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12 Cards in this Set

  • Front
  • Back
syncope causes
1. heart
a) CM (HCM outflow obstruct)
b) mechanical causes (mitral prolapse, AS, myxoma, thickened septum)
c) arrhythmias (VT, PSVT, AV block, sick sinus syndrome)
2. vasovagal--> short period of LOC, no incontinence of urine. age <40yrs on first presentation

3. seizure- loss of continence of urine, longer period of unconsciousness
4. orthostatic hypotension (elderly, drugs ie diurectics, vasodilators, ganglionic blockers, DM (autonomic neuropathy), prolonged bed rest)
5. other cause: metabolic (hypoglycaemic, hyperventilation), hypovolaemia (blood loss, dehydration), hypersensitivity (ie turning head), mechanical reduction in venous return (valsalva, postmicturition), meds (beta blockers, antiarrhythmics, nitrates)
6. TIA involving vertebrobasilar circulation (may lead to syncope (drop attacks) usually not dizziness or vertigo in isolation.

-find out events before during and after episode
-any meds?
-Hx heart disease or FHx of it or DM, Seizures?
-witness reports of events
-ECG and troponins for ruling out heart
-echo if ECG abnormal or evidence of heart disease
-tilt table testing for neuro causes
seizures
-is it tonic clonic (nausea, vomit, incontinence, tongue biting, post ictal confusion 30 min to hrs after, clonic full body jerking)
- is it a partial seizure (none of the above. simple partial --> conscious during, part of brain involved is Sx, or complex partial--> altered consciousness, automatizations, post-ictal confusion, olfactory or gustatory hallucinations
-petit mal (ethosuxumide) seizures: stare off into space, somtimes head nodding or blinking, can be up to 100/day, impaired consciousness, no loss of tone or incontinence.
-is there a fever? infection
-brain tumours?
-alcohol, benzos, barbiturates
-metabolic causes
-stroke RF (HTN, smoking, athero, DM)
-pregnancy? (eclampsia)
-HTN? (encephalopathy)
-intoxications (cocaine, theophylline, CO, lead, mercury, lidocaine, lithium,
-increased ICP (trauma)
weakness
onset:
-sudden unilateral then resolution and headache--> hemiplegic migrane
-sudden resolution w/o headache--> TIA
-subacute onset (hrs to days) --> meningitis, cerebral abscess, Guillain-Barre syndrome
-chronic (tumour--> wks to mths, degerative mths to years)
-metabolic/toxic disorders (any time)

which part of NS affected:
1. peripheral NS
2. spinal cord
3. posterior fossa
4. cerebral hemispheres
headache
-zig zag lines, flashing lights, photophobia, unilateral headache--> migrane with aura
-pain over one eye lasting mins to hrs with lacrimation, rhinorrhoea, flushed forehead, lasts wks a few times a year--> cluster headache
-pain in occiput assoc with neck stiffness (cervical spondylosis)
-generalized headache worse in morning assoc with drowsiness and vomiting (raised ICP)
-generalized headache with photophobia and fever and stiff neck with more gradual onset (meningitis)
-persistent unilateral headache w/ tenderness over temporal artery and blurring of vision (temporal arteritis) esp with jaw claudication and weight loss.
-pain or fullness behind eyes or cheeks or forehead with headache (sinusitis)
-dramatic and usually instantaneous onset of severe headache initially localized but becomes generalized adn assoc with neck stiffness (subarachnoid hemorrhage)
-chronic bilateral pain in either frontal, temporal, or occipital regions sensation of tightness recurs often and lasts hrs. ususally no assoc sx: nausea, vomit, weakness, paraesthesia (tension)
-other causes (trigeminal neuralgia, TMJ arthritis, cluster headache, temporal arthritis, psychiatric disease, aneurysm of internal carotid post com aneurysm, sup orbital fissure syndrome)
sensation of spinning/movement
is it peripheral? (usually benign)
mild (central) or severe N/V?
No assoc neuro findings (peripheral)
pt falls to same (central) or opposite (peripheral) side of lesion
1. is it fast onset and only in certain positions? (BPV)
-head injury?
-age>60yrs
-resolves w/in 6 mo. usually
2.menieres disease (vertigo tinnitius, hearing loss)
-attacks last hrs to days and may recur in mths to yrs later
-hearing loss eventually permanent
3. acute labyrinthitis (viral inf of cochlea or labyrinth (can last days)
4. ototoxic drugs (aminoglycosides, some diuretics)
5. acoustic neuroma (schwannoma) of 8th cranial nerve.

central (more serious)
is the onset gradual (central)
are other brainstem findings present? (weakness, hemiplegia, diploplia, dysphagia, dysarthria, facial numbness, CVD risk Fact, nystagmus bidirectional or vertical)
-MS (demyelination of vestibular paths of brainstem)
-vertebrobasilar insufficiency
-migrane assoc (w/ or w/o headache)
tremor
-is it mostly at rest? (resting tremor) and goes away on deliberate actions?
-worse as approach target (intension tremor of cerebellar disease)
-is it fine and assoc with holding a posture (physiological) anxiety and fatigue can worsen it
-is it physiological but exagerrated? (thyrotoxicosis)
-is the person taking beta agonists (worsens tremor)
-is it worst when arms are held out and during voluntary movements? Disappears at rest (benign essential tremor)
-slower resting pill rolling tremor (PD)
-involuntary jerky movements (chorea)
facial pain
-comes on fast and lasts a few seconds, one or two wks/ year, worst pain ever in maxillary and mandibular branches of trigeminal nerve (tic douloroux or trigeminal neuralgia)
-MS (neuralgia) episodes
-(along temporal artery and jaw claudication as well as vision loss) temporal arteriritis--> ESR increased
-aneurysm of internal carotid or PCA
-glaucoma
-TMJ arthritis
-cluster headache
what med Hx can you ask about in general?
-seizures
-strokes
-CAD or PVD and RFs
-paroxysmal AF (recurrent)
-STIs (HIV and syphilis)
-Hx encephalitis or meningitis
what meds do you ask about?
-anticoagulants
-antiplatelets
-steroids
-anti-hypertensives or anti-cholesterol drugs
-
socHx
-alcohol
-smoking
-drugs
-occupation and toxin exposure
FHx
-neurological disease
-CAD or PVD in family
-vascular disease
-psychiatric
Weber test
Place tuning fork on top of head.
-- Valuable when PT reports hearing better with one ear than the other.
-- Should hear equal tone by bone conduction through skull