Pain in the Brain
Your patient comes in complaining of continuous, spontaneous, episodes of vertigo, what are the two diseases on your differential?
Bonus: What test can you use to differentiate
Vestibular Neuritis and Vestibular Migraines
HINTS test
A patient presents with a horrible headache that has awakened them from their sleep. This headache has been on and off for the last 2 weeks. There PCP recommend an MRI. On MRI you see a tumor with a necrotic core and thick irregular bright margins. What tumor do you suspect?
Glioblastoma
Your patient presents to the ER unable to speak with contralateral hemiparesis in their face and arm, as well as contralateral hemineglect. The blockage is likely in what artery?
Middle cerebral artery
What is the treatment for psychogenic nonepileptic pseudoseizures
CBT
What is seen on imaging in a patient with Alzheimer's disease
hippocampal atrophy, shrinkage of cerebral cortex, enlarged ventricles
High flow 100% oxygen
A patient with a brain tumor is complaining of muscle weakness, what is the treatment for this?
High dose dexamethasone
A 68-year-old woman with a history of uncontrolled hypertension and diabetes presents with sudden-onset right-sided hemiparesis, facial droop, and dysarthria. CT angiography reveals a proximal left MCA occlusion. She arrived 5 hours after symptom onset.. How should you treat this patient?
mechanical thrombectomy with stent retriever
When would you order a lumbar puncture in a child who had a febrile seizure?
If suspect meningitis or child 6-12 mo old w/o HIB & pneumococcal vax
A 65-year-old man presents with progressive slowness and stiffness over the past year. He first noticed a resting tremor in his right hand that disappears as he is working. His wife reports that he has been shuffling around the house and has decreased facial expression. She also complains as she can barely see his handwriting. What is the likely treatment for this suspected diagnosis
Levadopa/Carvadopa
A 46 year old female comes in with complaints of spinning when she turns her head in the morning to get out of bed. What is a diagnostic test you can perform and what finding should you see?
Dix-hallpike maneuver - vertigo with nystagmus
BUZ WORDDDDDS: Name the tumor that goes with each word
Dural tail sign
AIDs/Immunodeficient
Parinaud syndrome
Meningioma
Primary CNS lymphoma
Pineal tumor
Patient presents to the ER saying "this is the worst headache of my life". A noncontrast CT was ordered and it comes back negative. What is the next test to order and what are you expecting to see?
LP - xanthochromia
Focal Seizures - impaired awareness
wobbly, wet, wacky - what disease involves these key features
normal pressure hydrocephalus (NPH)
Your patient presents with a throbbing, left sided headache, she said these headaches last 7 hours and often happen when she goes on runs. She experiences these episodes at least 5 times a month... What abortive medication could you give her? Is she eligible for prophylactic treatment?
If yes what is a first line tx?
Abortive: Triptans or ergots
Yes she is eligible for prophylactic: B-blocker (propranolol or timolol) or an anticonvulsant
Sandy a 24 year old women presents with trouble walking and weakness. MRI comes back and shows a large ventricle. Which type of glioma does she most likely have?
What is her prognosis??
Ependymoma
Good/better prognosis
A patient presents to the ER as his wife made him come in because he passed out and then regained consciousness but is complaining of a headache and seems weak and fatigued. What type of hemorrhage is this and likely from what vessel?
Epidural Hemorrhage, middle meningeal artery bleed
A patient presents to the ER, it is reported he had a seizure that lasted 7 minutes and resolved on the 4 minute ambulance ride. While in the ER another seizure begins. What is the first line tx for this?
IV lorazepam, diazepam, or IM midazolam
THIS IS A MEDICAL EMERGENCY
A 77 year old elderly female is brought to the ER from her assisted living unit due to an abrupt onset of confusion and hallucinations. What disease does she likely have?
Delirium
A 20 year old patient presents with multiple episodes of vertigo lasting 40 minutes, with associated hearing loss and ringing of the ears. What type of vertigo is this?
Meniere Disease
Meningioma
Acoustic Neuroma
A patient presents with pain with neck flexion, a fever and headache, they are 27 years old. You order a LP and in the meantime you begin what antibiotic therapy?
Dexamethasone + Vancomycin + Ceftriaxone
What is the most common type of seizure and what are its phases?
Tonic-Clonic (Grand Mal)
Tonic phase: LOC, flexion of arm, upward deviation of eyes, tonic contractions of flexion and extension, resp muscle contraction, vocalization, cyanosis, ends with tremors
Clonic phase: violent limb jerking, tongue biting, oral frothing, micturition, ends with deep inspiration & flaccid muscle
Post-ictal phase: headache, confusion, todd's paralysis
A 62-year-old woman presents with a 2-year history of progressive language difficulties. Initially, her speech was nonfluent, and she struggled with word finding. Over time, her behavior has changed; she exhibits compulsive behaviors, including binge eating, and has become disinhibited in social situations. Memory has remained intact, and there are no signs of extrapyramidal symptoms. What is the most likely diagnosis, and what treatment is recommended?
Frontal Temporal Atrophy, SSRIs