Manual of Neurologic Emergencies by Jagoda Andy S.;Lewandowski Christopher A.;Walls Ron M.; & Christopher A. Lewandowski

Author:Jagoda, Andy S.;Lewandowski, Christopher A.;Walls, Ron M.; & Christopher A. Lewandowski
Language: eng
Format: epub
Publisher: Wolters Kluwer Health
Published: 2022-03-15T00:00:00+00:00

Cranial nerve praxis

Double vision—often subtle, but may cause headache or sense of being off balance

Cervical strain

May cause headache

Cupulolithiasis

Can lead to vertigo and may lead to misdiagnosis of concussion

Medication overuse

Headache, somnolence, decreased concentration, and slowed reflexes

AMS, altered mental state; CSF, cerebrospinal fluid; CT, computed tomography; LOC, loss of consciousness; MRI, magnetic resonance imaging (eg, Headache).

APPROACH/THE FOCUSED EXAMINATION

A focused history and physical examination direct the need for additional diagnostic testing. Findings may be subtle. The history focuses on the events surrounding the injury, including the presence of LOC and of pre- or post-traumatic amnesia; these findings establish that at a minimum there was a concussion, but the absence of these findings does not eliminate the diagnosis. Patients should be evaluated for common symptoms associated with concussion such as headache, dizziness, fogginess, “feeling off” or imbalanced, blurred or double vision, or nausea/vomiting. These findings often occur rapidly after the injury, but may also develop hours to days after the injury (Table 11.3). The use of anticoagulant or antiplatelet medications should be assessed and may increase the likelihood of the patient having intracranial bleeding.

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