Exam 2 - Open-Ended Review Questions

Hormonal migraine

Type of headache that has photopsia and related to the menstrual cycle

Classic migraine

Type of headache that lasts 24-72 hrs, has an aura, and is unrelated to the menstrual cycle

Common migraine

Headache that lasts 24-72 hrs, severe unilateral, no aura

Cervicogenic migraine

Headache that radiates from the cervical spine, severe, 24-72 hrs, no aura usually

Cluster

Headache that has severe pain, rhinitis, episodic same time every year lasting 3 weeks

Costens/TMJ

Face pain that is related to jaw movements and aggravated by clenching

Trigeminal neuralgia

Face pain that is severe and aggravated by touching, shaving unilateral over the TMJ

Shingles/Herpes Zoster

Face pain over V1 that begins as a vesicular rash in V1 related to a virus

Temporal Arteritis

Face pain in an older person with elevated ESR, pain over the temple, with bulging of the artery

- Vestibulocerebellum/Floccularnodular lobe

- (+) Rhomberg's eyes open indicates the lesion is in the cerebellum

- Now determine the lobe or functional zone that is affected by the lesion. The loss of function shows nystagmus, vertigo is associated with a lesion of the vestibulocerebellum

Locate the lesion in a patient with vertigo, nystagmus, positive Romberg's eyes open

- Spinocerebellar

- All findings associated with propulsive movements of the lower extremities

Lesion location in a patient with positive Romberg's, gait ataxia, positive tandem walk test, alternate leg stand

- Cerebrocerebellar

- All findings are associated with a loss of fine skilled executive movements, and (+) Romberg's eyes open is a cerebellar lesion

Lesion location in a patient with mild vertigo, past pointing on the right, positive heel to shin right, and Romberg's eyes open

- Sensory ataxia

- Romberg's eyes closed test is indicative of a proprioception lesion

- Achilles reflex loss bilaterally is indicative of a sensory afferent lesion

- Loss of intrinsic factor points to pernicious anemia, the patient has a DCML afferent loss

Diagnose the type of ataxia in a patient with ataxia, loss of achilles reflex bilaterally, loss of intrinsic factor, positive Romberg's test eyes closed

- Vestibulocerebellum lesion afferents or efferents

- The patient exhibits peripheral vertigo, positive Romberg's eyes open = cerebellar lesion with ataxic gait is indicative of a Vermian lesion

Diagnosis of a patient with peripheral vertigo upon standing, ataxic gait, positive Romberg's eyes open

- Labyrinthitis

- Vertigo and Hallpike's negative rules out BPPV

- Hearing loss points to an otologic etiology, not vestibular as there is a hearing loss

Diagnosis of patient with peripheral vertigo, hearing loss, all cerebellar and vestibular tests normal

Vestibular neuritis

Diagnosis in a with peripheral vertigo, no hearing loss, all cerebellar and vestibular tests normal

- Cervicogenic vertigo

- A positive spinning chair test in indicative of a cervicogenic vertigo

- All other BPPV and cerebellar tests should be done first

Diagnosis in a patient with peripheral vertigo and a positive spinning chair test

- Right posterior canal canalithiasis

- (+) Hallpike's test is indicative of a posterior canal canalithiasis positive on right = right lesion

Diagnosis in a patient with peripheral vertigo, positive Hallpike's on the right

- Acoustic neuroma

- CN VIII hearing loss, fullness due to fluid in the middle ear, loss of gag reflex due to CN IX/X compression, chronic, and CNV tract compression is indicative of the paresthesia of the face

Diagnosis in a patient with hearing loss, fullness in the ear, mild vertigo, loss of gag reflex, pins and needles in the face right, for 1 year

- Lateral canal canalithiasis

- Cerebellar tests being normal rules out the cerebellum

- Supine head roll test is indicative of a lateral canal canalithiasis

Diagnosis of a patient with vertigo and nystagmus on supine head roll test and nystagmus, cerebellar test are WNL

Horner's syndrome

Location of lesion in a patient that has miosis, ptosis, anhydrosis

CN III lesion

Location of lesion and 1 differential in a patient that has mydriasis, pupil is down and out, with ptosis

CN IV

Location of lesion and 1 differential in a patient that has no ptosis, pupil is normal, diplopia that corrects with contralateral head tilting, and worsens with ipsilateral head tiling, pupil is hypertropic

Argyll Robertson

Name of the pupillary lesion in neurosyphilis

Argyll Robertson miosis with slow dilation

Pupillary defect in diabetes

Mydriasis

Pupillary defect in CN III lesion

CN VI

Which nerve is lesioned when there is an ipsilateral loss of abduction of the eye only?

- Afferent: CN V

- Efferent: CN VII

Name the afferent/efferent nerves of the corneal reflex

Cervical stenosis

Lesion in a patient that has neck stiffness, loss of proprioception and vibration of the feet, and hyperreflexia of the legs