Illness Scripts for the

Cervical Spine

Cardinal Signs of C-Spine

Facial Paresthesia
Peri-oral paresthesia
Bilateral/Quadrilateral/Hemilateral paresthesia
Fainting episodes (vaso-vagal causes)
Sudden changes in hearing
Post traumatic or gradual onset of visual deficit
Problem with communication
Ataxia
Cord signs & drop attacks (babinski, clonus,
hyper-reflexia)
Sterno Cleido Mastoid atrophy
Tongue weakness and atrophy
Dysphagia

VBI Illness Scripts

Drop attacks (not unconscious)

Perioral numbness
Diplopia
Dysarthria
Bilateral/hemilateral/Quadrilateral
paresthesia
Dizziness/Vertigo/spinign or tilting
sensation/light headedness
Headache

Causes of Dizziness

Inner ear infection

BPPV = Benign Paroxysmal Positional Vertigo
20 % dizziness is caused by BPPV
Dizziness triggered by lying down or rolling
on the bed
It is due to accumulation of ottoconia
Positional Dizziness gets worse on standing
Usually associated with head trauma,
degeneration changes with age, after
surgery, with prolong supine position

Illness Scripts for Cervical Vertigo

First rule out the VBI

Cervical vertigo comes with the neck movements
VOR (vestibulo-occular-reflex) will be abnormal
VOR is used to test vision stabilization
Optokinetic Reflex (OKR) will be abnormal
All of these reflexes are due to damage of trigeminal
nerve or Trauma to C1 to C3
Cervico-occular reflex (COR) = Imbalance/dizziness
due to rotation of the head
Or keep the head stationary and rotate the body
Or Keep the body stationary and rotate the head

Headaches

Migraine
Tension
Cluster
Cervicogenic

Illness Scripts for Migraine

Headaches
A form of vascular headache
Has two causes i-e. enlargement of
the blood vessels and chemical
release from the nerves that coil
around the blood vessels, chemical
causes inflammation leading to more
vaso-dialation.
The temporal arteries enlarge.
Symptoms can be NVD.

Illness Scripts for Migraine

Headaches
Described as intense throbbing pain that involves
temporal region
The pain can be located in the forehead, around
the eye or back of the head
Pain is usually unilateral
Although about 1/3rd of the time it can be bilateral
Pale skin and cold hands and feet
Blurred vision
It is usually aggravated by many activities like
walking upstairs, sensitivity to light and sound
A typical attack lasts for 4 to 72 hours

Illness Scripts for Tension

Headaches
Can be caused by stress or posture
Pain that begins at the back of the head or upper
neck is a band like tightness
Described as the band of pressure encircling the head
with the most intense pain over the eyebrows
The pain is usually mild and bilateral
It is differentiated from migraine, it is not associated
with aura or not associated with vomiting and nausea
and there is no sensitivity to light and sound
Usually occurs sporadically but can occur frequently
or even daily in some people (mostly in computer
users)

Illness Scripts for Cluster Headaches

It is much more common in males than females.

Cause is unknown or may be genetically associated
Episode lasts for 30 minutes or an hour
Pain tends to occurs about the same time every
day
The pain typically is excruciating and is located
around or behind one eye
The affected eye may become inflamed and watery
The nose on the affected side may become
congested or runny