Headache

Question 1

How do tension headaches typically present?

Answer 1

Generalised, bilateral headaches that feel like a ‘tight band’

Anaglesics are useful

Associated with stress and disturbed sleep

Question 2

How should you manage Tension headaches?

Answer 2

Conservative - Avoid Triggers and Analgesia

Look out for Medication-Overuse Headaches

Question 3

How do Migraines present?

Answer 3

Unilateral, Paroxysmal

Pulsating

Aura, Photophobia, Phonophobia

Visual Changes, Tingling, Numbness

Sitting in a dark, quiet room helps

Question 4

What can trigger migraines?

Answer 4

CHOCOLATE

Hangovers

Orgasms

Cheese/Caffeine

Oral Contraceptive

Lie-ins

Alcohol

Travel

Exercise

Question 5

How do you manage a Migraine?

Answer 5

Conservative

Acute Medical - Simple Analgesics, Triptans

Preventative - Beta Blockers, Antiepileptics (topiramate), Amitryptiline (Antidepressant)

Question 6

How do Cluster Headaches present?

Answer 6

Recurrent, Sever, Unilateral Headaches.

Cyclical Pattern

Typically Behind the eye

The eye may become red and water

Ptosis, Nasal Congestion

Question 7

What is Trigeminal Neuralgia?

Answer 7

Facial pain in the distribution of 2 or more of the divisions of the Trigeminal Nerve.

Associated with Multiple Sclerosis

Question 8

What are the triggers of Trigeminal Neuralgia?

Answer 8

Things that compress the affected area:

Eating

Washing your face

Brushing Teeth

Question 9

How does trigeminal neuralgia present?

Answer 9

Unilateral headache along the trigeminal division

Lasts for a few seconds

Stabbing, shooting pains

Question 10

What are the most common causes of meningitis in babies?

Answer 10

E.Coli

Group B Strep

Question 11

What are the most common causes of meningitis in children?

Answer 11

H. influenzae

Strep. pneumoniae

Question 12

What is the most common cause of meningitis in adults?

Answer 12

Neisseria meningitidis

Question 13

What are the most common causes of meningitis in the elderly?

Answer 13

Strep. pneumoniae

Listeria monocytogenes

Question 14

How does meningitis typically present?

Answer 14

Meningism - Neck Stiffness, photophobia

Fever

Non-blanching rash

Vomiting

Seizures

Question 15

What is Kernig’s Sign?

Answer 15

Passive Knee extension is painful when the hips are flexed.

Question 16

What is Brudzinski’s Sign?

Answer 16

Flexion of the hips and knees occurs when the neck is flexed.

Question 17

What does the presence of a non-blanching rash indicate in meningitis?

Answer 17

Meningococcal cause

Question 18

How should you investigate a suspected case of Meningitis?

Answer 18

1) CT if focal neurological signs are observed.
2) CSF Analysis if not

Question 19

How will CSF appear in Bacterial meningitis?

Answer 19

Turbid

Neutrophils (Polymorphs)

Low Glucose

High Protein

Question 20

How will CSF appear in Viral Meningitis?

Answer 20

Clear

Lymphocytes

Normal Glucose and Protein (Protein may also be high)

Question 21

How will CSF appear in TB Meningitis?

Answer 21

Fibrin Web

Raised Lymphocytes

Low Glucose

Raised Protein

Question 22

How should you manage a case of Meningitis?

Answer 22

Benzylpenicillin IV/IM instantly & refer to hospital if Bacterial Meningitis suspected.

Broad Spectrum Antibiotics (Ceftriaxone, Benzylpenicillin, Acyclovir - if viral)

IV dexamethasone to reduce cerebral oedema.

Question 23

What can cause Encephalitis?

Answer 23

Viral - HSV, CMV, EBV, HIV, Measles

Non-Viral - Bacterial Meningitis, TB, Malaria, Listeria, Lyme Disease, Legionella

Question 24

How does Encephalitis present?

Answer 24

Acute-Onset

Fever

Headache

Altered Mental State - Memory, personality, psychiatric changes, impaired consciousness

Seizures

Focal Neurological Signs

Question 25

How do you investigate a suspected case of Encephalitis?

Answer 25

LP Bloods EEG CT/MRI

Question 26

What can cause raised ICP?

Answer 26

Space-Occupying Lesion - Tumour, Abscess, Haemorrhage Hydrocephalus

Question 27

How does raised ICP present?

Answer 27

**Headache** - Bilateral, Gradual, Throbbing, Worse in the morning **Vomiting** **Altered GCS** **Seizures**

Question 28

Which signs may you see in a patient with raised ICP?

Answer 28

Focal Neurological Signs Papilloedema Cushing's Reflex (SBP raise, Irregular Breathing, Bradycardia) 'Cheyne-Stokes Respiration'

Question 29

How should you investigate a suspected case of Raised ICP?

Answer 29

Urgent CT Head

Question 30

How does an Extradural Haemorrhage typically present?

Answer 30

Post-Trauma, commonly shearing of the Middle Meningeal Artery Acute headache, followed by a Lucid Interval Increasingly severe headache

Question 31

How do you investigate a suspected Extradural Haemorrhage?

Answer 31

Urgent Non-Contrast CT scan - Lemon Shaped

Question 32

How do Subdural Haemorrhages typically present?

Answer 32

Elderly and Alcoholics (Brain Atrophy) Gradual onset, continuous headache Fluctuating Consciousness Confusion Personality Changes Raised ICP

Question 33

How would you investigate a suspected Subdural Haemorrhage?

Answer 33

Urgent non-contrast CT-Head - Banana Shape

Question 34

How should you manage a Subdural Haemorrhage?

Answer 34

ABCDE & Neurosurgery referal Admit, Observe and monitor Follow-Up CT in 2-3 Weeks Prophylactic Antiepileptics If Large, Burr Hole/Craniotomy (10mm or more)

Question 35

How do Sub-Arachnoid Haemorrhages present?

Answer 35

Sudden-Onset Worst ever headache Thunderclap presentation Meningism Raised ICP

Question 36

What are the main risk factors for SAH?

Answer 36

Polycystic Kidney Disease Alcohol Smoking Hypertension

Question 37

How would you investigate a suspected SAH?

Answer 37

Urgent Non-contrast CT Head Within 12 Hours, sensitivity decreases with time If CT is normal, Lumbar Puncture Xanthochromia & Oxyhaemoglobin

Question 38

How do CNS tumours generally present?

Answer 38

Headache - Bilateral, Gradual, Throbbing, Morning FLAWS Weakness Focal Neurological Signs

Question 39

How should you investigate a suspected Brain Tumour?

Answer 39

CT/MRI CXR, CT Thorax, Abdo and Pelvis Biopsy (Definitive)