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NMSP > Approach to Headache/Meningitis/Encephalitis > Flashcards

Approach to Headache/Meningitis/Encephalitis Flashcards

1
Q

Primary headache disorders are ____ headache disorders

A

Benign

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2
Q

Secondary headache disorders are headaches that?

A

Are a sign of a pathologic disease

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3
Q

It is worrisome if the onset of a headache is after 50 yo, if accompanied with a fever, or if there are neurological symptoms?

A

YES - worrisome

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4
Q

When the brain is insulted, what are its 3 possible responses?

A
  • Bleed
  • Swell
  • Seize
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5
Q

Any patient with a worrisome headache history or abnormal examination needs what 3 things?

A
  • Imaging
  • Lumbar puncture
  • Arteriogram
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6
Q

Is it possible for CT scans to miss subarachnoid hemorrhages?

A

Yes - need a lumbar puncture to see it

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7
Q

What are the 5 Primary Headache Disorders?

A
  • Common Migraine
  • Classic Migraine
  • Chronic Migraine
  • Tension-type Headache
  • Cluster Headache
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8
Q

A Common Migraine is lacking what that is present with a Classic Migraine?

A

Classic Migraine - has aura!

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9
Q

With Migraines, is the pain usually unilateral or bilateral and what types of behavior are common?

A
  • Unilateral

- - Patient may retreat to dark and quiet room

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10
Q

Is there aura present with Common Migraines?

A

NO

- present with Classic Migraines

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11
Q

What is Aura and how long does it usually last?

A
  • Lasts 15-30 mins
    = Anything neurologic, usually visual symptoms, that precedes migraine
    – Seen with Classic MIgraines
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12
Q

What defines a Chronic Migraine?

A
  • Headache > 15 days per month
  • Headache lasts > 4 hours
  • Period of time > 3 months
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13
Q

With Migraines, do they usually prohibit normal daily activities?

A

YES

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14
Q

Do Tension-Type Headaches prohibit daily activities?

A

NO

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15
Q

Where is the common location of Tension-Type Headaches?

A

Bifrontal or Bioccipital

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16
Q

Migraines are sharp and throbbing pain. How are Tension-Type Headaches felt?

A

Dull, aching and squeezing pressure

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17
Q

Migraines and Headaches are usually experienced more commonly in females. In males, what is the most common type?

A

Cluster Headaches

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18
Q

What are Cluster Headaches associated with?

A

Obstructive Sleep Apnea

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19
Q

Describe the pain and location of Cluster Headaches

A
  • 100% Unilateral

= Severe excruciating pain

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20
Q

What is unique behavior that is seen with Cluster Headaches?

A

Frenetic, pacing and rocking

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21
Q

There are many different treatments for Migraines. What class of drugs is commonly used and what is its MOA?

A

-Triptans = 5HT1 Agonists

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22
Q

What are a few contraindications to Triptan usage for Migraines?

A
  • Ischemic heart disease
  • Any vascular disease
  • Uncontrolled HTN
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23
Q

What are a few classes of medications that can be used as PREVENTATIVE medicine for a Migraine?

A
  • Antidepressants
  • Beta blockers
  • Calcium channel blockers
  • Anticonvulsants
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24
Q

With CHRONIC Migraines, what is the best PREVENTATIVE treatment?

A

BOTOX injections for at least close to a year

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25
Q

What can BOTOX injections be used to prevent?

A

Chronic Migraines

26
Q

What is Trigeminal Neuralgia?

A

Shooting electrical quality pain occurring in paroxysms in 1+ distributions of the Trigeminal Nerve

27
Q

Shooting electrical quality pain occurring in paroxysms in 1+ distributions of the Trigeminal Nerve

A

Trigeminal Neuralgia

28
Q

What is the treatment for Trigeminal Neuralgia?

A

Anticonvulsants = Carbamazepine or Oxcarbazepine

29
Q

Inflammation of the meninges surrounding the brain or spinal cord

A

Meningitis

30
Q

Inflammation of the brain tissue

A

Encephalitis

31
Q

What is the overall most common cause of Meningitis?

A

Strep. Pneumoniae

32
Q

If you are suspecting Bacterial Meningitis, what should be started before empirical antibiotics?

A

Dexamethasone (steroid)

33
Q

With Bacterial Meningitis, why should Dexamethasone be started before starting antibiotics?

A

It prevents meningitis complications

34
Q

Elevated opening pressure and extremely elevated WBCs in the CSF indicates what type of Meningitis?

A

Bacterial

35
Q

Glucose levels for Bacterial, Viral, Fungal Meningitis in the CSF?

A 
Bacterial = LOW
Viral = Normal
Fungal = LOW
36
Q

What is Infectious Encephalitis?

A

Inflammatory process of the brain usually due to a virus

37
Q

What is a common cause of Infectious Encephalitis?

A

Herpes Simplex Virus 1 (HSV1)

38
Q

With Herpes Simplex 1 Encephalitis, what will the MRI and EEG demonstrate abnormalities in?

A

Temporal lobes

39
Q

What is the treatment for Herpes Simplex 1 Encephalitis?

A

Acyclovir

40
Q

A patient presents with Herpes Simplex 1 Encephalitis, they are treated and make a recovery. They later return with neuropsych symptoms. What has likely developed?

A

AUTOIMMUNE Encephalitis

41
Q

What is Autoimmune Encephalitis?

A

Autoimmune cause of Encephalitis that can mimic infectious encephalitis

42
Q

What symptoms are Autoimmune Encephalitis’s usually associated with?

A

Seizures/untreatable epilepsy

43
Q

What are the 2 common types of Autoimmune Encephalitis?

A
  1. NMDA Encephalitis

2. LGI1 Encephalitis

44
Q

If Autoimmune Encephalitis is suspected but the CSF results are NOT back yet, should you treat the patient?

A

YES

45
Q

In what patients is NMDA Encephalitis more common?

A

Young/middle aged WOMEN

46
Q

How does NMDA Encephalitis usually present?

A

SUDDEN psych symptoms!

47
Q

With NMDA Encephalitis, what will the EEG show?

A

Extreme delta brush

48
Q

What is NMDA Encephalitis commonly associated with the presence of?

A

Teratoma

49
Q

What is the treatment for Autoimmune Encephalitis?

A

Immune suppression

50
Q

How long does recovery take with NMDA Encephalitis?

A

May take a long time, upwards of a year

51
Q

In what patients is LGI1 Encephalitis more common?

A

MEN

52
Q

How does LGI1 Encephalitis usually present?

A

Faciobrachial dystonic seizures

– face and arm on the same side briefly seize

53
Q

A patient presents with brief seizures involving one side of the face and the same sided arm. What associated abnormality may be seen on the brain and what behavior disturbance may be reported?

A

Abnormality of the brain = temporal lobe abnormality

Behavior disturbance = sleep disturbances

54
Q

Do the faciobrachial seizures respond to drugs with LGI1 Encephalitis?

A

NO – often drug resistant

55
Q

If the brain looks like grape jelly, what type of stroke occurred?

A

Hemorrhagic stroke

56
Q

If the brain looks like rose’ wine, what type of stroke occurred?

A

Ischemic stroke that then underwent hemorrhagic conversion

57
Q

With the treatment of a stroke, what symptom should NOT be treated?

A

Acute HTN should not be treated

58
Q

With the treatment of a stroke, IV fluids should NOT contain what?

A

Glucose

59
Q

If the NIH stroke scale number is lower, what does that correlate with?

A

LESS change of hemorrhage

60
Q

With a stroke, what should be given within a few hours of the onset and what is a possible treatment if a large vessel is affected?

A

t-PA thrombolytic therapy

– Endovascular therapy (clot retrieval) along with t-PA for large vessels

NMSP (28 decks)

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