neuro pt 4 - headaches & primary brain tumors

Question 1

headaches patho

Answer 1

vascular dilation (migraines)
muscle contraction (tension HA)
traction (increase ICP)
inflammation (infection)

Question 2

headache red flags

Answer 2

sudden onset reaching max intensity in seconds-minutes
no hx of headaches
worsening pattern
focal neuro sx
fever
AMS
fast HA w exercise
radiates to neck/shoulder
<5 or >50 yo
pt w cancer, Lyme, HIV, pregnancy, postpartum

Question 3

when to obtain CT for HA

Answer 3

change in pattern, freq, or severity
progressive worsening
focal neuro s/s
onset of HA w exertion, cough, or sex
onset >50
orbital bruit

Question 4

sinus HA classic presentation

Answer 4

pain behind the forehead and/or cheekbones

Question 5

cluster HA classic presentation

Answer 5

rapid onset unilateral periorbital pain

w/ ipsilateral nasal congestion, rhinorrhea, lacrimation, Horner syndrome

not well understood patho

men >women!!!

Question 6

tension HA classic presentation

Answer 6

pain like a band squeezing the head

bilateral, non-throbbing

Question 7

migraine HA classic presentation & cause

Answer 7

gradual buildup, unilateral pulsatile/throbbing HA

aura, nausea, and visual changes

autosomal dominant

caused by blood vessel dilation

Question 8

migraines meds CI

Answer 8

ergotamine avoided in pregnancy, CV disease, and med interactions w CYP 3A4 (verapamil, antifungals, erythromycin, cardizem)

also avoid triptans in pregnancy/CV

Question 9

migraines tx

Answer 9

1 - dihydroergotamimes (CI in preg, CV and meds)
triptans (CI in preg and CV)
antiemetics
ketorolac
avoid opioids

environmental modification

Question 10

migraines meds

Answer 10

dihydroergotamimes (CI in preg, CV and meds)
triptans (CI in preg and CV)
antiemetics
ketorolac
avoid opioids

Question 11

tension HA tx

Answer 11

dihydroergotamine
no triptans
NSAIDS, muscle realaxants
TCAs for prophylaxis

environmental modification

Question 12

cluster HA tx

Answer 12

100% O2
prevent triggers
sumatriptan
prophylaxis - lithium, verapamil, topiramate, valproate, steroids, ergotamines

Question 13

bells palsy

Answer 13

idiopathic facial nerve (VII) paralysis

abrupt onset, worsen over 48 h

unilateral facial paresis, taste disturbances

R/O stroke then can dx

RF: pregnancy, DM

Question 14

bells palsy tx

Answer 14

60% recover w/o treatment
prednisone within 3 days of onset

eye drops, antivirals (if herpetic vesicles)

Question 15

glioblastoma

Answer 15

grade IV astrocytoma
malignant - not in capsule
aggressive, highly infiltrative

tx - surgical resection (difficult, debunking), chemo, radiation

5 year survival <5%

Question 16

most common malignant primary brain tumor

Answer 16

glioblastoma

Question 17

most common primary brain tumor

Answer 17

meningioma

Question 18

meningioma

Answer 18

benign tumor
autosomal dominant neurofibromatosis - CNS tumors

hx of radiation (2ndary tumor)

no tx if asymptomatic, can resect if sx

Question 19

pituitary adenoma

Answer 19

tumor secreting specific cell type. –> s/s, HA, visual impairment

hormones: GH, PRL, FSH, LH, ACTH

transphenoidal resection