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Flashcards in Clinical- 6 Deck (50):
1

Which nerve innervate the anterior/middle fossa?

V

2

Which nereves supple the posterior fossa?

IX and X

3

What are the common causes of acute headaches?

SOMATIC DYSFUNCTION UP IN THIS BITCH
Subarachnoid Hemorrhage
Other Cerebrovascular diseases
Meningitis/encephalitis
Ocular Diseases (glaucoma)

4

What are the common causes of Subacute headaches?

Giant Cell (temporal) arteritis
Intracranial Mass (tumor, subdural hematoma, abcess)
Pseudotumor cerebri (benign intracranial hypertension)
Trigeminal neuralgia
Glossopharyngeal neuralgia
Postherpetic neuralgia
Hypertension
Atypical Facial Pain

5

What are the common causes of chronic headaches?

Migraine
Cluster Headache
Tension headache
Cervical Spine Disease
Sinusitis
Dental Disease

6

Subarachnoid hemorrhage (SAH)- causes

ruptured berry aneurysm from sites of branching arteries. can be from AV malformations too. polycystic kidney disease is assocaited with berry aneurysms

7

SAH- Sx

Worst headache ever. new headache. ↑ BP, global Sx (except AVMs and PCA aneurysms).

8

SAH- Dx

CT for confirmation, CSF has blood, u can do a cerebral arteriography

9

SAH- Tx

↓ BP. Nimodipine blocks Ca channels to reduce vasospasm. Surgery for mild cases

10

SAH- complications

recurrence, intraparenchymal extension, ischemia from arterial vasospasm, hydrocephalus, szrs

11

SAH- prognosis

60% die within the 1st day, but survivors can be either in a coma or Sx free. 1/2 have brain dmg.

12

Giant cell arteritis (GCA)- cause

granulomatous inflammation of the external carotids (sup temporal a.), women > 55

13

GCA- Sx

pain in jaw during chewing, blindness in 50% of pts

14

GCA- Dx

Bilateral biopsy for patchy inflammation, ESR is ↑↑↑

15

GCA- Tx

initially it's prednisone (antinflamm)

16

GCA- consequences

blindness is irreversible

17

Intracranial mass- Sx

headaches with different Sx depending on where the mass is and what the mass it.

Key: bifrontal pain, worse ipsilaterally, worse when u change position, worse when you INCREASE ICP (pooping, sneezing, coughing)

18

Intracranial mass- Dx

CT/MRI right away

19

Intracranial mass- Tx

removal of the offending lesion via surgery, radiotherapy, chemotherapy.

20

Idiopathic intracranial HTN (IIH)- cause

unknown, so u gotta rule out other disorders that cause intracranial HTN

21

IIH- Sx

headache, papilledema, visual loss, floaters, blurring, diplopia, pulsatile tinnitus

22

IIH- Dx

rule everything out by CT/MRI/LP. optic nerve sheath dilation is key.

23

IIH- Tx

acetazolamide or furosemide

24

Trigeminal neuralgia- cause

vascular compression of V

25

Trigeminal neuralgia- Sx

pain in V2/V3 region of the face, super hyperalgesia

26

Trigeminal neuralgia- Dx

nothing really. the vascular structures are too small to see

27

Trigeminal neuralgia- Tx

use of carbamazepine, or phenytoin (IV for acute attacks, oral for regular use); Lamotrigine or baclofen for refractory cases

28

Postherpetic neuralgia- cause

Herpes Zoster reactivation of VZV, specifically in a dermatome fashion, occurs mostly in older >70 patients

29

Postherpetic neuralgia- Sx

severe buring pain in a dermatome, usually V1, scarring

30

Postherpetic neuralgia- Dx

Hx of VZV infection, decreased sensations

31

Postherpetic neuralgia- Tx

ACV, corticosteroids, tricyclics for the pain

32

Migrane- cause

intracranial vasoconstriction and extracranial vasodilation, pulsatile headaches that have premonitory symptoms (mood, appetite), affects mostly women, and has familial history

33

Migranes- Tx

simple analgesics (ASA, otc stuff), ergot preparations (ergotamine, caffeine), narcotics, 5HT agonists

34

Migraines- prophylactics

NSAIDS, tricyclics

35

Migraines- precipitating factors

foods, tyramine containing foods, hotdogs, cheeses, nitrites, food additives like MSG, and a variety of other

36

Migraines with aura- pathogenesis

migrane preceeded by aura, called a classic migraine

37

Migraines with aura- Sx

throbbing, unilateral headache with signs of N/V, etc. gradual onset

38

Migraines with aura- Dx

Increased white matter lesions

39

Migraines w/o aura- Dx

compression of ipsilateral carotid or superficial temporal artery

40

Transformed Migraine- pathogenesis

episodic migraine that changes into a daily occurance over a period of months/years

41

Transformed Migraine- Sx

varies between migrane-like or tension headache

42

Cluster headache- epidemiology

more men than women, at around 25, no familial history, and are always unilateral, and seems to originate from the hypothalamic grey area

43

Cluster headache- Sx

burning sensation over lateral aspect of nose or pressure behind the eye, conjunctival injection, ptosis, lacrimation, nasal stuffiness, and horner syndrome also present

44

Cluster headache- acute Tx

sumatriptan, Zolmitriptan nasal spray, dihydroergotamine

45

Cluster headache- prophylaxis

verapamil sustained release, ergotamine, prednisone, lithium

46

Cluster headache- preceipitation

alcohol

47

Tension Headache- cause

unknown

48

Tension headache- Sx

tight band of pain around head, contraction of neck/scalp muscles,

49

Tension headache- Tx

same as migraine - Acute Attack - aspirin, NSAIDs, acetominophen, ergotamine, dihydroergotamine; prophylaxis - amitriptyline or imipramine (DO NOT use SSRI's)

50

Tension headache- precipitation

stress/hunger