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Flashcards in Conditions Deck (21)
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1

What are primary headaches?

Refer to disorders with no secondary underlying pathology e.g. migraine

2

What are secondary headaches?

- Space occupying lesion - increased pressure
- Intracranial hypertension
- Vasculitis/arteritis

3

What is cortical spreading depression?

Initiated by slowly propagated wave of depolarization in neurones and glial cells. This is followed by a sustained suppression of spontaneous neuronal activity.

4

What conditions does cortical spreading depression occur in?

- Cerebrovascular accident
- SAH
- Traumatic brain injury
- Epilepsy
- Migraine

5

What are some trigger factors for migraines?

- Relaxing after stress
- Menstruation - triggered by oestrogen decline
- Jet-lag - change in sleep pattern
- Cheese - food containing tyramine, red wine, cheese, chocolate, citrus fruits
- Flickering lights on tv screen - bright lights, loud sounds

6

What are the differentials of meningitis?

- Encephalitis: most common cause is herpes simplex virus (HSV). This is inflammation of the brain and causes confusion, disorientation, drowsiness. seizures, changes in personality and behaviour e.g. agitated.
- Non-infectious causes (blood, trauma, drugs) of meningeal irritation
- Subdural empyema

7

What are the risk factors for meningitis?

- Extremes of age
- Living in close proximity - outbreaks can occur in student halls and boarding schools
- Vaccination history (absence of)
- Immune suppression/deficiency

8

Who is most at risk of meningitis?

- Immunocompromised people to infections caused by less common organisms
- Neonates and children under 1 year of age are particularly vulnerable to meningitis, as their BBB is not fully developed

9

What do you need to ask in a history for meningitis?

Recent travel history as some countries have high rates of pneumococcal penicillin resistance.
e.g. Canada, Greece, Italy, Mexico, Poland, Spain, Turkey, USA

10

What are the causes of intracranial space occupying lesions?

- Tumours - primary: benign, malignant or secondary
- Infection
- Vascular
- Hydrocephalus

11

What are the infectious causes of intracranial space occupying lesions?

- Brain abscess
- Subdural empyema
- Granuloma e.g. tuberculosis
- Parasitic

12

What are the vascular causes of intracranial space occupying lesions?

- Extradural haemorrhage - acute/trauma
- Subdural haemorrhage - acute/trauma
- Subarachnoid haemorrhage - spontaneous
- Parenchymal brain haemorrhage - spontaneous
- Caveroma or vascular malformations
- Brain infarction

13

What are the hydrocephalus causes of intracranial space occupying lesions?

- Non-communicating or obstructive - tumours, cysts, intra-ventricular haemorrhage
- Communicating - meningitis, SAH
- Overproduction (rare) - choroid plexus papilloedema

14

What is the WHO grading of glioma?

Grade I: pilocytic astrocytoma (least malignant)
Grade II: low grade astrocytoma
Grade III: anaplastic astrocytoma
Grade IV: glioblastoma multiforme (most malignant)

15

What is meningioma?

- Arises from arachnoid cap cells
- Generally benign
- Trauma, radiation, oncogenic virus and hormones are implicated in their causation but still unclear

16

What is vestibular schwannoma?

- Benign tumour arising from the nerve sheath of vestibular nerves, typically in CP angle
- Usually presents with ipsilateral hearing problems and tinnitus
- 5th, 7th and lower cranial nerves can be affected

17

What is the normal and pathological ICP?

Normal - <15mmHg
Pathological - >20mmHg

18

What influences ICP?

- ICP is lower in children and can be negative in newborns
- Transient elevations occur when coughing/sneezing etc
- Can be negative standing up because of rigid venous sinuses
- Can be influenced by intra-thoracic pressures

19

What are the causes of raised ICP?

Increase in brain/tissue/mass volume
- Cerebral oedema
- SOL - tumour, haematoma, abscess
Increase in CSF volume
- Obstruction to CSF circulation
- Reduced CSF absorption
- Increased CSF production
Increase in blood volume
- Raised arterial pCO2
- Venous obstruction
- Increased temperature

20

What is a cluster headache?

Most severe pain ever lasting 30-120mins. Unilateral, side-locked. Agitation, pacing.

21

What is triptan overuse headache?

- Can be migrainous +/- or tension type
- Triptan intake > 10 days/month for >3 months or analgesics
- Treatment: stop triptan for 2-3 months
- Triptans can cause drowsiness