Colloquium: Severe Headache Flashcards Preview

Hugh's MD2 Gen Med > Colloquium: Severe Headache > Flashcards

Flashcards in Colloquium: Severe Headache Deck (20):
1

Which headaches are typically unilateral?

Migraine

Cluster

2

Red flags for headache?

Fever

Nausea, vomitting

Morning headache

Sudden onset

3

What predisposes someone to cerebral aneurysms?

Polycystic kidney

FHx

Connective tissue disorders

Smoking, HTN

4

What is a sentinal headache?

A small haemorrhage causing a milder headache

Precursor to a more severe subarachnoid

5

What are some causes of sudden death?

Sudden cardiac death

Aneurysms

6

Not to miss headaches?

Subarachnoid haemorrhage

Meningitis/encephalitis

Subdural haematoma

Space occupying lesion

Giant cell arteritis

Glaucoma

7

What causes focal neurological signs in subarachnoids?

Intracerebral component of bleeding

Local pressure of the aneurysms

Cerebral vasospasm

8

What do you do if CT is clear when SAH is suspected? What would you find?

LP

RBC

Blood breakdown products

- Xanthochromia (yellow CSF)

9

What pain management is safe for a patient with SAH?

Small IV doses of morphine

- Don't want to sedate as it will prevent the use of GCS to monitor patient

10

Why is it ok to LP someone with SAH hydrocephalus?

Because the pressures in the cranium and cord are the same

11

How does CSF get absorbed into venous system?

Via arachnoid granulations

 

12

Why does hydrocephalus occur in SAH?

Blood blocking the arachnoid granulations

13

Symptoms of raised ICP?

Nausea and vomiting

Headache - non-localised, morning headache

Blurred vision

Changes in conscious state

Blown pupil

Cushing reflect

14

Why do you get morning headaches with raised ICP?

Venous system is at the same level as the heart

Hypercapnia causes arterial vasodilation

15

How to reduce raised ICP?

Elevate head

Diuresis to reduce cerebral oedema (manittol)/extracellular fluid

Hyperventilation/avoid hypoventilation - can't do that too much

Sedate/paralyse

Remove Mass

Drain hydrocephalus

16

What are the symptoms of meningism?

Headache

Photophobia

Neck stiffness

Nausea/Vomiting

Fever

17

Apart from aneurysms what are some other causes of SAH?

Ruptured AVN

Spinal artheriovenous malformation

Tumour

Arterial dissection

Bleeding diathesis

18

How are SAH Mx?

Get normotensive

Avoid pain, straining, agitation, cough

Clip or coil

19

What is the Monro-Kellie doctrine?

ICP is directly related the contents of the cranium

20

What are the common sites for aneurysms to develop?

Acom (30-35%)

Bifurcation of internal carotid and Pcom (30-35%)

Bifurcation of MCA (20%)

Basillar bifurcation (5%)

Other posterior (5%)