Neurology Cases Flashcards
Tension headache Duration
Minutes to days
Tension Headache Location
Bilateral
Posterior and radiates anteriorly
Tension Headache Characteristics
Pressure: Waxing and Waning
Tension Headache Presentation of patient
Can still remain active only is annoying and discomforting
Tension Headache other symptoms or reasons for pain
MSK cervical pain
Tissue texture changes
Migraine Headache Duration
4hr- 72hr
Migraine Headache Location
Unilaterally (Temporal/frontal) : Adults
Bilaterally :Pediatrics
Migraine Headache Patient Presentation
Ill appearing
Room with no stimulus required
Migraine Headache Characteristics
Aura, gradual onset that is increasing in pain
Pulsating and severe pain
Migraine Headache Other symptoms and reasons of pain
Aura, photo/phonophobia
N/V
Photopsia, vertigo, call tenderness
Unknown real cause
Cluster Headache Duration
15min- 3hrs
Cluster Headache Characteristics
Quick onset
Sharp and stabbing pain with high intensity
Tearing of eyes
“Ice pick headache”
Cluster Headache Location
ALWAYS UNILATERAL
Eye or temple region
Cluster Headache other symptoms or reasons for pain
tearing, rhinorrhea, sweating, irritation
SNOOP = Danger
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
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
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
Obstructive Sleep Apnea
Headache that lingers in the morning and goes away through out the day
Occipital Neuralgia
Impingement of the greater occipital nerve
Benign Paroxysmal Positional Vertigo (BPPV)
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
Menière Disease
Spontaneous vertigo with unilateral hearing loss
Due to increases ENDOLYMPHATIC pressure in INNER EAR
Overproduction of endolymph, ringing in ear, unilateral hearing loss
Otosclerosis
Bony overgrowth of the STAPES
Results in spontaneous vertigo and hearing loss
Other things that cause vertigo
Migraines Cerebrovascular disease = arterial occlusion Mass at cerebellopontine angle Medications Psychiatric= depression, anxiety Orthostatic= lightheaded
Vertigo
Motion when not moving
Distorted motion when moving
TiTrATE evaluation for Dizziness
Ti= Timing or onset and duration
Tr= Triggers
And a Targeted Examination = episodic [BPPV] , spontaneous [MD], continuous vestibular
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)
Benign parachymal positional vertigo BPPV
Episodic - Triggered- Negative Dix Halpace Maneuver
Orthostatic Hypotension can be the cause
Episodic- spontaneous- hearing loss
Meniere Disease
Episodic - spontaneous- migraine headache
Vestibular migraine
Episodic - Spontaneous- psychiatric symptoms
Panic attack, or psychiatric condition
Continuous - toxin
Medication
Continuous - spontaneous - positive HINTS examination
Vestibular neuritis
In negative HINTS = stroke or ischemic attack
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
MENIERES DISEASE
(Sensitive to alcohol, drugs)
No BPPV, because it does not go away at rest
Orthostatic Hypotension causing Syncope
Positional changes can cause acute drop in BP
=medication like beta-blockers
= volume depletion
= autonomic failure from Parkinson’s or diabetes
Neuro mediated Syncope - Carotid Sinus syndrome
head rotation causes pressure to the carotid artery -> carotid sinus reflex ventricular pause that can cause syncope
Neuro mediated Syncope - Vasovagal
Sympathetic system is overstimulated during panic or sight of blood= rebound overstimulation of PNS= bradycardia and vasodilation
Neuro mediated Syncope - Situational
Standing, coughing…. causes neural reflex resulting in bradycardia and vasodilation can cause syncope
