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Flashcards in Headaches Deck (30):

what would you think of for a unilateral head ache?

cluster headache and migraine


what are the red flags for a headache on history?

1. morning headache
2. meningitis pain
3. in the setting of another significant illness
4. sudden thunderclap headache


what predisposes cerebral aneurysms?

1. family hx of aneurysms
2. Polycystic kidney disease
3. hypertension/smoking
4. connective tissue disorders


what should you consider if a young person dies in their sleep?

ruptured aneurysm or cardio-arrhythmia (sudden cardiac death) or analphylaxis


What are some benign causes of thunderclap headache

1. Reversible cerebral vasoconstriction syndrome
2. headache associated with orgasm
3. headache associated with exercise


what are the 6 headaches NOT to miss?

SAH, Meningitis/encephalitis, subdural haematoma, space occupying lesion, giant cell arteritis, glaucoma


who should get a CT brain scan?

1. query stroke
2. anyone who presents with a 'new headache'
3. anyone who presents with recurrent headaches


what do we mean by sentinel headache?

headache prior to SAH, important for neurosurg management.


what is SAH associated with?

hydrocephalism and meningitis signs


what are the 2 main causes of SAH?

ruptured cerebral aneursym (70%) and ruptured arteriovenous malformation (10%)


what are some rare causes of SAH?

spinal arteriovenous malformation, arterial dissection, tumour, bleeding diathesis


is raised intracranial pressure a contraindication for LP?

no if there is no pressure difference between the head and the spinal cord--> if pressure difference present then coning can occur


what are the 4 main categories which can cause a raised ICP?

too much CSF, too much brain, too much blood in venous sinuses--> raised ICP, another thing that shouldn't be there such as an abscess/intracerebral haematoma, brain tumour


What are the symptoms of raised ICP?

1. headache- morning, generalised
2. nausea and vomiting (you always hyperventilate after you vomit)
3. blurred vision related to papilloedema
4. altered conscious state due to pressure on the midbrain
5. cushings reflex (coning)


what causes morning headache?

raised ICP due to hypercapnia (arterial vasodilation from high CO2 due to hypoventilation during sleep) and pressure gravity


what is the cushing's reflex?

Coning due to raised ICP--> get high blood pressure and drop of HR = Cushing's reflex. Due to autonomic control


how might we drain CSF?

VP shunt or external ventricular catheter


what is normal ICP

10-15 mmHg


management of raised ICP? important!

1. sit the patient up to encourage venous return
2. diuresis to reduce cerebral odema/ECF (mannitol)
3. hyperventilate (to get rid of excess arterial blood, however too much is no good)
4. sedate/paralyse (reduces metabolic rate)
5. remove mass if present
6. drain hydrocephalus


how might we surgically treat an aneurysm?

clipping or coiling. Moving now towards coiling.


which diuretic do we like to used for raised ICP

simple, fast, non toxic


what are the 4 signs of transtentorial herniation?

1. unilateral dilated pupil (3rd nerve palsy)
2. contralateral hemiparesis (midbrain)
3. hypertension/bradycardia (cushion's reflex)
4. respiratory failure


Just say the CT scan for SAH (clinical story= thunderclap headache and is highly suspicious for SAH) comes back negative. what would you do?

LP. If there is blood in the 3 tubes of CSF, it is highly likely SAH has occurred. this is because blood in the csf indicates blood in the subarachnoid space


what other characteristics of LP do you see in SAH?

1. high opening pressure; 2. high xanthochromia after centrifuging; 3. blood in the CSF vials


what is another Ix that you could order other than LP and CTB if you suspect a cerebral aneurysm>

CT angiogram, DSA (digital subtraction angiography)


what are the 3 types of grading systems for SAH?

Hunt and Hess, Fisher grade; World's federation of neurosurgeons


symptoms of cluster headaches?

▪ Excruciating pain
▪ Lacrimation
▪ Rhinorrhea
▪ Partial Horner's syndrome
▪ Nausea and vomiting
▪ Agitation
Sometimes an aura may be present


what is the alternative name for idiopathic intracranial hypertension?

pseudotumour cerebri


risk factors for IIH?

• Female
• Overweight
• On OCP
• FMH of IIH
• Sleep apnea
Venous thrombosis


complications of SAH?

death, coma, hydrocephalus, raised ICP, coning