Podcast
Questions and Answers
What do the neurological examination findings suggest in the first case?
What do the neurological examination findings suggest in the first case?
- Cerebellar stroke and vestibular neuritis (correct)
- Benign positional vertigo and vestibular neuritis
- Cerebellar stroke and benign positional vertigo
- Vestibular neuritis and Meniere's disease
Which changes in the head MRI are likely to explain the symptoms found?
Which changes in the head MRI are likely to explain the symptoms found?
- Hyperintense focus in the DWI sequence in the brainstem
- Hyperintense focus in the DWI sequence in the right cerebellar hemisphere (correct)
- Hyperintense focus in the DWI sequence in the left cerebellar hemisphere
- Hyperintense focus in the DWI sequence in the right hemisphere of the brain
What two conditions are most likely based on the symptoms of severe dizziness and nausea, along with unidirectional right-sided horizontal nystagmus?
What two conditions are most likely based on the symptoms of severe dizziness and nausea, along with unidirectional right-sided horizontal nystagmus?
- Cerebellar stroke and vestibular neuritis (correct)
- Cerebellar stroke and benign positional vertigo
- Benign positional vertigo and vestibular neuritis
- Vestibular neuritis and Meniere's disease
What is the most appropriate action to relieve symptoms in a patient with unidirectional right-sided horizontal nystagmus and a positive head shake test to the left?
What is the most appropriate action to relieve symptoms in a patient with unidirectional right-sided horizontal nystagmus and a positive head shake test to the left?
Which characteristic differentiates migraine from cluster headache?
Which characteristic differentiates migraine from cluster headache?
Which symptom is typical of the beginning of wedging of the parahippocampal gyrus into the cerebellar tentorial notch?
Which symptom is typical of the beginning of wedging of the parahippocampal gyrus into the cerebellar tentorial notch?
Which statement is true regarding optic disc edema?
Which statement is true regarding optic disc edema?
What differentiates a hemiplegic migraine from other types of migraine?
What differentiates a hemiplegic migraine from other types of migraine?
What is the next appropriate management step for the 46-year-old patient with signs of subarachnoid hemorrhage on head CT?
What is the next appropriate management step for the 46-year-old patient with signs of subarachnoid hemorrhage on head CT?
Which intervention should be avoided in a patient with signs of subarachnoid hemorrhage on head CT?
Which intervention should be avoided in a patient with signs of subarachnoid hemorrhage on head CT?
Identify the incorrect information regarding migraine without aura.
Identify the incorrect information regarding migraine without aura.
What could be the most appropriate diagnosis for the 24-year-old patient presenting with hemiplegic and pulsating headaches accompanied by nausea, vomiting, and photophobia?
What could be the most appropriate diagnosis for the 24-year-old patient presenting with hemiplegic and pulsating headaches accompanied by nausea, vomiting, and photophobia?
Flashcards
What does unidirectional right-sided horizontal nystagmus suggest?
What does unidirectional right-sided horizontal nystagmus suggest?
Unidirectional right-sided horizontal nystagmus is a common sign indicating a problem with the inner ear or vestibular nerve.
What two conditions are most likely with the given symptoms?
What two conditions are most likely with the given symptoms?
Benign paroxysmal positional vertigo (BPPV) and labyrinthitis are the most likely culprits due to the severe dizziness, nausea, and unidirectional right-sided horizontal nystagmus.
What maneuver helps relieve symptoms of unidirectional nystagmus and a positive head shake test?
What maneuver helps relieve symptoms of unidirectional nystagmus and a positive head shake test?
The Epley maneuver is a specific set of head movements designed to reposition ear crystals responsible for BPPV.
What distinguishes migraine from cluster headache?
What distinguishes migraine from cluster headache?
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What symptom often indicates parahippocampal gyrus wedging?
What symptom often indicates parahippocampal gyrus wedging?
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What does optic disc edema signify?
What does optic disc edema signify?
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What distinguishes a hemiplegic migraine?
What distinguishes a hemiplegic migraine?
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How do you confirm subarachnoid hemorrhage?
How do you confirm subarachnoid hemorrhage?
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What intervention should be avoided with suspected subarachnoid hemorrhage?
What intervention should be avoided with suspected subarachnoid hemorrhage?
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What is incorrect about Migraine without aura?
What is incorrect about Migraine without aura?
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What is the most likely diagnosis for a 24-year-old with hemiplegic and pulsating headaches?
What is the most likely diagnosis for a 24-year-old with hemiplegic and pulsating headaches?
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Study Notes
Neurological Examination Findings
- Unidirectional right-sided horizontal nystagmus suggests a peripheral vestibular lesion, possibly affecting the inner ear or vestibular nerve.
Head MRI Changes
- The changes in the head MRI are likely to explain the symptoms of severe dizziness and nausea, indicating a possible vestibular lesion or labyrinthine dysfunction.
Differential Diagnosis
- Two conditions that are most likely based on the symptoms of severe dizziness and nausea, along with unidirectional right-sided horizontal nystagmus, are benign paroxysmal positional vertigo (BPPV) and labyrinthitis.
Symptom Relief
- The most appropriate action to relieve symptoms in a patient with unidirectional right-sided horizontal nystagmus and a positive head shake test to the left is to try the Epley maneuver.
Migraine vs. Cluster Headache
- The characteristic that differentiates migraine from cluster headache is the presence of unilateral, periorbital, and/or temporal pain in cluster headache.
Parahippocampal Gyrus Wedging
- The symptom typical of the beginning of wedging of the parahippocampal gyrus into the cerebellar tentorial notch is a false localizing sign, such as a sixth nerve palsy.
Optic Disc Edema
- The true statement regarding optic disc edema is that it can be a sign of increased intracranial pressure.
Hemiplegic Migraine
- What differentiates a hemiplegic migraine from other types of migraine is the presence of motor weakness or hemiplegia.
Subarachnoid Hemorrhage Management
- The next appropriate management step for the 46-year-old patient with signs of subarachnoid hemorrhage on head CT is to perform a lumbar puncture to determine the presence of blood in the cerebrospinal fluid.
Subarachnoid Hemorrhage Intervention
- The intervention that should be avoided in a patient with signs of subarachnoid hemorrhage on head CT is the use of anticoagulants or antiplatelet agents.
Migraine without Aura
- The incorrect information regarding migraine without aura is that it is not a recognized subtype of migraine.
Hemiplegic Headache Diagnosis
- The most appropriate diagnosis for the 24-year-old patient presenting with hemiplegic and pulsating headaches accompanied by nausea, vomiting, and photophobia is a hemiplegic migraine.
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Description
Test your knowledge of neurological examination findings and their correlation with head MRI results. Determine the changes in head MRI that explain the specific symptoms observed in the neurological examination.
