HA, Cohen Flashcards Preview

Year 2 neuro exam 2 > HA, Cohen > Flashcards

Flashcards in HA, Cohen Deck (58)
Loading flashcards...
1
Q
Primary HA
A
no obvious pathologic cause
migraine, cluster, tension type
2
Q
secondary HA
A
pathological cause: tumor hemorrhage infection
3
Q
warning signs and Sx of secondary HA
A
single HA
sudden onset
onset HA after age 50
recent onset HA <6 mo
systemic disease
change in HA pattern
neuro Sx or abnormal neuro exam
4
Q
PE for HA
A
general appearance
fever or abnormal vital signs, supple neck
mental status, speech, LOC
vision and retinal discs, pupils, EOMI, papilledema
asymmetry of strengths or reflexes
babinski
5
Q
imaging for recurrent migraines
A
no CT or MRI unless recent change in HA pattern, focal neurologic signs or Sx
6
Q
imaging for nonmigraine HA
A
CT MRI role unclear
7
Q
imaging more likely to show cause for HA
A
MRI
8
Q
imaging for HA in pregnancy
A
MRI w/o contrast
9
Q
LP necessary for
A
Dx meningitis or encephalitis or possible carcinomatous meningitis
confirm subarachnoid hemorrhage but no blood on CT or MRI
10
Q
increased opening pressure in LP
A
it can help Dx pseudotumor cerebri or idiopathic intracranial HTN
11
Q
Dx primary headache syndrome
A
clinical features
12
Q
characteristics of migraine features
A
sick HA with light and sound sensitivity
worse with activity
build up intensity
4-72 hours
aura or sensory or motor deficits before pain
13
Q
migrain criteria
A
>5 attacks
>2 of following:
-unilateral
-pulsating
-mod- severe intensity
-aggravation routine physical activity
>1 of following:
-nausea and/or vomiting
-photophobia, phonophobia
No evidence of Hx or exam of disease that might cause HA
14
Q
most common HA type that patients seek medical care
A
migraine
15
Q
migraine demographics
A
W>africans>asians
16
Q
genetics in migraines
A
possible 80% close family members with migraines too
17
Q
transmission of migraine genetics
A
mother to daughter
18
Q
mutations for familial hemiplegic migraine
A
Na and Ca Channels in neurons
19
Q
causes of migraines
A
environmental factors "triggers"
psychiatric disorders
hormones: migraines can end with menopause
20
Q
triggers for migraines
A
fasting, medication, circadian rhythms, environment, hormones, stress/overexertion
21
Q
visual auras before migraines
A
blurred vision or blind spots
seeing flashing lights
seeing jagged lines
difficulty in focusing
22
Q
sensory or motor changes before migraines
A
numbness or tingling of lips, face of hands on one side body
weakness in arms or legs, usually one side body
23
Q
speech or language changes before migraines
A
inability to understand words
loss of speech or inability to speak normally
24
Q
wolff concluded migraine pain from
A
reduction blood flow to occipital Cx in visual aura and the frontal or parietal cortices with other auras
actual pain from increase blood to brain
25
Q
cortical spreading depression
A
sudden brief depolarization of cortical neurons, followed by reduction in neuronal depolarization and synaptic transmission
26
Q
pain for migraine on PET
A
region of pons active up to 30 minutes before there is an increase in blood flow to brain
27
Q
increased activity to CN V leads to what
A
secondary vasodilation and inflammation of dura mater
"trigeminovascular activation"
28
Q
what NT are released from pons in migraine
A
serotonin
CGRP
substance P
NO
29
Q
what is increased in urine from migraine attack
A
increased 5-hydroxyindoleacetic acid in urine from increased release serotonin 5-hydroxytyptamine
30
Q
migraine ends with what
A
when neurons stop releasing more serotonin
31
Q
sumatriptan
A
serotonin 1b 1d agonist
effective in stopping migraine attack by binding these inhibitory serotonin autoR
32
Q
what is in migraine center
A
dorsal raphe nucleus
locus coeruleus
33
Q
antagonists to what molecule help stop migraine
A
CGRP
help show not purely vascular process because CGRP has no role in vasoconstriction
34
Q
most common type HA
A
tension type
35
Q
clinical features tension type HA
A
dull, b/l, squeezing, tight
non pulsating
routine physical acitivty does not aggravate pain
no vomiting and more than one of : nausea, photophobia, phonophobia
MSK component, cervicogenic
medication seldom necessary
36
Q
average length chronic tension type HA
A
>15/mo
avg duration >4 hr/day if untreated and history >6 mo
37
Q
chronic tension type HA should not take what
A
more than one analgesic a week
38
Q
common findings with tension type HA
A
HTN
depression
anxiety
insomnia
DM/hypoglycemia
39
Q
pain pills in people with frequent HA
A
cause increase frequency
40
Q
cluster HA characteristics
A
brief 15 minutes-2 hours
one sided around eye
often 1 hr after falling asleep
occur daily or multiple times a day for weeks or mo at a time "season"
41
Q
intense unilateral HA causing patient to bang head on wall
A
cluster HA
42
Q
autonomic features of cluster HA
A
conjunctival injection
lacrimation
congestion
rhinorrhea
swelling
miosis
ptosis
eyelid edema
43
Q
weight gain abnormal vision and HA
A
secondary HA
44
Q
pseudotumor cerebri
A
idiopathic intracranial HTN
45
Q
signs pseudotumor cerebri
A
-progressive diffuse HA with intermittent loss of vision in 1+ eyes especially with eye movements
- obese young women!! E and P maybe or acutane
- increased intracranial P, from overproduction CSF
opening P >25
papilledema
46
Q
what can occur in idiopathic intracranial HTN if not Dx early
A
irreversible loss of visual acuity
often extraocular palsy
CN VI III IV
47
Q
Dx idiopathic intracranial HTN
A
spinal tap P and imaging
48
Q
Tx idiopathic intracranial HTN
A
weight loss, corticosteroids, carbonic anhydrase inhibitors, topiramate
49
Q
Trigeminal neuralgia
tic douloureux
A
brief shooting pain lasting only a sec
triggered by facial contact
one branch CN V
50
Q
triggers for trigeminal neuralgia
A
touching face
eating
shaving
applying lipstick or makeup
51
Q
causes trigeminal neuralgia
A
idiopathic
52
Q
age of trigeminal neuralgia
A
uncommon under 50 y.o
unlesss brainstem lesion, MS tumors
53
Q
Giant Cell Arteritis
A
temporal
example of vasculitis
non-infectious inflammation of aa leading to gradual occlusion
involves superficial temporal a (off external carotid a)
54
Q
temporal arteritis can spread how leading to what complication
A
to adjacent internal carotid a
reaching ophthalmic a and cause complete visual loss via ischemia
55
Q
other Sx temporal arteritis
A
fatigue
difficulty chewing
pain in neck and shoulders
56
Q
giant cell arteritis component of
A
polymyalgia rheumatica
57
Q
Dx temporal arteritis
A
ESR and CRP
confirmed by superficial temporary artery biopsy
58
Q
cure for temporal arteritis
A
prednisone within 1st weeks of onset!!
typically 60 mg per day then gradually and slowly dec over mo