Tintinalli's - HA Flashcards
clinical red flags for HA onset
- Sudden
- trauma
- exertion
clinical red flags for HA sx
- Altered mental status
- Seizure
- Fever
- Neuro sx
- Visual changes
clinical red flags for HA meds
- anticoag/antiplatelet
- Recent abx use
- immunosupp
clinical red flags of HA hx
- No prior HA
- Change in HA quality, or worsening over wks/mo
clinical red flags of HA associated conditions
- Pregnancy or post pregnancy status
- SLE
- Behcet’s disease
- Vasculitis
- Sarcoidosis
- Cancer
clinical red flags of HA PE findings
- Altered mental status
- Fever
- Neck stiffness
- Papilledema
- Focal neurologic signs
what age group are considered high-risk pts?
> 50 y/o with new/worsening HA, “thunderclap HA”
CT noncontrast is useful for what other DDx?
- hemorrhage
- subdural hematoma
- space-occupying lesion
- elevated ICP
- SAH
MRI would be a good imaging choice for what DDx?
cerebral venous thrombosis
MR/CR angiography imaging would be a good choice for what other DDx?
- arterial dissection
- small SAH
lumbar puncture would be an important diagnostic work-up for what other DDx?
- meningitis
- encephalitis
- SAH
hemorrhagic causes of “thunderclap” HA
- Intracranial hemorrhage
- “Sentinel” aneurysmal hemorrhage
- Spontaneous intracerebral hemorrhage
vascular causes of “thunderclap HA”
- Carotid or vertebrobasilar dissection
- Reversible cerebral vasoconstriction syndrome (RCVS)
- Cerebral venous thrombosis
- Posterior reversible encephalopathy syndrome (PRES)
other causes (besides hemorrhage and vascular) of “thunderclap HA”
- Coital HA
- Valsalva-associated HA
- Spontaneous intracranial HoTN
- Acute hydrocephalus
- Pituitary apoplexy
- bilateral/unilateral
- Constant/intermittent
- Worse upon awakening, valsalva, positional
- N/V
- Cancer dx, seizures, or mental status change = primary or metastatic brain lesion
brain tumor
- Hypercoagulable state - OCP, postpartum or periop status, clotting factor def., polycythemia
- Papilledema
- Neuro findings - wax and wane
Cerebral venous thrombosis
diagnostics of Cerebral venous thrombosis
- LP - increased opening pressure
- DX: MR venography
- ≥50 y/o
- new HA
- temporal artery abnormality - tender, nonpulsatile, or diminished pulse
- ESR ≥50
- abnormal bx
other: Fatigue, F, jaw claudication, vision changes
temporal arteritis
diagnostics temporal arteritis
Labs - ESR/CRP
DX: temporal artery bx
tx temporal arteritis
- prednisone
- consult ophthalmologist or other specialist to arrange bx to confirm dx, f/u, and tx
MCC benign HA
migraine
Pt with HA describes it as:
Gradual onset, lasting 4-72h
Unilateral, pulsating
Worsening by physical activity
N/V, photophobia, phonophobia
W/ or w/o aura
what is the dx
migraine
tx migraine
- DHE, sumatriptan, metoclopramide, chlorpromazine, or prochlorperazine
- Dexamethasone IV - adjunctive to reduce migraine recurrence
Idiopathic intracranial HTN aka Pseudotumor cerebri is MC in what demographic
Obese women, 20-44 y/o
- quick vision disturbances, back pain, pulsatile tinnitus
- Permanent vision loss if left untreated
Idiopathic intracranial HTN
DX criteria for Idiopathic intracranial HTN
- Papilledema
- nml neuro exam
- increased LP opening pressure
HA after a procedure involving dura (LP, epidural anesthesia)
Intracranial HoTN
- HA worsens w/ upright position; Alleviated: lying down
- N/V, hearing/vision changes
Intracranial HoTN
tx Intracranial HoTN
- acetazolamide
- wt loss if obese
- LP for therapeutic to reduce pressure to 15-20 cm H2O
- consult neuro and/or ophthalmologist
- If d/t LP or epidural anesthesia - symptomatic; most effective epidural blood patch by anesthesiologist