HA, Cohen Flashcards Preview

Year 2 neuro exam 2 > HA, Cohen > Flashcards

Flashcards in HA, Cohen Deck (58):
1

Primary HA

no obvious pathologic cause
migraine, cluster, tension type

2

secondary HA

pathological cause: tumor hemorrhage infection

3

warning signs and Sx of secondary HA

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

PE for HA

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

imaging for recurrent migraines

no CT or MRI unless recent change in HA pattern, focal neurologic signs or Sx

6

imaging for nonmigraine HA

CT MRI role unclear

7

imaging more likely to show cause for HA

MRI

8

imaging for HA in pregnancy

MRI w/o contrast

9

LP necessary for

Dx meningitis or encephalitis or possible carcinomatous meningitis
confirm subarachnoid hemorrhage but no blood on CT or MRI

10

increased opening pressure in LP

it can help Dx pseudotumor cerebri or idiopathic intracranial HTN

11

Dx primary headache syndrome

clinical features

12

characteristics of migraine features

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

migrain criteria

>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

most common HA type that patients seek medical care

migraine

15

migraine demographics

W>africans>asians

16

genetics in migraines

possible 80% close family members with migraines too

17

transmission of migraine genetics

mother to daughter

18

mutations for familial hemiplegic migraine

Na and Ca Channels in neurons

19

causes of migraines

environmental factors "triggers"
psychiatric disorders
hormones: migraines can end with menopause

20

triggers for migraines

fasting, medication, circadian rhythms, environment, hormones, stress/overexertion

21

visual auras before migraines

blurred vision or blind spots
seeing flashing lights
seeing jagged lines
difficulty in focusing

22

sensory or motor changes before migraines

numbness or tingling of lips, face of hands on one side body
weakness in arms or legs, usually one side body

23

speech or language changes before migraines

inability to understand words
loss of speech or inability to speak normally

24

wolff concluded migraine pain from

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

cortical spreading depression

sudden brief depolarization of cortical neurons, followed by reduction in neuronal depolarization and synaptic transmission

26

pain for migraine on PET

region of pons active up to 30 minutes before there is an increase in blood flow to brain

27

increased activity to CN V leads to what

secondary vasodilation and inflammation of dura mater
"trigeminovascular activation"

28

what NT are released from pons in migraine

serotonin
CGRP
substance P
NO

29

what is increased in urine from migraine attack

increased 5-hydroxyindoleacetic acid in urine from increased release serotonin 5-hydroxytyptamine

30

migraine ends with what

when neurons stop releasing more serotonin

31

sumatriptan

serotonin 1b 1d agonist
effective in stopping migraine attack by binding these inhibitory serotonin autoR

32

what is in migraine center

dorsal raphe nucleus
locus coeruleus

33

antagonists to what molecule help stop migraine

CGRP
help show not purely vascular process because CGRP has no role in vasoconstriction

34

most common type HA

tension type

35

clinical features tension type HA

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

average length chronic tension type HA

>15/mo
avg duration >4 hr/day if untreated and history >6 mo

37

chronic tension type HA should not take what

more than one analgesic a week

38

common findings with tension type HA

HTN
depression
anxiety
insomnia
DM/hypoglycemia

39

pain pills in people with frequent HA

cause increase frequency

40

cluster HA characteristics

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

intense unilateral HA causing patient to bang head on wall

cluster HA

42

autonomic features of cluster HA

conjunctival injection
lacrimation
congestion
rhinorrhea
swelling
miosis
ptosis
eyelid edema

43

weight gain abnormal vision and HA

secondary HA

44

pseudotumor cerebri

idiopathic intracranial HTN

45

signs pseudotumor cerebri

-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

what can occur in idiopathic intracranial HTN if not Dx early

irreversible loss of visual acuity
often extraocular palsy
CN VI III IV

47

Dx idiopathic intracranial HTN

spinal tap P and imaging

48

Tx idiopathic intracranial HTN

weight loss, corticosteroids, carbonic anhydrase inhibitors, topiramate

49

Trigeminal neuralgia
tic douloureux

brief shooting pain lasting only a sec
triggered by facial contact
one branch CN V

50

triggers for trigeminal neuralgia

touching face
eating
shaving
applying lipstick or makeup

51

causes trigeminal neuralgia

idiopathic

52

age of trigeminal neuralgia

uncommon under 50 y.o
unlesss brainstem lesion, MS tumors

53

Giant Cell Arteritis

temporal
example of vasculitis
non-infectious inflammation of aa leading to gradual occlusion
involves superficial temporal a (off external carotid a)

54

temporal arteritis can spread how leading to what complication

to adjacent internal carotid a
reaching ophthalmic a and cause complete visual loss via ischemia

55

other Sx temporal arteritis

fatigue
difficulty chewing
pain in neck and shoulders

56

giant cell arteritis component of

polymyalgia rheumatica

57

Dx temporal arteritis

ESR and CRP
confirmed by superficial temporary artery biopsy

58

cure for temporal arteritis

prednisone within 1st weeks of onset!!
typically 60 mg per day then gradually and slowly dec over mo