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1B Neurology & Neuroscience > Headaches > Flashcards

Headaches Flashcards

1
Q

what are the different patterns of headaches?

A

acute single headache

dull headache- increasing severity or unchanged over months

recurrent headaches

triggered headaches

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2
Q

what are the red flags for headaches?

A

onset

meningism

systemic symptoms

neurological symptoms or focal symptoms

orthostatic (better lying down)

strictly unilateral-same pain in same spot

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3
Q

what are the red flags for onset of headaches?

A

thunderclap

acute

subacute

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4
Q

what are the red flags for meningism headaches?

A

photophobia

phonophobia

stiff neck

vomiting

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5
Q

what are the red flags for neurological symptoms or focal symptoms for headaches?

A
  1. Visual loss
  2. Confusion
  3. Seizures
  4. Hemiparesis
  5. Double vision
  6. 3rd nerve palsy
  7. Horner syndrome
  8. Papilloedema
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6
Q

what are the signs of subarachnoid haemorrhage?

A

sudden generalised headaches (thunderclap)

meningism= stiff neck and photophobia

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7
Q

what are the cause of a subarachnoid haemorrhage?

A

most caused by ruptured aneurysm

few arteriovenous malformations and some unexplained

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8
Q

what are the risks of subarachnoid haemorrhage?

A

50% instantly fatal

high risk further bleeding

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9
Q

what may stop the leak from a subarachnoid haemorrhage?

A

vasospasm

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10
Q

what is the treatment for subarachnoid haemorrhage?

A

nimodipine and BP control

early neurological assessment to confirm bleed and establish cause

CT scan, lumbar puncture (RBC and xanthochromia). MRA angiogram

used to clip or wrap aneurysm, now filled with platinum coils using catheter in groin

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11
Q

what is the cause of acute intracerebral bleed?

A

fatal haemorrhage due to coning

raised ICP causes brainstem death due to compression of brain

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12
Q

what is papilloedema?

A

optic disc swelling due to raised ICP

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13
Q

what can an issue with carotid and vertebral arteries cause?

A

headaches

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14
Q

what are the types of carotid and vertebral artery dissection?

A

traumatic and spontaneous

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15
Q

what are the common symptoms of carotid and vertebral artery dissection?

A

headache and neck pain

20% ischaemic strokes <45years (carotid>vertebral)

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16
Q

how are carotid and vertebral artery dissection detected?

A

MRI/MRA

doppler

angiography

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17
Q

what is the treatment for carotid and vertebral artery dissection?

A

aspirin/angicoagulant

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18
Q

what is seen on the scan of a chronic subdural haemorrhage?

A

areas of black (blood)- black due to clotting

destroyed ventricles and brain pushed onto other side

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19
Q

when is temporal arthritis more commonly seen?

A

over age 55

more common females

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20
Q

what are the signs of temporal arthritis?

A
  • Constant unilateral headache, scalp tenderness, jaw claudication
  • 25% polymyalgia rheumatica- proximal muscle tenderness
  • involvement of posterior ciliary arteries= blindness
  • elevated ESR and CRP
  • temporal arteries inflamed and tortuous
  • visible on ultrasound
  • biopsy shows inflammation and giant cells
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21
Q

what is the treatment for temporal arthritis?

A

high dose steroid and aspirin

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22
Q

what is cerebral venous thrombosis?

A

thrombosis in dural venous sinus or cerebral vein

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23
Q

what are the signs of cerebral venous thrombosis?

A

unusual amount headach due to raised ICP

non-territorial ischemia ‘venous infarcts’

haemorrhage

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24
Q

what are the risk factors for cerebral venous thrombosis?

A

thrombophilia

pregnancy

dehydration

behcets

25
Q

what are the causes of viral meningitis?

A

coxsackie

ECHO

mumps

EBV

26
Q

what are the bacterial causes of meningitis?

A

meningococci

pneumococci

TB

27
Q

what are the fungal causes of meningitis?

A

cyptococci

28
Q

what are the granulomatous causes of menigitis?

A

sarcoid

lyme

brucells

behcets’s

29
Q

what are the general causes of meningitis?

A

viral

bacterial

fungal

granulomatous

carcinomatous

30
Q

what are the presenting symptoms of meningitis?

A

malaise

headache

fever

neck stiffness

photophobia

confusion

alteration of consciousness

31
Q

what is the treatment for meningitis?

A

treat first then diagnose

  • antibiotics
  • blood and urine culture
  • CT/MRI scan
  • lumbar puncture- check for cerebral oedema first on MRI
32
Q

what are the signs of sinusitis?

A
  • malaise
  • headache
  • fever
  • blocked nasal passages
  • loss vocal resonance
  • anosmia
  • local pain + tenderness which clears up during afternoon
33
Q

what is the most common form of brain tumour?

A

glioblastoma multiforme

34
Q

what is a cause of idiopathic intracranial hypertension?

A

pseudotumour cerebri

35
Q

when is pseudotumor cerebri usually seen?

A
  • young obese women
  • headache, visual obscurations, diplopia, tinnitus

caused by hormones, steroids, antibiotics vitamin

36
Q

what is the treatment of pseudotumor cerebri?

A
  • treatment= weight loss, diuretics, optic nerve sheath decompression lumboperitoneal shunt, stenting of stenosed venous sinuses
37
Q

what is a low pressure headache?

A

orthostatic headache

38
Q

what is the cause of orthostatic headache?

A
  • CSF leak due to tear in dura
  • Traumatic post lumbar puncture or spontaneous
39
Q

what is the treatment of orthostatic headache?

A

rehydration

caffeine

blood patch

40
Q

what is chiari malformation?

A
  • Normal brain that sits very low
  • Cerebellar tonsils descending through foramen magnum
  • Descending further when patient cough can tug on meninges causing cough headache
  • Can remodel base skill
41
Q

what is obstructive sleep apnoea characteried by?

A

body habitus

history loud snoring

apnoeic spells

hypoxia

CO2 retention

non refreshing sleep

depression

impotence

poor performance at work

42
Q

how is obstructive sleep apnoea diagnosed?

A

require sleep study

43
Q

what is the treatment for obstructive sleep apnoea?

A

nocturnal NIV

surgery

44
Q

what is the sensation of trigeminal neuralgia?

A

electric shock like pain in distribution of sensory nerve

can be symptoms of MS

45
Q

what is trigeminal neuralgia triggered by?

A

innocuous stimuli

46
Q

what branch of the trigeminal nerve is affected in trigeminal neuralgia?

A

any division- neurovascular conflict at point of entry of nerve into pons

47
Q

what is the treatment for trigeminal neuralgia?

A

carbamazepine, lamotrigine, gabapentin, posterior fossa decompression

48
Q

what is atypical facial pain?

A
  • Most common middle aged women, depression or anxious
  • Daily, constant, poorly localised deep aching or burning
  • Facial or jaw bones but may extend neck, ear or throat
  • Not lancinating
  • Not conforming to strict anatomical distribution of any nerve
  • No sensory loss
  • Unresponsive to conventional analgesics, opiates and nerve blocks
49
Q

what must be done to diagnose atypical facial pain?

A

pathology of other areas must be excluded first

50
Q

what is the management of atypical facial pain?

A

tricyclics

51
Q

when is post-traumatic headache seen?

A
  • Depends on nature of head injury
    • High in victims of car accident
    • Low in sports injuries/ perpetrators of car accidents
  • Corelates with previous history of headache
  • Unrelated to duration of post-traumatic amnesia
52
Q

what are the mechanisms of post traumatic headache?

A
  • Neck injury
  • Scale injury
  • Depression- often delayed
  • Vasodilation? Autonomic damage
53
Q

what is the management of post traumatic headaches?

A
  • Explanation no damage
  • Prevent analgesic abuse
  • Treatment
    • NSAID
    • Tricyclic antidepressants- amitriptaline
    • Be patient- 3-4 yrs to get better
54
Q

what is the commonest cause of new headache in older patients?

A

cervical spondylosis

55
Q

what are the signs of cervical spondylosis?

A
  • Usually bilateral
  • Occipital pain can radiate forward to frontal region
  • Steady pain
  • No nausea or vomiting
  • Worsened by moving neck
56
Q

what is the management of cervical spondylosis?

A
  • Rest, deep heat, massage
  • Anti-inflammatory analgesics
  • Over- manipulation may be harmful
  • Gets better over course day usually
57
Q

what is cervical spondylosis?

A

narrowing of joint space due to worn disc

58
Q
A

1B Neurology & Neuroscience (14 decks)

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