Neurological Examination and Head MRI
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Questions and Answers

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?

  • 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?

  • 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?

    <p>Refer for MRI of the brainstem</p> Signup and view all the answers

    Which characteristic differentiates migraine from cluster headache?

    <p>Hemicephalic pain consistent with the extent of trigeminal nerve innervation</p> Signup and view all the answers

    Which symptom is typical of the beginning of wedging of the parahippocampal gyrus into the cerebellar tentorial notch?

    <p>Facial nerve palsy</p> Signup and view all the answers

    Which statement is true regarding optic disc edema?

    <p>Visual acuity is normal in the initial period</p> Signup and view all the answers

    What differentiates a hemiplegic migraine from other types of migraine?

    <p>Hemicephalic pain associated with transient ischemia of the cerebral cortex</p> Signup and view all the answers

    What is the next appropriate management step for the 46-year-old patient with signs of subarachnoid hemorrhage on head CT?

    <p>Performing a lumbar puncture</p> Signup and view all the answers

    Which intervention should be avoided in a patient with signs of subarachnoid hemorrhage on head CT?

    <p>IV rtPA administration in the absence of a hemorrhagic focus in head CT</p> Signup and view all the answers

    Identify the incorrect information regarding migraine without aura.

    <p>1,2,4,5</p> Signup and view all the answers

    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?

    <p>Migraine with aura</p> Signup and view all the answers

    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.

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