imaging to exclude SOL, consider idiopathic intracranial HTN.
medication overuse-especially mixed analgesics containing paracetamol, codeine, opiates
symptoms of a migraine?
classically visual or other aura lasting 15-30min, followed within 1hr by unilateral, throbbing headache
can be episodic, severe without aura, often premenstrual, usually unilateral with nausea, vomiting and possibly photophobia/phonophobia, may be allodynia
stops people from working and doing normal activites, just
want to be curl up in a dark room alone and sleep
NSAIDs preferred tment, less chance of medication misuse headache developing
triptans e.g. sumatriptan-5HT1 agonist, constricting cranial arteries, reducing oedema thought to cause migraine, but CI in IHD, coronary spasm, uncontrolled HTN.
migramax-aspirin and metoclopramide-used in tment of migraine assoc symptoms e.g. headache, nausea and vomiting, 900mg aspirin, metoclopramide-increases gastric emptying and improves peristalsis, which is often impaired in migraine-ease vomiting and constipation symptoms.
most common presenting symptom of an acoustic neuroma?*
pulsatile tinnitus-pulsing in the head
what is benign paroxysmal positional vertigo?
most common cause of vertigo-*room spinning-illusion of movement, which occurs due to otolith detachment from the macula into the semicircular canals in the inner ear, most commonly the posterior semicircular canal. these continue moving post stopping of head movement, so there is a conflicting sensation of ongoing movement with other sensory inputs.
most common presentation around 50yrs and female
40% of benign positional vertigo can be attributed to a particular causes, what causes are there?
post viral illness (viral neuronitis) head injury spontaneous labyrinth degeneration chronic middle-ear disease complication of stapes surgery
symptoms of benign positional vertigo?
sudden onset brief episodes of vertigo provoked by head movements e.g. turning over in bed, sitting up, lying down, turning head in horizontal plane
often worse when head tilted to 1 part. side and on a morning
brief latent period between head movement and vertigo
nausea common
light headedness and loss of balance can occur afterwards and may last several mins/hrs.`
