Neuro Guests: Dizzy, HA, Seizures, Peri Neuropathy Flashcards
(33 cards)
____ 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
