Neurology Cases

Question 1

Tension headache Duration

Answer 1

Minutes to days

Question 2

Tension Headache Location

Answer 2

Bilateral

Posterior and radiates anteriorly

Question 3

Tension Headache Characteristics

Answer 3

Pressure: Waxing and Waning

Question 4

Tension Headache Presentation of patient

Answer 4

Can still remain active only is annoying and discomforting

Question 5

Tension Headache other symptoms or reasons for pain

Answer 5

MSK cervical pain

Tissue texture changes

Question 6

Migraine Headache Duration

Answer 6

4hr- 72hr

Question 7

Migraine Headache Location

Answer 7

Unilaterally (Temporal/frontal) : Adults

Bilaterally :Pediatrics

Question 8

Migraine Headache Patient Presentation

Answer 8

Ill appearing

Room with no stimulus required

Question 9

Migraine Headache Characteristics

Answer 9

Aura, gradual onset that is increasing in pain

Pulsating and severe pain

Question 10

Migraine Headache Other symptoms and reasons of pain

Answer 10

Aura, photo/phonophobia
N/V
Photopsia, vertigo, call tenderness
Unknown real cause

Question 11

Cluster Headache Duration

Answer 11

15min- 3hrs

Question 12

Cluster Headache Characteristics

Answer 12

Quick onset
Sharp and stabbing pain with high intensity
Tearing of eyes
“Ice pick headache”

Question 13

Cluster Headache Location

Answer 13

ALWAYS UNILATERAL

Eye or temple region

Question 14

Cluster Headache other symptoms or reasons for pain

Answer 14

tearing, rhinorrhea, sweating, irritation

Question 15

SNOOP = Danger

Answer 15

Space occupying mass, vascular lesion, infection, metabolic disturbances, systemic problem
S: Systemic, illness (fever, weight loss, cancer, pregnancy, immunocompromised) = meningitis
N: Neuro, symptoms and signs = hemorrhage, tumor
O: Older onset (above 50yo) = mass, subdural hematoma
O: Onset Sudden (thunderclap headache)= subarachnoid hematoma
P: Papilledema, Precipitated by Valhalla, Positional Provocation, Progression or change in HA History = mass, hemorrhage, tear in dura mater, decreases CSF

Question 16

Onset 3 weeks ago, no Illinois’s or trauma
Pain starts posterior and radiated forward to left side
Constant, achy, 10/10, interrupts sleep
Pain turning head : OA E SrRl
Neurologically okay
Obese

Answer 16

Tension headache

(Put stethoscope on eye for arteriovenous malformations to brain
Palpate head and neck, and spine, get BP and HR)
Treat with NSAIDS, or ice pack on posterior head, or OMM

Question 17

Obstructive Sleep Apnea

Answer 17

Headache that lingers in the morning and goes away through out the day

Question 18

Occipital Neuralgia

Answer 18

Impingement of the greater occipital nerve

Question 19

Benign Paroxysmal Positional Vertigo (BPPV)

Answer 19

Transient symptoms of vertigo due to canalith movements {how you move the head} (filled with endolymph and hair) in the SEMICIRCULAR CANALS , where crystals from the utricle can come causing an additional stimulus
NO HEARING LOSS

Question 20

Menière Disease

Answer 20

Spontaneous vertigo with unilateral hearing loss
Due to increases ENDOLYMPHATIC pressure in INNER EAR
Overproduction of endolymph, ringing in ear, unilateral hearing loss

Question 21

Otosclerosis

Answer 21

Bony overgrowth of the STAPES

Results in spontaneous vertigo and hearing loss

Question 22

Other things that cause vertigo

Answer 22

Migraines
Cerebrovascular disease = arterial occlusion 
Mass at cerebellopontine angle 
Medications 
Psychiatric= depression, anxiety 
Orthostatic= lightheaded

Question 23

Vertigo

Answer 23

Motion when not moving

Distorted motion when moving

Question 24

TiTrATE evaluation for Dizziness

Answer 24

Ti= Timing or onset and duration
Tr= Triggers
And a Targeted Examination = episodic [BPPV] , spontaneous [MD], continuous vestibular

Question 25

Episodic - Triggered - Positive Dix Halpace Maneuver ( lay down and then stand up, and drop in BP) (have patient sit up or lay down and rotate the patients head and extend it respectively and see if there is dizziness)

Answer 25

Benign parachymal positional vertigo BPPV

Question 26

Episodic - Triggered- Negative Dix Halpace Maneuver

Answer 26

Orthostatic Hypotension can be the cause

Question 27

Episodic- spontaneous- hearing loss

Answer 27

Meniere Disease

Question 28

Episodic - spontaneous- migraine headache

Answer 28

Vestibular migraine

Question 29

Episodic - Spontaneous- psychiatric symptoms

Answer 29

Panic attack, or psychiatric condition

Question 30

Continuous - toxin

Answer 30

Medication

Question 31

Continuous - spontaneous - positive HINTS examination

Answer 31

Vestibular neuritis

In negative HINTS = stroke or ischemic attack

Question 32

Spontaneous dizziness 90min ago while at work
Constant spinning, N/V/ can’t walk
Decreased HEARING on right
Right nystagmus
No medication, rotation of neck makes it worse, [dix- hallpike]
No fever, headache, motor weakness, stiff neck
Similar episode 2 years ago

Answer 32

MENIERES DISEASE

(Sensitive to alcohol, drugs)

No BPPV, because it does not go away at rest

Question 33

Orthostatic Hypotension causing Syncope

Answer 33

Positional changes can cause acute drop in BP
=medication like beta-blockers
= volume depletion
= autonomic failure from Parkinson’s or diabetes

Question 34

Neuro mediated Syncope - Carotid Sinus syndrome

Answer 34

head rotation causes pressure to the carotid artery -> carotid sinus reflex ventricular pause that can cause syncope

Question 35

Neuro mediated Syncope - Vasovagal

Answer 35

Sympathetic system is overstimulated during panic or sight of blood= rebound overstimulation of PNS= bradycardia and vasodilation

Question 36

Neuro mediated Syncope - Situational

Answer 36

Standing, coughing…. causes neural reflex resulting in bradycardia and vasodilation can cause syncope