1. How are migraines measured? 2. How are migraines managed?

1. Measured by the hours 2. Managed with caffeine (recall not everyone responds to caffeine)

Neuro Dx WI18-Chapter 5 Flashcards by Juewuo R

What are the 3 fossae?

Anterior
Middle
Posterior

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What are the three layers of meninges and spaces

Meninges: Dura, arachnoid, pia

Spaces: Epidural, subdural, subarachnoid

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Where is CSF made and by what?

Made in the ventricles especially laterally.

Made by the choroid plexus

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What are the functions of CSF?

Mechanical protection
Chemical Protection
Nutrient and waste transport

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How much CSF is made at any given time?

How much is filtered an hour?

150 cc
20cc per hour

Recall filtering takes 7.5 hrs to completely filter

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What is ICD 10 code for general headache?

R51

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T/F: Headache is uncommon as a neurological symptom

False: 1st or 2nd most common

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T/F: Headache can be a sign of tumor, eyestrain

True

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If the brain itself does not have nocieceptors how is pain felts?

All the connective tissues and vasculature etc does.

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Which nerves are responsible for sensation felt in the connective tissue and all else in the brain?

CN 5,9,10, C1-3

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Headaches can be life or death. Headache with neck stiffness and fever suggests?

Meningitis: usually fatal 1-2 days

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Headaches can be life or death. A patient describing the headache as a sudden explosive pain suggests?

Subarachnoid hemorrhage

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Vascular Headaches: Migraines

What is the textbook presentation of migraines?

A Young woman (starts in teens; hormonal)

Unilateral

Throbbing

Phono/photophobia

Couple of hours

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Vascular headache: Migraines

This type of migraine occurs unilaterally, throbbing, aura, phono/photophobia.

Classic Migraine

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Vascular headache: Migraine

This type of migraine occurs unilaterally, throbbing, aura, phono/photophobia.

In addition blindness, tingling and fiery sensation on button of foot, and weakness on one side of the body.

Complicated Migraine

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Vascular headache: Migraine

This type of migraine presents with a tingling sensation on the side of the face radiating down the arm (may be associated with menstrual cycles), dizziness, and won’t give you headache but does give you transient neurological deficits.

Atypical Migraine

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How are migraines measured?

2. How are migraines managed?

Measured by the hours

2. Managed with caffeine (recall not everyone responds to caffeine)

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What are the two mechanisms of migraine?

BV relaxes too much and heart beat stretches it more. (Stimulating sympathetics with caffeine constricts vessels)
Muscle contraction so strongly causing pain (patient does not respond to caffeine)

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Vascular headache:

This type of vascular headache is present in middle aged men, unilateral behind ONE eye, and lasts minutes.

Usually occurs 4-5 times w/ 4-5 short intense headaches.

Alcohol makes it worse

Cluster Headache

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Vascular headache:

This vascular headache is stroke related.

This is due to a dissection of the tunica intima, leading to blood going into tear and not lumen.

May lead to a thrombus formation

Neurological headache

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This type of headache is characterized as a band squeezing the head too tight.

Cervicogenic/myogenic/suboocipital (textbook term)

Possibly related to dehydration, stress, pyschological

Lasts for days-weeks. Tends to release 4-5 minutes after adjustment.

Tension headaches

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This type of headache is due to sleep deprivation and eyestrain.

Rest and sleep is a great management.

Fatigue Headache

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This type of headache may be due to dehydration, chemical exposure and rebound (withdrawal effect from caffeine).

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Toxic or metabolic headache

This type of head comes as a headache from different sites such like CN V (sensory for head), dental, eyestrain, sinuses, suboccipital.

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Referred headaches

This type of headache is the temporal/giant cell arteritis. Occurs due to inflammatory cells invading the tunica media, causing swelling and closing the lumen. Temporal artery inflammed, it may affect the ophthalmic artery and other arteries.

Inflammatory headaches

What are the signs and symptoms of inflammatory headache?

1. Swelling of superficial temporal artery 2. Will be hard and palpable 3. Elderly complaining of scalp pain “hurts to brush hair.

T/F: Inflammatory headache etiology of lumen tear can lead to fibrotic changes

True

Increased Intracranial Pressure: What are the causes of neurological deficits?

1. Compression-things like tumor 2. Destruction-Causes destruction of tissue 3. Herniation- brain herniation in certain openings.

W/ intracranial pressure, Cushing’s triad is present. What is involved in cushings triad?

1. Increased BP due to pressure resisting blood flow 2. Carotid sinus reflex causes decrease of heart rate 3. Respiration irregularity- due to pressure on medulla (where respiratory centers are)

What are the global symptoms of increased intracranial pressure?

1. Headaches | 2. Changes in consciousness

What are the focal symptoms of increased intracranial pressure ?

1. Pain in area correlates to area of brain controlling that function affected by pressure

How are the eyes affected by increased intracranial pressure?

1. Ophthalmic vein get backed up causing BULGING | 2. Disk becomes swollen and puffy

What is the pathognomonic finding of increase intracranial pressure?

1. Papillaedema: puffy and swollen optic disc

What are the different areas that could herniate with increased intracranial pressure?

1. Cingulate gyrus 2. Inferior medial temporal 3. Cerebellar tonsil 4. New opening

A cause of increased intracranial pressure that is due to obstructed CSF flow.

Hydrocephalus

Describe hydrocephalus in infants

1. Swollen head/ large head 2. Setting sun eyes: eyes roll down 3. Bulging fontanels 4. Transillumination

What is transillumination in a infant patient with hydrocephalus?

1. Light passing through skull and being visible on opposite side because the head is mostly water.

How are infants with hydrocephalus treated?

Shunts

Describe hydrocephalus in adults?

1. Elderly patients gets “normopressure” hydrocephalus 2. Dementia 3. Urinary incontinence 4. Gait impairment: loss of forward and backward stability

Types of tumors in brain: Percentages of tumor types in brain.

1. 23% Mets- lung, cancer, liver and melanoma 2. 17% meningioma (benign & superficial) 3. 40% glioma (1 year survival rate 20% & 5 year, 1%) 4. 5% pituitary 5. 5% schwannoma

What are some common manifestation of brain tumors?

1. Intracranial triad: Headache, Nausea, Papillaedema 2. Bitemporal hemianopsia (loss of peripheral vision 3. Gait, equilibrium, coordination ataxia 4. Motor weakness, seizures, hypesthesias 5. Reflex abnormalities

Describe the coup and contracoup affect of trauma headache?

The coup is the side of the injury and the contra-coup is where the brain slams on the opposite.

Describe the shearing of neurons in trauma headache.

The Rotational component of the impact injures the lower part of brain, basal ganglia, thalamus and corpus callosum

What is dizziness in trauma headache usually due to?

1. Seen due to pivot point head trauma causing damage to cranial nerve 8

Symptoms of concussion

1. Loss of consciousness 2. Headache 3. Amnesia 4. Disorientation 5. Seizure 6. Focal neurological deficits Fatigue

Sign of concussion

1. Difficulty eye tracking 2. Vestibular disturbances 3. Balance and postural instability

Concussion test: This concussion test is a computerized mental system assessment that measures attention span, working memory, sustained and selective attentive time, non verbal solving, rxn compared to a pre-test.

Immediate post concussion assessment and cognitive testing

Concussion test: Test is a sport concussion assessment tool that has an exam for on the field and off.

Sport concussion assessment tool 5

What are the on field exam for SCAT 5?

1. Red flags 2. Observable neurologic test 3. Memory assesment 4. Glasgow coma scale and cervical examination • GCS: ex. Normal 15 and 13 concussed.

What are the off field exams for SCAT 5?

1. History of injury 2. Symptom scale 3. Cognitive assessment 4. Neurologic and balance exam 5. Short term memory testing (delayed recall) 6. Decision making (problem solving

What are the concussion recommendation?

‣ Removal from contest following sign and symptoms ‣ No return to play in current game ‣ Medical evaluation following injury ‣ Rule out more serious intracranial pathology(bleeding)

What is the stepwise order for return to play or ADL?

1. No activity until asymptomatic 2. Light aerobic exercise 3. Sport specific training 4. No-contact drills 5. Full contact drills 6. Game play *24hr between steps*

This concussion syndrome lasts days to weeks after injury. Sx of Fatigue, difficulty concentration, irritability, light sensitivity, noise sensitivity, emotional lability, dizziness, headache, neck pain, nausea and vomiting

Post concussion syndrome

Intracranial hemorrhage that forms quickly. 1. Lens shaped on imaging 2. Middle Meningeal artery rupture 3. Develops over hours 4. Pushes dura mater increasing pressure, displacing brain tissue 5. Leads to herniation

Epidural hematoma

Intracranial hemorrhage that forms slowly. 1. Rupture of bridging veins 2. Crescent shaped bleed 3. Acute w/in 24 hr; severe neural deficits, 50% mortality 4. Subacute-1-14days post injury with focal neurologic deficits ‣ Bleeding not fast enough to get recognize and send to ER right away ‣ Chronic-2-6 weeks after injury-headache, balance problems weakness

Subdural hematoma

Neuro Dx WI18-Chapter 5 Flashcards

(55 cards)