How do you differentiate a migraine from a SAH when both are meningeal origin?
A SAH is really sudden - the patient can remember exactly what they were doing when it hit eg getting something out of the fridge
Who gets idiopathic intracranial pressure?
Overweight females on the OCP
What is idiopathic intracranial pressure?
A neurological disorder of increased intracranial pressure that mimics of the present of a mass lesions but its etiology is not understood - related to venous pressure
What are the clinical features of a raised ICP headache?
Nausea is prominent
Worsened by - valsalva
Present on waking
Better on standing
What is the triad of symptoms of idiopathic intracranial pressure?
Intracranial noise - whooshing sound
What other syndromes can cause thunderclap headache?
Sexual and exertional headache
Primary thunderclap headache
What do you look for when LP someone with ?SAH?
How is idiopathic intracranial pressure Mx?
Carbonic anhydrase inhibitors - Acetazolamide
Surgical - optic nerve fenestration
- Venous stenting
- Shunting of CSF
What is Todd's paralysis?
Is a focal neurological defect (usually weakness) that follows a seizures - subsides after 48 hours
What is scintillating scotoma?
An area of partial alteration in the field of vision
Describe the clinical features of a tension-type headache
Mild to moderate pain
Not usually accompanied by nausea, photo/phonophobia or exercise induction
What are some red flags for headache?
Associated hard neurology
Present one waking
What do you do when there is clinical suspicion of a SAH but the CT is clear?
LP, no excuses!
What proportion of migraines have an aura?
Describe the clinical feature of migraine
Moderate to severe pain
Exacerbated by exercise
May be accompanied with: Nausea, vomiting, vertigo, photo or phonophobia
How does the symptoms of migraine aura progress? How is it useful?
Creeping over minutes, taking a path over the cortex
It's useful for differentiating the symptoms from those caused by a cerebrovascular event that all occur immediately