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The One Deck To Rule Them All > Neuro: Headaches, Haemorrhages & Oncology > Flashcards

Neuro: Headaches, Haemorrhages & Oncology Flashcards

1
Q

Severe orbital-temporal pain around eye
Short (30 mins)
10 - 30 X per day

A

Paroxysmal hemicrania

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2
Q

Management for Paroxysmal hemicrania

A

Idomethacin

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3
Q 
Unilateral 
Red, swollen + watery eye 
Miosis (pinpoint pupil)
Ptosis (Drooping of the eyelid)
Nasal discharge/stuffiness 
Facial sweating 
Severe pain around eye

Once or twice per day
Last 15 mins - 2 hours per episode
Continue for 4 - 12 weeks

A

Cluster headaches

  • triggered by strong smells / exercise
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4
Q

Acute management for cluster headaches

A

Triptans
- Sumatriptan
High flow O2

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5
Q

Prophylactic management for cluster headaches

A

Verapamil
Lithium
Prednisolone

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6
Q

Headache worse when upright

Associated with Marfan’s

A

Spontaneous Intracranial Hypotension

  • due to CSF leak
  • pachymeningeal (dural) enhancement on MRI
  • conservative tx
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7
Q

Unilateral headache in trigeminal area
10 - 20 per day
30s each episode

A

Trigeminal neuralgia
“suicide disease” - as so painful

  • 10% bilateral
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8
Q

Management of trigeminal neuralgia

A

Carbamazepine

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9
Q

Bilateral headache
“band around head”
Recurrent

A

Tension headache

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10
Q

Headache behind eyes and nose

A

Sinusitis

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11
Q

Scalp tenderness
> 60 years old

Associated with polymyalgia rheumatica

A

Giant Cell Arteritis “Temporal arteritis”

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12
Q

Pain at back of neck

A

Cervical spondylosis

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13
Q 
Unilateral throbbing pain 
Preceded by prodrome + aura 
Lasts all day 
Resolves with sleep 
Nausea + vomiting 
Limb weakness
A

Migraine

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14
Q

Features of migraine aura

A

Transient hemianopia disturbance “jagged crescent”
Sparks in vision
Photophobia

  • Develops hours before onset of pain
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15
Q

Triggers of migraine

A

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese + Caffeine
Oral contraception 
Lie ins
Alcohol (red wine)
Travel
Exercise
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16
Q

Acute management of migraines

A

Triptans (Sumatriptan) + NSAIDs
Metoclopramide
Prochlorperazine

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17
Q

Prophylactic management of Migraines

A
  1. Topiramate (avoid in pregnancy, risk of cleft palate)
  2. Propranolol (avoid in asthmatics)
  3. Riboflavin

Give when > 2 attacks per month

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18
Q

Management for menstrual migraine

A

Fovatriptan

Zolmitriptan

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19
Q

Excessive volume of CSF caused by an imbalance between CSF + absorption

A

Hydrocephalus

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20
Q

Child:

  • Increased head circumference
  • Bulging fontanelle
  • Sunsetting or eyes (impaired upward gaze)
  • Dilated scalp veins

Adult:

  • Morning headache (or upon lying down)
  • Nausea + vomiting
  • Papilloedema
  • Coma
A

Hydrocelphalus

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21
Q

Causes of hydrocephalus

A

Obstructive (non-communicating)

  • tumours
  • SAH
  • aqueduct stenosis

Non-obstructive (communicating)

  • Increased production of CSF (choroid plexus tumour)
  • Failure of reabsorption at arachnoid granulations)
    - meningitis
    - post-haemorrhage
  • Normal pressure hydrocephalus
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22
Q 
Enlarged ventricles in brain (4th)
Normal ICP 
Dementia (reversible)
Incontinence
Disturbed gait
A

Normal pressure hydrocephalus

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23
Q

Investigations of hydrocephalus

A

CT
MRI
LP (not in obstructive as can cause herniation)

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24
Q

Acute management of hydrocephalus

A

External ventricular drain (EVD)

- drains to external bag

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25
Q

Long-term management of hydrocephalus

A

Ventriculoperitoneal shunt

- drains to peritoneum

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26
Q 
Headache 
Blurred vision 
Papilloedema
Enlarged blind spot
Horizontal diplopia (CN VI palsy)
Young overweight female
A

Idiopathic intracranial HTN

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27
Q

Risk factors for idiopathic intracranial HTN

A 
Obesity
Female
Pregnancy
COCP
Steroids
Tetracyclines
Lithium
Vit A
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28
Q

Management for idiopathic intracranial HTN

A 
Weight loss
Acetazolamide
Topiramate
Repeat LP
Surgery
 - optic nerve sheath decompression 
 - lumboperitoneal shunt
 - ventriculoperitoneal shunt
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29
Q

Irregular/ decreased RR
Bradycardia
HTN
Wide pulse pressure

A

Cushing’s triad

  • seen in increased ICP
  • pre-terminal event
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30
Q

Headache post LP

A

Low pressure headache

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31
Q

Management of low pressure headache

A

Caffeine + hydration

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32
Q

Investigation for increased ICP

A

Fundoscopy

- looking for papilloedema

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33
Q

Headache
Postural hypotension
Papilloedema

A

Increased ICP

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34
Q

Management of increased ICP

A

Controlled hyperventilation

Raise head to 30 degrees

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35
Q

Management of severe increased ICP

A

Prior to surgery
- IV Mannitol / furosemide
Surgery

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36
Q

Diagnostic criteria for migraines

A

5 + attacks
- need
Lasting 4 - 72 hours
- need

Unilateral 
Pulsating 
Painful 
Aggravated by activity 
 -need 2/4

Nausea + vomiting
Photophobia + photophobia
- need 1/2

Not caused by another illness

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37
Q

Neuro red flags / when to review immediately

A 
GCS < 13 on assessment
GCS < 15 after 2 hours
Seizure post trauma
Focal neuro deficit 
> 1 episode of vomiting
Suspected skull fracture
   - haemotympanum
   - panda eyes
   - CSF leak
   - Mastoid bruising "battle sign"
38
Q

Neuro amber flags / when to review within 8 hours

A 
LOC/ amnesia + > 65 years old
Hx of bleeding/clotting disorder
Dangerous mechanism of injury
> 30 mins retrograde amnesia 
On warfarin
39
Q

First line investigation in suspected brain haemorrhage

A

CT

40
Q

Intraparanchymal bleeding

CT: bright hyper-dense lesion

A

Intracerebral haematoma

“Haemorrhagic stroke”

41
Q

Risk factors for a intracerebral haematoma

A 
HTN
Aneurysms
Atriovenous malformation
Cerebral amyloid angiopathy
Trauma
Brain tumour
Infarct
42
Q

Intra-ventricular haemorrhages are seen in

A

Premature babies

Non-accidental injury in kids

43
Q 
Trauma to the side of the head
  - acceleration/ deceleration injury 
Lucid interval 
Increased ICP
CT: Lens shaped
A

Extradural Haematoma “Epidural”

44
Q

Haematoma associated with temporal bone fracture

A

Extradural Haematoma

45
Q

Type of bleed from extradural haematoma

A

Arterial bleed

  • middle meningeal artery
  • between dura mater + skull
46
Q

Complications of extradural haematoma

A

Can lead to tentorial herniation

47
Q

Management of tentorial herniation

A

Parietotemporal Craniotomy

48
Q 
Haematoma of slow onset
Fluctuating confusion/ consciousness 
Old age
Alcoholism 
Anticoagulated
Crosses suture lines 
CT: Cresent shape
A

Subdural haematoma

49
Q

Hypodense present shape on CT

A

Chronic subdural haematoma

50
Q

Type of bleed from subdural haematoma

A

Venous bleed

  • bridging veins
  • bleeds into the outermost meningeal layer
  • around frontal and parietal lobes
51
Q 
Sudden onset
Severe occipital "thunder clap" headache
"Like getting hit on back of head by a baseball bat"
Meningism
 - photophobia
 - neck stiffness 
Nausea + vomiting
Coma/ sudden death
Seizures 
Increased ST
A

Subarachnoid haemorrhage (SAH)

52
Q

Causes of SAH

A 
Intracranial aneurysm (berry aneurysm) = 85%
  - Ehler danlos syndrome
  - PCKD
  - Coarctatino of aorta
Atriovenous malformation 
Pituitary apoplexy 
Arterial dissection 
Cocaine use
Sickle cell anaemia
53
Q

Investigation findings of SAH

A

CT: - bright hyperdense (acute bleed)

    - basal cisterns, sulk, ventricular system 
    - not picked up in 7%

LP: - increased RBC

  - Xanthochromia (yellow CSF- bilirubin)
          - performed 12 hours after (RBC breakdown)
  - normal/raised opening pressure

Bloods: Hyponatraemia (SIADH)

54
Q

Management of SAH

A
  1. Coiling of intracranial aneurysms
  2. Nimodipine (21 days)
    • CCB
    • Prophylaxis for vasospasm

Watch for - re-bleeding (10% first 12 hours)

                  - hydrocephalus
                  - hyponatraemia
55
Q

Cerebral perfusion pressure

A

Adults: > 70mmHg
Children: 40-70mmHg

56
Q

Most common cancers that cause brain metastasis

A

Lucky brains become so kind

Lung
Breast
Bowel
Skin
Kidney
57
Q 
Increased ICP
  - Papilloedema
Change in personality 
Vomiting 
Headache (worse on bending over)
A

Think brain tumour

  • mass effect
58
Q 
Unilateral hearing loss
Tinnitus 
Vertigo 
Absent corneal reflex 
Facial palsy
A

Vestibular schwannoma “Acoustic neuroma”

  • 5% of Intra Cranial Tumours
  • 90% of cerebellopontine angle tumours
  • slow growing & benign
59
Q

Vestibular schwannomas arise from what nerve

A

CN VIII

60
Q

Bilateral vestibular schwannomas are seen in

A

Neurofibromatosis Type 2

61
Q

Investigations for vestibular schwannomas

A

MRI: Cerebellopontine angle tumour

Audiometry

Histology: Antoni A/B patterns
                  Verocay bodies (acellular areas surrounded by nuclear palisades)
62
Q

Management of vestibular schwannomas

A

Surgery
Radiotherapy
Observation

63
Q 
Solid/cystic tumour of sellar region
Derived from remnants of Rathke's pouch
- Hormonal disturbance
- Hydrocephalus
- Bitemporal hemianopia
A

Craniopharyngioma

64
Q

Most common paediatric supratentorial tumour

A

Craniopharyngioma

  • also occurs in adults
65
Q

Investigations for Craniopharyngioma

A

Pituitary blood profile

MRI

66
Q

Management of Craniopharyngioma

A

Surgical

67
Q

Tumour found in the 4th ventricle

Hydrocephalus

A

Ependymoma

68
Q

Histology shows: Perivascular psuedorosettes

A

Ependymoma

69
Q

Vascular tumour of cerebellum

Associated with von-hipper-lindau syndrome

A

Haemangioblastoma

70
Q

Histology: Foam cells + high vascularity

A

Haemangioblastoma

71
Q

Benign slow growing tumour

Common in frontal lobes

A

Oligodendroma

72
Q

Histology: Calcifications with “fried egg” appearance

A

Oligodendroma

73
Q

Tumour of the brain membrane

Arises from the dura matter + compresses

A

Meningioma

74
Q

Tumour located at:

  • falx cerebri
  • superior sagittal sinus
  • convexity
A

Meningioma

75
Q

2nd most common primary brain tumour in adults

A

Meningioma

76
Q

Histology: Spindle cells in concentric whorls + calcified psammoma bodies

A

Meningioma

77
Q

Management of meningiomas

A

Observe
Radiotherapy
Surgical resection

78
Q

Most common primary brain tumour in adults

A

Glioblastoma multiforme

  • malignant
  • Poor prognosis (1y)
79
Q

MRI: Solid tumour with central necrosis + enhanced rim

A

Glioblastoma multiforme

80
Q

Histology: Pleomorphic tumour cells border necrotic areas

A

Glioblastoma multiforme

81
Q

Management of Glioblastoma multiforme

A

Dexamamethasone (for oedema due to disruption of blood brain barrier)

Post op chemo and radiotherapy

82
Q

Most common primary brain tumour in children

A

Pilocystic astrocytoma

83
Q

Histology: Rosenthal fibres (corkscrew eosinophilic bundle)

A

Pilocystic astrocytoma

84
Q

Aggressive paediatric brain tumour
Arises in infratentorial compartment
Spreads through CSF

A

Medulloblastoma

85
Q

Histology: Small blue cells, Rosette pattern, many mitotic figures

A

Surgical resection

Chemotherapy

86
Q

Types of pituitary adenoma

A

Secretory
Non-secretory
Microadenomas (<1cm)
Macroadenomas (> 1cm)

87
Q

Cushing’s features (Increased ACTH)
Acromegaly (Increased GH)
Bitemporal hemianopia

A

Pituitary adenoma

88
Q

Cause of bitemporal hemianopia in pituitary adenoma

A

Compression of the optic chasm

(due to crossing nasal fibres)

89
Q

Management of pituitary adenoma

A

Manage hormonal side of things

Surgical (transphenoidal resection)

90
Q

Decreased GCS
Quadraplegia
Miosis
Absent horizontal eye movements

A

Pontine haemorrhage

  • caused by chronic HTN

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