Dysdiadochokinesia
Dysmetria
Scanning speech
Hypotonia
Intention tremor
Nystagmus
wide-based Gait
Romberg
Pronator drift

Glasgow Coma Scale

Provides a reliable, objective way of recording the conscious state of a person.
e.g "GCS 9 = E2 V4 M3 at 07:35".

Severe coma, GCS < 8
Moderate, GCS 9 - 12
Minor, GCS > 13.

Limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor).

CT after Head Injury (CCHR)
(not applicable to ≤ 16 y/o or hypocoagulable state)

GCS score < 15 at ≥ 2 hrs after the injury
Suspected open or depressed skull fracture
Any sign of basal skull fracture
≥ 2 episodes of vomiting
≥ 65 y/o
≥ 30 minutes of amnesia of events prior to the injury
Automobile vs pedestrian crash
Ejection from a motor vehicle
Fall from ≥ 3 feet
Fall from ≥ 5 stairs.

Concussion

	Grade 1	Grade 2	Grade 3
Cantu guidelines	No LOC amnesia <30 mins	LOC <5 mins amnesia 30 mins to 24 hrs	LOC >5 mins amnesia >24 hrs
1st episode	If asymp x 1 wk → may rtn to play	If asymp x 1 wk → may rtn to play	Min. 1 mo If asymp ≥ 1 wk → may rtn to play
2nd episode	Min. 2 wks If asymp ≥ 1 wk → may rtn to play	Min. 1 mo If asymp ≥ 1 wk → may rtn to play Consider terminating season	Terminate season
3rd episode	Terminate season	Terminate season

Decreased level of consciousness

DDx:

"DIMS"
D rugs
I nfection
M etabolic
S tructural

Mgt:

"DONT"
D extrose
O xygen
N aloxone
T hiamine

Types of Headaches

International Headache Society Criteria For Migraine Without Aura

At least 5 attacks that fulfill criteria in B, C, D, and E Headache attacks that last 4 to 72 hrs (untreated or unsuccessfully treated) Headache has at least 2 of the following characteristics: Unilateral site Pulsating quality Moderate to severe intensity Aggravation by walking stairs or similar routine physical activity During headache, at least 1 of the following symptoms: Nausea or vomiting (or both) Photophobia and phonophobia No evidence of related organic disease No evidence of related organic disease

International Headache Society Criteria For Migraine With Aura

At least 2 attacks that fulfill criteria in B and C At least 3 of the following 4 characteristics: One or more completely reversible aura symptoms that indicate focal cerebral cortical or brain-stem dysfunction (or both) At least one aura symptom develops gradually over >4 min or two or more symptoms occur in succession No aura symptom lasts >60 min Headache follows aura in <1 hr No evidence of related organic disease

Acute Migraine Treatment

Migraine Prophylaxis

Faces Pain Scale

ICD-10 criteria:

H/o of TBI and the presence of ≥ 3 of the following 8 symptoms:
headache
dizziness
fatigue
irritability
insomnia
concentration difficulty
memory difficulty
intolerance of stress, emotion, or alcohol

Seizure

A irway	lateral decubitus posn O2
B reathing	intubate prn
C irculation	normal saline IV monitor EKG

↓

Blood glucose chemstrip - if low → D50W 1 amp
ABG
lytes, Ca, Mg, Cr, urea
blood cultures prn
drug levels: phenytoin, carbemazepine, valproate, phenobarbital

↓

if suspect opioid overdose → naloxone 0.4 mg IV or IM
if suspect EtOH → thiamine 100 mg IV or IM


↓

Diazepam 10 mg IV or q 15 mins x 2
Lorazepam 0.1 mg/kg q 15 mins x 2

↓

Phenytoin 18 mg/kg over 40 mins

max 1.5 g for males
max 1.0 g for females
Do not mix w glucose
Beware: dysrhythmias, hypotsn

↓

CT head
LP prn

More likely if provoked by maneuvers that change head position without lowering blood pressure, e.g. lying down, rolling over in bed, and bending the neck back to look up.

More likely if aggravated by moving the head. If head motion does not worsen the feeling, it is probably another type of dizziness.

Meniere's Dz
vertigo (hrs to days)
fluctuating, progressive, unilateral or bilateral SNHL, often initially in the lower frequency ranges
unilateral or bilateral tinnitus
sensation of fullness or pressure in one or both ears
nausea, vomiting, and sweating sometimes

Labyrinthitis
sudden, severe vertigo (7 - 10 days)
nystagmus
no HL
no tinnitus


BPPV
sudden, violent vertigo ( < 30s)
induced by changing head position (Dix-Hallpike maneuver is Dx'ic)
nystagmus
no HL
no tinnitus
often nausea