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3MB Neurology > Headache and Intracranial Bleeds > Flashcards

Headache and Intracranial Bleeds Flashcards

1
Q

List red flag symptoms/signs related to headache

A 
New onset in over 55 yr old
Known/previous cancer
Immunosuppressed
Early morning onset
Exacerbated by valsalva
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2
Q

What is a migraine?

A

Severe throbbing pain on one side of the head

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3
Q

Migraine affects males more than females. True/False?

A

False

Females more than males

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4
Q

What is the difference between migraine with and without aura? Which is more common?

A

Migraine with aura: warning signs before migraine begins, e.g. flashing lights
Migraine without aura is more common

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5
Q

What is the criteria for diagnosing migraine without aura?

A

At least 5 attacks in 72 hours
Moderate/severe unilateral throbbing pain, worse on movement
Autonomic features or photophobia/phonophobia

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6
Q

What is the pathophysiology of migraine?

A 
Vascular and neural influence
Stress triggers serotonin release
Trigeminovascular system activation
Blood vessel constriction-dilation
Substance P irritates nerves and vessels, causing pain
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7
Q

How long do auras typically last in migraine?

A

20-60 mins

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8
Q

List some visual auras

A

Central scomata
Central fortification
Hemianopia

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9
Q

List triggers of migraine

A 
Sleep
Diet
Stress
Physical exertion
Hormones
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10
Q

List non-pharmacological treatment for migraine

A

Trigger diary
Education
Stress management

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11
Q

List pharmacological management of migraine

A

NSAID + anti-emetic if vomiting

Triptans (rizatriptan)

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12
Q

When should prophylaxis be considered for migraine?

A

More than 3 attacks in a month or very severe

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13
Q

List prophylactic therapy for migraine

A 
Propranolol
Topiramate
Amitryptilline
Gabapentin
Sodium valproate
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14
Q

What type of drug is topiramate and what are its adverse effects?

A

Carbonic anhydrase inhibitors

Weight loss, paraesthesia, impaired concentration

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15
Q

What are trigeminal autonomic cephalgias?

A

Headache disorders characterised by unilateral pain in a trigeminal distribution with ipsilateral cranial autonomic features

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16
Q

List some ipsilateral cranial autonomic features

A 
Ptosis
Miosis
Nasal stuffiness
Nausea, vomiting
Tearing
Eyelid oedema
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17
Q

List the 4 main types of trigeminal cephalgias

A

Cluster headache
Paroxysmal hemicranias continua
Hemicrania continua
SUNCT

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18
Q

Who gets cluster headaches more - men or women?

A

Men

Typically 30-40 yr olds

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19
Q

When do cluster headaches typically come on?

A

Around sleep time

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20
Q

Describe a cluster headache

A

Severe unilateral headache lasting 20mins-3hrs

1 to 8 episodes a day

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21
Q

Outline management of cluster headache

A 
MRI scan
High flow oxygen
Sumatripan
Steroid
Verapamil for prophylaxis
22
Q

Who gets paroxysmal hemicranias continua more - men or women?

A

Women

Typically 50-60 yr olds

23
Q

How would you distinguish paroxysmal hemicranias continua from cluster headache?

A

Shorter duration, more frequent

24
Q

Which drug provides absolute response to paroxysmal hemicranias continua?

A

Indomethicin

25
What is a SUNCT trigeminal cephalgia?
``` Short Unilateral Neuralgia Conjunctival injections Tearing ```
26
What is the treatment for SUNCT?
Gabapentin
27
Who gets trigeminal neuralgia more - men or women?
Women | Typically elderly
28
What typically triggers trigeminal neuralgia?
Touch in V2/V3 region
29
How long does an episode of trigeminal neuralgia usually last?
1-90 seconds | 10-100 episodes a day
30
List treatment for trigeminal neuralgia
``` Carbamazepine Gabapentin Phenytoin Baclofen Surgical decompression ```
31
List the 3 main spontaneous intracranial haemorrhage disorders
Subarachnoid haemorrhage Intracerebral haemorrhage Intraventricular haemorrhage
32
Where does bleeding occur in a subarachnoid haemorrhage?
Into subarachnoid space that encloses CSF
33
What is the most common underlying pathology in a subarachnoid haemorrhage?
Berry aneurysm | Otherwise arteriovenous malformation or no identifiable cause
34
List typical clinical features of a subarachnoid haemorrhage
Sudden onset "thunderclap" headache Collapse Meningism - vomiting, photophobia, neck pain
35
Subarachnoid haemorrhage can occur whilst having sex. True/False?
True
36
Which cranial nerve can be particularly affected in subarachnoid haemorrhage?
CN III
37
What may be seen on fundoscopy in someone who has had a subarachnoid haemorrhage?
Retinal or vitreous haemorrhage
38
CT scan of a brain may be normal in subarachnoid haemorrhage. True/False?
True Depends on delay Once blood spills out bleeding may stop
39
If a CT scan of a person with suspected subarachnoid haemorrhage is normal, what is the next best investigation?
Lumbar puncture
40
Describe CSF appearance on lumbar puncture in subarachnoid haemorrhage
Xanthochromatic or bloodstained
41
What investigation is gold-standard for identifying bleeding location of a subarachnoid haemorrhage?
Cerebral angiography with/without CT
42
List some complications of subarachnoid haemorrhage
``` Re-bleeding Hydrocephalus Hyponatraemia Seizure Delayed ischaemia ```
43
How is re-bleeding in the brain addressed?
``` Endovascular repair (mainstay) Surgical clipping ```
44
When might delayed ischaemic neurological deficit occur post- subarachnoid haemorrhage? What is the drug of choice to treat?
3-12 days | Nimodipine
45
What is the H triple therapy used for delayed ischaemic neurological deficit?
Hypervolaemia Haemodilution Hypertension
46
How does hydrocephalus arise?
Increase in intracranial CSF pressure
47
How is hydrocephalus treated?
CSF drainage - lumbar puncture, ventricular drain, shunt
48
Why should you not fluid restrict someone with hyponatraemia as a complication of subarachnoid haemorrhage?
Will cause hypovolaemia, predisposing to vasospasm and cerebral ischaemia
49
What is the most common aetiology/risk factor for intracerebral haemorrhage?
Hypertension leading to microaneurysm
50
Typically where does a hypertensive intracerebral haemorrhage affect anatomically?
Basal ganglia (haematoma)
51
List the main investigations for intracerebral haemorrhage
``` CT scan (urgent if decreased consciousness) Angiography ```

3MB Neurology (17 decks)

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