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
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
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
▪ Partial Horner's syndrome
▪ Nausea and vomiting
Sometimes an aura may be present
what is the alternative name for idiopathic intracranial hypertension?
risk factors for IIH?
• On OCP
• FMH of IIH
• Sleep apnea