head injuries + headaches!

Question 1

when do you need to do a CT within 1 hour after a head injury

Answer 1

GCS <13 on assessment, GCS <15 at 2 hours post injury, more than one vomit, seizure, sign of a basal skull fracture

Question 2

when do you do a CT head within 8 hours of a head injury

Answer 2

dangerous mechanism of injury like RTA, age 65 years or older, on anticoags

Question 3

where is brocas area

Answer 3

left inferior frontal gyrus (frontal lobe)

Question 4

where is wernickes area

Answer 4

superior temporal gyrus

Question 5

where do cluster headaches affect

Answer 5

around the eye, unilateral (+ANS symptoms like ptosis, watery eye, rhinorrheoa)

Question 6

Acute Mx of cluster headaches

Answer 6

O2 and SC triptans

Question 7

prophylaxis of cluster headaches

Answer 7

veramapil

Question 8

MAO of triptans

Answer 8

5HT1 agonist

Question 9

when are triptans contraindicated

Answer 9

in cardiovascular disease

Question 10

Other MX points for headache

Answer 10

headache diary

Question 11

how does controlled hyperventilation work in raised ICP

Answer 11

causes hypocapnia which causes vasoconstriction to reduce blood into brain

Question 12

number of days using analgesia for classification of a medication over use headache

Answer 12

simple analgesics 15 days or triptans 10n days

Question 13

how long can people be advised that their headaches will get better after stopping analgesia in a medication over use headache

Answer 13

6 weeks, then they can restart but for no more than 10n days a month

Question 14

how is IIH diagnosed

Answer 14

LP - CSF opening of >25

Question 15

MX of IIH

Answer 15

lose weight
repeated LP
acetazolamide (reduce CSF production)
Surgical Mx –> CSF shunting or optic nerve sheath fenestration to protect optic nerve

Question 16

imaging for venous sinus thrombosis

Answer 16

MRI venogram

Question 17

Tx for venous sinus thrombosis

Answer 17

FIRSTLINE - LMWH or UFH

may need thrombolysis

Question 18

characteristics of a post traumatic headache

Answer 18

occurs within 7 days of the head trauma, at the site of injury and will settle in time

Question 19

Ix for a raised ICP

Answer 19

LP contraindicated
CT/MRI to look at underlying cause
Invasive ICP monitoring

Question 20

Mx of a raised ICP

Answer 20

Tx the underlying cause
-keep head of bed elevated to 30 degrees
-controlled hyperventilation
-shunt
-IV mannitol

Question 21

where does blood pool in a SAH

Answer 21

in the basal cisterns

Question 22

signs of a SAH

Answer 22

-thunderclap headache
-seizures
-CN palsy
-cushings triad
-neck stiffness

Question 23

Mx of a SAH

Answer 23

-discuss urgently with the neurosurgical team
-surgery to COIL (now preferred) the aneurysm
-ventricular drain
-nimodipine - prevent vasospasm

Question 24

most common cause of a CES

Answer 24

lumbar disc herniation

Question 25

do you get UMN or LMN signs with CES

Answer 25

LMN

Question 26

what is a primary vs a secondary head injury

Answer 26

a primary head injury can be focal or diffuse a secondary head injury is when cerebral oedema, ischaemia, infection, herniation, exacerbates the original injury

Question 27

Ix for encephalitis

Answer 27

LP - elevated lymphocytes and protein and do viral PCR on CSF -EEG -HIV testing -MRI

Question 28

where are changes most common seen in encephalitis

Answer 28

medial temporal and inferior frontal lobe

Question 29

Mx for encephalitis

Answer 29

IV aciclovir (before results)

Question 30

most common causes of meningitis in children younger than 28 days

Answer 30

-group B strep -E coli

Question 31

what should contacts of meningitis receive

Answer 31

oral cipro or rifampicin for 7 day s

Question 32

Ix for SAH

Answer 32

1) non contrast CT -if done within 6 hrs --> and negative no need to LP 2) if 6-12 hr do LP after 12 3) CT cranial angiogram 4) if CT does not show aneurysm but still suspecting do a MRA

Question 33

MX of an acute subdural haemorrhage

Answer 33

1) decompressive craniectomy (remove part of skull) if big bleed to prevent brain stem herniation 2) craniotomy --> both evacuates blood and reduces ICP

Question 34

how is chronic subdural haemorrhage managed

Answer 34

1) can be managed conservatively if there is no neurological deficit 2) if there is neurological deficit use burr holes

Question 35

classifications of subdural haemorrhage

Answer 35

acute < 3days subacute 3-21 days chronic >21 days

Question 36

Initial MX for brain haemorrhage

Answer 36

1) A-E 2) correct any coagulopathies 3) consider anticonvulsants 4) may give IV mannitol to reduce ICP temporarily through osmotic effect

Question 37

most common cause of a subdural haematoma is

Answer 37

trauma (can also be caused by aneurysm)

Question 38

most common cause of SAH

Answer 38

aneurysm

Question 39

3 groups of people to think about with a subdural haematoma

Answer 39

1) alcoholics 2) elderly 3) children (shaken baby syndrome)

Question 40

what is intracerebral haemorrhage more commonly thought of as

Answer 40

a hemorrhagic stroke

Question 41

where does an extradural haematoma occur

Answer 41

between the skull and the dura matter (MMA lies underneath pterion)

Question 42

signs of a extradural haematoma

Answer 42

pain over the pterion, reducing consciousness, CN palsy (CNIII), UMN lesions, motor or sensory deficits

Question 43

MX of EDH

Answer 43

1) burr hole craniotomy 2) trauma craniotomy (decompress and allow access to the bleeding but think of a bone flap rather than removal of part of the skull) 3) decompressive craniectomy if particularly large bleeding

Question 44

complications which can occur from all the brain haemorrhages

Answer 44

-herniation syndromes -meningitis -long term disability -seizures

Question 45

how does a cerebral abscess present

Answer 45

headache, focal neurology and normally hx of sinusitis (can also be due to direct inoculation)

Question 46

how is a cerebral abscess treated

Answer 46

craniotomy!! to give access to the abscess so it can be drained and antibiotics and dexamethasone

Question 47

firstline Tx for migraine

Answer 47

1) paracetamol or aspirin or ibuprofen